Sunday, September 30, 2012
CancerLand – The Undiscovered Country
CancerLand – The Undiscovered Country
By JAMES SALWITZ, MD
Diagnosed with metastatic esophageal cancer on June 8, 2011 Christopher Hitchens found that he had been transported to a foreign place. Until his death 18 months later the award winning author picked up pen and wrote about his travels in a "new land" where everyone "smiles encouragingly," "where the cuisine is the worst of any destination" and where a language is spoken that "manages to be both dull and difficult." The recently published book "Mortality" is his voyage into "sick country," a place we will call CancerLand.
The idea of moving far away is also described in Chet Skibinski's 2012 diary-like book, "Cancer Country. " "On May 15, 2008, I stepped into a foreign country" with freakish rules and disturbing customs. Skibinski takes the reader along on his journey though several years of complex care and metamorphosis, not only medical, but also social, spiritual and personal.
CancerLand is a place not only of a body which visits hospitals, clinics, subjected to knives, drugs, x-rays and deconstruction by machine, but it is a destination of mind, where confusion, isolation, and fear transform knowing, growing and comfort in a bizarre, painful, spinning world which tries to break down the soul to yield suffering. As both patient authors note, it is a transit from which it is difficult to return.
Cancer patients are cast out from safety, stability and control to a state of danger, chaos and subjugation. Understanding the disease process as a distinct place, with strange language, customs and goals provides clues to the survival of body and mind. Seeing CancerLand as an unwelcome Kafkaesque journey may help us fight the disease and adjust to the changes that occur.
In Cancerland, as on any foreign voyage, the traveler will fair best that has knowledge and control. This does not mean becoming a medical expert, but rather teaching the experts that you are the master of your fate and they need to educate and advise you, not direct or demand. If you understand the rules and insist on guiding your own decisions, you will tolerate care and better cope. While it may help to learn some of the language, this is one country where you should demand translation. You should always travel with others to help you, hire guides you trust and make careful decisions as you study the landscape. In CancerLand, there are many paths from which to choose and one must examine each. Remember Cancerland is a foreign place not only for travelers but even for those who work there, so take the time to study, cope and consider.
These simple ideas cannot change the reality; Cancer patients take a journey and at least in part, he or she is never coming back. Each patient and family needs to understand this transition, even if it cannot be seen, and accept that learning about this new mental and physical place will take time. The magnitude of the transition depends on much, inc...
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Sunnybrook Cancer Centre - Rapid Diagnosis Unit (breast)
Leading breast cancer centre to open sooner thanks to $10 million gift - Sunnybrook Hospital
"The centre's Rapid Diagnosis Unit will offer potential breast cancer patients a diagnosis and treatment plan within just 24 hours of assessment, eliminating current wait times of up to six weeks for such life-saving answers."
Saturday, September 29, 2012
Health information needs and health-related quality of life in a diverse population of long-term cancer survivors
Health information needs and health-related quality of life in a diverse population of long-term cancer survivors: Publication year: 2012
Source: Patient Education and Counseling
Objective To investigate health information needs and their association with health-related quality of life (HRQOL) in a diverse, population-based sample of long-term cancer survivors.
Methods We analyzed health information needs from 1197 cancer survivors 4–14 years post-diagnosis drawn from two cancer registries in California. Multivariable regression models were used to identify factors associated with endorsement of total number and different categories of needs. The relationship between number of needs and HRQOL and effect modification by confidence for obtaining information was examined.
Results Survivors reported a high prevalence of unmet information needs in the following categories: side effects & symptoms: 75.8%; tests & treatment: 71.5%; health promotion: 64.5%; interpersonal & emotional: 60.2%; insurance: 39.0%; and sexual functioning & fertility: 34.6%. Survivors who were younger, non-White, and did not receive but wanted a written treatment summary reported a higher number of needs. Number of information needs was inversely related to mental well-being, particularly for those with low confidence for obtaining information (P <0.05).
Conclusion These patterns suggest disparities in access to important health information in long-term survivors and that affect HRQOL. Practice Implications Findings suggest a need for tailored interventions to equip survivors with comprehensive health information and to bolster skills for obtaining information.
Diagnosis, Treatment, and Follow-Up of Borderline Ovarian Tumors
Diagnosis, Treatment, and Follow-Up of Borderline Ovarian Tumors:
Borderline ovarian tumors represent a heterogeneous group of noninvasive tumors of uncertain malignant potential with characteristic histology. They occur in younger women, are present at an early stage, and have a favorable prognosis, but symptomatic recurrence and death may be found as long as 20 years after therapy in some patients. The molecular changes in borderline ovarian tumors indicate linkage of this disease to type I ovarian tumors (low-grade ovarian carcinomas). The pathological stage of disease and subclassification of extraovarian disease into invasive and noninvasive implants, together with the presence of postoperative macroscopic residual disease, appear to be the major predictor of recurrence and survival. However, it should be emphasized that the most important negative prognostic factor for recurrence is just the use of conservative surgery, but without any impact on patient survival because most recurrent diseases are of the borderline type—easily curable and with an excellent prognosis. Borderline tumors are difficult masses to correctly preoperatively diagnose using imaging methods because their macroscopic features may overlap with invasive and benign ovarian tumors. Over the past several decades, surgical therapy has shifted from a radical approach to more conservative treatment; however, oncologic safety must always be balanced. Follow-up is essential using routine ultrasound imaging, with special attention paid to the remaining ovary in conservatively treated patients. Current literature on this topic leads to a number of controversies that will be discussed thoroughly in this article, with the aim to provide recommendations for the clinical management of these patients.
Governments failing to address 'global pandemic of untreated cancer pain'
Governments failing to address 'global pandemic of untreated cancer pain'
".... "Unrelieved cancer pain is a cause of major worldwide suffering, not because we don't have the tools necessary to relive pain, but because most patients don't have access to the essential pain-relieving medication," Prof Cherny said. "This pandemic affects literally billions of people. Not only are the patients suffering often terrible unrelieved pain, but their family members are often permanently scarred by the memories of witnessing such suffering in their loved ones.".....
Clinical Trials Research by Condition - ovarian carcinosarcoma, cysts, epithelial, germ cell, lmp....
Clinical Trials Research by Condition
- Ovarian Cancer 1255 studies
- Ovarian Carcinosarcoma 16 studies
- Ovarian Cysts 255 studies
- Ovarian Diseases 1585 studies
- Ovarian Epithelial Cancer 672 studies
- Ovarian Germ Cell Tumor 182 studies
- Ovarian Hyperstimulation Syndrome 34 studies
- Ovarian Low Malignant Potential Tumor 26 studies
- Ovarian Neoplasms 1255 studies
- Overbite 1 study
- Overdose 16 studies
- Overnutrition 2579 studies
- Overweight 2847 studies
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Clinical Trials Background
About
Trends in gynecologic cancer care in North America.
Abstract
Overall, there has been tremendous movement over the last decade toward centralization of cancer care into specialized centers. This comes from the recognition that multidisciplinary care, including access to opinions from gynecologic, medical, and radiation oncologists, can improve patient outcomes. In addition to this input, it is important to have access to subspecialty pathology, diagnostic radiology, oncology nursing, and other disciplines as necessary. The population-based literature on quality of care in gynecologic cancers reflects this movement, with many articles evaluating outcomes in terms of structural variables. However, the continued presence of regional and sociodemographic variation in outcomes suggests it is still possible to achieve significant improvements in survival by concentrating efforts to improve the quality of care provided to gynecologic cancer patients. Improved outcomes for patients with ovarian cancer can be achieved by continued centralization of gynecologic cancer care and provision of care by gynecologic oncologists in high-volume centers. Further study is needed to determine if cervical cancer and vulvar cancer outcomes can be improved with centralization. For uterine cancer, at this time there do not appear to be significant improvements in outcomes related to centralization.For all gynecologic cancers, more attention should be paid to the processes of care and their impact on patient outcomes. An appropriate goal for all health care systems is to ensure all women have access to evidence-based care. This is particularly important for high-risk women, older women, and minority women, who suffer a disproportionate amount of the gynecologic cancer–related mortality and often do not receive evidence-based care. Clinical practice guidelines exist to provide guidance to clinicians as to what constitutes evidence-based care and to make recommendations concerning current best practices. Adherence to guidelines can help to reduce variations in care due to sociodemographic factors. As the provision of cancer care becomes more and more centralized, outcomes at the population level will be improved only by focusing on the processes of care. A look at the three North American health care systems shows there are issues with women having ...
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Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening.
Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening.
Abstract
There are two mutations in BRCA1 and one in BRCA2, which are present in up to 2.5% of Jewish women. Population genetic testing for Jewish women has been proposed; however, it is unclear how this would impact the uptake of cancer prevention options and psychosocial functioning in women with a positive result. Two thousand and eighty unselected Jewish women were tested for the Jewish BRCA mutations, and 1.1% were positive. Cancer-related distress was measured before testing, and at 1 and 2 years post-testing. Information on uptake of cancer risk reduction options was collected at 2 years. Breast and ovarian cancer risks were estimated using BRCAPRO. Within 2 years of receiving a positive result, 11.1% of women had prophylactic mastectomy, and 89.5% had a prophylactic oophorectomy. The mean breast cancer risk was estimated to be 37.2% at time of testing, compared to 20.9% at 2 years post-testing. The mean ovarian cancer risk was estimated to be 24.5% at time of testing, compared to 7.5% at 2 years following testing. Distress decreased between 1 and 2 years for women with prophylactic mastectomy and oophorectomy (P = 0.02), and for women with prophylactic oophorectomy only (P = 0.04) but not for those with neither surgery. The majority of Jewish women with a BRCA mutation identified through a population screening elected prophylactic oophorectomy, but a few had a prophylactic mastectomy. Uptake of either surgery resulted in decreased distress. Provision of population BRCA testing resulted in reduced risks of breast and ovarian cancers in women with a mutation.
PMID: 22240989 [PubMed - indexed for MEDLINE]
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The Long Journey of Cancer Biomarkers from the Bench to the Clinic.
The Long Journey of Cancer Biomarkers from the Bench to the Clinic.
Clin Chem. 2012 Sep 27
Abstract
BACKGROUND:Protein cancer biomarkers serve multiple clinical purposes, both early and late, during disease progression. The search for new and better biomarkers has become an integral component of contemporary cancer research. However, the number of new biomarkers cleared by the US Food and Drug Administration has declined substantially over the last 10 years, raising concerns regarding the efficiency of the biomarker-development pipeline.CONTENT:We describe different clinical uses of cancer biomarkers and their performance requirements. We also present examples of protein cancer biomarkers currently in clinical use and their limitations. The major barriers that candidate biomarkers need to overcome to reach the clinic are addressed. Finally, the long and arduous journey of a protein cancer biomarker from the bench to the clinic is outlined with an example.SUMMARY:The journey of a protein biomarker from the bench to the clinic is long and challenging. Every step needs to be meticulously planned and executed to succeed. The history of clinically useful biomarkers suggests that at least a decade is required for the transition of a marker from the bench to the bedside. Therefore, it may be too early to expect that the new technological advances will catalyze the anticipated biomarker revolution any time soon.
PMID: 23019307 [PubMed - as supplied by publisher]
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Biologic therapies and personalized medicine in gynecologic malignancies.
Biologic therapies and personalized medicine in gynecologic malignancies.
 | Related Articles |
Biologic therapies and personalized medicine in gynecologic malignancies.
Obstet Gynecol Clin North Am. 2012 Jun;39(2):131-44
Authors: Schiavone MB, Bashir S, Herzog TJ
Abstract
Through advances in human genomic sequencing, the unique molecular biology that predisposes certain individuals to either health or disease has now been illuminated. Although many malignancies behave similarly on a phenotypic level, biologically there exist multiple layers of interconnected molecular and cellular pathways that may make each patient's disease significantly more unique than previously appreciated. In gynecologic oncology, the most progress in developing targeted biologics has been in the treatment of ovarian cancers. Future investigations will see further development in endometrial and cervical cancers. Technology such as whole genome sequencing can theoretically identify the individual tumor's genetic profile; however, identifying the priority pathways for therapeutic interventions and subsequent complex interactions remains a significant challenge. New therapeutic technologies such as siRNA and immune modulators will also play a promising role in the movement toward individualized therapies. It is hoped that the identification and use of targeted agents will lead to individualized care that in turn will lead to significantly improved outcomes manifested by more cures and better quality of life through amelioration of toxicities.
PMID: 22640707 [PubMed - indexed for MEDLINE]
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Molecular characterization of circulating tumor cells in patients with ovarian cancer improves their prognostic significance - A study of the OVCAD consortium.
Molecular characterization of circulating tumor cells in patients with ovarian cancer improves their prognostic significance - A study of the OVCAD consortium.
Molecular characterization of circulating tumor cells in patients with ovarian cancer improves their prognostic significance - A study of the OVCAD consortium.
Gynecol Oncol. 2012 Sep 24;
Authors: Obermayr E, Castillo-Tong DC, Pils D, Speiser P, Braicu I, Van Gorp T, Mahner S, Sehouli J, Vergote I, Zeillinger R
Abstract
OBJECTIVE: The study aims at identifying novel markers for circulating tumor cells (CTCs) in patients with epithelial ovarian cancer (EOC), and at evaluating their impact on outcome. METHODS: Microarray analysis comparing matched EOC tissues and peripheral blood leucocytes (N=35) was performed to identify novel CTC markers. Gene expression of these novel markers and of EpCAM was analyzed using RT-qPCR in blood samples taken from healthy females (N=39) and from EOC patients (N=216) before primary treatment and six months after adjuvant chemotherapy. All samples were enriched by density gradient centrifugation. CTC positivity was defined by over-expression of at least one gene as compared to the healthy control group RESULTS: CTC were detected in 24.5% of the baseline and 20.4% of the follow-up samples, of which two thirds were identified by overexpression of the cyclophilin C gene (PPIC), and just a few by EpCAM overexpression. The presence of CTC at baseline correlated with the presence of ascites, sub-optimal debulking, and elevated CA-125 and HE-4 levels, whereas CTC during follow-up occurred more often in older and platinum resistant patients. PPIC positive CTCs during follow-up were significantly more often detected in the platinum resistant than in the platinum sensitive patient group, and indicated poor outcome independent from classical prognostic parameters. CONCLUSIONS: Molecular characterization of CTC is superior to a mere CTC enumeration or even be the rationale for CTC diagnostics at all. Ultimately CTC diagnostics may lead to more personalized treatment of EOC, especially in the recurrent situation.
PMID: 23017820 [PubMed - as supplied by publisher]
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Malignant tumors of the female reproductive system.
Malignant tumors of the female reproductive system.
Malignant tumors of the female reproductive system.
Saf Health Work. 2012 Sep;3(3):166-80
Authors: Weiderpass E, Labrèche F
Abstract
This review summarizes the epidemiology of cancer of the female reproductive system and associated lifestyle factors. It also assesses the available evidence for occupational factors associated with these cancers. Cervical, endometrial, and ovarian cancers are relatively common, and cause significant cancer morbidity and mortality worldwide, whereas vulvar, vaginal, fallopian tube cancers, and choriocarcinomas are very rare. As several lifestyle factors are known to play a major role in the etiology of these cancers, very few published studies have investigated possible relationships with occupational factors. Some occupational exposures have been associated with increased risks of these cancers, but apart from the available evidence on the relationships between asbestos fibers and ovarian cancer, and tetrachloroethylene and cervical cancer, the data is rather scarce. Given the multifactorial nature of cancers of the female reproductive system, it is of the utmost importance to conduct occupational studies that will gather detailed data on potential individual confounding factors, in particular reproductive history and other factors that influence the body's hormonal environment, together with information on socio-economic status and lifestyle factors, including physical activity from multiple sources. Studies on the mechanisms of carcinogenesis in the female reproductive organs are also needed in order to elucidate the possible role of chemical exposures in the development of these cancers.
PMID: 23019529 [PubMed - in process]
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Immunohistochemical Localization of HE4 in Benign, Borderline, and Malignant Lesions of the Ovary.
Immunohistochemical Localization of HE4 in Benign, Borderline, and Malignant Lesions of the Ovary.
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Immunohistochemical Localization of HE4 in Benign, Borderline, and Malignant Lesions of the Ovary.
Int J Gynecol Pathol. 2012 Sep 26;
Authors: Georgakopoulos P, Mehmood S, Akalin A, Shroyer KR
Abstract
Despite advances in the development of novel methods to improve treatment, ovarian carcinoma is still the leading cause of gynecologic cancer death in the United States and other industrialized nations. Improvements in the clinical outcome of ovarian cancer will be achieved if methods can be developed to enable the detection of these tumors at the earliest possible stage. Thus, it is critically important to identify and validate new biomarkers of ovarian cancer. HE4 expression was defined by immunohistochemical analysis of a wide range of benign, borderline, and malignant ovarian lesions, including serous, endometrioid, mucinous, and clear cell lesions of the ovary and in primary tubal carcinomas and the normal fallopian tube. At the cellular level, HE4 was highly expressed in malignant ovarian tumors and in a wide range of benign and borderline ovarian lesions. In addition, HE4 was highly expressed in primary fallopian tube carcinomas and benign fallopian tubal epithelial cells. These results support the conclusion that HE4 is widely expressed in most benign, borderline, and malignant lesions of the ovary and the fallopian tube. The detection of HE4 expression at high levels in some benign lesions and normal tissues suggests that HE4 could have limited specificity as a marker of ovarian or tubal carcinoma. Furthermore, the relatively weak expression that was observed in many ovarian carcinomas indicates that HE4 could fail to detect some cases of primary or recurrent disease.
PMID: 23018214 [PubMed - as supplied by publisher]
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Prevalence of Loss of Expression of DNA Mismatch Repair Proteins in Primary Epithelial Ovarian Tumors.
Prevalence of Loss of Expression of DNA Mismatch Repair Proteins in Primary Epithelial Ovarian Tumors.
Abstract
Although different histologic subtypes of epithelial ovarian tumors have long been recognized, their molecular abnormalities have not been fully defined. We examined the prevalence of DNA mismatch repair (MMR) protein loss in these tumors. Tissue microarrays (TMA) of suspected ovarian carcinomas were stained for hMLH1, hMSH2, hMSH6, and hPMS2 and scored separately by 2 groups of investigators. Loss of staining (negative) or discrepant staining results on TMA were verified on whole-section slides. Intact (positive) staining results were also verified for an additional 25 randomly selected cases. Clinical data for cases demonstrating MMR protein loss were collected. A second set of TMA composed purely of mucinous tumors was also stained for antibodies to MMR proteins and scored by 1 group of investigators. TMA was an effective method for screening a large number of ovarian tumors for MMR protein expression, with a sensitivity of 100% for all 4 MMR proteins, and a specificity of 22.2%-53.8% for different MMR proteins. Of the primary epithelial tumors of the ovary, loss of expression of MMR proteins was significantly more common in the endometriosis-associated carcinomas (7/69; 10.1%) than in high-grade serous carcinomas (2/182; 1.1%): P=0.0021. The former group also showed more frequent loss of MMR proteins compared with mucinous intestinal-type carcinomas (0/32; P=0.0940). Cases within the group of endometriosis-associated carcinomas were endometrioid (2/29 cases), clear cell (1/27 cases), undifferentiated (1/8 cases), and mixed carcinomas with an endometrioid, clear cell, and/or undifferentiated component (3/5 cases). No loss of MMR protein expression was identified in epithelial tumors of other histologic subtypes. Our study demonstrated the loss of MMR protein expression in 10.1% of endometriosis-associated ovarian carcinomas. These results raise the possibility of selective screening for Lynch syndrome in patients with these types of ovarian carcinoma.
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Clinicopathologic and Immunohistochemical Features of Ovarian Clear Cell Carcinomas in Comparison With Type I and Type II Tumors.
Abstract
Two types of ovarian carcinomas are distinguished with respect to morphology, biology, and clinical course, and are designated as Type I and Type II tumors. However, placement of clear cell carcinomas into one of these 2 groups has been problematic as they exhibit morphologic, molecular, and clinical features that do not entirely resemble either Type I or Type II tumors. The present study aimed at better elucidating the clinicopathologic and immunohistochemical features of clear cell carcinomas, in comparison with the 2 main broad categories. To this end, a panel of classic clinicopathologic and immunohistochemical parameters, including estrogen receptor α (ERα), ERβ, progesterone receptor, Ki67, p53, and HER2/neu was evaluated in 71 Type I, 157 Type II, and 21 clear cell carcinomas. Overall, findings from the present study support the idea that ovarian clear cell carcinomas are neither Type I nor Type II carcinomas of the ovary; indeed, results obtained showed that similarities between clear cell carcinomas and Type I were limited to the patient's age, tumor dimension, incidence of lymph node and extranodal metastases, and p53 labeling index, whereas the patient's age and incidence of extranodal metastases were the only parameters comparable with the Type II group. The hormonal receptor profile of clear cell carcinomas was characterized by low expression of nuclear ERα and progesterone receptor, and by almost exclusively nuclear ERβ immunopositivity, features significantly different from both Type I and II tumors. Finally, the percentage of HER2/neu-positive samples in clear cell carcinomas was 10- and 2.5-fold higher than Type I and Type II ovarian tumors, respectively. In conclusion, our study provides insights into clear cell carcinoma that could help in explaining its unique prognostic features, and, eventually, in orienting toward new therapeutic options.
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