الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common female malignancy. Its treatment may be physically and emotionally disfiguring, because it affects a sexual important part of the body. In Egypt, breast cancer ranks firstly among female malignancies and accounting for about 40% of female cases presenting to National Cancer Institute (NCI). Breast cancer accounts for about 30% of cancer deaths in women in developed countries and about 15% in developing countries. The magnitude of the breast cancer problem emphasizes the need to determine the best possible predictor of prognosis. The ultimate goal of clinical prognostic parameters is to provide information that will allow the physician to appropriately tailor therapy to the specific circumstances and needs of each patient, to maximize the response, to minimize the hazards, morbidity and to lessen the cost. The present study aims to assess serum levels of BALP, CA 153, TGF?1 and PTHrP in patients located into two different stages of breast cancer (stages II and IV) in order to evaluate the role of these substances in the development and pathogenesis of bone metastases which are usually associated with the advanced stages of breast cancer. This study was performed on 66 patients with breast cancer. They were classified into: a)?Group I: consisted of 42 patients with stage II breast cancer with age ranged between 2570 years with a mean(R+(BSE of 48.05(R+(B1.48 years. b)?Group II: consisted of 24 patients with stage IV breast cancer (metastases) with age ranged between 3065 years with a mean(R+(BSE of 45.96(R+(B1.46 years. This group was further classified into 2 subgroups: ??The first subgroup included 12 patients with bone metastases with age ranged between 3465 years with a mean(R+(BSE of 47.83(R+(B2.41 years. ??The second subgroup included 12 patients with the non bone metastases with age ranged between 3054 years with a mean(R+(BSE of 44.08(R+(B1.58 years. All the cases involved in this study were clinically, radiologically and pathologically examined in the outpatient clinics of the Mansoura University Hospital. The control group consisted of 12 apparently healthy subjects. Red blood cells, white blood cells and platelets were counted by hemocytometer apparatus. Hematocrit value was obtained by Wintrobe method. Hemoglobin concentration was determined by colorimetric method. Serum was used for colorimetric estimation of liver function tests (serum ALT & AST activities total protein, albumin & globulin levels, A/G ratio and total alkaline phosphatase level), kidney function tests (serum creatinine and uric acid levels) and bone metabolism markers (serum calcium, phosphorous and bone specific alkaline phosphatase levels). Serum CA 153, TGF?1 and PTHrP levels were determined by enzyme linked immunosorbent assay (ELISA). The first morning urine samples were collected from patients and were subjected to estimation of urinary calcium/creatinine & phosphorous/creatinine ratios and the incidence of proteinuria. Breast cancer patients showed significant decrease in RBCs count, Hb concentration and HCT value as compared to control subjects. The RBCs count of bone metastases patients showed a significant decrease when compared with non bone metastases patients. White blood cells and platelets count decreased significantly in breast cancer patients as compared to control subjects. Regarding liver function tests, serum ALT and AST activities increased significantly in breast cancer patients. Stage IV showed more significant increase especially in non bone metastases group. Serum total protein and albumin concentrations and A/G ratio showed a significant decrease in breast cancer patients as compared to control subjects. Non bone metastases patients showed the most significant decrease in these levels. Non bone metastases patients only showed a significant increase in serum globulin level as compared to control subjects. Concerning kidney function tests, breast cancer patients showed a significant increase in serum creatinine and uric acid concentrations as compared with control subjects. There was a significant increase in the incidence of proteinuria in breast cancer patients as compared with control group. Regarding bone metabolism markers, hypercalcemia occurred in 23.8% of the subjects in stage II while in stage IV it was observed in about 50%. Serum calcium and urinary calcium/creatinine ratio increased significantly in breast cancer patients. The increase in urinary calcium/creatinine ratio was significant in stage IV bone metastases as compared with stage II patients. Serum phosphorous level of breast cancer patients showed a significant decrease in comparison with control subjects. On the other hand, urinary phosphorous/creatinine ratio increased significantly in breast cancer patients. The most marked elevation was found in bone metastases patients. Only stage IV showed a significant increase in serum alkaline phosphatase as compared to control subjects, while both stages II and IV showed a significant increase in serum BALP levels as compared to control subjects. Bothalkaline phosphatase and BALP levels of bone metastases patients extremely increased in comparison to the other patients. Also, the hypercalcemic patients with bone metastases showed a significant increase in serum alkaline phosphatase as compared with the corresponding normocalcemic patients of the same group. Concerning tumor markers, both stages II and IV showed a significant increase in serum CA 153 level when compared to control group. Also, marked significant increase in serum CA 153 was observed in stage IV patients as compared to stage II patients. Serum TGF?1 level increased significantly in breast cancer patients when compared with control subjects. Serum TGF? levels in stage II and stage IV bone metastases increased in hypercalcemic patients when compared with the control subjects. Serum PTHrP level increased significantly in breast cancer patients as compared to the control subjects. Bone metastases patients showed a significant increase in comparison to stages II and IV no