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Serum concentrations were determined serially in two groups of patients with colorectal carcinoma: in 123 after curative resection and in 34 with residual cancer. Of the first group, in 98 serum CEA fluctuated within the normal range or with a 2-fold larger amplitude evidencing effective surgery because only 9 had recurrence; in 25 serum CEA rose persistently from a postoperative nadir indicating relapse, mostly liver metastases. Of the 34 patients with relapse, 3 had clinically and 7 CEA-directed second-look laparotomy; although 7 had operation with curative intent, only 3 remained disease-free. In the second group, there were 26 patients after palliative surgery and 8 during nonsurgical treatment. Serum CEA fluctuated within the normal range in 2 patients in remission and in 3 with progressive cancer, and rose in parallel to cancer progression in 29. Thus, serum CEA within or slightly above the normal range was 88% predictive that the patient might be free of disease or in remission; whereas elevated or rising level indicated disease progression. Accordance between serum CEA and clinical status occurred in 145 of 157 (92%) patients.

Serum levels of AFP, hCG and CEA were initially and serially measured in 59 patients with testicular germ cell tumors, and serially in 37 with ovarian and 3 with extragonadal germ cell tumors. Patients with seminoma/dysgerminoma or mature teratoma had normal serum AFP and sporadically slightly elevated hCG. Some patients with embryonal carcinoma, pure or with admixture of seminoma, had serum AFP elevated to maximum 100 U/ml, yet its use for monitoring therapy was limited. Patients with yolk sac tumors had elevated AFP and sometimes CEA levels, those with choriocarcinoma had elevated hCG, and those with compound tumors had one or more of the markers highly elevated. High AFP and/or hCG levels indicated the presence of the relevant tumor cells both in the primary and in residual tumor and/or metastases, also those missed in histological material, and thus were useful in restaging. Unfortunately, their absence in serum did not exclude the presence of marker-negative subpopulations of tumor cells. Changes in marker values paralleled the effects of treatment: the level increasing from any nadir heralded recurrence in patients in remission; elevated or increasing levels during therapy implied resistance to the therapy; decreasing levels indicated regression even though a return to the normal range did not mean eradication of all tumor cells.

Pretreatment serum concentrations of breast Carcinoma antigen (CA 15.3) and mucin-like carcinoma-associated antigen (MCA) were determined in 129 patients with breast Carcinoma. Concentrations of both markers were within the normal ränge in patients with Stage I disease. Concentrations of CA 15.3 were elevated (> 40 U/ml) in 3, 11 and 48%, those of MCA(> 17 U/ml) in 11, 18 and 52%, and those of one or the other marker in 11,18 and 58% of the patients with Stage II, III and IV disease, respectively. The elevation of either marker roughly paralleled the size of the tumor being normal in the patients with localized Cancer, slightly elevated in a small proportion of the patients with locoregional Cancer, and moderately to markedly elevated in half of the patients with distant metastases. Correlation between serum concentrations of CA 15.3 and MCA was highly significant (p < 0.0001). It is concluded that the markers were equally sensitive and that an elevated serum level was a useful adjunct for Staging, implying systemic disease.

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