pituitrin and Colonic-Neoplasms

Sixteen tumor markers are reviewed, and measured to the ideal: produced by the tumor cell alone absent in health and in benign disease present in all patients with a given malignancy level in the blood representative of tumor mass detectable in occult disease. The only marker that approaches the ideal is human chorionic gonadotropin (HCG) in gestational trophoblastic tumors. In this malignancy, the HCG level suggests the diagnosis and stage, confirms response to therapy, and predicts relapse. The three most widely used and intensely studied tumor markers are carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and HCG. CEA cannot be used in screening for cancer, but in carcinoma of the colon its elevation preoperatively increases the likelihood of advanced disease and postoperative recurrence. Postoperatively, elevated titers are often but not invariably associated with recurrent disease. AFP and HCG are useful in the management of nonseminomatous germ cell testicular tumors. Like CEA, they cannot be used for screening. They are more likely to be increased with advancing stage, and after therapy rising levels almost always mean recurrent disease. Some markers are valuable in specific circumstances, such as calcitonin in screening for familial medullary carcinoma of the thyroid. In multiple myeloma, immunoglobulins are useful in determining the tumor mass and response to therapy. In neuroblastoma, catecholamine metabolites are useful primarily in making the diagnosis. In some malignancies, the absence of effective therapy lowers the value of the marker, as for AFP in hepatoma. The remaining markers are too unreliable or too little studied to be useful in the management of an individual patient with cancer. The purpose of this paper is to provide the clinician with an understanding of the limitations of the present tumor markers that will lead to wiser use of the tests, and to provide standards to which future tumor markers should be measured.

Topics: Acid Phosphatase; Adrenocorticotropic Hormone; Alkaline Phosphatase; alpha-Fetoproteins; Breast Neoplasms; Calcitonin; Carcinoembryonic Antigen; Catecholamines; Chorionic Gonadotropin; Colonic Neoplasms; Female; Ferritins; Humans; Hydroxyproline; Immunoglobulins; L-Lactate Dehydrogenase; Liver Neoplasms; Lung Neoplasms; Neoplasms; Neoplasms, Germ Cell and Embryonal; Parathyroid Hormone; Placental Lactogen; Polyamines; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms; Vasopressins

Topics: Adenocarcinoma; Adrenocorticotropic Hormone; Arginine; Biliary Tract Diseases; Bronchial Neoplasms; Carcinoma; Chorionic Gonadotropin; Colonic Neoplasms; Cushing Syndrome; Erythropoietin; Female; Follicle Stimulating Hormone; Growth Hormone; Gynecomastia; Hormones, Ectopic; Humans; Hypercalcemia; Lactation Disorders; Lung Neoplasms; Luteinizing Hormone; Models, Biological; Neoplasms; Paraganglioma; Paraneoplastic Endocrine Syndromes; Polycythemia; Pregnancy; Prolactin; Thyroid Neoplasms; Vasopressins

Interleukin-6 (IL-6) is an important mediator of the acute phase response and a sensitive marker of tissue damage. This study was conducted to investigate the fluctuation of serum cytokine and hormonal levels during the perioperative period after laparoscopic-assisted colectomy (LAC), and the data were compared with those after conventional open colectomy (OPEN). The subjects comprised eight patients who underwent OPEN and eight who underwent LAC. Blood samples were obtained by peripheral vein puncture before the induction of anesthesia, then 2, 4, 6, 8, 24, 48, and 72 h after skin incision to measure the levels of serum IL-6, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH). The level of serum IL-6 increased significantly during the perioperative course in both groups; however, the level 4 h after the commencement of surgery and the peak level were significantly lower in the LAC group than in the OPEN group (P < 0.05). Plasma ACTH, cortisol, and ADH rapidly increased in both groups, but there was no significant difference between them. The IL-6 levels in collected ascites samples were not significantly different between the two groups. The changes in serum IL-6 levels indicate that LAC is less invasive than conventional open colectomy. These findings corresponded well with the clinical courses of the patients who underwent the two types of operations.

Topics: Adrenocorticotropic Hormone; Colectomy; Colonic Neoplasms; Female; Humans; Hydrocortisone; Interleukin-6; Laparoscopy; Male; Middle Aged; Vasopressins

The effect of low (0.08 microU g-1 body wt min-1) and high (0.16 microU g-1 body wt min-1) rates of vasopressin infusion on blood flow to normal liver tissue and to liver metastases derived from azoxymethane induced colorectal carcinomas was studied in 36 male Wistar rats. Portal venous flow was measured by electromagnetic flowmetry and blood flow to normal and metastatic liver tissue by the clearance of xenon-133 injected directly into the liver parenchyma or metastasis. The low rate of vasopressin infusion decreased portal venous flow but increased blood flow to normal and metastatic liver tissue while at the higher rate of infusion these effects were reversed. Hepatic artery ligation (HAL) immediately following a low rate of vasopressin infusion abolished the observed increase in blood flow to both normal liver tissue and metastases. HAL immediately following the higher rate of vasopressin infusion further reduced blood flow to metastases but did not further alter blood flow to normal liver tissue. HAL prior to the infusion of the vasoactive drug significantly reduced blood flow to metastatic liver tissue, increased portal venous flow and was without effect on blood flow to normal liver tissue. Following HAL, blood flow to metastatic liver tissue was not further altered by either the low or high rates of vasopressin infusion. However, blood flow to normal liver tissue after HAL was reduced by a low rate of infusion of vasopressin and increased by the higher rate of infusion. The results of this study indicate that blood flow to normal or metastatic liver tissue can be increased or decreased by differential rates of infusion of vasopressin. These observations may have important implications in the treatment of liver metastases in man where different rates of vasopressin infusion may potentiate the effects of hepatic artery ligation or cytotoxic therapy.

Topics: Animals; Azoxymethane; Blood Flow Velocity; Blood Pressure; Colonic Neoplasms; Dose-Response Relationship, Drug; Hepatic Artery; Ligation; Liver; Liver Neoplasms; Male; Portal Vein; Rats; Rats, Inbred Strains; Vasopressins

Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.

Topics: Angiography; Angiotensin II; Animals; Colonic Neoplasms; Kidney Neoplasms; Liver Neoplasms; Neoplasm Transplantation; Neoplasms, Experimental; Norepinephrine; Rats; Rats, Inbred Strains; Sarcoma, Experimental; Tolazoline; Vasopressins

Topics: Colonic Neoplasms; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Intestinal Polyps; Mesenteric Arteries; Middle Aged; Postoperative Complications; Radiography; Vasopressins

Angiography has added a new dimension to the management of hemorrhage from the large bowel. In patients with diverticular hemorrhage, mesenteric angiography not only localizes the bleeding site but, in addition, the bleeding can be acutely controlled with intraarterial infusion of vasopressin, making an emergency colectomy unnecessary. Similarly in patients bleeding from inflammatory bowel disease or in patients with post-operative hemorrhage, angiography provides information about the nature of the lesion and selective arterial infusions of vasopressin can control the bleeding. At times intestinal varices have angiographically been demonstrated as a potential source of rectal hemorrhage while in patients with unexplained lower gastrointestinal bleeding and repeatedly negative barium and endoscopic examinations, angiography has been valuable for the diagnosis of angiodysplasia of the colon.

Topics: Acute Disease; Aged; Angiography; Blood Vessels; Colitis, Ulcerative; Colon; Colonic Neoplasms; Diverticulum, Colon; Endoscopy; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Intestine, Large; Male; Mesenteric Arteries; Middle Aged; Varicose Veins; Vasopressins

Topics: Adult; Aged; Antigen-Antibody Reactions; Circadian Rhythm; Colonic Neoplasms; Diuresis; Homeostasis; Humans; Lymph Node Excision; Middle Aged; Oliguria; Osmolar Concentration; Plasma; Postoperative Care; Preoperative Care; Radioimmunoassay; Splenectomy; Surgical Procedures, Operative; Urine; Vasopressins; Water-Electrolyte Balance