Wednesday, May 02, 2012
paywalled Primary fallopian tube carcinoma risk in users of postmenopausal hormone therapy in Finland
Primary fallopian tube carcinoma risk in users of postmenopausal hormone therapy in Finland: Publication year: 2012
Source:Gynecologic Oncology
Objective Primary fallopian tube carcinoma (PFTC) is a rare malignancy and only sparse data exist on its possible association with postmenopausal hormone therapy (HT). We therefore studied this association in a nationwide cohort of Finnish HT users.
Conclusions The long-term, sequential use of EPT associates with an increased risk for PFTC. In absolute terms, 4 additional cases of PFTC would be detected in 10-year follow-up of 10,000 women who have used EPT for at least 5 years
Family history: Still relevant in the genomics era - Cleveland Clinic
Family history: Still relevant in the genomics era
Key points
- The family history is an underused tool for predicting the risk of disease and for personalizing preventive care.
- Barriers to the appropriate collection and use of the family history include concerns over the reliability of patient reporting, a lack of time and reimbursement, and provider knowledge gaps.
- Use of family history to inform genetic testing for hereditary cancer syndromes has been shown to improve outcomes and may reduce overall health care costs.
- Future solutions need to focus on creating time-effective ways to collect and analyze the family history, and on developing innovative methods of educating medical providers at all levels of training as to how to apply the family history in clinical practice.
Study Downplays Risk of CT Scans - MedicineNet
Blogger's Note: cancer patients know this; the concern is 'excess' or unnecessary scans (as indicated in the article)
Study Downplays Risk of CT Scans - MedicineNet
"More often than not, patients should be getting that CT scan because the risk of the underlying cause is higher than from radiation."
"...The findings were similar -- with deaths ranging from 2 percent to 33 percent -- in the more than 15,000 who got abdominal CTs. The researchers think 23 people in the entire group would have gotten cancer due to radiation exposure."
""In the patients getting 15 or more scans, all of them had pretty significant disease, where their expected mortality was likely to occur much sooner than the chances of the radiation-induced cancer taking effect," Zondervan said. In other words: Those who were the sickest, requiring the most CT scans, would probably die before any cancer caused by the CT radiation could start hurting them."
Tuesday, May 01, 2012
Medscape Oncologist Compensation Report: 2012 Results - U.S.
Blogger's Note: not broken down specifically to the sub-specializtion of gyn/oncology, patients/public perceptions of physician's compensation/expenses, income demographics, time spent with patients, physician hours of work, satisfaction with profession.....
Medscape Oncologist Compensation Report: 2012 Results
Medscape: Many Clinical Trials Unable to Supply High-Quality Evidence
Many Clinical Trials Unable to Supply High-Quality Evidence
"Given the deficit in evidence to support key decisions in clinical practice guidelines…as well as concerns about insufficient numbers of volunteers for trials…the desire to provide high-quality evidence for medical decisions must include consideration of a comprehensive redesign of the clinical trial enterprise," they continue. Currently, less than 15% of major guideline recommendations are evidence-based, they write........
Women, Minorities More Likely to Leave Surgery Career Path
Women, Minorities More Likely to Leave Surgery Career Path
May 1, 2012 — Women and minority trainees in general surgery are more likely to fall short of board certification than their peers, according to a study published yesterday in the May issue of the Journal of the American College of Surgeons (JACS).......
paywalled: Epigenetic Resensitization to Platinum in Ovarian Cancer (low-dose decitabine/carboplatin)
Epigenetic Resensitization to Platinum in Ovarian Cancer
"Together, the results of this study suggest that low-dose decitabine altered DNA methylation of genes and cancer pathways, restoring sensitivity to carboplatin in patients with heavily pretreated ovarian cancer and resulting in a high RR and prolonged PFS."
Abstract
Preclinical studies have shown that hypomethylating agents reverse platinum resistance in ovarian cancer. In this phase II clinical trial, based upon the results of our phase I dose defining study, we tested the clinical and biologic activity of low-dose decitabine administered before carboplatin in platinum-resistant ovarian cancer patients. Among 17 patients with heavily pretreated and platinum-resistant ovarian cancer, the regimen induced a 35% objective response rate
paywalled: Requirements to Assess Feasibility of Phase 0 Trials during Major Abdominal Surgery: Variability of PARP Activity
Requirements to Assess Feasibility of Phase 0 Trials during Major Abdominal Surgery: Variability of PARP Activity
Abstract
Purpose: The aim of this
study was to evaluate the feasibility of phase 0 trials in the setting
of a routine surgical procedure. Logistic
considerations, tissue sampling and tissue
handling, and variability of a biomarker during surgery, in here PARP,
were evaluated.
Experimental Design:
Patients with highly suspicious or proven diagnosis of advanced ovarian
cancer, planned for debulking surgery were asked
to allow sequential tumor biopsies during surgery.
Biopsies were frozen immediately and PARP activity was measured
subsequently.
Conclusions: Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker.
Conclusions: Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker.
A Comprehensive Analysis of Human Gene Expression Profiles Identifies Stromal Immunoglobulin κ C as a Compatible Prognostic Marker in Human Solid Tumors
A Comprehensive Analysis of Human Gene Expression Profiles Identifies Stromal Immunoglobulin κ C as a Compatible Prognostic Marker in Human Solid Tumors
"No association was observed in ovarian cancer."
phase 1 - A Open-Label, Multiple Ascending Dose Study of DS-3078a, an Oral TORC1/2 Kinase Inhibitor, in Subjects With Advanced Solid Tumors or Lymphomas - Full Text View - ClinicalTrials.gov
A Open-Label, Multiple Ascending Dose Study of DS-3078a, an Oral TORC1/2 Kinase Inhibitor, in Subjects With Advanced Solid Tumors or Lymphomas - Full Text View - ClinicalTrials.gov
This study is currently recruiting participants.
Verified April 2012 by Daiichi Sankyo Inc.
First Received on April 26, 2012.
Last Updated on April 27, 2012
History of Changes
paywalled: Evaluation of prevalent and incident ovarian cancer co-morbidity : British Journal of Cancer
Access : Evaluation of prevalent and incident ovarian cancer co-morbidity : British Journal of Cancer
British Journal of Cancer , (1 May 2012) | doi:10.1038/bjc.2012.164
Evaluation of prevalent and incident ovarian cancer co-morbidity
Abstract
Background:
The
peak in incidence of ovarian cancer occurs around 65 years and
concurrent increasing risk by age for a number of diseases strongly
influence treatment and prognosis. The aim was to explore prevalence and
incidence of co-morbidity in ovarian cancer patients compared with the
general population.
Methods:
The study population was patients with ovarian cancer in Sweden 1993–2006 (n=11 139) and five controls per case (n=55 687).
Co-morbidity from 1987 to 2006 was obtained from the Swedish Patient
Register. Prevalent data were analysed with logistic regression and
incident data with Cox proportional hazards models.
Results:
Women
developing ovarian cancer did not have higher overall morbidity than
other women earlier than 3 months preceding cancer diagnosis. However,
at time of diagnosis 11 of 13 prevalent diagnosis groups were more
common among ovarian cancer patients compared with controls. The
incidence of many common diagnoses was increased several years following
the ovarian cancer and the most common diagnoses during the follow-up
period were thromboembolism, haematologic and gastrointestinal
complications.
Conclusion:
Women
developing ovarian cancer do not have higher overall morbidity the
years preceding cancer diagnosis. The incidence of many common diagnoses
was increased several years following the ovarian cancer. It is crucial
to consider time between co-morbidity and cancer diagnosis to
understand and interpret associations.
Next-generation 'epigenetic' cancer pill shown to be safe in phase I trial (CHR-3996)
Next-generation 'epigenetic' cancer pill shown to be safe in phase I trial
" CHR-3996 was tested in 39 patients with a range of advanced cancers."
BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?
BMJ » Blog Archive » Chris Williams: When will we learn HOW to deliver healthcare?
Chris Williams is a medical student at the University of Liverpool, currently intercalating at the Liverpool School of Tropical Medicine for an MSc in Humanitarian studies.
paywalled: Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication
Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication: Publication year: 2012
Source: Patient Education and Counseling
Objective The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members.
Methods Empathic opportunities and hospice team responses were analyzed from bi-weekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data.
Results Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgments of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities.
Conclusion Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers.
Practice implications Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers.
press release: New surgical technique for removing inoperable tumors of the abdomen
New surgical technique for removing inoperable tumors of the abdomen
New surgical technique for removing inoperable tumors of the abdomen
Abdominal tumors involving both roots of the celiac and superior mesenteric artery (SMA) are deemed unresectable by conventional surgical methods, as removal would cause necrosis of the organs that are supplied by those blood vessels.A case report published in the journal American Journal of Transplantation presents a novel surgical technique that enables surgeons to remove tumors that are unresectable by the usual surgical techniques.
Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination
Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination:
Diamond Pet Foods is expanding a voluntary recall to include Diamond Puppy Formula dry dog food. The company took this precautionary measure because sampling revealed Salmonella in the product.
Ovarian Cancer National Alliance Submits Comments to Government Regarding Ovarian Cancer Screening
Ovarian Cancer National Alliance Submits Comments to Government Regarding Ovarian Cancer Screening:
The Ovarian Cancer National Alliance submitted the following comments in response to the United States Preventive Service Task Force request for comments on draft recommendations for ovarian cancer screening.
Comments to USPSTF re:
Draft Reaffirmation Recommendation Statement
Screening for Ovarian Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
As a patient advocacy organization dedicated to promoting the interests of women with ovarian cancer, the Ovarian Cancer National Alliance is pleased to provide comments on the Draft Screening Statement for Ovarian Cancer.
The United States Preventive Services Task Force is to be commended for reviewing the recent scientific publications regarding ovarian cancer screening. As the Task Force correctly noted, the latest studies confirm that the current blood and imaging tests are not useful for population based screening.
However, the Recommendation Statement does not specify that these tools are valid as part of the diagnostic protocol for women suspected of having ovarian cancer, due in large part to the presence of symptoms.
Further, the Task Force did not appear to use the results of studies that indicate more favorable results of using the CA-125 in tailored ways. For example, a study presented at the 2010 American Society of Clinical Oncology Annual Meeting had more than 3,000 post-menopausal women stratified into high, medium and low risk categories based on an algorithm. The women, based on risk, then had different follow up procedures. The practice followed in this study had a low false-positive rate.
While we are by no means arguing that the CA-125 and/or transvaginal ultrasound be recommended as appropriate screening tools, we urge the Task Force to consider all available information when making its recommendations.
We also request that the recommendation include language regarding the symptoms of ovarian cancer (bloating, difficulty eating/feeling full quickly, urinary frequency or urgency, abdominal pain). We encourage the Task Force to also note that if women have symptoms of the disease these screening recommendations do not apply. We suggest: These recommendations apply only to asymptomatic women at average risk (or instead of “at average risk”, “without any hereditary or family history that would put them at an elevated risk”.)
We thank the Committee for noting that this recommendation does not apply to high risk women, including those with a known genetic mutation that puts them at an increased risk of developing ovarian cancer.
About Ovarian Cancer
According to the American Cancer Society, approximately 21,000 American women are diagnosed with ovarian cancer each year, and approximately 15,000 women die from the disease annually. Ovarian cancer is the deadliest gynecologic cancer and the fifth leading cause of cancer death among women in America. Currently, more than half of the women diagnosed with ovarian cancer die within five years.
About the Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance is a survivor-led national umbrella organization with state and local groups representing grassroots activists, women’s health advocates and health care professionals. The Ovarian Cancer National Alliance submits this testimony as a patient advocacy group dedicated to promoting the interests of women with ovarian cancer.
NIH grants $10.5 Million for Genome Explorations -The Burrill Report
NIH grants $10.5 Million for Genome Explorations -The Burrill Report:
The National Human Genome Research Institute, part of the National Institutes of Health, is awarding $10.5 million in ten grants to help researchers identify millions of genomic elements that play a role in determining what genes are expressed and at what levels in different cells. The multi-year grants are part of the Encyclopedia of DNA Elements project, or ENCODE, set up to provide scientists with a comprehensive catalog of functional genomic elements. The project's goal is to help explain the role that the genome plays in health and disease.
paywalled: Mucin 16 (cancer antigen 125) expression in human tissues and cell lines and correlation with clinical outcome in adenocarcinomas of the pancreas, esophagus, stomach, and colon
Mucin 16 (cancer antigen 125) expression in human... [Hum Pathol. 2012] - PubMed - NCBI
Hum Pathol. 2012 Apr 26
Mucin 16 (cancer antigen 125) expression in human tissues and cell lines and correlation with clinical outcome in adenocarcinomas of the pancreas, esophagus, stomach, and colon
Abstract
Mucin 16 (cancer antigen 125) is a cell surface glycoprotein that plays a role in promoting cancer cell growth in ovarian cancer. The aims of this study were to examine mucin 16 expression in a large number of digestive tract adenocarcinomas and precursors and to determine whether mucin 16 up-regulation is correlated with patient outcome.Tissue microarrays were constructed using surgical resection tissues and included pancreatic (115 normal, 29 precursors, 200 pancreatic ductal adenocarcinomas), esophageal (86 normal, 104 precursors, 95 esophageal adenocarcinomas, 35 lymph node metastases), gastric (211 normal, 8 precursors, 119 gastric adenocarcinomas, 62 lymph node metastases), and colorectal (34 normal, 17 precursors, 39 colorectal adenocarcinomas) tissues. Mucin 16 was detected in 81.5%, 69.9%, 41.2%, and 64.1% of the pancreatic ductal adenocarcinomas, esophageal adenocarcinomas, gastric adenocarcinomas, and colorectal adenocarcinomas, respectively. Mucin 16 was seen in a subset of the precursors. On multivariate analysis, moderate/diffuse mucin 16 in pancreatic ductal adenocarcinomas was strongly associated with poor survival (P < .001), independent of other prognosis predictors. A similar trend was observed for esophageal adenocarcinomas (P = .160) and gastric adenocarcinomas (P = .080). Focal mucin 16 in colorectal adenocarcinomas was significantly correlated (P = .044) with a better patient outcome, when compared with mucin 16-negative cases. Using Western blot analysis, we found mucin 16 expression in 3 of 6 pancreatic ductal adenocarcinoma and 1 of 2 esophageal adenocarcinoma cell lines.
We conclude that most of the digestive tract adenocarcinomas and a
subset of their precursors express mucin 16. Mucin 16 expression is an
independent predictor of poor outcome in pancreatic ductal
adenocarcinomas and potentially in esophageal adenocarcinomas and
gastric adenocarcinomas. We propose that mucin 16 may function as a
prognostic marker and therapeutic target in the future.
paywalled: Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study : The Lancet Oncology
Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study : The Lancet Oncology
Methods
"Resections done for small and large bowel cancer between January, 2002, and January, 2011, were retrieved. We systematically analysed non-tumorous mucosa from carriers of a Lynch syndrome mutation (set 1: ten patients) and control patients without Lynch syndrome (set 1: nine patients) for MMR protein expression (MLH1, MSH2, and EPCAM) with immunohistochemistry.....
May 1st (open access) Commentary including link to original paper: Lynch syndrome: new tales from the crypt : The Lancet Oncology
Blogger's Note: commentary focus is primarily on colorectal cancer:
Lynch syndrome: new tales from the crypt : The Lancet Oncology
"...Unfortunately, these lesions are too small and subtle to be relied upon clinically to suggest a diagnosis of Lynch syndrome. Importantly, the investigators acknowledge that, although they noted these lesions occurred frequently, most patients with Lynch syndrome will develop zero to two cancers, and typically only a few adenomatous polyps, through their lifetimes.5 Small bowel cancers occur in no more than 1—4% of patients with Lynch syndrome,6 yet that organ has one MMR-deficient crypt per 2 cm2 of mucosa. Obviously, most of these lesions do not develop into cancer. So, what happens to them?....."
"...The missing link in this work is the contrast between the large number of MMR-deficient crypts and the relatively small number of clinically relevant neoplasms in this disease. That said, this work is highly novel, underscores the differences between Lynch syndrome and sporadic colorectal cancers, and raises a fresh group of important questions to be addressed."
Original paper - link/reference:
. Prevalence of mismatch repair-deficient crypt foci in Lynch syndrome: a pathological study. Lancet Oncol 201210.1016/S1470-2045(12)70109-2. published online May 1.
Monday, April 30, 2012
Ovarian Cancer and Us posts viewed per geographic locations: top 10 (April)
Blogger's Note: it's always interesting to see the demographic variations over time
#1. United States
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#2. Russia
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#3. France
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#4. Germany
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#5. United Kingdom
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#6. Canada
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#7. China
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#8. India
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#9. Bulgaria
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#10. Ireland
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Ovarian Cancer and Us blog posts: top 10 viewed posts this month (April)
Top 10 most viewed posts this month (April):
Defining the Role of PET-CT in Staging Early Breast Cancer
Defining the Role of PET-CT in Staging Early Breast Cancer:
Abstract
Introduction. Currently, there is a lack of data on the role of combined positron emission tomography–computed tomography (PET–CT) in the staging of early invasive primary breast cancer. We therefore evaluated the role of 18F-fluorodeoxyglucose (18F-FDG)-PET–CT in this patient population.
Methods. We prospectively recruited 70 consecutive patients (69 women, one man; mean age, 61.9 ± 8.1 years) with early primary breast cancer for staging with 18F-FDG-PET–CT. All PET–CT images were interpreted by two readers (independently of each other). A third reader adjudicated any discrepancies. All readers had ≥5 years of specific experience. Ethics board approval and informed consent were obtained.
Results. The mean clinical follow-up was 22.7 ± 12.6 months. The primary tumor was identified with PET–CT in 64 of 70 patients. Of the unidentified lesions, surgical pathology revealed two intraductal carcinomas, one invasive tubular carcinoma, and three invasive lobular carcinomas. Undiagnosed multifocal breast disease was shown in seven of 70 patients. PET–CT identified avid axillary lymph nodes in 19 of 70 patients, compared with 24 of 70 confirmed during surgery. There were four patients who were axillary node positive on PET but had no axillary disease at surgery.
Five patients were reported with avid metastases. Two of those patients were treated for metastatic disease (nodal, lung, and liver in one and bone metastases in the other) following further imaging and clinical assessment. In the other three patients, lesions (lung, n = 1; pleural, n = 1; paratrachael node, n = 1) were subsequently diagnosed as benign lesions.
Conclusion. Integrated 18F-FDG-PET–CT may have a role in staging patients presenting with early breast cancer.
The Incidence of Ovarian Cancer In Transgendered Individuals | The LGBT Cancer Project -- Out With Cancer
The Incidence of Ovarian Cancer In Transgendered Individuals | The LGBT Cancer Project -- Out With Cancer
".... The incidence of ovarian cancer in LGBT transgendered individuals must be closely monitored and aggressively treated if the cancer is detected in that population. Transgendered individuals who have undergone an operation changing their gender from their original sexual orientation of female to male are facing the additional obstacle of being diagnosed with ovarian....."
Amazon.com: Memoir of a Debulked Woman: Enduring Ovarian Cancer (9780393073256): Susan Gubar: Books
Amazon.com: Memoir of a Debulked Woman: Enduring Ovarian Cancer (9780393073256): Susan Gubar: Books
Book Description
In this moving memoir, a renowned feminist scholar explores the physical and psychological ordeal of living with ovarian cancer.
Diagnosed with ovarian cancer in 2008, Susan Gubar underwent radical debulking surgery, an attempt to excise the cancer by removing part or all of many organs in the lower abdomen. Her memoir mines the deepest levels of anguish and devotion as she struggles to come to terms with her body’s betrayal and the frightful protocols of contemporary medicine. She finds solace in the abiding love of her husband, children, and friends while she searches for understanding in works of literature, visual art, and the testimonies of others who suffer with various forms of cancer.
Ovarian cancer remains an incurable disease for most of those diagnosed, even those lucky enough to find caring and skilled physicians. Memoir of a Debulked Woman is both a polemic against the ineffectual and injurious medical responses to which thousands of women are subjected and a meditation on the gifts of companionship, art, and literature that sustain people in need.
book reviews: New Perspectives From Cancer Patients - NYTimes.com
New Perspectives From Cancer Patients - NYTimes.com
".......That is Susan Gubar’s staggering, searing “Memoir of a Debulked Woman.” Ms. Gubar
may not be a health professional, but as a noted feminist critic (she
is an author of the influential 1970s classic “Madwoman in the Attic”),
she has certainly spent a career immersed in the meaning and functions
of the female body. In one of those inexplicably savage medical ironies,
she was felled in her early 60s by the worst of the “female” diseases: ovarian cancer. As is common, it had spread throughout her abdomen by the time of diagnosis.
Cases like Ms. Gubar’s are usually first treated with the surgical
removal of as much cancer as possible, along with all dispensable
abdominal organs that are affected or at risk. This is the “debulking”
of her title, and it is about as close to evisceration as civilians can
experience. It became her focal metaphor for the experience of sudden
dire illness, as all other interests drop away save “an overriding and
offensive obsession with one’s own physical vulnerability.” On a less
literary note, the procedure winds up bringing her almost more physical
grief than the cancer itself.
Ms. Gubar moves back and forth between poet and patient, with the
occasional sidestep into academic mode as she reviews writing by women
affected with similar illness. It is a difficult and potentially
cringe-making project.
But even the most skeptical and finicky reader — even the healthy
reader, even the healthy male reader — will not put this book down. Some
of its appeal comes from Ms. Gubar’s skill with textual analysis, and
some from various appealing verbal shenanigans (has anyone else found
and pondered the “mother” in chemotherapy,
for instance?). Most gripping, though, is her frank, courageous account
of life with a horrific postoperative infection in her large intestine
that came to involve the buttock area....
video/text: Leftover ovarian tissue after surgery can cause serious complications | Medical Alert-media
Blogger's Note: short video; not specific to ovarian cancer but note absence of menopausal symptoms
Leftover ovarian tissue after surgery can cause serious complications | Medical Alert - WBAL Home
paywalled: Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial : The Lancet Oncology
Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial : The Lancet Oncology
Interpretation
Our
findings provide reassurance for women with hysterectomy seeking relief
of climacteric symptoms in terms of the effects of oestrogen use for
about 5 years on breast cancer incidence and mortality. However, our
data do not support use of oestrogen for breast cancer risk reduction
because any noted benefit probably does not apply to populations at
increased risk of such cancer.
Lancet: [Cancer and Society] "A Monster Calls" (children's book)
[Cancer and Society] A Monster Calls:
The word “cancer” is not used once in A Monster Calls, but its influence is felt even before the first page. The story was conceived by children's author Siobhan Dowd, who died from breast cancer before being able to realise her vision. She did, however, leave behind the idea, the characters, and the beginning, from which Patrick Ness completed the story. The result is a harrowing and deeply engaging account of the heartbreaking effects that cancer has on the children of afflicted patients. It is by no means an easy tale to tell, but Ness's work has clearly resonated with young readers, whose votes awarded A Monster Calls the prestigious Red House Children's Book Award 2012.
Endometriosis and ovarian cancer – Authors' reply : The Lancet Oncology
Endometriosis and ovarian cancer – Authors' reply : The Lancet Oncology
"Both Vercellini and colleagues and Guo and
colleagues raise concerns about screening, with which we agree. Our
findings should not suggest to clinicians or the public that screening
for ovarian cancer should be implemented for women with endometriosis.
Rather, we hope that our work stimulates further research that can
refine risk groups related to endometriosis on the basis of anatomical
site, epidemiological risk factors, or molecular features. Vercellini
and colleagues raise an interesting point about atypical endometriosis,
but this diagnosis is not standardised or commonly used and can not be
addressed in epidemiological studies.
..................Regardless, the attenuated associations remain statistically
significant.
Commentary: Oestrogen and breast cancer: results from the WHI trial : The Lancet Oncology
Oestrogen and breast cancer: results from the WHI trial : The Lancet Oncology
"In The Lancet Oncology, the Women's Health Initiative (WHI) investigators report1 that receipt of conjugated equine oestrogen for a median of 5·9 years reduced the risk of invasive breast cancer by 23% compared with placebo (151 cases in 5310 women who received oestrogen vs 199 cases in 5429 controls; p=0·02). Women who did develop breast cancer after receipt of oestrogen had significantly reduced breast cancer-specific mortality (six deaths in the oestrogen group vs 16 deaths in controls; p=0·03) and all-cause mortality (30 deaths vs 50 deaths; p=0·04). This preventive effect occurred at all ages and continued beyond the period of oestrogen use, a carryover effect also noted in prevention trials of tamoxifen.2 ....Although modest, the WHI results are significant and raise important questions about their disparity with many observational studies and the mechanism of reported benefit with oestrogen therapy......
2012 Clinicopathological Features and Management of Cancers in Lynch Syndrome (easy to read)
Blogger's Note: nice, easy to read paper
Clinicopathological Features and Management of Cancers in Lynch Syndrome
Abstract
Lynch syndrome (LS) is characterized by an autosomal dominant inheritance of the early onset of colorectal cancer (CRC) and endometrial cancer, as well as increased risk for several other cancers including gastric, urinary tract, ovarian, small bowel, biliary tract, and brain tumors. The syndrome is due to a mutation in one of the four DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, or PMS2. The majority of LS patients and families can now be identified, and the underlying mutation detected using genetic diagnostics. Regular surveillance for CRC and endometrial cancer has proved beneficial for mutation carriers. However, screening for other tumors is also recommended even though experiences in the screening of these tumors is limited. Prophylactic colectomy, prophylactic hysterectomy, and bilateral salpingo-oophorectomy may be reasonable options for selected patients with LS. This paper describes the features and management of LS.
1. Introduction (The syndrome is due to a mutation in one of the four DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, or PMS2.)
2. Genetic Characteristics of Lynch Syndrome
3. Identification of Lynch Syndrome
4. Tumor Spectrum of Lynch Syndrome
5. Colorectal Cancer (>MLH1 and MSH2; <MSH6;)
6. Endometrial Cancer (MSH6 mutations are at higher risk)
7. Gastric Cancer (seems to be not different between different mutations)
8. Uroepithelial and Kidney Cancers (predominately MSH2)
9. Other Tumors
- 9.1. Ovarian Cancer Ovarian cancer has been shown to occur in excess in LS. Two Finnish studies [5, 45] have shown a lifetime risk for ovarian cancer in LS ranging between 9% and 12% compared to 1.3% in the general population. Recently, Watson et al. [6] reported a lifetime risk of 7% in a large series from four LS research centers. They also found that MSH2 family members had nearly twice the incidence rate observed in MLH1 family members, and the highest risk period for ovarian cancer was from age 40 to 55 years. Ovarian cancer in LS seems to have a better prognosis than that in the general population or in BRCA1/2 mutation carriers [59]. Information currently available is too limited to assess whether screening for ovarian cancer in LS mutation carriers has any advantages.
- 9.2. Carcinomas of the Biliary Tract and Pancreas (duodenum/jejunum)
- 9.3. Brain Tumors (higher in MSH2 than in MLH1)
10. Conclusions
(ovarian) reference:
59. E. M. Grindedal, L. Renkonen-Sinisalo, H. Vasen et al., “Survival in women with MMR mutations and ovarian cancer: a multicentre study in Lynch syndrome kindreds,” Journal of Medical Genetics, vol. 47, no. 2, pp. 99–102, 2010. View at Publisher · View at Google Scholar · View at Scopus
$8.68M in early researcher awards announced in Ontario | Laboratory Product News
$8.68M in early researcher awards announced in Ontario | Laboratory Product News
UNIVERSITY OF WATERLOO
Project title: Rational design of novel surface active compound for improving non-viral DNA transfection efficiencies. Lead researcher: Dr Shawn Wettig. Gene therapy uses DNA to treat disease. While it shows great promise, creating a delivery system to deliver DNA to specific areas in the body is a challenge. Dr Wettig is working to develop delivery systems, starting with one for ovarian cancer, the leading cause of death among gynecological cancers.
paywalled: Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies
Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies
published online 30 April 2012.
Purpose
To evaluate hematological toxicity after robotic stereotactic body radiosurgery (SBRT) for treatment of women with metastatic abdominopelvic gynecologic malignancies.Methods and Materials
A total of 61 women with stage IV gynecologic malignancies treated with abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3 divided consecutive daily doses) delivered by a robotic-armed Cyberknife SBRT system. Abdominopelvic bone marrow was identified using computed tomography-guided contouring. Fatigue and hematologic toxicities were graded by retrospective assignment of common toxicity criteria for adverse events (version 4.0). Bone marrow volume receiving 1000 cGy (V10) was tested for association with post-therapy (median 32 days [25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin levels, and platelet counts as marrow toxicity surrogates.Results
In all, 61 women undergoing abdominopelvic SBRT had a median bone marrow V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for metastatic disease. Bone marrow V10 did not associate with hematological adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue symptoms were self-reported among the 61 women within the first 10 days post-therapy, with fatigue resolved spontaneously in all 17 women by 30 days post-therapy. Neutropenia was not observed. Three (5%) women had a grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2, and 3 thrombocytopenias were documented in 3 women.Conclusions
Abdominopelvic SBRT provided ablative radiation dose to cancer targets without increased bone marrow toxicity. Abdominopelvic SBRT for metastatic gynecologic malignancies warrants further study.Journal of Experimental & Clinical Cancer Research | Abstract | Circulating microRNAs in cancer: origin, function and application
Journal of Experimental & Clinical Cancer Research | Abstract | Circulating microRNAs in cancer: origin, function and application
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
ReviewCirculating microRNAs in cancer: origin, function and application
Published: 30 April 2012
Abstract (provisional)
MicroRNAs (miRNAs) are a class of small non-coding RNAs that regulate gene expression
at the posttranscriptional level. The dysregulation of miRNAs has been linked to a
series of diseases, including various types of cancer. Since their discovery in the
circulation of cancer patients, there has been a steady increase in the study of circulating
miRNAs as stable, non-invasive biomarkers. However, the origin and function of circulating
miRNAs has not been systematically elucidated. In this review, we summarize the discovery
of circulating miRNAs and their potential as biomarkers. We further emphasize their
possible origin and function. Finally, we discuss the application and existing questions
surrounding circulating miRNAs in cancer diagnostics. Although several challenges
remain to be concerned, circulating miRNAs could be useful, non-invasive biomarkers
for cancer diagnosis.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Biomarkers in the circulation
"Circulating biomarkers undoubtedly play an increasingly significant role in clinicalapplications such as disease diagnostics, monitoring therapeutic effect and predicting recurrence in cancer patients. The currently used fluid-based biomarkers are primarily proteins, such as alpha-fetoprotein (AFP) [8], chromogranin A (CgA) [9], nuclear matrix
protein 22 (NMP 22) [10], carbohydrate antigen 125 (CA 125) [11]; enzymes, such as prostate specific antigen (PSA) [12]; and human chorionic gonadotropin (hCG) [13]. While these biomarkers provide an opportunity to analyze tumors comprehensively in an invasive
way, low sensitivity and specificity limit their clinical application. For example, serum levels of AFP are often elevated in hepatocellular carcinoma (HCC); however, this is also the case in germ cell tumors, gastric, biliary and pancreatic cancers.......
reference/cited (google):
23. Resnick KE, Alder H, Hagan JP, Richardson DL, Croce CM, Cohn DE: The detection of differentially expressed microRNAs from the serum of ovarian cancer patients using a novel real-time PCR platform. Gynecol Oncol 2009, 112:55–59.
paywalled: Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery (Lynch Syndrome, breast/ovarian BRCA 2....)
Blogger's Note: while full access is by subscription only, key words indicate 'high risk' categories not limited to Lynch Syndrome, BRCA 2; BRCA 2 - blogger's assumption based on genetics in absence of full text acccess)
Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery
Abstract
Pancreatic cancer (PC) is a highly lethal disease. Despite advances regarding the safety and long-term results of pancreatectomies, early diagnosis remains the only hope for cure. This necessitates the implementation of an intensive screening program (based mainly on modern imaging), which – given the incidence of PC – is not cost effective for the general population. However, this screening program is recommended for individuals at high-risk for PC development.Indications for screening include the following three clinical settings: hereditary cancer predisposition syndromes associated with PC, hereditary pancreatitis and familial pancreatic cancer syndrome. The aim of this strategy is to identify pre-invasive (precursor) lesions, which are curable. Surgery is recommended in the presence of recognizable lesion on imaging lesions. Partial (anatomic) pancreatectomy – depending on the location of the suspicious lesion – is the most widely accepted type of surgical intervention in this setting; occasionally, however, total pancreatectomy may be required, in carefully selected patients. Despite that experience still remains limited, there is evidence that this aggressive strategy allows early detection of neoplastic lesions, thereby improving the effectiveness of surgery and prognosis.
Keywords: Pancreas, Surgery, Cancer, PanIN, MCN, IPMN, Pancreatectomy, Total pancreatectomy, Screening
Abbreviations: PanIN, pancreatic intraepithelial neoplasia, IPMN, intraductal papillary mucinous neoplasm, MCN, mucinous cystic neoplasm, PJS, Peutz–Jeghers syndrome, FAMMM syndrome, familial atypical multiple mole melanoma syndrome, HNPCC, hereditary non-polyposis colon cancer (Lynch syndrome), HOBC, hereditary ovarian and breast cancer, VHL, von Hippel–Lindau, PD, pancreatoduodenectomy
financial news UK: Horizon lines up $multi-million cancer drug boom | Business Weekly | Technology | Biotechnology | Business news | Cambridge and the East of England
Horizon lines up $multi-million cancer drug boom | Business Weekly | Technology | Biotechnology | Business news
Horizon lines up $multi-million cancer drug boom
The UK pioneer is partnering US biopharma company H3 Biomedicine Inc in the venture. And Japanese giant Eisai, which has its European Knowledge Centre in Hatfield, will conduct any resulting clinical trials......Markus Warmuth, president and CEO, H3 Biomedicine said that the successful development of new personalised medicines depended on well validated and characterised targets and clearly defined patient populations.
“High attrition rates in clinical trials have been impacting industry for a while,” he said. “We believe that clinical success starts at target selection and validation.
“We have elected to work with Horizon because its tools will enable us to progress toward identifying the best possible targets for new drugs with the power to have meaningful therapeutic relevance. That may help us to increase clinical success rates and expedite the delivery of new therapies to the patients who need them.”
paywalled: Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis.
Intrapleural paclitaxel for malig... [Cancer Chemother Pharmacol. 2012] - PubMed - NCBI
Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis.
Abstract
INTRODUCTION:
Malignant pleural effusion (MPE) is a frequent complication in many types of tumors diminishing the patient's ability to perform activities. Despite various studies on talc treatment, some doubts about its safety and effectiveness remain, so the search for a more ideal intrapleural agent continues. We analyzed the effectiveness and safety of intrapleural paclitaxel in ovarian and breast cancer patients.CONCLUSION:
Intrapleural paclitaxel is a safe and effective palliative treatment for MPE from breast and ovarian cancers and may be integrated with systemic chemotherapy.Sunday, April 29, 2012
paywalled: Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?
Blogger's Note: a repost
Is comprehensive surgical staging needed... [Am J Obstet Gynecol. 2012] - PubMed - NCBI
Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?
Abstract
OBJECTIVE:
Patients with ovarian cancer may have occult metastasis at the time of surgery. Our purpose was to determine the prevalence and sites of occult metastasis in epithelial ovarian cancer grossly confined to the ovary and examine the significance of routine omentectomy and peritoneal biopsies as part of a comprehensive staging procedure.STUDY DESIGN:
Data were retrospectively abstracted from patients presenting to University of Texas Southwestern Medical Center Hospitals from 1993 through 2009 with ovarian cancer without gross spread beyond the ovary who underwent comprehensive surgical staging.RESULTS:
A total of 86
patients with ovarian cancer grossly confined to the ovary who underwent
complete surgical staging were identified. Of patients, 29% were
upstaged following comprehensive surgical staging; 6% had metastatic
disease in uterus and/or fallopian tubes, 6% in lymph nodes, and 17% in
peritoneal, omental, or adhesion biopsies.
CONCLUSION:
Patients with epithelial ovarian cancer should continue to undergo comprehensive surgical staging, since it identifies occult metastasis in a significant number of patients.EvidenceUpdates: Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials including professional commentaries
Blogger's Note: registration is free, the benefit of this secondary site (BMJ) is the addition of professional comments
This month's most accessed articles -- EvidenceUpdates
Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials
paywalled: Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials : The Lancet
Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials : The Lancet
Summary
Background
Daily
aspirin reduces the long-term risk of death due to cancer. However, the
short-term effect is less certain, especially in women, effects on
cancer incidence are largely unknown, and the time course of risk and
benefit in primary prevention is unclear. We studied cancer deaths in
all trials of daily aspirin versus control and the time course of
effects of low-dose aspirin on cancer incidence and other outcomes in
trials in primary prevention.
Interpretation
Alongside
the previously reported reduction by aspirin of the long-term risk of
cancer death, the short-term reductions in cancer incidence and
mortality and the decrease in risk of major extracranial bleeds with
extended use, and their low case-fatality, add to the case for daily
aspirin in prevention of cancer.
paywalled: PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.
PET/CT scanning guided intensity-modulated radi... [Eur J Radiol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.MATERIALS AND METHODS:
Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.RESULTS:
Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).CONCLUSIONS:
PET/CT guided IMRT in recurrent
ovarian cancer patients improved the delineation of GTV and reduce the
likelihood of geographic misses and therefore improve the clinical
outcome.
paywalled: Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence
Low-dose non-enhanced CT versus full-dose contr... [Eur J Radiol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated (18)F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer.MATERIALS AND METHODS:
One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months.RESULTS:
Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods ...... The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT.CONCLUSION:
PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT.
Commentary: Does aspirin really reduce the risk of colon cancer? : The Lancet
Does aspirin really reduce the risk of colon cancer? : The Lancet
Does aspirin really reduce the risk of colon cancer?
The study by John Burn and colleagues1
is unquestionably a superb piece of work that opens the door to
formalised chemoprevention in young carriers of Lynch syndrome. However,
setting aside the fact that the primary intention-to-treat analysis was
not significant, there is a need to address whether these data are
applicable to others at need of chemoprevention.
Specifically,
the study included a predominantly young population with a mean age at
recruitment in the early 40s and a mean follow-up of 5 years. Therefore
the current age of participants is about 50 years. At this age, the
frequency and severity of aspirin complications is very low.2
Indeed the number of adverse events quoted in the paper's appendix is
only 21 in more than 400 aspirin-taking patients. Moreover, Rothwell and
colleagues3
have indicated that, for the general public or those at risk of more
common cancers, taking aspirin before 55 years of age will not have a
significant benefit. Furthermore, the mean period of treatment is just
more than 2 years and although this suggests an impressive effect, it
means that the long-term safety is unknown.4
In
conclusion, although this study is excellent news for patients with
Lynch syndrome, we need data from other large and long-term randomised
trials with cancer endpoints such as the AspECT trial to assess the
safety of aspirin in an older and more general population.5
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