Cruciferous vegetables and cancer risk in a network of case–control studies

Background: Cruciferous vegetables have been suggested to protect against various cancers, though the issue is open to discussion. To further understand their role, we analyzed data from a network of case–control studies conducted in Italy and Switzerland.
Results: The multivariate odds ratio (OR) for consumption of cruciferous vegetables at least once a week as compared with no/occasional consumption was significantly reduced for cancer of the oral cavity/pharynx (OR = 0.83), esophagus (OR = 0.72), colorectum (OR = 0.83), breast (OR = 0.83), and kidney (OR = 0.68). The OR was below unity, but not significant, for stomach (OR = 0.90), liver (OR = 0.72), pancreatic (OR = 0.90), laryngeal (OR = 0.84), endometrial (OR = 0.93), ovarian (OR = 0.91), and prostate (OR = 0.87) cancer.

Conclusion: This large series of studies provides additional evidence of a favorable effect of cruciferous vegetables on several common cancers.

financial press release: Halt Medical, Inc. Calif., Feb. 11, 2012 (uterine fibroid technology) + link to clinical trial

Blogger's Note: uterine fibroids affects many women worldwide and can be the cause of a misdiagnosis in ovarian cancer (benign/malignancy); so of interest generally to women




About Halt Medical, Inc.
Founded in 2004, Halt Medical is a medical device company focused on women's health. The company has developed a procedure and related equipment for treating uterine fibroids that is less expensive, more effective and less invasive than other alternatives - the Halt GFA System. In June 2010, the U.S. Food and Drug Administration cleared the Halt 2000GI™ Electrosurgical System for soft tissue ablation using radiofrequency energy. The results of Halt Medical's international studies have led to recent approvals for treating uterine fibroids in Canada and the European Union. The Halt System may be used for general surgical use in the U.S. The company recently completed a 137 patient IDE clinical trial at 11 sites in 3 countries to demonstrate clinical safety and efficacy in the treatment of symptomatic uterine fibroids. FDA clearance is expected this year. The Company is located in Livermore, CA.
Information about the Halt Fibroid Study and a list of clinical sites in the U.S. may be found at www.clinicaltrials.gov, study number NCT00874029.

open access: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer

 Background/Aims.
Intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC) has been used in the treatment of ovarian cancer. The purpose of the study is to determine the efficacy of HIPEC after cytoreductive surgery in advanced ovarian cancer

 From 2006 to 2010, 43 women with primary or recurrent ovarian cancer were enrolled in the study and underwent maximal cytoreductive surgery and HIPEC. The mean age of the patients was 59.9 yrs (16–82) years.

Table 1: Characteristics of the patients.

Table 2: Peritonectomy procedures.

Table 3: Complications ( 6 grade 111/1V events)
"...Severe morbidity (grade 3 and 4) has been recorded in 6 patients (14%). It is obvious that the most severe complication is the anastomotic failure. Anastomotic failure has been reported in other series as the most frequent complication [8, 9, 25]. Cisplatin has been incriminated to impair anastomotic healing in animal studies [26] in contrast to local hyperthermia that has not [27]. As a consequence, the failures may be attributed either to cisplatin or to the immediate restoration of the gastrointestinal tract after low-anterior resection particularly in those cases with preoperative partial intestinal obstruction. The importance of intestinal obstruction and the avoidance of immediate restoration of the gastrointestinal tract has been emphasized [9] resulting in significant decrease of anastomotic failures [28]. Therefore a protective colostomy seems to be a reasonable solution. Other severe complications as intra-abdominal abscess or sepsis or postoperative bleeding are infrequent [8, 9, 25]....."


Conclusions
Maximal cytoreductive surgery with standard peritonectomy procedures combined with intraperitoneal chemotherapy is a well-tolerated and feasible method for treatment of advanced epithelial ovarian cancer. It appears to improve long-term survival securing that complete or near complete cytoreduction is possible in the vast majority as well as the eradication of the microscopic residual tumor.

Molecular profiling reveals differences between primary and recurrent ovarian cancers | Science Codex - Clearity Foundation

How long before CVac, a new treatment for ovarian cancer, is available in the UK? – Telegraph Blogs

"Since my blog post about the Stage 3 trial of CVac – a new treatment for ovarian cancer – I have been in contact with Dr Neil Frazer, who is heading this research for the Australian company Prima Biomed. He has answered my questions about the treatment, clarified the methodology and explained about Prima Biodmed's medical facility in Dubai where CVac will be supplied......

to open April - Concerned about ovarian cancer? Visit one of the DOVE clinics - media

Blogger's Note: the cost is not apparent nor availability to Quebec residents only or ?

MONTREAL - Of the 12 new DOVE clinics to open in the Montreal area as of April, the Anjou clinic is already up and running.

No referral is needed. Women age 50 and older with any symptoms – bloating, pelvic or abdominal pain, frequent urination, difficulty eating or feeling full quickly – lasting longer than two weeks but less than a year, are encouraged to go for testing.

Satellite Centre 1 — Clinique médicale du Haut Anjou, 7500 Galeries d’Anjou Blvd. 514-493-1999

Satellite Centre 2 — Clinique Familiale Pas-à-Pas, 3650 Henri Bourassa Blvd. E. 514-328-9797

Satellite Centre 3 — 8260 Maurice Duplessis Blvd. 514-643-1113

Satellite Centre 4 — Polyclinique Cabrini, 5700 St. Zotique St. E. 514-253-6776

Satellite Centre 5 — Clinique Perrier, 10749 Lajeunesse St. 514-383-0559

Satellite Centre 6 — Clinique Plein Ciel, 475 Côte Vertu Blvd. 514-337-3171

Satellite Centre 7 — Lakeshore General Hospital, 160 Stillview Rd., Pointe Claire 514-630-2225

Satellite Centre 8 — Cavendish Medical Centre Inc., 2545 Cavendish Blvd. 514-483-2424

Satellite Centre 9 — Lachine Hospital, 650 16th Ave., 514-934-1934, Local 77306

Satellite Centre 10 — Sacré Coeur Hospital, 5400 Gouin Blvd. W. 514-338-2222, Local 2063

Satellite Centre 11 — Queen Elizabeth Health Complex, 2100 Marlowe Ave. 514-699-4630

Satellite Centre 12 — St. Henri Medical Centre, 3966 Notre Dame St. W. 514-935-4330

Read more: http://www.montrealgazette.com/Concerned+about+ovarian+cancer+Visit+DOVE+clinics/6129807/story.html#ixzz1m0yVCBfu

abstract: No place like the hospital. [J Pain Symptom Manage

Source

Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA. mgillick@partners.org

Abstract

The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.

Drugs, Herbs and Supplements: MedlinePlus (alpha list)

FYI: top 5 most read items this week - Ovarian Cancer and Us Blog

Results of post-operative abdomino-pelvic radiotherapy Nov 3, 2008 original date posted

youtube video: "Do You See Politics on My Chest" Feb 5, 2012  original date posted

open access: Participatory Medicine: Must You Be Rich Feb 2, 2012 original date posted

JCO - open access - It Takes a Village (palliative care) Feb 8, 2012 original date posted

She the People - Komen, go back to your roots by Donna Trussell Feb 5, 2012 original date posted

(very short) abstract: A Surveillance Conundrum: A Case of 4 Distinct Primary Malignancies in a BRCA-1 Mutation Carrier - Intl Jnl Gyn Pathology

Abstract

Women with HBOC syndrome present a unique challenge to the oncology community, as will many genetic cancer syndromes yet to be discovered as genetic testing increases in availability. Issues of management and, most importantly, implication are yet to be elucidated. After a diagnosis of epithelial ovarian carcinoma lifelong follow-up is recommended. Given the high recurrence rate and dismal long term prognosis of advanced epithelial ovarian carcinoma this recommendation is more often than not moot. There are no clear guidelines or recommendations for surveillance designed for women with disease free survival greater than five years. This case presents a unique scenario of a woman with predictable disease that remains unpreventable.

abstract: Histological Grading of Ovarian Clear Cell Adenocarcinoma: Proposal for a Simple and Reproducible Grouping System - Intl Jnl Gyn Pathology

Blogger's Note: 'interesting' stat ranges between early/advanced clear cell ovarian cancers; read full abstract for more details (full access requires subscription $$$); some details deleted for ease of reading 

Abstract

"In this study, we aimed to develop a histological grading system for ovarian clear cell adenocarcinoma (CCA), based on the tumor growth architectures."

"The interobserver reproducibility and prognostic value of the assigned groups were analyzed for 159 CCAs from 5 institutions."

"In early-stage cases [International Federation of Gynecology and Obstetrics (FIGO) stage I–II], .....(survival rates 56-100%)

"In advanced cases (FIGO stage III–IV),.....(survival rates 16-52%)

"The proposed grouping system could divide patients with CCA into 3 subgroups with distinct prognostic indications, providing a 3-tier histological grading system for ovarian CCA."

abstract: A Systematic Review of Papers Examining the Use of Intraoperative Frozen Section in Predicting the Final Diagnosis of Ovarian Lesions Intl Jnl Gyn Pathology (clear cell, mucinous, borderline, invasive...)

Abstract

"This systematic review assesses the accuracy of the frozen section classification of benign and borderline lesions or invasive carcinoma when compared with the final diagnosis on paraffin section. A Pubmed database search identified 18 retrospective cohort studies, published since 2005 that satisfied the criteria, on the critical appraisal sheet of the center for evidence-based medicine, The University of Oxford.

The sensitivity, specificity, and negative and positive predictive values suggest that frozen section is more accurate at discriminating between benign lesions and invasive carcinoma than between benign and borderline or borderline lesions and invasive carcinoma and indicate a tendency to overcall benign tumors as borderline and borderline tumors as invasive malignancies.
A narrative review of individual papers and abstracts suggests that this particular difficulty is encountered when dealing with clear cell carcinoma and mucinous lesions of all sorts.
This may have greater importance in the future with the introduction of targeted chemotherapy requiring accurate typing to guide the use of genetic analysis. It would be beneficial if future researchers comparing the results of frozen section and paraffin sections presented their results in the context of preoperative assessment of the clinical and radiological findings or the intraoperative appearances of the tumor and abdominal cavity, which would allow the identification of those cases in which the frozen section allowed a refinement of the diagnoses made using these modalities."

abstract: Frequency of Serous Tubal Intraepithelial Carcinoma in Various Gynecologic Malignancies: A Study of 300 Consecutive Cases

Abstract:

Serous tubal intraepithelial carcinoma (STIC) has been implicated in the pathogenesis of pelvic serous carcinoma. We hypothesized that, if this is the case, the frequency of STIC should be substantially lower in endometrial serous carcinomas, in nonserous gynecologic malignancies, and in benign gynecologic neoplasms than in ovarian or peritoneal serous carcinomas.

From 2007 to 2009 the fallopian tubes of 342 consecutive gynecologic cases were entirely submitted for histology using the Sectioning and Extensively Examining the FIMbriated end protocol.

This study included 300 of these cases (277 TAH-BSO, 23 BSO) after exclusion. The hematoxylin and eosin-stained slides from the fallopian tubes were independently reviewed by 2 gynecologic pathologists who were blinded to all other findings; disagreements were resolved by a third pathologist.

Among 46 cases of ovarian malignancies, STIC was identified in 6 (18.8%) of 32 cases of serous carcinoma, but not in any other subtype. Similarly, STIC coexisted in 4 (14.3%) of 28 cases of endometrial serous carcinoma; however, no STIC was identified in any of the 74 cases of nonserous endometrial malignancies. STIC was identified in 2 (28.6%) of 7 cases of peritoneal serous carcinoma.

No STIC was identified among 15 nongynecologic malignancies, 90 cases of benign conditions, and 27 cases of other conditions including 4 cases of cervical adenocarcinoma in situ and high-grade cervical intraepithelial lesions, 8 cases of endometrial atypical complex hyperplasias, and 15 cases of ovarian borderline tumors.

In conclusion, the fallopian tube may be the origin of some pelvic serous carcinomas. Other possibilities that may explain the origin of pelvic high-grade serous carcinoma are discussed. Given that STIC coexisted with 14% of endometrial serous carcinomas, a more unifying theory may be that gynecologic serous carcinomas and STIC are multifocal lesions.

abstract: (Avastin) Bevacizumab-Associated Fistula Formation in Postoperative Colorectal Cancer Patients - adverse events

Blogger's Note: adverse events are worth noting albeit other types of cancers; full text of paper would be required to properly assess the conclusions of this particular study

           ~~~~~~~~~~~~~~~~~~~~

Conclusions

Bevacizumab is the most common antiangiogenesis agent used for treatment of metastatic CRC. Previous adverse events associated with bevacizumab treatment include venous thromboembolism, poor wound healing, and spontaneous bowel perforation. In this report, late postoperative development of fistulas occurred relatively soon after initiation of bevacizumab and usually spontaneously resolved with cessation of bevacizumab treatment. Based on the timing of fistula development relative to operation and initiation of bevacizumab, fistulas are likely secondary to bevacizumab therapy rather than postsurgical complications. Bevacizumab-induced fistulas occur in a small, but significant proportion of CRC patients and must be recognized early.

2012 Recently updated NCCN Clinical Practice Guidelines in Oncology™ plus link to Ovarian Cancer (and other related) NCCN guidelines

Blogger's Note: Lynch Syndrome is included in the Colorectal Cancer section (*see below)

NCCN Guidelines for Treatment of Cancer by Site

• Bone Cancer Version 2.2012
• Breast Cancer Version 1.2012
• Colon Cancer Version 3.2012
• Hodgkin Lymphoma Version 1.2012
• Non-Hodgkin's Lymphomas Version 1.2012
• Rectal Cancer Version 3.2012
• Testicular Cancer Version 1.2012
• Waldenström's Macroglobulinemia / Lymphoplasmacytic Lymphoma Version 1.2012
• Cancer Related Fatigue (and others)

NCCN Guidelines for Supportive Care

• Distress Management Version 1.2012

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

NCCN Guidelines for Treatment of Cancer by Site (professional)

You must Login or Register to access this information.

Occult Primary (Cancer of Unknown Primary)

Ovarian Cancer

• Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer)
• Borderline Epithelial Ovarian Cancer (Low Malignant Potential)
• Less Common Ovarian Histologies

Fallopian Tube Cancer (See Ovarian Cancer)

Primary Peritoneal Cancer (See Ovarian Cancer) 

          ~~~~~~~~~~~~~~~~~~~~~

---

NCCN Guidelines for Detection, Prevention, &  Risk Reduction (*includes genetic syndromes, supportive care):

---

Colorectal Cancer Screening

Genetic/Familial High-Risk Assessment: Breast and Ovarian

• Breast and/or Ovarian Genetic Assessment
• Hereditary Breast and/or Ovarian Cancer
• Li-Fraumeni Syndrome
• Cowden Syndrome

Fasting Plus Chemo May Help in Cancer Fight - MedicineNet - research in mice

Blogger's Note: note that this research was done in mice

"We don't know whether in humans it's effective," Longo said. "It should be off limits to patients, but a patient should be able to go to their oncologist and say, 'What about fasting with chemotherapy or without' if chemotherapy was not recommended or considered?"
The researchers warned that fasting may not be safe for all cancer patients, particularly those who have already lost a significant amount of weight or have other conditions, such as diabetes. They added that fasting can cause headaches and a drop in blood pressure. The study also pointed out that cancer-free survival resulting from fasting may not extend to large tumors.
According to the American Cancer Society, "available scientific evidence does not support claims that fasting is effective for preventing or treating cancer. Even a short-term fast can have negative health effects, while fasting for a longer time could cause serious health problems."

abstract: Adapted ice cream as a nutritional supplement in cancer patients: impact on quality of life and nutritional status

Conclusions

The administration of ice cream could cover, in part, the social aspect of food and improve QLQ in malnourished cancer patients. These results are encouraging and deserve further confirmation.

open access: BMC Cancer - Predictive models for mutations in mismatch repair genes: implication for genetic counseling in developing countries (Lynch Syndrome)

 Background

Lynch syndrome (LS) is the most common form of inherited predisposition to colorectal cancer (CRC), accounting for 2–5% of all CRC. LS is an autosomal dominant disease characterized by mutations in the mismatch repair genes mutL homolog 1 (MLH1), mutS
homolog 2 (MSH2), postmeiotic segregation increased 1 (PMS1), post-meiotic segregation increased 2 (PMS2) and mutS homolog 6 (MSH6). Mutation risk prediction models can be incorporated into clinical practice, facilitating the decision-making process and identifying
individuals for molecular investigation. This is extremely important in countries with limited economic resources. This study aims to evaluate sensitivity and specificity of five predictive models for germline mutations in repair genes in a sample of individuals with suspected
Lynch syndrome.

"Lynch syndrome (LS) is the most common form of inherited predisposition to colorectal cancer (CRC), accounting for 2–5% of all CRC [1]. Colorectal cancer in LS differs from sporadic cases by an earlier age of diagnosis (mean age approximately 44 years), a predominance of proximally-sited colon cancers (60–70%) and an increased propensity to
synchronous or metachronous CRCs (25%) [2,3]. Individuals with LS have an 80% probability of developing CRC at 65 years, and they are at an elevated risk of developing a second primary CRC [4] as well as at an increased risk for extra-colonic malignancies, including endometrial, gastric, small bowel, urological tract, ovary, pancreas and brain cancer
[5]."

 Conclusions

The Barnetson, PREMM, MMRpro and Wijnen models present similar AUC. The AUC of the Myriad model is statistically inferior to the four other models. 

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

open access PLoS ONE: Health Risk or Resource? Gradual and Independent Association between Self-Rated Health and Mortality Persists Over 30 Years

Wiki:  
 Salutogenesis is a term coined by Aaron Antonovsky,^[1] a professor of medical sociology. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease. More specifically, the "salutogenic model" is concerned with the relationship between health, stress, and coping.
Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum".^[1]

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

 Background

Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5–10 years. This study examined whether the SRH-mortality association remained significant 30 years after assessment when adjusting for a wide range of known clinical, behavioural and socio-demographic risk factors.

Conclusions

SRH (self reported health) is a strong and “dose-dependent” predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and reflects salutogenetic rather than pathogenetic pathways.

Feb 9th: The Maze of PARP Inhibitors in Ovarian Cancer - Cancer Network

Blogger's Note:  full access, free subscription

Conclusion

"While consideration of chemoprevention with PARP inhibitors is on the horizon, many knowledge gaps exist regarding these agents. Although the trials in EOC provided some answers regarding the activity of PARP inhibitors, they raised many other questions. These questions may actually complicate the picture as newer agents in this drug class make their way to the clinical arena. A collaborative approach among the researchers is needed to systematically answer these questions so we are better equipped to provide effective treatment to the BRCA-deficient patients. It is noteworthy that The Cancer Genome Atlas Group analysis did reveal other commonly deregulated pathways in this disease—such as RB, RAS/PI3K, FOXM1, and NOTCH—that might provide future opportunities for therapeutic targeting while the story of the PARP inhibitors continues to unfold."


 

Medical News:Cancer Treatment OK During Pregnancy - in OB/Gyn, Pregnancy from MedPage Today

media: Fast-track testing helps to find ovarian cancer early (relates to Dove Report/see comment 'pelvic cancer')

Blogger's Note:

this media report relates directly to the Dove Report published (and commentary) in the Lancet Oncology Jan 17th;

search this blog and/or direct link  to the Lancet: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2811%2970405-3/fulltext

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

" (Dr) Gilbert is also campaigning to change the name of ovarian cancer to "pelvic cancer."
Research over the last decade has shown that most cases of ovarian cancer don't actually begin in the ovaries at all, but in the fallopian tubes. Pre-cancerous cells grow in the tubes and then shed over the surface of the ovaries, where they cause tumours.
By the time the cancer is found in the ovaries, it's already advanced. She says the focus should be on finding the cancer in its earliest stage in the tubes.
"We, for so many years, [kept] looking at the wrong place," she told reporters Thursday.
"Put bluntly, we had the name wrong, the staging wrong, and the diagnostic testing wrong. It is no wonder we have lost so many lives to this disease.""

media: (re: Lancet report) Current trend is to preserve pregnancy in patients diagnosed with cervical or ovarian cancer

Blogger's Note: a slight bit more information

abstract: (cervical/ovarian) Gynaecological cancers in pregnancy : The Lancet

Blogger's Note: requires a subscription to view full paper $$$

open access: The Bangkok Statement on universal health coverage : The Lancet

"The theme of the Prince Mahidol Award Conference in Bangkok, Thailand on Jan 24—28, 2012, was Moving towards universal health coverage: health financing matters. At the close of the meeting, a 10-point declaration recognised universal health coverage (UHC) as fundamental to the right to health, and marked the commitment by more than 800 delegates to translate the rhetoric of UHC into better, more equitable health outcomes. Similar endorsements of UHC have been made before, including at the World Health Assembly in 2011. What makes the Bangkok Statement any more likely to hasten and widen the implementation of UHC?

One answer may be the power of the Prince Mahidol Award Conference and its sponsors to draw global health enthusiasts from a wide variety of disciplines and health systems. Delegates from 68 countries included donors and recipients of aid, managers and front-line health workers, ministers, economists, and consumers. From these many perspectives came the realisation that whether one seeks to provide access to health care for the 1 billion people who lack it, or to protect the 100 million people who end up in poverty every year as a result of medical costs, or to accelerate progress towards the Millennium Development Goals; UHC provides a common mechanism—and common cause. Simply put in a plenary by Peter Anyang' Nyong'o, Kenya's Minister for health services, “universal health coverage is fundamental to improving the lives of people.”.......

open access: Cancer treatment and care: a new and uneasy world : The Lancet

"......Thinking of the future, we sense oncological needs and expectations growing beyond what can be planned or provided for fairly. A drug like abiraterone, promising benefit in an area of evident clinical need, will have taken 20 years and substantial funds to develop. Early stage drug development is likely to have been undertaken by researchers with charitable or public funding, with the translational and clinical research by commercial entities leading, in abiraterone's case, to indelicate public haggling over how much 1 year of an average patient's life is reasonably worth....."

abstract: Prospective evaluation of molecular screening for Lynch syndrome in patients with endometrial cancer ≤ 70 years.

Blogger's Note: age >50 yrs will be at issue

Gynecol Oncol. 2012 Feb 1.

Abstract

OBJECTIVE:

Lynch syndrome (LS) is a hereditary syndrome that predisposes to multiple malignancies including endometrial cancer (EC). We aimed to evaluate a diagnostic strategy for LS based on routine analysis of microsatellite instability (MSI) and immunohistochemical (IHC) staining for mismatch repair (MMR) proteins in tumor tissue of all newly diagnosed EC patients ≤70years.

METHODS:

Consecutive EC patients ≤70years were included prospectively in eight Dutch centers. EC specimens were analyzed for MSI, IHC of four MMR proteins, MMR gene methylation status and BRAF-mutations. Tumors were classified as; 1) likely to be caused by LS, 2) sporadic MSI-H, or 3) microsatellite stable (MSS).

RESULTS:

Tumor specimens of 179 patients (median age 61years, IQR 57-66) were analyzed. In our study 92% of included patients were over 50 years of age. Eleven EC patients were found likely to have LS (6%; 95% CI 3-11%), including 1 patient suspected of an MLH1, 2 of an MSH2, 6 of an MSH6 and 2 of a PMS2 gene defect. Germline mutation analyses revealed 7 MMR gene germline mutations. Ten patients likely to have LS (92%) were older than 50years. In addition, 31 sporadic MSI-H tumors with MLH1 promoter hypermethylation (17%; 95% CI 13-24%) were identified.

CONCLUSIONS:

Molecular screening for LS in patients with EC diagnosed≤70years, leads to identification of a profile likely to have LS in 6% of cases. New screening guidelines for LS are needed, including recommendations for EC patients older than 50years of age.

video: Serving on a Clinical Practice Guideline Panel | US Cochrane Center

Canary Foundation Early Detecton Symposium May 1st Palo Alto, California

JCO: Editorial - Ovarian Suppression for Prevention of Premature Menopause and Infertility: Empty Promise or Effective Therapy? (in Breast Cancer) see note/your comments?

Blogger's Note:  compared with other young cancer survivors??
                 ~~~~~~~~~~~~~

"Fertility and premature menopause are major concerns for young patients who are undergoing treatment for cancer. Young women with breast cancer face particular challenges when considering future fertility compared with other young cancer survivors.¹ The greatest concern is whether preservation of ovarian function and a subsequent pregnancy in a breast cancer survivor could increase the risk of recurrence, particularly in patients with hormone receptor–positive disease....."

See accompanying article on page 533

Their So-Called Journalism, or What I Saw at the Women’s Mags

Blogger's Note: not related to ovarian cancer but possibly of interest ) to our community of women authors, those who write about ovarian/cancers

Hypocritical oaths : Nature : Nature Publishing Group

Editorial: Full-text - The Use of Sedation in Palliative Care

"....Often pain and suffering make it difficult for patients themselves to participate, further reducing their autonomy and empowerment. Patients should be kept fully empowered by being thoroughly informed of all means available to reduce their symptoms and maximize their comfort at the earliest possible stage of their palliative care."

"Dying patients in palliative care settings deserve to have maximum control over their futures. This includes full disclosure on the use and effectiveness of sedation for palliative ends. Allowing patients more decision-making power in choosing various levels of sedation through to CDS would significantly improve the dying process while maintaining ethically sound practices as viewed by all parties concerned. Health care practitioners would not have to feel that they are hastening death. Patients would have greater control over their symptoms. Family members would not have to watch their loved ones endure dysteleological suffering. It is the best we can do when facing our finitude, and dying patients deserve our best."

Editorial: Full-text - For a Modern Concept of Palliative Care

"Unfortunately, in most countries hospice care addresses end-of-life care."

"....This late referral to palliative care is also in contrast with the classical definition of palliative care provided by WHO: “Palliative care is ….. applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications” [6]. "

open access: The tone of life on social networking sites | Pew Research Center's Internet & American Life Project (adult, also section on teens & SNS)

Blogger's Note: there is also a section on teen SNS

abstract: Palliative Medicine Fellowship: A Study of Resident Choices

Context

There are no data on the motives or characteristics of physicians choosing fellowship training in Hospice and Palliative Medicine (HPM).

Objectives

To understand more about the residents who choose HPM and what leads them to this decision.

Conclusion

Negative experiences with end-of-life care in residency, particularly in the intensive care unit, continue to be a factor in selection of HPM as a specialty. Many residents make their decision to enter the field and apply during Postgraduate Year 3. Most received negative comments about the choice. Fellows require a broad range of experience when selecting a fellowship program.

abstract: Survival for Ovarian Cancer in Europe: The across-country variation did not shrink in the past decade.

abstract: Does public disclosure of quality indicators influence hospitals' inclination to enhance results? (using Oesophageal resection as the example)

CONCLUSION:

Our results support the assumption that low-volume hospitals are inclined to adjust their numbers when, because outcomes are public, pressure to report a sufficient number is high. So, external verification of data is essential when this 'need to score' is high.

Systematic Reviews - Why prospective registration of systematic reviews makes sense

Abstract (provisional)

Prospective registration of systematic reviews promotes transparency, helps reduce potential for bias and serves to avoid unintended duplication of reviews. Registration offers advantages to many stakeholders in return for modest additional effort from the researchers registering their reviews.

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

BioMed Central Blog : Systematic Reviews journal launches today

BioMed Central Blog : Systematic Reviews journal launches today

abstract: How valid are claims for synergy in published clinical studies?

Abstract

Background: Clinical trials evaluating drug combinations are often stimulated by claims of synergistic interactions in preclinical models. Overuse or misuse of the term synergy could lead to poorly designed clinical studies.

Conclusions: Synergy is cited frequently in phase I and phase II studies to justify the evaluation of a specific drug combination. Inappropriate methods for evaluation of synergy and poor assessment of therapeutic index have been used in most preclinical articles.

media: Is It Ever OK To Hug Your Doctor?

open access article: Human experiments: First, do harm : Nature News & Comment

Blogger's Note: a very good reminder on recognizing the actual 'end game' - the patients, obviously (not killing the patient in the process of a particular goal)


                                                                                
EVOLVING ETHICS
Sexually transmitted diseases (STDs) were a prime concern for health officials in the 1940s, and many medical studies — including the US experiments in Guatemala — used methods that would be considered unethical today. Although standards improved over the decades, clinical researchers continued to push the boundaries of acceptable science.....

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.