abstract: Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Abstract

"Several advances in imaging have become part of the work-up for localization, diagnosis, and management of infectious diseases and inflammatory disorders. Utility of multiple imaging modalities is a time-consuming step, and significant numbers of patients remain undiagnosed despite utilization of series of tests. Inflammatory cells have avidity for fluorine 18–labeled fluorodeoxyglucose (¹⁸F-FDG), and thus positron emission tomographic–computed tomographic (PET-CT) hybrid imaging provides anatomical and metabolic information that can be used to define the extent of infectious and inflammatory diseases and assess response to treatment. PET-CT provides a “one-stop test” in which use of hybrid imaging provides anatomical and metabolic information. The extent of disease is defined quickly, and response to treatment can be assessed. This modality also helps define the metastatic and/or septic foci where there is lack of localizing symptoms. More recently, there is increasing awareness among clinicians regarding the ability of PET-CT to help in diagnosing, characterizing, and assessing inflammatory disorders. This article reviews the usefulness of this imaging modality."

open access: Upper abdominal cytoreduction and thoracoscopy for advanced epithelial ovarian cancer: unanswered questions and the impact on treatment - 75 patient study

	Positive thoracoscopy	Negative thoracoscopy
GOG, Gynecologic Oncology Group.
n (%)	27 (36.0)	48 (64.0)
Median (range) age, years	60.5 (29–75)	63 (39–76)
GOG Performance Status (0,1)	100%	100%
Location of largest disease
Diaphragm	2/27 (7.4%)	1/48 (2.1%)
Omentum	7/27 (25.9%)	10/48 (20.8%)
Pelvis	15/27 (55.6%)	37/48 (77.1%)
Lymph nodes	2/27 (7.4%)	1/48 (2.1%)
Mesentery	2/27 (7.4%)	1/48 (2.1%)

Table 2.  Surgical Procedures

Table 3.   Morbidity and mortality (Positive/Negative thoracoscopy - complications)

Conclusions

Epithelial ovarian cancer is most commonly diagnosed in advanced stages. The prognostic value of complete cytoreduction has been reported and confirmed in several publications.^6,21,22 Similarly intraperitoneal chemotherapy is associated with improved overall survival in women with small-volume residual disease (<1 cm) and, as with cytoreductive surgery, carries with it increased morbidity.

It is therefore mandatory to do all that is necessary to identify disease that cannot be resected before undertaking a maximal cytoreductive effort for disease that will not benefit from the use of intraperitoneal chemotherapy.

Using the surgical approach described allows both of these goals to be met, thereby maximising the potential benefit to women with advanced-stage epithelial ovarian cancer.

open access: Cancer of unknown primary (CPU) : progress in the search for improved and rapid diagnosis leading toward superior patient outcomes

Abstract

This paper explores the enigma of cancer of unknown primary (CUP) in relation to rapidly improving molecular diagnostic approaches. It is based on the first global collaboration meeting on improving research and clinical outcomes in CUP organized by the CUP Foundation........All patients with CUP could thus be appropriately managed without the constant uncertainty that has previously severely hampered patient care and optimal outcomes. The longer-term objective is to understand the biology of highly metastatic disease, leading to the development of future global therapeutic programs. Current clinical studies, such as CUP-ONE, will address some of these issues.

introduction

definition, epidemiology, biology, and prognosis

diagnostic approaches to CUP

pathologic evaluation

clinical evaluation

molecular profiling and classification of human cancers

new technologies in practice

conclusion

 

"....Several of the favorable subsets of CUP patients seem to mimic the clinical and pathologic features of particular known metastatic cancers. These include ..............; peritoneal serous adenocarcinoma (ovarian primary) ........" 

Table 1.    Favorable prognostic subsets of patients with unknown primary cancer recognized by clinical and pathologic features in the last three decades

 

abstract: Reducing Time to Diagnosis Does Not Improve Outcomes for Women With Symptomatic Ovarian Cancer: A Report From the Australian Ovarian Cancer Study Group

Abstract

Purpose To determine if time to diagnosis is associated with stage of disease at diagnosis or survival among women with symptomatic ovarian cancer..........

Conclusion The results of this study suggest that, once ovarian cancer is symptomatic, reducing the time to diagnosis would not greatly alter stage of disease at diagnosis or survival.

....More Than A Month To Record Ovarian Cancer Diagnosis In One In 10 Cases

full free access: Quality in Cancer Diagnosis (table 1 gyn)

Table 1. Diagnostic Steps for Gynecologic and Nongynecologic Specimens

5 min video: SECOND OPINION | Ovarian Cancer | PBS

Note: the video seems to take a bit of time to load (patience req'd);

It's a choice to move forward: women's perceptions about treatment decision making in recurrent ovarian cancer

Abstract
OBJECTIVE: This research explores the treatment decision-making (TDM) experiences of women with recurrent ovarian cancer (ROC) with regard to treatment options; their understanding of risks and benefits of various treatment options; the decision-making role they want for themselves and for their oncologist; and the social context of the consultation as it pertains to the decision.
METHODS: We conducted semi-structured interviews with 26 women at the time of first recurrence. Through inductive data analysis key themes were identified.
RESULTS: Many women describe self-identifying the cancer recurrence fairly quickly due to new symptoms. Many feel that the goal for treating their recurrence is to control versus cure the cancer. They describe the subsequent process of diagnosis and TDM for ROC as quick and straightforward with all women accepting the oncologists' treatment recommendation. They feel that the type and number of treatment options are limited. They have a strong desire for physician continuity in their care. Participants feel that their doctor's recommendations as well as their previous experience with ovarian cancer are strong factors influencing their current TDM process.
CONCLUSIONS: Shared decision making is based on a simultaneous participation of both the physician and patient in TDM. When faced with ROC, women feel that their doctor's recommendation and their past experience with treatment and TDM are prominent factors influencing the current TDM process.

full access: Quality in Cancer Diagnosis CA: A Cancer Journal for Clinicians

Gastroenterology and Endoscopy News - Inherited Colon and Rectal Cancer

"In Part 1 of this four-part series, we examine the clinical pathology and molecular biology of (Lynch Syndrome) hereditary nonpolyposis colorectal cancer (HNPCC). In Part 2, we will discuss screening and treatment, and the roles of the epidemiologist, the diagnostician and the surgeon."

An estimated 150,000 Americans may be carriers of the (Lynch Syndrome) HNPCC mutation(s) and have a 90% lifetime risk for developing some type of cancer. (MSH2/MSH6/MLH1/PMS2)

Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care. J Barrett. 2010; BJOG: An International Journal of Obstetrics & Gynaecology - Wiley InterScience

media news: Symptoms have little value for early detection of ovarian cancer including editorial commentary

abstract: Current Update on Borderline Ovarian Neoplasms

CONCLUSION. Borderline tumors are considered to be precursors of low-grade ovarian cancers. Accurate diagnosis and staging facilitate optimal patient management particularly in patients desiring to preserve fertility.