Complementary and Alternative Medical Lab Testing Part 17: Oncology

By Ronald Steriti

Complementary and Alternative Medical Lab Testing (CAM Labs) contains summaries of the published research on lab tests, primarily from PubMed trials on humans. Each chapter (disease) begins with a brief summary of conventional lab tests, followed by additional lab tests, including diabetes, insulin resistance, metabolic syndrome, inflammation, etc. There are sections on endocrine hormones (thyroid, adrenal, sex steroids) and environmental medicine (toxic heavy metals). The nutritional assessments section includes minerals, vitamins and amino acids.

CAM Labs 17 – Oncology

1. Bone Cancer
2. Breast Cancer
3. Colon Cancer
4. Glioblastoma
5. Leukemia
6. Leukemia, Acute
7. Leukemia, Chronic
8. Lymphoma
9. Pancreatic Cancer
10. Prostate Cancer
11. Thyroid Cancer

• Language: English
• Publisher: Ronald Steriti
• Release date: Jun 4, 2016
• ISBN: 9781310355110

Ronald Steriti

Dr. Ronald Steriti is a graduate of Southwest College of Naturopathic Medicine and currently is researcher for Jonathan V. Wright at the Tahoma Clinic.

Book preview

Complementary and Alternative

Medical Lab Testing

Part 17: Oncology

By Ronald Steriti, ND, PhD

©

Complementary and Alternative Medical Lab Testing Clinician’s Guide Part 17: Oncology

By Ronald Steriti, ND, PhD

Copyright © 2016

All rights reserved. No part of this book may be reproduced in any form or by any means, including photocopying, including in a web site, or stored in a retrieval system, or transmitted in any form by any means, without expressed, written permission of the copyright owner.

The contents of this document are the sole property of the author.

Disclaimer

This book has not been evaluated by the FDA and is not intended to diagnose, treat, cure or prevent any disease.

The information contained in this book is for educational purposes only, and should not be construed as medical advice or instruction. No action should be taken based solely on the contents of this book. Readers should consult appropriate health officials.

While extensive efforts have been made to ensure the accuracy of the information contained, the possibility of errors, omissions, and misinterpretations cannot be ruled out. The reader is advised to consult the original references for verification and clarification.

Foreward

This book is a summary the published research on lab tests, primarily from PubMed. The studies are limited to those with trials on humans. As such, some labs may be excluded due to the lack of published research. That is simply a reflection of the current state of research - much more work is needed!

Although this book may be useful for differential diagnosis, lab tests are can also be used to identify inderlying causes and associated conditions.

The sections on conventional lab tests are purposefully brief. These tests are typically used to confirm a diagnosis. There are other more comprehensive sources of information on conventional medical lab testing.

Table of Contents

1. Bone Cancer

2. Breast Cancer

3. Colon Cancer

4. Glioblastoma

5. Leukemia

6. Leukemia, Acute

7. Leukemia, Chronic

8. Lymphoma

9. Pancreatic Cancer

10. Prostate Cancer

11. Thyroid Cancer

Chapter 1. Bone Cancer

Conventional Lab Tests

Serum alkaline phosphatase is an indirect reflection of bone destruction

Serum protein electrophoresis (SPEP)

Urinalysis and Urine protein electrophoresis (UPEP)

N-telopeptide (NTx) of type II collagen is a marker of bone resorption (not widely used) (Tamiya et al., 2013) (Rajpar et al., 2010)

Additional Lab Tests

C-Reactive Protein (CRP)

A study retrospectively reviewed 318 patients who presented with a primary sarcoma of bone between 2003 and 2010. Those who presented with metastases and/or local recurrence were excluded. Elevated CRP levels were seen in 84 patients before treatment; these patients had a poorer disease-specific survival (57% at five years) than patients with a normal CRP (79% at five years) (p < 0.0001). They were also less likely to be free of recurrence (71% at five years) than patients with a normal CRP (79% at five years) (p = 0.04). Multivariate analysis showed the pre-operative CRP level to be an independent predictor of survival and local control. Patients with a Ewing's sarcoma or chondrosarcoma who had an elevated CRP before their treatment started had a significantly poorer disease-specific survival than patients with a normal CRP (p = 0.02 and p < 0.0001, respectively). Patients with a conventional osteosarcoma and a raised CRP were at an increased risk of poorer local control. CRP levels can be measured routinely in patients with a suspected sarcoma of bone as a further prognostic indicator of survival. (Nakamura et al., 2013)

In this retrospective single-centre study, pre-operative serum CRP levels in 79 patients (37 females, 42 males; average age, 18 years; mean follow-up, 46 months) undergoing resection of an osteosarcoma were correlated with clinical data and survival. The mean pre-operative serum CRP level of all 79 patients was 0.53 mg/dl (SD, 1.27 mg/dl). Patients dying of their underlying disease had significantly higher CRP levels compared to patients surviving throughout the follow-up period (1.09 mg/dl +/- 2.02 mg/dl versus 0.32 mg/dl +/- 0.75 mg/dl, respectively; p = 0.015). CRP levels were significantly correlated with survival (Pearson's correlation coefficient = -0.25; p = 0.026) and histological subtype (Pearson's correlation coefficient = -0.42; p < 0.001), but not with sex, age, histological response, tumour size or metastatic disease. In uni- and multivariate survival analysis, age, response to chemotherapy and serum CRP were associated with disease-specific survival. Patients with a CRP level over 1 mg/dl had a significantly lower disease-specific five-year survival of 36.7% compared to 73.8% in patients with normal CRP values (p = 0.020). Infection was not correlated with disease-specific survival. Pre-operative serum CRP levels were not correlated with post-operative infection or deep prosthetic infection. Pre-operative serum CRP seems to be an independent predictor of survival in patients with high-grade osteosarcoma. (Funovics et al., 2011)

Six hundred and fifty-eight myeloma patients were evaluated retrospectively for surgery. Clinicopathological variables of patients who underwent surgery (n=71) were compared between patients with preoperative CRP>or=6 mg l-1 and those with CRP<6 mg l-1. Patients with an increase of CRP prior to surgery showed inferior survival compared to patients with normal levels. Patients with normal CRP levels at diagnosis but elevations prior to surgery do seem to have a similar unfavorable overall survival (OS) than patients with an increase both, at diagnosis and at surgery. Conversely, patients with normal CRP levels prior to surgery still have the best OS, irrespective of their basic values. Multivariate analysis revealed preoperative CRP levels above 6 mg l-1 Lactate dehydrogenase (LDH) above normal, and osteolyses in long weight bearing bones as independent predictors of survival. These findings suggest that in patients with MM serum levels of CRP increase during disease activity and might be significantly correlated with specific disease characteristics including adverse prognostic features such as osteolyses in long weight bearing bones. Thus, preoperative elevated CRP serum levels might be considered as independent predictor of prognosis and could provide additional prognostic information for the risk stratification before surgical treatment in patients with myeloma bone disease. (Zahlten-Hinguranage et al., 2006)

A study included 64 patients with primary bone and soft tissue tumors (primary bone tumors: 39, primary soft tissue tumors: 25) and 68 cancer patients that were compared with overall survival, local recurrence-free survival and metastasis-free survival. Only doubling time (DT) of CRP and alkaline phosphatase (ALP, CRP-DT, ALP-DT) were correlated with disease outcome in patients with primary bone and soft tissue tumors. In cancer patients, only CRP-DT showed a relation with clinical stage and histologic grade, but the ALP-DT in patients with bone metastasis was significantly shorter than that in patients with metastases at other sites or in those with no metastasis. Among all tumor patients, those with bone metastasis showed the shortest ALP-DT compared with those with lung, liver and brain metastasis. Univariate analysis showed that shorter CRP-DT and ALP-DT are associated with poor overall survival, and the development of local recurrence and metastasis. These findings suggest that pretreatment CRP- and ALP-DT could be additional prognostic parameters for disease outcome in patients with primary malignant bone and soft tissue tumors. However, in multivariate analysis, only ALP-DT, but not CRP-DT, was an independent prognostic parameter for these disease outcomes. (Yudoh et al., 1996)

Nutritional Assessments

Homocysteine

Nine consecutive patients with polyostotic Paget's disease of bone (PDB) (median age 66 years) received a single 5-mg zoledronic acid (ZOL) infusion. Twelve age-, gender- and BMI-matched healthy individuals were recruited for the control group at baseline assessment. Blood samples for HCY, folate, vitamin B(12), 25-hydroxyvitamin D (25-OH-D), total serum alkaline phosphatase (TSAP), bone-specific serum alkaline phosphatase (BSAP) and C-terminal cross-linking telopeptide of type I collagen (CTX) were obtained at baseline and 3, 6 and 12 months after ZOL infusion. Patients with PDB had significantly higher serum HCY (p = 0.028), folate (p < 0.001) and bone markers [TSAP (p < 0.001), BSAP (p < 0.001) and CTX (p < 0.001)] compared with the control group at baseline. In the pagetic group, serum HCY significantly decreased 3 months after ZOL infusion and remained essentially unchanged up to the end of the study (p = 0.005). Serum vitamin B(12) and folate remained unaffected throughout the study. Our data suggest that serum HCY levels are increased in patients with PDB. A single ZOL infusion results in a decrease in HCY levels that might represent another mechanism for the reduction of the activity of PDB achieved by ZOL. (Polyzos et al., 2010)

References

Funovics, P. T., et al. (2011), ‘Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma’, Int Orthop, 35 (10), 1529-36. PubMedID: 21249357

Nakamura, T., et al. (2013), ‘The prognostic value of the serum level of C-reactive protein for the survival of patients with a primary sarcoma of bone’, Bone Joint J, 95-B (3), 411-18. PubMedID: 23450030

Polyzos, S. A., et al. (2010), ‘Serum homocysteine, folate and vitamin B12 in patients with Paget’s disease of bone: the effect of zoledronic acid’, J Bone Miner Metab, 28 (3), 314-19. PubMedID: 19841860

Rajpar, S., et al. (2010), ‘Urinary N-telopeptide (uNTx) is an independent prognostic factor for overall survival in patients with bone metastases from castration-resistant prostate cancer’, Ann Oncol, 21 (9), 1864-69. PubMedID: 20181574

Ruza, E., et al. (2003), ‘Analysis of polymorphisms of the vitamin D receptor, estrogen receptor, and collagen Ialpha1 genes and their relationship with height in children with bone cancer’, J Pediatr Hematol Oncol, 25 (10), 780-86. PubMedID: 14528100

Tamiya, M., et al. (2013), ‘Prospective study of urinary and serum cross-linked N-telopeptide of type I collagen (NTx) for diagnosis of bone metastasis in patients with lung cancer’, Clin Lung Cancer, 14 (4), 364-69. PubMedID: 23276824

Yudoh, K., et al. (1996), ‘Prognostic value of the doubling time of serum C-reactive protein and alkaline phosphatase levels in primary bone and soft tissue tumors’, Jpn J Cancer Res, 87 (12), 1288-95. PubMedID: 9045965

Zahlten-Hinguranage, A., et al. (2006), ‘Preoperative elevation of serum C--reactive protein is predictive for prognosis in myeloma bone disease after surgery’, Br J Cancer, 95 (7), 782-87. PubMedID: 16969356

Chapter 2. Breast Cancer

Breast cancer is a malignant neoplasm in the breast. About 70% of all breast cancers possess a component of invasion.

Conventional Lab Tests

CBC with differential, Liver function and alkaline phosphatase

Tumor markers: CEA and CA15.3 or CA27.29

Estrogen and Progesterone Receptors, HER2 testing

Molecular profiling assays: Onco type Dx, MammaPrint

Additional Lab Tests

Fasting Glucose, Hemoglobin A1C

A meta-analysis was undertaken using a random effects model to investigate the association between diabetes and breast cancer risk. Thirty-nine independent risk estimates were available from observational epidemiological studies. The summary relative risk (SRR) for breast cancer in women with diabetes was 1.27 (95% confidence interval (CI), 1.16-1.39) with no evidence of publication bias. The risk of breast cancer in women with type 2 diabetes is increased by 27%, a figure that decreased to 16% after adjustment for BMI. No increased risk was seen for women at pre-menopausal ages or with type 1 diabetes. (Boyle et al., 2012)

A meta-analysis was conducted including 16 studies published between 2000 and 2010. The combined evidence supports that diabetes was associated with a statistically significant 23% increased risk of breast cancer, especially in postmenopausal women (RR=1.25 95%CI 1.20-1.29). The correlation between diabetes and breast cancer was the most obvious in Europe (RR=1.88,95%CI:1.56-2.25), followed by America (RR=1.16, 95%CI:1.12-1.20). (Liao et al., 2011)

Insulin Resistance, Metabolic Syndrome

975 patients were enrolled. Higher prevalence of metabolic Syndrome (MS) (35%) was found among postmenopausal women with breast cancer compared to postmenopausal healthy women (19%) [OR 2.16]. Hyperinsulinemia was detected in 7% of cases - OR 2.14 (95% CI 1.78-2.99) and only in 3% of controls. HOMA-IR score was elevated in 49% of cases compared to 34% of controls [OR 1.86], suggesting that insulin resistance can nearly double the risk of breast cancer development. (Capasso et al., 2013)

Nine articles (with 6,417 cancer cases), all published in English, were included in the meta-analysis. MS was associated with a 52% increase in cancer risk (P < 0.001)-for the most part confined to non-cohort studies. (Esposito et al., 2013)

The combined evidence supports a modest association between type 2 diabetes and the risk of breast cancer, which appears to be more consistent among postmenopausal than among premenopausal women. (Xue and Michels, 2007)

C-Reactive Protein (CRP)

A case-control study nested within the E3N prospective cohort included 549 postmenopausal breast cancer cases and 1,040 matched controls, all free of breast cancer at baseline. A statistically significant increase in breast cancer risk was observed in overweight and obese women (BMI >/= 25 kg/m(2)) (OR 1.92, 95 % CI 1.20-3.08 for CRP >/= 2.5 mg/L compared with CRP < 1.5 mg/l, p trend = 0.003, p interaction between CRP and BMI = 0.03). Similar results were observed in women with waist circumference (WC) >/= 88 cm (p trend = 0.01, p interaction = 0.06) and waist-to-hip ratio (WHR) >/= 0.80 (p trend = 0.06, p interaction = 0.35). CRP levels were not associated with breast cancer risk in women with normal BMI, WC, or WHR. (Dossus et al., 2014)

A total of 10 studies (n=4,502) were included for this meta-analysis (9 for OS, 3 for CSS, and 3 for DFS).