Some significant chemical changes in the blood coincident with malignant tumors

Abstract

With the view of ascertaining the systemic effect of malignant neoplasms upon the organism, a series of sixty cases of various types of malignancies have been studied and contrasted with benign tumors. The data accumulated comprise determinations of the uric acid, urea, creatinine, sugar, diastatic activity and carbon dioxide combining power of the blood; the phthalein excretion; the occurrence of proteinuria and casts; and the blood pressure.

Two thirds of our cases of malignancies present evidence of an impairment of kidney function. The appearance and progress of this renal insufficiency follows the order characteristic of interstitial nephritis, described by Myers and his co-workers. The nitrogenous waste product first to be retained is uric acid, later urea and finally creatinine, and paralleling the accumulation of these nitrogenous substances there was noted a drop in the carbon dioxide combining power of the blood. A hyperglycemia and an increased diastatic activity pointing to a lowered carbohydrate tolerance, were encountered only in those cases manifesting a nitrogen retention, and as this retention became more marked, the hyperglycemia and increased diastatic activity kept pace with it. Apparently, then, the hyperglycemia and lowered carbohydrate tolerance, as gauged by the diastatic activity of the blood, must be attributed not specifically to the malignant newgrowth but rather to the impairment of renal function. A further evidence of this impairment of kidney function was furnished by the decreased phthalein excretion, and the presence of protein and casts in the urine. Hypertension was noted in only a few instances.

This renal involvement was found to be associated invariably with general carcinomatosis; in 90 per cent. of carcinomata of the bladder, prostate, uterus and rectum and in about 50 per cent. of gastric carcinomata. On the other hand, carcinomata of the breast and epitheliomata produced no such changes. Of the small number of sarcomata coming under our observation, but one, a sarcoma of the kidney, disclosed a renal impairment.