Monday, October 29, 2012
About That Finding… | The Daily Scan | GenomeWeb
About That Finding… | The Daily Scan | GenomeWeb
"Medical studies that show large effects often don't hold up under further scrutiny, a new paper published in the Journal of the American Medical Association says. Stanford University's John Ioannidis and his colleagues analyzed clinical trial data from the Cochrane Database of Systematic Reviews and found that "when additional evidence is obtained, most of the very large treatment effects become much smaller and many lose their nominal significance," the authors write.
Ioannidis and his colleagues add that while there are some truly large, well-established effect sizes seen in medical studies, they are quite rare and don't usually affect mortality.....
State of Ignorance | The Daily Scan | GenomeWeb (eg. Lynch Syndrome)
State of Ignorance | The Daily Scan | GenomeWeb
State of Ignorance
October 26, 2012
Take Lynch syndrome, an inherited cancer disorder known since the mid 1990s to be caused by a set of distinct genetic mutations. Bloomberg's Robert Langreth and John Lauerman write that Lynch testing, from companies such as Myriad and Ambry Genetics, currently "costs as little as $300. Still, only about 50,000 people have been diagnosed with the disease of 800,000 afflicted with it."
"As scientists predict DNA testing will transform medicine, doctors and hospitals are ignoring existing tests that could help prevent thousands of cancer deaths, not just of their own patients, but in generations to come," they say.
An early Lynch diagnosis allows patients and their doctors to start close monitoring to prevent future cancers.
Langreth and Lauerman tell the stories of several Lynch patients, highlighting the impact that missing out on a genetic diagnosis of the syndrome has had on themselves and their families.
Of one family, they write, "Carroll survived because she had a less aggressive tumor that was caught and treated promptly. Her cousin, Deborah Raboin, wasn't as lucky … It wasn't until after Raboin died in 2006 and her father developed intestinal cancer that he was finally tested for Lynch syndrome … Carroll's two nieces, the daughters of Carroll's sister who died of ovarian cancer, have been screened and found to have Lynch syndrome genes."
According to Langreth and Lauerman, though awareness of disorders like Lynch (Lynch Syndrome) and their associated genetic tests is growing, lingering low rates of testing represent a failure; one that "shows how hard it is to bring the benefits of the genome to patients."
Sunday, October 28, 2012
open access: World J Surgery - (Lynch Syndrome patients) The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database
Conclusion
The implementation of diagnostic ureteroscopy increases
the time leading to RNU without signiWcantly altering cancer-
speciWc, recurrence-free or metastasis-free survival,
even for MI lesions. Our data and the current guidelines
indicate that diagnostic ureteroscopy can be performed systematically
for the appraisal of UTUC to reWne the therapeutic
strategy without aVecting oncological outcomes.
open access: Interrelationship between microsatellite instability and microRNA in gastrointestinal cancer
Interrelationship between microsatellite instability and microRNA in gastrointestinal cancer
Abstract
There is an increasing understanding of the roles that microsatellite instability (MSI) plays in Lynch syndrome (by mutations) and sporadic (by mainly epigenetic changes) gastrointestinal (GI) and other cancers. Deficient DNA mismatch repair (MMR) results in the strong mutator phenotype known as MSI, which is the hallmark of cancers arising within Lynch syndrome. MSI is characterized by length alterations within simple repeated sequences called microsatellites. Lynch syndrome occurs primarily because of germline mutations in one of the MMR genes, mainly MLH1 or MSH2, less frequently MSH6, and rarely PMS2. MSI is also observed in about 15% of sporadic colorectal, gastric, and endometrial cancers and in lower frequencies in a minority of other cancers where it is often associated with the hypermethylation of the MLH1 gene. miRNAs are small noncoding RNAs that regulate gene expression at the posttranscriptional level and are critical in many biological processes and cellular pathways....open access: Associations between BRCA Mutations in High-Risk Breast Cancer Patients and Familial Cancers Other than Breast or Ovary
Associations between BRCA Mutations in High-Risk Breast Cancer Patients and Familial Cancers Other than Breast or Ovary
Conclusion
BRCA
mutations in high-risk breast cancer patients were associated with
multiple risk factors and multiple family members with other primary
cancers. Genetic counseling based on accurate information should be
provided to families with BRCA mutation carriers.
Long-term disease-free survival in thre... [Eur J Gynaecol Oncol. 2012] - PubMed - NCBI
Long-term disease-free survival in three ovarian cancer patients with a single relapse.
Abstract
Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.open access: Immunohistochemical Expression of Platelet-Derived Growth Factor Receptors in Ovarian Cancer Patients with Long-Term Follow-Up
Immunohistochemical Expression of Platelet-Derived Growth Factor Receptors in Ovarian Cancer Patients with Long-Term Follow-Up
"....In conclusion, the frequent expression of PDGF-receptors in ovarian carcinomas that has been found in the present study gives reason to believe, as suggested by previous studies, that the PDGF system plays a role in ovarian cancer. We found that co-expression of PDGFR-α and PDGFR-β in stromal cells was seen more often in serous adenocarcinomas than in non-serous adenocarcinomas. Although PDGFR-α or PDGFR-β did not show significant prognostic value as single markers in this material with long-term followup, the findings invite further studies exploring biological and clinical aspects of the PDGF system in ovarian cancer."
protocol (Canada) How do surgeons decide to refer patients for adjuvant cancer treatment? Protocol for a qualitative study.
How do surgeons decide to refer patients for adjuvant cancer treatment? Protocol for a qualitative study.
Abstract
ABSTRACT:
BACKGROUND: Non-small cell lung cancer, breast cancer, and colorectal cancer are commonly diagnosed cancers in Canada. Patients diagnosed with early-stage non-small cell lung, breast, or colorectal cancer represent potentially curable populations. For these patients, surgery is the primary mode of treatment, with (neo)adjuvant therapies (e.g., chemotherapy, radiotherapy) recommended according to disease stage. Data from our research in Nova Scotia, as well as others', demonstrate that a substantial proportion of non-small cell lung cancer and colorectal cancer patients, for whom practice guidelines recommend (neo)adjuvant therapy, are not referred for an oncologist consultation. Conversely, surveillance data and clinical experience suggest that breast cancer patients have much higher referral rates. Since surgery is the primary treatment, the surgeon plays a major role in referring patients to oncologists. Thus, an improved understanding of how surgeons make decisions related to oncology services is important to developing strategies to optimize referral rates. Few studies have examined decision making for (neo)adjuvant therapy from the perspective of the cancer surgeon. This study will use qualitative methods to examine decision-making processes related to referral to oncology services for individuals diagnosed with potentially curable non-small cell lung, breast, or colorectal cancer.METHODS:
A qualitative study will be conducted, guided by the principles of grounded theory. The study design is informed by our ongoing research, as well as a model of access to health services. The method of data collection will be in-depth, semi structured interviews. We will attempt to recruit all lung, breast, and/or colorectal cancer surgeons in Nova Scotia (n [almost equal to] 42), with the aim of interviewing a minimum of 34 surgeons. Interviews will be audiotaped and transcribed verbatim. Data will be collected and analyzed concurrently, with two investigators independently coding and analyzing the data. Analysis will involve an inductive, grounded approach using constant comparative analysis.DISCUSSION:
The primary outcomes will be (1) identification of the patient, surgeon, institutional, and health-system factors that influence surgeons' decisions to refer non-small cell lung, breast, and colorectal cancer patients to oncology services when consideration for (neo)adjuvant therapy is recommended and (2) identification of potential strategies that could optimize referral to oncology for appropriate individuals.The incidence of pancreatic cancer in BRCA1 and BRCA2 mutation carriers : British Journal of Cancer
Access : The incidence of pancreatic cancer in BRCA1 and BRCA2 mutation carriers : British Journal of Cancer
Abstract
Background:
Germline
mutations in BRCA1 and BRCA2 predispose to pancreatic cancer. We
estimated the incidence of pancreatic cancer in a cohort of female
carriers of BRCA1 and BRCA2 mutation. We also estimated survival rates
in pancreatic cancer cases from families with a BRCA mutation.
Methods:
We
followed 5149 women with a mutation for new cases of pancreatic cancer.
The standardised incidence ratios (SIR) for pancreatic cancer were
calculated based on age group and country of residence. We also reviewed
the pedigrees of 8140 pedigrees with a BRCA1 or a BRCA2 mutation for
those with a case of pancreatic cancer. We recorded the year of
diagnosis and the year of death for 351 identified cases.
Results:
Eight incident pancreatic cancer cases were identified among all mutation carriers. The SIR for BRCA1 carriers was 2.55 (95% CI=1.03–5.31, P=0.04) and for BRCA2 carriers was 2.13 (95% CI=0.36–7.03, P=0.3). The 5-year survival rate was 5% for cases from a BRCA1 family and 4% for cases from a BRCA2 family.
Conclusion:
The
risk of pancreatic cancer is approximately doubled in female BRCA
carriers. The poor survival in familial pancreatic cancer underscores
the need for novel anti-tumoural strategies.
Predicting PARP inhibitor sensitivity and resistance
Predicting PARP inhibitor sensitivity and resistance: Comment on: Oplustilova L, et al. Cell Cycle 2012; 11:3837-50.
"The concept of precision therapy in cancer implies an ability to customize treatment according to the molecular makeup of the patient and the tumor. While many pharmaceutical agents are described as targeted therapies, their precise role in cancer treatment is unclear. Often the new drug’s target is well-described, but the precise indication of when it should be used (i.e., a prospectively validated predictive marker) is often not defined. PARP inhibitors exemplify this paradigm well............
Cancer Doc Attacked - German Herald English Online
Cancer Doc Attacked - Germany in Focus News - German Herald English Online Newspaper
A world-leading ovarian cancer specialist was beaten senseless by relatives of a woman undergoing treatment in his clinic, police in Berlin, Germany, have revealed.
Professor Jalid Sehouli - now recovering from serious injuries in his hospital's casualty ward - was attacked when two men burst into his office at the Clinic for Gynaecology in the city's Charité Hospital on Tuesday afternoon.
A colleague who rushed to help was also attacked, say police.........
Asian and Hispanic Cancer Survivors Reported Poorer Follow-up Care Communication With Providers « AACR News
Asian and Hispanic Cancer Survivors Reported Poorer Follow-up Care Communication With Providers « AACR News
- In adjusted analyses, findings persisted for Asian survivors only.
- Poor communication may contribute to poor ratings for follow-up care.
Black Patients Received Less Clinical Trial Information Than White Patients « AACR News
Black Patients Received Less Clinical Trial Information Than White Patients « AACR News
- Discussions of cancer clinical trials with black patients were shorter in length.
- These data may explain under-enrollment of black patients in cancer clinical trials.
(2008) Playlist: Ovarian Cancer Symposium | Memorial Sloan-Kettering Cancer Center
Playlist: Ovarian Cancer Symposium | Memorial Sloan-Kettering Cancer Center
Expert physicians from Memorial Sloan-Kettering Cancer Center describe recent advances in treatment and research.
Wednesday, October 24, 2012
open access: Significance of lymphovascular space invasion in epithelial ovarian cancer - Cancer Medicine
Significance of lymphovascular space invasion in epithelial ovarian cancer - 2012 - Cancer Medicine
"While the prognostic significance of lymphovascular space invasion (LVSI) is well established in endometrial and cervical cancer, its role in ovarian cancer is not fully understood.....
Robot assisted surgery in gynaecologic oncology - starting a program and initial learning curve from a UK tertiary referral centre: the Guildford perspective.
Robot assisted surgery in gynaecologic oncology - starting a program and initial learning curve from a UK tertiary referral centre: the Guildford perspective.
Abstract
BACKGROUND: The
paper discusses the setup and evaluation of early data following the
establishment of a robotic surgery programme in a UK gynaecological
oncology cancer centre.
METHODS: Prospective
data were collected between December 2009 and December 2011 for all
women undergoing robotic assisted procedures within the gynaecological
oncology department. Patient demographics, intra, peri and
post-operative data were collected at a single institution, which is a
tertiary referral centre for gynaecological oncology and minimal access
surgery.
RESULTS: In
total, 104 robotically assisted cases were performed within the
gynaecological oncology team. The procedures undertaken included simple
and radical hysterectomy, radical trachelectomy, BSO following previous
hysterectomy, pelvic and para-aortic node dissection and omentectomy.
The mean blood loss was 155.24 mL and the mean hospital stay was 3 days
with more than half the women being discharged on day 1 post surgery.
CONCLUSIONS: These
data suggest that robotic assisted surgery is well suited to treating
women with principally endometrial and cervical cancers and selected
cases of ovarian cancer, enabling surgical staging to be completed with
many more patients benefitting from a minimal access surgery approach.
Thorough preparation, appropriate case selection and preceptorship in
robotic surgery is essential to minimize the associated risks associated
with adopting new surgical techniques.
Blood Test With Potential to Detect Stage One Cancer: Soricimed Biopharma Inc. Announces Initiation of Cancer Diagnostic Study - press release
Blood Test With Potential to Detect Stage One Cancer: Soricimed Biopharma Inc. Announces Initiation of Cancer Diagnostic Study
"Half the battle with cancer is being able to detect it early enough to save lives", stated Elisabeth Ross, Chief Executive Officer, Ovarian Cancer Canada. "In the case of ovarian cancer, there are no early symptoms and currently no screening tests available so it's not usually detected until Stage Three or Four........"
" Soricimed Biopharma Inc., a private clinical stage company developing novel cancer therapeutics and diagnostics, announced that a pre-regulatory study of their blood test for early detection of cancer has commenced.
Soricimed developed their blood test to detect the presence of TRPV6
messenger RNA, a biomarker identified as being present in many
epithelially derived cancers. The test has been shown to detect a
host of cancers, including ovarian, breast and prostate, at their
earliest stages......
Metachronous double primary cancer after diagnosis of gastric cancer.
Metachronous double primary cancer after diagnosis of gastric cancer.
Abstract
PURPOSE:
The pattern of double primary cancers after treatment for gastric cancer is important for a patient's survival.
MATERIALS AND METHODS:
We analyzed the clinicopathologic data of 214 gastric cancer
patients from October 1996 to November 2007 with regard to metachronous
second primary cancers.
RESULTS:
Out of 5,778 patients with gastric cancer, metachronous
second primary cancers occurred in 214 patients. The median age was 61.8
years, the number of male and female patients was 140 (65.4%), 74
(34.6%), respectively. The median time to the occurrence of second
cancers after diagnosis of the first was 39.2 months (standard
deviation, 31.2 months). The most common cancer was colorectal cancer,
which occurred in 44 patients (20.6%), and lung cancer in 33 patients
(15.4%), hepatocellular carcinoma in 26 patients (12.1%), ovarian cancer
in 15 patients (7.0%), cervical cancer in 12 patients (7.0%), breast
cancer in 11 patients (5.1%), and esophageal cancer in 11 patients
(5.1%). The observed/expected (O/E) ratio showed a significant increase
in colorectal (1.25), male biliary (1.60), ovarian (8.72), and cervical
cancer (3.33) with primary gastric cancer. After five years from
diagnosis of gastric cancer, secondary cancer occurred in 50 patients
(23.4%), and breast cancer, prostate cancer, laryngeal cancer, lung
cancer, and hepatocellular carcinoma were the most frequent.
CONCLUSION:
The O/E ratio showed a significant increase in colorectal,
male biliary, ovarian, and cervical cancer with primary gastric cancer,
and second primary cancer as the main cause of death for these patients.
A follow-up examination for metachronous double primary cancer is
needed in order to improve the survival time in patients with gastric
cancer.
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