Thursday, February 07, 2013
Height, weight, BMI and ovarian cancer survival
Height, weight, BMI and ovarian cancer survival.
Abstract
OBJECTIVES:
Ovarian cancer is a highly fatal gynecologic malignancy. Prognosis is primarily based on clinicopathologic features. There is interest in the role of modifiable factors including overweight and obesity, although data to date have been inconclusive. Here we evaluate the relationship between body size and ovarian cancer survival among 1423 women diagnosed with epithelial ovarian cancer in a large population-based study.METHODS:
Information on risk factors and characteristics was collected by telephone. Vital status was determined both by computerized record-linkage and by chart review. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for height, weight and body mass index (BMI) in association with ovarian cancer-specific mortality.RESULTS:
Height, weight and BMI 5 years prior to diagnosis did not significantly predict ovarian cancer survival in this study. The HR for ovarian cancer-specific mortality for women with a weight of >61 kg compared with >50-55 kg was 0.91 (95%CI 0.71-1.20). The HR among women with a BMI≥30 kg/m2 compared to 18.5-<25 kg/m2 was 1.11 (95%CI 0.87-1.42). These findings did not vary by histologic subtype.CONCLUSIONS:
Our results do not support a role of height, adult weight or adiposity in ovarian cancer prognosis.Ovarian metastasis is associated with retroperitoneal lymph node relapses in women treated for colorectal peritoneal carcinomatosis
Ovarian metastasis is associated with retroperitoneal lymph node relapses in women treated for colorectal peritoneal carcinomatosis
Abstract
PURPOSE:
To analyze the patterns of recurrence and the prognostic impact of ovarian metastases (OM) in a population of women with colorectal peritoneal carcinomatosis (CRPC) treated with curative intent.METHODS:
Data from all consecutive women with CRPC who underwent curatively intended complete cytoreductive surgery (CRS) plus intraperitoneal chemotherapy at our institution were retrieved from a prospective database. A bilateral oophorectomy or a complementary unilateral oophorectomy was systematically performed during CRS.RESULTS:
From 1994 to 2009, among 105 women who underwent CRS plus intraperitoneal chemotherapy for CRPC, 62 (60 %) had OM. Women with and without OM had comparable peritoneal cancer index (PCI) scores (10 vs. 12, respectively, p = 0.09). After a median follow-up of 60 (range 5-145) months, median overall survival of women with OM did not differ statistically from that of women without OM (respectively, 36 and 40 months; p = 0.75). Relapses occurred in 82 % of the patients, distributed similarly between the two groups except for retroperitoneal lymph node recurrence, which occurred in 19 patients (18 %), including 18 with OM. The only predictive factor for a retroperitoneal relapse was a history of OM (ovarian metastases) (p = 0.0012).CONCLUSIONS:
Retroperitoneal lymph node recurrence seems to be linked to OM originating from colorectal cancer and could worsen the prognosis. A systematic lymphadenectomy could be evaluated in women with isolated OM or very limited peritoneal carcinomatosis to analyze the incidence of invaded lymph nodes and study its potential benefit on survival.Journal of Ovarian Research - Insulin and insulin-like growth factor signaling increases proliferation and hyperplasia of the ovarian surface epithelium and decreases follicular integrity through upregulation of the PI3-kinase pathway (in mice)
Journal of Ovarian Research | open access | Insulin and insulin-like growth factor signaling increases proliferation and hyperplasia of the ovarian surface epithelium and decreases follicular integrity through upregulation of the PI3-kinase pathway
Background
The ovarian surface epithelium responds to cytokines and hormonal cues to initiate
proliferation and migration following ovulation. Although insulin and IGF are potent
proliferative factors for the ovarian surface epithelium and IGF is required for follicle
development, increased insulin and IGF activity are correlated with at least two gynecologic
conditions: polycystic ovary syndrome and epithelial ovarian cancer. Although insulin
and IGF are often components of in vitro culture media, little is known about the
effects that these growth factors may have on the ovarian surface epithelium morphology
or how signaling in the ovarian surface may affect follicular health and development......
2012 Management of a suspicious adnexal mass: a clinical practice guideline - Gynecology Cancer Disease Site Group Canada
Management of a suspicious adnexal mass: a clinical practice guideline - Current Oncology
Practice Guideline
"These recommendations apply to adult women presenting with a suspicious adnexal mass, either symptomatic or asymptomatic.
Identification of an Adnexal Mass Suspicious for Ovarian Cancer
Sonography (particularly 3-dimensional sonography), magnetic resonance imaging (
mri
), and computed tomography (
ct
) imaging are each recommended for differentiating malignant from
benign ovarian masses. However, the working group offers the following
further recommendations, based on their expert consensus opinion and a
consideration of availability, access, and harm:
-
Where technically feasible, transvaginal sonography should be the modality of first choice in patients with a suspicious isolated ovarian mass.
-
To help clarify malignant potential in patients in whom ultrasonography may be unreliable, mri is the most appropriate test.
-
In cases in which extra-ovarian disease is suspected or needs to be ruled out, ct is the most useful technique.
-
Evaluation of an adnexal mass by Doppler technology alone is not recommended. Doppler technology should be combined with a morphology assessment.
-
Ultrasonography-based morphology scoring systems can be used to differentiate benign from malignant adnexal masses. These scoring systems are based on specific ultrasound parameters, each with several scores base on determined features. All evaluated scoring systems were found to have an acceptable level of sensitivity and specificity; the choice of scoring system may therefore be made based on clinician preference.
-
As a standalone modality, serum cancer antigen 125 is not recommended for distinguishing between benign and malignant adnexal masses.
-
Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow.
Surgical Procedures for an Adnexal Mass Suspicious for Malignancy
To improve survival, comprehensive surgical staging with lymphadenectomy
is recommended for the surgical management of patients with early-stage
ovarian cancer.
Laparoscopy is a reasonable alternative to laparotomy, provided that
appropriate surgery and staging can be done. The choice between
laparoscopy and laparotomy should be based on patient and clinician
preference. Discussion with a gynecologic oncologist is recommended.
Fertility-preserving surgery is an acceptable
alternative to more extensive surgery in patients with
low-malignant-potential tumours and those with well-differentiated
surgical stage
i
ovarian cancer. Discussion with a gynecologic oncologist is recommended......
open access: Do current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada? A qualitative inquiry | Miedema | Current Oncology
Do current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada? A qualitative inquiry | Miedema | Current Oncology
Purpose
The purpose of the present study was to assess whether current cancer
follow-up care practices meet the needs of young adult cancer survivors
in Canada.
Methods
This qualitative study used a constructivist grounded
theory framework to analyze telephone interviews with cancer survivors
from across Canada diagnosed between the ages of 18 and 39 years. The
focus was specifically on cancer follow-up care (
cfc
).....
Canada: When jurisdictional boundaries become barriers to good patient care | Stephen | Current Oncology
When jurisdictional boundaries become barriers to good patient care | Stephen | Current Oncology
"...e-Health is the answer to ensuring portability and accessibility of health care services as mandated in the Canada Health Act. National organizations such as acpro , the Federation of Medical Regulatory Authorities of Canada, and the Canadian Counselling and Psychotherapy Association need to adopt consistent and forward-thinking position statements such as the one adopted by the Canadian Nurses Association, so as to override current provincial policy patchworks and to harmonize e-health practice across provincial boundaries. The only way to bring about the needed change is to raise awareness, to identify the caveats in the system, and to bring everyone together with a clear vision and consistent advocacy for national leverage on the issue of professional barriers to good patient care. Ultimately, we need to answer one question: Is it ethical to deny patients online care based on presumed professional risk?"
Can Facebook Save Us? | The Health Care Blog (EMRs)
Can Facebook Save Us? | The Health Care Blog
"At some point, this gets to be ridiculous. Online, I can buy any item from anywhere at any price, pay any bill, watch any movie, listen to any song, order dinner, schedule car repair or read about any subject on Wikipedia. I can determine the weather in Rio, sport scores of Barcelona, Parisian traffic or by GPS the location of my kids, just down the block. However, I absolutely cannot learn anything at all of the health history of the flesh and blood cancer patient sitting right in front of me......
Wednesday, February 06, 2013
Constitutional Mismatch Repair-Deficiency Syndrome (CMMR-D) - a Case Report of a Family with Biallelic MSH6 Mutation
[Constitutional Mismatch Repair-Deficiency Syndrome (CMMR-D) - a Case Report of a Family with Biallelic MSH6 Mutation].
Abstract
This work gives comprehensive information about new recessively inherited syndrome characterized by development of childhood malignancies. Behind this new described syndrome, called Constitutional mismatch repair-deficiency syndrome (CMMR-D), there are biallelic mutations in genes, which cause adult cancer syndrome termed Lynch syndrome (Hereditary non-polyposis cancer syndrome-HNPCC) if they are heterozygous mutations. Biallelic germline mutations of genes MLH1, MSH2, MSH6 and PMS2 in CMMR-D are characterized by increased risk of hematological malignancies, atypical brain tumors and early onset of colorectal cancers. An accompanying manifestation of the disease are skin spots with diffuse margins and irregular pigmentation reminiscent of Café au lait spots of NF1. This paper reports a case of a family with CMMR-D caused by novel homozygous MSH6 mutations leading to gliomatosis cerebri, T-ALL in an 11-year-old female and glioblastoma multiforme (brain cancer) in her 10-year-old brother, both with rapid progression of the diseases. A literature review of brain tumors in CMMR-D families shows that they are treatment-resistant and lead to early death. Therefore, this work highlights the importance of early identification of patients with CMMR-D syndrome - in terms of initiation of a screening program for early detection of malignancies as well as early surgical intervention.
PLOS Pathogens: Preclinical Therapy of Disseminated HER-2+ Ovarian and Breast Carcinomas with a HER-2-Retargeted Oncolytic Herpesvirus
PLOS Pathogens: Preclinical Therapy of Disseminated HER-2+ Ovarian and Breast Carcinomas with a HER-2-Retargeted Oncolytic Herpesvirus
Introduction
The past decades have witnessed remarkable progresses in the ability to treat numerous cancers by means of surgery, chemio- and radiotherapy, or combinations thereof. Nonetheless, there remains a tremendous burden of tumors not sensitive or accessible to standard treatments. Oncolytic virotherapy exploits the intrinsic ability of viruses to kill the target cell and simultaneously to spread to other target cells. A key requirement is that the virus specifically targets cancer cells [1]. Herpes simplex virus- 1 (HSV-1) is being actively investigated in preclinical and phase 1–3 clinical studies as it lends itself to numerous genetic modifications that make it cancer-specific [2], [3].The strategy pursued in our laboratories is to modify HSV-1 tropism, and efficiently retarget the virus to cancer-associated cell-surface molecules, such as the human epithelial growth factor receptor 2 (HER-2), a member of the tyrosine kinase receptors [4]–[9]. The clinical impact of the HER-2 oncogene stems from the fact that it is overexpressed in human breast and ovary carcinomas (>200,000 new cancer cases each year in the U.S.), and correlates with worsened prognosis. Because of these properties, HER-2 is currently the target of antibody-based (trastuzumab) therapies, or small molecule tyrosine kinase inhibitors.......
Diagnostic Pathology | open access - P53, MAPK, topoisomerase II alpha and Ki67 immunohistochemical expression and KRAS/BRAF mutation in ovarian serous carcinomas
Diagnostic Pathology - P53, MAPK, topoisomerase II alpha and Ki67 immunohistochemical expression and KRAS/BRAF mutation in ovarian serous carcinomas
Conclusions
Although this study is limited by its humble number of low-grade samples, our data
fit the proposed dualistic pathway of ovarian carcinogenesis. Mutational analysis
for KRAS and BRAF discloses some possible interactions between different tumorigenic
pathways of lowand high-grade carcinomas. Immunohistochemical staining for MAPK was
not sufficiently sensitive, nor specific, to precisely predict the KRAS mutation.
However, it appears to be quite reliable in ruling out a KRAS mutation if the staining
is negative. Virtual Slides The virtual slide(s) for this article can be found here:
http://www.diagnosticpathology.diagnomx.eu/vs/9283563368804632
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Journal of Ovarian Research | open access | Pegylated liposomal doxorubicin in ovarian cancer treatment: A mono-institutional retrospective analysis. Do we still need it?
Journal of Ovarian Research Pegylated liposomal doxorubicin in ovarian cancer treatment: A mono-institutional retrospective analysis. Do we still need it?
Conclusions
No evidence of superiority if PLD was compared to alternative agents was found in
this analysis, particularly in the platinum-refractory setting. Our findings indicate
a modest therapeutic activity of PLD in OC. Analysis of cost/benefit of PLD in OC
is eagerly awaited.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Gastrointestinal Events With First-Line Paclitaxel, Carboplatin, and Vorinostat Chemotherapy for Advanced-Stage Epithelial Ovarian, Primary Peritoneal, and Fallopian Tube Cancer
International Journal of Gynecological Cancer:
POST AUTHOR CORRECTIONS, 1 February 2013
doi: 10.1097/IGC.0b013e31828566f1
Original Study: PDF Only
Increased Incidence of Severe Gastrointestinal Events With First-Line Paclitaxel, Carboplatin, and Vorinostat Chemotherapy for Advanced-Stage Epithelial Ovarian, Primary Peritoneal, and Fallopian Tube Cancer
Objectives: We sought to assess the response rate and
toxicity of paclitaxel, carboplatin, and vorinostat primary induction
therapy for the treatment of advanced-stage ovarian carcinoma.
Methods: Patients were treated with 6 cycles of weekly
paclitaxel (80 mg/m2), carboplatin (6 times area under the curve), and
vorinostat (200 mg) every 28 days according to an institutional review
board-approved protocol. The subjects were eligible for response
evaluation; in patients who achieved stable disease or better following
the conclusion of primary induction chemotherapy, they were subsequently
treated with a planned 12 cycles of paclitaxel (135 mg/m2) and
vorinostat (400 mg) maintenance chemotherapy every 28 days.
Results: Eighteen patients received a combined 90 cycles
(median, 6 cycles; range, 1-6 cycles) of primary induction chemotherapy.
Of the 18 subjects, 7 demonstrated a complete response, and 2 subjects
exhibited a partial response (a total response rate of 50.0%). Eight
patients also received a combined total of 50 cycles (median, 5 cycles;
range, 1-12 cycles) of consolidation therapy. Grade 3/4 neutropenia and
thrombocytopenia were observed in 9 (56.3%) and 2 (12.5%) patients. One
patient (6.3%) developed grade 3 anemia, and another (6.3%) manifested a
grade 3 neuropathy. Remarkably, we observed a significant
gastrointestinal event (eg, bowel anastomotic perforation) in 3
patients, which effectuated the study's closure.
Conclusions: Because the current study was prematurely
terminated, we cannot derive a conclusive assessment regarding the
efficacy of this treatment. Nevertheless, the high incidence of severe
gastrointestinal toxicity warrants further consideration when using
vorinostat in the adjuvant setting for patients who have undergone a
bowel resection as part of their initial tumor debulking.
Supporting self-management of pain in cancer patients: methods and lessons learned from a randomized controlled pilot study
Supporting self-management of pain in cancer patients: Methods and lessons learned from a randomized controlled pilot study.
Abstract
PURPOSE OF THE RESEARCH:
The purposes of this paper are to describe the methods used and the knowledge gained during a pilot study that evaluated the effects of a self-management intervention for cancer pain, as well as the adaptations that were made for a larger clinical trial.METHODS AND SAMPLE:
In a randomized controlled trial, the adapted German version of the PRO-SELF(©) Plus Pain Control Program (PCP), a 10-week intervention to support self-management of pain in adult oncology outpatients and their family caregivers, was compared to attention control. Primary endpoints were average and worst pain measured at 6, 10, 14, and 22 weeks after enrollment.KEY RESULTS:
A total of 39 patients (19 intervention, 20 control) were recruited over 18 months. During the study, inclusion criteria were expanded. Furthermore, the structured timing of the intervention visits was too static for a dynamic symptom like cancer pain. The intervention was expanded to include symptoms that severely impacted pain self-management including chemotherapy-induced nausea and vomiting.CONCLUSIONS:
Apart from the provision of information and skills building, coaching cancer patients across a complex treatment is an important function of an intervention to support pain self-management. The pilot study proved to be highly useful in order to adapt planned study procedures, to balance burden and benefit for participants, and to customize the intervention to patients' needs and abilities in order to enhance feasibility and effectiveness. Findings from this pilot study will be fully integrated in a larger randomized controlled trial. Clinical trial registration number: NCT00920504.Tuesday, February 05, 2013
open access: Quality of Life of Cancer Survivors in England: Analysis of Patients' Free Text Comments: Final Report
Blogger's Note: 74 pages; gyn/ovarian cancer patients were not included
Quality of Life of Cancer Survivors in England: Analysis of Patients' Free Text Comments: Final ReportSE1
open access: UK - Cancer Patient Experience Survey 2011/12 National Report
Blogger's Note: report is 168 pages; gyn cancers grouped together
Cancer Patient Experience Survey 2011/12National Report
Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips
Health Information -About CAM- OCCAM
If you are a patient… this workbook is designed to help you talk with your health care provider(s) about your complementary and alternative medicine (CAM) use during and after your cancer care. This workbook can be used in its entirety or as individual sheets to best meet your needs and interests.
If you are a health care provider… this workbook contains several documents which can be used to help your patients keep track of their medicines, CAM use, and complementary providers. It is intended to help you talk with your patients about their goals, beliefs, symptom management, and use of CAM therapies during and after cancer care.
Download the entire workbook:
This 15 page workbook provides a one-stop resource for all your CAM conversation and tracking needs.
open access: BJC - Targeted anti-vascular therapies for ovarian cancer: current evidence
British Journal of Cancer - Targeted anti-vascular therapies for ovarian cancer: current evidence
"..........Anti-angiogenic agents such as VEGF/PDGF/FGF inhibitors have been developed, of which the most successful to date is bevacizumab, a humanised monoclonal antibody that inhibits the binding of VEGF to its receptors, VEGFR-1 and VEGFR-2. Neutralising the biological activity of VEGF inhibits the formation of new tumour vessels, causing regression of the remaining tumour vasculature. This slows tumour growth and metastasis (Jain, 2005). Preclinical and early clinical studies show resistance to VEGF inhibition occurring quite quickly and pure VEGF inhibitors such as bevacizumab are best used in conjunction with chemotherapy. However, in contrast to most other anti-vascular agents (Rustin et al, 2003), bevacizumab has shown single-agent activity in ovarian cancer (Burger et al, 2007; Cannistra et al, 2007), but not in many other solid tumour types (Cobleigh et al, 2003; Sandler et al, 2006; Giantonio et al, 2007)...........
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