Monday, February 11, 2013
Current State of Pain Care for Hospitalized Patients at End of Life
Current State of Pain Care for Hospitalized Patients at End of Life
"A sizable gap between pain science and clinical practice continues."
Sunday, February 10, 2013
World Journal of Obstetrics and Gynecology - Platinum-resistant ovarian cancer: Prematurely stopped phase II Austrian AGO chemotherapy studies
World Journal of Obstetrics and Gynecology
World J Obstet Gynecol. 2012 October 10; 1(3): 35-39.
Published online 2012 October 10. doi: 10.5317/wjog.v1.i3.35.
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Copyright©2012 Baishideng. All rights reserved.
Platinum-resistant ovarian cancer: Prematurely stopped phase II Austrian AGO chemotherapy studies
2012: Scottish Intercollegiate Guidelines Network Guideline 75: Epithelial ovarian cancer
Guideline 75: Epithelial ovarian cancer
"Meta-analyses of observational studies suggest that tamoxifen may produce a response in a low proportion of women with recurrent ovarian cancer.115 No randomised studies were identified."
Most meta-analyses of drug interventions have narrow scopes and many focus on specific agents
ScienceDirect.com - Journal of Clinical Epidemiology - Most meta-analyses of drug interventions have narrow scopes and many focus on specific agents
Abstract
Conclusion
The scope of meta-analysis publications frequently is narrow and shaped to serve particular agents.
Objective
To
assess the extent to which meta-analysis publications of drugs and
biologics focus on specific named agents or even only a single agent,
and identify characteristics associated with such focus.
Study Design and Setting
We
evaluated 499 articles with meta-analyses published in 2010 and
estimated how many did not cover all the available comparisons of tested
interventions for a given condition (not all-inclusive); focused on
specific named agent(s), or focused strictly on comparisons of only one
specific active agent vs. placebo/no treatment or different
doses/schedules.
open access: (Lynch Syndrome) A proportion of hereditary upper urinary tract urothelial carcinomas are misclassified as sporadic according to a multi-institutional database analysis
A proportion of hereditary upper urinary tract urothelial carcinomas are misclassified as sporadic according to a multi-institutional database analysis: proposal of patient-specific risk identification tool
"Based on the most recent European Association of Urology (EAU) guidelines on UUT-UC, a hereditary tumour has to be suspected if the patient is less than 60 years of age or has a personal or family history of an HNPCC-associated cancer [9]. The aim of this study was to analyse the demographic and epidemiological factors that are associated with a suspicion of hereditary UUT-UC in a large cohort from a national collaborative group."
DISCUSSION
"Although
UUT-UCs are rare, with an annual estimated incidence in western
countries of approximately one or two new cases per 100 000 inhabitants [9], epidemiological data demonstrate that in patients with HNPCC syndrome the cumulative risk of UUT-UC ranges up to 6% [3]. Watson et al. [3]
reported a 22-fold increased risk compared with the general population.
This may even represent an underestimation as the authors did not
consider UUT-UCs of the renal pelvis together with those of the ureter.
To our knowledge, there are few publications investigating the risk of
having an HNPCC tumour among patients with UUT-UC [4,7]....."
What's known on the subject? and What does the study add?
Hereditary
non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome,
is an autosomal dominant multi-organ cancer syndrome. Upper urinary
tract urothelial carcinomas belong to HNPCC-related tumours and rank
third within this group after colorectal and endometrial cancer.
However, many urologists are not aware of this association and it is
presumed that some hereditary cancers are misclassified as sporadic and
that their incidence is underestimated. Consequently, family members of
patients with upper urinary tract urothelial carcinomas secondary to
HNPCC may be denied appropriate surveillance and early detection.
A
significant proportion of patients (21.3%) with newly diagnosed upper
urinary tract urothelial carcinomas may have underlying HNPCC.
Demographic and epidemiological characteristics suggest different mechanisms of carcinogenesis among this population.
Demographic and epidemiological characteristics suggest different mechanisms of carcinogenesis among this population.
Gynecologic Oncology Case Reports - A Very Rare Case of Synchronous Carcinomas of the Endometrium and Ovary with Peritoneal Keratin Granulomatous Involvement
ScienceDirect.com - Gynecologic Oncology Case Reports - A Very Rare Case of Synchronous Carcinomas of the Endometrium and Ovary with Peritoneal Keratin Granulomatous Involvement
Highlights
►
Peritoneal keratin granulomas infrequently manifest themselves in
conjunction with gynecologic cancer.
► We report on a patient with synchronous ovarian and uterine cancers that contained extensive keratin granulomas.
► Comprehensive pathologic sampling may be essential to conferring optimal patient management.
► We report on a patient with synchronous ovarian and uterine cancers that contained extensive keratin granulomas.
► Comprehensive pathologic sampling may be essential to conferring optimal patient management.
Gynecologic Oncology Case Reports - Unexpected long-term survival in a BRCA2 patient with metastatic carcinosarcoma associated with tamoxifen
ScienceDirect.com - Gynecologic Oncology Case Reports - Unexpected long-term survival in a BRCA2 patient with metastatic carcinosarcoma associated with tamoxifen
Highlights
► This report concerns a long survival of a BRCA2
patient with a relapsing uterine carcinosarcoma.
► Rarity of long survivorship in relapsing carcinosarcoma is confirmed by literature review.
► BRCA2 status plus platinum-hypersensitivity as contributors for the favorable outcome, even if carcinosarcoma doesn't belong to the BRCA1/2 phenotype.
► Rarity of long survivorship in relapsing carcinosarcoma is confirmed by literature review.
► BRCA2 status plus platinum-hypersensitivity as contributors for the favorable outcome, even if carcinosarcoma doesn't belong to the BRCA1/2 phenotype.
Gynecologic Oncology Case Reports - Primary neuroendocrine carcinoma of the fallopian tube: A case report
ScienceDirect.com - Gynecologic Oncology Case Reports - Primary neuroendocrine carcinoma of the fallopian tube: A case report
Highlights
► This case is an exceptionally rare primary neuroendocrine carcinoma of the fallopian tube, with a clinical presentation as torsion.
► TTF1 immunoreactivity can be found in neuroendocrine carcinomas originating from the fallopian tube
Gynecologic Oncology Case Reports - Metastatic ovarian papillary serous carcinoma to the breast: Diagnosis and pitfalls
ScienceDirect.com - Gynecologic Oncology Case Reports - Metastatic ovarian papillary serous carcinoma to the breast: Diagnosis and pitfalls
Highlights
►
The breast as a site of metastasis from primary ovarian carcinoma is
uncommon.
► Distinguishing these metastases from primary breast tumors is important because the prognosis and therapeutic approach differ significantly.
► Immunohistochemical markers (e.g., PAX8) can be utilized when morphology and clinical history are insufficient to render the correct diagnosis.
► Distinguishing these metastases from primary breast tumors is important because the prognosis and therapeutic approach differ significantly.
► Immunohistochemical markers (e.g., PAX8) can be utilized when morphology and clinical history are insufficient to render the correct diagnosis.
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.
Case
A 52-year-old woman with no familial cancer history and an unknown BRCA-status presented with a palpable right breast mass. Four years earlier, she had been diagnosed with and treated for advanced stage high grade PS OC with neoadjuvant carboplatin–paclitaxel followed by an optimal interval cytoreductive surgery and additional chemotherapy. Her serum cancer antigen-125 (CA-125) normalized after treatment, and she had no evidence of disease. At the time of her first recurrence, 16-months later, her serum CA125 was 453U/mL and a biopsy of a xyphoid mass revealed recurrent high grade PS OC(Lynch syndrome) Occult transitional cell carcinoma and Lynch syndrome incidentally revealed after laparoscopic hysterectomy and cystoscopy during staging for endometrial cancer
ScienceDirect.com - Gynecologic Oncology Case Reports - Occult transitional cell carcinoma and Lynch syndrome incidentally revealed after laparoscopic hysterectomy and cystoscopy during staging for endometrial cancer
Case Report
Open Access Article
Highlights
►
Lynch syndrome involves many rare cancers, such as urothelial
carcinoma.
► The case describes incidental urothelial carcinoma associated with Lynch syndrome.
► Clinical suspicion of rare cancers must be maintained in certain patients.
"There is lack of consensus regarding potential screening tools for urologic neoplasms in patients with Lynch and other familial cancer susceptibility syndromes. The National Comprehensive Cancer Network (NCCN) guidelines on screening for different Lynch-associated cancers are vague and lack supportive data."
"Nonetheless, one study suggests that 21% of newly-diagnosed urothelial carcinomas may be associated with Lynch syndrome (Audenet et al., in press)"
► The case describes incidental urothelial carcinoma associated with Lynch syndrome.
► Clinical suspicion of rare cancers must be maintained in certain patients.
"There is lack of consensus regarding potential screening tools for urologic neoplasms in patients with Lynch and other familial cancer susceptibility syndromes. The National Comprehensive Cancer Network (NCCN) guidelines on screening for different Lynch-associated cancers are vague and lack supportive data."
"Nonetheless, one study suggests that 21% of newly-diagnosed urothelial carcinomas may be associated with Lynch syndrome (Audenet et al., in press)"
Comment
Ureteral
TCCs are extremely uncommon in the general population. The lifetime
risk of these lesions is greatly increased with a history of Lynch
syndrome (Watson et al., 2008).
A
salient point from this case is that clinical suspicion of a urothelial
neoplasm is heightened with additional findings such as hematuria,
Lynch syndrome-associated cancers, and low BMI. Indeed, the mean BMI of
patients with microsatellite-unstable and Lynch-related tumors is
significantly less than those with microsatellite-stable tumors (Cohn et al., 2008).
Thus, in this patient, endometrial cancer with superimposed hematuria
raised concerns about an occult TCC in the setting of Lynch syndrome........
Gynecologic Oncology Case Reports - Ovarian angiosarcoma: Extended survival following optimal cytoreductive surgery and adjuvant chemotherapy
ScienceDirect.com - Gynecologic Oncology Case Reports - Ovarian angiosarcoma: Extended survival following optimal cytoreductive surgery and adjuvant chemotherapy
Highlights
►
Ovarian angiosarcoma is rare and associated with a poor prognosis.
► We present the novel use of paclitaxel in the treatment of ovarian angiosarcoma.
► Paclitaxel may be effective through an anti-angiogenic effect on angiosarcomas.
► We present the novel use of paclitaxel in the treatment of ovarian angiosarcoma.
► Paclitaxel may be effective through an anti-angiogenic effect on angiosarcomas.
Gynecologic Oncology Case Reports - Primary strumal carcinoid tumor of the ovary: A pregnant patient exhibiting severe constipation and CEA elevation
ScienceDirect.com - Gynecologic Oncology Case Reports - Primary strumal carcinoid tumor of the ovary: A pregnant patient exhibiting severe constipation and CEA elevation
Highlights
►
We present a rare case of a PYY-positive primary strumal carcinoid
tumor of the ovary during pregnancy.
► MRI was useful for the preoperative diagnosis, and the prenatal course was uneventful after the operation.
► Colitis due to severe constipation caused by PYY, which is an inhibitor of intestinal mobility, might induce serum CEA elevation.
► MRI was useful for the preoperative diagnosis, and the prenatal course was uneventful after the operation.
► Colitis due to severe constipation caused by PYY, which is an inhibitor of intestinal mobility, might induce serum CEA elevation.
open access journal - Gynecologic Oncology Case Reports - Destructive T10 vertebral lesion leads to diagnosis of metastatic ovarian cancer
Gynecologic Oncology Case Reports - Destructive T10 vertebral lesion leads to diagnosis of metastatic ovarian cancer
Highlights
►
Ovarian cancer presents as thoracic vertebral lesion in the absence of
gross abdominal disease
► Bilateral salpingo-oophorectomy with surgical resection of vertebral lesion leaves patient with no clinical evidence of disease
► Ovarian cancer can present as vertebral metastases in the absence of pelvic or abdominal metastatic disease
► Bilateral salpingo-oophorectomy with surgical resection of vertebral lesion leaves patient with no clinical evidence of disease
► Ovarian cancer can present as vertebral metastases in the absence of pelvic or abdominal metastatic disease
Saturday, February 09, 2013
Two Cases of Malignant Struma Ovarii with Metastasis to Pelvic Bone.
Two Cases of Malignant Struma Ovarii with Metastasis to Pelvic Bone.:
Abstract
Histologically, malignant struma ovarii metastasizes rarely, and only a few cases reported bone metastasis. Here, we describe 2 cases of biologically malignant struma ovarii with pelvic bone metastasis. Case 1 is a 22-year-old female who was found to have a large left ovarian mass during routine prenatal ultrasound. Papillary thyroid cancer arising in struma ovarii was identified after laparoscopic salpingo-oophorectomy. After total thyroidectomy, radioactive iodine whole-body scan revealed extrathyroidal iodine uptake in left anterior pelvis. Subsequent I-131 treatment resolved the pelvic metastasis. Case 2 is a 49-year-old female who was diagnosed with malignant struma ovarii in 1996 and presented in 2007 with pelvic recurrence and extensive left hip metastasis. Treatment with resection of the pelvic tumor, total thyroidectomy, and multiple I-131 ablation led to eventual resolution of the abdominal and left hip foci. In conclusion, we present 2 rare cases of malignant struma ovarii, both with metastasis to the pelvic bone. This report makes pelvic bone the most frequent site for bone metastasis in malignant struma ovarii. It also emphasizes the importance of total thyroidectomy in allowing identification and treatment of bony metastasis with radioactive iodine.
Extremely poor postrecurrence oncological outcome for patients with recurrent mucinous ovarian cancer
Extremely poor postrecurrence oncological outcome for patients with recurrent mucinous ovarian cancer
Abstract
BACKGROUND:
This study was conducted to assess the long-term clinical outcome for patients with recurrent mucinous epithelial ovarian cancer (RmOC) in comparison with recurrent serous epithelial ovarian cancer (RsOC).CONCLUSIONS:
The clinical outcome after recurrence in patients with RmOC was extremely poor. This confirms that RmOC should be considered a different entity from other epithelial ovarian cancers.Increasing lynch syndrome identification through establishment of a hereditary colorectal cancer registry
Increasing lynch syndrome identification through establishment of a hereditary colorectal cancer registry
Abstract
BACKGROUND:
Lynch syndrome contributes to 5% of all colorectal cancers. Patients seen in most surgical clinics have limited or no family histories documented and are rarely assessed for hereditary syndromes. In 2007 a clinic-based hereditary colorectal cancer registry was established to screen for Lynch syndrome and facilitate genetic counseling/testing.OBJECTIVE:
To evaluate the effectiveness of the hereditary colorectal cancer registry to identify high-risk colorectal cancer patients and have them referred for genetic counseling/testing for Lynch syndrome.press release: Compound (TIC10) stimulates tumor-fighting protein in cancer therapy
Compound stimulates tumor-fighting protein in cancer therapy
"We have enough preclinical information to support the rationale for testing this new drug in the clinic," El-Deiry said.
Patterns of chemotherapy treatment for women with invasive epithelial ovarian cancer – a population-based study
ScienceDirect.com - Gynecologic Oncology - Patterns of chemotherapy treatment for women with invasive epithelial ovarian cancer – a population-based study
Abstract
Highlights
►
Medical records of all Australian women with ovarian cancer in 2005
were abstracted
► Older women, those with high-grade/low-stage or mucinous cancers had less chemotherapy
► Only 32% completed 6 cycles of carboplatin/paclitaxel without dose reduction/delay
► Older women, those with high-grade/low-stage or mucinous cancers had less chemotherapy
► Only 32% completed 6 cycles of carboplatin/paclitaxel without dose reduction/delay
Objective
Ovarian
cancer five-year survival is poor at < 40%. In the absence of
effective screening or new treatments, ensuring all women receive
optimal treatment is one avenue to improve survival. There is little
population-based information regarding the primary chemotherapy
treatment that women with epithelial ovarian cancer receive. This
information is essential to identify potential gaps in care.
Methods
Cancer
registries identified all women diagnosed with invasive epithelial
ovarian cancer in Australia in 2005 (n = 1,192). Histopathology,
chemotherapy and comorbidity information was abstracted from medical
records. Multivariable logistic regression was used to identify factors
associated with chemotherapy commencement, regimen, and completion.
Results
Women
> 70 years, those with high-grade, stage IA/IB
cancers (vs. stage IC-IV) and those with mucinous cancers were less likely to start chemotherapy. Most treated women
received platinum-based drugs (97%), but only 68% received combination
carboplatin-paclitaxel and only half completed six cycles without
treatment modification/delay. Approximately 19% received single-agent
carboplatin: mostly those aged > 70 (p < 0.0001) and/or with
co-morbidities (p < 0.0001). Age was the strongest predictor of
completing six cycles of combination therapy.
Conclusions
For
specific patient groups, particularly older women, there is notable
variation from standard treatment. Understanding how treatment
variations affect survival and determining optimal regimens for these
groups are research priorities.
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