Metastasis to sigmoid colon mucosa and submucosa from serous borderline ovarian tumor: response to hormone therapy.

Distant metastasis to sites other than lymph nodes of borderline ovarian tumor is rare. We describe a case metastasized to sigmoid colon mucosa and submucosa. The metastatic lesion was detected incidentally by screening colonoscopy 7 years after the patient was treated for the primary tumor. The metastatic lesion responded well to treatment with oral Arimidex 1 mg/day. A follow-up colonoscopy with biopsy and imaging studies after 3 months of treatment revealed no evidence of disease in the sigmoid colon. This case showed that the sigmoid colon mucosa and submucosa should be considered as one of distant metastatic sites of a serous borderline ovarian tumor and the favorable response to Arimidex provides support the use of hormone therapy in women with serous borderline ovarian tumor.

Colorectal polyp incidence among polypropylene manufacturing workers.

To follow up earlier findings of increased colorectal cancer and polyp risk among a group of Texas polypropylene manufacturing workers, a second company-sponsored colorectal cancer screening program was conducted. Ninety-four (64%) of the 147 male workers negative for polyps in the first screening were rescreened. Age- and examiner-adjusted incidence rate ratios (IRRs) were modestly elevated for polypropylene manufacturing workers compared with patients screened at the same clinic for total (IRR = 1.31; 90% confidence interval [CI] = 0.84 to 2.03) and adenomatous (IRR = 1.80; 90% CI = 0.68 to 4.78) polyps. However, risk of adenomas among the highest exposed group (early term process/mechanical workers: IRR = 1.77; 90% CI = 0.51 to 6.18) was similar to risk in the least-exposed group (engineer/chemist/administrative workers: IRR = 2.02; 90% CI = 0.56 to 7.31). The modest, nonsignificant excesses and the similarity in risk across job categories does not suggest an occupationally related risk, although small numbers and potential biases preclude making definitive conclusions.

Nonrandom chromosomal abnormalities in lymphocyte cultures of individuals with colorectal polyps and of asymptomatic relatives of patients with colorectal cancer or polyps.

We studied chromosomal alterations in the peripheral blood lymphocytes of 10 individuals with colorectal polyps and 10 asymptomatic first-degree relatives of patients with colon cancer or colorectal polyps. The analysis was performed on T-lymphocytes using short term blood cultures and on B-lymphocytes by establishing lymphoblastoid cell lines by Epstein-Barr virus transformation. Chromosomal changes were not common in T- and B-lymphocytes. Chromosomes 1 and 5 were most frequently involved in numerical or structural changes in the patients with polyps as well as in the asymptomatic relatives. These alterations were observed in either the T-lymphocytes or the B-lymphocytes but rarely in both, thus accentuating the importance of studying both the cultures concurrently. Chromosome 5, which is known to play an important role in the development of adenomatous polyps, was found to be involved in 6 (60%) of 10 patients with polyps and 4 (40%) of 10 asymptomatic relatives. These findings show that lymphocytic chromosomal analysis can aid in identifying individuals who are genetically susceptible and are at a higher risk of developing colorectal cancer. Because lymphocytic chromosomal analysis is relatively simple and inexpensive, we expect that it will be very useful in screening asymptomatic individuals who are at a higher risk due to inherited or environmental factors.

Cytogenetic abnormalities in colon cancer patients: a comparison of T- and B-lymphocytes.

Cytogenetic analysis of peripheral blood lymphocytes of 19 colorectal cancer patients was carried out in short term blood cultures (T-cells) as well as in Epstein-Barr virus transformed B-cell lymphoblastoid cell lines. One hundred Giemsa-banded metaphases from the T lymphocytes and 50 metaphases from the B lymphocytes of each patient were evaluated for cytogenetic abnormalities. Clonality was not observed in every paired sample. Structural and/or numerical aberrations were most frequent in chromosomes #1, #2, #5, #7, #9, #12, #14, #17, #18 and #21. Aberrations among these chromosomes could be observed individually in either of the cultures, which proves that the analysis of both cultures (T and B cells) is complementary to each other. In some cases involving multiple primary cancers it was interesting that the specific chromosomal change, crucial for a particular malignancy, was identified only in the lymphoblastoid cell line analysis. This supports the notion that B-cell analysis can serve as a useful adjunct to the study of short-term blood cultures and also poses a question as to whether the specific chromosomal changes observed in the analysis are confined to the B-cell lineage.

Quality of care for colorectal cancer in a fee-for-service and health maintenance organization practice.

This study assessed the effectiveness of two types of health plans, offered by the same health care provider, in the diagnosis and treatment of colorectal cancer. Data on 330 cases diagnosed from 1984 through 1989 were abstracted from medical records. Of these, 205 (62%) used fee-for-service (FFS) and 125 (38%) used health maintenance organization (HMO) plans. Overall, there were no differences between FFS and HMO cases for duration of symptoms before diagnosis, training of physician who diagnosed the tumor, anatomic location of the tumor, type of primary treatment, Dukes' stage at final diagnosis, or survival. There were differences between the groups for age, presence of symptoms at diagnosis, time from detection to treatment, and method of detection. Cox regression analysis showed no difference in survival by type of health plan before or after adjusting for age and stage at diagnosis. The findings from this study are consistent with those from studies reporting little or no difference in the process or outcome of care for patients with different types of medical insurance coverage.

Identification of colon cancer-predisposed individuals: a cytogenetic analysis.

Peripheral blood lymphocyte cultures from 23 individuals with polyps and 10 age-matched controls were cytogenetically studied. Of 23 individuals with polyps, 13 were males and 10 females. The age distribution of these patients was between 22 and 84 yr, with a medium age of 49.6 yr. Chromosome 5 was involved in structural rearrangements in 10 of the 18 patients with adenomatous polyps (55.5%). All those who showed involvement of chromosome 5 alterations had either adenomatous polyps or Gardner's syndrome, and two had colon adenocarcinoma. Of the remainder who did not show involvement of chromosome 5, eight had adenomatous polyps and five had hyerplastic polyps (non-neoplastic). Of the 10 control samples, only one showed alteration of chromosome 5. Of the 10 adenomatous polyp subjects that showed chromosome 5 defects, two had translocations of chromosome 5 and the short arm of 17. Chromosome 5 was broken 13 times (5 times in the q arm and 8 times in the p arm). Based on our present cytogenetic data, we tentatively conclude that lymphocyte metaphases may be used to identify colon cancer-predisposed individuals.

Carcinoembryonic antigen in serum of patients with colorectal polyps: correlation with histology and smoking status.

To measure the concentration of carcinoembryonic antigen (CEA) in serial serum specimens of 47 healthy subjects and in serial sera of 59 patients with colorectal polyps of confirmed histology, obtained before or after (sometimes both) polypectomy, we used the Roche EIA and the Hybritech Tandem-E double monoclonal immunoenzymometric assays. Both methods gave comparable results for the healthy subjects but discordant values for some polyp patients. The Tandem-E test gave increased CEA results more frequently for two groups of polyp patients, the group of ex-smokers with neoplastic polyps (n = 14) and the group of smokers (n = 20). Smokers had significantly greater (P less than 0.025) mean concentrations of serum CEA than did nonsmokers, irrespective of whether they were healthy or had colorectal polyps. Smokers with recurrent polyps demonstrated significantly greater (P less than 0.050) mean concentrations of serum CEA than did smokers with a first occurrence of polyps. Polypectomy was followed by statistically significant decreases (P less than 0.050) of mean concentrations of serum CEA, primarily in polyp patients who were smokers. However, although CEA increases occurred frequently in polyp patients who smoked, these abnormalities did not fully correlate with polyp histology.

Chromosome anomalies in human breast cancer: evidence for specific involvement of 1q region in lymphocyte cultures.

Constitutional chromosome abnormalities that may predispose a group of individuals to develop certain neoplasms have been reported for some human solid tumors. Deletions of 13q in retinoblastoma, 11p in Wilms' tumor, 1p in neuroblastoma, 3p in renal cell carcinoma, 5q in colorectal carcinoma and 22q in meningioma are examples of such anomalies. In breast carcinoma, a specific cytogenetic defect has not been conclusively identified. We have studied Phytohemagglutinin-stimulated lymphocytes of 76 breast cancer patients, 68 predisposed family members, 40 controls, and 30 additional controls with lung cancer to determine whether nonrandom chromosome defects are present. From each sample 100, G-or Q-banded metaphase spreads were studied for rearrangements. A marked clustering of alterations in the long arm of chromosome no. 1 (q11-22) was seen in breast cancer patients and in some predisposed family members. Alterations in 1q were present in 1% to 3% of metaphases, and included translocations to chromosomes 3, 6, 7, 9, 12, 15, 17, 18, 21 and the X; deletion of 1q, or pericentric inversion. Twelve out of 62 (19.3%) familial cases, 3 out of 14 (21.4%) sporadic cases, 9 out of 68 (13.2%) predisposed cases and 2 out of 40 (5%) control cases showed 1q alterations. None of the 30 lung cancer patients showed chromosome 1 anomaly in this region. This is consistent with the reports on primary breast tumor tissues, cell lines and pleural effusions where 1q defects have been reported. We conclude that chromosome 1q rearrangement might be one of the primary lesions specifically associated with the development of breast cancer.

Plasma protein-bound sialic acid in patients with colorectal polyps of known histology.

Protein-bound sialic acid (PBSA) was measured in serial plasma specimens from 62 healthy subjects, 48 patients with colorectal polyps, and 30 patients with colorectal adenocarcinomas. The mean plasma PBSA concentration in healthy smokers was significantly greater than that in healthy nonsmokers and healthy ex-smokers (P less than 0.0001). Villoglandular polyps were associated with higher plasma PBSA values than were the most benign hyperplastic polyps (P less than 0.025). Patients with the most neoplastic villoglandular and villous polyps had significantly greater (P less than 0.010-0.050) plasma PBSA values than healthy subjects. Polypectomy decreased the mean PBSA value significantly to the mean value for healthy subjects only for patients with villoglandular (P less than 0.010) or villous (P less than 0.050) polyps. Colorectal cancer patients had mean plasma PBSA concentrations significantly greater than those for the healthy subjects (P much less than 0.001) and the polyp patients (P much less than 0.001). Surgery significantly reduced (P less than 0.025) the mean PBSA value for the cancer patients to the mean PBSA value observed for the healthy subjects.

Nonlinear refractive-index changes induced by carrier injection in an InSb étalon.

We report the bistable switching of an InSb étalon in a novel mode of operation where the necessary changes in refractive index are induced by minority carrier injection through a p-n junction. Refractive-index changes of approximately 10(-5) are achieved using 3-V pulses. Switch ON and switch OFF characteristics and projected performance are discussed.

Multiple polyposis coli associated with Gardner's syndrome and chromosomal mosaicism: a family analysis.

A family in which the proband (father) has multiple polyposis coli associated with Gardner's syndrome and his only son, also with multiple polyps, has been studied cytogenetically. The karyotypes of the proband and the son have shown deletion in the short arm of one chromosome 12 in a small percentage of cells. Normal cells and cells with a deletion of a 12p were noted, not only in the lymphocytes, but also in the skin fibroblast culture of the son. The karyotypes of the asymptomatic mother and their unaffected daughter were considered to be normal.

Reasons for participation and nonparticipation in a colorectal cancer screening program for a cohort of high risk polypropylene workers.

Little is known about reasons for participation in occupational colorectal cancer screening programs using flexible sigmoidoscopy and barium enema. To assess this issue, telephone interviews were conducted with a sample of participants and nonparticipants in such a program. This study was a follow-up of a previous assessment of factors that affected screening participation among a cohort found to have elevated rates of colorectal cancer. The major finding of this survey was that the absence of symptoms was the major reason for nonparticipation, although both participants and nonparticipants expressed the view that early detection was important and that colorectal cancer could be cured if treated at an early stage. Based on the results of this study and of other surveys, educational messages to workers explaining the asymptomatic development of colorectal cancer should be tried as a way of increasing participation.

Assessment of colorectal cancer screening outcomes among workers involved in polypropylene manufacture.

To follow up on a previous finding of an elevated colorectal cancer incidence rate among Exxon employees on a unit devoted to the manufacture of polypropylene (the polyolefin unit [POU]), a company-sponsored screening program was offered to all former and present POU workers. Overall participation was 52.5%, with lower participation among older workers and workers who had retired or were no longer employed by the company. Evaluation of polyp prevalence rates for POU workers v rates for non-Exxon employees screened at the same clinic showed a general pattern of elevated rates for POU employees, especially for mechanical and process workers. This pattern was most marked for polyps at least 0.5 cm in diameter, but findings were less clear for adenomatous polyps. The effect of factors that might bias evaluation of colorectal polyp prevalence rates (eg, selection bias, observation bias, genetic susceptibility) is discussed, but none of these factors seemed a likely explanation for the findings observed in this study.

Methods for determining "reference changes" from serial measurements: plasma lipid-bound sialic acid.

Lipid-bound sialic (neuraminic) acid (LSA) was measured in EDTA-treated plasma of 26 healthy subjects at three-month intervals for up to one year. The change in LSA concentration for consecutive measurements ranged from -54 to 42 mg/L (mean, -2.1 mg/L; SD, 19.6 mg/L; n = 56). The "reference change" for plasma LSA (+/- 2 SD), calculated from distribution of the differences, was +/- 39 mg/L. The 88th percentile of the intra-individual variance was 338 mg2/L2 and the mean variance was 159 mg2/L2. Using the homeostatic, autoregressive time-series model, a reference change of +/- 51 mg/L between two consecutive measurements was determined to be statistically significant (i.e., expected by chance no more than 5% of the time) in 88% of the healthy subjects. Only 73% of the healthy subjects would have had intra-individual variances corresponding to the reference change of +/- 39 mg/L according to the autoregressive model. The concentration of LSA in plasma was significantly decreased upon surgery in five of 10 patients with colorectal adenocarcinomas of Dukes stages A-C when we used +/- 39 mg/L as the reference change, but in only two of the 10 when we used +/- 51 mg/L as the reference change.

Factors associated with participation in an occupational program for colorectal cancer screening.

This study reports factors associated with participation in a colorectal cancer screening program for a cohort of workers on a polypropylene manufacturing unit. The impetus for the screening program was the discovery of a colorectal cancer cluster among workers on this unit. The program included a life-style/risk factor questionnaire, fecal occult blood test, a 60-cm colonoscopy, and an air-contrast barium enema. Overall, 52.5% of the 406 men who were offered screening participated in the program. Of those screened, only 40% attended a briefing, but over 80% of those who attended a briefing came for screening. Factors associated with completion of screening are analyzed and discussed in the context of the literature on participation in colorectal screening programs. The implications for colorectal cancer screening of occupational groups believed to be at high risk are considered.

Pancreatic oncofetal antigen and carbohydrate antigen 19-9 in sera of patients with cancer of the pancreas.

Pancreatic oncofetal antigen (POA) and carbohydrate antigen 19-9 (CA 19-9) were measured in the sera of 23 patients with cancer of the pancreas to determine the true positive rates of these cancer markers. In one group of unselected pancreatic cancer patients (n = 9), both tests showed above-normal results in three patients and both gave values that were within reference limits in three other patients. Two of the three remaining patients had increased CA 19-9 but normal POA values, and one patient had increased POA but normal CA 19-9 concentrations in serum. In another group of 14 pancreatic cancer patients, selected on the basis of increased concentrations of POA in serum, the CA 19-9 values were increased in eight. In four patients who had progressive disease, the concentrations of both markers increased with time in one patient, only POA in one, and only CA 19-9 concentration in another. (The fourth patient had increased but stable concentrations of POA and CA 19-9 in serum.) These data suggest that serum POA and CA 19-9 measurements should be used in combination in the evaluation of patients with cancer of the pancreas.

Comparison of participants and nonparticipants in a work site cancer awareness and screening program.

In 1985, Pennzoil Company offered a company-paid cancer awareness and screening program focusing on breast and colorectal cancers for its employees. Following a lecture/slide presentation, employees filled out a risk assessment questionnaire. Those at risk for breast and/or colorectal cancers were invited for consultation, mammography, and/or short colonoscopy. Overall completion rates were 49% for mammography, 20% for the fecal occult blood test, and 31% for short colon oscopy, but these rates varied by risk status. Moreover, the same demographic and risk factors were not consistently associated with completion of the same screening procedure across risk groups. Based on these findings, we suggest that different interventions may need to be developed depending on the risk characteristics of subgroups within the target population.

A double-monoclonal immunoenzymometric assay for alpha 1-fetoprotein modified for increased analytical precision.

We modified a one-step, two-site, double monoclonal immunoenzymometric assay (Abbott Laboratories) for serum alpha1-fetoprotein (AFP) to increase its sensitivity and improve test precision at the low end. We increased sample size, incubation interval, and reaction time and temperature, and decreased the final reaction volume. Interassay CVs for the modified method ranged from 6.2 to 8.0% for mean concentrations of AFP in serum of 5.2 to 34.2 micrograms/L--substantially better than those for the unmodified monoclonal method--and agreed well with those of the comparison method (modified Abbott polyclonal immunoenzymometric assay). AFP values by the modified monoclonal procedure (y) correlated well with results by the polyclonal method (x): y = 0.983x + 1.84 micrograms/L (r = 0.927, n = 59). The detection limit of the modified monoclonal test was 0.2 microgram/L, as compared with 1.0 and 1.4 micrograms/L, respectively, for the modified polyclonal and the unmodified monoclonal procedures. We recommend using the modified monoclonal method for monitoring cancer patients with low tumor burden.