Lynch Syndrome - GeneReviews™ - NCBI Bookshelf
Sunday, January 27, 2013
open access: Lynch Syndrome - GeneReviews™ - NCBI Bookshelf
Lynch Syndrome - GeneReviews™ - NCBI Bookshelf
Significance of Ureteroscopic Biopsy Grade in Patients with Upper Tract Urothelial Carcinoma (Lynch Syndrome patients)
Significance of Ureteroscopic Biopsy Grade in Patients with Upper Tract Urothelial Carcinoma
Abstract
Background: The objective of this study was to assess the significance of the ureteroscopic biopsy grade for patients with upper tract urothelial carcinoma (UTUC).
Patients and Methods: This study included 40 patients who were diagnosed with a single focus of UTUC by ureteroscopic biopsy and subsequently underwent nephroureterectomy. The significance of the biopsy grade as a predictive factor for pathological outcomes of nephroureterectomy was retrospectively analyzed.
Results: Of these 40 patients, 19 (47.5%) and 21 (52.5%) were diagnosed with low and high grade UTUC, respectively. The ureteroscopic biopsy grade matched the pathological grade of surgically resected specimens in 35 of the 40 cases (87.5%), and there was a significant correlation between the biopsy and pathological grades (p < 0.001). Furthermore, the biopsy grade was also shown to be closely associated with the pathological stage (p < 0.001); that is, only 1 of the 19 patients (5.3%) with biopsy low grade UTUC were pathologically diagnosed as having muscle invasive disease, while 17 of the 21 patients (81.0%) with biopsy high grade UTUC appeared to show tumor invasion into muscle or deeper.
Conclusions: The grade of UTUC on ureteroscopic biopsy could provide accurate diagnostic information on the final pathology of nephroureterectomy specimens.
Gynecologic Oncology Case Reports - Topotecan-induced Sweet's syndrome: A case report
Gynecologic Oncology Case Reports - Topotecan-induced Sweet's syndrome: A case report
Case
Patient is a 37-year old, gravida 3, para 2 with a history of previously treated melanoma who was undergoing treatment with topotecan chemotherapy for recurrent stage IIIc low-malignant potential neoplasm of the ovary.....CD47 - Research and Clinical Trials - Institute for Stem Cell Biology and Regenerative Medicine (ISCBRM) - Stanford Medicine
CD47 - Research and Clinical Trials - Institute for Stem Cell Biology and Regenerative Medicine (ISCBRM) - Stanford Medicine
"...For the last year, many people have been working to make clinical trials possible. We are now hopeful that the first human clinical trials of anti-CD47 antibody will take place at Stanford in mid-2014, if all goes well. Clinical trials may also be done in the United Kingdom.
As we get closer to clinical trials, we will start posting information about enrollments on this page."
open access - Gynecologic Oncology Case Reports - Metastatic ovarian papillary serous carcinoma to the breast: Diagnosis and pitfalls
Gynecologic Oncology Case Reports - Metastatic ovarian papillary serous carcinoma to the breast: Diagnosis and pitfalls
Introduction
Breast
metastases from ovarian carcinoma (OC) have scarcely been reported.
Morphologic and radiographic similarities between primary breast cancers
(BC), and high grade papillary serous (PS) OC make distinguishing
between the two diagnoses challenging, yet carry important consequences
for treatment and prognosis. Herein, we describe a patient with a
metastatic OC presenting with a palpable breast mass and discuss the
utility of immunohistochemistry for distinguishing between OC and BC.
Summary
Although
relatively uncommon, metastatic tumors to the breast should be
appreciated so that a secondary malignancy from rare sites (e.g.,
ovary), is not overlooked. Accurate diagnosis of these metastases is
important because the prognosis and therapies differ dramatically. While
the clinical history and morphology can help distinguish between
primary and metastatic BC, immunohistochemistry is essential when the
diagnosis is still vague. PAX8 seems to be important in differentiating
OC from BC. We recommend evaluating PAX8 immunohistochemistry when
metastatic OC is suspected.
paywalled - Robotic surgery – Advance or gimmick?
Robotic surgery – Advance or gimmick?
Best Practice & Research Clinical Obstetrics & Gynaecology
Abstract
Robotic surgery is increasingly implemented as a minimally invasive approach to a variety of gynaecological procedures. The use of conventional laparoscopy by a broad range of surgeons, especially in complex procedures, is hampered by several drawbacks. Robotic surgery was created with the aim of overcoming some of the limitations. Although robotic surgery has many advantages, it is also associated with clear disadvantages. At present, the proof of superiority over access by laparotomy or laparoscopy through large randomised- controlled trials is still lacking. Until results of such trials are present, a firm conclusion about the usefulness of robotic surgery cannot be drawn. Robotic surgery is promising, making the advantages of minimally invasive surgery potentially available to a large number of surgeons and patients in the future.
Saturday, January 26, 2013
The Role of Palliative Surgery in Gynecologic Cancer Cases
Blogger's Note: the Oncologist is a subscriber based journal
The Role of Palliative Surgery in Gynecologic Cancer Cases
Abstract:
"The decision to undergo major palliative surgery in end-stage gynecologic cancer is made when severe disease symptoms significantly hinder quality of life. Malignant bowel obstruction, unremitting pelvic pain, fistula formation, tumor necrosis, pelvic sepsis, and chronic hemorrhage are among the reasons patients undergo palliative surgeries. This review discusses and summarizes the literature on surgical management of malignant bowel obstruction and palliative pelvic exenteration in gynecologic oncology"
CME Learning Objectives
-
Describe the range of palliative procedures utilized in gynecologic cancers.
-
Evaluate the indications for palliative bowel surgery in ovarian cancer.
-
Assess the clinical scenario for which palliative pelvic exenteration would be considered.
-
Compare the morbidities associated with palliative gynecologic surgeries to the potential benefits gained.
"The decision for palliative intervention in end-stage gynecologic cancers is among the most difficult decisions that a patient, her family, and a gynecological oncologist will face. There is no right or wrong answer. There is no level I data to guide decision making. Two patients, along with their physicians, in identical situations may make opposite and equally valid choices. In select situations, major surgery may enhance the quality of the life remaining for patients with advanced gynecologic cancer. "
paywalled: Blood transfusions and the subsequent risk of cancers in the United States elderly - 2013 - Transfusion
Blood transfusions and the subsequent risk of cancers in the United States elderly
Background
Blood
transfusions are common in older adults and also may modulate the
immune system. However, the impact of transfusion on cancer risk in the
elderly has not been studied.
Study Design and Methods
Cancer
risk after blood transfusion was evaluated in a US population-based
case–control study using 552,951 elderly cases identified from cancer
registries and 100,000 frequency-matched controls. Transfusions received
0 to 12, 13 to 30, and 31 to 48 months before cancer diagnosis or
selection date were identified using Medicare claims. Odds ratios (ORs)
and 95% confidence intervals (CIs) were calculated using logistic
regression models. A Bonferroni correction adjusted for multiple
testing.
Results
Transfusions
received 0 to 12 months before cancer diagnosis and/or selection were
associated with significantly elevated risk of cancer overall (OR, 2.05;
95% CI, 1.95-2.16) and cancer of the stomach; cancer of the colon;
cancer of the liver, kidney, renal pelvis, and/or ureter; lymphoma;
myeloma; and leukemia. No significant associations for cancer overall
were observed for the two earlier intervals. No site was associated with
transfusions received 13 to 30 or 31 to 48 months before diagnosis
and/or selection. Nonetheless, overall cancer risk increased with the
number of transfused periods (p-trend < 0.0001).
Conclusion
Risk
of overall cancer and specific sites was elevated 0 to 12 months after
blood transfusion and associated with multiple transfusions, possibly
due to reverse causation, that is, incipient cancers or cancer
precursors causing anemia.
paywalled: EPCAM deletion carriers constitute a unique subgroup of Lynch syndrome patients.
EPCAM deletion carriers constitute a unique subgroup of Lynch syndrome patients.
Abstract
Lynch syndrome, one of the most common cancer susceptibility syndromes, is caused by germline mutations of genes affecting the mismatch repair proteins MLH1, MSH2, MSH6 or PMS2. Most of these mutations disrupt the open reading frame of the genes involved and, as such, lead to constitutive inactivation of the mutated allele. In a subset of Lynch syndrome patients MSH2 was found to be specifically inactivated in cell lineages exhibiting EPCAM expression. These patients carry deletions of the 3' end of the EPCAM gene, including its polyadenylation signal. Due to concomitant transcriptional read-through of EPCAM, the promoter of MSH2 15 kb further downstream becomes inactivated through hypermethylation. As these 3' EPCAM deletions occur in the germline, this MSH2 promoter methylation ('epimutation') is heritable. Worldwide, numerous EPCAM 3' end deletions that differ in size and location have been detected. The risk of colorectal cancer in carriers of such EPCAM deletions is comparable to that of MSH2 mutation carriers, and is in accordance with a high expression of EPCAM in colorectal cancer stem cells. The risk of endometrial cancer in the entire group of EPCAM deletion carriers is significantly lower than that in MSH2 mutation carriers, but the actual risk appears to be dependent on the size and location of the EPCAM deletion. These observations may have important implications for the surveillance of EPCAM deletion carriers and, thus, calls for an in-depth assessment of clinically relevant genotype-phenotype correlations and its underlying molecular mechanism(s).paywalled - Analysis of Secondary Cytoreduction for Recurrent Ovarian Cancer by robotics, laparoscopy and laparotomy
Analysis of Secondary Cytoreduction for Recurrent Ovarian Cancer by robotics, laparoscopy and laparotomy
Analysis of Secondary Cytoreduction for Recurrent Ovarian Cancer by robotics, laparoscopy and laparotomy
Objective
Analysis
of perioperative outcomes and survival of patients with recurrent
ovarian cancer undergoing secondary cytoreduction by robotics,
laparoscopy, or laparotomy.
Methods
Retrospective
analysis of 52 selected patients with recurrent ovarian cancer
undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33)
or robotics (10) between January 2006 and December 2010. Comparison was
made by a total of 21 factors including age, BMI, number of previous
surgeries, tumor type and grade, number of procedures, and 15 types of
procedures performed at secondary cytoreduction..
Results
For
all patients, the mean operating time was 213.8 minutes, mean blood
loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was
achieved in 75% of patients. Postoperative complications were noted in
36.5% of patients. Overall and progression-free survival at 3-years were
58.8% and 34.1 %, respectively. Laparoscopy and robotics had reduced
blood loss and hospital stay, while no differences were observed among
the three groups for operating time, complications, complete debulking,
and survival.
Conclusion
Selected
patients with recurrent ovarian cancer benefit from a laparoscopic or
robotic secondary cytoreduction without compromising survival. Robotics
and laparoscopy provide similar perioperative outcomes, and reduced
blood loss and shorter hospital stay as compared to laparotomy.
Laparotomy seems preferable for patients with widespread peritoneal
implants, multiple sites of recurrence, and/or extensive adhesions.
No single quality of life parameter can predict survival across all cancers | EORTC
No single quality of life parameter can predict survival across all cancers | EORTC
"An EORTC study has shown that health related quality of life parameters provide prognostic information regarding the survival of patients with cancer. However, no single health related quality of life scale or single quality of life parameter can predict survival across all cancers, and each cancer site requires careful examination...."
paywalled - "Cautiously Optimistic That Today Will Be Another Day With My Disease Under Control": Understanding Women's Lived Experiences of Ovarian Cancer (Canada)
"Cautiously Optimistic That Today Will Be Another Day With My Disease Under Control": Understanding Women's Lived Experiences of Ovarian Cancer.
Abstract
BACKGROUND:: Women diagnosed with ovarian cancer face a multitude of physical, psychological, and social issues. However, existing research has typically focused on those newly diagnosed with an initial occurrence or recurrence or women with advanced disease. As such, few studies have examined women's experiences across the illness trajectory and the impact of ovarian cancer on their everyday lives.OBJECTIVE:: This research explores women's lived experiences of ovarian cancer and how they negotiate and make sense of illness-related issues.
METHODS:: Sixteen women participated in face-to-face interviews and e-mail follow-ups that were informed by hermeneutic and social phenomenological approaches.
RESULTS:: Five broad themes emerged from data analysis related to changes in health status and the body, disruptions to everyday activities and relationships, uncertainty, and coping and finding meaning in illness. These themes reflect the structures of participants' experiences and constitute the essence of living with ovarian cancer, "cautious optimism."
CONCLUSIONS:: This research contributes to our understanding of women's lived experiences of ovarian cancer across the illness trajectory; specifically, the findings indicate that embodiment and relationships were a central focus for participants as they sought to cope with myriad issues resulting from ovarian cancer.
IMPLICATIONS FOR PRACTICE:: Insight into women's ovarian cancer experiences can help nurses in their provision of care to this population. Furthermore, the findings can inform support interventions for affected women across the illness trajectory, as participants' experiences show that support needs often persist following treatment as women negotiate survivorship or recurrence.
Friday, January 25, 2013
paywalled: Diabetes Mellitus and Ovarian Cancer Risk: A Systematic Review
Objective: The objective of this study was to evaluate
the epidemiologic association between diabetes and risk of ovarian
cancer.
Methods: We searched PubMed, EMBASE, and The Cochrane
Library for observational studies on the association between diabetes
and ovarian cancer. Cohort studies that reported relative risks (RRs)
and case-control studies that showed odds ratios were included in the
analysis. Summary RRs with 95% confidence intervals (CIs) were
calculated with a random-effects model.
Results: A total of 19 studies from 18 articles (7
case-control studies and 11 cohort studies) met the inclusion criteria.
Combining data from all studies, diabetes was associated with an
increased risk of ovarian cancer, compared with no diabetes (summary RR
of ovarian cancer incidence, 1.17; 95% CI, 1.02-1.33). In cohort and
nested case-control studies, patients with diabetes had statistically
significant increased risk of ovarian cancer (RR, 1.16; 95% CI,
1.01-1.33), without significant heterogeneity (I2 = 27; P = 0.172).
Among studies that control for age, body mass index, smoking, and
alcohol, a prominent association between diabetes and ovarian cancer was
found (RR, 1.55; 95% CI, 1.11-2.19).
Conclusions: This study suggests that women with diabetes have a moderately increased risk of ovarian cancer.
paywalled: The Prevalence of Human Papillomavirus in Ovarian Cancer: A... : International Journal of Gynecological Cancer
The Prevalence of Human Papillomavirus in Ovarian Cancer: A... : International Journal of Gynecological Cancer
The Prevalence of Human Papillomavirus in Ovarian Cancer: A Systematic Review
Abstract
Objective: We performed a systematic review and a
meta-analysis to estimate the prevalence of human papillomavirus (HPV)
in ovarian cancer.
Methods: A comprehensive search of the Cochrane Library,
MEDLINE, CANCERLIT, LILACS, Grey literature and EMBASE was performed for
articles published from January 1990 to March 2012. .....
Results: In total, 24 primary studies were included in
this meta-analysis. Studies from 11 countries on 3 continents contained
data on HPV and ovarian cancer, including 889 subjects. Overall, the HPV
prevalence in patients with ovarian cancer was 17.5 (95% confidence
interval [CI], 15.0%-20.0%). Human papillomavirus prevalence ranged from
4.0% (95% CI, 1.7%-6.3%) in Europe to 31.4% (95% CI, 26.9%-35.9%) in
Asia. An aggregate of 4 case-control studies from Asia showed an odds
ratio of 2.48 (95% CI, 0.64-9.57).
Conclusions: We found a high prevalence of HPV-positive
DNA in ovarian cancer cases, but the role of HPV in ovarian cancer
remains inconclusive. Further studies are needed to control case to
answer this question.
paywalled: Does the Diagnosis of Breast or Ovarian Cancer Trigger Referral to Genetic Counseling?
Does the Diagnosis of Breast or Ovarian Cancer Trigger Refer... : International Journal of Gynecological Cancer
Abstract
Objective: Kaiser Permanente Northern California is a
large integrated health care delivery system in the United States that
has guidelines for referring women with newly diagnosed BRCA1-and
BRCA2-associated cancers for genetic counseling. This study assesses
adherence to genetic counseling referral guidelines within this health
system.
Methods: Chart review was performed to identify patients
with cancer who met the following pathology-based Kaiser Permanente
Northern California guidelines for referral for genetic counseling:
invasive breast cancer, younger than age 40; nonmucinous epithelial
ovarian, fallopian tube, or peritoneal cancer, younger than age 60;
women with synchronous or metachronous primary cancers of the breast and
ovaries; and male breast cancer. We assessed compliance with referral
guidelines. An electronic notice was sent to the managing physician of
patients with newly diagnosed cancer to assess the feasibility of this
intervention.
Results: A total of 340 patients were identified with
breast cancer at younger than age 40 or with ovarian, peritoneal, or
tubal cancer between January and June, 2008. Upon chart review, 105 of
these patients met pathology-based criteria for referral to genetic
counseling, of whom 47 (45%) were referred within the 2-year study
period. Of the 67 subjects with breast cancer, 40 subjects (60%) were
referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer
were referred (P < 0.001). A pilot study was performed to test the
feasibility of notifying managing oncologists with an electronic letter
alerting them of eligibility for genetic referral of patients with new
diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of
these 21 patients were referred for counseling including 5 of 7 patients
with a diagnosis of ovarian cancer.
Conclusion: There is a missed opportunity for referring
patients to genetic counseling, especially among patients with ovarian
cancer. A pilot study suggests that alerting treating physicians is a
feasible strategy to increase appropriate referral.
JCO: Need for Estradiol Assays With a Lower Functional Sensitivity in Clinical Studies Examining Postmenopausal Women Treated With Aromatase Inhibitors
1) Need for Estradiol Assays With a Lower Functional Sensitivity in Clinical Studies Examining Postmenopausal Women Treated With Aromatase Inhibitors
2) Author's Reply:
"We are pleased that Pauwels et al1 have drawn readers' attention to the difficulties of measuring low baseline plasma levels of estrogen in postmenopausal women and the extra demands imposed by measurements in patients treated with aromatase inhibitors (AIs)...."
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