Ultrastructural study of small cell carcinoma (author's transl)

Fifty bronchopulmonary tumors were studied by light and electron microscopy: 39 carcinomas (25 small cell carcinomas, 8 undifferentiated carcinomas, 6 poorly differentiated squamous cell carcinomas) and 11 carcinoid tumors (5 central, 4 peripheral, 1 atypical, 1 of the tumorlet type). The results indicate that small cell carcinoma is a precise entity characterized by the presence of neurosecretory granules in the cytoplasm. Ultrastructurally carcinoid tumor resemble small cell carcinomas and there is a continuous spectrum of differentiation between the less undifferentiated neuro-endocrine tumors, i.e. the small cell anaplastic carcinomas, and the higher differentiated types, i.e. the carcinoids. The diagnostic and prognostic value of the ultrastructural findings are discussed.     

Undifferentiated small cell carcinoma and diffuse endocrine system (author's transl)

Oat cell carcinomas of the lung are sometimes associated with endocrine secretion. Resulting syndromes, first regarded as "paraneoplasic", are in fact imputable to secretory activity of the tumoral cells, as demonstrated by electron microscopy and immunofluorescence studies. Such ascertainments are explained by the existence in the bronchial tree of a diffuse endocrine system sector, from which carcinoid and oat cell carcinoma originate. However, the authors consider other histogenetic hypotheses and rapidly survey the extra-pulmonary oat cell carcinomas.     

Lymphographic evaluation of cervico-uterine carcinoma (author's transl)

Bilateral pedial lymphography is a technique which has already been long employed and which had aroused great hopes in the detection of metastatic node involvement. The method has nevertheless failed to form an invariable part of the pretherapeutic assessment of cervico-uterine carcinomas. This attitude may be easily explained by the difficulties encountered in the interpretation of lymphographies as indicated in the first publications. New data nevertheless have made it possible to refine the method. Whilst false negatives remain inevitable in almost half the cases with histological evidence of involvement, false positives may be reduced to a minimum by very strict criteria of interpretation. Lymphography, a harmless technique, can then provide valuable information which enables the surgeon to confirm the success of his lymph node dissection and the radiotherapist to define areas requiring treatment. It is of major prognostic value. It may be used to guide transparietal lymph node biopsies and secondary detect lumbo-aortic nodes.     

Carcinoembryonic antigen in carcinoma of the uterine cervix (author's transl)

The authors analyse 123 cases of carcinoma of the uterine cervix treated by radiotherapy, with CEA radio-immuno-assay performed before treatment then each time patients are seen in follow-up. The CEA level is positive in 35 per cent of the cases with a mean value of 21 per cent for stage I, 36 per cent for stage II and 48 per cent for stage III. CEA level become negative at the end of the treatment (80%) or after (100%) when there is a complete disappearance of the tumour. The persistence of a positive level is well correlated with the abscence of sterilization, and reappearance of CEA evokes a recurrence. Preliminary results do not seem to show a prognosis value of pre-therapeutic level of CEA according to survival rate at 2 years.     

Neuroendocrine carcinomas (carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma): current concepts

Neuroendocrine carcinomas are ubiquitous neoplasms that may occur anywhere in the human body. A unifying concept regarding the classification of these tumors has been controversial. Although most neuroendocrine neoplasms occur in the gastrointestinal tract, current concepts regarding classification and nomenclature are being driven by studies of thoracic tumors. One issue that has been put forward to keep separate nomenclatures for these tumors in different organ systems is the different clinical behavior of these neoplasms in different systems. The most important aspect regarding this group of tumors is the fact that they should be considered neoplasms capable of local recurrence and distant metastasis. Close clinical correlation and appropriate treatment are important to improve the survival rate in this group of patients.     

Nutrition, alcohol and oesophageal cancer (author's transl)

Nutritional factors are suspected to cause oesophageal cancer as well as other cancers of the digestive tract. Sideropenia, lack of molybdenum, tannins have been reported to be associated with the disease. Polycyclic hydrocarbons and nitrosamines have been found in alcoholic beverages from high incidence regions; the significance of the small amounts detected remains to be assessed. A recent survey in Iran points out the role of poor and monotonous diet. In Brittany, no major deficiencies were found, neither in quantity or quality, in the diet of 200 male cases of oesophageal cancer when compared with a population control group. Differences in consumption were detected for a few items; the most obvious discrepancies concerned the various alcoholic beverages for which the proportion of heavy consumers was systematically greater among cases. Alcohol and tobacco are both independently associated with the disease; there is a dose-response relationship for both and their effects are multiplicative. The mechanism of the action of alcohol in oesophageal cancer is briefly discussed.     

Urinary complications and sequelae of carcinoma of the cervix treatment (author's transl)

The authors describe the sequelae and urinary complications of:--radiotherapy only in 524 patients, stage I to III treated between 1960 and 1974;--721 operations performed between 1968 and 1974, according to the protocol of treatment as used in the Fondation Curie. This reveals:--for irradiated patients, no iatrogenic damage to the upper urinary tract, whilst bladder complications were often present. No major complication was found in this group;--for operated patients, the surgical act was without harmful consequence in the 672 cases when the operation was foreseen in the initial protocol (0,6% of chief complications). On the other hand, surgery performed for persistent tumour or recurrence after exclusive radiotherapy showed 8 per cent of chief complications. In this group they analyse the factors that might influence ureterohydronephroses, especially the extent of node dissection and associated external irradiation.     

Small cell carcinomas of the gastrointestinal tract: clinicopathological features and treatment approach

Small cell undifferentiated carcinoma (SmCC) of the gastrointestinal tract (GIT) is a rare and highly aggressive malignancy. To date, fewer than 1,000 cases have been reported, with an estimated prevalence of 0.1% to 1% of all gastrointestinal (GI) tumors. Data on the disease are scarce due to its rarity and the fact that most authors have focused on one site within the GIT. In light of the limited data and its perceived similarity to SmCC of the lung, the disease has usually been treated as the latter. Nevertheless, recent clinicopathologic and molecular data imply several differences between the two entities, questioning the extent to which extrapolations from one to the other can be made. We review the available data on GI SmCC with emphasis on outlining its clinicopathologic features and the recommended treatment approach.     

Anatomical extension of invasive carcinoma of the uterine cervix (author's transl)

Invasive epithelioma of the uterine cervix spreads in two different ways. Locally, tumour involves progressively upon neighbouring structures (vagina parametrium, uterine corpus, bladder, rectum). Regionally, lymphatic dissemination occur preociously moving towards the nodes of the pelvic wall. Local extension can be appreciated by clinical examination which determines the clinical staging of cervical cancer. It does not take sufficiently into account the volume of the tumour which is a principal factor in lymphatic dissemination. Nodal metastases essentially localise in the external iliac chain (obturateur group), from there spreading to the common iliac or latero aortic nodes which may, under exceptionnal circumstances be involved primarily. The incidence of latero-aortic metastases has recently been high-lighted by pre-treatment staging laparotomy. Besides lymphatic metastases, systematic metastases via a venous spread are rare. They indicate a late diagnosis or therapy failure with pelvic relapse. The therapeutic effort in cancer of the uterine cervix, at the present time, ought to be found on loco-regional treatment using either radiotherapy or surgery.     

Radiation therapy for stage IV carcinoma of the cervix (author's transl)

Fifty four cases of stage IVa carcinoma of the cervix and treated with radiotherapy were collected between 1971 and 1977. Overall actuarial survival was 16 per cent at 3 years and almost all the deaths occurred before that time. Amongst the factors studied, the initial size of the pelvis tumour and lumbo-aortic lymphography findings were the determing factors in the prognosis. To a lesser extent, the age of the patient, tumour differentiation and the amount of irradiation modified the prognosis. It was thus possible to define, within the stage IVa category, several prognostic groups, the determination of which has therapeutic consequences.     

Nutrition and carcinoma of the breast: presentation of a french investigation (author's transl)

The existence of dietary risk factors in breast cancer of post-menopausal women is a recent, and yet unproven hypothesis. A French survey made possible by the cooperation of general surgeons and radiotherapists practising in private clinics is currently in progress in a number of metropolitan departments. A preliminary evaluation of the first 654 questionnaires has proved entirely negative. There was no difference between women with breast cancer and a population of age-matched controls with regard to weight, height or the various traditionnal indices of obesity. However, the number of patients studied is too small to allow this hypothesis to be still rejected.