It
is clear that the emergency department (ED) is a source of care for a
considerable portion of the population, including patients experiencing
acute and subacute effects of the underlying malignant disease or
perhaps adverse effects of treatment.1
For those with advanced disease and/or symptoms requiring prompt
palliation, it would seem intuitive to begin formal palliative care in
the ED. In fact, ED practitioners offer end-of-life care management.2
Saturday, May 14, 2016
case report: Acute pancreatitis induced by paclitaxel and carboplatin therapy in an ovarian cancer patient
Abstract
A 46-year-old female was treated with a regimen of paclitaxel and carboplatin (TC therapy) as adjuvant chemotherapy for Stage IC ovarian adenocarcinoma. There was no severe toxicity except for grade 3 neutropenia during the first four cycles of TC therapy. However, she developed acute pancreatitis at 14 days after fifth cycle. TC therapy is commonly associated with adverse effects such as myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy, but acute pancreatitis has rarely been reported. Ovarian cancer patients often present with nausea and abdominal pain, which are the same symptoms of pancreatitis. It is very important to keep in mind that acute pancreatitis may be concealed in these common symptoms of ovarian cancer during and after TC therapy. Because acute pancreatitis is fatal complication and quitting the drug usually leads to complete cure. The authors report an uncommon case in which TC therapy may have caused acute pancreatitis.
Novel Mutations in MLH1 and MSH2 Genes in Mexican Patients with Lynch Syndrome
open access
Conclusions. This is the first report of mutations in MMR genes in Mexican patients with LS and these appear to be novel.
recent comment: Ovarian Cancer and Us blog
[OVARIAN CANCER and US] New comment on Detection of the HE4 protein in urine as a biomark....
I’m inspired with the surpassing and preachy listing that you furnish in such little timing
Sandi Pniauskas responds:
preachy ? ?
definition: preach·y
ˈprēCHē/
having or revealing a tendency to give moral advice in a tedious or self-righteous way.
abstract: Review Management of malignant ascites in women with ovarian cancer
define: intractable
1. not easily controlled or directed; not docile or manageable; stubborn; obstinate:
an intractable disposition.
2. (of things) hard to shape or work with
3.hard to treat, relieve, or cure
abstract
Malignant ascites is one of the most common sequela of epithelial ovarian cancer. It causes significant symptoms and can have a detrimental impact on patient quality of life, especially in women with recurrent ovarian cancer. The management of symptomatic ascites consists of both mechanical treatments that aim to drain the peritoneal cavity, and medical therapies that prevent and diminish the development of ascites. Mechanical options include serial paracentesis, peritoneal catheters, and peritoneovenous shunts. Pharmaceutical treatments include diuretics, angiogenesis inhibitors, and other targeted agents. There is a perception, without formal analysis, that intractable ascites is less common in the taxane era of therapy. In this review paper, we highlight current and emerging therapeutic strategies, complications and contraindications, and their effects on patient quality of life.
Techniques to Resect the Distal Ureter in Robotic / Laparoscopic Nephroureterectomy
Blogger's Note: not specific to issue of patients with Lynch Syndrome eg. genetics - specific to types of surgeries
open access
While the nephrectomy part of the case is relatively straightforward, the management of the distal ureter and the bladder cuff has been a source of controversy for at least the past two decades. This is, in part, due to the advanced laparoscopic skills required to mobilize the distal ureter to the level of the bladder and reconstruct the bladder defect with laparoscopic suturing after excising the bladder cuff.
Diagnostic ureteroscopy for upper tract urothelial carcinoma is independently associated with intravesical recurrence after radical nephroureterectomy
Blogger's Note: not specific to Lynch Syndrome; view abstract for stats
Abstract
Objective
To
determine the effect of diagnostic ureteroscopy on intravesical
recurrence in patients with upper tract urothelial carcinoma (UTUC)
after radical nephroureterectomy (RNU).
Methods
We
conducted a retrospective analysis of 664 patients who were treated
with RNU for UTUC from June 2000 to December 2011, excluding those who
had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent
diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic
ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier
method. Univariate and multivariate analyses were used to determine the
independent risk factors.
Results
The
median follow-up time was 48 months: 31–77
months]. Patients who underwent ureteroscopy were more likely to have a
small, early-staged, multifocality and
ureteral tumor. IVR occurred in 223 patients during
follow-up within a median of 17 months (IQR: 7–33). Patients without
preoperative ureteroscopy have a statistically significant better 2-year and 5-year intravesical recurrence-free survival rates than patients who underwent ureteroscopy. In
multivariate analysis, the diagnostic ureteroscopy, multiple
tumors, tumor size <3 cm, low-grade and
pN0 stage tumor were independent predictors of IVR.
Conclusions
Diagnostic ureteroscopy is independently associated with intravesical recurrence after radical nephroureterectomy.
Two large randomised trials show ovarian cancer screening has minimal impact on survival - Johnson (no abstract requires subscription)rnal of Obstetrics
no abstract - requires $$ to view
Commentary
Two large randomised trials show ovarian cancer screening has minimal impact on surviv
Version of Record online: 13 MAY 2016
DOI: 10.1111/1471-0528.14052
© 2016 Royal College of Obstetricians and Gynaecologists
Issue
. Two large randomised trials show ovarian cancer screening has minimal impact on survival. BJOG 2016; DOI: 10.1111/1471-0528.14052.
- Version of Record online: 13 MAY 2016
- Manuscript Accepted: 29 JAN 2016
Self Reported Quality of Life Among Patients Who Have Undergone Outpatient IP Chemotherapy for Ovarian Cancer [11]. - PubMed - NCBI
abstract
Author information
- Winthrop-University Hospital, Mineola, NY.
INTRODUCTION:
To assess impact of outpatient intraperitoneal (IP) chemotherapy on quality of life (QOL).METHODS:
Cross sectional study of patients with optimally cytoreduced stage III and IV ovarian cancer who received IP chemotherapy between 2006 and 2011 at a single institution. A self administered, anonymous survey assessed 4 domains: physical health (PH), mental health (MH), social health (SH) and patient subjective sense of worth (WO) of IP chemotherapy.RESULTS:
Seventy-one participants were mailed surveys. 52 (73.2%) returned the survey, 4 were excluded (incomplete) and 48 (67.6%) were included in the final sample. Mean age was 62.4 (±10.3). Mean time from completion of chemotherapy was 30.8 months. In the PH domain, 50.0% reported that fatigue severely affected QOL. Other aspects were pain (39.6%), GI problems (37.5%) and "chemotherapy brain" (29.2%). In the MH domain, 25% reported significant stress and 20.8% experienced anxiety. In the SH domain, 27.5% reported therapy interfered with work. The majority (83.3%) reported the effectiveness of IP chemotherapy was "worth" the side effects, 95.8% did not regret it, and 87.5% would recommend it to a friend. Eleven patients had recurrent disease, of whom 90% indicated IP chemotherapy was worthwhile and none regretted the decision to receive this therapy.CONCLUSION/IMPLICATIONS:
IP chemotherapy has been shown to improve OS and PFS and yet is not universally prescribed. It is known to have more toxicities compared to IV chemotherapy. The present study suggests that while these side effects affect QOL, patients feel that the therapy is worthwhile and do not regret treatment.Post-Surgical Readmissions Among Women Undergoing Benign & Malignant Gynecologic Surgery
Blogger's Note: click on 'abstract' to view stats
abstract
Author information
- University of Pennsylvania, Philadelphia, PA.
INTRODUCTION:
To compare 30 day postoperative readmission rates and risk factors for readmission between women following benign and malignant gynecologic surgery.METHODS:
We identified patients following benign and malignant gynecologic surgery in the National Surgical Quality Improvement Program database from 2006-2012. Data collected included surgical procedure, operative time, 30-day readmission, co-morbidities, pre-operative condition and serious postoperative morbidity. Standard statistical analyses were performed.RESULTS:
5% (654/13,093) versus 1.75% (375/21,331) of patients who underwent surgery for malignant and benign indications, respectively, were readmitted (P<.001).Is FDA Approved Bevacizumab Cost-Effective in the Setting of Platinum-Resistant Recurrent Ovarian Cancer?
Bevacizumab
Author information
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX.
INTRODUCTION:
The recent FDA approval of inclusion of bevacizumab (BEV) in the treatment of platinum-resistant recurrent ovarian cancer will likely lead to more widespread adoption of this intervention. We assessed the cost effectiveness of this expensive treatment for this specific indication.METHODS:
A cost effectiveness decision model was constructed using results from AURELIA, a phase III randomized trial comparing BEV plus cytotoxic chemotherapy versus chemotherapy alone in patients with platinum-resistant recurrent ovarian cancer. The BEV arm of AURELIA had improved progression free survival and quality of life (QOL). Costs, paracentesis rates, and adverse events were incorporated.RESULTS:
Inclusion of BEV in the treatment of platinum-resistant recurrent ovarian cancer costs on average $26,790 more than cytotoxic chemotherapy alone when 15 mg/kg dosing is used and $40,813 more when biweekly 10 mg/kg is used. The incremental cost-effectiveness ratio (ICER) per progression-free life year saved (PF-LYS) is $146K with 10 mg/kg dosing and $96K with 15 mg/kg dosing. In sensitivity analysis, the ICER drops below a willingness-to-pay (WTP) threshold of $100K when greater than 68% of patients receive salvage single agent BEV. Incorporating better QOL in the BEV arm based on AURELIA improves the ICER in both dosing regimens, but does not lower the ICER below $100K at the 10 mg/kg dose.CONCLUSION/IMPLICATIONS:
Our results suggest that incorporation of BEV using the 15 mg/kg regimen is cost-effective based on the common WTP threshold ICER of $100K. In light of FDA approval for this indication, evidence for cost-effectiveness further supports utilization in women with platinum-resistant recurrent ovarian cancer.Abstracts of Papers and Posters - 64th Annual Clinical and Scientific Meeting of the ACOG
May 2016
Abstracts of Papers and Posters to be Presented at the 64th Annual
Clinical and Scientific Meeting of the American College of Obstetricians
and Gynecologists, May 14-17, 2016, Washington, DC.
Friday, May 13, 2016
Demoralization syndrome: New insights in psychosocial cancer care - Grassi - 2016 - Cancer - Wiley Online Library
editorial - abstract
Define: demoralization
Demoralization is confirmed as a significant clinical dimension that needs to be part of the vision physicians should have when treating cancer patients. It is not a psychiatric disease but the expression of an unfolding, situational existence already involved in an irreducibly complex social world, in which cancer and its consequences as traumatic stressors impact the patient's experience and feelings, inducing a profound sense of emotional suffering.
Improving the quality of survivorship for older adults with cancer
abstract
In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer.
Efficacy of the neurokinin-1 receptor antagonist rolapitant(VARUBI) in preventing nausea and vomiting in patients receiving carboplatin-based chemotherapy - Hesketh - 2016 - Cancer - Wiley Online Library
Blogger's Note: ovarian cancer patients were included in this study
Rolapitant (VARUBI®
open access - Efficacy of the neurokinin-1 receptor antagonist rolapitant in preventing nausea and vomiting in patients receiving carboplatin-based chemotherapy
Study Design and Patients
A global, multicenter, randomized, parallel-group, double-blind, controlled phase 3 study (NCT01500226) was conducted in 23 countries in North America, Central and South America, Europe, Asia, and Africa.[12] The protocol was approved by institutional review boards at each study site, all patients provided written informed consent, and all investigators and site personnel were required to follow ethical principles outlined in the Declaration of Helsinki and consistent with the International Conference on Harmonisation Good Clinical Practice guidelines and applicable local laws and regulations.
Patients (see Table1)
Of the 1332 patients who composed
the modified intent-to-treat population for the phase 3 MEC trial, 401
received their first course of chemotherapy with a carboplatin-based
regimen and were included in the efficacy analysis for cycle 1. Baseline
and disease characteristics were similar for patients in the rolapitant
and control groups, as shown in Table 1.
The median age of the patients was 62 years, and more patients were
female (54.9%) than male (45.1%). The primary malignancy among patients
treated with carboplatin-based chemotherapy was lung cancer (52.1%);
other malignancies included ovarian, breast, and uterine cancer (13.7%,
13.7%, and 7.7%, respectively). The receipt of concomitant emetogenic
chemotherapy with a Hesketh level ≥ 3 was low and occurred in 15.7% of
the patients.
CONCLUSIONS
Rolapitant provided superior CINV protection to patients receiving carboplatin-based chemotherapy in comparison with the control. These results support rolapitant use as part of the antiemetic regimen in carboplatin-treated patients.FUNDING SUPPORT
CONFLICT OF INTEREST DISCLOSURES
Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations
open access: Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations (PanCareLIFE Consortium)
INTRODUCTIONBACKGROUND
Fertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations.
CONCLUSIONS
Only approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors.
Over
the last several decades, the survival of patients with childhood
cancer has increased significantly due to advances in treatment. In
Europe and the United States alone, nearly 80% of children, adolescents,
and young adults (CAYAs) survive 5 years from a cancer diagnosis, with
the vast majority expected to achieve extended long-term survival into
adulthood.[1, 2]
As the number of childhood cancer survivors increases, the long-term
side effects of treatment gain greater importance. Of particular concern
is the substantially elevated risk of fertility impairment after
treatment of childhood cancer, especially after treatment with
alkylating agents (and similar DNA interstrand cross-linking agents)
and/or radiation to fields that expose the ovaries or testes.[3-6]
Fertility impairment has serious consequences for quality of life among
newly diagnosed patients, their parents, and adults surviving childhood
cancer.[7, 8]
Interventions currently can be offered to individuals diagnosed with cancer to preserve their fertility potential.[9, 10]
Survey data have indicated that many patients, especially females, are
not or are inadequately counseled regarding the potential adverse
effects of treatment on fertility and even fewer are referred for
fertility preservation.....Cancer Epidemiology Hypertension, use of antihypertensive medications, & risk of epithelial ovarian cancer
Abstract
Few studies have examined the associations of hypertension and antihypertensive medications with ovarian cancer. In particular, beta-blockers, one of the most commonly prescribed medications to treat hypertension, may reduce ovarian cancer risk by inhibiting beta-adrenergic signaling. We prospectively followed 90,384 women in the Nurses' Health Study (NHS) between 1988–2012 and 113,121 NHSII participants between 1989–2011. Hypertension and use of antihypertensive medications were self-reported biennially....(stats).
We documented 948 ovarian cancer cases during follow-up. Similar results were observed in the two cohorts. While hypertension was not associated with ovarian cancer risk, current use of any antihypertensive medication was associated with slightly increased risk compared to never users (stats). This increased risk was primarily due to use of thiazide diuretics (stats). No associations were observed for beta-blockers or angiotensin-converting-enzyme inhibitors. Calcium channel blockers (CCBs) were associated with suggestively reduced risk, after adjusting for all antihypertensive medications. Associations were similar among hypertensive women and stronger for longer use of thiazide diuretics and CCBs.
In conclusion, our results provided no evidence that beta-blockers were associated with reduced ovarian cancer risk. In contrast, we observed an increased risk for use of thiazide diuretics that should be confirmed in other studies.
BRCA1/2 testing in newly diagnosed breast & ovarian cancer patients without prior genetic counselling: the DNA-BONus study
open access - European Journal of Human Genetics
In conclusion, we show that BRCA1/2 mutation testing is well accepted among patients with newly diagnosed breast or ovarian cancer. We further conclude that current clinical guidelines are sufficient to identify the majority of the BRCA1/2 mutation carriers among patients with breast cancer. Because of the high prevalence of pathogenic BRCA1/2 variants, we recommend that all patients with epithelial ovarian cancer are offered germline BRCA1/2 testing, irrespective of age or family history of cancer.
Your Daily 'Miracle Cure' for Cancer (disappointing patients...)
medscape
There is a major gulf between what is being promised and what we are actually able to deliver, and the people making these hyped promises don't see or appreciate the negative consequences of disappointed patients and the frustrated oncologists who actually manage their unrealistic expectations.
Many Breast Cancer Patients Try Alternative Medicine First: Study
science news
THURSDAY May 12, 2016, 2016 -- Women with early stage breast cancer who turn to alternative medicine may delay recommended chemotherapy, a new study suggests.
And although most of the more than 300 women in the study eventually had recommended chemotherapy, 11 percent did not, the researchers said.
"Previous studies have shown that timely initiation of breast cancer chemotherapy is associated with better breast cancer survival," said lead researcher Heather Greenlee. She is an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.
The findings show that "women who do not initiate [chemotherapy] are more likely to be users of dietary supplements, and use many different forms of complementary and alternative therapies simultaneously," she said.....
Prospective, Interdisciplinary Randomized Clinical Trials for Patients With Cancer in the Emergency Department...
Define: verb (used with object), palliated, palliating. to relieve or lessen without curing; mitigate; alleviate.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
JAMA Network | JAMA Oncology | Prospective, Interdisciplinary Randomized Clinical Trials for Patients With Cancer in the Emergency Department: A Step Forward for Palliative Oncology Care
Editor's Note | May 2016
Grudzen and colleagues3
from Mt Sinai and New York University are to be congratulated on their
attempt to address this question in a prospective, randomized clinical
trial.4
The investigators did show an improvement in quality of life as
measured by the Functional Assessment of Cancer Therapy–General Measures
(FACT-G) score at 3 months, in those patients randomized for immediate
palliative care team consultation while they were in the ED. There was a
trend in survival. It would be important to know whether ED initiation
of the palliative care chain will result in a decrease in readmission
rates and the ethnic/racial and socioeconomic disparity of these
services rendered. Future prospective interdisciplinary studies
involving the intersection of emergency and/or urgent care, oncology,
and palliative care practitioners are necessary to further refine
optimal and cost-effective, patient-centered care for patients with
cancer and caregivers.
FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together
Drug Safety and Availability > FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together
fluoroquinolones: (cipro) ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin
[ 05-12-2016 ]
The U.S. Food and Drug Administration is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolone should be reserved for those who do not have alternative treatment options.
An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.
As a result, we are requiring the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs to be updated to reflect this new safety information. We are continuing to investigate safety issues with fluoroquinolones and will update the public with additional information if it becomes available.
Patients should contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine. Some signs and symptoms of serious side effects include tendon, joint and muscle pain, a “pins and needles” tingling or pricking sensation, confusion, and hallucinations. Patients should talk with your health care professional if you have any questions or concerns......
Is Ovary Removal Tied to Colon Cancer Risk?
MedNews
THURSDAY May 12, 2016, 2016 -- Women who have their ovaries removed may have a higher-than-average risk of developing colon cancer, a large study suggests.
Researchers found that among nearly 196,000 Swedish women who'd had their ovaries removed, the risk of eventually being diagnosed with colon cancer was 30 percent higher than the norm for women their age.
The women had their ovaries removed for noncancerous conditions, so a history of ovarian cancer would not explain the findings, the researchers said.
Still, the link does not prove that ovary removal contributes to colon cancer risk, cautioned Mia Gaudet, strategic director of breast and gynecologic cancer research for the American Cancer Society.
The researchers were not able to account for a number of critical factors, said Gaudet, who was not involved in the study.
For one, she said, women who'd undergone ovary removal ("oophorectomy") may have had higher rates of colon cancer screening.
"Oophorectomy, itself, is tied to more frequent contact with the health care system, including higher rates of cancer screening," Gaudet said.
Beyond that, she said, there was limited information on the women's weight, and no details when it came to their diets or use of hormone therapy.
Lead researcher Dr. Josefin Segelman agreed that the study had limitations.
However, it is biologically plausible that ovary removal could affect colon cancer risk, according to Segelman, a colorectal surgeon at the Karolinska Institute in Stockholm.
Other research, she explained, has suggested that sex hormones influence colon cancer development: Some studies have linked hormone replacement therapy after menopause and birth control pills to a decreased colon cancer risk, for example.
And in lab studies, estrogen has been shown to inhibit colon cancer cells from growing, Segelman said.
But Gaudet cautioned that the connection between hormones and colon cancer is unclear. Studies have been "mixed," she said, as to whether a woman's natural estrogen levels, or hormone replacement therapy, are related to her odds of developing the cancer.
Thursday, May 12, 2016
The Top 13 Things You Need To Know About Cancer
CancerDocs
author:
Michel Choueiri
Michel completed his Oncology training at
the University of California at San Diego and specialized in cancers of
the kidneys, prostate and testicular cancer at the MD Anderson Cancer
Center. With the constant changes in diagnostic tests and treatment
options, he believes every patient should have access to the highest
level of care.
The most important cancer treatments you should know-Part I
Part I | CancerDocs
author:
John Paul Chen
John Paul is a native of St. Louis, MO, and a
dedicated supporter of the St. Louis Cardinals. He has received a broad
medical training at the Washington University in St. Louis, Harvard and
the MIT and UCSD. His research interests include the development of new
cancer treatment compounds.
The Ethical and Practical Challenges of Value-Based Cancer Care at the Patient’s Bedside
JAMA Network (requires $$ for full access)
....As both a practicing physician and a researcher who performs economic analyses, I am greatly challenged by these questions. As a researcher, I believe deeply in value-based cancer care. As a physician, I feel an intense responsibility to do anything within my power to support my patients and make them confident that they have heard about all the options that could possibly benefit them.
Ovary removal may increase the risk of colorectal cancer
Medical News
The development of colorectal cancer is influenced by hormonal factors, and removal of the ovaries alters a woman's sex hormone levels. Among 195,973 Swedish women who had undergone ovary removal between 1965 and 2011, there was a 30% increase in the rate of colorectal cancer compared with the general population. After accounting for various factors, women who had both ovaries removed had a 2.3-times higher risk of rectal cancer than those who had only one ovary removed.
"Colorectal cancer risk was increased after oophorectomy in both pre- and postmenopausal women. This emphasizes that prophylactic resection of normal ovaries should be reserved for women with a clear indication," said Dr. Josefin Segelman, lead author of the British Journal of Surgery study.
Article: Population-based analysis of colorectal cancer risk after oophorectomy Segelman, J., Lindström, L., Frisell, J. and Lu, Y., British Journal of Surgery, doi: 10.1002/bjs.10143, published online 26 April 2016.
2 Cases: Carcinosarcomas of Ovary Involved in Hereditary Cancer Syndromes (BRCA1/MSH6)
abstract
Ovarian carcinosarcomas (OCS), also known as malignant mixed mesodermal/Müllerian tumors, are rare neoplasms
(1%-4% of all malignant ovarian tumors) composed of high-grade
malignant epithelial and mesenchymal elements. OCS occurs in older
women. It is associated with a poor outcome and is usually not involved
in inherited cancer syndromes. We present 2 cases of OCS; one arising in
a patient with a pathogenetic BRCA1 mutation and the other in a woman
affected by Lynch Syndrome
(LS) carrying a MSH6 germline mutation. To the best of our knowledge,
this is the first time that this second type of case has been reported.
In this study, we investigated somatic impairment of the wild-type BRCA1
and MSH6 alleles in the OCS of these 2 patients. We also explored in
both OCS, the occurrence of TP53 loss of function, which is a genetic
alteration known to occur in BRCA-linked ovarian tumorigenesis but not
in LS tumors. Moreover, we also provide further data about the
histogenesis of OCS.
Wednesday, May 11, 2016
Extrauterine Pelvic Serous Carcinomas: Current Update on Pathology and Cross-sectional Imaging Findings
abstract
The spectrum of extrauterine pelvic serous carcinomas includes ovarian serous carcinoma, primary peritoneal serous carcinoma, and primary fallopian tube carcinoma. Ovarian serous carcinoma, the most common ovarian malignant epithelial neoplasm, consists of two distinct entities: high-grade and low-grade serous carcinomas. Primary peritoneal serous carcinoma and primary fallopian tube carcinoma are rare malignancies that share many characteristics of high-grade serous carcinomas. Recent advances in the genetics and molecular biology of gynecologic cancers have suggested a common origin of many extrauterine pelvic serous carcinomas from fallopian tube epithelium. With the exception of low-grade serous carcinomas, which arise from cortical inclusion cysts lined by tubal epithelium, most extrauterine pelvic serous carcinomas are believed to originate from serous tubal intraepithelial carcinomas and show similar clinical-biologic behaviors and natural histories. Indeed, the International Federation of Gynecology and Obstetrics Committee on Gynecologic Oncology recently recognized that these cancers should be considered collectively, with a common system of staging and management strategies for ovarian, primary peritoneal, and fallopian tube cancers. A paradigm shift has occurred in our understanding of the pathogenesis of extrauterine pelvic serous carcinomas that has the potential to change current strategies for screening, prevention, diagnosis, and management. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging, and combined positron emission tomography and CT are pivotal in screening, initial diagnosis, and treatment follow-up; however, because of this paradigm shift, new radiologic techniques, such as contrast material-enhanced US and molecular US imaging, and various optical imaging techniques are being investigated as important screening and diagnostic tools. Because of evolving knowledge of genetic and molecular changes underlying the pathogenesis of extrauterine pelvic serous carcinomas, new targeted therapies are being developed to improve patient prognosi
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