Tumour Cells in the Blood with Special Reference to Pre- and Post-Hepatic Blood

Abstract

BLOOD stream metastasis of malignant tumours has long been recognised. Over the years there have been sporadic reports of atypical cells in the blood of cancer patients but it is only with the advent of techniques for isolating different types of cells from whole blood by utilising minor differences in their gravity (Fawcett and Valle, 1952) that it has been possible to demonstrate definitely such tumour cells.Engell (1955) (1958) who refined this technique by layering the tumour cells at an albumin interface of known specific gravity after sedimentation of the erythrocytes with bovine fibrinogen.Our own work falls into two parts. We first of all investigated patients with a variety of tumours, but particularly with tumours of the parotid and breast. Having found that we were able to identify tumour cells both in the blood draining tumour sites and in the peripheral venous blood, we have attempted to determine to what extent tumour cells are filtered from the blood by the liver in patients either with primary gastro-intestinal carcinoma or with abdominal secondary deposits. METHODFor the second part of our studies blood was taken before and after it entered the liver. Fig. 1 demonstrates the way in which the post-hepatic samples were taken. A catheter is passed under fluoroscopy through the right side of the heart and into the right and then the left hepatic vein, and a 5 ml. sample of blood is taken from each vein. At the same time 5 ml. sample of peripheral blood is also taken. As it is difficult to take pre-and post-hepatic blood simultaneously at operation, the post-hepatic is taken pre-operatively. The pre-hepatic samples are taken at operation from the portal vein as soon as the abdomen is opened and with minimal handling of the tumour. Again a simultaneous 5 ml. of peripheral blood sample is taken.

Atypical Cells in the Peripheral Blood A Cytological Study Applied to Cancer Research

“…It may be explained partly by the fact that our studies were car ried out usually 24 to 48 h after the last clinical examination while most of the results reported by others are based on samples obtained dur ing or soon after the examination or handling of the tumor. The difficulty of finding such cells and the rigid criteria that must be applied make it impossible to include the identification of such cells as a routine laboratory test [1,21,57,58,66,80,82,83,87,92,100,104,114,119,124,127,128,132,134,158], In the search for cancer cells in peripheral blood the best results may be obtained by taking samples from blood vessels draining the tumor area [18,34,39,43,44,51,55,118,131,135,142,147]. In such blood our search had positive results in 75% of the cases.…”

Cancer Cells in the Blood Stream: Review and Personal Findings with the Fluorochrome Method

“…It should also be emphasized th at some reports deal with patients studied after surgery. Surgical procedures, according to some authors [15,16,19,32,42], tend to increase the frequency of circulating cancer cells, whereas the effect is the opposite according to others [7,36,52,61].…”

Circulating Cancer Cells in Peripheral Blood

“…lation. 12,[14][15][16][17][18][19] Although such cells are frequently detected in regional blood, probably due to surgical manipulation, they usually are not found in peripheral circulation. Some authors hypothesized that either the liver or regional lymph nodes could act as a barrier.…”