Cancer

Lymph nodes that are shown to be negative for tumor by hematoxylin and eosin staining may appear positive for tumor on polymerase chain reaction (PCR). Consequently, PCR positivity alone must not be used as evidence of lymph node metastasis. The "clinical" meaning of PCR positivity in lymph node tissue requires detailed study before it can or should be used as a prognostic marker.

See also pages 1393-8.

Data on 199 patients diagnosed with esophageal small cell carcinoma (SCC), selected from among a total of 230 found in the literature, were evaluated in an attempt to study the best management strategy. The authors suggest that, to increase survival, both chemotherapy and radiotherapy be used as standard treatment of limited stage SCC of the esophagus.

Patients with primary malignant mucosal melanoma of the head and neck have a 5-year survival rate of 17%. Approximately 50% of patients experience local failure after surgery, which is the treatment of choice. In this article, 14 patients with this disease are reported, and the literature is comprehensively reviewed.

The aim of this study was to determine the tolerance of concomitant chemoradiation in 17 patients age ≥ 75 years, with anorectal carcinoma. The data suggest that concomitant chemoradiation using a schedule of continuous infusion 5-fluorouracil plus bolus mitomycin C and external radiation therapy can be performed safely in selected elderly patients.

This study suggests that positive results with genetic diagnosis may simply indicate the presence of tumor DNA and do not necessarily mean that a true metastasis of viable cancer cells is present. Although the genetic approach may still hold promise for the detection of cancer micrometastases, its predictive value should be carefully assessed clinicopathologically, because its supersensitivity may be associated with a greatly increased false-positive rate.

See also pages 1363-5.

Adjuvant postoperative thoracic radiotherapy may improve local control and survival in patients with N2 nonsmall cell lung carcinoma.

In rare instances, locally aggressive, lymphocyte-rich thymomas are associated with T-cell lymphocytosis in the peripheral blood. In this article, the pathophysiology of this phenomenon is discussed, using immunophenotyping and gene rearrangement analysis of T cells in both thymoma and peripheral blood.

In a population-based study, isolated local recurrence of cutaneous malignant melanoma was found to be rare (1.3%). The outcomes of patients with a local recurrence was relatively favorable, with a melanoma specific survival rate of 83% 5 years after the diagnosis of the recurrence.

The results of this study support the University of Pennsylvania four-variable model (age, gender, site, and thickness) for the prognosis of primary cutaneous melanoma, using a New York University Melanoma Cooperative Group data base of 780 patients.

Breast carcinoma patients diagnosed 5-22 years since their last mammography showed a lower frequency of advanced disease compared with patients who had never been screened. This finding suggests that even if health-aware women who volunteered for screening stop undergoing regular mammography, they present for a relatively prompt diagnosis in the event they develop clinical breast carcinoma.

A greater than 2-fold increase in the risk of incident invasive breast carcinoma was found to be associated with use of calcium channel blockers in a prospective observational cohort of 3198 women age ≥ 65 years who were assessed annually for medications and followed for 5 years.

α-1 acid glycoprotein is an immunosuppressive factor in ascites from ovarian carcinoma and appears to inhibit interleukin-2 secretion by lymphocytes.

Production of extracellular matrix-degrading proteinases by short term primary cultures of epithelial ovarian carcinoma cells was analyzed. The cells were derived from primary ovarian tumors, intraperitoneal metastases, and ascites. Matrix metalloproteinase-2 (MMP-2, gelatinase A) was the predominant proteinase secreted, with lower levels of MMP-9 (gelatinase B) and urinary-type plasminogen activator (u-PA) detected. This suggested that MMP-2 may play a significant role in the intraperitoneal invasion of epithelial ovarian carcinoma.

This Phase I study, involving patients with infiltrating transitional cell bladder carcinoma, defines the maximum tolerated doses for an innovative schedule of concurrent protracted intravenous infusion of cisplatin and 5-fluorouracil plus hyperfractionated radiotherapy administered with organ-sparing intent. The data suggest that this treatment schedule has the potential to enhance synergistically the effect of radiation and provide higher response rates with very low acute and late toxicity.

Quantitative immunohistochemical evaluation of nuclear p53 and MIB-1 immunostaining identifies prognostic indicators inexpensively in cases of TCC of the bladder.