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Sunday, October 21, 2012

iTunes - Podcasts - Ovarian Cancer CancerCare Connect Education Workshops by CancerCare



iTunes - Podcasts - Ovarian Cancer Cancer Care Connect Education Workshops by CancerCare

Ovarian Cancer CancerCare Connect Education Workshops

By CancerCare

To listen to an audio podcast, mouse over the title and click Play. Open iTunes to download and subscribe to podcasts.

Description

CancerCare's free Connect Education Workshops are a way for people to learn about cancer-related issues from the convenience of their home or office. Leading experts in oncology provide the most up-to-date information in these workshops to help you and your loved ones better understand and cope with your cancer diagnosis, treatment options, quality-of-life concerns, treatment side effects, pain management, doctor-patient communication and other important topics.
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ovarian/lynch syndrome patients: CT urography for hematuria : Nature Reviews Urology



CT urography for hematuria : Nature Reviews Urology

Review

Nature Reviews Urology 9, 218-226 (April 2012) | doi:10.1038/nrurol.2012.32

CT urography for hematuria

Hematuria can signify serious disease such as bladder cancer, upper urinary tract urothelial cell carcinoma (UUT-UCC), renal cell cancer or urinary tract stones. CT urography is a rapidly evolving technique made possible by recent advances in CT technology. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration. The reasoning for using CT urography to investigate hematuria is based on its high diagnostic accuracy for urothelial cell carcinoma (UCC) and favorable comparison with other imaging techniques. The optimum diagnostic imaging strategy for patients with hematuria at high-risk for UCC involves the use of CT urography as a replacement for other imaging tests (ultrasonography, intravenous urography, or retrograde ureteropyelography) and as a triage test for cystoscopy, resulting in earlier diagnosis and improved prognosis of bladder cancer, UUT-UCC, renal cell cancer and stones. Current problems with CT urography for investigating hematuria might be solved with a formative educational program simulating clinical reporting to reduce reader error, and a new technique for image-guided biopsy of UUT-UCC detected by CT urography for histopathological confirmation of diagnosis and elimination of false-positive results. CT urography is recommended as the initial imaging test for hematuria in patients at high-risk for UCC.
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HRT DECREASE SUBSTANTIALLY CVD RISK IN WOMEN (blog)




HRT DECREASE SUBSTANTIALLY CVD RISK IN WOMEN 

October 12, 2012 (Hvidovre, Denmark) — Hormone-replacement therapy (HRT) in postmenopausal women with a mean age of 50 significantly reduced the risk of the combined end point of mortality, MI, or heart failure in a new randomized Danish study published online October 9, 2012 in BMJ [1]. The participants, who used HRT for more than 10 years, were not at significantly increased risk of breast cancer or stroke either, report Dr Louise Schierbeck (Hvidovre Hospital, Denmark) and colleagues.
"This is the longest randomized trial with hard end points, and we found a 50% reduction in cardiovascular end points for the women who took HRT, and there was no increased risk of cancer," Schierbeck told heartwire . The women were also followed for a further six years after discontinuation of randomized treatment, she noted.
Schierbeck says the findings, in 1000 women, confirm the "timing hypothesis." In 2002, primary results from the Women's Health Initiative (WHI) showed no cardiovascular benefit from HRT--something that had been suggested by numerous observational trials--and even an indication there may be harm; this led to the widespread abandonment of this therapy. But subsequent analyses of WHI, and data from other studies, have suggested that the time at which HRT is first prescribed is key. The women in this Danish study were 13 years younger, on average, than the women in WHI (mean age 63 years). "It doesn't make much sense to start treating women 13 years after menopause for menopausal symptoms. It's important to initiate the treatment at menopause and not many years later," she observes.
Asked to comment on the new findings, Dr Howard N Hodis (UCLA) told heartwire , "Until this came out there had been no trial to directly study the estrogen cardioprotective hypothesis. This is unique, because it is the only study to have looked at women, a priori, randomized basically at the time of or just a little beyond menopause. And that's a really important point that I think some of the detractors have glossed over. The women averaged 50 years old, just like the women that we treat who come in close to the menopause and say, 'I want hormones,' because they are having symptoms. So scientifically, this is a very important trial."
Ob/gyn Dr James Liu (Case Western Reserve University School of Medicine, Cleveland, OH) said: "This paper adds to the evolving data on HRT for newly menopausal women in the under-age-60 category. The study conclusions are worth noting and are statistically significant and congruent with older observational studies such as the Nurses' Health Study and the subgroup-stratified analyses of the WHI cohort from 50 to 60. Thus, there are two randomized trials that have congruent data." Among the "surprising points," says Liu, are no increase in breast cancer risk for the 16 years of follow-up and the fact that stroke risk was not increased.
Hodis also addressed criticisms that the new Danish trial is too small to yield any meaningful results. "Although the sample size is small, there are 16 years and 20 000 women-years of follow-up." Schierbeck concurs. "We had a very long study, so there are 10 000 person-years of randomized treatment, and we do have a significant outcome in 1000 women, so it's clinically relevant."
Greater-Than-50% Reduction in CV Events Without Increasing Cancer Risk
The 1006 healthy women aged 45 to 58 who were recently postmenopausal or had perimenopausal symptoms were participants in the Danish Osteoporosis Prevention Study and were randomized to receive HRT (n=502) or no treatment (control, n=504).
The primary end point was a composite of death, hospitalization for heart failure, and MI. Secondary end points were the individual components of the primary end point and admission to the hospital for stroke. Safety end points included death or a diagnosis of breast cancer or other cancer grouped together and admission to the hospital for pulmonary embolism or deep venous thrombosis (DVT).
The women in the treated group with an intact uterus received 2-mg synthetic 17-{:beta:}-estradiol for 12 days, 2 mg 17-{:beta:}-estradiol plus 1 mg  norethindrone acetate for 10 days, and 1 mg 17-{:beta:}-estradiol for six days (Trisekvens, Novo Nordisk, Denmark). In women who had undergone hysterectomy, first-line treatment was 2 mg 17-{:beta:}-estradiol a day (Estrofem, Novo Nordisk, Denmark). Other treatment modalities were offered to those who experienced side effects or insufficient relief of symptoms.
The planned duration of the study was 20 years. However, as the WHI data--which came out in 2002 around the time of the 10-year visit--indicated that use of HRT might result in more harm than benefit, the participants were advised to stop treatment. But they were followed for death, cardiovascular disease, and cancer for up to 16 years.
After 10 years of intervention, there was a 52% reduction in the primary composite end point of death, MI, or heart failure, and this was not associated with an increase in any cancer. Schierbeck said numbers were too small to draw any meaningful conclusions on venous thromboembolism (VTE), although she acknowledges that HRT is known to increase the risk of VTE but pointed out, "This is a less serious event than a CV event."
After 16 years, the reduction in the primary composite outcome was still present and still not associated with an increase in any cancer, something both Schierbeck and Hodis say is "reassuring," particularly in terms of breast cancer.
Results After 10 Years of Intervention in Danish Osteoporosis Prevention Study
End pointHRT group (n=502), nControl group (n=504), nHazard ratio95% CIp
Primarya16330.480.26– 0.870.015
Mortality15260.570.30–1.080.084
Cancer36390.920.58–1.450.71
Breast cancer10170.580.27–1.270.17
DVT212.010.18– 22.16--b
Stroke11140.770.35–1.700.70
a. Composite end point of death, MI, or heart failure
b. Numbers too low to calculate p
Emotion Has Overtaken the Evidence in Discussions About HRT
Hodis says emotion has long overtaken reason in the HRT debate. "We have had observational studies for the past 50 years in this field, at least 40 of them, and they are all consistent--and you just don't see that in medicine--across two very important outcomes: they reduced cardiovascular disease and they reduced mortality" in women around the time of menopause, he asserts. "But when WHI was conducted, it was done in women who were 12 years or more past menopause. These are two completely different populations of women.
"In all of the emotions after WHI, that 'hormones are killing women'--which is absolutely ridiculous--nobody sat back and said, 'Where is the evidence to support that?' The guidance that unfortunately came out of the results of WHI was 'lowest dose for shortest period of time possible.' Now what we have is a well-conducted, 10-year randomized trial that clearly shows that short-term usage of these products is not going to derive maximum benefits for women."
And other "important" data have come out recently in support of HRT, he notes, including the KEEPS study, reported just last week. "This was the largest trial ever done to assess mood, and it showed positive effects in terms of anxiety, depression, and tension, and no adverse effects."
Schierbeck says: "It is a shame that so many women are anxious about HRT, because it's so important for life quality around the time of menopause." She agrees the current mantra seems to be that if a woman wants to use HRT to "go with the lowest dose for the shortest time," but she hopes that this study will have a major impact and influence international societies working on new guidelines.
Asked what she thinks the optimal duration of HRT should be, she said: "I don't think we can set a time limit on it. At least for 10 years, we didn't find any serious side effects."
Hodis says he does not believe there will be a seismic shift in recommendations, because doctors and women have lived in fear of HRT for so long, but "people will look at this and say we can feel comfortable going longer with therapy." Personally, he says, "I'm neither a proponent nor an opponent of HRT: I use these products in women, with or without symptoms, who want to be put on them, with caveats--for example, not if they have had blood clots. They do have risks, but they are so low, and certainly no higher than many other drugs we use."
Where Next? HRT and Chronic Disease Prevention
Hodis also believes there is a role for HRT in chronic disease prevention. "The data strongly indicate that hormones are an excellent prevention for chronic diseases, including bone fractures and heart disease." And although the reduction in deaths in the Danish study was not significant, Hodis says the totality of evidence points to HRT adding "almost two years" to the life of a woman, with the additional benefit that hormones "are cost-effective, coming in at around $2300 per quality-adjusted life-year [QALY]. There's nothing else in women that does that. Statins do not extend life and they cost $50 000 $100 000 per QALY."
But not everyone agrees. KEEPS and WHI trialist Dr JoAnn E Manson (Brigham and Women's Hospital, Boston, MA) maintained last week that HRT should be used only for the treatment of menopausal symptoms.
"We certainly would not say at this point in time to initiate hormone therapy for the express purpose of trying to prevent heart disease or cognitive decline; the evidence is not to that point," she said in an interview. "But for women who have menopausal symptoms and who are considering HRT to reduce their symptoms and improve their quality of life related to these symptoms, there were many favorable effects seen of taking HRT for four years."
Differences in Doses of Hormones, Medication Schedules
Liu says there are also some limitations to the Danish study that are pointed out by the authors, but others that are not. The latter include the fact that the medication used was lower dose than the 0.625-mg conjugated equine estrogen traditionally used [in the US] and in the WHI, although "there are some who may state that the 2-mg estradiol dose is similar," he observes. And the progestin used is different.
In addition, the type of dosing is different: "The Danish study used cycle estrogen and progestin in a 28-day dose-pack form, and the pattern of estrogen-progestin administration is somewhat unique in that the last six days used a lower estradiol dose of 1 mg.  Thus, the estrogen exposure is not uniform across the 28 days. This dose is also different from women with hysterectomy who received 2-mg estradiol continuously. This contrasts with WHI, which used continuous combined estrogen/progestin daily for those women with a uterus."
And the data end points for the Danish study--due to its small size--are combined for women on estrogen alone (due to hysterectomy) and cyclic estrogen-progestin. "This analyses is different from the WHI approach, where there were two separate studies (those with a uterus were in a separate study from those with a hysterectomy) with larger cohort sizes."
But on a more positive note, he points out: "Follow-up in the Danish study is longer than the WHI on a trial and post trial surveillance basis."
Schierbeck reports no conflicts of interest; disclosures for the coauthors are listed in the paper. Hodis and Manson report no conflicts of interest.
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Review Have we learned from lessons of the past? A systematic review of training for single incision laparoscopic surgery



Surgical Endoscopy


Abstract

Introduction  

Single incision laparoscopic surgery (SILS) represents the next step in laparoscopic surgery in further reducing the invasiveness of surgical procedures with cosmetic advantages. Recalling the increased rates of major complications at the advent of laparoscopic cholecystectomy 20 years ago, however, it is clear that appropriate training is required before adopting a new technique. This study aims to review the current evidence for training and skills acquisition for SILS.

Methods  

A comprehensive database search of PubMED, MEDLINE, EMBASE and Google Scholar was carried out. Studies considered for inclusion were those addressing SILS learning curves, skills acquisition, or training.

Results  

21 studies were included in the final analysis. Ten clinical case series with analysis of SILS learning curve demonstrated a significant learning curve for conventional multiport laparoscopic (LAP)-trained surgeons over the course of initial SILS cases, with several studies reporting increased risk of conversion and complication rates. Five laboratory-based studies demonstrated differences in SILS skills acquisition compared with LAP. Six studies describing SILS-specific training curricula were analysed, but none included a robust validation of the curriculum.

Conclusions  

Clinical case series and laboratory-based skills acquisition studies demonstrate the unique requirements of SILS, with skill sets and ergonomic demands which cannot be directly adapted from existing LAP experience. Some studies have already reported higher complication rates in initial SILS cases. To avoid repeating the mistakes of the past, the implementation of an evidence- and competency-based SILS curriculum is necessary to ensure appropriate training of future SILS surgeons.
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Doc, Ever Heard of Lynch Syndrome? animated short video



Doc, Ever Heard of Lynch Syndrome?
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Saturday, October 20, 2012

Repeating tests: different roles in research studies and clinical medicine, Biomarkers in Medicine, Future Medicine



Repeating tests: different roles in research studies and clinical medicine, Biomarkers in Medicine, Future Medicine

"Researchers often decide whether to average multiple results in order to produce more precise data, and clinicians often decide whether to repeat a laboratory test in order to confirm its validity or to follow a trend. Some of the major sources of variation in laboratory tests (analytical imprecision, within-subject biological variation and between-subject variation) and the effects of averaging multiple results from the same sample or from the same person over time are discussed quantitatively in this article. This analysis leads to the surprising conclusion that the strategy of averaging multiple results is only necessary and effective in a limited range of research studies. In clinical practice, it may be important to repeat a test in order to eliminate the possibility of a rare type of error that has nothing to do analytical imprecision or within-subject variation, and for this reason, paradoxically, it may be most important to repeat tests with the highest sensitivity and/or specificity (i.e., ones that are critical for clinical decision-making)."
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The changing face of tumor phenotypes, Biomarkers in Medicine, Future Medicine



The changing face of tumor phenotypes, Biomarkers in Medicine, Future Medicine
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Transfer of Carboplatin and Paclitaxel into Breast Milk



Transfer of Carboplatin and Paclitaxel into Breast Milk

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Serous and mucinous epithelial ovarian tumors--a clinicopathologic study of 116 cases




Serous and mucinous epithelial ovarian tumors--a clinicopathologic study of 116 cases


CONCLUSIONS:

Of great interest in our research was to identify ovarian borderline tumours, still representing a controversial group, in the same time corresponding with a scientiphic progress. Because the spectrum of epithelial tumors is very large, extensive sampling is essential to carry out all these important determinations, because benign, borderline and malignant patterns can be found in the same tumor.
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Friday, October 19, 2012

UPDATE: Vermillion Repays Quest $5.9M, Ending Companies' Credit Agreement (OVA1/OVA2)



UPDATE: Vermillion Repays Quest $5.9M, Ending Companies' Credit Agreement | ProteoMonitor | Proteomics | GenomeWeb

"... Vermillion had been developing OVA2 in collaboration with Zhen Zhang, a professor at Johns Hopkins University, and Daniel Chan, professor and director of the university's Biomarker Discovery Center. The company aimed to identify new biomarkers that could enhance the overall positive predictive value and specificity of the OVA1 ovarian cancer panel, potentially allowing it to move into broader fields of use such as screening of symptomatic and at-risk women...."
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When health insurance falls short in Canada-media



When health insurance falls short in Canada
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Do Vitamins Prevent Cancer? The Answer Will Give You Whiplash - Forbes



Do Vitamins Prevent Cancer? The Answer Will Give You Whiplash - Forbes
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In the jungle of the miracle healers - Cancer World



http://www.cancerworld.org/Articles/Issues_50/Best_Cancer_Reporter_Award/In_the_jungle_of_the_miracle_healers.html


Sent from my iPhone
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Thursday, October 18, 2012

Journal of Clinical Oncology Update on Progress in Cancer Survivorship Care and Research



Journal of Clinical Oncology Update on Progress in Cancer Survivorship Care and Research
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Surgery: never too old to be treated : The Lancet



Surgery: never too old to be treated : The Lancet


The Lancet
Is 80 the new 50? It should be, according to Access all ages: assessing the impact of age on access to surgical treatment, a new report from the Royal College of Surgeons of England and Age UK. By examining access to common surgical interventions for older people in the UK, the report shows that otherwise healthy people are being denied timely surgical treatments because of assumptions made about their health and fitness....
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open access: Second Malignant Neoplasms: Assessment and Strategies for Risk Reduction



Second Malignant Neoplasms: Assessment and Strategies for Risk Reduction

Navigate This Article

  1. Top
  2. Abstract
  3. INTRODUCTION
  4. SECOND MALIGNANCIES IN SURVIVORS OF ADULT-ONSET CANCER
  5. SECOND MALIGNANCIES DUE LARGELY TO ANTECEDENT CANCER THERAPY
  6. SHARED ETIOLOGIC FACTORS INCLUDING ENVIRONMENTAL AND LIFESTYLE INFLUENCES
  7. INTERACTIONS AMONG FACTORS
  8. PROPOSED RISK REDUCTION STRATEGIES
  9. SCREENING
  10. PREVENTION
  11. CHEMOPREVENTION
  12. COORDINATION AND ACCESS TO CARE
  13. RESEARCH OPPORTUNITIES AND FUTURE DIRECTIONS
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Journal of Clinical Oncology Update on Progress in Cancer Survivorship Care and Research



Journal of Clinical Oncology Update on Progress in Cancer Survivorship Care and Research
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Impact of colonoscopic screening in male and female Lynch syndrome carriers with an MSH2 mutation - Nov 15th - Clinical Genetics



Impact of colonoscopic screening in male and female Lynch syndrome carriers with an MSH2 mutation  Clinical Genetics 

 The lifetime risk of developing colorectal cancer (CRC) in Lynch syndrome (LS) carriers is very high. To determine the impact of colonoscopic screening in 54 male and 98 female MSH2 mutation carriers, outcomes were compared with 94 males and 76 females who were not screened. CRC incidence and survival in the screened group were compared to that expected, derived from the non-screened group. To correct for survivor bias, controls were matched for age at entry into screening and also for gender. In males, median age to CRC was 58 years, whereas expected was 47 years (p = 0.000), and median survival was 66 years vs 62 years (p = 0.034). In screened females, median age to CRC was 79 years compared to 57 years in the non-screened group (p = 0.000), and median survival was 80 years compared with expected of 63 years (p = 0.001). Twenty percent of males and 7% of females developed an interval CRC within 2 years of previous colonoscopy. Although colonoscopic screening was associated with decreased CRC risk and better survival, CRCs continued to occur. CRC development may be further reduced by decreasing the screening interval to 1 year and improving quality of colonoscopy.
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Letter: Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma (of interest to Lynch Syndrome/MSH2 mutation carriers)



Re: Evanguelos Xylinas, Michael Rink, Eugene K. Cha, et al. Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol.

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Myriad Publishes Data on HRD Test to Detect Response to Platinum-Based Therapy, PARP Inhibitors | GenomeWeb



Myriad Publishes Data on HRD Test to Detect Response to Platinum-Based Therapy, PARP Inhibitors | GenomeWeb

 Researchers from Myriad Genetics, the Royal College of Surgeons, and elsewhere have published data showing that the company's homologous recombination deficiency assay can gauge whether ovarian tumor cells have impaired ability to repair DNA function that cancer cells need to survive.....
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Gynecologic Oncology Case Reports - Prolonged response of relapsed high grade serous ovarian carcinoma to the oral angiokinase inhibitor nintedanib in a patient with a germline BRCA1 mutation



Gynecologic Oncology Case Reports - Prolonged response of relapsed high grade serous ovarian carcinoma to the oral angiokinase inhibitor nintedanib in a patient with a germline BRCA1 mutation

Highlights

► Nintedanib is an anti-angiogenic agent that has demonstrated activity in relapsed ovarian cancer
► Our patient had prolonged response to nintedanib, allowing her to have potentially curative surgery six years after her diagnosis
► The relationship between angiogenesis and BRCA mutation is worth exploring in ovarian cancer
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PLOS ONE: Measurement of Phospholipids May Improve Diagnostic Accuracy in Ovarian Cancer



Note: see tables included in this open text publication for cell types, stages.....

PLOS ONE: Measurement of Phospholipids May Improve Diagnostic Accuracy in Ovarian Cancer

Background

More than two-thirds of women who undergo surgery for suspected ovarian neoplasm do not have cancer. Our previous results suggest phospholipids as potential biomarkers of ovarian cancer. In this study, we measured the serum levels of multiple phospholipids among women undergoing surgery for suspected ovarian cancer to identify biomarkers that better predict whether an ovarian mass is malignant......
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Takotsubo cardiomyopathy - Wikipedia, the free encyclopedia



Takotsubo cardiomyopathy - Wikipedia, the free encyclopedia

Takotsubo cardiomyopathy, also known as transient apical ballooning syndrome,[1] apical ballooning cardiomyopathy,[2] stress-induced cardiomyopathy, Gebrochenes-Herz-Syndrome, and stress cardiomyopathy is a type of non-ischaemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, a break-up, or constant anxiety, the condition is also known as broken heart syndrome.[3] Stress cardiomyopathy is a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.[4].......
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Gynecologic Oncology Case Reports - Takotsubo Cardiomyopathy Following Laparoscopic Port Placement in a Patient with Ovarian Cancer



Gynecologic Oncology Case Reports - Takotsubo Cardiomyopathy Following Laparoscopic Port Placement in a Patient with Ovarian Cancer

Highlights

► Gynecologic oncology patients can be exposed to both chronic and acute physical and emotional stress.
► Gynecologic oncology patients appear to represent an at-risk population for the development of Takotsubo's cardiomyopathy.
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