Background: Effective screening for colorectal cancer can reduce mortality by early detection of tumours and colonic polyps. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a potential non-invasive diagnostic tool for detection of cancer. The aim of this study was to evaluate the reliability of breath-testing for colorectal cancer screening and early diagnosis using an advanced breath sampler. Methods: The exhaled breath of patients with colorectal cancer and non-cancer controls with negative findings on colonoscopy was collected using the ReCIVA ® Breath Sampler. This portable device is able to capture the alveolar breath fraction without environmental contamination. VOCs were desorbed thermally and analysed by gas chromatography-mass spectrometry. The discriminatory ability of VOCs in detecting colorectal cancer was evaluated by receiver operating characteristic (ROC) curve analysis for each VOC, followed by cross-validation by the leave-one-out method, and by applying stepwise logistic regression analysis. Results: The study included 83 patients with colorectal cancer and 90 non-cancer controls. Fourteen VOCs were found to have significant discriminatory ability in detecting patients with colorectal cancer. The model with the diagnosis of cancer versus no cancer resulted in a statistically significant likelihood of discrimination of 173⋅45 (P < 0⋅001), with an area under the ROC curve of 0⋅979. Cross-validation of the model resulted in a true predictive value for colorectal cancer of 93 per cent overall. Reliability of the breath analysis was maintained irrespective of cancer stage. Conclusion: This study demonstrated that analysis of exhaled VOCs can discriminate patients with colorectal cancer from those without. This finding may eventually lead to the creation of a smart online sensory device, capable of providing a binary answer (cancer/no cancer) and directing to further screening.
The gastrointestinal cancer-associated antigen (GICA) is recognised by a monoclonal antibody in both serum and tissues of patients with neoplasm of the GI tract. This study compared the serum and saliva values of carcinoembryonic antigen (CEA) and GICA in 19 healthy subjects, 43 patients with benign oral cavity lesions and 26 with histologically confirmed squamous-cell carcinomas. Serum CEA levels were much the same in all three groups, whereas salivary values were significantly higher (p less than 0.001) in both patient groups than in the controls. Serum GICA gave the opposite result: lower in carcinoma than in controls (p less than 0.001) and benign lesions (N.S.), while salivary GICA was significantly lower in carcinoma than in both the other two groups (p less than 0.001). The meaning of this difference between the values for the two antigens is discussed.
The favorable results obtained by other authors with polichemotherapy encouraged us to employ therapeutic scheme using a combination of 4 drugs. Treatment envolved the administration of 300 mg/mz cyclophosphamide, 350 mg/m2 5-fluorouracil, 10 mg/mw2 methotrexate i.v. on alternate days 6-8 times, and 15 mg bleomycin on alternate days until a total dose of 150-200 mg is reached. Thirty-five out of 37 patients treated with this protocol (30 previously treated and 5 not) qualified for analysis; the site of the neoplasm, mostly squamous cell carcinoma, was different; for the most part it was in the larynx (18/35) and the oral cavity (10/35). Complete remission was achieved in 9/35 patients (25.7%), varying from 5 to 33 months (median 22); partial remission was achieved in 15/35 cases (42.8%), varying from 1 to 14 months (median 3); and there was no success in 11/35 cases (31.5%). Overall, a total remission greater than 50% was observed in 24/35 patients (68.5%). The most serious side effects both ascribed to BLM were observed in the central nervous system (increasing drowsiness and coma) and the lung. This study has shown that in the ultra head and neck malignancies medical treatment can achieve satisfactory results.
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