Full text of DOI:10.1007/BF02910978

The need persists for some clinically easy and simple test relatively less work has been done on the the study of
which can suggest cancer quite early even before the these enzymes in head and neck cancers.
patients become symptomatic, if performed during routine
physical checkup.
MATERIALS AND METHODS
The cases were divided into 2 groups :
Early detection of malignancy always have great
significance in cancer management.
Control Group - Consisted 20 cases age matched healthy
donors of both sexes.
A large number of biological markers for cancer are the
focus of ongoing research in the field of cancer
management as they can be used to screen, to aid in
differential diagnosis and to aid in therapy by determining
tumour burden.
Study group - Included 43 patients of histologically proved
patients of head and neck malignancy. Pre and post
therapeutic estimation of serum levels of PHI was done
in control group and study group by Bodansky (1954)
method. Post-therapeutic estimation of LDH was done
according to the type of therapy. The patients treated by
surgery estimations were done after two weeks of
surgery estimations were done after two weeks of surgery
while the patients treated by radiotherapy, serum enzyme
estimations were made one month after completion of
radiotherapy. Repeated serum enzyme estimations were
done in regular followup patients.
In present study an attempt is made to evaluate the
usefulness of estimation of serum levels of
phosphohexoisomerase- a diagnostic tool in cases of head
and neck cancers. PHI catalysis the reversible conversion
of glucose -6- phosphate to fructose-6-phosphate. It was
first discovered in skeleton muscles in 1933 by Ohm. PHI
activity in most body tissues is high relative to that of the
plasma. Liver and muscles containing more than 1000
times the activity of an equal quantity of serum. The
erythrocytes contain about 100 times as much as serum.
Control Group - The levels of serum PHI for the control
group ranged from 17.5 to 33.8 with mean of 22.40 ±
5
.20 unit/ml. The enzyme showed no difference in these
activity in relation to age and sex.
According to Bodansky (1961) three major factors
influence the passage of an enzyme into the serum from
tissues
OBSERVATIONS
The value of PHI levels for the patients of cancer was
significantly higher as compared to control group (Table -
I). There was 3 to 4 times increased in the mean serum
PHI activity in patients of head and neck cancer in present
study. Schwartz et al (1962) reported nearly 2 fold
increase while Goel et al, (1986) observed approximately
1
2
. Altered production of the enzyme by the tissue.
. The blocking of the pathway of normal secretion or
excretion of the enzyme by an organ.
. Change in the permeability or integrity of the tissues so
3
that the enzyme leaks out of the damaged cells and passes
into the extracellular fluid and then into the serum.
4
fold increase in serum PHI activity.
Normal serum levels of intracellular enzymes are produced
due to routine destruction of cells. Malignancy may be
the cause of accelerated cell death resulting in raised serum
PHI levels.
The highest mean serum PHI activity has been observed
in cancer nasopharynx may be because it is an hidden site
and patients report in very advance stage with cervical
metastasis. Vaid et al (1974) found serum PHI level raised
more significantly in patients of oral cancer : while Rao et
al (1976) found it to be least informative in oral cancer.
Contrary to present series, Bhatia et al (1979) observed
increased serum PHI activity only in 25% of cancer of
nose and PNS. Vaid et al (1974) reported significant serum
PHI rise in patients with Ca maxilla. This difference can
be explained by the fact that in series of Bhatia et al no
patient of malignancy nose and PNS had cervical
metastasis.
Warburg and Christian (1943) noted that the serum of
tumor bearing rats showed increased levels of glycolytic
enzymes. Various enzymes have been studied in malignant
conditions after this observation viz. alkaline and acid
phosphateses, 5’-Nucleotidase transaminases, isocitric-
dehydrogenase, phospho-glucomutase, phosphohexose
isomerase and alilsterase but most of these studies were
made in cases of cancers of breast, liver and prostate and

It seems that probably, the advancement of lesion Bhatia et al (1979) and Goel et al (1986) did not observed
influences, the serum PHI activity more than the mere any significant alteration in PHI level in relation to the
site of lesion. The mean serum PHI level was higher in histology of the tumor.
the patients with cervical metastasis (Table -II).
Initially the study was started with 43 patients but only 29
Bhatia et al (1979) also had observations similar to the patients (66%) completed their treatment. The clinical
present study. They concluded that alteration in serum response to the treatment was good in 4 patients. The
PHI level occurred more significantly in cancer cases mean serum PHI activities decrease significantly after
having cervical metastasis than in those without metastasis. treatment in patients who had good response. These values
This shows that the lymphatic spread in head and neck were comparable to the control group (Table-VI), while
cancer definitely affects the enzyme level in serum and its in patients who had poor response mean serum PHI levels
an indicator of metastatic growth.
rather increased slightly as compared to their pre-
therapeutic levels. These patients of poor response group
Results shows that there was no significant difference in had very advance serum, even at initial reporting and the
level of PHI 1.1 the ulcerative and proliferative growths disease probably continue to advance either at primary or
(
Table-Ill). These findings are consistent with the secondary site, irrespective to the mode of treatment.
observations of Goel et al (1986). However Bhatia et al
1979) reported higher serum PHI level in patients with As regard to site of lesion approximately 62% patients of
(
ulcerative growth than in proliferative growth.
cancer larynx had good response while all patients of
cancer oropharynx, nasopharynx and postcricoid region
In present study - the mean serum PHI activity in relation had poor response and accordingly the mean serum PHI
to TNM clinical staging (Table-IV) revealed that the activities altered.
increase was directly proportional to the advancement in
the stage of cancer. Goel et al (1986) had similar results. On comparing the mean serum PHI pre and post
On comparing serum PHI levels according to the therapeutic levels, according to the clinical stage it was
histological type of cancer it was observed in present study seen (Table-VII) that levels of these enzymes decreased
(
Table V) that most of patients (86%) studied had proportionately in relation to the clinical staging. In stage
squamous cell carcinoma. A significant rise in serum PHI IV the mean serum PHI levels though decreased as
level was found in lymphoepithelioma as compared to other compared to their pretherapy level yet were significantly
histological types.
higher than control level.
Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 53 No. I, January - March 2001

to site of lesion, clinical staging and mode of treatment. significant role in diagnosis of cancer, detection of residual
Repeated estimation of these enzymes in followup period growth, response to treatment and early detection of
is very informative as seen (Table-IX), in some of cases recurrence and secondaries.
in the present study. Case No. 4 though showed a good
clinical improvement after combined therapy i.e. REFERENCES
radiotherapy and surgery, but his serum enzymes level
continued to be higher which aroused us with the suspicion
of having either recurrence or distant metastasis and then
after detail clinical examination there was another primary
in tonsil region, by radiotherapy the tonsillar lesion also
regressed but, there was continuous rise in serum level of
these enzymes and subsequently patient had stomal
recurrence and secondaries in neck.
1. Bhatia, P. L., Singh, M. M. and Chakaravorty, M. (1979):
Enzymatic study in diagnosis of head and neck cancer. Indian J.
of Otolaryngology. 31 : 76-79.
2.
Bodansky, O., (1954) : Serum phosphohexose Isomerase in
cancer I : Method of determination and establishment of range
and normal values. Cancer. 7 : 1191 - 1199.
3.
Bodansky, O. (1954) : Serum hexose isomerase in cancer II, as
an index of tumor growth in metastatic carcinoma of breast.
Cancer. 7 : 1200- 1226.
4
.
Goel, H., Kohli G. S.. and Lai, H. (1986): Serum phosphohexose
isomerase levels in patients with head and neck cancer. J. of
Laryngology and Otology. 100 : 581-585.
In another interesting case (Case No. 15) after an adequate
surgical excision patient had presented but there was
significant fall in serum enzymes level and in subsequent
followup patient had a very good clinical response. These
observations showed that repeated estimation of these
enzyme levels in serum during followup period may help
in early detection of recurrence even before they are
clinically detectable.
5.
Priestman, T. J., (1977): Cancer chemotherapy, an introduction,
Montedison Pharmaceuticals Ltd., Herts. U. S. A. p. 22.
6.
Rao, Y. N., Chakravorty, M. and Khanna. N. N. (1976): Serum
phosphohexose isomerase in cancer. Indian J. of Cancer. 13 :
361-366.
7.
Schwartz, M. A., Walsh, s.. West, N. and Zimmerman, H.
J.( 1962 b) : Serum enzymes in diseases X.GIycolytic and
oxidative enzymes and transaminaes in patients with carcinoma
of head, neck and oesophagus. Cancer. 15 : 927-930.
Vaid et al (1974) also opined that serum enzymes level
came to normal only after complete excision of tumor
mass and their level will rise again with recurrence.
8.
Vaid, P., Sharma, D. C, and Shastri, K. D. (1974) : a
clinicobiochemical study of phosphohexose isomerase,
aliesterase and sulfhydral group in 25 normal and 35 cancer
sustpects. Indian J. of Cancer. 1 : 448 - 456.
Estimation of serum PHI levels is not a confirmatory test
for head and neck malignancy. Elevated levels of serum
PHI are also found in various other conditions like
myopathies, hepatitis, myocardial infarction etc. These
alterations in serum PHI levels are also known to occur in
the lung, breast and prostate cancers.
9. Warburg, O.. and Christian. W.(1943) : Ganengsfermente in
Blutdrumvon Tumor Ratten. Bio. Chem.Ztshr. 314 : 399-408.
Address by Correspondence
Dr. P. C. Verma
CONCLUSION
Zlo. Dr. Suresh Lalwani
However the estimation of this enzyme was found to have
K..24, Gandhi Nagar, Naka Madar, AJMER.