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October 1980, Volume 30, Issue 10

Original Article

PLASMA VITAMIN A AND CAROTENE LEVELS IN RELATION TO THE CLINICAL STAGES OF CARCINOMA OF THE ORAL CAVITY AND OROPHARYNX

N.A. Chaudhy  ( Department of Pathology, Punjab Medical College, Faisalabad. )
N.A. Jafarey  ( Department of Pathology, B.M.S.I. Jinnah Postgraduate Medical Centre, Karachi. )
K. Ibrahim  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )

Abstract

Mean plasma vitamin A and carotene levels were significantly lower (P<0.01) in carcinoma patients as compared to controls. The plasma vitamin A and carotene levels showed a steady decline with the advance of the disease. Whether vitamin A plays some role in carcinogenesis needs further investigation (JPMA 30:221, 1980).

Introduction

It is known that vitamin A is involved in the maintenance of certain types of epithelia. In the hamster cheek pouch, vitamin A deficiency resulted in a high incidence of squamous tumours following topical application of dimethylbenzan-thracene (Rowe and Gorlin, 1959) whereas the topical application of vitamin A pellet induced metaplasia of mucous glands (Lawrence et al., 1960). Vitamin deficiency also resulted in squamous metaplasia which resembled that induced by chemical carcinogens (Deluca et al., 1969).
In human beings, vitamin A deficiency had been found to be associated with carcinoma of esophagus and stomach (Abies et al., 1941; Basu et al., 1974) and carcinoma of the bronchus (Basu et al., 1976). Subnormal levels of vitamin A have also been reported in carcinoma of the oral cavity and oropharynx (Wahi et al., 1965; Jafarey et al., 1974).

Material and Methods

The study was conducted in 52 biopsy proven patients of carcinoma of the oral cavity and oropharynx. The lesions were clinically studied as recommended by the American Joint Com­mittee (1967) for cancer staging and results reporting.
Forty nine age, sex and socio-economically matched controls free from any systemic dis­ease, Avere also selected for the study.
Six milliliters of blood were drawn from the cephalic vein of patients as well as controls using heparin as an anticoagulant. Plasma was separated by centrifugation. Carr-Price method with modification (Kimble, 1939; Kesser and Sketol, 1943) for photocolorimetric determinations of plasma vitamin A and carotene was used. The plasma vitamin A and carotene levels were grouped according to criteria used in WHO studies (Jellife, 1960).

Results

The plasma vitamin A and carotene levels in carcinoma patients and controls are shown in Table I.


Statistical analysis showed that the mean plasma level of vitamin A and carotene was significantly lower in carcinoma patients as compared to controls.


Table II shows the classification of vitamin A and carotene levels. It is evident that according to the ICNND criteria, majority of the cases of carcinoma and controls had acceptable values of vitamin A (20-50 ug%). However, significantly greater (P<0.01) number of the carcinoma cases were in the low range of vitamin A (10-19 ug%) when compared with controls, whereas none of carcinoma cases had high levels of vitamin A (above 50 ug). Nevertheless, the carcinoma patients differed significantly (P<0.01) from controls.
The number of carcinoma cases that showed acceptable plasma carotene levels was signi­ficantly lower (P<0.05) as compared to controls. The number of carcinoma cases with low- range of plasma carotene (20-39 ug% )were significantly higher (P<0.0l).
The relationship between clinical staging of carcinoma patients and mean plasma vitamin A and carotene levels has been shown in Fig. 1.

Mean plasma vitamin A and carotene levels showed a fall with the advancement of disease.

Discussion

The significantly lower levels of plasma vitamin A and carotene in patients of carcinoma of the oral cavity and oropharynx observed in this study are in agreement with previous reports. Abies et al (1974) reported subnormal levels of plasma vitamin A in 36% patients of carcinoma of gastrointestinal tract. A high incidence of reduced vitamin A levels was also found in plasma of patients with other malignant diseases. Deficient vitamin A levels have been reported in patients with carcinoma of the stomach and oesophagus (Basu et al., 1974) and in bronchial carcinoma patients (Basu et al., 1976). Similarly in patients with carcinoma of the oral cavity, low or subnormal vitamin A levels have also been reported (Jafarey et al., 1974).
Furthermore, the plasma vitamin A and carotene levels showed a steady decline with the advance of the disease (Fig. 1). However, the association observed between low plasma vita­min A and carotene levels and carcinoma of the oral cavity and oropharynx, especially declining levels within the advance of the disease need careful elaboration whether:
1. Low vitamin A and carotene levels are due to lesion in the oral cavity leading to generalized malnutrition.
2. Vitamin A has direct effect on the target cells since vitamin A deficiency in experimental     animals resulted in decrease in goblet cells and squamous metaplasia and marked keratinization (Pappenleimer and Larimore, 1924; Moore, 1967; Deluca, 1969).
3. Vitamin A deficiency indirectly enhances the cellular growth by depressing immunity as vitamin A has been suggested to have definite influence on lymphoid organs and immune    responses (Jurin and Tannock, 1972; Leutskaia, 1973; Krishman et al., 1974; Sherwani, 1979).

References

1. Abies, J.C., Gorham, A.T., Pack, G.T. and Rhoads, C.P. (1941) Metabolic studies in patients with cancer of the gastro-intestinal tract. 1. Plasma vitamin A levels in patients with malignant neoplastic disease particular of gastrointestinal tract. J. Clin. Invest., 20:749.
2. Basu, T.K., Raven, R.W., Dickerson, J.W. and Williams, D.C. (1974) Vitamin A nutrition and its relationship with plasma cholesterol level in patients with cancer. Int. J. Vitam. Nutr. Res., 44:14.
3. Basu, T.K., Donaldson, D., Jenner, M., Williams, D.C. and Sakula, A. (1976) Plasma vitamin A in patients with bronchial carcinoma. Br. J. Cancer, 33:119.
4. Deluca, L., Little, E.P. and Wolf, G. (1969) Vitamin A and protein synthesis by rat. intestinal mucosa. J. Biol. Chem., 244:701.
5. Jafarey, N.A., Vahidy, N.A., Zaidi, S.H.M. and Rahman, A. (1974) Serum vitamin A levels in cases with carcinoma of the oral cavity. A preliminary report. Pakistan J. Med. Res., 13:37.
6. Jellife, D.B. The assessment of the nutritional status of the community, WHO monograph Ser. No. 53. Geneva, WHO, 1966, p. 88.
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8. Kaser,M. and Sketol, J.A. (1943) A critical study of the Carrprice reaction for the determination of B-carotene and vitamin A in biological materials, J. Lab. Clin. Med., 28:904.
9. Kimble, M.G. (1939) The phofocolorimeteric determination of vitamin A and carotene in human plasma. J. Lab. Clin. Med., 24:1055.
10. Krishman, S., Bhuyan, U.N., Talwar, G.P. and Ramaling-aswami, V. (1974) Effect of vitamin A and protein-calorie undernutrition on immune responses. Immunology, 27:383.
11. Lawerence, D.J., Bern, H.A. and Steadman, M.G. (1960) Vitamin A and keratinization. Studies on hamster cheek pouch. Ann. Otol., 69:645.
12. Leutskaia, Z.K. (1973) Experimental study on the role of vitamin A in antibody formation. Med. Parazitol. (Mosk), 42:542.
13. Moore, T. Effect of vitamin deficiency in animals. In the vitamins, edited by W.H. Sebrell and Robert S. Harris, 2nd ed. New York, Academic Press, 1967, vol. 1, P. 245-266.
14. Pappenheimer, A.M. and Larimore, L.D. (1924) The occurrence of gastric lesions in rats. Their relationship to dietary deficiency and hair ingestion. J. Exp. Med., 40:719.
15. Rowe, N.H. and Gorlin, R.J. (1959) The effect of vitamin A deficiency upon experimental oral carcinogenesis. J. Dent. Res., 38:72.
16. Sherwani, M.I.K. (1979) Studies on the effect of vitamin A deficiency on humoral immunity. Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisal-abad. M.Sc. thesis.
17. Wahi, P.N., Kehar, U and Lahiri, B. (1965) Factors influencing oral and oropharyngeal cancers in India. Br. J. Cancer, 19:642-

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