Document 155YEn5q4NQpdKneBbv5aLk8d

AMERICAN j CANCER {1 SOCIETY q2 V# NEWS SERVICE 219 EAST 42nd STREET NEW YORK. N. Y. 1C017 TN 7-3700 AMERICAN CANCER SOCIETY'S SCIENCE-WRITERS' SEMINAR Vacation Village Hotel, San Diego, Calif. March 22-27, 1968 OVARIAN CANCER. DETECTION & ETIOLOGY .John B. Graham, M.D. Gynecologic Department. Roswell Park Memorial Institute School of Medicine State University of New York at Buffalo Buffalo, New York ASARCO ELP 0003216 OVARIAN CANCER, DETECTION ?. ETIOLOGY John Graham and Ruth Graham Gynecologic Department Roswell. Park Memorial Institute School of Medicine, State University Hew York at Buffalo Cancer of the ovary la a serious and growing problem. In Hew York State it ranks third in cancer deaths of women. If the cancer is recognized when it is apparently confined to the ovary, the five-year cure rate is 20%. About 205$ of core advanced cases are cured. Unfortunately, thd majority (8CJo) of cases are . advanced which results in a poor overall cure rate (25-305$). Early diagnosis could increase the salvage but symptoms and signs are unre liable until the tumor is far advanced.. Cytology has been effective in cervical cancer and cay have comparable value in ovarian cancer. A sample of peritoneal fluid, which contains cells shed from the ovary, can be obtained with a needle passed through the upper vagina into the pouch of Douglas. This is done in the office or clinic with only mild discomfort. The sample is processed much like a vaginal smear. In 22 cases with malignant cells in the cul-de-sac fluid and normal physical examination the.ovaries were removed. In two, there were small invasive cancers and in the remainder, there was malignant epithelium on the surface. The noninvasive malignant epithelium is referred to as a borderline lesion and is regarded as comparable to carcinoma in situ of the cervix. Borderlino lesions are composed of malignant cells, I.e.i they have an irregular chromatin pattern in the nucleus. This type epithelium is found in and adjacent to clinical ovarian cancers. The frequency that borderline lesions progress to clinical cancer is unknown. That needs to be studied by biopsy and protracted follow up without treatment. Ve are currently following fifteen of this type case. ASARCO ELP 0003217 Graham 2 Vo regard cul-do-cac aspiration as useful -in the high risk or 'diagnostic problem patient. These include all vho cone to examination under anesthesia for vaginal bleeding without an obvious cause, those with pelvic masses of uncertain character, and those with vague pelvic or abdominal discomfort. It also could be used, in the patient, scheduled for pelvic laparotomy where preser- va.tion of the .ovaries,is contemplated to avoid leaving those with malignant.~ proclivity. , Ovarian .canc.er. has quadrupled since the- turn of -the-century in this country. A hundred years .ago it was relatively rare in Western Europe and North'America. Now it is cocmon and increasing. In other parts of the-world such as Latin ...America, Japan and China ovarian cancer is still uncommon'.-'--This "suggests some" etiologic element in modern western life. Women with aobestosig frequently ' "' have mesotheliomas.and ovarian cancer. Some mesotheliomas due to asbestos are indistinguishable from ovarian cancer. ,Ve have injected finely divided asbestos intra-peritoneally in guinea pigs' and rabbits. Weekly injections are followed by malignant changes on the ovarian surface. These are seen as early*as.seven weeks. Ey a year, half of the guinea pigs and all of the rabbits show these changes. But none showed-invasive cancer. However,_if stibestrol is given after a course of intra-peritoneal asbestos, invasive cancer resulted in one of three guinea pigs and four of six rabbits. The guinea pig received asbestos for ten months and 5 mg./week of stibestrol for four months. The rabbits had received asbestos for eight to thirteen months end stibestrol 10 mg./week for two weeks to three months. Two of the cancers are sarcomas and three carcinomas. Two probably are ovarian in origin. The ASARCO ELP 0003218 cite of origin of the others is" less certain. Asbestos fibers are demonstrable in non-neoplastic tissues of exposed animals and mnn but are rarely found in the cancer itself. Ve have looked for asbestos fibers in ovarian cancers without success. Histologic sections of ovaries of 12 patients with borderline lesions or-nicroinvasive lesions-were examined under polarized light. -In six, bi-rofringent crystalize material vas found near the abnormal epithelium. These crystals could be ashee-to-S-but .have^ not been identified. Until recently, -laparotomy and gross inspection were needed to cake or exclude the diagnosis of ovarian cancer. (Endoscopy is used in some clinics for this purpose.) Cul-de-centesis offers a method of excluding cancer diagnosis if norcal .peritoneal fluid is-found and of recognizing preclinical.-cancer--.r---.-IrJ; The prevention of ovarian cancer is preferred^ to its early detection. Our evidence suggests^ but by- no.-means proves, that there may he an etiologic .. .relation between asbestos and ovarian cancer. The lesions on the ovarian surface elicited by asbestos in guinea pigs and rabbits are sicilar to those found in patients with borderline lesions and adjacent to clinical cancer. - It is of interest that invasive cancer -was only found after the addition of stibestrol. This inplys a two-6tep process. The use of asbestos has increased a thousand fbld since the-turn of the century. It is ubiquitous in our environment.* It is virtually undestructable. It can be fragmented into ever smaller particles but is still there. The smaller particles (less than five microns) readily pass into ASARCO ELP 0003219 Graham 4 the tissues by way of the respiratory tract and possibly by the intestinal tract aa well. The home, the automobile, the office and industry all provide exposure. We think that asbestos may be a.factor that predisposes to ovarian cancer and that it deserves further investigation. ASARCO ELP 0003220