Tuesday, February 05, 2013
Person-centred Support for Women After Treatment for Gynaecological Cancer: clinical trial
Gynaecological Department at The University Hospital Rigshospitalet in Copenhagen
Person-centred Support for Women After Treatment for Gynaecological Cancer
Verastem launches ovarian cancer trial (VS-6063) - Boston Business Journal
Verastem launches ovarian cancer trial - Boston Business Journal
Verastem Inc. (Nasdaq: VSTM) has launched an early stage human trial to test its cancer drug candidate in patients with ovarian cancer.
The potential therapy is designed to kill cancer stem cells, which are thought to be key to the spread of the disease. This is the first of three planned trials using drug candidates with the same mechanism, including a planned study in patients with mesothelioma, which is expected to begin mid-year.
The Cambridge, Mass.-based company’s drug candidate, called VS-6063, will be combined with an approved cancer drug, paclitaxel, in Phase 1/1B study, including up to 30 patients with advanced ovarian cancer.
“We believe that cancer stem cells are ultimately responsible for disease progression with ovarian and other cancers,” Verastem Chief Medical Officer Dr. Joanna Horobin said in a statement. “Verastem has advanced the science of targeting cancer stem cells so that we can now clinically evaluate the therapeutic benefit of this approach in the treatment of cancer.”
More information on the trial can be found at clinicaltrials.gov
Gene expression microarray-based assay to determine tumor site of origin in a series of metastatic tumors to the ovary and peritoneal carcinomatosis of suspected gynecologic origin.
Gene expression microarray-based assay to determine tumor site of origin in a series of metastatic tumors to the ovary and peritoneal carcinomatosis of suspected gynecologic origin.
"....A combination of Tissue of Origin-Frozen and immunohistochemistry
correctly identified the site of origin in 19 of 22 ovarian metastases
of known origin. Although conventional pathologic examination and
immunohistochemistry are commonly used for assessing the tumor site of
origin, Tissue of Origin testing can be useful in difficult cases."
Circulating prolactin levels and risk of epithelial ovarian cancer
Circulating prolactin levels and risk of epithelial ovarian cancer
Abstract
PURPOSE:
Indirect evidence from experimental and epidemiological studies suggests that prolactin may be involved in ovarian cancer development. However, the relationship between circulating prolactin levels and risk of ovarian cancer is unknown.METHODS:
We conducted a nested case-control study of 230 cases and 432 individually matched controls within three prospective cohorts to evaluate whether pre-diagnostic circulating prolactin is associated with subsequent risk of ovarian cancer. We also assessed whether lifestyle and reproductive factors are associated with circulating prolactin among controls.RESULTS:
Prolactin levels were significantly lower among post- versus pre-menopausal women, parous versus nulliparous women, and past versus never users of oral contraceptives in our cross-sectional analysis of controls. In our nested case-control study, we observed a non-significant positive association between circulating prolactin and ovarian cancer risk (OR(Q4vsQ1) 1.56, 95 % CI 0.94, 2.63, p trend 0.15). Our findings were similar in multivariate-adjusted models and in the subgroup of women who donated blood ≥5 years prior to diagnosis. We observed a significant positive association between prolactin and risk for the subgroup of women with BMI ≥25 kg/m(2) (OR(Q4vsQ1) 3.10, 95 % CI 1.39, 6.90), but not for women with BMI <25 kg/m(2) (OR(Q4vsQ1) 0.81, 95 % CI 0.40, 1.64).CONCLUSIONS:
Our findings suggest that prolactin may be associated with increased risk of ovarian cancer, particularly in overweight/obese women. Factors associated with reduced risk of ovarian cancer, such as parity and use of oral contraceptives, were associated with lower prolactin levels, which suggests that modulation of prolactin may be a mechanism underlying their association with risk.Agreement for tumor grade of ovarian carcinoma: analysis of archival tissues from the surveillance, epidemiology, and end results residual tissue repository
Agreement for tumor grade of ovarian carcinoma: analysis of archival tissues from the surveillance, epidemiology, and end results residual tissue repository
Abstract
BACKGROUND:
Emerging data suggest that ovarian cancers differ by tumor grade. However, the reliability of microscopic grade from paraffin tissue in the general medical community and as reflected in population-based cancer registries is unknown.METHODS:
We examined grade agreement between two gynecologic pathologists and the Surveillance Epidemiology and End Results Residual Tissue Repository (SEER). Grade agreement was assessed with percent observer agreement and kappa coefficients for 664 invasive ovarian carcinomas, using previously defined three-tier and two-tier grading systems. A random subset of ovarian carcinomas was selected to compare intra- and inter-pathologist agreement.RESULTS:
Five hundred and eighty-six of SEER's 664 tumors were confirmed invasive. Percent agreement was 49 % with fair kappa coefficient = 0.25 (95 % CI: 0.20-0.30) for the 664 tumors. Agreement improved slightly when restricted to the 586 confirmed invasive cancers; it was better for high grade than low grade tumors, for two-tier than three-tier grading systems, and within (66 %) than between study pathologists (43 %). Grade was not a robust independent predictor of ovarian cancer-specific survival.CONCLUSIONS:
Grade agreement was fair between SEER and study pathologists irrespective of grading system. Recorded grade in SEER should be used with caution and is probably not a reliable metric for ovarian cancer epidemiology.Catalysts to withdrawal from familial ovarian cancer screening for surgery and reactions to discontinued screening: a qualitative study - abstract
Catalysts to withdrawal from familial ovarian cancer screening for surgery and reactions to discontinued screening: a qualitative study - abstract
Abstract
Women at high risk of
familial ovarian cancer face a potentially difficult risk management
choice between unproven ovarian cancer screening (OCS) and bilateral
salpingo-oophorectomy (BSO). It is not fully understood why women who
initially opt for OCS may later undergo BSO, nor what the impact of this
may be. This study explored the catalysts for surgery and reactions to
discontinuing OCS. Semi-structured interviews were completed with 21
women who had undergone surgery having initially chosen OCS to explore
their screening experiences, reasons for and feelings about surgery, and
reactions to discontinuing OCS. The invasive nature and frequency of
OCS were not by themselves a catalyst for surgery. A number of
catalysts, including abnormal OCS test results, and secondary
considerations, such as age-related factors, were found to prompt
surgery. The emotional impact of discontinuing OCS following BSO varied
between relief, acceptance, and loss of reassurance. OCS appears to be
an acceptable risk management strategy under certain circumstances, but
varying factors can prompt the decision to opt instead for BSO. The
complexity of this management change decision should not be
underestimated and needs to be taken into account by clinicians
assisting women making choices. These findings highlight the importance
of the timing of decision-making about BSO and that risk management
options need routine reconsideration, through clinical discussions,
information and support.
10 rare tumors that warrant a genetics referral - abstract
10 rare tumors that warrant a genetics referral - abstract
Abstract
The number of
described cancer susceptibility syndromes continues to grow, as does our
knowledge on how to manage these syndromes with the aim of early
detection and cancer prevention. Oncologists now have greater
responsibility to recognize patterns of cancer that warrant referral for
a genetics consultation. While some patterns of common cancers are easy
to recognize as related to hereditary cancer syndromes, there are a
number of rare tumors that are highly associated with cancer syndromes
yet are often overlooked given their infrequency. We present a review of
ten rare tumors that are strongly associated with hereditary cancer
predisposition syndromes: adrenocortical carcinoma, carcinoid tumors,
diffuse gastric cancer, fallopian tube/primary peritoneal cancer,
leiomyosarcoma, medullary thyroid cancer,
paraganglioma/pheochromocytoma, renal cell carcinoma of chromophobe,
hybrid oncocytoic, or oncocytoma histology, sebaceous carcinoma, and sex
cord tumors with annular tubules. This review will serve as a guide for
oncologists to assist in the recognition of rare tumors that warrant
referral for a genetic consultation.
Battles Erupt Over Filling Doctors' Shoes - WSJ.com
Blogger's Note: these are not new issues nor are they specific to the U.S.
Battles Erupt Over Filling Doctors' Shoes - WSJ.com
open access: PREDICTIVE, PREVENTIVE, PARTICIPATORY, AND PERSONALIZED HEALTH: The Duplicitous Origin of Ovarian Cancer
Blogger's Note/Opinion: worth reading
~~~~~~~~~~~~~~
PREDICTIVE, PREVENTIVE, PARTICIPATORY, AND PERSONALIZED HEALTH
The Duplicitous Origin of Ovarian Cancer
Gil Mor M.D., Ph.D.* and Ayesha Alvero M.D.
Department of Obstetrics Gynecology and Reproductive Sciences, Reproductive Immunology Unit, Yale University School of Medicine, New Haven, CT, USA
Bilateral Ovarian Lymphangioma (Lymphangioleiomyoma) : International Journal of Gynecologic Pathology
Bilateral Ovarian Lymphangioma (Lymphangioleiomyoma) : International Journal of Gynecologic Pathology
Abstract
Lymphangiomas of the ovary are rare and are usually
unilateral. We present a 50-yr-old patient who presented with irregular
bleeding secondary to multiple uterine leiomyomas who was found to have
bilateral ovarian lymphangiomas. There was no evidence of pelvic
lymphatic obstruction or of lymphadenopathy, and this appeared to
exclude the possibility of acquired lymphangiectasia. The ovarian tumors
were associated with a prominent smooth muscle cell component that
partly surrounded many of the dilated vascular spaces to the extent that
the diagnoses of lymphangioleiomyoma and lymphangioleiomyomatosis were
also considered. However, there was no clinical evidence of
lymphangioleiomyomatosis in other sites and the smooth muscle cells did
not express melanocytic markers immunohistochemically. Lymphangioma and
lymphangioleiomyoma should be considered in the differential diagnosis
of bilateral, multicystic ovarian neoplasms.
Monday, February 04, 2013
open access: Association of p21, p21 p27 and p21 p53 Status to Histological Subtypes and Prognosis in Low-stage Epithelial Ovarian Cancer
Association of p21, p21 p27 and p21 p53 Status to Histological Subtypes and Prognosis in Low-stage Epithelial Ovarian Cancer
Aim: The objective of this study was to evaluate the prognostic value of p21 alone and in combination with p53 or p27 for different histological subtypes of epithelial ovarian cancer and disease-free survival.
Methods: The specimens were obtained at primary surgery from a series of 129 ovarian carcinomas in FIGO stages I-II.....
Conclusion: A subgroup, constituting 25/129 (19%) of the patients with predominantly serous tumors with concomitant p21 negativity and p53 positivity had a poor survival. Another subgroup of 11/129 (9%) patients with non-serous tumors with concomitant p21 and p27 positivity had excellent survival.....
Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy
ScienceDirect.com - Gynecologic Oncology - Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy
Highlights
►
Longterm outcomes of 32 patients with unsuspected noninvasive and
invasive neoplasia found at RRSO are reported.
► 45% recurrence rate of the 15 invasive lesions was reported in the median 88mth follow up.
► The first documented case of a recurrence at 43 months, after a noninvasive neoplasm in the fallopian tube is reported.
► 45% recurrence rate of the 15 invasive lesions was reported in the median 88mth follow up.
► The first documented case of a recurrence at 43 months, after a noninvasive neoplasm in the fallopian tube is reported.
Abstract
Objectives
The reported incidence of neoplasia identified at the time of risk-reducing salpingo-oophorectomy (RRSO) in germlineBRCA1/2mutation
carriers ranges from 4-12% but long-term outcomes have not been
described. We evaluated recurrence and survival outcomes of mutation
carriers with neoplastic lesions identified at RRSO.
Methods
We identified BRCA1/2mutation
carriers with neoplasia at RRSO at three institutions. Data was
collected on clinical variables, adjuvant treatment and follow-up.
Results
We
identified 32 mutation carriers with invasive carcinomas (n = 15) or
high-grade intraepithelial neoplasia (n = 17) that were not suspected
prior to surgery. 26 occurred in BRCA1 and 6 in BRCA2
mutation carriers. Median and mean age for carcinomas was 50 years and
49.3 respectively, significantly younger than for intraepithelial
neoplasm, median 53 years, mean 55 years (P = 0.04). For the 15 invasive
carcinomas, median follow up was 88 months (range 45–172 months), 7
recurred (47%), median time to recurrence was 32.5 months and 3 have
died of disease; 1 additional patient died of breast cancer. Overall
survival was 73%, disease specific overall survival was 80% and disease
free survival was 66%. For the 17 high-grade intraepithelial neoplasms,
median follow up was 80 months (range 40–150), 4 were treated with
chemotherapy. One recurred at 43 months and is currently not on therapy
with a normal CA125, 16 months later. All patients with noninvasive
neoplasia are alive.
Conclusions
BRCA1 and BRCA2
mutation carriers with unsuspected invasive carcinoma at RRSO have a
relatively high rate of recurrence despite predominantly early stage,
small volume disease. High-grade intraepithelial neoplasms rarely recur
as carcinoma and may not require adjuvant chemotherapy.
Advanced ovarian cancer: Omental bursa, lesser omentum, celiac, portal and triad nodes spread as cause of inaccurate evaluation of residual tumor
ScienceDirect.com - Gynecologic Oncology - Advanced ovarian cancer: Omental bursa, lesser omentum, celiac, portal and triad nodes spread as cause of inaccurate evaluation of residual tumor
Abstract
Objective
We
evaluated the role of omental bursa (OB), surface of the pancreas,
lesser omentum, caudate lobe, celiac nodes (CNs), portal nodes and triad
nodes spread in advanced ovarian cancer (AOC). We investigate if the
exploration and cleaning up of these areas can lead to a more complete
cytoreduction and to a more realistic assessment of residual tumor in
AOC.
Methods
We prospectively
recruited patients diagnosed with AOC, who underwent a complete
cytoreduction. Demographics, surgical procedures, morbidities,
pathologic findings and correlations with OB spread were assessed.
Results
A
total of 37 patients had an optimal debulking including OB evaluation
and peritonectomy. The OB area procedure required in mean 65 minutes
with an estimated blood loss of 250 ml. OB involvement was found in 67%
(25/37) of cases. Peritoneal disease was found in 22 cases including 18
supragastric lesser sac and 4 porta hepatis peritoneum. CNs metastases
were found in 5 cases, of which 3 cases with bulky nodes, all presented
also bulky nodes in the para-aortic area. Only in case of a macroscopic
involvement of the diaphragm OB was positive for disease. When adhesions
occluding the Winslow foramen were present, no OB peritoneum
involvement was found. OB resection related complications were low (2
out 25).
Conclusions
The data of
this prospective study demonstrate the high rate of OB, surface of the
pancreas, lesser omentum, caudate lobe, CNs, portal and triad nodes
involvement and the value of investigating the dissemination and
cytoreduction in these sites to obtain a real optimal debulking.
Highlights
►
Omental Bursa area is frequently involved by disease in advanced
ovarian cancer
► To achieve an optimal debulking, Omental Bursa and Celiac Nodes should be routinely evaluated
► To achieve an optimal debulking, Omental Bursa and Celiac Nodes should be routinely evaluated
In vitro fertilization is associated with an increased risk of borderline ovarian tumors
Gynecologic Oncology - In vitro fertilization is associated with an increased risk of borderline ovarian tumors
Highlights
► We examined the risk of borderline ovarian tumors in a cohort of women undergoing infertility treatment► Women having IVF had 2.5 times the risk of borderline tumors compared with women having infertility treatment but not IVF
► In contrast to invasive epithelial ovarian cancer, neither birth nor hysterectomy nor sterilization appeared protective
Conclusions
Women undergoing IVF
treatment are at increased risk of being diagnosed with borderline
ovarian tumors. Risk factors for borderline ovarian tumors appear
different from those for invasive ovarian cancer.
Functional Impairments as Symptoms in the Symptom Cluster Analysis of Patients Newly Diagnosed With Advanced Cancer
Journal of Pain and Symptom Management - Functional Impairments as Symptoms in the Symptom Cluster Analysis of Patients Newly Diagnosed With Advanced Cancer
Abstract
Context
Symptoms
and subsequent functional impairment have been associated with the
biological processes of a disease, including the interaction between the
disease and treatment in a measurement model of symptoms. However,
hitherto cluster analysis has primarily focused on symptoms.
Objectives
This
study among patients within 100 days of diagnosis with advanced cancer
explored whether self-reported physical symptoms and functional
impairments formed clusters at the time of diagnosis.
Methods
We
applied the cluster analysis to self-reported symptoms and activities
of daily living of 111 patients newly diagnosed with advanced
gastrointestinal (GI), gynecological, head and neck, and lung cancers.
Based on the content, expert evaluations, the best techniques, variables
were identified, yielding the best solution.
Results
The
best cluster solution used a K-means algorithm and cosine similarity
and yielded five clusters of physical as well as emotional symptoms and
functional impairments. Cancer site formed the predominant organizing
principle of composition for each cluster. The top five symptoms and
functional impairments in each cluster were Cluster 1 (GI): outlook,
insomnia, appearance, concentration, and eating/feeding; Cluster 2 (GI):
appetite, bowel, insomnia, eating/feeding, and appearance; Cluster 3
(gynecological): nausea, insomnia, eating/feeding, concentration, and
pain; Cluster 4 (head and neck): dressing, eating/feeding, bathing,
toileting, and walking; and Cluster 5 (lung): cough, walking,
eating/feeding, breathing, and insomnia.
Conclusion
Functional
impairments in patients newly diagnosed with late-stage cancers behave
as symptoms during the diagnostic phase. Health care providers need to
expand their assessments to include both symptoms and functional
impairments. Early recognition of the functional changes may accelerate
diagnosis at an earlier cancer stage.
Figures and tables from this article:
- Fig. 1. Top five symptoms and impairments in activities of daily living listed in descending order of conditional probability in each cluster.
Development of Fatigue in Cancer Survivors: A Prospective Follow-Up Study From Diagnosis Into the Year After Treatment
Journal of Pain and Symptom Management - Development of Fatigue in Cancer Survivors: A Prospective Follow-Up Study From Diagnosis Into the Year After Treatment
Context
There
is a lack of longitudinal studies investigating fatigue from before
cancer treatment to long after successful cancer treatment.
Objectives
This
prospective follow-up study aimed to determine the prevalence and
predictors of persistent fatigue in cancer survivors in the first year
after completion of cancer treatment.
Methods
Sixty
patients with various malignancies were assessed before (T1), shortly
after curative cancer treatment (T2), and one year after T2 (T3).
Fatigue was assessed monthly between T2 and T3. Fatigue severity was
measured using the subscale of the Checklist Individual Strength.
Questionnaires were used to measure impaired sleep and rest, physical
activity, social support, fatigue catastrophizing, and somatic-related
attributions regarding fatigue. Linear regression analyses were
performed to identify predictors of persistent fatigue.
Results
In
total, 22% of survivors had severe persistent fatigue over the last six
months in the first year after cancer treatment. Fatigue at T1, T2, and
negative interactions predicted the severity of persistent fatigue.
Analyses without fatigue showed that more negative interactions,
impaired sleep and rest, fatigue catastrophizing, and lower
self-reported physical activity at T2 were associated with the severity
of persistent fatigue.
Conclusion
Twenty-two
percent of the survivors had severe persistent fatigue in the year
after cancer treatment. Fatigue and cognitive behavioral factors
predicted persistent fatigue in the year after cancer treatment.
Diagnosis or cancer treatment did not predict persistent fatigue. The
implication is that cognitive behavioral therapy for postcancer fatigue,
aimed at the fatigue-perpetuating factors, could be offered from two
months after successful cancer treatment.
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