Statin use and risk for ovarian cancer

Abstract
 

Background:Limited data suggest that statin use reduces the risk for ovarian cancer.
Methods:Using Danish nationwide registries, we identified 4103 cases of epithelial ovarian cancer during 2000-2011 and age-matched them to 58 706 risk-set sampled controls. Conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for epithelial ovarian cancer overall, and for histological types, associated with statin use.
Results:We observed a neutral association between ever use of statins and epithelial ovarian cancer risk (OR=0.98, 95% CI=0.87-1.10), and no apparent risk variation according to duration, intensity or type of statin use. Decreased ORs associated with statin use were seen for mucinous ovarian cancer (ever statin use: OR=0.63, 95% CI=0.39-1.00).
Conclusions:Statin use was not associated with overall risk for epithelial ovarian cancer. The inverse association between statin use and mucinous tumours merits further investigation.

British Journal of Cancer (2014), 1-5. doi:10.1038/bjc.2014.574 www.bjcancer.com.

Novel and recurrent BRCA2 mutations in Italian breast/ovarian cancer families widen the ovarian cancer cluster region boundaries to exons 13 and 14

abstract

Hereditary breast and ovarian cancer are mainly linked to mutations in BRCA1 and BRCA2 genes which confer a similar cumulative risk of developing breast cancer. Importantly, while BRCA2 mutation carriers generally have a lower cumulative risk for ovarian cancer, mutations clustered in the central portion of BRCA2 are associated with a higher proportion of ovarian compared with breast cancer cases. The boundaries of this ovarian cancer cluster region (OCCR) have been tentatively defined within a 3.3 kb region of BRCA2 exon 11, and herein, we reassessed these boundaries using our series of Italian breast/ovarian cancer families.

The Yolk Sac Tumor: Reflections on a Remarkable Neoplasm and Two of the Many Intrigued By It

abstract


One of the most remarkable of human neoplasms, the yolk sac tumor, is reviewed, emphasizing its histologic diversity and differential diagnosis, occurrence at many sites, and the shared passion for this unique neoplasm of Dr Gunnar Teilum (who deserves almost all credit for delineation of the nature of the tumor and its features) and Dr Aleksander Talerman (who made his own contribution to our knowledge of it) and the friendship it helped forge between these 2 distinguished pathologists. In a unique series of articles, beginning in the early 1940s, Teilum delineated the distinctive features of the neoplasm and recognized that it was 1 of 2 initially included as "mesonephroma ovarii" by Dr Walter Schiller in 1939 (the second we now know as clear cell carcinoma). Teilum named the tumor "endodermal sinus tumor" because it came to his attention that papillary formations common in the yolk sac tumor resembled the endodermal sinuses of the rat placenta. He focused on the histogenesis of the tumor and its morphologic features culminating in a classic paper in Cancer in 1959. Although Teilum and others recognized that yolk sac tumor could be a component of mixed germ cell tumors, Talerman was one of the first to emphasize that, particularly in the testis, it was common to see yolk sac tumor as a component of a mixed germ cell tumor. Teilum, working in Copenhagen, and Talerman, when the former was alive, working in Rotterdam, developed a warm friendship in part due to their great interest in the yolk sac tumor, although it also extended to other areas of gonadal neoplasia and indeed beyond the boundaries of medicine when they shared time together. The typical histologic features of the yolk sac tumor are the reticular-microcystic patterns Teilum described, but various other patterns, including solid and even rarer ones such as glandular and hepatoid, are now well known. There are some interesting variations in the age distribution of this tumor at various sites: for example, vaginal examples are almost restricted to children under 2 years of age; those of the testis that are pure also occur mostly in young boys (average age about 20 months) but are occasionally seen in later years; ovarian examples peak at about 19 years of age; mediastinal forms are mostly restricted to young adult males. Brief consideration is also given to the occurrence of this tumor at well-known extragonadal sites such as retroperitoneum, mediastinum, and pineal as well as more exotic locations. Note is made of the recently emphasized occurrence of the yolk sac tumor on the background of a somatic neoplasm, most often endometrioid carcinoma of the ovary. Given the wide ranging and fascinating clinical and pathologic aspects of the neoplasm, it is no surprise that it continues to be a source of great interest to any pathologist who sees one or more examples, and we are indebted to Dr Teilum for his monumental studies and to Dr Talerman for his own contributions.

Coping With Cancer: Examining the Supports Available to Women With Gynecologic Cancer at Saskatoon Cancer Center

abstract

Smith SN¹, Chizen D, Agrawal A.

Author information

• ¹*College of Medicine, University of Saskatchewan; and †Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.

OBJECTIVE:

When women are diagnosed and treated for gynecologic cancer, they must find ways to cope. Cancer is both a physically and emotionally challenging disease. This study aims to identify existing coping strategies in women diagnosed with gynecologic cancer throughout their cancer journey and to add to these supports to help women cope with their cancer.

METHODS:

Women with gynecologic cancer were interviewed individually according to focus group principles during scheduled clinic visits at Saskatoon Cancer Center to identify coping strategies following diagnosis and treatment of cancer. Interviews were used to inform researchers before preparing a survey about coping with cancer. During 8 weeks, women receiving care were surveyed. Questions explored diagnosis, therapy phase, feelings, attitudes, and support.

No Cognitive Difference Between Early, Late Estrogen Therapy

medscape



....She also pointed out that the study's findings provide reassurance regarding the lack of cognitive harm in the older group especially, tracing back to the trend seen in the Women’s Health Initiative.
She told Medscape Medical News that although she usually does not start older women on estrogen, it is still an option for some who are still having hot flashes. "You have to individualize [treatment]."
The study was supported by the National Institute on Aging. Dr Mack and Dr Nachtigall have disclosed no relevant financial relationships.
North American Menopause Society (NAMS) 2014 Annual Meeting. Presented October 17, 2014. Abstract S-12.

If the Mountain Does Not Come to Mohammad: The Significance of Guest Operations for Early Stage Ovarian Cancer

abstract

Background:
In women with early ovarian cancer (EOC), comprehensive surgical staging is known to enhance ovarian cancer outcomes and requires specific surgical competence. Given that centralization of care remains a topic of continuing debate, a system of "guest operations" was introduced ...... 

A case of ovarian yolk sac tumor associated with endometrioid adenocarcinoma

open access

Introduction

Ovarian yolk sac tumor (YST) is characterized by endodermal differentiation, and represents approximately 20% of malignant germ cell neoplasms. The age distribution of patients reported with YST ranges from 16 months to 46 years, but most patients are under 30 years of age (Talerman and Vang, 2011). YST is often found admixed with other types of germ cell neoplasm, but YST associated with epithelial ovarian carcinoma is extremely rare......

MTV reality star Diem Brown dies at 32 (from ovarian cancer)

Diem Brown dies at 32

FDA Approves Avastin for Recurrent Ovarian Cancer (U.S.)

Medpage


Published: Nov 14, 201WASHINGTON -- The FDA has approved the angiogenesis inhibitor bevacizumab (Avastin) for use in combination with paclitaxel to treat platinum-resistant recurrent #ovarian cancer.
The approval was based on results of an international, phase III, randomized trial to compare paclitaxel alone with paclitaxel plus bevacizumab. Known as AURELIA, the trial involved 361 women whose ovarian cancer had recurred less than 6 months after their most recent platinum-based chemotherapy regimen.
The trial had a final endpoint of progression-free survival (PFS), and the results demonstrated a 62% reduction in the hazard for progression or death in patients who received bevacizumab.........

Patient Experience vs. Evidence-Based Medicine

Medpage

Action Points

• This perspective piece criticizes a recent New York Times opinion essay for failing to properly define evidence-based medicine.
• The author feels that evidence-based medicine does not ignore anecdote or clinical experience, but merely weights those findings in a hierarchy of evidence.

open access - May 2014: Ovarian Cancer (Cancer Network)

open access

Overview

Despite the fact that it is highly curable if diagnosed early, ovarian cancer causes more mortality in American women each year than all other gynecologic malignancies combined. An estimated 21,980 new cases of this cancer will be diagnosed in the United States in 2014, and about 14,270 women will die.

Notable advances in chemotherapy and surgery over the past several decades have begun to translate into improved survival. According to American Cancer Society data, the 5-year overall survival rate from ovarian cancer has increased significantly, from 37% in the mid-1970s to 46% in the mid-2000s (P < .05). Recent data from the National Cancer Institute show a similar increase in stage-specific survival. It is expected that data from the current decade, reflecting continued improvements in chemotherapy and surgery, will continue this trend.
This chapter will focus on epithelial cancers of the ovaries, which account for about 90% of ovarian malignancies......

The evolution of colorectal cancer genetics—Part 2: clinical implications and applications

open access

The risk of CRC in LS is approximately 60-85% depending on which MMR gene is involved. Patients with MLH1 and MSH2 mutations have a higher risk of cancer, with diagnosis at a younger age, compared to MSH6 and PMS2 mutations (25,26). MLH1 mutation carriers have a higher risk of CRC, while MSH2 carriers have a higher rate of multiple primary extracolonic cancers, to include brain (glioblastoma), ovarian, stomach, hepatobiliary, urinary tract, breast, and prostate cancers (27-32). Colonoscopy screening decreases the risk of a second CRC by 62% when patients have routine surveillance (33). It is rare for colonoscopy to miss a polyp >10 mm. However, for polyps between 1-5 mm, up to 35% can be overlooked (34). With this knowledge, prophylactic colectomy may be ideal for some patients, requiring only a subsequent yearly rectal surveillance. Prophylactic colectomy before the age of 25 has been associated with the greatest increase in life expectancy when compared to older patients and those where surgery was performed after a CRC diagnosis (35). It is still widely debated about recommendations for a prophylactic colectomy. It is important to evaluate the patient for both emotional and physical perspectives, understand his or her MMR mutation status, and ensure that a genetic counselor is actively engaged with the decision making process. In women who present with uterine cancer, prophylactic colectomy can be considered in addition to the surgical treatment of gynecologic diseases, if the patient is being managed in a comprehensive manner (36). Prophylactic hysterectomy and bilateral salpingo-oophorectomy is a prudent option given limited endometrial and extremely poor ovarian cancer screening (36).......

Completeness of pedigree and family cancer history for ovarian cancer patients (Korea)

abstract

OBJECTIVE:

To investigate the completeness of pedigree and of number of pedigree analysis to know the acceptable familial history in Korean women with ovarian cancer.

Anaesthesia: accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

open access

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

Table 1. NAP5 suggestion for describing sedation definitions from a patient's perspective, as part of a process of consent.

	What will this feel like?	What will I remember?	What's the risk related to the sedation drugs?
Not sedated; awake	I am awake, possibly anxious. There may be some mild discomfort (depending on the what I am having done)	Everything	Zero: not applicable
Minimal sedation	I am awake and calm. There may be some mild or brief discomfort	Probably everything	Very low risk
Moderate sedation	I am sleepy and calm but remain in control. I may feel some mild discomfort	I might remember some things	Low risk
Deep sedation	I am asleep. I will not be in control	Probably very little	Higher risk. My breathing may stop when I am asleep –and I may need help to breathe – a tube might be inserted into my nose, mouth or windpipe. I will need oxygen and special monitoring
Anaesthesia	I am deeply ‘asleep’ and unable to respond	Very unlikely to remember anything	High risk (but the presence of an anaesthetist is designed to increase safety). My breathing may stop and my blood pressure and heart rate may fall. I will need a specialist doctor to look after my breathing and support my blood pressure and heart rate. I will need oxygen and special monitoring and equipment

Promising treatment option (Olaparib) and improved survival rates for patients with ovarian, breast, pancreatic, and prostate cancers - Medical News Today

medical news

....For the majority of patients in the study, olaparib was at least their third different cancer therapy. Based on the new data, the authors say olaparib warrants further investigation in phase III trials.....

(Roswell) RPCI researchers identify two novel candidate prognostic markers for ovarian cancer

Rmedical news

...."There is a lot of interest right now in what to do with the human genome," says Kevin Eng, PhD, an Assistant Professor of Oncology in the Department of Biostatistics and Bioinformatics at RPCI who was first author on both studies. "We are focused on finding the gene or combination of genes that are going to predict how long a woman's ovarian cancer is going to remain in remission or what treatment is best for her cancer." ......

OvMark: a user-friendly system for the identification of prognostic biomarkers in publically available ovarian cancer gene expression datasets

open access

 Research

Stephen F Madden^1*†, Colin Clarke^1†, Britta Stordal³, Mark S Carey⁷, Russell Broaddus⁶, William M Gallagher², John Crown¹, Gordon B Mills⁵ and Bryan T Hennessy⁴

Author Affiliations

¹ Molecular Therapeutics for Cancer Ireland, National Institute for Cellular Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
² UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
³ Department of Histopathology, St James’ Hospital and Trinity College Dublin, Dublin 8, Ireland
⁴ Department of Medical Oncology, Beaumont Hospital, Beaumont Road, P.O. Box 1297, Dublin 9, Ireland

⁵ Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Tx, USA

⁶ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Tx, USA
⁷ Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada

For all author emails, please log on.

Molecular Cancer 2014, 13:241  doi:10.1186/1476-4598-13-241

The electronic version of this article is the complete one and can be found online at: http://www.molecular-cancer.com/content/13/1/241

TP53 oncomorphic mutations predict resistance to platinum‑ and taxane‑based standard chemotherapy in patients diagnosed with advanced serous ovarian carcinoma

abstract

.....Since mutations in TP53 occur in nearly all ovarian tumors, the objective of this study was to determine the relationship of oncomorphic TP53 mutations with patient outcomes in advanced serous ovarian cancer patients..... 

Pathologic Findings at Risk-Reducing Salpingo-Oophorectomy: Primary Results From Gynecologic Oncology Group Trial GOG-0199

abstract

For Optimal Cancer Care, Consider the Nontraditional

Clinical Oncology News 

Experts Urge More Individualized Treatment for Cancer Pain

Clinical Oncology News

Acupuncture for symptom management in cancer care: an update

Abstract

Lactose-intolerant people have lower risk of certain cancers - but why?

medical news

Diagnostic tool developed to investigate traveling cancer cells and improve health outcomes - Medical News Today

medical news

Correspondence: Combination of Bevacizumab and Chemotherapy for Platinum-Resistant Recurrent Ovarian Cancer:(AURELIA Trial)

open access

 Combination of Bevacizumab and Chemotherapy for Platinum-Resistant Recurrent Ovarian Cancer: Some Observations About the AURELIA Trial

(BRCAPRO) Misreported Family Histories and Underestimation of Risk

open access

To the Editor:

The study by Daniels et al¹ focused on women with high-grade serous ovarian cancer and showed that carrier probabilities provided by risk prediction model BRCAPRO² are too low among low-risk patients. This important observation agrees with earlier reports, including probands with both ovarian and breast cancers,² in which the ratio of observed to expected cases (O/E) in low-risk groups was substantially greater than one. As genetic testing becomes more affordable and appropriately broadens to segments of the population who are at lower prior risk, this limitation deserves serious consideration........

Debating the Oncologist's Role in Defining the Value of Cancer Care: Our Duty Is to Our Patients

open access

Evaluation of 30-Day Hospital Readmission After Surgery for Advanced-Stage Ovarian Cancer in a Medicare Population

abstract

Conclusion
Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.

Recurrent BRCA1 and BRCA2 mutations in Mexican women with breast cancer

abstract

Background: Germline mutations in the BRCA1 and BRCA2 genes confer an estimated 58-80% lifetime risk of breast cancer. In general, screening is done for cancer patients if a relative has been diagnosed with breast or ovarian cancer. There are few data on the prevalence of mutations in these genes in Mexican women with breast cancer and this hampers efforts to develop screening policies in Mexico. Methods: We screened 810 unselected women with breast cancer from three cities in Mexico (Mexico City, Veracruz and Monterrey) for mutations in BRCA1 and BRCA2, including a panel of 26 previously reported mutations.
Results: Thirty-five mutations were identified in 34 women (4.3% of total) including 20 BRCA1 mutations and 15 BRCA2 mutations. Twenty-two of the 35 mutations were recurrent mutations (62.8%). Only five of the 34 mutation carriers had a first-degree relative with breast cancer (three with BRCA1 and two with BRCA2 mutations). Conclusion: These results support the rationale for a strategy of screening for recurrent mutations in all women with breast cancer in Mexico, as opposed to restricting screening to those with a sister or mother with breast or ovarian cancer. Impact: These results will impact cancer genetic testing in Mexico and the identification of at-risk individuals who will benefit from increased surveillance.

A phase I study of farletuzumab, a humanized anti-folate receptor α monoclonal antibody, in patients with solid tumors

Abstract
 

Invest New Drugs

Farletuzumab  (MORAb-003)  is a humanized monoclonal antibody against folate receptor α (FRA). The purpose of the study is to assess safety and tolerability, the pharmacokinetic (PK) profile, and preliminary antitumor effect. Patients with ovarian cancer (OC) or FRA-expressing solid tumors who are resistant to standard treatments were eligible for the study.

Case-control estimation of the impact of oncolytic adenovirus on the survival of patients with refractory solid tumors

abstract

Oncolytic immunotherapy with cytokine armed replication competent viruses is an emerging approach in cancer treatment. In a recent randomized trial an increase in response rate was seen but the effect on overall survival is not known with any virus.

Remembrance Day Canada November 11, 2014 Lest We Forget

In Flanders Fields

Ovarian Cancer and Us - social networks

http://ovariancancerandus.blogspot.com/feeds/posts/default

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Lynch Syndrome: Identification of a novel MSH6 germline variant in a family with multiple gastro-intestinal malignancies

abstract

The identification of germline variants that predispose to cancer is important to further our understanding of tumorigenesis, guide patient management, prevent disease in unaffected relatives, and inform best practice for health care. We describe a kindred with multiple gastrointestinal malignancies where a novel MSH6 germline susceptibility variant was identified by exome sequencing after eluding serial routine testing in multiple affected members. This case fosters discussion of our current understanding of DNA mismatch repair deficiency, the management of Lynch Syndrome, and the emerging role of next generation sequencing in laboratory medicine to identify rare pathogenic germline variants in a comprehensive, unbiased fashion.

2014 Dietary Supplement Use and Colorectal Adenoma Risk in Individuals with Lynch Syndrome

open access

In conclusion, in this prospective cohort study no associations between dietary supplement use and colorectal adenoma risk among individuals with Lynch syndrome were indicated. Further research is warranted to determine whether or not dietary supplement use is associated to colorectal adenoma and colorectal cancer risk in MMR gene mutation carriers.

Risk Factors for Pancreatic Neuroendocrine Tumors

Note: abstract does not detail BRCA or Lynch Syndrome - and/or which would depend on the study population

abstract

Objectives
Pancreatic neuroendocrine tumors (PNETs) are uncommon, and little is known about their risk factors and association with other cancers. We evaluated whether the following risk factors known to be associated with pancreatic adenocarcinoma are also associated with PNETs: smoking, alcohol use, family history of PNET, and other cancers, and personal history of diabetes as potential risk factors.

Methods
Patients with PNETs seen at Mayo Clinic Rochester between 2000 and 2011 were compared with controls seen for a general medical evaluation. Patients and controls completed the same questionnaires. After excluding insulinoma and high-grade PNETs, 355 cases were evaluated, and 309 were matched to 602 controls (2:1) on age, sex, and region of residence.

Results
Personal smoking history was not associated with PNETs. Alcohol use was less common among cases (54% vs 67%, P < 0.001). Cases were more likely to report a family member with sarcoma (P = 0.02), PNET (P = 0.02), gallbladder cancer (P = 0.02), ovarian cancer (P = 0.04), and gastric cancer (P = 0.01). There was no association with other cancers in family members. Diabetes was more commonly reported by cases than controls (19% vs 11%, P < 0.001).

Conclusions
With the exception of diabetes, risk factors that are associated with pancreatic adenocarcinoma are not risk factors for PNETs.

2014 Transparency in Interim Monitoring

open access - article

To the Editor:

Most phase III randomized clinical trials (RCT) in oncology are designed to change clinical practice by convincingly demonstrating whether a new (often toxic) treatment provides meaningful improvement in outcome relative to an active standard treatment or best supportive care. To protect patients and resources, RCTs should use formal interim monitoring so that trials can be stopped early once the study question has been answered. Accordingly, in addition to stopping for convincing evidence of new treatment benefit, futility/inefficacy (lack of benefit) interim monitoring should be included to allow an RCT to be stopped if it becomes clear that the new treatment is unlikely to provide tangible improvement. In particular, to demonstrate lack of benefit, there is no need to establish that a new treatment is significantly worse than the control treatment; instead, ruling out meaningful benefit is sufficient to address the study goal while maintaining a proper balance between patient interests and the need to acquire scientific evidence.^1,2

Vergote et al³ report an RCT in patients with ovarian carcinoma and no progression after first-line chemotherapy; the study evaluated the addition of 2 years of erlotinib maintenance treatment versus observation.......
open access - response

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Related Article

• CORRESPONDENCE: Reply to B. Freidlin et al

  • Ignace Vergote,
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  • Antonio Casado,
  • and Antonio Jimeno

  JCO Aug 1, 2014:2388; published online on June 30, 2014;
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  • [PDF]

Articles citing this article

• Reply to B. Freidlin et al JCO Aug 1, 2014:2388
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Risk for borderline ovarian tumours after exposure to fertility drugs

abstract

 LIMITATIONS, REASONS FOR CAUTION:
Although we tried to minimize the effects of the underlying infertility, the severity of infertility might have affected our risk estimates, as women with more severe fertility problems may receive more treatment. The results from the subgroup analyses, e.g. the findings of an elevated risk for borderline ovarian tumours associated with increased time since first use of progesterone and with increased number of treatment cycles, should be interpreted with caution as these analyses are based on a limited number of women with borderline ovarian tumours.

WIDER IMPLICATIONS OF THE FINDINGS:

Although this study, which is the largest to date, provides reassuring evidence that there is no strong link between the use of fertility drugs and risk for borderline ovarian tumours, the novel observation of an increased risk for serous tumours after use of progesterone should be investigated in large epidemiological studies. The results of the present study provide valuable knowledge for clinicians and other health care personnel involved in the diagnosis and treatment of fertility problems.

Metastatic ovarian carcinoma to the brain: An approach to identification and classification for neuropathologists

abstract


Brain metastasis is an uncommon but increasing manifestation of ovarian epithelial carcinoma and neuropathologists' collective experience with these tumors is limited. We present clinicopathological characteristics of 13 cases of brain metastases from ovarian epithelial carcinoma diagnosed at two academic institutions. The mean ages at diagnosis of the ovarian carcinoma and their subsequent brain metastases were 58.7 and 62.8 years, respectively. At the time of initial diagnosis of ovarian carcinoma the majority of patients had an advanced stage and none had brain metastases as their first manifestation of malignancy. Brain metastases tended to be multiple with ring-enhancing features on neuroimaging. Primary tumors and their brain metastases were all high-grade histologically and the histologic subtypes were: nine high-grade serous carcinoma (HGSC) cases, two clear cell carcinoma (CCC) cases and a single case each of carcinosarcoma and high-grade adenocarcinoma. A recommended histo- and immunopathological approach to these tumours are provided to aid neuropathologists in the recognition and classification of metastatic ovarian carcinoma to the brain.

2014 Cigarette smoking and risk of ovarian cancer: a pooled analysis of 21 case–control studies

open access

 Cancer Causes Control

Results

Current cigarette smoking increased the risk of invasive mucinous (OR = 1.31; 95 % CI: 1.03–1.65) and borderline mucinous ovarian tumors (OR = 1.83; 95 % CI: 1.39–2.41), while former smoking increased the risk of borderline serous ovarian tumors (OR = 1.30; 95 % CI: 1.12–1.50). For these histological types, consistent dose– response associations were observed. No convincing associations between smoking and risk of invasive serous and endometrioid ovarian cancer were observed, while our results provided some evidence of a decreased risk of invasive clear cell ovarian cancer.

 Conclusions

Our results revealed marked differences in the risk profiles of histological types of ovarian cancer with regard to cigarette smoking, although the magnitude of the observed associations was modest. Our findings, which may reflect different etiologies of the histological types, add to the fact that ovarian cancer is a heterogeneous disease.

"....In conclusion, in this large pooled analysis, we observed moderate increases in risk of invasive and borderline mucinous tumors and borderline serous tumors associated with cigarette smoking. For each of these histological types, the risk increased with increased daily cigarette consumption and duration of smoking. This dose–response relationship supports a causal association between smoking and ovarian cancer. In contrast, our results suggest that smoking is not likely to importantly increase the risk of invasive serous ovarian cancer. There was a decreased risk of invasive clear cell ovarian cancer in relation to smoking. Thus, our results indicate that differences in risk profiles with regard to cigarette smoking are not only present between mucinous and non-mucinous ovarian tumors but across the major histological types of invasive ovarian cancer. These findings further underscore the importance of histological subtype analyses in epidemiological, genetic, and clinical investigations of ovarian cancer, due to the vast heterogeneity in this disease."

Intermediate clinical endpoints: A bridge between progression-free survival and overall survival in ovarian cancer trials + Editorial (link)

abstract

 Intermediate clinical endpoints: A bridge between progression-free survival and overall survival in ovarian cancer trials

1. Ursula A. Matulonis MD^1,*,
2. Amit M. Oza MD²,
3. Tony W. Ho MD³ and
4. Jonathan A. Ledermann MD⁴

Cancer

Author Information

1. Dana-Farber Cancer Institute, Boston, Massachusetts
2. Princess Margaret Cancer Centre, Toronto, Canada
3. AstraZeneca, Wilmington, Delaware
4. UCL Cancer Institute, University College London, London, United Kingdom

Review Article

 

Ovarian cancer patients are usually diagnosed at an advanced stage, experience recurrence after platinum-based chemotherapy, and eventually develop resistance to chemotherapy. Overall survival (OS), which has improved in recent years as more active treatments have been incorporated into patient care, is regarded as the most clinically relevant endpoint in ovarian cancer trials. However, although there remains a significant need for new treatments that prolong OS further without compromising quality of life, it has become increasingly difficult to detect an OS benefit for investigational treatments because of the use of multiple lines of chemotherapy to treat ovarian cancer. Progression-free survival (PFS), which measures the time to disease progression or death, is unaffected by postprogression therapies but does not evaluate the long-term impact of investigational treatments on tumor biology and responses to future therapies. Recent clinical trials of targeted agents in relapsed ovarian cancer have shown improvements in PFS but not OS, and this is possibly reflective of the long postprogression survival (PPS) period associated with this disease. Intermediate endpoints such as the time to second disease progression or death and the time to second subsequent therapy or death may provide supportive evidence for clinically meaningful PFS improvements and may be used to determine whether these improvements persist beyond the first disease progression and throughout subsequent lines of therapy. For clinical trials that have settings with a long PPS duration and/or involve multiple rounds of postprogression therapy, a primary endpoint of PFS supported by intermediate clinical endpoints and OS may provide a more comprehensive approach for evaluating efficacy.


also see editorial
Assessing benefit in trials: Are we making progress in assessing progression in cancer clinical trials?

Bringing PROMIS to practice: Brief and precise symptom screening in ambulatory cancer care (EHR)

abstract

 Patient Reported Outcomes Measurement Information System (PROMIS)

 METHODS
Six hundred thirty-six women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, an EHR patient communication portal.....

The rise in metastasectomy across cancer types over the past decade

abstract



CONCLUSIONS

From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns.

 Keywords:

• metastasectomy;
• colorectal cancer metastasectomy;
• lung cancer metastasectomy;
• breast cancer metastasectomy;
• melanoma metastasectomy;
• surgical trends

2014 Current Approaches and Challenges in Managing and Monitoring Treatment Response in Ovarian Cancer

open access

Simultaneous pet/mri for whole-body staging in patients with recurrent gyn malignancies of the pelvis: a comparison to whole-body mri alone

Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone

abstract

Early pregnancy sex steroids and maternal risk of epithelial ovaria... - PubMed - NCBI

abstract

Management of gynecological cancers during pregnancy

abstract

Cytoreductive Surgery Under Aminolevulinic Acid-Mediated Photodynamic Diagnosis Plus Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Ovarian Cancer and Primary Peritoneal Carcinoma: Results of a Phase I Trial

 Cytoreductive Surgery Under Aminolevulinic Acid-Mediated Photodynamic Diagnosis Plus Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Ovarian Cancer and Primary Peritoneal Carcinoma: Results of a Phase I Trial

open access

Relevance and efficacy of breast cancer screening in BRCA1 and BRCA2 mutation carriers above 60 years

abstract

Relevance of Pelvic and Para-aortic Node Metastases in Early-stage Ovarian Cancer

abstract

Lactose-intolerant people have lower risk of certain cancers - but why?

 Medical News Today

Breast Cancer Following Ovarian Cancer in BRCA Mutation Carriers

Brabstract

At a median follow-up of 6.3 years, 4 of the 12 patients (33.3%) died of recurrent EOC after a diagnosis of breast cancer. The overall 10-year survival rate for the entire cohort of 135 patients was 17.0%.

Features of ovarian cancer in Lynch syndrome (Review) - open access

open access

The lifetime risk for ovarian cancer in families with Lynch syndrome is ~8%, which is lower than colorectal and endometrial cancers, and ovarian cancer is not listed in the Amsterdam Criteria II. More than half of sporadic ovarian cancers are diagnosed in stage III or IV, but ≥80% of ovarian cancers in Lynch syndrome are diagnosed in stage I or II. 

Risk of Secondary Malignancy (Including Breast) in Patients With Mismatch-repair Protein Deficiency (Lynch syndrome)

abstract

Primary debulking surgery for advanced ovarian cancer: Are you a believer or a dissenter?

abstract

Survival differences of Asian and Caucasian epithelial ovarian cancer patients in the United States

abstract

Contemporary phase III clinical trial endpoints in advanced ovarian cancer: assessing the pros and cons of objective response rate, progression-free survival, and overall survival - Gynecologic Oncology

abstract

Acceptance of PFS as the optimal endpoint for ovarian cancer trials by investigators and regulatory agencies is crucial to further advances in management because effective post-progression therapy has rendered differences in OS virtually impossible to assess reliably.

Ovarian cancer in the United States: Contemporary patterns of care associated with improved survival

abstract

Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis

Open access

Limitations

Although 68% of the studies included here employed identical follow-up protocols for both “insiders” and “outsiders,” some studies did not explicitly state whether “outsiders” included all eligible patients or only those for whom data could be obtained. If “outsiders” are more likely to become lost to follow-up, in part because they have died or suffered other adverse events, true trial advantages might be missed.

Conclusion

We found no evidence to support either clinically important harm or clinically important benefit when patients’ illnesses were managed inside or outside an RCT. These results can inform discussions between clinicians and the patients to whom they are offering entry into peer-reviewed, ethically conducted RCTs. These results are also relevant to the policies, procedures and actions of institutions, ethics committees and granting agencies that permit and support the execution of RCTs.

Our findings and conclusions are only as good as the publication base of relevant RCTs, and we look forward to the day when the proposals of Vickers160 and Altman and Cates161 are fully realized, with all trials registered and reported and with raw trial data made readily available. When that day arrives, our study should be repeated to determine the validity of the conclusions reached here.

"If Only for A Second" - Watch How These Cancer Patients Reacted To Their Hilariously Awful Makeovers PrattTribune

video

Editorial: Screening guidelines: A matter of perspective

Editorial

Tubal origin of ovarian low-grade serous carcinoma

open access

Effects of BRCA1- and BRCA2-related mutations on ovarian and breast cancer survival: a meta-analysis

abstract

SEOM guideline in ovarian cancer 2014. - MD Anderson - Spain

SEOM guideline in ovarian cancer 2014. - PubMed - NCBI

link to open access pdf file

2014 Radiation-Induced Small Bowel Disease

open access

• What Is Radiation-Induced Small Bowel Disease?
• Pathogenesis
• Clinical Assessment
• Prevention of Radiation-Induced Small Bowel Disease
• Treatment of Acute Radiation-Induced Small Bowel Disease
• Treatment of Chronic Radiation-Induced Small Bowel Disease
• Secondary Effects of Chronic Radiation-Induced Small Bowel Disease
• Conclusion

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JCO -- Collected Resources : Art of Oncology Articles (popular series)

open access: All Art of Oncology Articles


 Related collections:

• Art of Oncology
• End of life issues
• Emotions of the oncologist
• Ethics and legal issues
• Hospice and symptom control
• Patient communication
• Survivorship issues

 

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European OK for Olaparib in Ovarian Cancer

Olaparib

Whole exome sequencing of muscle-invasive bladder cancer identifies recurrent mutations of UNC5C and prognostic importance of DNA repair gene mutations on survival

open access

".....Patients who were carriers of somatic mutations in DNA repair genes (one or more of ATM, ERCC2, FANCD2, PALB2, BRCA1 or BRCA2) had a higher overall number of somatic mutations (p=0.011)....

(other cancers - increased risk from variations of the ATM gene

Research suggests that people who carry one mutated copy of the ATM gene in each cell may have an increased risk of developing several other types of cancer. In particular, some studies have shown that cancers of the stomach, bladder, pancreas, lung, and ovaries occur more frequently in ATM mutation carriers than in people who do not carry these mutations. The results of similar studies, however, have been conflicting. Additional research is needed to clarify which other types of cancer, if any, are associated with ATM mutations.)

New Strategies in Ovarian Cancer: Translating the Molecular Complexity of Ovarian Cancer into Treatment Advances Oct 15, 2014

open access

(review) Intestinal Obstruction - Scientific American Surgery

open access

Ovarian Cancer and Antiangiogenic Therapy: Caveat Emptor - JCO

open access

Ovarian Cancer and Antiangiogenic Therapy: Caveat Emptor - JCO

open access

Multiple neoplasms, single primaries, and patient survival

open access

Rare cancers and the difficulties in making clinical decisions. ESMO 2014 (1 in 5 dx are rare)

video

Importance of gynaecological surgeons and multidisciplinary strategies in advanced ovarian cancer. ESMO 2014.

 Note: includes reference to recent U.S. study

video

open access: Assessment of adnexal masses using ultrasound: a practical review

 IJWH

  Download Article [PDF]     

• Abstract

Published Date September 2014 Volume 2014:6 Pages 857—863
DOI http://dx.doi.org/10.2147/IJWH.S47075
Received 7 May 2014, Accepted 15 July 2014, Published 23 September 2014

Noam Smorgick, Ron Maymon

Department of Obstetrics and Gynecology, Assaf HaRofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract: Pelvic ultrasound is commonly used as part of the routine gynecologic exams, resulting in diagnosis of adnexal masses, the majority of which are functional or benign. However, due to the possible complications involving benign adnexal cysts (ie, adnexal torsion, pelvic pain) and the utmost importance of early diagnosis and treatment of ovarian cancer, the correct ultrasound diagnosis of adnexal masses is essential in clinical practice. This review will describe the typical ultrasound appearance of the common physiologic, benign, and malignant adnexal masses with the aim of aiding the clinician to reach the correct diagnosis.


Download Article [PDF]   

2014 Guidelines on genetic evaluation and management of Lynch syndrome: A consensus statement by the U.S. Multi-Society Task Force on Colorectal Cancer

open access


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What do patients and carers WANT from health apps? Survey (closes Fri, 24th Oct 2014)

Note: survey includes many options for country locations

Survey


 

Exit this survey >> 

 

INTRODUCTION TO THIS INDEPENDENT STUDY

Thank you for your interest in participating in this short online survey, “What do patients and carers WANT from health apps?”

The survey is being conducted by PatientView in collaboration with Health 2.0, with the input of relevant healthcare stakeholders (policy-makers, suppliers of apps and mobile services, and healthcare professionals).

The results of the survey will be made public on November 10th-11th 2014 at the Health 2.0 conference in London, which attracts about 500 delegates. The 2014 conference is focusing on engaging the entrepreneurs who are behind the development of health apps.

So, the results of this survey should go some way to providing valuable information to app developers about how to improve their apps to meet your needs.

ABOUT THE SURVEY
The survey is open to anybody who is living with an illness or condition that lasts many years (or even a lifetime), and is also open to the carers of people living with an illness or condition that lasts many years (or even a lifetime).

The survey is COMPLETELY ANONYMOUS AND CONFIDENTIAL.

The survey is short, with only 10 main questions, and should probably take no more than 10-15 minutes of your time.

As a survey participant, you can have a copy of the results emailed to you if you wish.

When this study will close
The study will close on Friday, 24th October 2014.

If you have any questions about this study, please contact ...
Dr Alexandra Wyke of PatientView
Tel: ++44-(0)1547-520-965
E-mail: info@patient-view.com


WHAT ARE 'HEALTH APPS'?
Health apps are software (computer programs) that can be downloaded onto smartphones or tablets, or, in some cases, accessed through the Web browser on your computer. Health apps aim to help people improve their health in various ways—for instance, by boosting their ability and motivation to exercise; by helping them manage their diet, or eat healthier foods; by providing them with a log to record their symptoms, blood pressure, diet, etc, for their doctor; by offering them information about their condition, etc.


Please continue with the survey by clicking NEXT >>

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The Histomorphology of Lynch Syndrome–associated Ovarian Carcinomas: Toward a Subtype-specific Screening Strategy

Abstract

Women with Lynch syndrome (LS) are at increased risk for the development of epithelial ovarian cancer (OC). Analogous to previous studies on BRCA1/2 mutation carriers, there is evidence to suggest a histotype-specific association in LS-associated OCs (LS-OC). Whereas the diagnosis of high-grade serous carcinoma is an indication for BRCA1/2 germline testing, in contrast, there are no screening guidelines in place for triaging OC patients for LS testing based on histotype. We performed a centralized pathology review of tumor subtype on 20 germline mutation-confirmed LS-OCs, on the basis of morphologic assessment of hematoxylin and eosin–stained slides, with confirmation by immunohistochemistry when necessary. Results from mismatch-repair immunohistochemistry (MMR-IHC) and microsatellite instability (MSI) phenotype status were documented, and detailed pedigrees were analyzed to determine whether previously proposed clinical criteria would have selected these patients for genetic testing. Review of pathology revealed all LS-OCs to be either pure endometrioid carcinoma (14 cases), mixed carcinoma with an endometrioid component (4 cases), or clear cell carcinoma (2 cases). No high-grade or low-grade serous carcinomas or mucinous carcinomas of intestinal type were identified. Tumor-infiltrating lymphocytes were prominent (≥40 per 10 high-powered fields) in 2 cases only. With the exception of 1 case, all tumors tested for MMR-IHC or MSI had an MMR-deficient phenotype. Within this cohort, 50%, 55%, 65%, and 85% of patients would have been selected for genetic workup by Amsterdam II, revised Bethesda Guidelines, SGO 10% to 25%, and SGO 5% to 10% criteria, respectively, with <60% of index or sentinel cases detected by any of these schemas. To further support a subtype-driven screening strategy, MMR-IHC reflex testing was performed on all consecutive non-serous OCs diagnosed at 1 academic hospital over a 2-year period; MMR deficiency was identified in 10/48 (21%) cases, all with endometrioid or clear cell histology. We conclude that there is a strong association between endometrioid and clear cell ovarian carcinomas and hereditary predisposition due to MMR gene mutation. These findings have implications for the role of tumor subtype in screening patients with OC for further genetic testing and support reflex MMR-IHC and/or MSI testing for newly diagnosed cases of endometrioid or clear cell ovarian carcinoma."

Commentary/Research: Obesity: a certain and avoidable cause of cancer - the Lancet

 Note: both open access; note strengths/weaknesses of study for clarity

Commentary: The Lancet

 The Study (the Lancet)  Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults



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Turkish man pleads guilty to importing illegal cancer drugs (Avastin)- Drugs.com MedNews

 MedNews

Cancer biomarkers: Written in blood : Nature News

full text

 DNA circulating in the bloodstream could guide cancer treatment — if researchers can work out how best to use it.

The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial

Full text 

Conclusions

Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports 

case report/review: A late, solitary brain metastasis of epithelial ovarian carcinoma

 Full text 

open access: (2013) GEICO (Spanish Group for Investigation on Ovarian Cancer) treatment guidelines in ovarian cancer 2012

GEICO 

Dying at home – is it better: A narrative appraisal of the state of the science

abstract

Background: Achieving home care and home death is increasingly used as an outcome measure of palliative care services. 

Aim: To appraise the state of the science on dying at home. 

Methods: Appraisal and narrative review developed from a plenary presentation at the European Association for Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place of death, factors associated with dying in the preferred place, presenting evidence on outcomes for those dying at home and suggesting future research questions. 

Results: Meeting patients’ preferences and creating home-like environments has been a major concern for hospice and palliative care since its inception. During the 20^th century, in many countries, hospital deaths increased and home deaths reduced. Despite the fact that this trend has been halted or reversed in some countries (notably the United States, Canada and, more recently, the United Kingdom) in the last 5–20 years, a home death is still a distant reality for the majority, even though evidence shows it is the most commonly preferred place to die. Epidemiological studies identified factors associated with home death, including affluence, patients’ preferences, provision of home care and extended family support. Evidence about the benefits of home care is conflicting, but recent data suggest that holistic well-being may be greater at home. 

Implications: We call for further analyses of variations in place of care and place of death and robust studies on how patients and families formulate and change preferences over time. Regular monitoring of outcomes, quality and costs of palliative home care is urged.

 

Psychological distress in women with breast and gynecological cancer treated with radical surgery

abstract

Objectives

The objective of this study is to compare psychological distress (body image disturbance, self-esteem, depression, and anxiety) in women with breast or gynecological cancer treated by radical surgery. Additionally, another objective is to analyze the association between psychological distress and sociodemographic characteristics, medical history, and social support to produce a prediction model for the outcome measures.

Methods

A cross-sectional study was carried out with 100 women who had undergone radical surgery for breast or gynecological cancer. Both groups were divided into the following: younger than 50 years old and 50 years old or older. Body Image Scale, Rosenberg's Self-Esteem Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used.

Results

Age had a significant main effect on psychological distress but the type of cancer did not. Younger women showed significantly greater distress than older women (p-values < 0.001). A significant interaction between age and type of cancer was found, indicating that older women with breast cancer had worse body image and more depression than those with gynecological cancer (p-values < 0.001); no significant differences were found between younger groups.

The prediction model for increased body image disturbance and depression included the joint effect of the following variables: being younger, inactive occupational status, and post-adjuvant therapy side effects. For lower self-esteem, the variables were: being younger, post-adjuvant therapy side effects, and dissatisfaction with social support. And for higher anxiety, the sole variable included was post-adjuvant therapy side effects.

Conclusions

Both mastectomy and hysterectomy/oophorectomy cause similar psychological distress in younger women, but mastectomy causes greater distress in older women than hysterectomy/oophorectomy.

 

Twenty tips for interpreting scientific claims

Nature News & Comment

Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer

abstract

Objective: The aims of this study were to compare the rate of completion of optimal debulking and/or 6 cycles of intraperitoneal (IP) chemotherapy in women with International Federation of Gynecologists and Obstetricians stage III/IV ovarian cancer undergoing neoadjuvant chemotherapy (NACT) versus primary surgery (PS) and to compare morbidity between these 2 groups.

Methods: Ninety-six subjects with stage III/IV ovarian cancer who underwent either NACT or PS were identified. Data comparisons include rate of optimal debulking and completion rate of 6 cycles of IP chemotherapy. Other data collected included surgical times, length of stay, intensive care unit admissions, blood transfusions, bowel resections, major complications, and dose reductions. SigmaStat version 2.0 was used for statistical analysis.

Results: Of the 96 subjects, 38 received NACT and 58 had PS. All 14 subjects with stage IV disease received NACT, and all experienced resolution of pleural effusion, based on computed tomographic imaging. Thirty-five (92%) of 38 NACT subjects versus 47 (81%) of 58 PS subjects were optimally debulked (P = 0.08). Thirty-six (95%) of 38 NACT subjects versus 37 (64%) of 58 PS subjects completed IP chemotherapy (P < 0.001). Length of stay was 3.26 (NACT) versus 5.08 (PS) days (P < 0.001). Intensive care unit admissions were 1 of 38 (NACT) versus 12 of 58 (PS) (P < 0.001). Bowel resections were done in 2 of 38 (NACT) versus 14 of 38 (PS) (P < 0.05). Duration of surgery was 96 minutes (NACT) versus 138 minutes (PS) (P < 0.001). A trend to fewer dose reductions occurred in NACT (1/38) versus PS (8/58) (P = 0.056).

Conclusions: The NACT subjects were more likely to complete IP chemotherapy and had decreased length of stay, intensive care unit admissions, bowel resections, and duration of surgery. Both optimal debulking and dose reductions were numerically but not statistically associated with NACT versus PS. This likely reflects a relatively high overall rate of optimal debulking and low rate of dose reductions in these subjects and would require a larger group to determine significance.