Medical Terms Learned today

Useful Serologic markers: (from Medscape)

"Recent attention has been paid to 2 serologic markers, anti-Saccharomyces cerevisiae antibody (ASCA) and perinuclear anti-neutrophilic cytoplasmic antibody (pANCA), which have been proposed as screening tools for patients who present with signs and symptoms of IBD. The Prometheus IBD First Step Generation II (Prometheus Laboratories; San Diego, California) is a commercially available serologic panel of antibodies, including pANCA/ANCA, ASCA IgA, ASCA IgG, and anti-OmpC (outer membrane porin from Escherichia coli) IgA. This test is intended to exclude the presence of IBD in patients with nonspecific symptoms. (The pANCA and ASCA assays are offered commercially through several other companies as well, but these other serologic panels do not include some of the other antibodies, such as anti-OmpC.)"

Along with the discovery of anti-CBir1 flagellin, another technique has been introduced in an attempt to increase diagnostic ability. The Smart Diagnostic Algorithm technology (personal communication with Prometheus Laboratories, 2006) has now been incorporated into the diagnostic armamentarium.
(Lois A, Waldleigh F, Neri B. Development of a hybrid algorithm based on learning classifiers that improves diagnosis of inflammatory bowel disease and differentiation between Crohn's and ulcerative colitis in a multi-marker system. Gastroenterology. 2006;130:Abstract M 1198.)

Breast cancer. For the majority of patients with stage I or II breast cancer, bone scans are considered

optional at diagnosis, and routine bone scans in asymptomatic patients provide no advantage in survival or

ability to palliate recurrent disease.[65]=National Comprehensive Cancer Network. Clinical practice

guidelines in oncology, breast cancer, v.2.2006. National Comprehensive Cancer Network; 2004.

Prostate cancer
Cancer Network guidelines recommend a bone scan at diagnosis for T1 to T2 disease in the presence of a PSA

level >20 ng/mL, a Gleason score of >/=8, T3 to T4, or symptomatic disease.

ASCO Screening Recommendations for Cancer Treatment-Related Bone Loss in Women With Localized Breast

Cancer
Initial screening

* All women aged 65 years or older
* All women aged 60 to 64 years with
– Family history of fragility fracture
– Body weight <70 kg
– Prior nontraumatic fracture
– Other risk factors
* Postmenopausal women of any age receiving aromatase inhibitors
* Premenopausal women with therapy-associated premature menopause

Repeat BMD annually after initial examination.

Bisphosphonates are divided into 2 classes based on their chemical structure and mechanism of action—

nitrogen-containing bisphosphonates (ie, alendronate, ibandronate, pamidronate, risedronate, zoledronic

acid) and non–nitrogen-containing bisphosphonates (ie, clodronate, etidronate).[92] Nitrogen-containing

bisphosphonates are more potent than non–nitrogen-containing bisphosphonates because they inhibit the

enzyme farnesyl diphosphate synthase, an enzyme in the cholesterol biosynthesis pathway.

During bone formation, the biochemical markers released into the circulation include bone-specific ALP,

the procollagen extension peptides (PICP, PINP), and OC.[7,68] ALP and OC are measured in serum. Bone

resorption leads to collagen breakdown and results in the release of bone resorption markers into the

circulation, including NTx, CTx, Pyr, and DPD.

Commonly used radiopharmaceuticals include strontium chloride-89, sodium phosphate-32, and samarium-153

lexidronam. In patients with bone metastases, radiopharmaceuticals may be used as an alternative or

adjunct to external beam radiation therapy.[84,85] These agents are not useful in spinal cord or

peripheral nerve invasion by adjacent metastases, for acute pathologic fractures, or for pure osteolytic

lesions.

Table 4. Proposed Scoring System for Predicting Risk of Pathologic Fracture Through a Metastatic Lesion in

a Long Bone. Reprinted with permission from Mirels H et al. Clin Orthop Relat Res. 1989;249:256-265.
Points

1 2 3
Image Blastic Mixed Lytic
Size <1/3 1/3 to 2/3 >2/3
Site Upper extremity Lower extremity Peritrochanteric
Pain Mild Moderate Mechanical

This system grades each of 4 radiographic and clinical risk factors on a scale of 1 to 3. The authors

suggest that lesions with a cumulative score of 7 or less can be safely irradiated without risk of

fracture, while a score of 8 or higher (higher risk of fracture) should prompt prophylactic internal

fixation prior to irradiation.

Disease-free and overall survival were significantly better with clodronate. With longer follow-up (103 ±

12 months), the incidence of osseous and visceral metastases was similar in both groups.[103] A difference

in disease-free survival could no longer be demonstrated; however, overall survival was still

significantly better with clodronate (P < .01). The authors concluded that adjuvant clodronate therapy

prolongs survival in patients with breast cancer.[103]=# Jaschke A, Bastert G, Solomayer EF, et al.

Adjuvant clodronate treatment improves the overall survival of primary breast cancer patients with

micrometastases to bone marrow—a longtime follow-up. Proc Am Soc Clin Oncol. 2004;23:9. Abstract 529.

Osteonecrosis of the jaw (ONJ) is a serious dental condition that has been reported inpatients receiving

IV and, to a lesser extent, oral bisphosphonates.114,115 Incidence has been reported in a recent large,

retrospective review series at 0.6%.[116]=Van Poznak CH, Estilo CL, Sauter NP, et al. Osteonecrosis of the

jaw in patients with metastic breast cancer. Presented at 27th Annual Breast Cancer Symposium; December 9,

2004; San Antonio, Tex. Abstract 3057.


Medscape