Thursday, February 21, 2013
open access: Massive Ascites as the Only Sign of Ovarian Juvenile Granulosa Cell Tumor in an Adolescent: A Case Report and a Review of the Literature
open access:
"Ovarian neoplasms are relatively rare in childhood and adolescence; only 5% to 8% of the cases are of sex cord stromal origin. Granulosa cell tumors are a group of estrogen producing sex cord stromal tumors of the ovary. They occur in 95% of the cases in adults, and only about 5% of the cases, which differ in histologic characteristics, are of juvenile type. A 13-year-old girl is reported who presented with massive abdominal distention and ascites.
Selective blockade of matrix metalloprotease-14 with a monoclonal antibody abrogates invasion, angiogenesis and tumor growth in ovarian cancer (MMP-14/Avastin/primary peritoneal)
Abstract
Most ovarian cancer patients are diagnosed
late in progression and often experience tumor recurrence and relapses
due to drug
resistance. Surface expression of matrix
metalloprotease MMP-14 on ovarian cancer cells stimulates a
tumor-stromal signaling
pathway that promotes angiogenesis and tumor
growth. In a cohort of 92 patients, we found that MMP-14 was increased
in the
serum of women with malignant ovarian tumors.
Therefore, we investigated the preclinical efficacy of a MMP-14
monoclonal antibody
that could inhibit the migratory and invasive
properties of aggressive ovarian cancer cells in vitro. MMP-14 antibody
disrupted
ovarian tumor-stromal communication and was
equivalent to Avastin in suppressing blood vessel growth in mice
harboring matrigel
plugs. These effects on angiogenesis correlated
with down regulation of several important angiogenic factors. Further,
mice
with ovarian cancer tumors treated with anti-MMP-14
monotherapy showed a marked and sustained regression in tumor growth
with
decreased angiogenesis compared to IgG treated
controls. In a model of advanced peritoneal ovarian cancer,
MMP-14-dependent
invasion and metastasis was effectively inhibited
by intraperitoneal administration of monoclonal MMP-14 antibody.
Together,
these studies provide a preclinical
proof-of-concept for MMP-14 targeting as an adjuvant treatment strategy
for advanced ovarian
cancer.
- Received April 19, 2012.
- Revision received January 11, 2013.
- Accepted February 7, 2013.
open access: Small cell ovarian carcinoma: genomic stability and responsiveness to therapeutics (in mice)
Abstract (provisional)
Background
The biology of small cell ovarian carcinoma of the hypercalcemic type (SCCOHT), which
is a rare and aggressive form of ovarian cancer, is poorly understood. Tumourigenicity,
in vitro growth characteristics, genetic and genomic anomalies, and sensitivity to
standard and novel chemotherapeutic treatments were investigated in the unique SCCOHT
cell line, BIN-67, to provide further insight in the biology of this rare type of
ovarian cancer.
Conclusions
These results show that SCCOHT differs from high-grade serous carcinomas by exhibiting
few chromosomal anomalies and lacking TP53 mutations. Although BIN-67 cells are resistant
to standard chemotherapeutic agents, their sensitivity to oncolytic viruses suggests
that their therapeutic use in SCCOHT should be considered.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
More Research, More Responsibility: The Expansion of Duty to Warn in Cancer Patients Considering Fertility Preservation
ScienceDirect.com - American Journal of Obstetrics and Gynecology - More Research, More Responsibility: The Expansion of Duty to Warn in Cancer Patients Considering Fertility Preservation
Abstract
Reproductive
technology is advancing at a steadfast pace. Researchers are
successfully refining options for fertility preservation, to the benefit
of the cancer community. Research has consistently shown cancer
patients and survivors desire to have risks to fertility and
preservation options disclosed, and major campaigns have been undertaken
to refer these patients to fertility specialists. However, the decision
to pursue fertility preservation is not an isolated judgment. A variety
of future decisions may arise for the individual or couple, choices
that may not have been relayed during the initial decision-making
process. Future decisions include the length of time to continue to
store frozen gametes, donating banked gametes to infertile couples, and
whether embryos created with one partner would be accepted by a new
partner. It is important to continue the advancement of fertility
preservation not only in the scientific milieu, but also in addressing a
patient’s preparedness for long-term decision making
The 2011 Duty-Hour Requirements — A Survey of Residency Program Directors — NEJM (patient safety)
The 2011 Duty-Hour Requirements — A Survey of Residency Program Directors — NEJM
"....Although program directors supported the 80-hour workweek, the maximum frequency of in-house call, and mandatory off-duty time, they opposed limiting first-year residents to 16-hour shifts.2 Residents expressed greater concern than program directors, fearing potential negative effects on quality of care, as well as resident education, experience, and preparedness for senior roles.....
" More detailed study of the effects of fatigue and work hours on patient outcomes, “near misses,” and medical errors is also warranted. The results of these studies should be considered in future revisions of the Common Program Requirements and in the implementation of the Next Accreditation System."
Putting carcinogens into context: understanding the International Agency for Research on Cancer’s ratings
Putting carcinogens into context: understanding the International Agency for Research on Cancer’s ratings (Feb. 2013)
Increasingly,
when a new substance is identified as a carcinogen, it becomes a major
news story. For example, when radiofrequency electromagnetic fields were
classified as a possible carcinogen, it raised many questions about
whether cell phones are safe to use. Understanding the range of
classifications and the meanings behind them can help put these stories
in context......
Overcoming chemotherapy resistance of ovarian cancer cells by liposomal cisplatin: Molecular mechanisms unveiled by gene expression profiling
ScienceDirect.com - Biochemical Pharmacology - Overcoming chemotherapy resistance of ovarian cancer cells by liposomal cisplatin: Molecular mechanisms unveiled by gene expression profiling
"...This sheds new light on liposomal drug carrier approaches in cancer and suggests liposomal CDDP as promising strategy for the treatment of CDDP resistant ovarian carcinomas."
OPEN ACCESS: Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts -- Vasen et al. -- Gut
Published Online First 13 February 2013
Blogger's Note: reference gyn cancers including prophylatic surgery/primary peritoneal eg. per selected examples quote; read full paper full scope
~~~~~~~~~~~~~
"Question no 3
How effective is surveillance for endometrial and ovarian cancer?
Relevant literature
In LS, the risk of developing EC is very high and equals or even exceeds the risk of CRC in female gene carriers.49"....."....Since that review, another retrospective study was published on the impact of gynaecological screening in MSH2 carriers (n=54).57....
~~~~~~~~~~~~~~~~
Cancer of the urinary tract
"Many studies have reported an increased risk of urothelial cancers of the upper urinary tract in LS. Recent studies have also
demonstrated an increased risk of bladder cancer.18 ,19 ,75 The estimated risk varies from 5% to 20%, with the highest risk in male carriers and those with an MSH2 mutation. The risk for non-urothelial tumours was not increased.
The classic presenting sign of urothelial tumours is haematuria (hematuria) without pain.......__________________________________________________
The Association Between Frequency of Self-Reported Medical Errors and Anesthesia Trainee Supervision: A Survey of United States Anesthesiology Residents-in-Training.
OvidPPV - Abstract: Anesthesia & Analgesia, Volume Publish Ahead of Print() February 13, 2013 p The Association Between Frequency of Self-Reported Medical Errors and Anesthesia Trainee Supervision: A Survey of United States Anesthesiology Residents-in-Training.
CONCLUSIONS:
Anesthesiology trainees who reported a greater incidence of medical errors with negative consequences to patients and drug errors also reported lower scores for supervision by faculty. Our findings suggest that further studies of the association between supervision and patient safety are warranted.
Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship (eg. BRCA2)
Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship:
Background
The causes, optimal treatments, and medical/psychosocial sequelae of breast cancer in men are poorly understood.
Design
A systematic review of the English language literature was conducted to identify studies relevant to male breast cancer between 1987 and 2012 and including at least 20 patients. Searches were carried out on PubMed using the title terms ‘male breast cancer’ or ‘male breast carcinoma’.
Results
Relevant published data regarding risk factors, biological characteristics, presentation and prognosis, appropriate evaluation and treatment, and survivorship issues in male breast cancer patients are presented. BRCA2 mutations, age, conditions that alter the estrogen/androgen ratio, and radiation are proven risk factors. Disease biology is distinct in men, but diagnostic approaches and treatments for men are generally extrapolated from those in women due to inadequate research in men. Survivorship issues in men may include sexual and hormonal side-effects of endocrine therapies as well as unique psychosocial impacts of the disease.
Conclusion
Further research is needed to address gaps in knowledge pertaining to care of male breast cancer patients and survivors.
Fraudulent Data May Have Led to Use of Risky Treatment in ICUs - MedicineNet
Fraudulent Data May Have Led to Use of Risky Treatment in ICUs - MedicineNet
TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.
At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.
"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review............
Primary Peritoneal Cancer in Lynch Syndrome: A Clinical–Pathologic Report of a Case and Analysis of the Literature
Abstract
Lynch syndrome is a genetic disease, caused by a
germ-line mutation in a mismatch repair gene (MLH1/MSJ2/MSH6/PMS2) , related to an increased
risk of developing colorectal and extracolonic cancer. Despite that, the
incidence of primary peritoneal cancer after adnexectomy remains
unknown. We here report a case of primary peritoneal cancer in a woman
affected by Lynch syndrome who underwent
hysterectomy+salpingo-oophorectomy for endometrial cancer 13 yr before.
Morphology and immunophenotype allowed to differentiate peritoneal
malignancy from the previously diagnosed endometrial carcinoma.
Physicians should be aware of the potential risk of primary peritoneal
cancer in women affected by Lynch syndrome, despite previous
prophylactic surgery.
Wednesday, February 20, 2013
open access: Outcomes in Ovarian Cancer among Hispanic Women Living in the United States: A Population-Based Analysis
Abstract
Introduction
Ovarian cancer is the deadliest gynecologic cancer in the United States. There is limited data on presentation and outcomes among Hispanic women with ovarian cancer.
Objective.
To investigate how ovarian cancer presents among Hispanic women in the USA and to analyze differences in presentation, staging, and survival between Hispanic and non-Hispanic women with ovarian cancer.
Methods
Data from January 1, 2000 to December 31, 2004 were extracted from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. Results. The study sample comprised 1215 Hispanics (10%), 10 652 non-Hispanic whites (83%), and 905 non-Hispanic blacks (7%). Hispanic women were diagnosed with ovarian cancer at a younger age and earlier stage when compared to non-Hispanic whites, non-Hispanic blacks.......
".....The current study has several limitations that must be considered when interpreting the results. First, the use of the SEER database as our source of patients lacks external validity. The SEER database only represents 14% of the USA population. The configuration of the SEER data set does not allow stratification of different Hispanic subgroups in order to evaluate whether the diagnosis of ovarian cancer at a younger age is a Hispanic characteristic or whether it is more strongly related to the subethnicity within the Hispanic community. There is incomplete followup, and also, the self-reporting of race and ethnicity may be subjective. The information in the SEER database does not provide information on provider specialization.
Resilience Chapter 8 - About Ovarian Cancer Australia - YouTube
Resilience Chapter 8 - About Ovarian Cancer Australia - YouTube
Published on Feb 7, 2013
Resilience is a free support guide
and personal record for Australian women diagnosed with ovarian cancer.
The guide and DVD includes information on diagnosis, treatment,
well-being, support for women, their partners family and friends. Also
includes practical information and details about additional support
resources. To order or for more information on ovarian cancer, please
call (in Australia) 1300 660 334 or online at www.ovariancancer.net.au
This eighth chapter of Resilience provides an overview of Ovarian Cancer Australia
This eighth chapter of Resilience provides an overview of Ovarian Cancer Australia
Acrylamide hemoglobin adduct levels and ovarian cancer risk: a nested case-control study
Abstract
Background: Acrylamide is a probable human carcinogen formed during cooking of starchy foods. Two large prospective cohort studies of dietary acrylamide intake and ovarian cancer risk observed a positive association, although two other studies reported no association.....We used logistic regression models to examine the association between acrylamide exposure and ovarian cancer risk, adjusting for matching factors, family history of ovarian cancer, tubal ligation, oral contraceptive use, body mass index (BMI), parity, alcohol intake, smoking, physical activity, and caffeine intake.....
Conclusions: We observed no evidence that acrylamide exposure as measured by adducts to hemoglobin is associated with an increased risk of ovarian cancer.
Impact: Our finding indicates that acrylamide intake may not increase risk of ovarian cancer.
Serum tumor markers and PET/CT imaging for tumor recurrence detection (ovarian/breast/colorectal/CA125....)
Abstract
"When
confronted with a suspicious rise in CA 15.3 in asymptomatic breast
cancer patients following primary treatment and negative or equivocal
conventional imaging findings, FDG PET/CT allows assessment of the site
and extent of the recurring disease with an accuracy of 83 %. Both FDG
PET and FDG PET/CT are superior when compared to CT alone for the
purpose of recurrence detection in patients suffering from ovarian
carcinoma who have completed primary therapy but demonstrate a rising
serum CA-125 level. As the global accuracy of CT alone for detection of
recurrence of ovarian cancer approximates 80 %, CT scan should be
performed upfront to identify the site of recurrence. When confronted
with negative or equivocal CT findings, FDG PET alone or FDG PET/CT
should be added. In patients with rising serum CEA levels that have
undergone primary treatment for a colorectal carcinoma, both FDG PET and
FDG PET/CT allow detection of tumor recurrence with an accuracy of
95 %, well above that of CT and MRI. Available studies further suggest
that FDG/PET findings will affect treatment management in 28-50 % of
these patients. The detection rate of both 11C-choline and 18F-choline
PET and PET/CT for local, regional, and distant recurrence in prostate
carcinoma patients with a biochemical recurrence increases with rising
PSA value at the time of imaging and reaches about 75 % in patients with
PSA >3 ng/mL. Furthermore, PET and PET/CT with [(11)C]- and
[(18)F]-choline derivates may be helpful in the clinical setting for
optimization of individualized treatment."
A potentially neuroprotective role for erythropoietin with paclitaxel treatment in ovarian cancer patients: a prospective phase II GINECO trial
Abstract
PURPOSE:
A prospective phase II multicenter study was performed in two steps in paclitaxel-treated ovarian cancer patients in France. A French version of the four-item Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire was validated. This was then used to evaluate neurotoxicity in relation to erythropoietin treatment.METHODS:
Patients received standard second-line paclitaxel-based chemotherapy and erythropoietin for anemia. Neurotoxicity and hemoglobin levels were evaluated every cycle with the FACT/GOG-Ntx and NCI-CTCAE. The translated questionnaire was tested in 20 patients to confirm the translation accuracy. The final questionnaire was validated in 98 patients with internal consistency (Cronbach's coefficient) and item correlation (Pearson's r coefficient) tests. Neurotoxicity severity was analyzed according to erythropoietin intake (first three cycles versus no or late intake) and correlated with anemia.RESULTS:
Patients received a median of six paclitaxel cycles (range 1-9). Neurotoxicity was validated in 484 questionnaires. Internal consistency was excellent with Cronbach's coefficients of ≥0.89 at inclusion, after 3 cycles and at study end. Inter-question correlation was high with Pearson's coefficients of 0.65-0.85. FACT/GOG-Ntx and NCI-CTCAE severity scoring was similar. Globally, the incidence of severe neurotoxicity (FACT/GOG-Ntx and NCI-CTCAE) was found significantly higher in patients with severe anemia. Of 98 evaluable patients, 31 received erythropoietin during the first three cycles. Mean hemoglobin level was significantly lower in this group from baseline to cycle 4; however, these anemic patients with early EPO intake did not develop an increase rate of severe neurotoxicity.CONCLUSIONS:
The French FACT/GOG-Ntx questionnaire is a reliable and valid tool for assessing chemotherapy-induced neuropathy. This study raises the possibility that erythropoietin might play a neuroprotective role when administered with paclitaxel.Role of new endoscopic techniques in Lynch syndrome
Abstract
Lynch syndrome, or
hereditary nonpolyposis colorectal cancer (HNPCC), is the most common
hereditary condition predisposing for colorectal cancer. International
guidelines recommend surveillance of the colorectum by colonoscopy every
1-2 years starting at the age of 20-25 years. This has been shown to
reduce the incidence of, and mortality due to colorectal cancer. Aim of
this review was to determine the current role of new endoscopic
techniques, such as narrow-band imaging, autofluorescence endoscopy and
chromoendoscopy in the surveillance of Lynch syndrome. So far, six
studies have been published in which the new endoscopic techniques were
investigated in Lynch syndrome: narrow-band imaging (n = 1),
autofluorescence endoscopy (n = 1) and chromoendoscopy (n = 4). At this
moment, none of the new endoscopic techniques have shown clear and
convincing superiority over conventional white light colonoscopy in
Lynch syndrome subjects. Of these three techniques, chromoendoscopy
appears to be the most promising new endoscopic technique in aiding in
the detection of neoplastic lesions in Lynch syndrome, although further
prospective studies are needed.
open access: British Journal of Cancer - Cancer heterogeneity: implications for targeted therapeutics
British Journal of Cancer - Cancer heterogeneity: implications for targeted therapeutics
Clinico-pathological heterogeneity and its molecular basis
"Morphological
variation between different regions of a tumour has long been familiar
to histopathologists. For this reason, it is routine for pathologists to
examine multiple sections from the same tumour, but to report only the
highest grade. Nuclear pleomorphism is another example of intra-tumour
heterogeneity, which is accounted for in breast cancer grading. It is
also readily apparent to those clinicians treating cancer that there is
marked variation in tumour behaviour between patients with the same
tumour type, and between different tumour sites in the same patient; the
latter is usually manifested as differential or mixed responses to
therapy (Figure 1).
the Oncologist: Publicly Funded Clinical Trials and the Future of Cancer Care
Blogger's Note: this journal is subscriber-based for full access
Publicly Funded Clinical Trials and the Future of Cancer Care
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