- Email: [email protected]
Diagnostic tests for lung cancer
216
Abstracts/Lung
Significantlygreaterdifferencesindisruptionsofqurdityoflifeoccurred in women younger than 65 years (p = 0.04). women with recurrent disease @ = 0.003). and women with low income @ = 0.008). In stepwise regression. symptom distress predicted 53% of the variance followed by fonctional status (59 96)and recorrence (63 96) when QGL was the outcome variable.
Clinical manifestation3 of lung cancer Pate1 AM, Peters SG. Mayo Clin Prw 1993;68:273-7. Theiniti~cl~crlmpnif~tioasoflungcollcerarediverse~dmav lesions areproduced bb l&xl nrowth or invasion. &astaticdisea&
.
.
or
.
syndrome or the superior vena cava syndrome are.relatively uncommoo but well recognized. M-tic bmg cancer can involve almost any anatomicareabybem&genowemstogeaous, lymphatic,or,occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte distorbances, nod coexisting diseasea influence the initial manifestations. AlthoughiadividuPltumorcelltypesnresssocintedwith characteristic features, no constellation of tindiigs is pathognomonic for P specific histologic vtisnt. Becaose stwessfld treatroeat of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is importaot.
Partmeoplnstic syndromes pssoeiated with lung cancer Pate1 AM, DavilnDG, Peters SG. VniversiiyofAlabamn, Birmingham, AL Mayo Clii. Pmt. 1993:68:278-87. P~raneopl&ic pheaomerta associ&d with primary long caocerhave diverse initial manifestntions and epitomize the systemic nature of human malignant disease. The spectrum of clinical features in patients witb paraneoplastic syndromes ranges from mild systemic or cutaneous disease to bypercoagulability nod severe neoromyopatbic disorders. Although the diagnosis is often one of exclusion, a0 improved understandiig of the pstbogenesis involved io some of these syndromes has provided another means of recognizing the disorders and perhaps treating the affected patients. Proposed mechanisms of paraneoplastic processes include the aberraot release of bumoral mediators such as bonnones sod hormone-likepeptides, cytokinw, and antibodies. In this update, we review the potential mechanisms, diagnosis, and treatment of paraneoplastic syndromes associated with long cancer.
Diagnostic tests for lung cancer Karsell PR, McDougall JC. Mayo Clin Proc 1993;68:288-96. Tbegoalsofdiagnostic testing inpatients withsuspected long cancer are to establish the diagnosis and to determine the stage of the disease so that appropriate therapy can be initiated. Unless a patient has bemoptysls, fever, or a change in cough as an initial rnaoifestation, resectable lung cancer will seldom be diagnosed on the basis of the history. Screeoingtests-particularlycbestroatgwography-bavewully identified the abnormality. The managing pbysiciao should then select diagnostic procedures that are associated with low risk and that will provide further diagnostic and staging information. A biopsy will almost always be necessary before definitive therapy can be planned. In many cases, a single procedure-for example, a needle biopsy of a bepatic lesion or biopsy of P supraclavicolar lymph node- will provide a definitive diagnosis and establish the stage. of the disease.. The roles of cytology, histopatbologic examination, radiologic studies, and various types of biopsy in the diagnosis of lung cancer are reviewed in this report.
Serum tumor markers CEA, CA 50, TATI, and NSE in lung cancer screening Jsrvisalo J, Hakama M, Knekt P, Stenmao U-H, Leino A, Teppo Let al. Research and Dewlopmenr Vnir, Social Insurance Insrirurion, Pelmlantie 3, SF-2OMo
Turku. Cancer 1993:71: 1982-8.
Background. There are. no effective means for screening for long cancer, so the authors assessed the utility of four lung cancer honor markers for screening. Methods. A case-control study, nested in B cohort study based on the linkage of records of health survey exam&es
Cancer 10 (1993) 266-286
with Finnish Cancer Registry records, was used to test the validrty of honor markers carcinoembryonic antigen (CEA), tumor-associated trypsin inhibitor (TATI), neuron-specific eoolase (NSE), and CA 50 in lung cancer screening. Ten years after health examinations, record linkage indicated that 187 men bad lung caocer; 344 control subjects. matched for age, sex, and municipality were draw from the same records. Results. The data allowed assessment of the sensitivity of the marker assays at a 95 96 specificity level, which was highest for CEA (17% at a concentration level of 5.3 g/l). Logistic discrimination analysis indicated that of the other markers, only TATI, when used in combination. improved the discriminatory power of CEA. CEA and TAT1 levels correlated significantly with smoking. They also showed a significant gradient toward increasing risk of lung cancer from the lowest to the highest quintiles of marker levels (for CEA, crude relative risk between the highest and lowest quintiles, 8.6). The gradient also was evident in the subgroup whose cancer had been diagnosed more than 5 years after serum specimen collection. The trend persisted, although relative risk was balvedsfteradjustment for smoking. Conclusions. The markers do not seem to be useful tools for lung caocer screening. However, CEAaodTATl levelsseemtogiveinformationoncancerrisk long before the clinical cancer stage, as the quintile-based analyses of marker levels indicate. Lung cancer in patients with immunod&ciency syndrome Karp J, Profeta G. Marantz PR, Karpel JP. Monrefiore MedicoI Center, 111 Em 210th Srreet, Brom, NY 10467. Chest 1993;103:410-3. We report adenocarcinoma of the lung in seven patients with buman immunodeficiency virus (HIV) infection. We compared age, clinical findings sod survival data with B sex-matched control group of HIVnegative patients with adenocarcinoma of the lung. Median age of HIVinfected patients with hmgcancerwas lower than in control patients with lung cancer. The HIV- infected patients had more systemic symptoms and abnormal physical findings than control subjects. Both groups had smoking histories. Laboratory d&were similar but control subjects bad lower blood oxygen tensions than did HIV patients; HIV patients bad moreabnormalitiesoncbestroe.ntgenogramsaodcomputedtornograpby scans tbandidcontrol subjects. All HIV-infected patientswerestageIV. Median survival was 4 weeks. For control patients, 50percent bad stage IV disease; median survival was 25.5 weeks. Thus, patients with HIV infection develop lung cancer ntayoongerage than sex-matched control subjects and undergoa tnorefulminant course withshortened survivals.
Protein turnover in advanced lung cancer patients Richards EW, Long CL, Nelson KM, Tobver OK, Pinkston JA, Navari RM et al. Depanment of Research. Baprisr Medical Cenrers, 701 Princeron Ave. Birmingham, AL 35211. Metab Clin Exp 1993;42:2916 Understanding the extent to which changes in whole-body protein kinetics contribute to the commonly observed weight loss aod decrease in lean body mass (LBM) in patients with cancer is currently obscured by conflicting reports in the literature. While several studies have reported significant increases in whole-body protein tornover (WBPT), synthesis (WBPS), and catabolism (WL3PC) in patients with caocar, others have failed to confirm these observations. We have measured whole-body protein kinetics using II primed constant infusion of “Nglycine in a homogeneous group of 32 newly diagnosed advanced long cancer patients with cornparable staging nod before soy antineoplastic treatment, and in 19 normal healthy volunteer controls. Urinary urea and ammonia “N emicbment was determined io individully colle&d urine samples obtained during the 24-boor study period end averaged for the determination of protein kinetics. During the last 6 boors of urine collection, samples were obtained hourly for determination of “N plateau enrichment. Twenty-four-hour urinary nitrogen nod creatinine excretion was determined from 24-boor pooled urine samples. Resting metpbolic expenditore (RME) was determined by indirect calorimetry and LBM was estimated from deoterium oxide dilution. Age. body weight, LBM, RME, and 24-hour urinary nitrogen excretion did not differ between canceraod control subjects. WBPT, WBPC. and WBPS (g/kg/d) were significantly increased in long ceocer patients. However, when the same results were expressed either per kilogram LBM or per gram 24-hour urinary cnxtioine excretion, WBPT. WBPC, and WBPS rates were not statistically different from those of the controls. Net
Abstracts/Lung
Significantlygreaterdifferencesindisruptionsofqurdityoflifeoccurred in women younger than 65 years (p = 0.04). women with recurrent disease @ = 0.003). and women with low income @ = 0.008). In stepwise regression. symptom distress predicted 53% of the variance followed by fonctional status (59 96)and recorrence (63 96) when QGL was the outcome variable.
Clinical manifestation3 of lung cancer Pate1 AM, Peters SG. Mayo Clin Prw 1993;68:273-7. Theiniti~cl~crlmpnif~tioasoflungcollcerarediverse~dmav lesions areproduced bb l&xl nrowth or invasion. &astaticdisea&
.
.
or
.
syndrome or the superior vena cava syndrome are.relatively uncommoo but well recognized. M-tic bmg cancer can involve almost any anatomicareabybem&genowemstogeaous, lymphatic,or,occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte distorbances, nod coexisting diseasea influence the initial manifestations. AlthoughiadividuPltumorcelltypesnresssocintedwith characteristic features, no constellation of tindiigs is pathognomonic for P specific histologic vtisnt. Becaose stwessfld treatroeat of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is importaot.
Partmeoplnstic syndromes pssoeiated with lung cancer Pate1 AM, DavilnDG, Peters SG. VniversiiyofAlabamn, Birmingham, AL Mayo Clii. Pmt. 1993:68:278-87. P~raneopl&ic pheaomerta associ&d with primary long caocerhave diverse initial manifestntions and epitomize the systemic nature of human malignant disease. The spectrum of clinical features in patients witb paraneoplastic syndromes ranges from mild systemic or cutaneous disease to bypercoagulability nod severe neoromyopatbic disorders. Although the diagnosis is often one of exclusion, a0 improved understandiig of the pstbogenesis involved io some of these syndromes has provided another means of recognizing the disorders and perhaps treating the affected patients. Proposed mechanisms of paraneoplastic processes include the aberraot release of bumoral mediators such as bonnones sod hormone-likepeptides, cytokinw, and antibodies. In this update, we review the potential mechanisms, diagnosis, and treatment of paraneoplastic syndromes associated with long cancer.
Diagnostic tests for lung cancer Karsell PR, McDougall JC. Mayo Clin Proc 1993;68:288-96. Tbegoalsofdiagnostic testing inpatients withsuspected long cancer are to establish the diagnosis and to determine the stage of the disease so that appropriate therapy can be initiated. Unless a patient has bemoptysls, fever, or a change in cough as an initial rnaoifestation, resectable lung cancer will seldom be diagnosed on the basis of the history. Screeoingtests-particularlycbestroatgwography-bavewully identified the abnormality. The managing pbysiciao should then select diagnostic procedures that are associated with low risk and that will provide further diagnostic and staging information. A biopsy will almost always be necessary before definitive therapy can be planned. In many cases, a single procedure-for example, a needle biopsy of a bepatic lesion or biopsy of P supraclavicolar lymph node- will provide a definitive diagnosis and establish the stage. of the disease.. The roles of cytology, histopatbologic examination, radiologic studies, and various types of biopsy in the diagnosis of lung cancer are reviewed in this report.
Serum tumor markers CEA, CA 50, TATI, and NSE in lung cancer screening Jsrvisalo J, Hakama M, Knekt P, Stenmao U-H, Leino A, Teppo Let al. Research and Dewlopmenr Vnir, Social Insurance Insrirurion, Pelmlantie 3, SF-2OMo
Turku. Cancer 1993:71: 1982-8.
Background. There are. no effective means for screening for long cancer, so the authors assessed the utility of four lung cancer honor markers for screening. Methods. A case-control study, nested in B cohort study based on the linkage of records of health survey exam&es
Cancer 10 (1993) 266-286
with Finnish Cancer Registry records, was used to test the validrty of honor markers carcinoembryonic antigen (CEA), tumor-associated trypsin inhibitor (TATI), neuron-specific eoolase (NSE), and CA 50 in lung cancer screening. Ten years after health examinations, record linkage indicated that 187 men bad lung caocer; 344 control subjects. matched for age, sex, and municipality were draw from the same records. Results. The data allowed assessment of the sensitivity of the marker assays at a 95 96 specificity level, which was highest for CEA (17% at a concentration level of 5.3 g/l). Logistic discrimination analysis indicated that of the other markers, only TATI, when used in combination. improved the discriminatory power of CEA. CEA and TAT1 levels correlated significantly with smoking. They also showed a significant gradient toward increasing risk of lung cancer from the lowest to the highest quintiles of marker levels (for CEA, crude relative risk between the highest and lowest quintiles, 8.6). The gradient also was evident in the subgroup whose cancer had been diagnosed more than 5 years after serum specimen collection. The trend persisted, although relative risk was balvedsfteradjustment for smoking. Conclusions. The markers do not seem to be useful tools for lung caocer screening. However, CEAaodTATl levelsseemtogiveinformationoncancerrisk long before the clinical cancer stage, as the quintile-based analyses of marker levels indicate. Lung cancer in patients with immunod&ciency syndrome Karp J, Profeta G. Marantz PR, Karpel JP. Monrefiore MedicoI Center, 111 Em 210th Srreet, Brom, NY 10467. Chest 1993;103:410-3. We report adenocarcinoma of the lung in seven patients with buman immunodeficiency virus (HIV) infection. We compared age, clinical findings sod survival data with B sex-matched control group of HIVnegative patients with adenocarcinoma of the lung. Median age of HIVinfected patients with hmgcancerwas lower than in control patients with lung cancer. The HIV- infected patients had more systemic symptoms and abnormal physical findings than control subjects. Both groups had smoking histories. Laboratory d&were similar but control subjects bad lower blood oxygen tensions than did HIV patients; HIV patients bad moreabnormalitiesoncbestroe.ntgenogramsaodcomputedtornograpby scans tbandidcontrol subjects. All HIV-infected patientswerestageIV. Median survival was 4 weeks. For control patients, 50percent bad stage IV disease; median survival was 25.5 weeks. Thus, patients with HIV infection develop lung cancer ntayoongerage than sex-matched control subjects and undergoa tnorefulminant course withshortened survivals.
Protein turnover in advanced lung cancer patients Richards EW, Long CL, Nelson KM, Tobver OK, Pinkston JA, Navari RM et al. Depanment of Research. Baprisr Medical Cenrers, 701 Princeron Ave. Birmingham, AL 35211. Metab Clin Exp 1993;42:2916 Understanding the extent to which changes in whole-body protein kinetics contribute to the commonly observed weight loss aod decrease in lean body mass (LBM) in patients with cancer is currently obscured by conflicting reports in the literature. While several studies have reported significant increases in whole-body protein tornover (WBPT), synthesis (WBPS), and catabolism (WL3PC) in patients with caocar, others have failed to confirm these observations. We have measured whole-body protein kinetics using II primed constant infusion of “Nglycine in a homogeneous group of 32 newly diagnosed advanced long cancer patients with cornparable staging nod before soy antineoplastic treatment, and in 19 normal healthy volunteer controls. Urinary urea and ammonia “N emicbment was determined io individully colle&d urine samples obtained during the 24-boor study period end averaged for the determination of protein kinetics. During the last 6 boors of urine collection, samples were obtained hourly for determination of “N plateau enrichment. Twenty-four-hour urinary nitrogen nod creatinine excretion was determined from 24-boor pooled urine samples. Resting metpbolic expenditore (RME) was determined by indirect calorimetry and LBM was estimated from deoterium oxide dilution. Age. body weight, LBM, RME, and 24-hour urinary nitrogen excretion did not differ between canceraod control subjects. WBPT, WBPC. and WBPS (g/kg/d) were significantly increased in long ceocer patients. However, when the same results were expressed either per kilogram LBM or per gram 24-hour urinary cnxtioine excretion, WBPT. WBPC, and WBPS rates were not statistically different from those of the controls. Net