Top 10 most viewed posts this month (April):
Monday, April 30, 2012
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.
Subscribe to:
Posts
(
Atom
)
