Friday, March 13, 2009
Treatments of epithelial ovarian cancer by histological subtype
note specific reference to clear cell ovarian cancer international trial
Cumulative lifetime incidence of extracolonic cancers in Lynch Syndrome: a eport of 121 families with proven mutations
Cumulative risk for females of an extracolonic tumour is 47.4% (95% CI 43.9-50.8). The risk to males is 26.5% (95% CI 22.6-30.4). There was no reduction in gynaecological malignancies due to gynaecological screening (examination, transvaginal ultrasound scan, hysteroscopy and endometrial biopsy).
Thursday, March 12, 2009
Wednesday, March 11, 2009
Medical News: SGO: Novel Drug Combination Shows Promise in Advanced Ovarian Cancer - in Meeting Coverage, SGO from MedPage Today
Oxaliplatin (Eloxatin), Docetaxel (Taxotere) and Bevacizumab (Avastin)
CBC news report: Tests may detect ovarian cancer sooner: study
Comment: spniauskas
Posted 2009/03/11
at 3:42 PM ET
Dr Jacobs published a randomised trial in the Lancet in 1999. This study was again specific to screening/early detection of ovarian cancer. In this study, now a decade old, 22,000 women enrolled. The abstract can be viewed at: http://www.ncbi.nlm.nih.gov/pubmed/10217079?holding=ukpmc
or: http://tinyurl.com/alo2st
Similar results were found in that of the 22,000 in the prior study (1998), 468 women had an elevated CA125 with 6 actual detections of malignancy. The current study indicates that of the 50,000 women screened with a CA125, 38 were found to have a malignancy. Without having read the full paper recently published, but relying on the abstracts, it would seem the 1999 and 2009 results do not differ in any appreciable way. The only question I might have would be in any technological advances in the ultrasounds which were used. There are several issues here which will and have always impacted decision-making specific to ovarian cancer. One is based on the fact that a public screening (meaning all women) of the CA125 will not be adopted, such as the PSA, because the cost are too high and the results are two low. Even the PSA test for public screening has been debated widely over the years. Assuming patients symptoms are acknowledged and there is a suspicion of ovarian cancer then nothing really has changed as it is the responsibility of the health care professional to order the appropriate tests. This brings us back to the same issues we have faced in ovarian cancer (forever) and that is recognizing the symptoms, however, complicated this may be. Lastly, Australia/UK today are using a test called the HE4 which, when added to the CA125, apparently improves detection of ovarian cancer. It would be most interesting for someone to compare the 2 Jacob trials.
IGF2BP3 (IMP3) Expression Is a Marker of Unfavorable Prognosis in Ovarian Carcinoma of Clear Cell Subtype
"The same prognostic significance is shown and validated here for ovarian clear cell carcinomas, but not other subtypes of ovarian carcinoma, suggesting a unique role of IGF2BP3 in these morphologically similar tumors."
Tuesday, March 10, 2009
AcademyHealth Issues: Consumer Choice
also: 2009 Robert Wood Johnson Foundation - Increasing consumer engagement
http://www.rwjf.org/qualityequality/af4q/focusareas/consumer.jsp
Monday, March 09, 2009
Management of women with clear cell endometrial cancer: a SGO review
"It shares many similarities with clear cell neoplasms of the ovary and kidney."
Saturday, March 07, 2009
Medical societies' recommendations for immunization with HPV and disclosure of conflicts of interest
"One of the Canadian documents did not include any conflict of interest statement, although Merck and GSK are listed among the sponsors.
CONCLUSIONS: Disclosure of conflicts of interest in documents where medical societies issue recommendations on HPV vaccination is very unusual. However, lack of disclosure is more frequent (near twice) when recommendations are in favour of the vaccination."
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA 1 or BRCA 2 gene
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA1 or BRCA2 gene
note:in the absence of the full paper, a small study which confuses the issues/results by using actual numbers and then % results
Friday, March 06, 2009
Inequalities, patient safety, and waste : The Lancet Oncology
"Fragmented decision-making by government departments, agencies, and insurers, often working in isolation and without a common framework of objectives, is causing an increasingly unfair distribution of cancer services. In the current global recession, a root and branch re-evaluation of services, focused on patient-centred medicine rather than government or insurer-imposed medicine, would undoubtedly improve care for patients with cancer; reduce polarisation in accessibility; and possibly even shrink healthcare budgets."
Thursday, March 05, 2009
Genetic Risks: Should Physicians Inform Relatives?
Genetic Risks: Should Physicians Inform Relatives?
Do physicians have an obligation to disclose genetic-risk information to relatives, even without the consent of the patient?
Wednesday, March 04, 2009
Bodies and barriers : The Lancet Oncology - review
Bodies and barriers : The Lancet Oncology
"Take the preface to Whose Life is it Anyway? which informs us that “the hero's actions are an assertion of those contractual rights [between doctor and patient] viewed in terms of current philosophical arguments which hold that the dual principles of autonomy and contract keeping, conceptually linked, provide the sole moral foundation for clinical practice consistent with the social context in which the practice occurs”. I've read this sentence at least twelve times now, and I'm still no nearer to knowing what it means."
"Presented together, the plays form an intriguing whole, each focussed on a different aspect of medicine and mortality. “We are discussing life and death, and not in the abstract either”, explains Vivian Bearing.
They've done a fine job."
Tuesday, March 03, 2009
Cancer Cell - Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis - Sunitinib/SU11248
definition: orthotopic = in the normal position
Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis
John M.L. Ebos,Christina R. Lee,William Cruz-Munoz,Georg A. Bjarnason,James G. Christensen and Robert S. Kerbel1
Molecular and Cellular Biology Research, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 2M9, Canada
Sunnybrook Odette Cancer Centre, Toronto, ON M5G 2M9, Canada
Pfizer Global Research and Development, La Jolla Labs, La Jolla, CA 92121, USA
Summary
Herein we report that the VEGFR/PDGFR kinase inhibitor sunitinib/SU11248 can accelerate metastatic tumor growth and decrease overall survival in mice receiving short-term therapy in various metastasis assays, including after intravenous injection of tumor cells or after removal of primary orthotopically grown tumors. Acceleration of metastasis was also observed in mice receiving sunitinib prior to intravenous implantation of tumor cells, suggesting possible metastatic conditioning in multiple organs. Similar findings with additional VEGF receptor tyrosine kinase inhibitors implicate a class-specific effect for such agents. Importantly, these observations of metastatic acceleration were in contrast to the demonstrable antitumor benefits obtained when the same human breast cancer cells, as well as mouse or human melanoma cells, were grown orthotopically as primary tumors and subjected to identical sunitinib treatments.
Epithelial ovarian cancer: Does the time interval between primary surgery and postoperative chemotherapy have any prognostic importance?
Worldwide, much effort is used every day to perform optimal surgery in the treatment of epithelial ovarian cancer. Treatment of ovarian cancer is a combination of surgery with optimal debulking followed by chemotherapy. However, the optimal timing of postoperative chemotherapy for ovarian cancer remains poorly defined. The literature is made up of seven studies performed in different ways and which have included varying prognostic factors. The general supposition is that the time interval (TI) does not have a prognostic influence but experimental studies have shown that it does affect the prognosis of the cancer. This commentary focuses on the importance of the TI between surgery and postoperative chemotherapy in this horrible disease.
Steps and Time to Process Clinical Trials at the Cancer Therapy Evaluation Program
At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial.
Monday, March 02, 2009
Has pain management in cancer patients with bone metastases improved? A seven year review at an outpatient palliative radiotherapy clinic
Sunday, March 01, 2009
Selection Endometrial Carcinomas for DNA Mismatch Repair Protein IMHC Using Patient Age and Tumor Morphology Enhances Detection of MMR Abnormalities
- Am J Surg Pathol. 2009 Feb 20
- Women with hereditary nonpolyposis colorectal cancer (HNPCC) (Lynch Syndrome) have a high risk for endometrial cancer (EC) and frequently present with a gynecologic cancer as their first or sentinel malignancy. Identification of these patients is important given their personal and family risk for synchronous and metachronous tumors........... more frequent synchronous clear cell carcinomas of the ovary..........cont'd
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