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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study describes the distribution and frequency of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and glucocorticoid receptor (GR) in a large series of patients with primary metastatic breast cancer. 329 patients were in this series. All 4 steroid hormone receptors were present in the population: ER was positive in 53%, PR was positive in 38%, AR was positive for 31%, and GR was positive in 52%. Next, the distribution of ERs as well as the distributions of PR, AR, and GR values seemed unimodal. There was a very high correlation between any steroid hormone receptor value expressed as either fmol/mg of cytoplasmic protein or fmol/mg of breast tumor. Of more importance was that alternate methods of data expression did not alter the classification of values as positive or negative. No correlation was found between any of the steroid hormone receptors and laterality of the breast tumor, location and size of the primary tumor, extent of disease, or type of tissue assayed. None of the steroid hormone receptors correlated with age. There was a strong correlation noted between ER values and menopausal status. Neither PR, AR, nor GR was significantly associated with menopausal status. ER status was correlated with axillary nodal status, with the ER positive group containing a high proportion of node-negative patients. Finally, quantitative analysis of steroid receptor hormone values demonstrated correlations among other receptors. Plotting values of any 1 receptor vs. any other receptor resulted in a positive Kendall rank test correlation which was highly significant.
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PMID:Distribution, frequency, and quantitative analysis of estrogen, progesterone, androgen, and glucocorticoid receptors in human breast cancer. 42 88

The estrogen receptor (ER) level in carcinoma of the breast is a useful predictor of response to hormonal therapy. Metastatic disease may not have the same level of ER as the primary. In a series of 37 patients who had simultaneous ER determination in both primary neoplasm and regional nodal metastasis there was 81% agreement. The true ER character of the tumor would have been missed in seven patients if only the primary tumor had been sampled. The possible reasons for this discrepancy are discussed. We feel that the nodal metastatic deposit may reflect the true nature of the ER status because it represents a purer concentration of tumor cells as well as representing the aggressive element of the tumor.
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PMID:Comparison of estrogen receptor levels in primary and regional metastatic carcinoma of the breast. 46 82

Steroid receptor assays in advanced or recurrent breast cancer are now recognized as a method for predicting therapeutic response to endocrine therapy. ER (estrogen receptor) and PgR (progesterone receptor) were measured by sucrose gradient centrifugation. Breast cancer, benign mammary tumors, and normal mammary tissue were examined. Following extensive laboratory procedures, several results were observed. The specific binding of ER was observed at the 8S as was the binding of PgR. 45% of human breast cancers were ER(+) and about 20% were PgR (+), with the positive rate of PgR lower than that of ER. All normal mammary tissues were ER (-) and with the benign mammary tumors, 1 of 10 fibroadenomas and 1 of 3 giant fibroadenomas was ER (+). Positive rates of ER and PgR were similar between premenopausal and postmenopausal females and across blood types A, B, and O. ER and PgR were negative in AB blood. The occurrence of ER in 10 cases of primary tumor and in metastatic or recurrent lesions was almost identical and binding sites were at almost the same level. Where both ER and PgR were measured in 39 cases, the 8 cases of PgR (+) showed ER (+) and there was a close relationship between the 2. With ER (+), papillotubular carcinomas tended to be lower than other histological types; in binding sites of ER, medullary tubular carcinoma occurred more frequently than schirrous carcinoma. Medullary tubular carcinoma occurred more often in the PgR. In 21 cases where the clinical response to endocrine therapy and the occurrence of ER were measured, 50% (6) of ER (+) and 25% of ER (+) or (-) displayed a response with 5 ER (-) cases showing no response. Endocrine therapy in 11 of 39 above mentioned cases was carried out with cases of ER (+) and PgR (+) responding better than those of ER (+) only. (Author's modified)
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PMID:[Studies on estrogen and progesterone receptors in human breast cancer by sucrose gradient centrifugation (author's transl)]. 48 78

Endocrine hormone treatment has been found to be effective in treating metastatic breast cancer in 20-40% of the cases. The effectiveness of this treatment can be predicted to a certain extent by determining whether the hormone receptors in the tumor tissue react positively or negatively when incubated with highly active hormones, e.g. H3-17 beta-estradiol. Estrogen receptors are found in 60-70% of primary tumors and 40-50% of tissue samples from metastatized tumors. Estrogen receptors are more frequently found in post-menopausal women than in women who are still menstruating. Progesterone receptors have been found in 20-40% of all investigations undertaken, androgen receptors in 20-30%, and corticosteroid receptors in 20-50%. A remission rate of 56% has been achieved after endocrine therapy of those with positive estrogen receptor tests, compared to 10% among those with negative tests. The correlation between the receptor test results and (the success of) endocrine therapy is not very high; this could be a factor determined by the cellular constitution of a tumor. The remission rate is 75% among patients with positive receptor tests for both estrogen and progesterone. Faulty lab techniques could be responsible for low correlation. Determination of the receptor activity of both the primary tumor and its metasases, or immunological or immunohistological determination of receptor activity may improve the usefulness of the test in determining tumor reaction to endocrine hormone treatment.
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PMID:[The clinical value of hormone receptors in the treatment of breast neoplasms]. 54 83

The estrogen receptor protein content of recurrent breast cancer correlates well with the clinical response of hormonal manipulation. This predictive value of the ER of the primary tumor obtained at the time of mastectomy has not yet been proven. If this predictive capability should hold for primary tumors and eventual endocrine treatment, the ramifications are obvious: endocrine therapy could be offered to patients on a rational basis and adjuvant therapy could be considered on a plausible biochemical basis. This report details our observations as to the ER content of the primary tumor and the eventual result of endocrine therapy. Thirty-seven patients whose tumor ER was determined from the primary tumor eventually underwent some form of endocrine therapy for recurrent disease. Fifteen of the primary tumors had significant ER content and 22 possessed insignificant amounts. Only one of the 22 patients with insignificant ER content was benefited by endocrine treatment. Those patients whose tumors contained low amounts of ER experienced recurrence of their disease more rapidly than did those with higher ER content. There was no correlation of age, cell type of tumor or metastatic site with the ER content of the tumor. There is a positive correlation between response to chemotherapy and ER content of tumor. Measurement of the estrogen receptor protein content of the primary breast tumor is a reliable method for choosing patients for eventual endocrine therapy. Those patients whose tumors contain insignificant estrophilin are not candidates for such attempts at palliation.
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PMID:Correlation of estrophilin content of primary mammary cancer to eventual endocrine treatment. 68 99

Estrogen receptor assays of primary breast tumors have been related to early recurrence of the disease. A significantly longer disease-free interval was found in women whose primary tumor was estrogen receptor positive. Although there was no relationship of receptor content to stage of disease at mastectomy, the greatest difference between recurrence rates was found when the tumor had spread to the lymph nodes, especially to those in the apex of the axilla or in the internal mammary chain. Presence of estrogen receptor is closely related to histologically well-differentiated tumors, but it was found that poorly differentiated estrogen receptor-negative tumors recurred earlier than poorly differentiated receptor-positive tumors and had a very unfavorable prognosis.
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PMID:Estrogen receptor assay in primary breast cancer and early recurrence of the disease. 69 68

Studies of various technics that aid in performing estrogen receptor assays on small tissue samples from primary cancers of the breast are reported. It is shown how sufficient protein can be obtained from less than 100 mg of small primary tumor without ultracentrifugation to assay estrogen receptor by a simplified two-point Scatchard plot method. The resulting Kd and maximum binding site values with 36 tumor tissue samples approximated the values obtained with the more laborious, larger tissue sample-demanding six-point Scatchard plot. Target and nontarget tissue controls are easily included in an assay run of four to eight samples. For interpretive purposes the derivation of the characterizing value of the Kd for estrogen receptor is given and compared with nonspecific associating binders.
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PMID:Improved estrogen receptor assay in human mammary cancer. Technics for handling small tissue samples. 85 26

A wide variety of approaches are being applied to the therapy of breast cancer. Treatment begins with a biopsy followed by mastectomy to remove the primary tumor. The risk category must be determined and, at present, an axillary dissection appears to be required; in the future, tumor cell markers may replace the role of an axillary dissection in the determination of risk category (TORMEY et al., 1975). If the nodes are positive, adjuvant chemotherapy and possibly immunotherapy should be considered. A positive estrogen receptor assay suggests that patients may also benefit from endocrine treatments. If it is negative, the chances of responding to hormonotherapy are very limited, except, perhaps, for anti-estrogens (McGUIRE, et al., 1975). Adjuvant therapy for patients with negative nodes is not recommended at this time; this view may have to be modified as the results of current adjuvant studies become available. We have at hand the means to improve the cure rate of patients with breast cancer. We are getting better diagnostic methods and find more patients with negative nodes. We know more about the primary treatment and have systemic modalities that are effective in the adjuvant situation. The immediate problem is to learn how to put these treatments together, and this task has been undertaken by on-going clinical trials. We are anticipating the results with optimism.
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PMID:The role of chemotherapy in the treatment of breast cancer. 101 6

The natural history of breast cancer is complex and the treatment modalities need to be adjusted to this heterogeneous disease. Several prognostic indicators have been described for breast cancer, including the extent of axillary nodal metastasis, the size of the primary tumor mass, various histopathologic characteristics, estrogen and progesterone receptor content, tumor proliferation index, detection of oncogenes, tumor suppressor genes, loss of heterozygosity, and growth factors. Although no single parameter or combination of parameters can definitively predict the outcome of the disease, combined criteria such as tumor estrogen receptor content, cell proliferative index, and lymph node status are relevant for identifying subsets of breast cancer patients that may require different therapeutic modalities. Detection of oncogenes, tumor suppressor genes, and growth factors need further evaluation to determine their usefulness as prognostic factors.
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PMID:The pathology of breast cancer: staging and prognostic indicators. 146 Feb 23

Evaluation of the patient with metastasis of unknown origin should be structured to quickly identify treatable tumors or the need for palliation while avoiding prolonged hospital stays and testing that will result in neither improved treatment nor better prognosis. The evaluation should be symptom-directed and pathologically oriented. It is the responsibility of the family physician in caring for a patient with MUO to ensure that communication is facilitated between surgeon, oncologist, pathologist, and patient. The physical examination should include thyroid, breasts, pelvic, and rectal examinations. General lab analyses should include fecal occult blood testing, complete blood count, urinalysis, serum calcium, and liver function studies. Men should have assays for prostate-specific antigen and serum prostatic acid phosphatase. Women should undergo mammography and pelvic ultrasound. Undifferentiated carcinoma is likely to originate from either small cell bronchogenic, lymphoma, or germ cell, and thus, serum should be assayed for HCG and AFP. Further radiologic studies, in the absence of specific symptoms, should be limited to chest radiographs and abdominal CT. Contrast studies should be included only if there is organ dysfunction. Biopsy of the malignant tissue should be done early, and studies should include histochemistry, immunohistology, and electron microscopy. Tissues from female patients should be studied for estrogen and progesterone receptors. When a biopsy is planned, advance communication between the family physician or surgeon and the pathologist greatly increases the chance of identifying a primary site. It is important that the surgeon obtain sufficient material to enable study, not only by standard histologic techniques, but also by electron microscopy, special stains, estrogen receptor activity, hormonal markers, and tumor markers. Treatment of patients for whom a primary tumor remains undiscovered must include toxic therapies only for those with good functional status who are likely to respond. Therapy must be pursued for palliation of symptoms when they develop. As physicians, we must control the urge to do something at those times when doing nothing is more appropriate. We must provide continuous support for both the patient and family, protecting to the best of our ability their quality of life. A physician should never convey the impression that it is "not cost-effective" to look for the source of a patient's malignancy. It can be emphasized that further search for a primary tumor carries both medical risk and expense, yet is unlikely to locate the primary tumor or improve the response to therapy or the quality of life.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Metastasis of unknown origin. 146 85


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