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Wednesday, April 24, 2013
HER2 Amplification and Clinicopathological Characteristics in a Large Asian Cohort of Rare Mucinous Ovarian Cancer
open access
Mucinous epithelial ovarian cancer has a poor prognosis in the advanced stages and responds poorly to conventional chemotherapy. We aim to elucidate the clinicopathological factors and incidence of HER2 expression of this cancer in a large Asian retrospective cohort from Singapore. Of a total of 133 cases, the median age at diagnosis was 48.3 years (range, 15.8–89.0 years), comparatively younger than western cohorts. Most were Chinese (71%), followed by Malays (16%), others (9.0%), and Indians (5%). 24% were noted to have a significant family history of malignancy of which breast and gastrointestinal cancers the most prominent. Majority of the patients (80%) had stage I disease at diagnosis. Information on HER2 status was available in 113 cases (85%). Of these, 31 cases (27.4%) were HER2+, higher than 18.8% reported in western population. HER2 positivity appeared to be lower among Chinese and higher among Malays patients (p = 0.052). With the current standard of care, there was no discernible impact of HER2 status on overall survival. (HR = 1.79; 95% CI, 0.66–4.85; p = 0.249). On the other hand, positive family history of cancer, presence of lymphovascular invasion, and ovarian surface involvements were significantly associated with inferior overall survival on univariate and continued to be statistically significant after adjustment for stage. While these clinical factors identify high risk patients, it is promising that the finding of a high incidence of HER2 in our Asian population may allow development of a HER2 targeted therapy to improve the management of mucinous ovarian cancers.......
Ovarian Cancer: In Search of Better Marker Systems Based on DNA Repair Defects
Abstract: Ovarian
cancer is the fifth most common female cancer in the Western world, and
the deadliest gynecological malignancy. The overall poor prognosis for
ovarian cancer patients is a consequence of aggressive biological
behavior and a lack of adequate diagnostic tools for early detection. In
fact, approximately 70% of all patients with epithelial ovarian cancer
are diagnosed at advanced tumor stages. These facts highlight a
significant clinical need for reliable and accurate detection methods
for ovarian cancer, especially for patients at high risk. Because CA125
has not achieved satisfactory sensitivity and specificity in detecting
ovarian cancer, numerous efforts, including those based on single and
combined molecule detection and “omics” approaches, have been made to
identify new biomarkers. Intriguingly, more than 10% of all ovarian
cancer cases are of familial origin. BRCA1 and BRCA2 germline
mutations are the most common genetic defects underlying hereditary
ovarian cancer, which is why ovarian cancer risk assessment in developed
countries, aside from pedigree analysis, relies on genetic testing of BRCA1 and BRCA2. Because not only BRCA1 and BRCA2
but also other susceptibility genes are tightly linked with ovarian
cancer-specific DNA repair defects, another possible approach for
defining susceptibility might be patient cell-based functional testing, a
concept for which support came from a recent case-control study. This
principle would be applicable to risk assessment and the prediction of
responsiveness to conventional regimens involving platinum-based drugs
and targeted therapies involving poly (ADP-ribose) polymerase (PARP)
inhibitors.
The Molecular Fingerprint of High Grade Serous Ovarian Cancer Reflects Its Fallopian Tube Origin
Abstract: High
grade serous ovarian cancer (HGSC), the most lethal and frequent type
of epithelial ovarian cancer (EOC), has poor long term prognosis due to a
combination of factors: late detection, great metastatic potential and
the capacity to develop resistance to available therapeutic drugs.
Furthermore, there has been considerable controversy concerning the
etiology of this malignancy. New studies, both clinical and molecular,
strongly suggest that HGSC originates not from the surface of the ovary,
but from the epithelial layer of the neighboring fallopian tube
fimbriae. In this paper we summarize data supporting the central role of
fallopian tube epithelium in the development of HGSC. Specifically, we
address cellular pathways and regulatory mechanisms which are modulated
in the process of transformation, but also genetic changes which
accumulate during disease progression. Similarities between fallopian
tube mucosa and the malignant tissue of HGSC warrant a closer analysis
of homeostatic mechanisms in healthy epithelium in order to elucidate
key steps in disease development. Finally, we highlight the importance
of the cancer stem cell (CSC) identification and understanding of its
niche regulation for improvement of therapeutic strategies.
open access: Review Article - Recurrent Epithelial Ovarian Cancer: an Update on Treatment (Apr 15, 2013)
Blogger's Note: requires registration to view (free)
REVIEW ARTICLE
"We conducted a systematic review using the MEDLINE database, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1979 through July 2012.
Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Recent abstracts of research presented at symposia
and scientific conferences were also considered."
"This review will focus on the medical treatment, specifically chemotherapy options, available for women with recurrent ovarian cancer."
(case report) Active Shingles Infection as Detected on 18F-FDG PET/CT | Frontiers in Cancer Imaging and Diagnosis
Active Shingles Infection as Detected on 18F-FDG PET/CT
"....Discussion
Varicella zoster (shingles) is a common but serious
infection in immunocompromised patients, especially in those with
deficient cell-mediated immunity. However, it is often effectively
prophylaxed with antivirals in these patients. The infection typically
manifests as a painful rash often limited to a skin dermatome but can
spread causing more serious complications and become life threatening.
Active infection will show increased metabolic activity in the
inflammatory cells on FDG PET images......
Management of keloids and hypertrophic scars: current and emerging opt
open access
Abstract
In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations.
Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients (Netherlands)
open access
Viewing options
- Abstract
- Provisional PDF (612KB)
We developed a questionnaire that measures the importance of aspects and the experiences of all types of cancer patients based on quality aspects formulated by patients. We showed known and new quality aspects that are very important to patients, the experiences of patients
with respect to these aspects, and that differences exist in experiences between people with different tumour types. After testing for discriminatory power our questionnaire can be used nation-wide to measure quality of cancer care from the patient perspective and to identify differences in the experiences of patients in different hospitals. Finally, in contrast to most previously developed questionnaires, our questionnaire makes a distinction between care provided by doctors and by nurses.
Lead In Rice Study Retracted; Truth About Heavy Metals In Rice
press release
CULVER CITY, Calif., April 23, 2013 /PRNewswire/ -- On April 11, 2013, Dr. Tsananagurayi Tongesayi of Monmouth University presented a study at the American Chemical Society announcing that "rice from Asia, Europe and South America had 20-60 times higher toxic levels of lead than is allowed by the Food & Drug Administration." The news caused an international uproar, as breaking news outlets from BBC to TIME magazine issued reports. On April 19th, Dr. Tongesayi admitted he was having an "issue" with his measuring instruments and recalled his paper. Consumers remain unaware of the flawed nature of the study. World rice expert, David Janow , sets the record straight to quell consumer's fears about rice.....
(worth reading) From P0 to P6 medicine, a model of highly participatory, narrative, interactive, and “augmented” medicine (patient/social media/cure)
Blogger's Note/Opinion: worth reading; not related specifically to ovarian cancer but to a patient's progressive social media action
open access
"... Involving patients in the health care process is an added value, as patients have a unique knowledge of their own health status:1 this is the so-called theory of the “expert patient,” that is to say a model of a patient that knows himself/herself better than a physician could, and one who has a tacit and implicit knowledge of his/her disease could more properly interact with the physician and take part in each step of the therapeutic process.2,3 In fact, shared medical decisions have been proven to result in better therapeutic compliance and clinical outcomes.2–4........However, mere consultation is often mistaken for negotiating and interactive partnership, and thus the patient still holds a passive role.8.......
"Salvatore Iaconesi is a talented computer scientist and a skilled and polyvalent artist who was abruptly diagnosed with a brain tumor, and from one day to another he found himself experiencing the tragic odyssey of cancer.16 Since “my tumor is also an opportunity” (as other oncology patients have said in their narrative stories),17,20 and since computers and art are all integral to his life, he surprisingly decided to share his medical records with everybody on his website.21 However, his clinical records were in a proprietary format file, so he had to crack them as a hacker. Like an open-source software that is easily available on the public domain, users can freely download, edit, or reuse these records; he thus wanted to make his cure an “open-source cure.” Not only doctors, but literally everybody, can consult his data, grab information on his disease, share his pain, and even find him a cure.....
Independent contributors to overall quality of life in people with advanced cancer
Abstract
Background:
The
definition of health for people with cancer is not focused solely on
the physiology of illness and the length of life remaining, but is also
concerned with improving the well-being and the quality of the life
(QOL) remaining to be lived. This study aimed to identify the constructs
most associated with QOL in people with advanced cancer.
Methods:
Two
hundred three persons with recent diagnoses of different advanced
cancers were evaluated with 65 variables representing individual and
environmental factors, biological factors, symptoms, function, general
health perceptions and overall QOL at diagnosis.
Results:
The
most important contributor of overall QOL for people recently diagnosed
with advanced cancer was social support. It was followed by general
health perceptions, energy, social function, psychological function and
physical function.
Conclusions:
The
findings emphasise the importance of incorporating the assessment and
treatment of relevant symptoms, functions and social support in people
recently diagnosed with advanced cancer as part of their clinical care.
Tuesday, April 23, 2013
Another Compounding Company Recalls All Sterile Product
Medscape
"......The problems and product recall involving Balanced Solutions comes on the heels of recalls at 3 other compounding pharmacies because of similar problems and concerns over sterility of products. As previously reported by Medscape Medical News, those companies are ApothéCure Inc and NuVision and Green Valley Drugs. .........
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Consumer Updates > FDA Wants You to Get Involved
Consumer Updates
"....Phase 3 is the FDA Patient Network website, to launch the week of April 22, 2013. The website is an interactive tool for educating patients, patient advocates and consumers on how their medications and medical devices go from idea to the shelf.
FDA launched the site to engage patients and consumers as partners, and encourage them to share ideas and concerns about the medical product development process.
"When it comes to FDA's regulatory process, we feel very strongly patients should have a say," notes Klein. "The new website provides an excellent place to start."
According to Klein, consumers have complained that they find it difficult to locate the information they need on the agency's website, and when they do, it is targeted for industry use.........
Evaluation of Optimal Treatment With Bevacizumab in Patients With Platinum-sensitive Recurrent Ovarian Cancer - Scottish Gyn Cancer Study Group
Full Text View - ClinicalTrials.gov
This study is not yet open for participant recruitment.
Verified April 2013 by AGO Research GmbH
Sponsor:
AGO Research GmbH
Collaborators:
Arbeitsgemeinschaft Gynaekologische Onkologie Austria
ARCAGY/ GINECO GROUP
ANZGOG
Scottish Gynaecological Cancer Study Group
Information provided by (Responsible Party):
AGO Research GmbH
Press Release: CDMRP Research Funding for 2013, Congressionally Directed Medical Research Program
Press Release: CDMRP Research Funding for 2013
NEWS RELEASE
Department of Defense
United States Army Medical Research Materiel Command
Congressionally Directed Medical Research Programs
Released: April 12, 2013
CDMRP Research Funding for 2013
The Fiscal Year 2013 Department of Defense Appropriations Act provides research funding for the following peer reviewed programs managed by the Department of Defense (DoD) office of Congressionally Directed Medical Research Programs (CDMRP):- Amyotrophic Lateral Sclerosis Research Program - $7.5 million
- Autism Research Program - $6 million
- Bone Marrow Failure Research Program - $3.2 million
- Breast Cancer Research Program - $120 million
- Duchenne Muscular Dystrophy Research Program - $3.2 million
- Gulf War Illness Research Program - $20 million
- Lung Cancer Research Program - $10.5 million
- Multiple Sclerosis Research Program - $5 million
- Neurofibromatosis Research Program - $15 million
- Ovarian Cancer Research Program - $20 million
- Peer Reviewed Cancer Research Program - $15 million
- Peer Reviewed Medical Research Program - $50 million
- Peer Reviewed Orthopaedic Research Program - $30 million
- Prostate Cancer Research Program - $80 million
- Spinal Cord Injury Research Program - $30 million
- Tuberous Sclerosis Complex Research Program - $6 million
Requests for e-mail notification of the Program Announcement releases may be sent to help@cdmrp.org.
After the Program Announcement is released and prior to the deadline, a Pre-Application is required, and must be submitted through the CDMRP eReceipt website (https://cdmrp.org). Some required forms can also be found on this website. Full applications must be submitted through the Grants.gov website (http://www.grants.gov).
If further funding opportunities become available, additional announcements will be released on the CDMRP website. For more information about the CDMRP, previous awardees and Program Announcements, as well as other CDMRP-sponsored Programs and research highlights and videos, please visit the website at http://cdmrp.army.mil.
clinical trial: Official Title: “The Impact of Emergency Physician Empathy on Litigation Propensity”
Blogger's Note: of particular interest to Patient Safety communities
Official Title: “The Impact of Emergency Physician Empathy on Litigation Propensity” clinical trial
Can we test for hereditary cancer at 18 years when we start surveillance at 25? Patient reported outcomes (Lynch Syndrome/BRCA)
Abstract
DNA-testing
for BRCA1/2 or Lynch syndrome is possible from the age of 18 years,
although surveillance usually starts at 25. Some patients regret their
decision of testing before age 25. This retrospective study evaluates
whether the testing age should be above 25 years to prevent adverse
effects such as regret or decisional conflict, by determining the
percentage and characteristics of patients reporting these problems. 111
of 219 patients (51 %) tested for BRCA1/2 mutations or Lynch syndrome
between 18 and 25 years from July 1996 to February 2011, returned
self-report surveys. Primary measures were regret, decisional conflict
and family influence. Secondary measures included quality of life (QoL),
coping style, impact of genetic testing, and risk perception. Median
age was 27 [21-40] years, with 86 % female. 73 % was tested for BRCA1/2,
27 % for Lynch syndrome. Only 3 % reported regret, however 39 % had
moderate (32 %) to severe (7 %) decisional conflict. Regression analysis
revealed that decisional conflict was associated with more
monitoring/neutral coping style (p < 0.03) or paternal/no family
mutation (p < 0.02); there were no differences in QoL, impact or risk
perception. 42 % were mutation carriers, showing equal decisional
conflict to non-carriers. 68 % would recommend testing <25 years;
77 % desired surveillance <25 years if a mutation carrier. Almost no
patient tested for hereditary cancer
between 18 and 25 years regretted this decision. A third reported
retrospective decisional conflict, especially those actively seeking
information when faced with a threat and/or those with a paternal or
unknown inheritance. These patients may benefit from decisional support
and personalized information.
Assessing information and service needs of young adults with cancer at a single institution: the importance of information on cancer diagnosis, fertility preservation, diet, and exercise
Abstract
CONCLUSIONS:
YA's have clear supportive care preferences and needs. Developing programs that incorporate the services identified as important should improve quality of life, psychosocial adjustment, and other outcomes during and after cancer therapy.
Ovarian fibroma/fibrothecoma: Retrospective cohort study shows limited value of risk of malignancy index score
Abstract
Background
Ovarian
fibromas/fibrothecomas are uncommon benign tumours of ovary. Due to
their solid structure, these benign tumours are sometimes confused with
malignant tumours during clinical evaluation.
Aims
To
determine the clinico-pathological characteristics of ovarian
fibroma/fibrothecoma and analyse the efficiency of risk of malignancy
index (RMI) scoring system to distinguish malignancy among these
tumours.
Methods
Between
November 2001 and February 2012, women with a pathological diagnosis of
ovarian fibroma/fibrothecoma were identified. Depending on the
menopausal status, serum CA-125 level and ultrasonographic findings, RMI
scores were calculated for each of the patients.
Results
During
the study period, 43 ovarian fibroma/fibrothecoma (4.7%) were detected
among 912 adnexal masses operated. The mean age of the women was 52.2
(range, 21–80 years). Upon calculating RMI scores, 33 women (76.7%) were
classified as low risk and 10 women (23.3%) as high risk for
malignancy. Sensitivity, specificity, positive predictive value and
negative predictive value of the RMI scoring for identification of
malignant lesions preoperatively were found as 0%, 76%, 0% and 97%,
respectively. Final pathological diagnosis was ovarian fibroma in 13
(30%) women, fibrothecoma in 29 (67%) and fibrosarcoma in one woman
(2%).
Conclusion
There
are no specific markers for accurate preoperative diagnosis of ovarian
fibroma/fibrothecoma. Moreover, according to our results, RMI scoring
system does not aid clinicians in this issue either, with a high
false-positive rate and very low sensitivity. Further studies with
higher number of cases are needed to state clearly the role of RMI
scores in preoperative discrimination of malignancy.
open access: Risk of Cancer in Cases of Suspected Lynch Syndrome Without Germline Mutation
open access
Index
- Background & Aims
- Patients and Methods
- Results
- Discussion
- Acknowledgments
- Appendix. Study Participants: Members of the EPICOLON Consortium (Gastrointestinal Oncology Group of the Spanish Gastroenterological Association)
- Supplementary Material
- References
Table 2. Characteristics and Family History of Patients With LLS
| Patient | Protein lost | Age of index case (y) | No. of relatives with CRCa (n = 14) | No. of relatives with noncolorectal LSRCb (n = 8) | Total no. of first-degree relatives (n = 177) | Cases of CRC (%)c | Cases of noncolorectal LSRC (%)d |
|---|---|---|---|---|---|---|---|
| 1 | PMS2 | 71 | 0 | 1 (pancreas) | 10 | 0 | 10 |
| 2 | MLH1/PMS2 | 81 | 0 | 0 | 9 | 0 | 0 |
| 3 | MLH1/PMS2 | 73 | 0 | 0 | 7 | 0 | 0 |
| 4 | MLH1/PMS2 | 75 | 1 | 1 (stomach) | 7 | 14.2 | 14.2 |
| 5 | MLH1/PMS2 | 45 | 3 | 1 (ovary) | 10 | 30 | 10 |
| 6 | MSH2/MSH6 | 38 | 0 | 0 | 5 | 0 | 0 |
| 7 | MSH2/MSH6 | 74 | 0 | 0 | 6 | 0 | 0 |
| 8 | MSH2/MSH6 | 32 | 2 | 0 | 3 | 66.6 | 0 |
| 9 | MLH1/PMS2 | 72 | 2 | 3 (uterus) | 11 | 18.1 | 27.2 |
| 10 | MLH1/PMS2 | 51 | 0 | 0 | 4 | 0 | 0 |
| 11 | MLH1/PMS2 | 46 | 1 | 1 (pancreas) | 3 | 33.3 | 33.3 |
| 12 | MSH2/MSH6 | 69 | 1 | 0 | 9 | 11.1 | 0 |
| 13 | MSH6 | 55 | 0 | 0 | 6 | 0 | 0 |
| 14 | MSH6 | 56 | 0 | 0 | 4 | 0 | 0 |
| 15 | MLH1/PMS2 | 72 | 1 | 0 | 7 | 14.2 | 0 |
| 16 | MSH2/MSH6 | 69 | 0 | 0 | 5 | 0 | 0 |
| 17 | MSH2/MSH6 | 66 | 0 | 1 (stomach) | 6 | 0 | 16.6 |
| 18 | MSH2/MSH6 | 66 | 0 | 0 | 9 | 0 | 0 |
| 19 | MLH1/PMS2 | 63 | 1 | 0 | 8 | 12.5 | 0 |
| 20 | MLH1/PMS2 | 46 | 0 | 0 | 11 | 0 | 0 |
| 21 | MLH1/PMS2 | 71 | 0 | 0 | 4 | 0 | 0 |
| 22 | MLH1/PMS2 | 69 | 1 | 0 | 12 | 8.3 | 0 |
| 23 | MLH1/PMS2 | 59 | 0 | 0 | 4 | 0 | 0 |
| 24 | MSH6 | 79 | 1 | 0 | 8 | 12.5 | 0 |
| 25 | MSH6 | 54 | 0 | 0 | 9 | 0 | 0 |
a
Number of first-degree relatives diagnosed with CRC at any time until diagnosis of the index case.
|
b
Number of first-degree relatives diagnosed with noncolorectal LSRC at any time until diagnosis of the index case.
|
c
Percentage of family members diagnosed with CRC at any time until diagnosis of the index case.
|
d
Percentage of family members diagnosed with noncolorectal LSRC at any time until diagnosis of the index case.
|
Clear Cell Carcinomas of the Ovary: A Multi-Institutional Study of 129 Cases in Korea With Prognostic Significance of Emi1 and Galectin-3
Abstract
"... On the basis of the fact that the expression of Emi1 in CCC was correlated with a high histologic grade and worse overall survival, target therapy using inhibitors of Emi1 may be tried in the management of CCC patients with Emi1 expression."
Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts -- Vasen et al. -- Gut
open access
Recommendation
Professionals should be
aware of the potential psychosocial problems before and after genetic
testing and during follow-up
and surveillance visits. People with
increased psychological distress should be offered referral to a
clinical psychologist.
All efforts should be made to make
colonoscopies as comfortable as possible by paying full attention to
adequate pain control
and sedation.
Table 5
Pros and cons of surveillance for gynaecological cancer
| Pros | Cons |
|---|---|
| Identification of precursor lesions of endometrial cancer | Small risk of death |
| Identification of early stage endometrial cancer (not proved) | Physical burden of surveillance examination especially Pipelle biopsy |
| No evidence of efficacy for early stage ovarian cancer detection | |
| Psychological burden |
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