A review of the most relevant clinical data of patients with primary carcinoma of the gall bladder referred to our hospital over a 16-year-period has indicated that this is the third most common and aggressive cancer of the gastrointestinal tract. The disease occurs predominantly in elderly females who often present with extremes of clinical symptoms indicating benign biliary disease on the one hand and incurable malignant disease on the other. Laboratory and roentgenographic data tend to confirm the clinical diagnosis of this almost entirely incurable disease. The overall 5-year survival of the patients with primary carcinoma of the gall bladder is less than 1%; a majority of the patients are dead in less than 6 months.

Serum copper, zinc, and the Cu/Zn ratio were measured in 55 patients with breast disease (20 with benign breast diseases and 35 patients with breast cancer) and 30 controls. The mean serum copper levels were higher in breast cancer than in benign breast diseases (167.3 micrograms/dl vs. 117.6 micrograms/dl) (P less than 0.001) and controls (167.3 micrograms/dl vs. 98.8 micrograms/dl) (P less than 0.001). Patients with advanced breast cancer had higher serum copper levels than did patients with early breast cancer (177.9 micrograms/dl vs. 130.4 micrograms/dl) (P less than 0.001). The mean serum zinc levels were lowered only in patients with advanced breast cancer as compared with controls (88.6 micrograms/dl vs. 115.1 micrograms/dl) (P less than 0.001). Serum zinc levels were not decreased in patients with early breast cancer and benign breast diseases. The Cu/Zn ratio was increased in breast cancer patients (1.91 vs. 0.86) (P less than 0.001) but not in patients with benign breast diseases. The precise mechanisms responsible for the alterations in trace element levels in breast cancer patients are still unclear and require further evaluation. However, the serum copper levels and the Cu/Zn ratio may be used as biochemical markers in these patients.

Serum copper, zinc, and Cu/Zn ratio were measured using atomic absorption spectrophotometry in 30 patients with colorectal cancer and compared with 30 healthy control subjects. In the patients with colorectal cancer, the tissue copper and zinc levels were also measured in paired histologically normal and malignant colorectal tissue samples obtained at surgery. The mean serum copper levels were higher in patients with colorectal cancer (165.99 vs. 98.84 micrograms/dl) (P < 0.001). The mean serum zinc levels were lowered only in advanced (Dukes stages C and D) colorectal cancer compared to controls (89.94 vs. 115.08 mu/dl) (P < 0.001). However, the Cu/Zn ratio progressively increased with the advancing stage of malignancy (1.86 vs. 0.86) (P < 0.001). The cancerous colorectal tissue showed a higher concentration of both copper (2.78 vs. 1.79 micrograms/g) (P < 0.001) and zinc (27.16 vs. 18.98 micrograms/g) (P < 0.01) compared to non-cancerous colorectal tissue. The exact mechanism responsible for the alterations in trace element levels in patients with colorectal cancer is largely unclear and requires further evaluation. However, the serum copper level and the Cu/Zn ratio are of value in estimating the extent of the carcinoma as well as in determining the prognosis of these patients.

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