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have been estimated in parallel with the CEA values in a wide spectrum of clinical stages in the evolution of colorectal cancer. A combination of yGT and CEA gave an improvement in the discrimination of hepatic metastases but this combination still appears to lead to error in some patients with residual diseases apparently confined to the pelvis. The rise in serum yGT is a more sensitive indicator of early metastases than AP or LAP, but once the level of yGT was above 100 i.u./ml (normal = 13-9 ± 7-7 i.u./ml) the rate of rise of AP and LAP parallel the increase of yGT. The rates of increase of these enzymes in advanced hepatic metastases have a fairly uniform course. On the other hand, the levels ofCEA are extremely variable and there is no simple correlation between the apparent extent of the metastases and the CEA level. Following individual patients by repeated measurements after the excision of the primary tumour has shown that the combination of CEA and yGT can indicate metastatic cancer several months before clinical examination. Furthermore, the treatment of advanced colorectal cancer with chemotherapy produces a fall in the yGT and the CEA values. Unfortunately, this combination of CEA and yGT is reliable as an indicator of hepatic metastases in only a few types of tumours. It failed to identify many forms of cancer that gave positive evidence of metastases on liver scintiscans. This preliminary experience has suggested that it may be possible to set up other combinations of tumour antigens and chemical indicators of organ site involvement to help in the surveillance of common forms of cancer. This may be particularly appropriate when suitable forms of chemotherapy are available to warrant early treatment.

Predictive tests in cancer. Tuesday 9 April 1974