Elevated Serum CEA Research Articles

Ⅱc型早期胃癌を合併した十二指腸乳頭部癌の1例

Double cancer of the stomach and the papilla of Vater is rare. A 67-year-old man was admitted to our hospital for the examination of elevated serum CEA. Dilation of the common hepatic and intrahepatic ducts were noted by abdominal ultrasonography. Duodenoscopy and hypotonic duodenography revealed lobelated tumor at the papilla of Vater. Biopsied speciman of this tumor showed well defferentiated adenocarcinoma. Also, screaning gastroscopy revealed a shallow depressive lesion which was diagnosed as IIc type of early gastric cancer consisting of tubular adenocarcinoma. The patient was diagnosed as double cancer of stomach and the papilla of Vater. Subtotal gastrectomy and pancreaticoduodenectomy were performed.

A CASE OF RECTAL CANCER PRESENTING AS NEPHROTIC SYNDROME

This paper reports a case of rectal cancer complicated with nephrotic syndrome. A 47-year-old woman was seen at the hosipital because of edema, and admitted under a diagnosis of nephrotic syndrome. Laboratory studies showed an elevated serum CEA level (81ng/ml). Barium enema and colonoscopy revealed rectal carcinoma. Abdominoperineal resection and left renal biopsy were perfor-med. Pathological findings of the kidney revealed membranous glomerulonephritis. Proteinuria decreased after the operation and nephrotic syndrome was improved. It is presumed that tumor antigen-associated immune complexes are cause of the membranous glomerulonephritis. This case strongly suggested the association of nephrotic syndrome and the rectal cancer, for the nephrotic syndrome was remitted after the resection of the rectal cancer.

Imaging of medullary carcinoma of the thyroid using 111In-labelled anti-CEA monoclonal antibody fragments.

The distribution of 111In-labelled anti-carcinoembryonic antigen (CEA) monoclonal antibody fragments [F(Ab')2] was studied in five patients either with known inoperable medullary carcinoma of the thyroid (MCT) or evidence of recurrence/metastases based on elevated calcitonin (hCT) levels. All five cases had elevated serum CEA levels and positive immunohistochemical stains for both hCT and CEA prior to scintigraphy. In two patients with identified inoperable disease both planar and SPECT scans were positive. In the remaining three patients, where the recurrence/metastatic sites were unknown, SPECT images were positive in two. Of these, only one had positive planar images. These results indicate that 111In-labelled anti-CEA F(ab')2 scintigraphy, especially in conjunction with SPECT, is useful for the diagnostic evaluation of patients with MCT. The limiting factor of this technique is the high level of non-specific uptake, particularly in the liver, but improvements in the specificity of newer anti-CEA antibodies and the ability to label these with 99Tcm is addressing this problem.

Intraarterielle präoperative Chemotherapie fortgeschrittener Zervixkarzinome

Three patients suffering from very advanced primary cancers of the cervix uteri (FIGO II B or III B) were treated. By preoperative selective perfusion of both uterine arteries, using cis-platinum alone, a distinct reduction of the tumour volume was achieved. This was demonstrated clinically and also by CAT scan and NMR technique. The elevated serum CEA and SCC levels decreased to normal values. The histomorphology of the Wertheim-Meigs specimens revealed no tumour invasion of the initially infiltrated parametria. This treatment modality has been developed to minimise the toxic side effects of the inductive (neo-adjuvant) chemotherapy for cervical cancers.

A RESECTABLE CASE OF HEPATIC METASTASIS DEVELOPED 8 YEARS AND 6 MONTHS AFTER THE RESECTION OF PRIMARY COLON CANCER

It is general that the metachronous metastasis of primary colorectal cancer to the liver occurs within 3 years after surgery, and it rarely occurs after 3 years. This time we could successfully resect a hepatic metastasis which was found 8 years and 6 months after resection of the primary lesion.A 60-year-old male was referred to our hospital because of the elevated serum CEA. He had undergone sigmoidectomy for primary colon cancer in Oct. 1980, which was 3.5×3.0 cm in size and moderately differentiated tubular adenocarcinoma of type 2. Abdominal US, CT and celiac angiogram demonstrated a mass, 5×5 cm in size, at the anterior segment of the liver. Extended right hepatic lobectomy was performed. The hepatic lesion was diagnosed as tubular adenocarcinoma that was similar to the primary sigmoid colon cancer in the histological feature.It seemed inevitable that the periodical measurements of serum CEA and evaluative imagings should be taken for a long term.

ANALYSIS OF HEMATOGENOUS METASTASIS FROM COLORECTAL CANCER

Among 337 patiens undergone curative resections for primary colorectal cancers, 65 had the recurrences and 43 (15 with colon and 28 with rectal cancer) out of the 65 hematogenous recurrences. In these patients liver metastasis was observed in 30 (69.8%), pulmonary metastasis in 12 (27.9%), and bone or brain metastasis in 8 (18.6%). Hematogenous recurrences were most commonly observed within 3 years, in which an elevated serum CEA was the most useful indicator in detecting the recurrence. Histopathologically, there was no difference by tissue types, however, the recurrence was more frequently noted in patients group having vascular invasion and lymphnode patients group having vascular invasion and lymphnode metastasis. The recurrence rate was elevated with an advance of the stage of the disease. The hematogenous recurrent rate for cases in aneuploid was higher than that in diploid pattern. For 14 patients with recurrent liver metastasis, curative resection of liver metastatic lesions was carried out and the resulting 5-year survival rate was as favorable as 42.5%.

Successful immunoscintigraphic tumor detection with technetium 99m marked monoclonal anti-CEA antibodies

Twenty patients aged 32-76 years (median 56 years) with various primary cancers or tumor recurrences (colorectal n = 14; lung, breast, medullary thyroid carcinoma n = 2, each) were studied with a technetium-99m labeled anti-CEA antibody. Intact monoclonal antibody BW 431/26 (Scintimum CEA-Tc-99m, Behringwerke AG, Marburg) was successfully labeled (Schwarz Method) by an instant 2-vial kit (labeling efficiency greater than 95% (TLC, HPLC), preserved immunoreactivity). The most frequent clinical indications were (1) the detection of tumor recurrences in patients with a steadily increasing serum CEA level (at a mean 2.3 years after complete removal of the primary tumor) but normal findings by conventional imaging modalities, (2) the search for extrahepatic tumor involvement in patients with known liver metastases scheduled for regional chemotherapy. Gamma camera scintigrams (planar and ECT) were performed 6-12 h and 18-26 h postinjection yielding a sensitivity of 95% (positive tumor contrast in 19/20 patients) with a specificity of 90% (positive predictive value 95%). Immunoscintigraphy successfully depicted tumor recurrences in 4/6 patients with elevated serum CEA values where all conventional imaging modalities had failed. The successful labeling of monoclonal antibodies with 99mTc represent an important step in clinical progress for the more practically orientated use of immunoscintigraphy and also opens new diagnostic fields.

Detection and treatment of local recurrence.

The chance of a curative reoperation is better in patients with an asymptomatic recurrence than in those with a symptomatic one. Pelvic recurrences are often detected by thorough physical examination. In general, however, the sensitivity of the clinical examination is low, so that about 75% of the patients have symptomatic recurrence when it is detected clinically. Serial examinations of CEA, however, seem at present time to be the best indication of recurrence. Thus, elevated serum CEA concentration seems to predict cancer recurrence correctly in 80-90%.

Immunoscintigraphy in Medullary Thyroid Cancer Using an 123I- or 111ln-Labelled Monoclonal Anti-CEA Antibody Fragment

The monoclonal anti-CEA F(ab')2 fragment MAb BW 431/31, labelled with 123I or 111In, was used for immunoscintigraphy (IS) in 9 patients with medullary cancer of the thyroid (CCC). The results of 11 studies lead to the following conclusions: When using radioiodine as a label for MAb in IS, potassium iodide is absolutely necessary to block the thyroid which is of special importance in patients with thyroid cancer; Preinjection of "cold" MAb reduces the relatively high unspecific uptake (especially in bone marrow) of MAb BW 431/31, which is of special importance for the antibody labelled with 111In; IS with MAb BW 413/31 in patients with CCC and elevated serum CEA is positive only in cases with large secondaries; and In patients with CCC and several manifestations of secondaries, only a single (large) metastasis may be apparent.

Immunoreactive carcinoembryonic antigen [CEA] levels in feces from colorectal cancer patients

Immunoreactive CEA (IR-CEA) in feces or sera from 20 volunteers and 20 patients with colorectal cancer were measured before and at various intervals after surgery by a radioimmunoassay utilizing a "one step sandwich method." Elevated fecal IR-CEA level was observed in 17 of 20 patients with colorectal cancer; elevated serum CEA levels were observed in only 7 of all patients. There could not be found any correlation between fecal IR-CEA levels and Dukes' classification; there was but a little correlation between serum and fecal IR-CEA levels. In 8 of 14 patients treated by surgery, fecal IR-CEA levels obviously dropped, but in 2 patients with hepatic metastasis they were found rising in spite of colon tumor removal. It was speculated from these data that high values of fecal CEA depend on mass production of CEA by cancer cells. From these observations, it appears that fecal IR-CEA level presents a more ideal diagnostic competency in colorectal cancer than serum CEA level.