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Repeated determinations of serum CEA levels in untreated advanced gastrointestinal cancer patients with initially elevated values showed day to day variations of ±35%. If there was no intervening chemotherapy, all such patients who were followed over long term showed progressively increasing CEA levels. With chemotherapy there was a general correlation between changes in serum CEA levels and clinically measured changes in tumor mass. Among patients who showed objective improvement, 75% had reduction in serum CEA levels (> 35%) and 87% had either reduced or unchanged levels. Among those who showed objective progression, 65% had increases in serum CEA levels (> 35%) and 80% had either increased or unchanged levels. Paradoxical reductions in CEA levels were observed in some patients approaching terminal status. Among 80 patients being followed with serial CEA determinations after potentially curative resections of large bowel cancer and normal postoperative CEA levels, 6 have again showed clinical evidence of malignant disease and in 5 of these there was concurrent elevation of serum CEA. Serial serum CEA determinations appear to have some value for following the course of gastrointestinal cancer patients after surgery or chemotherapy, but these determinations must be interpreted in the context of the over-all clinical picture.

43 patients with gastrointestinal carcinoma were treated with a sequential combination of BCNU and 5-FU. There were no responses among 25 patients previously exposed to chemotherapeutic agents, includ

E OSINOPHILS are frequentIy observed in varying numbers in and about neopIastic tissue. Many patients with carcinoma involving a viscus show some degree of increase in eosinophiIic leukocytes in the periphera1 blood. This study and review of the Iiterature constitutes an evaiuation of the significance and importance of these findings. In reviewing the Iiterature, many authors have reported either eosinophilia of the peripheraI bIood associated with mahgnancy [3,4,7,12, 13,15,17,19,22-26,29,31,33,35,3&4o-42,441 or eosinophilic infiItration of the tumor tissue [2,9II,I9,2o(a),2o(b),2r,25,27,28,3o,?2,?6,?71. better prognosis than those without eosinophiIic infltration. ImmediateIy after this Schoch [36,37], PavIovsky and Widakowich [27], FIuhmann [IO], and Goforth and Snoke [I I] emphasized this same point. Nothing more was written about these points unti1 Fischer [9] in 1932 stated that eosinophiIic infiItration in tumor tissue is usuaIIy associated with a poor prognosis. In 1956 Podhragyai [30] studied I ,087 cases of carcinoma of the skin and seventy intestina1, breast and uterine carcinomas and concIuded that there is no reIation between prognosis and the degree of eosinophiIic infihration in tumor or eosinophi1 percentage in bIood.

AN interaction between lymphocytes and cancer cells is an essential component in the defense against the growth of neoplastic cells in the human body.1 2 3 4 5 6 The ability of the lymphocyte to ad...

While it is impossible to produce palliation in an asymptomatic patient, a patient in reasonable general physical condition with specific symptoms related to metastatic or recurrent gastrointestinal carcinoma deserves vigorous attempts at control. A clear idea of what symptoms need palliation is essential to plantherapy intelligently; simple measures may suffice and allow postponement of more vigorous palliative measures.

In order that patients with gastrointestinal carcinoma achieve a maximum survival rate, it is necessary to adopt a prudent attitude of optimism, not only toward those with early lesions but also those who appear to have advanced disease. Eight cases are reviewed in which the patients, following radical surgery, are enjoying long periods of survival, even though the initial clinical picture seemed hopeless.

This report describes 2 patients with Peutz-Jeghers syndrome, a father and his son, who were shown on barium enema examination to have unsuspected colon carcinoma.Individuals with PJS appear to have a greater tendency to develop gastrointestinal carcinoma than individuals in the general population. The malignant lesions are located predominantly in the colon, stomach and duodenum.The radiologist plays an important role in evaluating patients with PJS and needs to be alert to the possible presence of gastrointestinal malignancy.

Two patients had sebaceous adenomas of the skin associated with adenocarcinoma of the gastrointestinal tract. Histopathologic and histochemical staining demonstrated the sebaceous gland origin. Review of eight similar cases from the literature suggests that multiple sebaceous gland adenomas may be a sign of visceral carcinoma.

Excerpt The occurrence of spontaneous hypoglycemia in association with large non-pancreatic tumors has been described in the medical literature by several investigators (1, 2). This type of hypogly...

The clinician who treats gastrointestinal neoplasms has had a long frustrating flirtation with the chemotherapy doxy. This book memorializes the encounters and encompasses the treatment regimens and the clinical investigations of cancer chemotherapy at the Mayo Clinic in more than 1,300 patients.In the first part the clinical management of advanced gastrointestinal cancer is discussed in 69 pages; the second somewhat longer part reviews the experience of the Mayo Clinic in the chemotherapy of advanced gastrointestinal cancer. The first section is short but good, and the best chapters are written by Dr. Moertel himself, that on symptomatic and supportive management, for example, being particularly wholesome. Other aspects of cancer care are much less thoroughly covered. The place of chemotherapy is well summarized:It is doubtful also that today's chemotherapeutic approaches to gastrointestinal carcinoma have any place in the routine practice of clinical medicine.... [but]... the patient may be

The patient who harbors a gastrointestinal carcinoma is doomed unless the growth is removed by a surgical operation. The contraindications for the removal of such a primary growth are decreasing. The primary lesion is being removed with increasing frequency because of a constantly decreasing primary mortality. Two questions must be answered: 1. What is responsible for the decrease in the primary mortality? 2. Should one remove the primary malignant lesion if it is impossible to eradicate all gross evidence of the disease, such as metastases in the liver or in the regional lymph glands? The lowering of the primary operative mortality of gastrointestinal carcinoma is not due solely to an extensive surgical experience coupled with a perfection of surgical technical procedures. Superb technical skill avails little if the patient's condition is such that he cannot tolerate without disaster the necessary operative procedure. The surgeon must pay tribute and acknowledge his

THE STUDY of cancer including its diagnosis and treatment appears to be reaching its most intensive phase currently. Familial and hereditary predispositions, environmental influences of many kinds, racial tendencies, and other factors are all under profound scrutiny now in the battle against cancer. Of great interest and possibly of more than mere statistical value are the cases of multiple malignant lesions occurring in the same person. It is well known to the oncologist that, in general, those patients having developed one malignant lesion will have an increased tendency to subsequent affliction by additional primary cancers. 6 However, a breakdown of these large series of cases presenting multiple tumors, as has recently been reported by Mider and his associates, 1 reveals that this so-called increased cancer susceptibility is probably limited to only a few sites, for example, colon and female breast. Even in the groups of colon and breast cancer patients