In Japan, where gastric cancer is a vastly more prevalent public health problem, mass screening has seemed to result in earlier detection and a higher cure rate.
Excellent results has also been reported at the National Cancer Center Hospital, as the ratio of 5-year survival has reached 95.3% and that of 10-year survival 93.7% for cancer with submucosal invasion.
Inspite of the development of chemotherapy, it is fact that the effects against tumors and those for long-term survival still remain unsatisfactory in scirrhous carcinoma of the stomach.
With special reference to scirrhous carcinoma in the stomach, the author will attempt to dwell on the present status and problems posed for the clinical application and assesment of chemotherapy, factors producing an impact on the effect against for longer life.
The 109 patients chosen for this analysis were all those at the National Cancer Center Hospital who had histologically and photofluorographycally prove the inoperable scirrhous carcinoma originating in the stomach.
The median survival were 10.7 months from the onset of symptoms, 5.5 months from the diagnosis and 4.8 months from the initial chemotherapy. Long-term survival in the face of inoperable scirrhous gastric cancer was quite rare: 11% of patients were alive after 1 year, 1% after 2 years. The longest survival time occurred in a 39-years-old female who was found to have involving the entire stomach without the extent of metastatic involve-ment at the time of initial chemotherapy.
The median survival was uninfluenced by the sex of patient.
Among patients less than 30 years and a high PS score were associated with death within a relatively short time. The extend of metastatic involvement at the time of initial therapy also had the anticipated relationship to survival, with a progressive decrease as the disease advanced from regional to more diffuse nodal involvement or peritoneal implantation and to involvement of liver and lung.
The most commonly employed chemotherapy in our series is combination chemotherapy such as FAMT, FT-207 and MMC that has been able to induce a long survival than any single agents.

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The prognosis of the gastric cancer is affected by its serosal invasion, metastasis to lymph nodes, metastasis to distant organs and many other factors. The prognosis is de-termined by a single factor in rare case but some factors in many cases.
We experienced 272 cases of absolute curative operation among 423 cases of the opera-tive gastric cancer between 1968 and 1973. Among these 272 cases, 128 cases of advanced cancer were studied about the prognostic factors, except 119 early cases and 25 death cases by the other diseases.
In our results, the factors which aggravate the prognosis are 1) macroscopical invasive type of cancer, 2) wider exposure of macroscopical serosal invasion (especially 4.0 cm over exposed diameter), 3) deeper invasion of the gastric wall, 4) comparing with lymph nodes metastasis, such cases as no, ssγ over, n₁ (+), ssβ over and n₂(+) pm over, 5) some metastases in 2nd group of lymph nodes without another factors.

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Immunocompetence seems to play an important role in the development and growth of cancer in man. Maintenance of immuno-responsiveness has been associated with increased survival in patients with tumor.
In this study Immunocompetence is evaluated in the patients with cancer of the stomach in various stages of the disease.
Delayed hypersensitivity of skin reaction was detected applying purified protein deriva-tive of tuberculin (PPD) and phytohemagglutinin (PHA) as antigen. In in vitro assays the ratio of peripheral lymphocytes (T-cell and B-cell) is calculated dy the sheep red cell rosset forming method and PHA transformation of lymphocyte as mitogen is used to asses function of T-cell. These in vivo and in vitro tests were done preoperatively and on the 14th day after operation to asses effects of anesthesia, operation, chemotherapy and nutrition upon immune responce.
Statistical correlation between decrease of skin reaction and development of gastric cancer was found. PHA induced transformation assay demonstrated significant fall statisti-cally on patients with gastric cancer in any stage, which may indicate that the immune function is suppressed even in the patients of early stage of cancer. There is poor corre-lation of T-cell population of the peripheral lymphocyte in each stage of malignancy. Im-mune function was restored to the level of preoperation on the 14th day after operation except for diminishing T-cell subpopulation without statistical significance.

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Factors influencing the prognosis of progressive and recurring breast cancer were studied in 53 cases of progressive or recurring breast cancer who were treated with endo-crine ablative surgery over 10 years from 1969 to 1979 with special reference to whether endocrine ablative surgery could be applied in the presence of hepatic metastasis and how often hepatic metastasis would be seen after endocrine ablative surgery as well as to pos-sible development of diabetes as a complication, and the following results were obtained.
1) Remarkable hepatic metastasis makes the prognosis of endocrine ablative surgery poor.
2) Development of diabetes as a complication makes the effect of endocrine ablative surgery poor, occasionally leading to development of extensive infection or erosion around locally recurring skin metastasis and also to a poor prognosis.
3) Small lesions of hepatic metastasis do not affect the effect of endocrine ablative surgery or the prognosis as long as they are confined to such small ones about 2 cm in diameter and several in number as may not be detected until laparotomy.
4) If patients suffer a sudden aggravation of conditions which have long been main-tained after endocrine ablative surgery, they often present a rapid progress of hepatic metastasis, suggesting development of immunological and endocrinological abnormalities in the tumor-host relation.

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Out of 125 cases of renal cell carcinoma, in 24 cases in which bone metastasis was observed clinically a study was carried out in terms of the disease entity, treatment and prognosis. Bone metastasis was found initially in 17 cases, in 9 of which the diagnosis was established in the department of orthopedic surgery. In 7 cases bone metastasis was detected after nephrectomy. Radiologically the bone metastasis in our series was of osteolytic nature, and in none of the cases osteoplastic one was found. Bone metastasis was multiple in 16 cases and solitary in 8 cases. The most frequent site of metastasis was femoral bone following by costal bone and lumbar vertebra. Metastasis to the vertebra and pelvic bone accounted for 58% and that to the long bone 36% of all the cases. In 11 of 24 cases of renal cell carcinoma, in which bone metastasis was found, metastasis to the lung, liver and skin was observed. Removal of the kidney as the primary lesion was possible in 15 cases, while it was impossible in 9 cases. In the treatment of bone metastatic lesion the radiation therapy was used chiefly, being often combined with chemotherapy. Surgical treatment was used in only 5 cases, with the purpose to remove pain and to maintain functions.
The 5-yr survival rate after the diagnosis of metastasis was established was as low as 9.1%. However, in cases in which nephrectomy could be carried out, and in which bone metastasis appeared after nephrectomy, the survival period was found to be prolonged with relatively favourable prognosis. In cases where nephrectomy was impossible and multiple metastasis was found, the prognosis was very poor. From these findings, it was con-sidered that the resection of the kidney as the primary lesion may be sufficiently justified in cases of bone metastasis. In order to improve their survival rate, nephrectomy and treatment actively to the bone metastasis should be carried out whenever possible in patients with solitary osteolytic bone lesion.

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Ovarian carcinoma has been known as one of gynecological diseases with unfavorable prognosis, even stage 1 of ovarian cancer shows 5 year survival rate of only 50% while prognosis of cervical cancer has been remarkably improved. Therefore, examination of factors which appear to have influence on the prognosis of this diseases is highly important for its diagnosis and therapy. However, such factors are so much complex and diversified, that a number of points should be taken into consideration, i. e. the histological malignancy of tumor, classification of clinical stages, therapeutic effect, age and body protection mecha-nism. Many of these are still to be known due to biological singularity of cancer. Particu-larly, research on the body protection mechanism is just started, though it is the most significant problem from the clinical view-point. Therefore, a retrospective study of about 250 voluntary cases were conducted on factors to affect prognosis of ovarian cancer, in-cluding stage, histological type, histological malignancy, and therapy. The term “Ovarian cancer” is used here to mean adenocarcinoma of epithelial origin.
While it is obvious that more serious stage results in more unfavorable prognosis, it should be noted that even stage Ia gave considerably high mortality. Histological types were examined according to the Histological Classification by the International Union of Gynecology. It was found that endometrioid, mucinous type showed favorable prognosis, and serous, unclassified type gave poor results. High correlation was recognized between the histological malignancy and prognosis by applying the Takizawa's classification of infil-tration. Examination of therapeutic factor was made by pursueing prognosis after operation and radiological therapies. It gave a conclusion that adequate and individual treatments are necessary on the above factors to expect longer survival.

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Histological investigation of the cancerous extention in the surgical specimen will be not only a useful tool for the supposition of prognosis, but also gives us many important suggestions for the treatment of cancer. Now a trial was made to get useful informations on the treatment of cancer of the cervix by investigating the correlation between the prog-nosis and histological extention on a lot of cases of cancer of the cervix treated by radical hysterectomy with lymphnode dissection. Cancerous invasion in the parametrium, lymph-node, vagina, uterine body, fallopian tubes and ovaries was clarified and the importance of their spread as prognostic factor was estimated. Then several histological factors like vessel invasion, C. P. L. classification and etc. were evaluated in the relation with prognosis.
Main results are as follow: 1) Main route of the metastasis to the pelvic lymphnode is via the boundary zone located in the cervix and not via parametrium which was con-sidered as true previously. 2) The grade of cancerous extention is well correlated with prognosis. 3) The effectiveness and the limitation of surgical treatment was dearly demonstrated. Surgery has superior power in control of well localized cancer, but in a case of a little advanced cancer radiotherapy is preferable. 4) Histological investigation of the surgical specimen is the best tool for supposing prognosis and gives us good foundation for individualized postoperative irradiation.
These results give many fruitful informations in both surgical and radiological treatment of carcinoma of the cervix. We would like to conclude that the treatment of cancer of the uterine cervix should be individualized in the sense of better prognosis and less damage from now on.

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We know that we can measure the cancer patient's cellular immunity by the PPD. The ratio of the PPD negative patients increase relatively to the advancement of the stage of the cancer. As the prognosis of the PPD negative group is worse than that of PPD positive group in the same stage, we must consider the patients prognosis not only from the stage of the disease but also the view-point of the PPD reaction. The lymphocytes as well as T-cell decrease in number when the cellular immunity becomes poor in condition. conse-quently we may use them as the assistant parameter of the PPD test.
We believe that by the use of the therapy which changes PPD reaction from negative to positive and maintain this condition will prolong the patients life. Either the removal of the tumor or chemotherapy(i. A. ) improved the cellular immunity of the patients.
The PPD negative patients who are inoperable group in the stomach cancer stage-IV can not be treated effectively with unspecified-immunotherapy without the use of the chemotherapy(i.A.).
The timing methode in the cancer immunochemotherapy seems to be needed the PPD reaction as the index of the treatment point.

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A case of adenoid cystic carcinoma, which had originated from left submandibular gland resulting in multiple lung metastasis three years after onset was reported. But, the patient had been in good condition for more than two years after metastasis.
The patient was a 61-years-old female, who noticed a tumor 2cm in size at the left submandibular gland in 1974. The tumor was extirpated and revealed to be adenoid cystic carcinoma. It was recurred in 1975 and was excised again.
In July, 1977, the chest x-ray film revealed multiple lung metastasis. She had been treated with MMC, BLM, 5FU and OK 432 without success. In February, 1979, she was admitted again for local recurrence at oral cavity. Increased multiple nodular shadows were seen in chest x-ray film. Despite the multiple lung metastasis, she had not com-plained of noticeable symptom and also had no trouble in daily activities. She was following her condition as an outdoor patient.
In January, 1980, yet there was not any notable sign of lung metastasis. The growth rate of oral tumor was slow. She was well and did not look to be a carrier of multiple cancer metastasis.
In regard to adenoid cystic carcinoma including our case, slow progression of the disease might result from good tumor-host relationship. Now, we are investigating the immune mechanism of this disease.

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A-56-years-old male patient with carcinoma of the right tonsil was treated initially by irradiation, Linac x-ray 7, 000 rads, being combined with administration of anticancer drugs, Endoxan, Mitomycin-C and FT-207. But about 14 months after irradiation, the recur-rence of the carcinoma of the hypopharynx was found clinically. A few days later since the recurrence was observed, he suddenly complained of severe abdominal pain and dis-tension. At emergency operation, it was revealed that his complaints were caused by an acute diffuse suppurative peritonitis due to the perforation of the duodenal ulcer, from which he had never been suffered.
Fortunately, a month after the laparotomy, the ulcerated tumor in the right hypo-pharynx had disappeared macroscopically. Therefore he had been discharged without treatment regarding to the tumor of the hypopharynx.
However, nine months later he complained of difficulty of swallowing because of the recurrence of the tumor. And then total laryngectomy and excision of the tumor of the hypopharynx was performed.
We presumed that the tumor had regressed for nine months because his immunological reactivity was increased by the severe inflammation, namely, an acute diffuse suppurative peritonitis.

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Two cases of primary adenocarcinoma in the urinary bladder were reported. The first case was 61-years-old female who had about thumb tip sized tumor at posterior wall of the urinary bladder showing intestinal type of adenocarcinoma with prominent mucin production. Many signet ring cells were found in muconodular lesion. Cystitis glandularis was seen in non-tumorous mucosa of the urinary bladder. Histogenesis of this cancer was suspected of glandular metaplasia in urothelium.
The second was 79-years-old male who had little finger tip sized, infiltrating carcinoma at lateral wall of urinary bladder and followed recurrence. Histological examination revealed poorly differentiated adenocarcinoma without prominent mucin production. A part of this cancer showed the pattern of embryonal carcinoma and also transitional cell carcinoma. Regarding of histogenesis, tissue malformation in urinary bladder was rather suggested than glandular metaplasia. Urachal origin was denied in both cases because of localization.

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A rare case of bladder tumor of 72-years-old woman is reported.
Papanicolaou's staining of urinary sediment showed loosely packed clump of small atypi-cal cells with granular chromatin and large eosinophilic nucleoli.
Histolbgical finding is undjfferentiated transitional cell carcinoma with sarcoma like pattern.
Sarcoma like tumor cell is surrounded by reticulin fibers.

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There are 592 primary cases of cancer of the breast which have undergone operation at the Shikoku National Cancer Center Hospital in the past 13 years.
Using 328 cases which underwent operation more than five years earlier as the subject, we studied the significance, indication and influence of the postoperative irradiation.
The survival rate was slightly better in the non-irradiation group (73 cases) than the irradiation group (255 cases), with the 5-year survival rate being 75.0% for the former and 71.6% for the latter and the 10-year survial rate 68.6% and 62.8% respectively.
When compared by the stage of illness, however, there was no difference between the two group.
The case of recurrence in the field of irradiation, particularly recurrence in the para-sternal region was few in the irradiation group. Edema in the upper limb, pain and motor disturbance were often found in the irradiation group.
Postoperative irradiation has no advantage when viewed from the survival rate, but can be expected to prevent recurrence in the irradiated area to some extent.
The incidence of parasternal lymph node metastasis is high in cases in which there are more than four metastases to axillary lymph nodes and the primary lesion measures than 5.1cm and is located on the medial side or in the center, judging from results of removal of parasternal lymph nodes in 414 cases.
Postoperative irradiation to the parasternal region and supraclavicular fossa appears necessary in such cases.

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