The clinical and histopathologic characteristics of gastric carcinoma in young patients (less than 40 years old) were studied retrospectively. The carcinoma was of the diffuse type in 94% of the young patients, and typical features were poor prognosis, an equal sex ratio, and a strong association with blood group A. The family histories of the young patients were studied. There was a highly significant (p less than 0.001) overrepresentation of gastric cancer in the parents of the index cases. In four instances (13%) the findings were compatible with hereditary cancer. One of the patients belonged to a cancer family syndrome (CFS) kindred. The CFS is an autosomal, dominantly inherited trait for adenocarcinomas is well documented. It seems, on the basis of the present study, that CFS should also be added to the list of genetic risk factors for gastric carcinoma. The high incidence of familial cases indicates the importance of studying the family history of every patient with abdominal symptoms.

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Summary We determined the concentrations of immunoreactive epidermal growth factor in the urine (U-irEGF) of 97 adult patients with various malignancies, including carcinomas of the urinary bladder, kidney, stomach, colon, rectum, breast, endometrium, uterine cervix, ovary, vagina, prostate, pancreas and thyroid, liposarcoma and skin melanoma. The relative U-irEGF concentrations (ng m-1 creatinine) were higher (P=0.002) for the whole series of female patients than for healthy controls matched for sex and age. Such difference did not appear for male patients. The only specific group with a statistically supranormal U-irEGF concentration (P=0.0005) comprised women with endometrial carcinoma of the uterus.Epidermal growth factor (EGF) appears to be involved in the regulation of proliferation, differentiation and differentiated functions of a multitude of cell types (Gospodarowicz, 1981;Carpenter & Zendegui, 1986). In certain normal cells in vitro EGF elicits transformation-associated responses (Stoscheck et al., 1986). There is also a considerable body of evidence associating EGF receptor with oncogenesis. The EGF receptor is the product of the c-erbB proto-oncogene, which is closely related to the v-erb B (Downward et al., 1984). The receptor is present in enormous numbers on the cells of many human epidermoid and glial malignancies (Lin et al., 1984;Merlino et al., 1984;Libermann et al., 1984). Many malignant cells produce another EGF receptor agonist, transforming growth factor alpha (TGF-a) Roberts et al., 1980). TGF-cx is excreted in urine by patients with various malignancies (Sherwin et al., 1983), but not by healthy subjects (Twardzik et al., 1985). Uchihashi et al. (1983) and Kurobe et al. (1985) found urinary excretion of EGF to be higher in patients with cancer than in healthy persons. This has not been generally accepted. We have now measured urinary immunoreactive EGF (U-irEGF) levels in patients with a variety of malignancies before and after tumour removal. Materials and methodsSubjects and samples Spot urine samples were collected from 97 patients (49 men and 48 women, aged 28-88 years) with various malignancies before surgical removal (or any other treatment) of the tumour. In addition to those shown in Figure 1, six patients had carcinomas, I of the vagina, 2 of the pancreas, and 3 of the thyroid, and 1 patient had liposarcoma and 1 skin melanoma. The malignancies included both metastasized and in situ tumours. We also measured U-irEGF concentration in 24 patients daily during the first week after removal of the tumour, and in a further 7 patients on the sixth postoperative day. For comparison, urine samples were collected from age-and sex-matched healthy subjects (56 men and 62 women, aged 28-86 years).Assay procedures Human EGF, used both as standard and labelled tracer, and a rabbit antiserum against it (8C-217,3129) were donated by AMGen (Thousand Oaks, California). U-irEGF was measured by a specific homologous radioimmunoassay (Mattila et al., 1985) and creatinine by the kinetic method of Ja...