UK survey - young adults - : When do life crises strike? Help us find out (online 20 min survey)

 When do life crises strike? Help us find out

17:45 7 February 2012

Being Human

Health

Jessica Griggs, careers editor

Psychologist Dan Levinson once remarked that he had never met anyone who had not gone through at least one major crisis during their adult life.
While films, sports-car cliches and personal experience may back up his comment, the questions of when and for whom crises occur have received little academic attention. Well, not for much longer.

Last year, New Scientist reported on the phenomenon of the quarter-life crisis; the re-evaluation and dramatic change of direction that sometimes occurs during early adulthood.

This was based on research carried out by researchers at the University of Greenwich who interviewed 50 young people about their emotional experiences during this time. The work established that the quarter-life crisis exists (as corroborated by the comments on our news story) but the sample wasn't large enough to determine how common it is or when it occurs.

Now, the innermost secrets of the crisis are to be laid bare. The Greenwich team are conducting an online survey of British adults which will probe the link between crisis episodes, age and life stage across a diverse group of adults.

The researchers are looking for adult volunteers to participate in the study. You can take part here (and be in with the chance of winning a cash prize for your efforts).

Stay tuned as New Scientist will exclusively report the findings later this year.
                      ~~~~~~~~~~~~~~

What does it involve and how long does it take?

The online questionnaire will involve approximately 20 minutes of your time.

You will be asked for the following information:
-    Age, job, income, marital status and number of children.
-    Crisis episodes and turning points in your adult life (if you are currently aged 25 or above)
-    Your marital satisfaction (if you are married)
-    Your sense of happiness, life satisfaction and wellbeing
-    Your sense of empathy

Who can participate?
In order to participate, you must be age 20 or over, have lived in the UK for the majority of your life since the age of 15 and be able to read and write English fluently.

Article: Friend or foe? Nature (PhD student)

"As a PhD student, learning to navigate the murky waters of collaboration and competition is pretty confusing........But many labs continue to jealously guard their progress and sacrifice paper quality for personal recognition. Should such egotism be acceptable in science, the main aims of which are, ideally, discovery and innovation, rather than accolades for its practitioners? As a young researcher, I am puzzled that a community reliant on integrity and transparency is tolerant of lies and misdirection in the publications race....."

abstract: (in mice) MEK1/2 Inhibitor Selumetinib (AZD6244) Inhibits Growth of Ovarian Clear Cell Carcinoma in a PEA-15–Dependent Manner in a Mouse Xenograft Model

Blogger's Note: in research (mice)

Abstract

Clear cell carcinoma (CCC) of the ovary tends to show resistance to standard chemotherapy, which results in poor survival for patients with CCC. Developing a novel therapeutic strategy is imperative to improve patient prognosis. Epidermal growth factor receptor (EGFR) is frequently expressed in epithelial ovarian cancer. One of the major downstream targets of the EGFR signaling cascade is extracellular signal–related kinase (ERK). PEA-15, a 15-kDa phosphoprotein, can sequester ERK in the cytoplasm. MEK1/2 plays a central role in integrating mitogenic signals into the ERK pathway. We tested the hypothesis that inhibition of the EGFR–ERK pathway suppresses tumorigenicity in CCC, and we investigated the role of PEA-15 in ERK-targeted therapy in CCC. We screened a panel of 4 CCC cell lines (RMG-I, SMOV-2, OVTOKO, and KOC-7c) and observed that the EGFR tyrosine kinase inhibitor erlotinib inhibited cell proliferation of EGFR-overexpressing CCC cell lines through partial dependence on the MEK/ERK pathway. Furthermore, erlotinib-sensitive cell lines were also sensitive to the MEK inhibitor selumetinib (AZD6244), which is under clinical development. Knockdown of PEA-15 expression resulted in reversal of selumetinib-sensitive cells to resistant cells, implying that PEA-15 contributes to selumetinib sensitivity. Both selumetinib and erlotinib significantly suppressed tumor growth (P < 0.0001) in a CCC xenograft model.  
However, selumetinib was better tolerated; erlotinib-treated mice exhibited significant toxic effects (marked weight loss and severe skin peeling) at high doses. Our findings indicate that the MEK–ERK pathway is a potential target for EGFR-overexpressing CCC and indicate that selumetinib and erlotinib are worth exploring as therapeutic agents for CCC. Mol Cancer Ther; 11(2); 360–9. ©2011 AACR

open access: American Society for Radiation Oncology - Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (2012)

Blogger's Note: 

search of the document = 0  'ovarian','ovary'

                                       ~~~~~~~~~~~

Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (2012) 

Read the guideline.

 This guideline provides guidance for patients and physicians regarding the following key clinical questions: What prognostic factors are important for assessing and managing patients with newly diagnosed brain metastases; for patients with single brain metastasis (excluding radiosensitive histologies such as small cell lung cancer, leukemia, lymphoma and germ cell tumor), does surgical resection and whole brain radiotherapy improve survival or brain control compared with whole brain radiotherapy alone or surgical resection alone; is survival or brain control different in selected patients with single brain metastasis (excluding radiosensitive histologies such as small cell lung cancer, leukemia, lymphoma and germ cell tumor) treated with surgery or radiosurgery; is there a survival or brain control difference in patients treated with WBRT and radiosurgery boost versus WBRT alone; is there a difference in survival, brain control or neurocognitive outcomes in patients treated with radiosurgery alone versus WBRT and radiosurgery; what is the role of comfort measures or palliative supportive care alone versus WBRT in patients with multiple brain metastases; what is the optimal WBRT dose fractionation schedule; what is the role of radiosensitizers with WBRT in the management of patients with brain metastases; and what is the role of chemotherapy and WBRT? 

Read the guideline.

(still) recruiting: Paclitaxel in Treating Patients With Ovarian Stromal Cancer - Full Text View - ClinicalTrials.gov (granulosa/sertoli-leydig, sex cord...)

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed ovarian stromal cancer not amenable to surgery
  • Granulosa cell tumor
  • Granulosa cell theca cell tumor
  • Sertoli-Leydig cell tumor (androblastoma)
  • Gynandroblastoma
  • Unclassified sex cord stromal tumor
  • Sex cord tumor with annular tubules
  • Steroid (lipid) cell tumor
• Recurrent disease after no more than 1 prior chemotherapy regimen
• Measurable disease
  • At least 1 cm in diameter

abstract: Microparticles From Ovarian Carcinomas Are Shed Into Ascites and Promote Cell Migration (EpCAM/assay/benign ascites/small study)

Abstract

Objective: Microparticles are cellular-derived vesicles (0.5-1.0 [mu]m) composed of cell membrane components, which are actively shed from the surface of various cells, including epithelial cells. We compared microparticles in ascites between women with ovarian carcinoma and women with benign ovarian pathology, and isolated tumor-derived (epithelial cell adhesion molecule [EpCAM]-positive) microparticles for functional analysis and proteomics.

Results: Microparticles in benign pelvic fluid were similar to early and advanced-stage ascites (2.4 vs 2.8 vs 2.0 x 106 microparticles/mL). Advanced stage had a greater proportion of EpCAM-positive microparticles than early or benign disease (13.3% vs 2.5% vs 2.1%; P = 0.001), and serous histology had more than endometrioid (13.2% vs 1.8%; P = 0.01).......
Conclusions: Ascites from advanced-stage and serous ovarian carcinomas contain large numbers of tumor-derived microparticles. In vitro, these microparticles bind to cancer cells and stimulate migration. Tumor-derived microparticles in ascites could mediate the predilection for peritoneal spread in serous ovarian carcinomas.

JCO - open access - It Takes a Village (palliative care and end of life decisions - worth reading)

JCO Editorials: Time to Focus on Inpatient Safety: Revision of the American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards

Editorials 

Time to Focus on Inpatient Safety: Revision of the American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards  

JCO published online on February 6, 2012; DOI:10.1200/JCO.2011.40.9409.

• [PDF]
•  See related article in J Oncol Pract 8:2-6, 2012

"... Most US hospitals are accredited by the Joint Commission and many are certified by the American College of Surgery Commission on Cancer. To date, these bodies have not focused attention on the safety of patients who are receiving chemotherapy. 

The modified ASCO/ONS Chemotherapy Administration
Safety Standards serve as a call-to-action to these organizations.
We encourage medical oncologists to bring the standards to the
attention of medical and administrative leaders in their hospitals and
to offer their expertise to assist in their implementation. ASCO, ONS,
and other organizations must also take the lead to develop quality
metrics that are focused on the unique aspects of inpatient medical
oncology care."

American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care into Standard Oncology Care

Clinical Context
"Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness......

open access: “Doctor, Will the Treatment You Are Recommending Cause Chemobrain?” JCO

Blogger's Note: actually it has been closer to 2 decades (or more); most of the prior research focused on breast cancer patients as is the case with the references in this article

     ~~~~~~~~~~~~~~~~~

"For more than a decade, patients and their oncologists have been sharing conversations about cognitive complaints after chemotherapy treatment.¹ Early on, only occasional patients complained of trouble with concentration and memory during treatment, with a minority noting persistence beyond the end of treatment. The oncologist, who rarely heard this complaint, could be dismissive, saying that the drugs the patient received did not cross the blood-brain barrier, and therefore, it was unlikely that the difficulties were related to the cancer treatment. Post-treatment cognitive complaints became much more evident during the late 1990s and early 21st century as adjuvant treatment regimens intensified and autologous bone marrow transplantation became more common in adults.<sup>2,3 ......."

"</sup>In summary, patient complaints of persistent cognitive difficulties after cancer treatment ends must not be dismissed, given that there is mounting evidence for the biologic effects of cancer treatments on behavioral symptoms, and cognitive complaints are one of the most troublesome of these manifestations.^{21,40,41..."......}We can no longer deny the existence of this long-term effect of cancer treatment; we must work to tailor future treatments to minimize this adverse outcome."

Helen Palmquist: Supporting my cyber-sisters with words of hope | e-Patients.net

open access: Pharmaceutical care for patients with breast and ovarian cancer - adverse drug events

Blogger's Note:  'tag' line includes breast cancer only; study included few ovarian cancer patients

Conclusions

 

In conclusion, our results suggest that pharmaceutical care for patients with breast and ovarian cancer is feasible and may have an impact on PROs as particularly indicated by significant improvements of the antiemetic response and patient satisfaction. 

Although there is no doubt that a higher awareness of drug-related problems is beneficial, final conclusions on the effectiveness of a new health care intervention can only be drawn when studied in a randomized trial. Therefore, our data may serve as a valuable basis for planning a large randomized multicenter trial.

open access -Jan 2012 Advances in the Treatment of Ovarian Cancer — A Potential Role of Anti-inflammatory Phytochemicals - Discovery Medicine

 Sections:

Epithelial Ovarian Cancer Pathology and Inflammation Associated Molecular Targets

Is There a Role for Non-steroidal Anti-inflammatory Drugs (NSAIDS) in EOC Prevention?

Anti-inflammatory Phytochemicals

In conclusion, results from many published studies described above indicate a definitive involvement of inflammation pathway in the progression and treatment of ovarian cancer. Some anti-inflammatory phytochemicals exhibit the activities to intervene the dysregulated inflammation pathway, and may play a beneficial role in the treatment of advanced EOC. However, there are many questions remain to be answered. Further research in this area is urgently needed.  

Evidence Updates: Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev includes professional commentaries

AUTHORS' CONCLUSIONS:

Antibiotic prophylaxis in afebrile neutropenic patients significantly reduced all-cause mortality.

In our review, the most significant reduction in mortality was observed in trials assessing prophylaxis with quinolones. The benefits of antibiotic prophylaxis outweighed the harm such as adverse effects and the development of resistance since all-cause mortality was reduced. As most trials in our review were of patients with haematologic cancer, we strongly recommend antibiotic prophylaxis for these patients, preferably with a quinolone.

Prophylaxis may also be considered for patients with solid tumours or lymphoma.

Alternate source/link

abstract: A phase II evaluation of Lapatinib in the treatment of persistent or recurrent epithelial ovarian or primary peritoneal carcinoma: A GOG group study

Conclusions

Lapatinib has minimal activity in recurrent ovarian cancer. Ki-67 expression may be associated with prior PFS and a polymorphism in EGFR exon 20 (2361G>A, Q787Q).

---

Highlights

► Lapatinib has minimal activity in unselected recurrent ovarian cancer.
► Ki-67 expression may be associated with prior PFS and a polymorphism in EGFR exon 20.
► EGFR and HER2/neu are overexpressed in a minority of ovarian cancers.

abstract: Predictive value of serum CA-125 levels in patients with persistent or recurrent epithelial ovarian cancer or peritoneal cancer treated with Bevacizumab (Avastin) Gynecologic Oncology Group phase II trial

Purpose

To compare two methods of determining therapeutic response and disease progression — modified Gynecologic Cancer Intergroup (GCIG) criteria based on CA-125 and Radiographic Evaluation Criteria in Solid Tumors (RECIST), in a phase II trial of bevacizumab for patients with recurrent or persistent epithelial ovarian and peritoneal carcinoma.

Results

Sixty-two patients were evaluable by RECIST, 59 for progression by CA-125, and 45 for response by CA-125..........

Conclusions

In this study, disease assessment by RECIST and CA-125 appears to correlate in general. However, approximately 10% of patients might demonstrate progression earlier by CA-125.

---

Highlights

► CA125-defined response and progression were assessed for women with recurrent ovarian cancer.
► CA125 and RECIST-defined response and progression correlated in most cases, but CA125 progression significantly preceded RECIST in 8 cases.
► CA125-defined response to bevacizumab was associated with a statistically significant correlation with overall survival.

abstract: A systematic review of sexual concerns reported by gynecological cancer survivors

Conclusion

Gynecological cancer survivors experience a broad range of sexual concerns after diagnosis and treatment, but the majority of studies emphasized physical aspects of sexuality, and may not adequately represent women's psychological and social sexual concerns. Health care providers should remain mindful of psychological and social sexual concerns when caring for gynecologic cancer survivors. Future research should systematically evaluate the full range of sexual concerns in large, representative samples of GYN cancer survivors and develop and test interventions to address those concerns.

---

Highlights

► Literature focuses on physical sexual dysfunction in gynecologic cancer survivors.
► Women report range of sexual concerns: physical, psychological, social.
► Research should include comprehensive/systematic assessment of sexual concerns.

abstract: A survey of gynecologic oncologists regarding the End-of-Life discussion: A pilot study

Results.

Response rate was 12.8%.

 Highlights

► A survey was sent to 1105 gynecologic oncologists to evaluate practices and attitudes regarding the end-of-life discussion
► This discussion appears to be had late
► This may contribute to patients' inability to effectively take part in her plan of care

abstract: Involvement in decision-making about treatment and ovarian cancer survivor quality of life

Highlights

► Involvement in decision-making about ovarian cancer treatment is associated with better mental and emotional health related quality of life.
► Complementary and Alternative Medicine (CAM) use is associated with age, education, and stage of disease.
► Involvement in decision-making about (CAM) use is also associated with better quality of life.

abstract: Informational needs of gynecologic cancer survivors

Abstract:

Objectives

In preparation for the launch of a gynecologic oncology survivorship program, this study looked at the informational needs of women with gynecologic cancers. Although studies have touched on some of these needs, no published literature has investigated the comprehensive informational needs of gynecologic oncology patients within all sites of gynecologic cancers.

Methods

A needs assessment, consisting of a self-administered questionnaire, was conducted at an ambulatory gynecologic oncology clinic from August 2010 to March 2011. This study investigated the informational needs of patients, including the importance of information, the amount desired, and the preferred mode of delivery. Informational needs were grouped into six domains: medical, practical, physical, emotional, social, and spiritual.

Results

185 surveys were analyzed and the majority of the respondents were Caucasian (77%) and over the age of 50 (66%). Forty-nine percent of respondents were diagnosed with ovarian cancer, and there was an even distribution between newly diagnosed patients (38%), those in long-term follow-up (27%), and those with recurrent disease (37%). Overall, respondents placed more importance on receiving medical information (P < 0.01). The three preferred education modalities were; pamphlets, one-on-one discussions with health care professionals and websites. Age, education, and disease site were associated with differing informational needs.

Conclusions

This study has highlighted the most important informational needs of patients with gynecologic malignancies in our patient population. This information may guide the development of clinical survivorship programs and educational resources for patients in the future.

---

Highlights

► We report the results of a needs assessment that was done to better understand the informational needs of gynecologic cancer survivors.
► Increasing responsiveness to survivor needs can greatly affect health outcomes and patient satisfaction.
► We did this to launch a gynecologic cancer survivorship program that is responsive to survivor needs.

abstract: The association between quality of life domains and overall survival in ovarian cancer patients during adjuvant chemotherapy: patients from GOG 172 trial

Highlights

► Physical QOL is associated with OS in ovarian cancer patients receiving adjuvant chemotherapy.
► Poor physical well-being at baseline is associated with risk of death in patients undergoing adjuvant chemotherapy for advanced ovarian cancer.
► Identifying modifiable characteristics that are associated with survival offers the potential for providing support that may improve outcomes.

Hormone therapy for menopausal symptoms | BMJ

 Editorial

Hormone therapy for menopausal symptoms

BMJ 2012; 344 doi: 10.1136/bmj.e815 (Published 8 February 2012)

Cite this as: BMJ 2012;344:e815

Access to the full text of this article requires a subscription or payment. 

"Recent evaluations of the methods of key studies should not change how we advise wome.

A recently published and much publicised paper by Shapiro and colleagues, the last in a series of four, evaluated the effects of hormone therapy on the risk of breast cancer.1 

The authors of the four review articles applied epidemiological principles to the findings of two randomised placebo controlled studies from the Women’s Health Initiative (WHI; 27 347 women) and two observational studies—the Collaborative Reanalysis (53 865 women) and the Million Women Study (MWS). Shapiro and colleagues concluded in their fourth paper that the MWS had design defects, that it contained multiple biases, and that its findings were thus not robust enough to show that hormone therapy increased the risk of breast cancer.

All observational studies are inherently biased because subjects are not randomly assigned to treatment or control. Adjustment for confounders and careful design of observational studies help to reduce bias. However, because there is no independent variable, such studies can tell us only about association not causation.

The MWS was published in the Lancet in August 2003,2 and a flurry of letters was published in a print issue later that year, many …"

Letter:: Physical activity for cancer survivors: meta-analysis of randomised controlled trials | BMJ

Blogger's Note:  BMJ is a subscription based journal 

    ~~~~~~~~~~~~~~~~~~~~~~

Rapid Response (Letter):

Physical activity versus exercise in cancer survivors: it is a matter of definition!

7 February 2012

Fong et al.  (Fong DY, Ho JW, Hui BP et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. Bmj 2012;344:e70.) systematically evaluated the effects of ‘physical activity’ in adult patients after completion of main treatment related to cancer.(1) Nevertheless, the effects of (increased) physical activity on health indicators were not studied, and changes in daily physical activity levels were not reported.(2) Indeed, the characteristics of the 34 randomized controlled trials included in this meta-analysis show that Fong et al. mostly studied the effects of structured exercise training programs including aerobic and/or resistance exercises.(1) Although physical activity and exercise training are closely related, these are two distinct domains with their own definitions. Physical activity refers to ‘body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure’; while exercise refers to ‘planned, structured, and repetitive movement to improve or maintain one or more components of physical fitness’.(3)
Therefore, we believe that the conclusion of this meta-analysis should be that structured exercise training is associated with clinically important positive effects on physical functions and quality of life in patients who had completed their treatment for cancer.
Whether and to what extent these interventions will also increase daily physical activity levels in cancer survivors remains currently unknown.

Dr. Martijn A. Spruit, scientific advisor
Program Development Center, CIRO+, center of expertise for chronic organ failure
Horn, the Netherlands
Dr. Emiel F.M. Wouters, professor in respiratory medicine
Dept. of Respiratory Medicine, Maastricht University Medical Centre (MUMC+)
Maastricht, the Netherlands

Radiation Oncology A National Survey of the Availability of Intensity-Modulated Radiation Therapy and Stereotactic Radiosurgery in Canada

Blogger's Note: no references to 'ovarian'/'ovary'/'gyn'

Conclusions

The survey showed a growing adoption of IMRT and SRS in Canada, although the latter was available in less than half of responding centers. Barriers to implementation differed for IMRT compared to SRS. Enhancing human resources is an important consideration in the implementation of new RT technologies, due to the multidisciplinary nature of the planning and treatment process.

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

 

abstract: From "Sex Toy" to Intrusive Imposition: A Qualitative Examination of Women's Experiences with Vaginal Dilator Use Following Treatment for Gynecological Cancer.

 Abstract

Introduction.  Regular use of vaginal dilators has been recommended as a prophylactic measure following radiation treatment for gynecological cancer....
Aim.  To investigate women's experiences with the vaginal dilator and to understand the psychosocial factors that influence women's adoption of rehabilitative dilator use.
Results. The analysis resulted in five main categories underlying the core category of "From 'Sex Toy' to Intrusive Imposition." These were: (i) embarrassing sex toy; (ii) reliving the invasion of treatment; (iii) aversive "hands-on" experience; (iv) not at the forefront of my recovery; and (v) minimizing the resistance.

Conclusions.  Rehabilitative vaginal dilator use is a complex, multifaceted, and personal phenomenon that carries deep psychological and emotional implications that make it intrusive.

(still) recruting: Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women - ClinicalTrials.gov

Early Detection of Ovarian Cancer - Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women

This study is currently recruiting participants.

Verified January 2012 by M.D. Anderson Cancer Center

First Received on October 3, 2007. Last Updated on January 13, 2012 History of Changes

abstract: Long-Term Follow-Up for Mortality and Cancer in a Randomized Placebo-Controlled Trial of Vitamin D3 and/or Calcium (RECORD Trial)

Conclusions:
Daily vitamin D or calcium supplementation did not affect mortality, vascular disease, cancer mortality, or cancer incidence.

open access: Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Blogger's Note: note patient numbers per physician; study limitations

      ~~~~~~~~~~~~

"Primary care providers are increasingly interested in ensuring that preventive health care be part of their work routines.1 This reorientation fits with the evidence that recommendations from family practitioners increase substantially the likelihood of patients undergoing preventive manoeuvres,2 whereas the lack of such recommendations has been linked with patient noncompliance.3^,4

Studies evaluating adherence to recommended preventive care suggest that the most pervasive barriers rest with the organization of the health care system and the practice itself, such as the absence of external financial incentives for the work done and the lack of a reminder system in the office.3^,5^–9

Countries attempting to reform their delivery of primary care and improve the delivery of preventive services have often directed their efforts in finding alternatives to the traditional fee-for-service model, in which providers receive payment for each service provided......."

(repost) Genomethics - background and Questionnaire UK

Questionnaire

This ethics and genomics study is being conducted by two Ethics Researchers. The team consists of:
Dr Anna Middleton, Ethics Researcher and Registered Genetic Counsellor,
and
Prof Mike Parker, Professor of Bioethics and Director of the Ethox Centre, University of Oxford
The two Ethics Researchers are part of the Deciphering Developmental Disorders (DDD) Study based at the Wellcome Trust Sanger Institute, Cambridge, UK. More information about the DDD study can be found here: www.ddduk.org
The DDD study involves a large team of scientists and informaticians and the Principal Investigators are:

• Dr Nigel Carter, molecular cytogeneticist, Wellcome Trust Sanger Institute, Cambridge, UK
• Dr Helen Firth, consultant clinical geneticist, Addenbrooke's Hospital, Cambridge, UK
• Dr Matt Hurles, molecular geneticist, Wellcome Trust Sanger Institute, Cambridge, UK
• Dr Jeff Barrett, statistical geneticist, Wellcome Trust Sanger Institute, Cambridge, UK
• Prof David Fitzpatrick, consultant clinical geneticist, Western General Hospital, Edinburgh, UK
• Prof Mike Parker, professor of bioethics, Director of Ethox, University of Oxford, UK

open access: Breast manifestations of systemic diseases

Metastases from other solid organ primaries
"Breast cancer is the most common type of primary malignancy
in women, but metastatic spread to the breast from other solid
organs, although rare, has been reported 51–53 and may be the
first sign of malignancy.54..."
                           
                    ~~~~~~~~~~~~~~~~~~~

Abstract: Although much emphasis has been placed on the primary presentations of breast cancer, little focus has been placed on how systemic illnesses may affect the breast. In this article, we discuss systemic illnesses that can manifest in the breast. We summarize the clinical features, imaging, histopathology, and treatment recommendations for endocrine, vascular, systemic inflammatory, infectious, and hematologic diseases, as well as for the extramammary malignancies that can present in the breast. Despite the rarity of these manifestations of systemic disease, knowledge of these conditions is critical to the appropriate evaluation and treatment of patients presenting with breast symptoms.


References as noted above (Metastases from other solid organ primaries):

51. Akcay MN. Metastatic disease in the breast. Breast. 2002;11(6):
526–528.

52. Lee SK, Kim WW, Kim SH, et al. Characteristics of metastasis in thebreast from extramammary malignancies. J Surg Oncol. 2010;101(2):137–140.

Blogger's Note:  - excerpt from reference #52  above:


"The breast is an uncommon site for metastasis from
extramammary tumors with incidence of 0.4 - 1.3%.1,2 In
about 25–40% of cases, metastasis to the breast is the
initial manifestation of the disease.2 The common
sources of primary tumors are haematological
malignancies, malignant melanoma, lung tumors, renal
cell carcinoma, ovarian tumors, thyroid carcinomas and
small bowel carcinoid.4,6  Other tumors metastasized to
breast are prostate, stomach, malignant mesothelioma
and rhabdomyosarcoma.9"

53. Young JL Jr, Ward KC, Wingo PA, Howe HL. The incidence of
malignant non-carcinomas of the female breast. Cancer Causes Control.
2004;15(3):313–319.

54. Hamby LS, McGrath PC, Cibull ML, Schwartz RW. Gastric carcinoma
metastatic to the breast. J Surg Oncol. 1991;48(2):117–121.

Recruiting: Pilot Program to Personalize Care & Improve Quality of Life for Women With Recurrent Ovarian Cancer - Full Text View - ClinicalTrials.gov

Pilot Program to Personalize Care & Improve Quality of Life for Women With Recurrent Ovarian Cancer

This study is currently recruiting participants.

Verified January 2012 by H. Lee Moffitt Cancer Center and Research Institute

New insights on the pathogenesis of ovari... [Gynecol Endocrinol. 2012] - PubMed - NCBI

New insights on the pathogenesis of ovarian carcinoma: molecular basis and clinical implications.

Gadducci A, Guerrieri ME, Genazzani AR.

Source

Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy.

Abstract

Ovarian carcinoma can be subdivided into two categories termed type I and type II. Type I tumours, usually having an indolent clinical behaviour, are often detected in early stage, and rarely harbour p53 gene mutations. Each histological type has a distinct molecular profile with mutations of genes involved in different signalling transduction pathways, such as KRAS, BRAF, CTNNB1, PTEN, PIK3CA and ARID1A. Type II tumours, accounting for 75% of the cases, have a very aggressive biological behaviour, are usually in advanced stage at presentation, harbour p53 gene mutations in 80% of the cases, and sometimes have alterations of homologous recombination (HR). Both type I and type II tumours arise from extra-ovarian precursors. Serous carcinomas derive from tubal epithelium, endometrioid and clear cell carcinomas from endometrial tissue, and mucinous and Brenner tumours from transitional epithelial cells located near the tubo-peritoneal junction. These new concepts on the pathogenesis of ovarian carcinoma could deeply modify both the preventive approach in women with germ-line BRCA(1) or BRCA(2) mutations and the treatment of patients with advanced or recurrent disease. For instance, BRAF inhibitors could be used in low-grade serous carcinomas, PIK3CA inhibitors could be employed in clear cell carcinoma, and poly (ADP-ribose) polymerase inhibitors could be used not only in hereditary ovarian carcinoma but also in non-hereditary, high-grade serous ovarian carcinoma which sometimes shows defective HR.

Reports: ICES - Payments to Ontario Physicians from Ministry of health - period comparisons 1992/3 - 2009/10 (zip file)

Reports

Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources 1992/93 to 2009/10

Henry DA, Schultz SE, Glazier RH, Bhatia RS, Dhalla IA, Laupacis A. February 2012 In Canada, payments to physicians constitute approximately 20% of provincial health care budgets. This report estimates public payments to Ontario physicians from multiple sources between 1992/93 and 2009/10, and presents these graphically by specialty and specialty group. The report examines variations between specialty groups and considers the impact of changes in the different models of physician payment, including fee for service, capitation and alternate payment plans. [3.3 MB zipped] PDF version [9.9 MB]

Comparative effectiveness research plan seeks input from all sides (including patients/families) deadline March 15th ... American Medical News

"PCORI leaders want feedback from patients, caregivers, clinicians and others on its research agenda. They want to know if the tentative agenda covers key subjects for which more evidence-based information is needed, said Eugene Washington, MD, MSc, PCORI's board chair and dean of the David Geffen School of Medicine at the University of California Los Angeles. The leaders also want to involve patients in a significant way in the research process, according to PCORI Executive Director Joe Selby, MD, MPH. "This initial agenda does not limit which conditions or treatments will be studied. It is a starting point," he said, adding that 2012 "will be a year of engagement."".........

Also: "The 53-day public comment period, which will end March 15, will be used to solicit feedback and revise the priorities and agenda before a final version of each is adopted by PCORI's Board of Governors."

abstract: Effects of vitamin E on bone turnover markers among US postmenopausal women.

Abstract

Increased oxidative stress and inflammation resulting from aging and declining estrogen levels can lead to increased bone loss in postmenopausal women. Alpha- and gamma-tocopherol, the two predominant isomers of vitamin E, have antioxidant and anti-inflammatory properties, but their effects on bone metabolism have not been well studied in humans. We examined the associations between dietary and total (diet and supplements) alpha-tocopherol intake, serum alpha- and gamma-tocopherol levels and their ratio, and bone turnover markers (BTMs) among postmenopausal women aged ≥45 years........

Women of Teal: Cancer Support Community Website Relaunch

Tuesday, February 7, 2012

Cancer Support Community Website Relaunch

The Cancer Support Community is relaunching their website and blog in the next few days. Over the past 6 years, I have taken part both as a participant and a workshop provider in many Cancer Support Community Central NJ programs. I was pleased to learn that the CSC blog will include my Women of Teal blog in their blog roll. Thank you CSC.

You can find the new site at

http://www.cancersupportcommunity.org/

and their blog at

http://blog.cancersupportcommunity.org/.

Researchers Find Ovarian Cancer Risk Related To Inherited Inflammation Genes - newswise

"... The authors noted that in 2011 there were an estimated 225,500 new cases of ovarian cancer worldwide. Although some women are at greatly elevated risks of ovarian cancer due to inherited mutations in the BRCA1 and BRCA2 genes (and Lynch Syndrome amongst other rarer syndomes), these are rare in the population and account for perhaps 10 percent of cases. However, a substantial portion of genetic influence on ovarian cancer risk has been “unexplained” and some of that may be due to common genetic variants. Sellers points out that “the Il1A variant that was most strongly protective is carried by 30 percent of women in the study, so the impact at the population level is not trivial.”




Blogger's Note: interleukins and therefore the interest in interleukin research noting the variables within (eg. IL2;IL3..) as an example:

(2009) Interleukin 2-mediated conversion of ovarian cancer-associated CD4+ regulatory T cells into proinflammatory interleukin 17-producing helper T cells.

abstract: A Phase I Study of Veliparib in Combination with Metronomic Cyclophosphamide in Adults with Refractory Solid Tumors and Lymphomas (brca/triple negative bc)

CONCLUSIONS:

The combination of veliparib with metronomic cyclophosphamide is well tolerated and shows promising activity in a subset of patients with BRCA mutations. A phase II trial of the combination compared to single-agent cyclophosphamide is ongoing in BRCA-positive ovarian cancer, triple-negative breast cancer, and low-grade lymphoma.

open access: Chinese Medical Journal - Evaluation of whether serum tumor markers in patients with epithelial ovarian carcinoma change following chemotherapy

Blogger's Note: the pdf version is easier to view


Fulltext PDF(314K) Free

"The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence." 

"With respect to the pathological type, there were 20 cases of serous carcinoma, 6 cases of mucinous carcinoma, 3 cases of
endometrial carcinoma, 2 cases of clear cell carcinoma
and 4 cases of mixed epithelial carcinoma in the 35 cases
of de novo patients. 

For the recurrent patient group there were 25 cases of serous carcinoma, 4 cases of mucinous carcinoma, 2 cases of endometrial carcinoma, 2 cases of clear cell carcinoma, 1 case of mixed epithelial carcinoma, 2 cases of transitional cell carcinoma and 1 case of undifferentiated carcinoma in the 37 cases of recurrent patients."

Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence, indicating that in addition to the markers that are abnormal before surgery, those markers that are normal
should also be monitored during chemotherapy and follow-up.

CMAJ: Private rooms: A choice between infection and profit

ASCO: Why Cancer Care and Palliative Care Should Be Combined - Health Blog - WSJ

Glenn D. Braunstein, M.D.: What's Behind Our National Drug Shortages?

Glenn D. Braunstein, M.D.

Chairman of the Department of Medicine, Cedars-Sinai

Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?

Abstract

"Background: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms.

Objective: To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening.

Design: Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125).........."

abstract: Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?

Many Doctors Don’t Follow Ovarian-Cancer Screening Guidelines - Health Blog - WSJ

The study is published in the Annals of Internal Medicine.

ePrognosis: How to Use

How to Use

To illustrate the clinical application of prognostic indices, we highlight 3 common clinical scenarios for older adults in which the consideration of prognosis may improve decision making:

Case 1: Cancer screening

Case 2: Hospice eligibility

Case 3: Incidental pulmonary nodule

Web resource helps assess life expectancy - - ModernMedicine website: ePrognosis.org

Blogger's Note:

“Not everything that can be counted counts and not everything that counts can be counted.” Albert Einstein

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

"A set of prognostic indices used to calculate a patient’s life expectancy has been created and posted on a new Web site.

The site, www.ePrognosis.org, was created in conjunction with a review of these assessments that was published in JAMA (2012; 307:182-92). That study concluded that the most accurate and usable indices might have value when used in conjunction with other clinical information.
Many medical interventions, including those for urologic and other cancers, have guidelines recommending that physicians take a patient’s life expectancy into account, said senior investigator Alexander K. Smith, MD, MPH, of the University of California, San Francisco. "Given this goal, it would be ideal if there were one index that would allow you to plug in your patient’s information—age, diseases, functional impairments—and get an accurate long-term prognosis.

"Unfortunately, there is not. In the absence of that, we have this systematic review and corresponding online compendium, which we hope physicians will find a useful adjunct, along with patient preferences and their own professional judgments, in making clinical decisions that involve life expectancy," Dr. Smith said........

Finding a Clinical Trial - NIH Clinical Research Trials and You - National Institutes of Health (NIH) Around the Nation and Worldwide

Finding a Clinical Trial

Around the Nation and Worldwide

NIH conducts clinical research trials for many diseases and conditions, including cancer, eye diseases, and allergy and infectious diseases. To search for other diseases and conditions, you can visit ClinicalTrials.gov.

website: NIH Clinical Research Trials and You - National Institutes of Health (NIH)

• Home
• The Basics
• Volunteer Stories
• Researcher Stories
• Finding a Clinical Trial

• For Health Care Providers

• Educational Resources
• Glossary of Common Terms

press release: New website: NIH Clinical Research Trials and You, February 6, 2012 News Release - National Institutes of Health (NIH)

For Immediate Release
Monday, February 6, 2012

Contact:
NIH Office of Communications
301-496-5787

New website: NIH Clinical Research Trials and You

Agency-wide resource provides important information for the public and health care providers

The National Institutes of Health has created a new website, NIH Clinical Research Trials and You to help people learn more about clinical trials, why they matter, and how to participate. From the first cure of a solid tumor with chemotherapy to the use of nitroglycerin in response to heart attacks, clinical research trials — or research studies involving people — have played a vital role in improving health and quality of life for people around the globe.
Clinical trials are essential for identifying and understanding ways to prevent, diagnose, and treat disease. Research has shown that among the greatest challenges to recruitment of volunteers is the lack of general knowledge about what trials involve, where they are carried out, and who may participate.
"The ability to recruit the necessary number of volunteers is vital to carrying out clinical research that leads to health and medical advances," said NIH Director Francis S. Collins, M.D., Ph.D. "This new, centralized resource will make it much easier for the public and health professionals to learn about clinical trials and how people can participate in them."
Visitors to the website will find information about:

• The basics of clinical trial participation
• First hand experiences from actual clinical trial volunteers
• Explanations from researchers
• Links on how to search for a trial or enroll in a research matching program

In addition, health care professionals can read about evidence-based strategies for talking with patients about trials, print audience-tested posters to help promote trials in clinics and offices, and find other educational materials.
NIH supports clinical research trials across the country and throughout the world. NIH’s ongoing effort to raise awareness about clinical research and educate potential clinical trial participants about the option of a clinical trial is vital to developing public support and understanding for how clinical research drives medical discovery and improves health outcomes.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Medscape: The Case for Retaining Bereavement Exclusion

"....
"The evidence suggests that the excluded episodes are best considered a normal variation in bereavement and not a mental disorder," he added.
Reflection Advisable
In an accompanying editorial, Mario Maj, MD, PhD, of the Department of Psychiatry, University of Naples, Italy, and chairperson of the World Health Organization Working Group on the Classification of Mood and Anxiety Disorders, concludes that the removal of the BE from the diagnosis of major depressive episode can only be justified by "strong and unequivocal new research evidence. Wakefield and First's review...suggests that such a solid and consistent new evidence is not available."
"Further reflection," Dr. Maj writes, "seems therefore warranted before proceeding with the deletion of the bereavement exclusion.".....

Genome Canada launches funding competition in personalized medicine | Laboratory Product News

new open access journal section: Introducing the Nutrition & Metabolism section of Journal of Translational Medicine

Editorial

Introducing the Nutrition & Metabolism section of Journal of Translational Medicine

Laura Soldati, Elena Dogliotti, Irene Camera and Annalisa Terranegra

Journal of Translational Medicine 2012, 10:17 doi:10.1186/1479-5876-10-17
Published: 30 January 2012

Abstract (provisional)

Our food should be our medicine. Our medicine should be our food Hippocrates (460 BC - 377 BC) Nutrition experts, as well as specialists of different pathologies, are disclosing an ever increasing interest for protocols devoted to the welfare of patients and to prevention of nutrition related diseases.

abstract: Adjuvant Analgesics in Cancer Pain: A Review

"Adjuvant analgesics (co-analgesics) are medications whose primary indication is the management of a medical condition with secondary effects of analgesia (pain killer). Cancer pain is multifactorial and often involves inflammatory, nociceptive, and neuropathic pain subtypes. Adjuvant analgesics used in conjunction with opioids have been found to be beneficial in the management of many cancer pain syndromes; however, they are currently underutilized. Antidepressants, anticonvulsants, local anesthetics, topical agents, steroids, bisphosphonates, and calcitonin are all adjuvants which have been shown to be effective in the management of cancer pain syndromes. When utilizing analgesic adjuvants in the treatment of cancer pain, providers must take into account the particular side effect profile of the medication. Ideally, adjuvant analgesics will be initiated at lower dosages and escalated as tolerated until efficacy or adverse effects are encountered."

Loved Ones Obtain Various Information About the Progression of the Patient’s Cancer Disease Which is Important for Their Understanding and Preparation

Blogger's Note: no access; see below

Patient Access

• Access for Patients - Patients desiring access should contact the journal.

abstract: The Pattern of Antimicrobial Use for Palliative Care In-Patients During the Last Week of Life

Background: In terminally ill cancer patients approaching the dying phase, liberal use of antimicrobials is often viewed by palliative care experts as irrational. No previous reports have reviewed current antimicrobial use in palliative care settings in Saudi Arabia.
Objective: The objective of this study was to explore the pattern of antimicrobial use in a tertiary palliative care unit (TPCU) during the last week of patients’ life.
Methods: Medical records of all patients who died in the TPCU over a 14-month period were reviewed for demographics as well as the frequency and rationale of antimicrobial use during the patients’ last week of life. Information on antimicrobial use was obtained from a computerized pharmacy database.
Results: Of 138 patients who died with advanced cancer in the TPCU, 87 (63%) were on one or more antimicrobials during their last week of life. Antibiotics were more frequently used as compared to antifungal and antiviral agents, 64 (46.4%); 45 (32.6%); and 2 (1.5%), respectively. About one third (31.3%) of patients who received antibiotics during their last week of life were prescribed more than one antibiotic. Antimicrobials were mostly given systemically (79%) rather than topically (21%). The most common rationales for antimicrobial prescribing were oral thrush in 36 patients (25.4%), wound care in 29 patients (20.4%), and on empirical basis in 29 patients (20.4%).
Conclusions: The current practice of antimicrobial prescribing, especially for patients who are eminently dying, may need to be reviewed. Initiation of antimicrobial treatment in this group of patients should be based on clear treatment goals and desired outcomes, considering views of patients and families.

abstract: End-of-Life Care at an Academic Medical Center

"Background: End-of-life care is deemed to be poor in the United States – particularly in large teaching hospitals. Via a brief survey, we examined satisfaction with end-of-life care for those patients who died in our academic medical center from provider and family perspectives.
Methods: To assess the correlation between overall satisfaction between providers (attending, housestaff, and nurses) as well as family members for decedents who died in our hospital, we conducted a satisfaction survey regarding care in the last three days of life. The nine item survey was administered within 1 week of the patient s death to care providers and approximately 8 to 12 weeks to next of kin.
Results: There were 166 deaths examined over the four month study period. Overall satisfaction with care was 3.02 out of 4.0, and differed by respondent group (p= 0.035). Correlation between respondents was very low (range 0.02 to 0.51). The least discordance was between residents and interns (0.5), who had the lowest level of satisfaction (2.72). Housestaff and attendings had the lowest overall correlation in mean satisfaction scores (0.05). Most providers knew their patients for 24 hours or less.
Conclusions: Overall satisfaction was high, but there was discordance among different providers. Continuity of care was limited. Age and location of death alone did not significantly affect satisfaction with end-of-life care. Implications of this type of research for improving end of life care at academic centers are discussed."

abstract: A Qualitative Study of Family Involvement in Decisions About Life Support in the Intensive Care Unit

"We explored family involvement in decisions about life support interventions in the intensive care unit study using a critical incident technique to focus on specific case exemplars contributed by participants. A total of 6 family members and 9 health care professionals were interviewed. Participants described 2 options (life support or comfort care) and values associated with options: maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, needing adjustment time, and judicious health care resource use. Barriers to involvement included not being offered alternative options; no specific trigger to initiate decision making; dominant influence of professionals’ values; and families lacking understandable information. Family members are unlikely to engage in decision making unless professionals identify the decision and address other barriers to family involvement."

abstract: Distinct Subpopulations of Epithelial Ovarian Cancer Cells Can Differentially Induce Macrophages and T Regulatory Cells Toward a Pro-Tumor Phenotyp

Problem  Presence of immune infiltrates in the tumor does not always correlate with an anti-tumoral immune response. (eg. vaccine therapies...)
Conclusion  We demonstrate that each ovarian cancer cell subpopulation can induce a unique phenotype of macrophages and T cells, both associated with tumor-supportive function.

Supportive Care in Cancer-abstract: Home care—a safe and attractive alternative to inpatient administration of intensive chemotherapies

Blogger's Note:  some abstracts are amazing in their results and conclusions, this being an example

press release Feb 2012: Scripps invents way to spot spread of cancer | UTSanDiego.com

"The test will require FDA approval before it can move beyond clinical testing.Pathologists and oncologists already have a test, called CellSearch, that’s used to look for CTCs (circulating tumor cells). But Kuhn says physicians need a test that is far more sensitive, and thus more useful for a wide array of cancer patients."

The Scripps Research Institute - Biological Studies

"Among the many areas of biological studies at Scripps Research are molecular biology, which deals with such fundamental phenomena as DNA, RNA, and proteins; cell biology, which studies the interactions, chemical and molecular, that make our cells work; structural biology, which looks at the architecture of large molecules; and pharmacology, which uses biology to understand the effects of drugs on an organism."

Scientists demonstrate effective new 'biopsy in a blood test' to detect cancer

Blogger's Note: review of 5 studies in various cancers; early and advanced stages

youtube video: "Do You See Politics on My Chest" (breast cancer survivor/ovarian cancer surgery/patient view)

abstract: Importance of Histologic Subtype in the Staging of Appendiceal Tumors

Blogger's Note:  appendiceal cancer (cancer of the appendix) is not the only cancer where cell type histologic records are deficient eg. breast cancer; why it's important? many reasons: patients with dual malignancies, primary vs metastatic, borderline/invasive.....; as in ovarian cancer cell,  type/s are included in one's own individual pathology report/s

Abstract

Background

Malignant neoplasms of the appendix have different behavior based on their histologic subtypes in anecdotal series. Current staging systems do not capture the diversity of histologic subtypes in predicting outcomes.

She the People - Komen, go back to your roots By Donna Trussell (author/ovarian cancer survivor) (including public comments)

"...... There is a school of thought that when charity founders retire or die, the organizations should die with them. The original mission gets lost amid the everyday tasks of promoting a brand, delivering services, and managing employees.......What did surprise me about Susan Komen’s story was how similar cancer experiences are. When you have a less publicized form of cancer, you tend to notice the boundaries between cancers, and the unequal allocation of resources......."

Australia - Cancer Directory - Lynch Syndrome booklet (pdf file - updated Jan 25, 2012)

Understanding genetic tests for Lynch syndrome. Information and decision aid

Year first published or reviewed: 2010
Last updated on: 25-01-2012
By: Centre for Genetics Education

 

DOWNLOAD PDFSource of document

---

Lynch syndrome cancers
People affected by Lynch syndrome have a higher risk of bowel cancer
and some other cancers listed in the table below.

Men with Lynch syndrome are at
high risk of developing:
large bowel cancer

Women with Lynch syndrome are
at high risk of developing:
large bowel cancer
endometrial cancer
ovarian cancer

Men and women have an
increased risk of developing:
cancers of the stomach, small
bowel, kidney, brain, pancreas,
ureter (tube from kidney to
bladder

abstract: Comparability of cancer identification among death registry, cancer registry and hospital discharge registry - International Journal of Cancer

Abstract

Registry based cancer incidence and mortality data are widely used for etiologic research, cancer control and health care monitoring and planning. The complete coverage of all cases is the key criteria of data quality but it is difficult to assess because the alternative sources of data may be flawed. ..........

..........In conclusion, some 10% of cancer deaths had no cancer records in CR (cancer registry) or in HDR (hospital discharge registry), and 3.4% were missing in both sources. The identification rate depended on tumor site, age at death, and, to some extent, death outside hospital.

open access: The tumour suppressor SOX11 is associated with improved survival among high grade epithelial ovarian cancers and is regulated by reversible promoter methylation (references major epithelial OC cell types including clear cell)

Background

The neural transcription factor SOX11 has been described as a prognostic marker in epithelial ovarian cancers (EOC), however its role in individual histological subtypes and tumour grade requires further clarification. Furthermore, methylation-dependent silencing of SOX11 has been reported for B cell lymphomas and indicates that epigenetic drugs may be used to re-express this tumour suppressor, but information on SOX11 promoter methylation in EOC is still lacking.

Results

SOX11 expression was associated with an improved survival of patients with high grade EOC, although not independent of stage.

 

"SOX11 is a diagnostic and prognostic antigen in B cell lymphomas [12-17] and has recently been demonstrated by us to have tumour suppressor functions [18]. This transcription factor is also a prognostic antigen in EOC, where its presence is associated with improved recurrence-free survival (RFS) [19]. In the present study, we confirm the relationship between SOX11 and survival in EOC, although a larger set of endometrioid cancer needs to be investigated to show independent prognostic relevance."

 

Conclusions:

In the present study, SOX11 was demonstrated to be of prognostic value for high grade EOC, which could have a clear clinical value. The possibility to re-express SOX11 indicates a potential use of epigenetic drugs to affect cell growth through common cell regulatory pathways, controlled by SOX11, and other tumour suppressors that are silenced in EOC. 

 

Furthermore, functional investigations in vitro confirmed a growth regulatory role for SOX11 in EOC.

 

Competing interests

A patent has been filed on the use of SOX11 as a diagnostic and prognostic antigen in EOC.

open access: Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study - 45 pts

Blogger's Note: interesting study worth reading

Background

The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.

Conclusions

IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.

Patients

This study was a non-randomized trial and included retrospective analysis of 45 women with EOC who were treated with IOERT at the 1st Affiliated Hospital of the Medical College of Xi'an Jiaotong University between January 2000 and January 2010.........The mean follow-up time was 78 months (range: 11-123 months).........

Table 1

Patient Characteristics

	Total	PD	ILR
Cases	45	25	20
Histology type
serous adenocarcinoma	36	21	16
papillary adenocarcinoma	9	4	4
CA-125 level
≥ 35 U/ml	38	20	18
< 35 U/ml	4	3	1
unknown	3	2	1

Conclusions
IOERT may be feasible and effective as a boosting technique to treat advanced and recurrent ovarian cancers. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. However, careful attention should be paid to peripheral nerves as specific IOERT dose-limiting structures.

abstract: Evaluation of microRNA expression profiles and their associations with risk alleles in lymphoblastoid cell lines of familial ovarian cancer

Lymphoblast - Wikipedia, the free encyclopedia

en.wikipedia.org/wiki/Lymphoblast

Lymphoblasts are immature cells which typically differentiate to form mature ... Although commonly lymphoblast refers to a precursor cell in the maturation of ...

open access: Cancer screening in the United States, 2012 - CA: A Cancer Journal for Clinicians

open access: Cancer risks associated with external radiation from diagnostic imaging procedures - Linet - 2012 - CA: A Cancer Journal for Clinicians

Blogger's Note: extensive (long) analysis; important to assess individual circumstances and as the research article indicates - risk vs benefit

 

Recommendations for Clinicians

• 1
  Become knowledgeable about the radiation doses for the imaging studies.
• 2
  Consider ultrasound and MRI when these are appropriate alternatives since these procedures do not subject the patient to ionizing radiation.172, 236
• 3
  Do not order a higher radiation dose study if a lower dose study (or an imaging study that does not use ionizing radiation) can provide the clinical information needed.
• 4
  All requests for imaging studies should be justified (eg, when all benefits and risks are considered, the study should be expected to do more good than harm).
• 5
  Available aids for justification, such as the ACR's Appropriateness Criteria and the ACC's Appropriate Use Criteria for Cardiac Computed Tomography, should be utilized to provide guidance for choosing the most appropriate imaging examination.
• 6
  Unnecessary imaging studies (duplicate studies and those that are not medically necessary) should not be performed.
• 7
  In general, neither screening nor elective x-ray examinations should be performed on pregnant women.
• 8
  Refer patients who require imaging studies to a facility that strives to optimize radiation dose, so that imaging is performed with the least amount of radiation necessary to provide adequate image quality.

How the CA-125 became a $50,000 blood test (blog) including public/professional responses

How the CA-125 became a $50,000 blood test

The New Old Age - Caring and Coping (looking after your pet/s) - 'pet trust' document

Australia: media - Charities push for overhaul of cancer funding 03/02/2012

ASHLEY HALL: "Cancer charities are calling for a massive overhaul of the $300 million fundraising and research sector.

They're becoming concerned about what they say is duplication and waste within the cancer research field.

The head of the Cancer Council of Australia says the attention paid to breast, cervix and ovarian cancer comes at the expense of other high mortality cancers including lung and pancreatic cancer....."

Art and Science: Color Explosion A fluorescence microscopy image (ovarian cancer cells/dna) competition straddles the boundary of science and art.

Research assistant at MD Anderson Cancer Center, Geoffrey Grandjean, obtained this image showing human ovarian cancer cells stained for DNA (red) and microtubules (green), during an siRNA screening. The particular gene knockdown in this screen disrupted cell division, causing the giant cell in the middle to grow very large.

The IN Cell Analyzer Image Competition winners 2011

Winning image for Asia PacificLeslie Caron GENEA, Australia

Winning image for the AmericasGeoffrey Grandjean MD Anderson Cancer Center, USA

Winning image for EuropeMarie Neguembor ALEMBIC - San Raffaele Scientific Institute, Italy

Vascular smooth muscle cells differentiated from human embryonic stem cells stained for DNA (blue) and the smooth muscle markers Smoothelin (red) and Caldesmon (green).

Human ovarian cancer cells stained for DNA (red) and microtubules (green).

Myoblast stained for DNA (blue), Myosin heavy chain (green) and methylated Histone H4 (red).

press release: Avoid a Pet Emergency in Overtime: Super Sunday's Parties Can Be Dangerous, Feb. 3, 2012

abstract: Importance of Histologic Subtype in the Staging of Appendiceal Tumors.

Blogger's Note: common feature is mucinous cell type; understudied is familial appendiceal carcinoid

BACKGROUND:

Malignant neoplasms of the appendix have different behavior based on their histologic subtypes in anecdotal series. Current staging systems do not capture the diversity of histologic subtypes in predicting outcomes.

METHODS:

We queried all patients with appendiceal malignancies captured in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2007. Tumors were classified as colonic type adenocarcinoma, mucinous adenocarcinoma, signet ring cell type, goblet cell carcinoid, and malignant carcinoid. We compared incidence, overall survival, and disease-specific survival for these tumors on the basis of patient, tumor, and therapy characteristics. Estimates from Cox proportional hazard modeling were used to predict hazard ratios for differing histologic subtypes with similar tumor, node, metastasis system (TNM) stages.

RESULTS:

Of the 5672 patients identified, we included 5655 (99%) in our analysis. The 5-year disease-specific survival rates were 93% for malignant carcinoid, 81% for goblet cell carcinoid, 55% for colonic type adenocarcinoma, 58% for mucinous adenocarcinoma, and 27% for signet ring cell type. Predicted estimates of adjusted hazard ratios revealed an 8-fold difference between histologic subtypes for similar TNM stages.

CONCLUSIONS:

Histologic subtype is an important predictor of disease-specific survival and overall survival in patients with appendiceal neoplasms. Addition of the histologic subtype to the TNM staging is simple and may improve prognostication.

abstract: Use of Mismatch Repair Immunohistochemistry and Microsatellite Instability Testing: Exploring Canadian Practices

METHODS:

Two web-based questionnaires were administered, a general and a specialist laboratory questionnaire, to establish the availability of such tests, requisite clinical/pathology integration, current mode of test initiation, reporting and recommendation practices, and education and attitudes among pathologists. Technical aspects were reviewed on the basis of specialist laboratory practice.

RESULTS:

Of 76 respondents, 21.5% were unaware or were uncertain whether they had access to MMR immunohistochemistry. Although 78.9% of respondents had access to such testing, an integrated approach to the identification of patients with LS is lacking, being limited to just 9 centers. The majority (70%) of testing is clinician initiated, with variable implementation of reflex testing and divergent practices in recommendation to test. Standardized reporting is lacking in many centers. Education on MMR in endometrial cancer is poor compared with that in colorectal cancer (P<0.0001).

(Blogger's Note: and so it would be safe to assume, based on this abstract, that the full spectrum of Lynch Syndrome related cancers requires obviously increased attention. As a further note, this and similar abstracts should take the opportunity to detail, in the background section, the full cancer spectrum - a one-line sentence is all that is required.)

INTERPRETATION:

This multicenter questionnaire highlights heterogenous practices in dMMR testing and LS identification, both in clinical terms and with regard to technical aspects of testing. An integrated multidisciplinary approach is lacking, and there is a need to educate physicians and resolve ethical issues. A Canadian consensus statement and national guidelines on dMMR testing are urgently needed, requiring input from pathologists, clinicians, and genetic counselors.

abstract: Predicting platinum resistance in primary advanced ovarian cancer patients with an in vitro resistance index

PURPOSE:

We aimed to identify primary platinum resistance in epithelial ovarian cancer (OC) patients with FIGO stage III-IV disease by an in vitro drug-response assay and to correlate the findings with clinical response. We considered whether neoadjuvant chemotherapy or anatomic sample site and tumor heterogeneity would influence the results.

CONCLUSIONS:

This in vitro assay predicted primary platinum resistance, without misclassification of sensitive OC patients, and the results were significantly associated with PFS. We suggest that samples from primary tumor and metastatic samples have different responses to chemotherapy and that exposure to chemotherapy might induce in vitro platinum resistance.

abstract: Malignant ovarian germ-cell tumours

Malignant ovarian germ-cell tumours account for about 5% of all ovarian malignancies and typically present in the teenage years. They are almost always unilateral and are exquisitely chemosensitive. As such, the surgical approach in young women with such tumours confined to a single ovary should aim to preserve fertility.....

abstract: KRAS mutations in ovarian low-grade endometrioid adenocarcinoma: association with concurrent endometriosis (study of KRAS/BRAF mutations)

Summary

The association between ovarian endometrioid adenocarcinoma and endometriosis is well established. However, not all endometrioid adenocarcinomas are directly related to endometriosis, and it has been suggested that there may be clinicopathologic differences between endometriosis-positive and endometriosis-negative tumors. Molecular alterations in endometrioid adenocarcinoma include KRAS and BRAF mutations, but the incidence of these abnormalities in previous reports has been highly variable (0%-36% and 0%-24%, respectively).....

Keywords

• Ovary;
• Endometrioid;
• Adenocarcinoma;
• Endometriosis;
• Molecular

The Cost of Knowledge - petition to allow open access publishing - Elsevier journals

Blogger's Note: Gynecologic Oncology is a journal published through Elsevier