Prognostic value of microsatellite instability (MSI) and PTEN expression in women with endometrial cancer: results from studies of the NCIC Clinical Trials Group (NCIC CTG)

Abstract

AIM: The impact of PTEN status and microsatellite instability (MSI) on the prognosis of women with endometrial cancer is controversial. The aim of this study was to investigate MSI and PTEN expression in two patient populations using data from NCIC CTG studies.
METHODS: Archival paraffin embedded tumour from women with endometrial cancer enrolled in NCIC CTG studies: EN5 (stage I/II) and IND 126, 148 and 160 (advanced/recurrent disease) were examined for MSI using BAT25/26 and for PTEN expression using immunohistochemistry. PTEN and MSI status were correlated with clinicopathologic variables and survival using data from NCIC CTG trial databases.
RESULTS: PTEN and MSI results were available from 128 and 163 patients, respectively. MSI+ tumours were more common in women enrolled in EN5 compared to the IND studies (p=0.01). PTEN negative tumours were associated with improved survival in both univariate (hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.32-0.94; p=0.03) and multivariate (adjusted HR 0.54, 95% CI 0.30-0.96; p=0.03) analyses in women enrolled in IND studies. Microsatellite stable tumours were associated with an improved prognosis in univariate (HR 0.18, 95% CI 0.06-0.51; p<0.0001)>
CONCLUSIONS: PTEN negative tumours in women with advanced disease are associated with improved survival. MSI+ tumours are more common in early stage disease and in this group of women are associated with a worse prognosis

abstract: Will designated patient navigators fix the problem? Oncology nursing in transition

Abstract

With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.

abstract: Will designated patient navigators fix the problem? Oncology nursing in transition

Abstract

With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.

BRCA1 mutations and colorectal cancer in Poland

Abstract
Evidence to date that germline mutations in the tumor suppressor gene BRCA1 increase the incidence of colorectal cancer is mixed, and both positive and negative results have been reported. To establish whether or not inherited variation in BRCA1 influences the risk of colorectal cancer, we genotyped 2,398 unselected patients with colorectal cancer and 4,570 controls from Poland for three BRCA1 founder mutations (C61G, 4153delA and 5382insC). A BRCA1 mutation was present in 0.42% of unselected cases of colorectal cancer and in 0.48% of controls (OR = 0.8; P = 0.8). The mutation frequency was slightly higher (0.93%) in 321 cases who reported a family history of colon cancer in a first- or second-degree relative (OR = 1.9; P = 0.5). A BRCA1 mutation was also seen in excess (0.82%) in 851 cases who were diagnosed with colorectal cancer at age 60 or earlier (OR = 1.7; P = 0.3). The mean age at onset in carriers was 7 years younger than in non-carriers (57.0 years vs. 64.0) and the difference was significant (P = 0.05). This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer.

Mucosal carcinoma of the fallopian tube coexists with ovarian cancer of serous subtype only: a study of Japanese cases

Abstract
Previous studies in Western countries have revealed that mucosal carcinoma of the fallopian tube frequently coexists with pelvic (ovarian, tubal, and peritoneal) serous carcinomas, and early tubal carcinoma is now regarded as a possible origin of these tumors. However, the relationship between early tubal carcinoma and non-serous ovarian cancer, such as clear cell adenocarcinoma, has not been studied in detail. In this study, we sought to examine the coexistence of mucosal carcinoma of the fallopian tube in Japanese ovarian cancer cases. We submitted the fallopian tubes in toto for histological examination in 52 ovarian carcinoma cases and three peritoneal serous carcinoma cases. The ovarian tumors included 12 serous adenocarcinomas, 23 clear cell adenocarcinomas, nine endometrioid adenocarcinomas, three mucinous adenocarcinomas, and four mixed epithelial carcinomas. Mucosal carcinoma of the fallopian tube did not coexist with non-serous adenocarcinoma (n = 40). In contrast, mucosal carcinoma of the fallopian tube was observed in six cases of ovarian serous adenocarcinoma and one case of peritoneal serous adenocarcinoma. In these cases, the p53 immunophenotypes were similar in tubal lesions and invasive ovarian or peritoneal carcinomas. Tumors were negative for p53 in four of seven cases, and one of the p53-negative serous adenocarcinomas showed low-grade morphology. We believe that some ovarian and peritoneal serous adenocarcinomas develop from early tubal carcinomas. However, it should be noted that early tubal carcinomas are not always p53-positive immunohistochemically. Finally, it is unlikely that early tubal lesions are involved in the carcinogenesis of clear cell adenocarcinoma and other non-serous adenocarcinomas.

Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome

Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome
Neuroendocrine tumors (NETs)

NETs: A common and heterogenous group of solid malignant tumors »

Carcinoid tumors: A frequently occurring GI malignancy »

NETs: Survival rates are correlated with extent of disease and tumor differentiation »

The rising incidence of carcinoid tumors »

Sept 27th: Lots of Epogen and Procrit Recalled Due to Glass Flakes in Vials

"According to the manufacturer, the lamellae result from the interaction of the formulation with glass vials during the shelf life of the product. However, the company states that it has found that the lamellae have a low potential to affect patients who may have received the recalled product. "To date, there have been no complaints or adverse events reported which can be directly attributed to the presence of glass lamellae," the company notes."

eMedicine: Selective Serotonin Reuptake Inhibitors and CYP2D6: eMedicine Genomic Medicine (anxiety/depression)

Ovarian Cancer Tweets about........ selected slide re: OCATS/Regina conference

(full free access) Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada

Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada
 
O U R F I N D I N G S:

The Health Council of Canada is unable to conclusively determine if the use of family physician services has increased, decreased or remained stable over the past decade, despite a rise in the number of practising family physicians in Canada. This is due to the growing variety of physician practice models across the country and the way data are collected,(or not) to reflect the services provided.

Editorial :: Cochrane in the United States of America - The Cochrane Collaboration (background/2010 Keystone, Colorado conference)

 Note: The Gynecologic Cancer Review Group section of the Cochrane is based out of the UK. Consumer reviewers may participate irrespective of geographic location as the Cochrane is primarily internet-based.


"On 18 October 2010, the first joint Colloquium between the Campbell and Cochrane Collaborations opens in Keystone, Colorado, USA. The USA last hosted the Cochrane Collaboration Colloquium and annual meeting in 1998 in Baltimore, Maryland. The Colloquium's return to the USA comes on the heels of President Obama's signing of historic health care reform legislation. As reported, "the reforms, which will cost an estimated USD 940 billion over 10 years, will expand the provision of care to 32 million more people, predominantly the poorest, and will result in the country achieving 95% coverage" (MacAskill 2010). At the same time The American Recovery and Reinvestment Act of 2009 has provided USD 1.1 billion for Comparative Effectiveness Research (CER), and established the Patient-Centered Outcomes Research Institute (PCORI). PCORI will make a major annual investment in CER, through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

The US contribution to the development of The Cochrane Collaboration has been considerable. US-based researchers represented 7/84 (8.3%) of the pioneers attending the first Cochrane Colloquium in October 1993........."cont'd