Cancer

Three recent articles have raised the long-standing question of how frequently women should be screened for breast carcinoma. The diversity of recommendations reflects the level of uncertainty regarding this issue.

Lymphatic vessel permeation is a good predictor of lymph node metastasis. Lymph node metastasis, and the histologic grade determined by combining the degree of nuclear atypia and growth pattern, are independent prognostic factors for patients with superficial squamous cell carcinoma of the esophagus. Vessel permeation, vertical tumor invasion depth in the submucosal layer, and histologic grade were determined to be important factors for identifying patients who did not require additional surgical treatment after endoscopic mucosal resection.

A study was conducted in which subjects with colorectal carcinoma were recruited from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry and asked to complete two self-administered surveys. The results found that those individuals who achieve a long term remission from colorectal carcinoma may experience a relatively high quality of life, although deficits remain for several areas, particularly in those of low socioeconomic status.

The telomerase activity of 60 surgical specimens of primary colorectal carcinoma was measured quantitatively by a fluorescence-based telomeric repeat amplification protocol assay. This study showed that a high telomerase index may be a risk factor for metastasis of colorectal carcinoma to the liver.

Thirty-nine patients with metastatic renal cell carcinoma were treated with infusional floxuridine and subcutaneous interleukin-2 or interferon-α-2b. Objective tumor responses occurred in 23% of patients, with a median survival of 21 months; toxicity was acceptable.

Two Phase II studies using granulocyte-macrophage–colony stimulating factor as adjunctive therapy to interleukin-2–based regimens for patients with metastatic renal cell carcinoma did not have enhanced response rates.

To the authors' knowledge, this is the first published clinical trial to use allogeneic mixed lymphocyte culture (cytoimplant), a new form of immune therapy, combined with a novel nonsurgical delivery system (endoscopic ultrasound−guided fine-needle injection) in the treatment of patients with advanced pancreas carcinoma. These preliminary results showed no substantial toxicities, 20%% partial responders, and a median survival of 13.2 months.

This survey confirms many differences in practice patterns among oncologists in the treatment of patients with nonsmall cell lung carcinoma and suggests the need for the multidisciplinary management of nonsmall cell lung carcinoma.

In this study, oncogenic mucosal human papillomavirus (HPV) was detected in a small proportion of 185 cases of bronchopulmonary tumor (2.7%) using a liquid hybridization assay, Hybrid Capture II. Thus, it appears unlikely that HPV infection plays a role in the development of the great majority of lung carcinomas.

Second-line treatment with gemcitabine and vinorelbine produced an 18% major response rate and was well tolerated by patients with advanced nonsmall cell lung carcinoma.

The important tumor suppressor gene at the 13q14 locus, which has been reported to be commonly deleted in patients with chronic lymphocytic leukemia, also is deleted in some patients with acute lymphoblastic leukemia (ALL). ALL patients with a deletion at 13q14 have been found to have a shorter survival.

Basosquamous carcinoma is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. The authors reviewed their recent experience with basosquamous carcinoma to identify prognostic factors influencing recurrence.

This study reveals the prognostic and diagnostic relevance of image cytometry to the evaluation of melanocytic lesions of the skin.

The expression of Fhit is reduced as the stage of disease progresses in patients with breast carcinoma. The finding is consistent with the tumor suppressor role of Fhit protein noted in breast carcinogenesis.

The bombesin (BN)/gastrin-releasing peptide (GRP) antagonists RC-3940-II and RC-3095 significantly inhibit in vivo growth of estrogen-independent MDA-MB-468 human breast carcinoma, which expresses mRNA for three BN receptor subtypes (GRP receptor, neuromedin B receptor, and BN receptor subtype-3) and overexpresses epidermal growth factor (EGF) receptors. BN/GRP antagonists such as RC-3940-II and RC-3095 may be considered as therapy for breast tumors that express BN and EGF receptors.

The data from the current study show that 9.5% of women diagnosed with breast carcinoma before age 35 years who were unselected for family history and 12.0% of women diagnosed before age 45 years who had a first-degree family history of breast carcinoma were found to be either BRCA1 or BRCA2 carriers. Analysis of particular subsets of cases highlighted features of family history that may specifically affect risk.

Microinvasive carcinoma of the breast (with each focus of invasion ≤ 1 mm) is a disease associated with high grade ductal carcinoma in situ (DCIS), is not associated with axillary lymph node metastasis, and has a low recurrence rate. Microinvasive carcinoma should be distinguished from small invasive carcinomas (those with at least 1 focus of invasion > 1 mm) associated with ≥ 90% DCIS because these tumors are associated with a poor outcome, especially in younger women.

Among the 298 breast carcinoma patients with carcinomas tested for 8p22 markers, those whose tumors had lost an allele at 8p22 had a significantly higher risk of postoperative mortality than those whose tumors retained both alleles, suggesting the potential of this allelic loss as a negative prognostic indicator to guide the postoperative management of patients.

Induction chemotherapy with either paclitaxel or a combination of fluorouracil, doxorubicin, and cyclophosphamide was shown to be effective in downstaging both the primary tumor and axillary metastases in Stage IIA, IIB, and IIIA breast carcinoma patients. Although residual microscopic disease will still require additional local therapy, minimally invasive surgical approaches should be feasible for such patients.

Uterine sarcomas, except for low grade stromal sarcomas, are associated with a poor prognosis. The grading score validated by the French Federation of Anticancer Centers for soft tissue sarcoma was not a prognostic factor in this study.

Ascitic, but not serum, anti-p53 immunostatus is of relevance in predicting the disease free survival of patients with ovarian carcinoma.

A regimen of oral estramustine and cyclophosphamide showed encouraging results (response rate of 43.7%) and good tolerance in a group of patients for whom, to the authors' knowledge, therapeutic options are scarce and poorly documented. Criteria for response evaluation were a posttherapy decline ≥ 50% in the prostate specific antigen level combined with improvement (or no worsening) of Eastern Cooperative Oncology Group performance status and relief of bone pain (if present).

In men with prostate carcinoma detected by screening, general quality-of-life outcomes are encouraging, and morbidity related to urinary function may be less severe than previously believed. However, in this study the majority of men experienced decrements in sexual function.