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Although narrative reviews have concluded that there is strong support for familial clustering of prostate carcinoma, the association has never systematically been quantified in reviews. The purpose of this meta-analysis was to summarize and quantify the recurrence risk ratio with emphasis on the degree of relation, the specific relationship of the family member, the number of affected family members, and the age at diagnosis.Publications were identified through computerized database searches for epidemiologic studies published up to December 2002. In addition, references cited in original and review papers were examined. Three blinded reviewers extracted both qualitative and quantitative information from each paper. Using random effects meta-regression analyses, the authors calculated summary recurrence risk ratios (S(lambda)). The reviewers also evaluated changes in S(lambda) according to differences in study methodology.Thirty-three epidemiologic studies were included in the current review. S(lambda) was 2.53 (95% confidence interval, 2.24-2.85) for first-degree family members. S(lambda) appeared to be greater for men with an affected brother than for men with an affected father. S(lambda) for men who had second-degree relatives with prostate carcinoma was only slightly elevated. The nature of the familial clustering is such that S(lambda) increases with decreasing age of the patient and family members, with increasing genetic relatedness of the affected relative, and with increasing number of individuals affected within a family.The studies that were reviewed consistently demonstrate that family history is a significant risk factor for development of prostate carcinoma.

Anemia is common in cancer patients, although the prevalence is influenced both by the type of malignancy and the choice of treatment. Individual studies have compared the survival of patients with and without anemia and have shown reduced survival times in patients with various malignancies, including carcinoma of the lung, cervix, head and neck, prostate, lymphoma, and multiple myeloma. The objective of this study was to systematically review, to summarize, and to obtain an overall estimate of the effect of anemia on survival in patients with malignant disease.A comprehensive literature review was carried out using the MEDLINE data base and reviewing the reference lists from published studies. Two hundred papers were identified. Of these, 60 papers that reported the survival of cancer patients according to either hemoglobin levels or the presence of anemia were included. Among these papers, 25% related to patients with lung carcinoma, 17% related to patients with head and neck carcinoma, 12% related to patients with multiple myeloma, 10% related to patients with prostate carcinoma, 8% related to patients with cervicouterine carcinoma, 7% related to patients with leukemia, 5% related to patients with lymphoma, and 16% related to patients with other types of malignancies.The relative risk of death increased by 19% (95% confidence interval, 10-29%) in anemic patients with lung carcinoma, by 75% (37-123%) in anemic patients with head and neck carcinoma, by 47% (21-78%) in anemic patients with prostate carcinoma, and by 67% (30-113%) in anemic patients with lymphoma. The overall estimate increase in risk was 65% (54-77%).Anemia is associated with shorter survival times for patients with lung carcinoma, cervicouterine carcinoma, head and neck carcinoma, prostate carcinoma, lymphoma, and multiple myeloma.

The elderly experience the major impact of cancer. The incidence rate for those aged 65 and older is 2085.3 per 100,000 as compared with 193.9 per 100,000 for those younger than 65. Overall, 58% of all cancer incidence is in the older segment of the population. Cancer mortality in the elderly now accounts for 67% of all cancer deaths. Data from the National Cancer Institute Surveillance, Epidemiology, and End Results program for 1985-1989 reveal many salient facts. Older persons have a risk of developing cancer 10 times greater than that for individuals younger than 65. This paper outlines the magnitude of the major cancers that affect the elderly. Incidence and mortality data are presented according to individual tumors (colon, rectum, lung/bronchus, pancreas, stomach, urinary bladder, breast, ovary, and prostate). Demographic data from the U.S. Bureau of the Census focus on the expanding elderly population in the United States and projections for the future. Needs for cancer care and treatment for the elderly, already great, are likely to increase. It is imperative that older persons receive special attention for cancer prevention, early diagnosis, and treatment efforts, especially because there is almost always an overlay of other chronic diseases and age-associated declines concurrent with the diagnosis of cancer in the elderly. This paper highlights issues unique to older persons as individuals at high risk for cancer and suggests research strategies that should be made in anticipation of the even greater cancer burden for the elderly as this subset of the population expands.

Improving care coordination is a key priority for health services. The aims of this study were to identify patient- and health service-related predictors of poorly coordinated care and to explore patient preferences to assist care coordination.Patients with incident colorectal cancer, identified from a state-wide cancer registry, completed a self-report questionnaire 6 to 8 months after their diagnosis. Care coordination was assessed with the Cancer Care Coordination Questionnaire for Patients. Multiple linear regression models were used to predict factors associated with a poor experience with cancer care coordination.Among 560 patients (56% response rate), care coordination experiences were normally distributed (mean score, 76.1; standard deviation, 10.9). Patients who had 3 or more comorbid conditions (β, -4.56; standard error [SE], 1.46; P = .006), little or no understanding of the health system (β, -4.34; SE, 0.94; P .001), and no regular general practitioner (GP; β, -4.09; SE, 2.07; P = .049) experienced poorer care coordination. At the health service level, patients who did not receive a written pretreatment plan (β, -4.15; SE, 0.95; P .001) or did not see a cancer care coordinator (β, -3.29; SE, 1.03; P = .001) had lower scores. The most preferred resources included information packs (92%), written care plans (88%), and improved access to their own personal medical records (electronic, 86; paper, 84%), with most patients preferring a shared GP and surgeon care model.There was wide variation in experiences across the state. The factors associated with lower scores provide a focus for targeted strategies for improving patients' experience with colorectal cancer care coordination. Cancer 2017;123:319-326. © 2016 American Cancer Society.

This paper presents a preliminary report of 66 patients who underwent en bloc resection for osteogenic sarcoma of the femur (34 patients), tibia (12 patients), shoulder girdle (19 patients), and fibula (1 patient). Presentation of a limb, without sacrificing the principles of cancer surgery, is a desirable goal in people with osteogenic sarcoma. Up to the present time, amputation has been regarded by most authorities as the only well-established typical curative treatment for this malignancy. Usually when a tumor is close to a joint, amputation includes excision of a part of the adjacent joint as well as a wide removal of the involved bone to encompass both area of potential capsular-joint local skip and possible intraosseous skip areas of tumor. The former has been observed more than the latter. In an effort to improve survival rates, the distal femur lesion (having the lowest extremity cure rate in our opinion) requires removal of the whole bone. The following study was undertaken to determine whether en bloc resection in association with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy. We believe our definition of osteogenic sarcoma, unlike some, excludes the good prognostic medullary invading juxtacortical osteogenics, chondrosarcomas (making bone), and includes telangiectatic osteogenic sarcomas. Therefore, our cure rate, with amputation under the age of 21 was 17% with no evidence of disease. Any paper not analyzing the age of the patient (under 21 years old) cannot in itself be comparable. Cure rates of older patients can be as high as 35% according to Dr. Andrew Huvos at our hospital.

Anticoagulants have been demonstrated to reduce tumor growth in certain experimental animal systems. Inhibition of clot formation interferes with tumor growth and spread while enhancement of coagulation promotes tumor growth and spread. The fact that the coagulation mechanism is commonly activated in human malignancy together with preliminary reports of therapeutic efficacy of anticoagulants suggests that the coagulation mechanism may be of pathophysiologic significance also in the growth of human tumors. A VA Cooperative Study has been established to test the hypothesis that warfarin anticoagulation will modify the course of malignancy in man. The purpose of this paper is to present the rationale and experimental design for this study with emphasis on management of anticoagulant administration in cancer patients. This paper serves as the basis for forthcoming reports of toxicity and therapeutic efficacy of warfarin in human malignancy.

Over the last 30 years, dramatic advances have been made in understanding the cell biology of cancer and the genetic changes involved in oncogenesis. Many tumors now are curable and overall, cancer mortality has decreased significantly. Cancer has been transformed from a primarily fatal disease into a chronic condition. To accelerate these trends, the American Cancer Society has set its goals for the year 2015 to reduce the burden of cancer in this country. The goals are to decrease mortality by 50% and decrease the rate of incidence by 25%, as well as increase the quality of life for all individuals with cancer. However, to achieve these goals, changes must occur on two levels, in cancer control research and programming. Greater resources must be directed toward social and behavioral research, and conceptual clarity must be developed so that refinements can be made in the methodologies used to study the effects of cultural differences on health behavior. This paper provides a broad overview of the complex, intricate, and interrelated interaction that is emerging as a salient area of study. To our knowledge, the information to date is in disparate disciplines and needs to be integrated within an overarching framework for cancer control in diverse populations.

Age-adjusted mortality from cancer is steadily increasing among Native Americans, raising concern about environmental causes. Toxic waste dumps, mining activities, paper mills, military activities, agricultural chemicals, and urban pollution are common sources of carcinogen exposure on reservations and among the urban poor. Despite documented hazards, we do not see a pattern of cancer excess that might result if Native Americans were exposed to these carcinogens more than other Americans. Abuse of tobacco can be shown to be the most important contributor to cancer mortality among Native Americans. Although there are good reasons for environmental regulation and clean-up, the most cost-effective method of cancer prevention is tobacco control.

BACKGROUND Several studies have proven the usefulness of microvessel quantification as a prognostic factor for patients with various malignant tumors. The aim of this paper was to clarify the relationship between microvessel density (MVD) as a parameter of tumor angiogenesis and liver metastasis in colorectal cancer. METHODS A total of 175 patients with advanced colorectal cancer were evaluated (58 with concurrent liver metastasis). Microvessel quantification was performed immunohistochemically, using monoclonal antibodies against endothelial protein Factor VIII-related antigen (F8RA) and against endothelial surface marker CD34. Finally, the relationship between MVD and liver metastasis was analyzed. RESULTS A significant correlation was observed between MVD for F8RA and MVD for CD34 (n = 175, r = 0.9560, P = 0.0001). MVD in the tumors stained for F8RA ranged from 15.2 to 78.6 microvessels per × 200 field (mean 32.8 ± 11.7), while the tumors stained for CD34 varied between 21.6 and 118.8 microvessels per × 200 field (means 56.1 ± 20.5). A significantly higher MVD was observed in the tumors with liver metastatic disease compared with the tumors without liver metastasis (F8RA: mean 36.1 ± 11.3 vs. 31.2 ± 11.5, P = 0.0090; CD34: mean 64.4 ± 20.4 vs. 52.0 ± 19.4, P = 0.0010). CONCLUSIONS Microvessel quantification within a colorectal tumor using immunohistochemical staining methods has shown a significant correlation between MVD and liver metastasis. Tumors with a greater MVD may thus have a greater hematogenous metastatic propensity. Cancer 1996;77:1722-8.

There is considerable uncertainty regarding the acceptability of routine distress screening.In an unfunded implementation study, the authors asked 50 clinicians (chemotherapy nurses and treatment radiographers/radiation technologists) to implement a screening program for distress as part of routine care and to record their feedback after each clinical encounter. In total, 379 patients were screened using a simple paper-and-pencil versions of distress thermometer and the emotion thermometer (ET).Across all screening applications, clinicians believed that screening was useful during 43% of assessments and was not useful during 35.9% of assessments, and they were unsure or neutral in 21.1% of assessments. The application of the screening program assisted staff in changing their clinical opinion after 41.9% of assessments, and clinicians believed that the screening program helped with communication in50% of assessments. However, 37.5% believed that screening was impractical for routine use, and more chemotherapy nurses than radiographers rated the screening program as "not useful." On multivariate analysis, 3 variables were associated with high staff satisfaction with screening, namely, receipt of prior training, talking with the patient about psychosocial issues, and improved detection of psychological problems. A favorable perception of screening also was linked to a change in clinical opinion.Opinions of cancer clinicians regarding routine distress screening were mixed: Approximately 33% considered screening not useful/impractical, whereas50%n believed promoted good communication and/or helped with recognition. Clinicians who were more positive about screening gained greater benefits from screening in terms of communication and recognition.

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer.

The present overview of advanced prostate cancer required the identification of randomized clinical trials studying the question of maximal androgen blockade versus the classic castration therapy. The heterogeneity of the trials concerned the type of castration (surgical or chemical) and the type of antiandrogen (flutamide, Anandron, or cyproterone acetate) added to castration. This paper reviews the different types of heterogeneity that might exist among trials that are involved in the overview: study design, randomization procedure, treatment evaluation, statistical evaluation, and data maturity. In order to overcome these various types of heterogeneity and to compare like with like, the treatment comparison should be stratified a posteriori by question (i.e., type of castration or type of anti-androgen studied) and by study. In this way, one may draw valid conclusions. Of course, those trials with a larger number of patients and a longer follow-up will contribute more to the overview's results.

Tumor cell and host immune cell interaction plays a key role in carcinogenesis. Signal transducer and activator of transcription 3 (STAT3) is constitutively activated in cancer and believed to be an important mediator of tumor-induced immunosuppression. This paper aims to describe the prognostic impact of neutrophil and dendritic cell infiltration in primary melanoma and the association of this infiltration with activated STAT3 (pSTAT3) in primary melanoma cells.Formalin-fixed, paraffin-embedded primary melanomas from 186 stage-I/II melanoma patients surgically resected from 1997 to 2000. Infiltrating neutrophils (CD66b), dendritic cells (CD123+ and DC-LAMP+), T-lymphocytes (CD8) and pSTAT3 melanoma cell expression were studied by immunohistochemistry and evaluated as present or absent. DC-LAMP+ cell infiltration was evaluated as absent/few versus dense. Study endpoints: relapse-free survival, melanoma-specific, and overall survival.The median observation time was 12.2 years (range, 10.4-14.2 years). Fifty-one deaths were observed of which 38 (20%) were melanoma-specific. In a multivariate Cox proportional hazards model including ulceration and melanoma thickness, neutrophil and CD123+ dendritic cell infiltration were independently associated with poor prognosis (CD66b: hazard ratio [HR] = 3.13; 95% confidence interval [CI], 1.43-6.83; P = .004; CD123: HR = 2.45; 95% CI, 1.22-4.92; P = .012). The association between melanoma cell pSTAT3 expression and immune infiltration (neutrophils and CD123+ cells) was strong. pSTAT3 expression, CD8 and DC-LAMP infiltration were not independently associated with poor prognosis.Neutrophil infiltration and CD123+ dendritic cell infiltration in primary melanoma are independently associated with poor prognosis. Melanoma cell expression of pSTAT3 is strongly associated with the surrounding immune infiltrate.

BACKGROUND The rise in adenocarcinoma (AC) of the esophagus has been reported in several papers. However, the results are only comparable to a limited extent, because they are based on differing periods and different computational methods. The purpose of the current investigation was to collect the available data and to analyze them in a unified manner. METHODS The authors requested data on the incidence of AC of the esophagus for each year since 1960 from 43 tumor registries in North America, Europe, and Australia. The data from 22 centers were used. The trend was calculated by fitting the data to an exponential growth model. RESULTS The incidence of AC of the esophagus in white males is rising in most countries. The highest values of the estimated incidence rate in the year 2000 were found in Great Britain (5.0– 8.7 cases per 100,000 population) and in Australia (4.8 cases per 100,000 population) followed by The Netherlands (4.4 cases per 100,000 population), the United States (3.7 cases per 100,000 population), and Denmark (2.8 cases per 100,000 population). Low rates (< 1.0 cases per 100,000 population) were found in Eastern Europe. The largest changes in incidence were reported in the Southern European countries, with an estimate of the average increase over six registries of 30% per year; in Australia, with an average increase of 23.5% per year; and in the United States, with an average increase of 20.6% per year. The rates of increase ranged from 8.7% to 17.5% on average in Northern Europe, Central Europe, and the United Kingdom. In Eastern Europe, at most, there was a minor rise in incidence. CONCLUSIONS In the Western industrialized nations, the analyzed data show that the incidence of AC of the esophagus has been rising rapidly in the last 20 years. The only exceptions to date are the countries of Eastern Europe. Cancer 2001;92:549–55. © 2001 American Cancer Society.

As more oncology care is moved to the outpatient setting, the need for a rapid means for oncologists to identify patients with significant distress has increased. Concurrent with this move has been the pressure to reduce time spent with each patient, adding to the likelihood that a distressed patient will not be recognized and will remain untreated in the current health care environment.A pilot program was conducted in a prostate carcinoma oncology clinic to test the feasibility of a two-stage approach that identifies patients in significant distress and refers them for treatment. Two pencil and paper self-report measures were used to detect psychologic distress in patients over the previous week: 1) The Hospital Anxiety and Depression Scale (HADS) and 2) "The Distress Thermometer." Patients who scored above an agreed upon cutoff score on either measure (HADS = 15+; Thermometer = 5+) were referred to the psychiatric liaison in the clinic for evaluation.Compliance in filling out the measures was excellent; only 8 of 121 patients (6.6%) refused. Thirty-one percent of evaluable patients were referred based on elevated scores. Seventeen of 29 patients actually were evaluated. Eight of 17 patients met Diagnostic and Statistical Manual (of Mental Disorders)-IV criteria for a psychiatric disorder.This approach for rapid screening for distress was acceptable in prostate carcinoma patients, although these older men were reluctant to agree to evaluation and treatment. This simple screening method needs further testing and the identification of barriers on the part of the patient and oncologist that impede the identification of the most distressed patients.

Mass screening of infants for neuroblastoma began in Japan after studies suggested that survival rates could be improved by early detection. This study was initiated in 1991 to test the methodology and feasibility of screening for neuroblastoma within the U. S. health care system.Infants ages 5-10 months (mean age, 9 months, 25 days) who were born in Texas were screened for neuroblastoma. An enzyme-linked immunoadsorbent assay (ELISA) for homovanillic acid (HVA) and vanillylmandelic acid (VMA) used to quantify the HVA and VMA was performed on urine extracted from specimens dried on filter paper. Infants were recruited to participate in the study by several methods, and the effectiveness of each method was determined by calculating compliance rates.Between February 1991 and June 1994 a total of 14,046 infants were recruited to participate in neuroblastoma screening. Neuroblastoma was detected in 2 children for an incidence rate of 1 in 7023. A total of 291,158 screening kits were distributed to the parents of these infants, resulting in an overall compliance rate of only 4.8%. Compliance rates varied by method of distribution of the test kits: Houston Women, Infants, and Children (WIC) clinic (53%), volunteers (31%), Rio Grande Valley WIC clinics (14.5%), the patient's private physician (9.9%), and by mail (4.7%).Early detection of neuroblastoma in infants ages 5-10 months was achieved using ELISA. Compliance rates were poor, but clinics with a preventive health focus, such as the WIC clinics, achieved higher compliance rates than did private physicians.

The clinician has long been challenged by the diversity in clinical expression of carcinoma of the prostate. On one end of the spectrum is a disease that is phenotypically malignant but biologically not virulent. It is the prostate carcinoma that males die with rather than of. On the other end of the spectrum, there is a carcinoma of the prostate that is relentless and virulent, and has been resistant to our intervention efforts. Although all males are known to be at risk for the occurrence of carcinoma of the prostate, there is no means at present to predict the type and behavior of the disease they will experience. This is the conundrum faced upon recognition of premalignant and early microscopic disease.This paper presents a conceptual framework of the evaluation of disease behavior along one of three distinctive pathways. In this trilogy of expression of carcinoma of the prostate, there are the indolent (Type I), the slowly progressive (Type II), and the virulent and systemic (Type III). These general patterns of behavior may be an expression of the tumor cell ("seed") and the factors that were its genesis, or the effect of the environment ("soil") in which the tumor cell finds itself. The more likely fact is that it is the product of both ("seed and soil").Our goal is to identify tumors for which no therapy is warranted at their outset by molecular and biologic methods; age group in whom curative local therapy is feasible; and the carcinomas that require effective systemic therapy.The three general patterns of clinical expression provide a framework in which to identify the genetic, molecular, and cellular determinant of the biologic behavior of carcinoma of the prostate. Being able to correlate such parameters with likely behavior patterns would help us choose appropriate therapy.

High dose interleukin-2 (IL-2) has been found to produce durable antitumor responses in some patients, benefiting most greatly those patients with melanoma and renal cell carcinoma. In this paper, the hematologic toxicity and changes resulting from high dose IL-2 alone administered by intravenous bolus are discussed.One hundred ninety-nine consecutive patients treated with high dose IL-2 alone from January 1, 1988 to December 31, 1992 were included in this study. All patients had a diagnosis of metastatic melanoma or metastatic renal cell carcinoma and were treated at the National Cancer Institute (Bethesda, MD).Anemia, requiring erythrocyte transfusions, occurred in 14% of all treatment courses, with a median of two units of erythrocytes transfused. Severe leukopenia (1,000 leukocytes/mm3) was rare (1.5% of all patients) and was not associated with any infectious complications. Severe thrombocytopenia (30,000 platelets/mm3) occurred in 2.2% of all treatment cycles, with two patients experiencing a grade 3 hemorrhage, defined as gross blood loss, and one patient experiencing a grade 4 hemorrhage, defined as a debilitating blood loss. Defects in the coagulation pathway were common: abnormal partial thromboplastin time and prothrombin time values occurred in 64% and 25% of the treatment cycles, respectively. In addition, a mean clearance of 93% of lymphocytes from the peripheral blood was observed within 24 hours after initiating IL-2 therapy. This was followed by rebound lymphocytosis to a mean of 198% of baseline on posttreatment Day 4. There were no treatment-related deaths.During IL-2 therapy, adverse sequelae of anemia, thrombocytopenia, coagulopathy, and leukopenia were usually mild, transient and rarely limited therapy. A profound decrease in lymphocytes in the peripheral circulation occurred within 24 hours after initiating therapy, with a rebound occurring after stopping IL-2. No specific hematologic parameter was associated significantly with a patient's increased probability of responding to therapy.

The clinical need to identify and evaluate changes of cutaneous lesions in melanoma screening or follow-up of patients with cancer is of paramount importance. Because skin-lesion changes may be small and numerous, clinical assessment alone does not meet the requirements of quantitative assessment. Using the computer as a diagnostic tool for the image analysis of sequentially captured skin surface images has resulted in the technical problem of insufficient registration reproducibility. This paper describes the technical logistics, setup procedure, and clinical evaluation of the novel technique termed "topodermatography," which performs the quantitative videographic image analysis of skin-lesion changes over time.Digitized measurements of skin-surface image parameters were performed using a high-speed processor with an onboard coprocessor, a high-resolution video camera, specifically designed image processing software, and a position framework for the adjustment of the patient's standing position. The topodermatographic image analysis was performed on 109 consecutive patients who were at risk for melanoma (N = 98), had lesions from Kaposi's sarcoma (N = 4), had metastatic skin deposits from melanoma (N = 3), and had breast cancer (N = 4).Skin lesion changes over time could be identified reliably within a few millimeters of diametric enlargement. In this series, a 0.51% early melanoma detection rate was assessed in 19 of 98 patients followed for 12 months. By monitoring manifest neoplastic skin lesions, tumor growth kinetics were analyzed quantitatively to determine the total area of skin involvement, thus facilitating precise response assessment.Topodermatographic image analysis helps to optimize screening and follow-up procedures for patients with melanoma and populations at risk for melanoma. In addition, metastatic tumor lesions on the skin can be monitored dynamically, facilitating the accurate evaluation of the impact of systemic therapy on multiple skin deposits from melanoma and nonmelanoma cancers.

The estimated 165,000 cancers of the male genital system that will occur in the United States during 1993 represent one fourth of the expected 600,000 newly diagnosed cancers in American males for the year.Data were collected by the Surveillance, Epidemiology, and End Results (SEER) program. This paper examines histologic data collected by the SEER program from 1973-1987 and focuses on incidence, stage at diagnosis, and survival for the dominant histologic types of cancer that occur in the four major topographic divisions of the male genital system: prostate gland, testis, penis, and scrotum. Some less common histologic types within each organ are also discussed.The incidence of male genital cancer has increased rapidly over the period of study. Cancers of the prostate, most of which are adenocarcinomas, represent more than 92% of all male genital cancers. Among adolescents and young men, germ cell cancers of the testis predominate, but decline rapidly in occurrence after 40 years of age. Blacks had higher incidence rates for prostate cancer than whites; however, the situation was reversed for testicular cancer. Survival increased dramatically for testicular cancer. Cancers of the penis and scrotum of any histologic type are uncommon in the United States.The increased incidence of prostate adenocarcinomas and testis germ cell tumors indicates the need for further etiologic studies as a basis for prevention efforts.

Racial/ethnic groups' participation in clinical trials is a relatively new area of research that warrants attention. Although racial/ethnic groups have been included in experimental studies since the 1940s, they were not included in significant numbers in clinical trials for cancer. Clinical trials play a dominant role in clinical oncology. Despite this state-of-the-art cancer treatment, however, there is mounting concern that this scientific progress is not being shared equitably by all segments of the U.S. population. There is underrepresentation of members of racial/ethnic groups in cancer clinical trials, which suggests that participation may be a critical issue. Unfortunately, little is known or documented about these groups' participation in clinical trials.This paper discusses racial/ethnic groups' views and opinions about clinical trial participation. Diagnostic research was conducted as a beginning phase to investigate this new area of research. African Americans, Hispanics, and Native Americans in three Buffalo, New York, communities were selected as study subjects. Data were collected via telephone surveys. Qualitative methods were employed for data analysis and reporting.Findings showed that study subjects knew little about cancer clinical trials and basically had no opportunity to participate. They believed that participation in clinical trials could be beneficial. In each of the three groups, however, there were cultural factors believed to influence participation. A primary concern was "mistrust of white people" and the feeling of being treated like "guinea pigs."Based on study findings, it was evident that recruitment for improving participation requires strategic planning that involves participants representative of the study population. To yield results, the plan should be tailored to the target group, presented as a credible study, designed to reflect trust in the medical care team, and implemented through a continuous educational process.

Without organized clinical trials, we are doomed to repeat our mistakes endlessly. There are many genuine conflicts of interest intrinsic to clinical research. Some of these arise from the necessity of admitting that we as physicians do not know the best way to treat every disease or each patient and that all treatments currently available for this patient's disease are suboptimal. With humility and honesty, these conflicts of interest can be overcome. Surmounting other more palpable ones, however, is equally challenging. Supporting the participation of our patients in clinical trials requires a practical reconfiguration of practice patterns, different and more record keeping, and the surrender of autonomy. Each of these facts has economic implications. Practitioners who are paid according to the specific services they provide risk both significant income loss and cost increase by participating in clinical trials. The Department of Veterans Affairs is a charter member of the cancer clinical trials establishment and the originator of a long string of important firsts in cancer research. The nature of the VA system eliminates or diminishes the impact of many of the conflicts of interest that hinder clinical trial participation. This globally budgeted comprehensive system, which theoretically is responsible for the care of more citizens than is the entire Canadian national health service, is an unique clinical research resource. Some of the high points of the VA contributions to cancer treatment development are listed in this paper. Hopefully, this overview makes the point that the VA clinical research enterprise is a treasure that can ask critical questions that, because of irresolvable economic conflicts of interest, can be asked neither in the fee-for-service nor the prepaid health maintenance settings. This clinical cancer research resource must be nurtured and supported, and it must continue to address critical questions that it alone can answer.

During the course of cancer treatment and as the disease progresses, symptoms may worsen and physical status may deteriorate. The interaction of age, symptoms, and nearness to death on the physical and mental health of patients and family members has not been examined. The research questions in this paper focus on how age and survival status influence the frequency and severity of patients' symptoms and dependencies in functioning. The impact of patient age and survival status on family depression, schedule, and health also are explored.Cancer patients in treatment and their caregiver dyads (n = 208) were followed for 12 months. Survival status was measured by those who survived the year, those who died within 6 months, and those who died between 6 and 12 months. Measures used included frequency and severity counts of patient symptoms, functioning (activities of daily living [ADL] and immobility), depression, frequency of others' assistance to caregivers, and caregiver reactions to care. Analysis of variance was applied to test for significant differences according to age and survival status.Symptoms did vary significantly by survival status; however, age demonstrated no independent effect on patient variables including: symptom severity, patient depression, and ADL or immobility. When controlling for symptom severity and age, survival group had no effect on ADL status. For immobility, survival status continued to have a direct impact. Survival status does not influence dependencies in ADL but is related directly to losses in mobility. Significant differences occurred by survival groups for caregiver depression, caregiver reactions, and patient assistance.Strategies for assisting patients and families to deal with immobility are important. Family members require assistance for their distress as patient status deteriorates.

In 1990, the five leading causes of cancer death in men aged 65 and older were carcinomas of the lung, prostate, colon and rectum, and pancreas, and leukemia. For women in this age group, the five leading causes of cancer death were carcinomas of the lung, breast, colon and rectum, pancreas, and ovary. To determine the representation of the elderly in clinical trials, the 1992 accrual of the National Cancer Institute (NCI)-sponsored Clinical Cooperative Group treatment trials (which included more than 8000 elderly patients) for the aforementioned sites was compared with the 1990 incidence data from the NCI's Surveillance, Epidemiology, and End Results program. Of the male patients enrolled in the trials, an average of 39% were older than 65 (47.3% lung, 79.5% prostate, 47.5% colorectal, 45.6% pancreas, and 9.6% leukemia); whereas 25.9% of all women enrolled in trials were 65 or older (43.6% lung, 17.3% breast, 46.2% colorectal, 59.6% pancreas, and 35.4% ovary). With respect to incidence, older patients generally are underrepresented in cancer treatment trials. With the exception of the data on prostate cancer, each of the comparisons using the Z statistic gave probability values of less than 0.01. The most significant discrepancies between incidence and participation in cancer treatment protocols were noted for leukemia in males and breast cancer in females. Possible explanations for these findings include (1) a research focus on aggressive therapy, which may be unacceptably toxic to the elderly; (2) presence of comorbidity in the elderly; (3) fewer trials available specifically aimed at older patients; (4) limited expectations for long term benefits on the part of physicians, relatives, and the patients themselves; and (5) a lack of financial, logistic, and social support for the participation of elderly patients in clinical trials. Recognizing this situation, NCI recently sponsored a number of trials that specifically target the elderly. This paper describes the status of all major Phase II and III clinical trials that recently were closed, still are active, or now are in review that address the clinical care of this important segment of the U.S. population.

If health professionals wish to help increase the number of older adults who get screened regularly to detect cancer at an early stage, they must first understand the barriers to screening that older people experience. This paper discusses the barriers older women face regarding mammography screening. Data from American Association of Retired Persons research are presented, and strategies being implemented across the country are discussed. Barriers that older men face in terms of screening for prostate cancer and preventive health in general are also addressed. Finally, specific recommendations for health providers to use to educate seniors are offered.

A 24-year-old male patient seropositive for the human immunodeficiency virus with Burkitt's Leukemia was treated successfully with aggressive systemic chemotherapy and central nervous system prophylaxis. He presented with a leukocyte count of 68,900/microliter with 33% L3 lymphoblasts, massive hepatosplenomegaly, generalized lymphadenopathy, a lactic dehydrogenase level of 9105 IU/l, creatinine level of 5.8 mg/dl, and a uric acid level of 43.5 mg/dl. Hemodialysis, intrathecal methotrexate, hydrocortisone and cytosine arabinoside, and fractionated doses of cyclophosphamide followed by vincristine and doxorubicin were promptly instituted. He received eight subsequent courses of chemotherapy consisting of either methotrexate with leucovorin rescue and high dose, continuous infusion cytosine arabinoside or cyclophosphamide, vincristine, and methotrexate with leucovorin. There was marked hematologic toxicity resulting from this treatment. However, the patient was alive and in complete remission more than 6 years from diagnosis. This paper demonstrated that it is possible to successfully treat a patient who is HIV-1 antibody positive with poor prognosis Burkitt's Leukemia. Further studies need to be undertaken to define the least toxic, most effective therapy for this disease.

The most frequently encountered doxorubicin related cardiac toxicity is a dose-related myocardial dysfunction occurring 1-6 months after chemotherapy. Recently, late cardiotoxicity has been the focus of interest. This paper explores the possibility that acute intercurrent viral illness may trigger late cardiotoxicity.Thirty selected pediatric patients were followed for changes in their echocardiographically measured fractional shortening (FS) for 2-10 years after completion of their doxorubicin chemotherapy. They were divided according to the dose of doxorubicin they received (300 mg/m2 oror = 300 mg/m2) and to whether the manifestations of an acute intercurrent viral illness during the observation period were documented. Eleven patients experienced such infections.Changes in FS demonstrated two different responses. The usual response to doxorubicin was a gradual, dose-related fall in FS, followed by recovery; while the second response included an unexpected, late, sudden decrease in FS. Four patients in the low dose subgroup experienced an acute intercurrent viral illness, but none of these demonstrated the unexpected decrease. Of the seven patients who acquired such illness in the high dose subgroup, five demonstrated the sudden, late decrease in FS, with two of them developing severe, reversible congestive heart failure.The most likely explanation for the late, sudden decrease in FS is an additional stress in patients who already have sustained subclinical cardiac damage as a result of their doxorubicin chemotherapy. An acute intercurrent viral illness may have triggered late cardiac dysfunction in some of these patients.

Background. Occupational exposures and physical activity have been considered as risk factors for the development of colorectal cancer. Methods. A case-control study on working conditions and the risk of colon and rectal cancer was performed in southeastern Sweden during 1984–86. Involved were 177 patients, 98 with colon cancer and 79 with rectal cancer, and two groups of control subjects, 371 hospital control subjects and 430 population control subjects. Results. A significantly decreased risk of left-sided colon cancer was observed in persons involved in more than 20 years of physically active work and a significantly decreased risk of rectal cancer in persons involved in more than 20 years of sedentary work. A tendency toward increased risk was seen for colon cancer in male railroad workers and in male gas station workers. A reduced risk of rectal cancer was found for drivers, textile workers, and administration workers, whereas an increased risk of rectal cancer appeared among paper workers and assistant nurses. A low risk of both colon and rectal cancer was found among construction workers and forestry workers. Exposure to asbestos carried a slightly increased risk of colon cancer, whereas exposure to solvents slightly decreased the risk of rectal cancer. Conclusion. This study confirms earlier findings that physical activity decreases the risk for left-sided colon cancer, but also suggests that occupational factors influence the risk of colon and rectal cancer in different ways.

Advanced adenocarcinoma of the prostate after hormonal manipulation has been noted to be a relatively chemotherapeutic nonresponsive tumor. Earlier reviews have reported objective responses, that is, complete and partial remissions in 6.5% of 3184 patients, and the current review examines the efficacy of new agents.The current review consists of 26 new drug trials culled from papers and abstracts published between 1987-1991.Results of these 26 drug trials found a similar trend, 8.7% (95% confidence interval, 6.4-9.0%), indicating that hormone-resistant adenocarcinoma of the prostate still fails to respond to most cytotoxic agents. The most interesting of the new therapeutic agents is the combination of vinblastine plus estramustine. Only six agents had an objective response rate greater than 10%, such as vinblastine by continuous infusion, trimetrexate, mitoguazone, and estramustine. The recent introduction of radioactive-labeled monoclonal antibodies is intriguing and these will undoubtably be used as carriers for radiotherapeutic and cytotoxic compounds.Although multidrug resistance may explain the marginal efficacy of cytotoxic drugs, methods to overcome such resistance and, more importantly, new classes of agents must be developed. In addition, reliable disease markers must be found for osseous and visceral metastases to avoid the prevailing confusion in evaluating more precisely the destruction of prostate cancer cells.

Very often not enough patients are entered and/or the follow-up is insufficient to be able to draw valid conclusions in cancer clinical trials. In this article, we discuss the possibility of pooling the data from two or more trials asking the same or similar questions in order to overcome such problems. How comparable the studies should be for combining their data, in terms of design, patient population, follow-up, and end-points, is discussed in the first part of this paper. Whether these general considerations were completely or partially fulfilled in the two prostatic studies of the EORTC and DAPROCA is the subject of the second part of this article. Problems of interpreting apparently contradictory results, like the superiority of zoladex and flutamide over orchidectomy in terms of time to progression with no clear superiority in terms of overall duration of survival, is also discussed.

Effective assessment of treatment outcome and the development of successful rehabilitation for head and neck cancer patients demand an evaluation of the relevant parameters of functional status. This paper reports the development and testing of a new Performance Status Scale for Head and Neck Cancer Patients designed to assess the unique areas of dysfunction experienced by this population. The instrument is a simple, practical, clinician-rated assessment tool consisting of three subscales: (1) Understandability of Speech, (2) Normalcy of Diet, and (3) Eating in Public. The scale was administered to a group of 181 head and neck patients and a comparison group of 30 breast cancer patients. Results indicate that the scale is reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer.

This paper reports a case of carcinoma of the prostate in an 11-year-old boy. The clinical findings were characterized by a mass in the prostatic region, extensive osteoblastic bone metastasis, and normal serum acid phosphatase. Autopsy demonstrated an undifferentiated tumor, which probably originated from the outer gland of the prostate. Metastases to the bones, liver, lungs, and the lymph nodes were present. Light and electron microscopic studies revealed undifferentiated neoplastic cell, which is in contrast to the usual adenocarcinoma in older individuals. Histochemical examination failed to demonstrate acid phosphatase activity within the tumor cells. The authors considered that this tumor probably originated from immature basal cells of the prostatic gland. Review of the literature disclosed 15 cases of carcinoma of the prostate in individuals under 21 years of age. These cases were also characterized by an undifferentiated appearance of tumor cells and normal serum acid phosphatase level.

In this paper, an attempt has been made to provide an overview of the major issues facing cancer researchers who are interested in the conceptualization and measurement of social support. Taken as a whole, the literature reflects a growing appreciation for the complexity of the social-support construct, and a need for greater conceptual and research specificity. The following issues were discussed: (1) the importance of measuring support in a way that will permit assessment of distinct types of support (e.g., emotional support, advice) by distinct providers (e.g., spouse, physician) since available evidence suggests that the impact of support is strongly affected by these factors; (2) the importance of using a multimethod approach to support measurement which includes both structural aspects and subjective assessments of the adequacy of the support network; and the problems inherent in assuming that structural variables alone are an indication of the adequacy of support; (3) the importance of considering negative as well as positive support, since there is evidence suggesting that such behaviors may be very prevalent in the interactions between cancer patients and those in their support network that they may have strong influence on subsequent health outcomes; (4) the need to consider the perspective of the provider as well as the recipient in obtaining judgments of the effectiveness of particular kinds of support, given the evidence that providers sometimes make attempts to be supportive that are regarded as unhelpful; (5) the importance of focusing on actual utilization as well as availability of the support network, since an understanding of how people mobilize their support networks has important theoretical and practical implications; and, finally, (6) the importance of studying more explicit, specific behaviors that occur between cancer patients and those in their support network, as well as more general judgments regarding whether support is adequate. Investigators in the social support area agree that it is time to move beyond demonstrations of a relationship between support and health outcomes to a more careful explication of the processes underlying support. This review highlights the importance of designing research that will shed light on the precise mechanisms through which support influences health outcomes. Hopefully, such research will clarify how social support interacts with other important psychosocial variables such as coping strategies and self-esteem.(ABSTRACT TRUNCATED AT 400 WORDS)

A rare incidence of a primary gonadotropin-producing bladder carcinoma in which gynecomastia appeared in the terminal stage was encountered in a 76-year-old Japanese male. There was a good probability that the symptoms of hormonal activity were due to chorionic gonadotropin (hCG), since its whole molecule, beta- and alpha-subunits were detected by radioimmunoassay in the blood, urine, and the tissue from the malignant neoplasm, and the plasma and urine estrogens were elevated. Recent papers concerning the synthesis of hCG-like material by neoplastic cells are reviewed and the implication of the measurement of beta- and alpha-subunits of hCG in various neoplastic diseases are discussed. Other characteristic profiles of plasma hormonal levels are also discussed in this case.

This paper reports on a case of intestinal leiomyosarcoma with metastases to the liver, peritoneum, and omentum, which has been successfully treated with four operations. The initial operation was performed for a primary intestinal leiomyosarcoma and intraperitoneal seeding. Three months later "shelling out" of a liver metastasis was carried out. The patient has subsequently been operated upon twice for abdominal recurrence at six years and nine months, and nine years and six months, respectively. The patient is free from symptoms and is working now, ten years after resection of metastasic leiomyosarcoma of the liver. A review of the literatures has revealed that our patient is the first ten-year survivor after resection of hepatic metastasis of leiomyosarcoma. An aggressive surgery is acceptable in selected patients who have spreading leiomyosarcoma of the bowel.

In 1977 a retrospective study was started into the cancer incidence in the Netherlands Antilles, simultaneously with the onset of a cancer registry. This paper presents the results of this study and of the running registry, together covering a period of 12 years. In total, 1496 cancer cases were registered in males, and 1480 in females. The resulting age-standardized cancer rate (World Standard Population) was 215 cases per 100,000 males and 164 cases per 100,000 females. The most frequently involved primary sites in males were, in order of frequency, lung, stomach, prostate, skin, and esophagus. Cancer in females was most frequently found in breast, uterine cervix, skin, stomach and esophagus. A comparison is made with countries inside and outside the Caribbean region, and a short comment is made on possibly etiologic factors.

There are no absolute criteria for determining the effect of early detection on cancer mortality, and evidence from many sources must be examined. The best evidence is provided by randomized controlled trials that use mortality as an endpoint (RCTMs), but this type of evidence is available for only two cancers, i.e., of the breast and colon. The decision to recommend a test for a particular person must take into account the strength of the evidence that early detection reduces mortality, the expected amount of the reduction, the chance the person will ever get the cancer, and the anticipated costs and risks. This paper describes the evidence that early detection of various cancers reduces mortality, and estimates the expected reduction in mortality to be achieved by various tests. Three specific examples are discussed: breast self-examination, mammography in women younger than age 50 years, and chest x-rays for male smokers over age 40.

Features of intestinal differentiation, including the presence of brush borders, have been described previously in a pulmonary blastoma following xenotransplantation in athymic nude mice. This paper reports similar findings in a pulmonary blastoma subjected directly to electron microscopic study. Ultrastructural manifestations of intestinal differentiation in other types of primary lung tumors are also discussed.

The study reported here examines the survival experience up to 84 months of patients from the five major racial groups in Hawaii diagnosed with colorectal cancer during the years between 1960 and 1974 based on data in the Hawaii Tumor Registry. Previous research in Hawaii showed that racial differences in survival existed even after adjusting for sex, age at diagnosis, stage of the disease at diagnosis, and normal life expectancy. In this paper, socioeconomic status differences between racial groups are hypothesized as a possible explanation for these survival differences. The results show that socioeconomic status did account for some survival differences between racial groups beyond what could be explained by the other variables. After adjusting for all the covariates, the only statistically significant racial differences which remained were higher survival rates for the Japanese patients compared with the rates for the Hawaiian and Filipino patients. Socioeconomic status was not found, however, to have a statistically significant effect on survival independent of race or the other variables examined. Reasons for the modest effects of socioeconomic status in this study are discussed.

Carcinoma of the oropharyngeal region is one of the most common malignant lesions seen in western India, comprising about 47% of all cases seen at the Gujarat Cancer and Research Institute. Of these, carcinoma of the tongue has the maximum incidence. In India the ratio between carcinoma of the anterior and posterior tongue is 33:66, the reverse of that published in Europe and America. The highest incidence of carcinoma of the anterior tongue appears in males 50 to 60 years of age; only 11 cases have been reported in patients under 20 years of age. From 1969 to 1974, 218 cases of carcinoma of the anterior tongue was seen at the M.P. Shah Hospital. This paper reports five cases of carcinoma of the anterior tongue found in patients under 20 years of age. Although the anterior tongue is a visible and approachable site, all five lesions were too advanced to cure. There did not seem to be any contributory factor to produce this malignant lesion at such a young age. The patients were all male, the youngest 11 years old. Two cases were treated with surgery; one also received postoperative radiotherapy. The remaining three cases were treated with palliative radiotherapy and chemotherapy. The pathology and the current view of management are discussed.

This paper describes preliminary radiotherapy results in 90 patients with Stage I and II Hodgkin's disease who were evaluated by laparotomy, including splenectomy, and liver and bone marrow biopsies. As a result of selection by laparotomy, the estimated five-year survival rate for these patients was 96%. No statistically significant differences were detected in the disease-free survival for patients with mixed cellularity, nodular sclerosis, and lymphocytic predominance disease. Since only one patient with lymphocytic depletion was in this series, no statement can be made regarding this rare histopathology. Patterns of new disease differed for Stage I and II patients. The major difference was that patients with nodular sclerosing Stage II presentations involving the mediastinum were at considerable risk of developing subsequent disease in the pulmonary parenchyma or the pleura. This finding, together with the demonstration that a histologic diagnosis of mixed cellularity did not carry an inferior prognosis, indicates the need for reassessment of the appropriateness of applying treatment programs based on results of lymphangiographically staged patients to Stage I and II patients evaluated by laparotomy.

As a result of many studies in descriptive and analytic epidemiology, in animal carcinogenesis, and in the direct examination of body fluids for mutagens/carcinogens, it is possible to develop a list of dietary factors that may be associated with the high rate of colon cancer and related cancers in Western countries. This paper is concerned with the design of intervention studies to clarify which of these factors is important. The size of such intervention trials is influenced primarily by two factors: the incidence of the disease outcome studied in a control population and the magnitude of risk reduction in a treated group. Calculations based on a variety of assumptions suggest that a randomized trial in which cancer mortality is measured as the outcome of the intervention in a healthy population is probably too costly to be justified by current evidence linking the disease to diet. However, precursor lesions can be considered as an alternative outcome. The choice of the precursor lesion depends on the link to the disease in question, the prevalence of the lesion in the population, and the ease of detection. Recent developments in the application of endoscopic methods and in the description of the pathologic process leading to cancer suggest the use of gastrointestinal polyps as "precursor lesions" as the outcome of a trial. We illustrate these points with a protocol for a study in progress, a randomized double-blind study of the effect of ascorbic acid and alpha-Tocopherol on the rate of recurrence of colorectal polyps.

Clinical photographs of 79 prospectively studied cases of non-familial cutaneous malignant melanoma were reviewed; special attention was directed to the distribution pattern of coexistent melanocytic lesions. A group of 15 patients had moles on the covered buttock area. Seven of these patients had large clinically atypical nevi, and biopsies of these nevi showed severe melanocytic dysplasia. Residual elements of melanocytic dysplasia were identified in five of the primary melanomas in this group of patients. It is suggested that these patients represent a distinctive syndrome, the Dysplastic Nevus Syndrome (DNS) and that they are at increased risk for development of primary cutaneous malignant melanoma. The clinically and histologically distinctive dysplastic nevi of these patients are identical to the precursor lesion for melanoma that we have previously described in a familial context, the B-K mole syndrome. This paper represents the first description of this form of dysplasia in non-familial melanoma.

Two infants, a sister with motor retardation and brother with slight microcephaly and an undescended testis, died of hepatoblastoma. Only another documented familial occurrence of this tumor, affecting siblings of the same sex, can be found in the literature. The two patients described in this paper exhibited high platelet counts prior to liver resection. Although iron deficiency may have contributed to the thrombocytosis, the finding of many megakariocytes within the hepatoblastomas suggests an intra-tumoral production of platelets. An epidemiological investigation of the family under study failed to yield conclusive data. Hepatoblastoma is a rare tumor, but it may affect more than one sibling. Therefore, periodic clinical and laboratory evaluations of the siblings at risk appear to be justified.

This paper reports the preliminary results of a controlled study randomizing MOPP vs. a new four-drug combination (ABVD) in advanced Hodgkin's disease. ABVD consists of 6 cycles of adriamycin, bleomycin, vinblastine, and imidazole carboxamide. The purpose for designing this new combination was two-fold: to compare the efficacy of ABVD with MOPP, and to demonstrate absence of cross-resistance between the two regimens. Of 60 patients entered into the study, 45 (MOPP25, ABVD20) are presently evaluable for the analysis of remission induction. No patient was previously treated with chemotherapy; 20% had relapsed after primary radiotherapy. Whenever possible, complete remission was defined also through rebiopsy of known organ involvement. Complete remission occurred in 76% of patients treated with MOPP and in 75% of those given ABVD, with no difference between the two regimens as far as stage (IIIB-IIIS and IV), histologic type, and prior irradiation were concerned. Crossover carried out for progressive disease or for relapse after initial remission showed absence of cross-resistance between MOPP and ABVD. Toxic manifestations after ABVD were in general well tolerated and reversible. The percent of optimal dose for each drug was as follows: adriamycin 87%, vinblastine 87%, bleomycin 96%, and imidazole carboxamide 96%. These preliminary results indicate that in terms of complete remission, ABVD could represent a successful alternative to MOPP to be used either in MOPP failures or in sequential combination with MOPP. However, the lack of long-term followup limits at the present time an adequate comparison between the two treatments.

This paper reports the association of acute pancreatitis coincident with cytosine arabinoside (Ara-c) therapy in a single patient on at least two occasions. The patient had previously received L-asparaginase, but the last dose had been given 4 months prior to the onset of pancreatitis. A literature review provided two more cases of pancreatitis associated with Ara-c therapy in patients previously treated with L-asparaginase. In view of th extreme rarity of pancreatitis in patients receiving Ara-c, the possibility arises that prior treatment with L-asparaginase may predispose the pancreas to this complication.

From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people's Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow-up varied from 10 years and 1 month to 26 years and 7 months, with a mean follow-up of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 X 8 X 6 cm in size and underwent local resection. Upon follow-up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha-fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long-term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.