text/video: Can Aspirin Reduce Risk for Cancer Metastasis? Cancerwise/MD Anderson

Can Aspirin Reduce Risk for Cancer Metastasis?: Results from a report released today in a leading medical journal indicate that low dose daily aspirin reduces the risk of metastasis of several cancers. According to articles in The Lancet, the protective effect occurs within 3-5 years of beginning aspirin use.

Read more about the study in a post from our Cancer Frontline blog.

Raymond DuBois, M.D., Ph.D, MD Anderson's provost and executive vice president and a professor of cancer biology and cancer medicine, shares his insights on the study's significance and addresses questions about aspirin dose, and how cancer patients should respond to this news.

ECCO: MRI screening for women with a family history of breast cancer

MRI screening for women with a family history of breast cancer

 MRI screening for women with a family history of breast cancer but no genetic predisposition is expensive but could be cost-effective for some

DNA donor rights affirmed : Nature News & Comment

DNA donor rights affirmed : Nature

NIH committee urges that genome study subjects be told of medically relevant results.

"It is a familiar scenario in genetic research: a subject's DNA is collected for one study, deposited in a database or biobank and then analysed by other researchers for separate studies. But what happens when a later study stumbles on something that could be of significance for the donor, such as an allele for familial hypercholesterolaemia — a treatable genetic disorder that causes progressive atherosclerosis — or some other health-related variation? Do researchers conducting secondary studies and biobanks have a duty to share such revelations with the original research subjects?

They do, when possible, according to a detailed consensus statement from a working group funded by the US National Institutes of Health (NIH) in Bethesda, Maryland, and published this week (S. M. Wolf et al. Gen. Med. http://dx.doi.org/10.1038/gim.2012.23; 2012). The statement's 26 signatories consulted dozens of other researchers and biobank managers over a two-year period. They conclude that biobanks “shoulder significant responsibility” for addressing how to deal with 'incidental findings' — those research results that could have medical consequences for the donors of genetic material.

Genetic testing is increasingly

coming up with 'incidental

findings'.

Genetics researchers are divided on the matter of incidental findings......"

press release: Canada, Australia and New Zealand establish a new research partnership - CIHR

Canada, Australia and New Zealand establish a new research partnership - CIHR

Ottawa (March 20, 2012) – The Canadian Institutes of Health Research (CIHR), the Australian Primary Health Care Research Institute (APHCRI) at the Australian National University and the Health Research Council of New Zealand (HRC NZ) are partnering to fund research on innovative models of Community-based Primary Healthcare (CBPHC). As part of CIHR's Signature Initiative, funded teams will examine how to better prevent and manage chronic disease, as well as improve access to care for vulnerable populations.
Recognizing that innovative research in CBPHC is essential to better health outcomes, improved equity, reduced wait times, and an improved patient experience, the partners have agreed to support cross-jurisdictional Canada-Australia and Canada-New Zealand teams of researchers, patients, decision-makers and clinicians.
"This collaborative research between Canada, Australia, and New Zealand will allow our three countries to test different models of primary healthcare", said Dr. Beaudet, President of CIHR. "The international best practices that emerge will benefit our healthcare systems and, most importantly, contribute to better health outcomes."
...........cont'd

(open access journal) Journal of Ovarian Research - Struma Ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report (Iran)

Journal of Ovarian Research -  Struma Ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report

Case report

Struma Ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report

Journal of Ovarian Research 2012, 5:10 doi:10.1186/1757-2215-5-10
Published: 21 March 2012

Abstract (provisional)

Struma ovarii is a rare form of ovarian neoplasm in a form of mature teratoma and is composed predominantly of thyroid tissue. In the literature review, there has only been 10 cases of this tumor, associated with ascites and pleural effusion (Meig's Syndrome) and increased CA125 so far. In such cases, the tumor mimics malignant ovarian tumor. In this article, the case of a 72-year-old symptomatic woman with a pelvic mass, pleural and peritoneal effusion and high level of serum CA125  (607.4)  is presented. Cytological evaluation for the pleural fluid was performed. She underwent hysterectomy and bilateral salpingo-oophorectomy. The result of pathologic diagnosis is presented in this paper. The patient was well in postoperative period and paraclinical tests including CA 125 were normal as well.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Case Reports in Oncology - Journal Home (Editor: M. Markman - open access journal)

Case Reports in Oncology - Journal Home

Editor(s): Markman M.  (Philadelphia, Pa.)

book review: The Caregiver's Bookshelf: Dying by Degrees - NYTimes.com

The Caregiver's Bookshelf: Dying by Degrees - NYTimes.com
  
The Caregiver’s Bookshelf: Dying by Degrees

By PAULA SPAN

 

Ira Byock has been writing books about the way Americans die since 1998, when he published “Dying Well.” For most of that time, he has been appalled.

He still is. Dr. Byock, director of palliative medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., pulls no punches in his new book, “The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life.” The American way of dying, he points out, involves too much suffering for both patients and families, and routinized medical response with not enough individualized care. It means not enough listening, not enough support for families, way too much expense. “A national disgrace,” the author calls it in his introduction..........

abstract: Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy - Reeves - 2012 - Cancer - Wiley Online Library

Blogger's Opinion: since this journal is a publication of the ACS then open access should be mandated

Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy

Abstract

BACKGROUND:

Paclitaxel causes an acute pain syndrome (P-APS), occurring within days after each dose and usually abating within days. Paclitaxel also causes a more classic peripheral neuropathy, which steadily increases in severity with increasing paclitaxel total doses. Little detail is available regarding the natural history of these 2 syndromes, or any relationship between them, although a recent publication does provide natural history data about weekly paclitaxel, supporting an association between the severity of P-APS and eventual peripheral neuropathy symptoms.

METHODS:

Patients entering this study were about to receive paclitaxel and carboplatin every 3 weeks. Daily questionnaires were completed for the first week after every chemotherapy dose, and European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Chemotherapy-Induced Peripheral Neuropathy 20-item instruments were completed weekly.

RESULTS:

The P-APS severity peaked on day 4 after the initial chemotherapy dose, with 12%, 29%, 23%, and 36% of patients having maximal pain scores of 0, 1 to 4, 5 or 6, or 7 to 10 during the first week after the first dose of therapy, respectively. Patients with P-APS scores of 0 to 4 with the first dose of chemotherapy had less eventual sensory neuropathy than did patients with P-APS scores of 5 to 10 (P = 0.001). With regard to the more peripheral neuropathy, sensory neuropathy was more problematic than was either motor or autonomic neuropathy. Numbness and tingling were more common components of the sensory neuropathy than was pain.

CONCLUSIONS:

Patients with worse P-APS severities appear to have more eventual chemotherapy-induced peripheral neuropathy. This provides support for the concept that P-APS is a form of nerve pathology.

The Germline MLH1 K618A Variant and Susceptibility to Lynch Syndrome-Associated Tumors.

The Germline MLH1 K618A Variant and Susceptibility to Lynch Syndrome-Associated Tumors.:

Abstract
Missense variants discovered during sequencing of cancer susceptibility genes can be problematic for clinical interpretation. MLH1 K618A, which results from a 2-bp alteration (AAG→GCG) leading to a substitution of lysine to alanine in codon 618, has variously been interpreted as a pathogenic mutation, a variant of unknown significance, and a benign polymorphism. .........................We conclude that MLH1 K618A is not a fully penetrant Lynch syndrome mutation, although it is not without effect, appearing to increase the risk of Lynch syndrome-associated tumors approximately twofold. Our systematic assessment approach may be useful for variants in other genes.

abstract: Clinical characteristics and outcomes of BRCA-associated ovarian cancer: genotype and survival.

Clinical characteristics and outcomes of BRCA-associated ovarian cancer: genotype and survival

Cancer Genet. 2012 Jan;205(1-2):34-41


Abstract
Previous studies have suggested that BRCA-related epithelial ovarian cancer (EOC) conveys improved survival compared with that of sporadic EOC, but few studies have evaluated differences between BRCA genotypes.

We compared characteristics and outcome by genotype in BRCA-associated EOC. Patients with BRCA-associated EOC who were diagnosed between January 30,1981, and December 30, 2008, were retrospectively identified through institutional review board-approved registry studies. We examined clinical characteristics, including event-free survival (EFS) and overall survival (OS), for BRCA1 versus BRCA2 patients. We identified 197 cases (148 BRCA1 cases; 49 BRCA2 cases); the median follow-up period was 63 months. BRCA2 patients were older (55.4 vs. 51.1 y) and had fewer poorly differentiated tumors (67% vs. 82%). No difference in EFS was observed. OS at 5 years was 75% in BRCA2 patients versus 61% in BRCA1 patients; this was not statistically significant. A non-significant trend toward improved OS was observed in BRCA2 patients with advanced-stage disease (hazard ratio = 0.59; 95% confidence interval 0.32-1.08).

Age and grade differed significantly between BRCA1 and BRCA2 carriers in our study population. Whereas no overall differences in EFS or OS were observed, there was a trend toward improved OS in BRCA2 carriers with advanced-stage disease.

This may reflect important differences between BRCA genotypes and should be validated in larger studies.

abstract: Regimens with intraperitoneal cisplatin plus intravenuous cyclophosphamide and intraperitoneal carboplatin plus intravenuous cyclophosphamide are equally effective in second line intraperitoneal chemotherapy for advanced ovarian cancer.

Regimens with intraperitoneal cisplatin plus intravenuous cyclophosphamide and intraperitoneal carboplatin plus intravenuous cyclophosphamide are equally effective in second line intraperitoneal chemotherapy for advanced ovarian cancer.:


Abstract
Purpose:
We compared response, survival and side effects of regiments with intravenous cyclophosphamide followed by intraperitoneal cisplatin versus intravenous cyclophosphamide followed by intraperitoneal carboplatin as second line treatment in one center retrospective study.

Material and Methods:
Inclusion criteria were: relapse or recurrence of the disease after surgery and first line treatment; stage III histologicaly documented serous epithelial ovarian cancer after one or more prior regiments of chemotherapy. Recurrence were confirmed throughout restaging laparotomy or second look laparotomy. Patients from one of the groups received 90mg/m2 cisplatin on the first day and 750mg/m2 cyclophosphamide intravenously, while the second group members AUC 6 carboplatin intraperitoneally and 750mg/m2 cyclophosphamide intravenously. Four courses were administrated for each patient.

Results: 

Of the 49 patients in the cisplatin group the response rates were 21 (43%), 10 (20%) and 18 (37%) in the groups of pathologic complete response, pathologic partial response and progressive disease, respectively. The median survival from the initiation of intraperitoneal chemotherapy was 59 months.

Of the 25 patients in the carboplatin group the response rates were 10 (40%), 4 (16%) and 11 (44%) respectively. The median survival -51 months.

The differences between the groups were not statistically significant p 0.05 either in response or in toxicity.

Conclusions: 
The results of our research including relatively long survival from intraperotoneal chemotherapy initiation confirm that carboplatin treatment is as good as cisplatin in second line intraperitoneal chemotherapy for ovarian cancer.

abstract: Does long-term treatment with Doxil(®) predispose patients to oral cancer?

Does long-term treatment with Doxil(®) predispose patients to oral cancer?

Abstract

We present a possible adverse reaction related to long-term use of Doxil(®) in female patients. We believe that long-term use of Doxil(®) may predispose female patients to oral squamous cell carcinoma. The patients in this report were not exposed to the common risk factors related to oral cancer formation such as smoking or alcohol consumption.  

Both patients were 59-year-old females.

The first patient was diagnosed in 2001 with stage IIIC ovarian cancer. Seven years following treatment with Doxil(®), she was diagnosed with stage III squamous cell carcinoma of the right maxilla.

The second patient was diagnosed with Kaposi's sarcoma with evidence of spread to the lungs. Four years following treatment with Doxil(®) she was diagnosed with stage I squamous cell carcinoma of the left maxilla.

A literature review did not reveal any report on Doxil(®) and predisposition to oral cancer; however, we found an abstract that was presented at the last annual meeting of the American Society of Clinical Oncology (ASCO) by Cannon et al.

When we combine the data from Cannon et al. and the data presented here, a total of six female patients developed an epithelial carcinoma of the oral cavity following long-term treatment with Doxil(®).

We believe that a large-scale study should be initiated on patients that were treated with Doxil(®) for more than 3 years, since these patients might be at risk for developing secondary cancer of the oral cavity.

abstract: HE4 combined with MDCT imaging is a good marker in the evaluation of disease extension in advanced epithelial ovarian carcinoma.

HE4 combined with MDCT imaging is a good marker in the evaluation of disease extension in advanced epithelial ovarian carcinoma

Abstract

The purpose of the study was to evaluate the expression of the biomarkers CA125 and HE4 combined with imaging, in patients with advanced epithelial ovarian cancer (EOC). Forty-six women with EOC were included in the study all affected with peritoneal carcinomatosis. ................The availability of biomarkers, particularly HE4, together with sophisticated imaging techniques, strengthens the clinical relevance of this study, for the follow-up of patients with peritoneal carcinomatosis.

                        ~~~~~~~~~~~~~~~~~~~~~~~

carcinomatosis - definition of carcinomatosis in the Medical ...

medical-dictionary.thefreedictionary.com/carcinomatosis

carcinomatosis /car·ci·no·ma·to·sis/ (kahr″sĭ-no-mah-to´sis) the condition of widespread dissemination of cancer throughout the body.

abstract: Widespread endometriosis mimicking ovarian malignancy: A case report

Widespread endometriosis mimicking ovarian malignancy: A case report.

Abstract

A 26 year old Nigerian nulliparous woman who presented in the medical emergency unit of a teaching hospital was referred after two weeks of management to the gynecology casualty with a diagnosis of malignant left ovarian cyst, because of the ascites, massive haemorrhagic pleural effusion, a left ovarian mass and an elevated C-125 marker.

However, exploratory laparotomy, cytologic and histological examination of the pleural fluid and biopsied specimens revealed endometriosis. We present a case of intra and extra-pelvic endometriosis which simulated a malignant ovarian lesion and was histologically confirmed by cytology of the haemorrhagic pleural effusion and biopsy of the ovarian mass and peritoneal deposits obtained at laparotomy.

This is to draw the attention of clinicians to endometriosis as a cause of pleural effusion, ascites and groin swelling which can simulate ovarian cancer.

abstract: Presence of key findings in the medical record prior to a documented high-risk diagnosis.

Presence of key findings in the medical record prior to a documented high-risk diagnosis.


Abstract

Background
Failure or delay in diagnosis is a common preventable source of error. The authors sought to determine the frequency with which high-information clinical findings (HIFs) suggestive of a high-risk diagnosis (HRD) appear in the medical record before HRD documentation.
  
Methods
A knowledge base from a diagnostic decision support system was used to identify HIFs for selected HRDs: lumbar disc disease, myocardial infarction, appendicitis, and colon, breast, lung, ovarian and bladder carcinomas. Two physicians reviewed at least 20 patient records retrieved from a research patient data registry for each of these eight HRDs and for age- and gender-compatible controls. Records were searched for HIFs in visit notes that were created before the HRD was established in the electronic record and in general medical visit notes for controls.

Results
25% of records reviewed (61/243) contained HIFs in notes before the HRD was established. The mean duration between HIFs first occurring in the record and time of diagnosis ranged from 19 days for breast cancer to 2 years for bladder cancer. In three of the eight HRDs, HIFs were much less likely in control patients without the HRD.
  
Conclusions
In many records of patients with an HRD, HIFs were present before the HRD was established. Reasons for delay include non-compliance with recommended follow-up, unusual presentation of a disease, and system errors (eg, lack of laboratory follow-up). The presence of HIFs in clinical records suggests a potential role for the integration of diagnostic decision support into the clinical workflow to provide reminder alerts to improve the diagnostic focus.

Panniculitis Associated With Dermatomyositis and Recurrent Ovarian Cancer.

 Definition(s) General term for inflammation of adipose tissue, usually of the skin, characterized by reddened subcutaneous nodules.


Panniculitis Associated With Dermatomyositis and Recurrent Ovarian Cancer.:

Abstract
BACKGROUND:
Panniculitis is a rare cutaneous manifestation of dermatomyositis (DM), typically presenting as tender, erythematous subcutaneous nodules. Complications, such as pain, calcinosis, and lipoatrophy, are associated with high morbidity. While it has been suggested that panniculitis in DM may correlate with a better prognosis, our understanding of its true significance, prognostic implications, and management is limited by the paucity of reported cases. We describe the first reported case to our knowledge of DM-associated panniculitis in the setting of ovarian adenocarcinoma as well as in association with a recurrent malignancy. 

 OBSERVATIONS: 
A 63-year-old woman with a history of DM and recurrent ovarian adenocarcinoma presented with multiple painful, erythematous subcutaneous nodules on the bilateral upper arms, thighs, and buttocks. Histologic examination showed lymphoplasmacytic panniculitis with associated dermal mucin deposition, consistent with lobular panniculitis in association with connective-tissue disease. Treatment with oral methotrexate resulted in sustained clinical improvement over a 10-month period.

CONCLUSIONS:
Although panniculitis in DM has previously been suggested to be a good prognostic indicator, our case report describes an association with ovarian adenocarcinoma and a recurrent malignancy. Methotrexate may be an effective treatment for panniculitis in DM.

abstract: DNA repair gene polymorphisms and risk of early onset colorectal cancer in Lynch syndrome (eg. BRCA2, MSH3 (polymorphisms)...)

DNA repair gene polymorphisms and risk of early onset colorectal cancer in Lynch syndrome:

Source:Cancer Epidemiology, Volume 36, Issue 2


DNA repair plays a pivotal role in maintaining genomic integrity with over 130 genes involved in various repair pathways that include base excision repair, nucleotide excision repair, double strand break repair and DNA mismatch repair. Polymorphisms within genes that are involved in these processes have been widely reported to be associated with cancer susceptibility in an extensive range of malignancies that include colorectal cancer (CRC).

Lynch syndrome is caused by inherited germline mutations in DNA mismatch repair genes, predominantly in MLH1 and MSH2, that predispose to a variety of epithelial malignancies, most notably CRC. Despite being a relatively well understood hereditary cancer syndrome there remain several questions in relation to genetic influences on disease expression. Since Lynch syndrome is associated with a breakdown in DNA mismatch repair variation in other DNA repair genes may influence disease expression.

In this report we have genotyped 424 Australian and Polish Lynch syndrome participants for eight common DNA repair gene polymorphisms to assess any association with the age of CRC onset.

 The DNA repair gene SNPs included in the study were: BRCA2 (rs11571653), MSH3 (rs26279), Lig4 (rs1805386), OGG1 (rs1052133), XRCC1 (rs25487), XRCC2 (rs3218536 and rs1799793) and XRCC3 (rs861539). Cox multi-variant regression modelling failed to provide any convincing evidence of an effect in any of the polymorphisms analysed. The data suggest that polymorphisms in DNA repair genes do not contribute to cancer risk in a population of CRC patients who are at increased risk of disease as a result in a deficiency of DNA mismatch repair.

abstract: Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials : The Lancet Oncology

Blogger's Note: the 'risk' refers to the risk of cancer as opposed to the risk/side effects/adverse events/safety of asprin use.

Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials : The Lancet Oncology