الفهرس 
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Abstract
Primary lung cancer is the most leading cause of cancer deaths in most industrialized countries, and non-small-cell lung cancer (NSCLC) accounts for 75–80% of primary lung cancer. Tumor node metastasis (TNM) factors are generally used in the evaluation of tumor progression, and nodal involvement (N-factor) as well as distant metastasis (M-factor) is the critical factor to determine the prognosis of NSCLC (Mountain, 1997; Naruke et al, 1998; Tanaka et al, 2000). In addition, some clinical studies demonstrated that lymphatic invasion is also a prognostic factor in NSCLC (Macchiarini et al, 1993; Brechot et al, 1996). Thus, lymphatic spread is a critical factor to determine the progression and prognosis.
The present study was designed to asses serum vascular endothelial growth factor –C(VEGF-C) in diagnosis of lymph node metastasis in patients with primary non-small cell lung cancer (NSCLC)and if VEGF-C could give additional information for discrimination between the absence and the presence of lymph node metastasis and also Bcl-2and nitric oxide concentrations for early detection of lung cancer.
To fulfill the target of this study, a total of 50 male subjects were included and classified into two groups:
- The control group (group 1) which included 15 subjects (healthy persons) their ages ranged from 34 – 69 years old with a mean value of 47.1 years old (±10 SD).
-The NSCLC group (group 2) included 35 subjects; their ages ranged from 41 – 72 years old with a mean value of 58.2 years old (±7.2 SD) which were then subdivided into two subgroups:
•Subgroup 2a NSCLC with lymph node metastasis.
•Subgroup 2b NSCLC without lymph node metastasis.
The NSCLC group had primary tumor M0 (with no distant metastasis).
In the NSCLC patients the tumor was in the right lobe in 20 of them (57%), where 15 in the right upper part, 2 in the right middle part and 3 in the right lower part, while 15 patients of the NSCLC patients had the tumor in the left lobe (42.8%) as 6 had tumor in the left upper part of the lung and 9 in the left lower part of the lung.
The stages of the disease were:
Eleven patients at stage IA and 6 patients at stage IB, 3 at stage IIA and 2 at stage IIB, 13 at stage IIIA.
Total leukocytic count, Red blood cells count, ESR,S.AST,S.ALT,BUN,and S.creatinine were assayed for all the studied groups.
Serum VEGF-C and S.Bcl-2 were analyzed using ELISA technique. Serum nitric oxide was analyzed colorimetrically.
Results obtained from this study demonstrated that:
1. The WBCs in the NSCLC group exhibited non- significant increase, and when NSCLC with lymph node metastasis (subgroup 2a) was compared to NSCLC without lymph node metastasis (2b) there was also a non-significant increase.
2. The RBCs in the NSCLC group significantly decreased compared to the control group, when NSCLC with lymph node metastasis (subgroup 2a) was compared to NSCLC without lymph node metastasis (2b), there was a non-significant increase.
3. ESR highly significantly increased in the NSCLC group compared to the control group, when NSCLC with lymph node metastasis (subgroup 2a) was compared to NSCLC without lymph node metastasis (2b) non-significant change was observed.
4. AST and ALT non- significantly increased in the NSCLC group compared to the control group and also in NSCLC with lymph node metastasis (subgroup 2a) when compared to NSCLC without lymph node metastasis (2b).
5. BUN non-significantly increased in the NSCLC group compared to the control group and also in NSCLC with lymph node metastasis (subgroup 2a) when compared to NSCLC without lymph node metastasis (2b).
6. Creatinine in the NSCLC group decreased non- significantly compared to the control group .In NSCLC with lymph node metastasis (subgroup 2a) when compared to NSCLC without lymph node metastasis (2b) non-significant increase was observed.
7. Serum nitric oxide concentration increased significantly in NSCLC group compared to the control group and also in NSCLC with lymph node metastasis (subgroup 2a) when compared to NSCLC without lymph node metastasis (2b).
8. Serum Bcl-2 in NSCLC significantly increased compared to the control group, when NSCLC with lymph node metastasis (subgroup 2a) was compared to NSCLC without lymph node metastasis (2b) there was non-significant increase in Bcl-2.
9. Serum VEGF-C concentration increased significantly in NSCLC group compared to the control group and also in NSCLC with lymph node metastasis (subgroup 2a) when compared to NSCLC without lymph node metastasis (2b).
Among the studied parameters there was a significant positive correlation between RBCs and S.AST and between S.VEGF-C and S.NO among NSCLC group, also significant positive correlation was found between S.Bcl-2 and RBCs among the control group.
Results obtained from this study demonstrate that S.NO, S. Bcl-2 and VEGF-C significantly increased in NSCLC patient group, comparing NSCLC with lymph node metastasis (subgroup 2a) to NSCLC without lymph node metastasis (2b) S. Bcl-2 was non-significantly changed but VEGF-C and S.NO were significantly increased.