Sunday, July 19, 2009
Article Submission by Kat Sanders: CA125 and the Role of a Radiologist in Treating Cancer
CA125 and the Role of a Radiologist in Treating Cancer
http://becomingaradiologist.org/
There are various factors that cause cancer, and in the fight back against this terrible disease, mankind has discovered and invented some of the best methods of treating and managing it. One such aspect is CA125, also known as Cancer Antigen 125, a marker that can potentially detect the early stages of ovarian cancer in women. More than the diagnosis however, the role of CA125 comes to the fore in the continuing treatment and future prognosis. It helps your oncologist detect if your cancer has the potential to return or if you are well on the way to recovery.
As with any cutting edge treatment, CA125 has come it for its share of criticism when it is used as a marker to diagnose ovarian cancer. While it has been accepted as the standard in determining the future prognosis of a patient who has been diagnosed with ovarian cancer and treated for the same, there are doubts over how effective it is in helping to determine the presence of cancerous growths in the ovary. This is because women with elevated levels of CA125 in their blood are not necessarily suffering from ovarian cancer or are at risk for the disease. Also, there is no evidence to prove that the absence of or low level of CA125 is enough to rule out the possibility of ovarian cancer.
Although CA125 is primarily known for its use in treating and managing ovarian cancer, there is evidence to show that it is helpful in diagnosing other kinds of cancers like those that originate in the endometrium, breast, fallopian tubes, lungs and the gastrointestinal tract.
Recent research has found that Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is more effective than CA125 in helping to assess the recurrence of ovarian cancer and the efficacy of the treatment being followed by those who are affected by this disease.
Even so, CA125 is extremely useful in monitoring therapy for ovarian cancer and in determining the recurrence of the cancer over a period of time.
By-line:
This article is written by Kat Sanders, who regularly blogs on the topic of radiologist technician at her blog "The Overwhelmed Student" Blog. She welcomes your comments and questions at her email address: katsanders25@gmail.com.
http://becomingaradiologist.org/
Saturday, July 18, 2009
Menopausal HT and Ovarian Cancer: Causal Role Remains Unclear - Commentary on the Danish study
This is a commentary on the Danish study.
Friday, July 17, 2009
Thursday, July 16, 2009
Wednesday, July 15, 2009
Market Report -- In Play (JNJ): Trabectedin (Yondelis)
Market Report -- In Play (JNJ): Briefing.com Business News - MSN Money: "Johnson & Johnson: Centocor Ortho Biotech issues statement on the FDA ODAC opinion regarding trabectedin for relapsed ovarian cancer Co announces based on the data presented today, the FDA Oncologic Drugs Advisory Committee recommended that the combination of trabectedin when administered with DOXIL did not provide a sufficient benefit-risk profile for the treatment of relapsed ovarian cancer. Centocor Ortho Biotech Products continues to believe trabectedin has an important role in the treatment of recurrent ovarian cancer. The company remains committed to working with the FDA to address the committee's concerns. The committee provides non-binding recommendations based on its evaluation. The final decision regarding approval of the drug will be made by the FDA."
FDA panel recommends against Centocor’s trabectedin (ovarian cancer)
The Food and Drug Administration’s Oncologic Drugs Advisory Committee voted Wednesday not to recommend approval of trabectedin, an experimental cancer treatment being developed by Centocor Ortho Biotech.
Centocor Ortho Biotech of Horsham, Pa., is seeking approval of trabectedin as part of a combination therapy with the cancer drug Doxil for patients with relapsed ovarian cancer.
FDA committee recommendations are nonbinding, but the federal agency generally follows the advice of its advisory panels when making a final determination......Under a licensing agreement with PharmaMar SAU of Spain, Centocor has worldwide marketing rights for trabectedin except in Europe and Japan, where the product is marketed as Yondelis by PharmaMar.
Methylation and protein expression of DNA repair genes: association with chemotherapy exposure and survival in sporadic ovarian and peritoneal carcinomas
Abstract | Methylation and protein expression of DNA repair genes: association with chemotherapy exposure and survival in sporadic ovarian and peritoneal carcinomas: "Methylation and protein expression of DNA repair genes: association with chemotherapy exposure and survival in sporadic ovarian and peritoneal carcinomas"
Monday, July 13, 2009
Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2)
Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2): "Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2)"
Saturday, July 11, 2009
Friday, July 10, 2009
Thursday, July 09, 2009
Wednesday, July 08, 2009
Cancer Does Discriminate -- Couzin-Frankel 2009 (707): 1 -- ScienceNOW
Cancer Does Discriminate -- Couzin-Frankel 2009 (707): 1 -- ScienceNOW: "For advanced ovarian cancer, median survival was 1.3 years for African Americans and 2.3 years for the rest of the participants."
Southern Sask. gets a second gynecologic oncologist
The women of Saskatchewan can thank Darlene Gray and her group in large part for keeping up the pressure on this issue. OCATS is on Facebook and a new website is in progress.
Monday, July 06, 2009
Sunday, July 05, 2009
Saturday, July 04, 2009
Friday, July 03, 2009
Thursday, July 02, 2009
Cases - Losing a Comforting Ritual - Treatment - NYTimes.com
Cases - Losing a Comforting Ritual - Treatment - NYTimes.com: "For those who have never been seriously ill, treatment often seems cut and dried. You get sick, you get treated and, in theory, you get better. One day you’re a patient, the next you’re not. Simple, right?"
Tuesday, June 30, 2009
Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2 : Abstract : Nature Genetics
Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2 : Abstract : Nature Genetics: "Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2"
Saturday, June 27, 2009
Women hear advances in breast/ovarian cancer research
"Dr. Joanne Jeter said it’s important to identify and manage genetic risk factors.
She said Hispanic women face a higher risk of breast cancer than the general population; Jewish women of Ashkenazi descent, those who have ancestors from Germany, Poland, Lithuania, Ukraine and Russia, have a higher incidence of specific mutations increasing the risk of developing breast and ovarian cancer."
Center for Genomics and Public Health - EGAPP - What is EGAPP?
What is EGAPP?
The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) is a project launched in 2004 by the Centers for Disease Control and Prevention (CDC) to put selected genetic tests to the test. Hundreds of genetic tests, which could give information about susceptibility to major diseases such as cancer, diabetes and heart disease, are in development. It is important for the public health community that a reliable method, based on reliable scientific evidence, be found for evaluating these tests. The EGAPP project is a key step.
EGAPP follows in the footsteps of an earlier CDC-funded project, ACCE. The ACCE project took its name from four key components of test evaluation - analytic validity, clinical validity, clinical utility, and associated ethical, legal and social implications. Evaluating five genetic tests between 2000 and 2004, ACCE served as a model for investigating the availability and quality of data on the safety and effectiveness of all DNA-based genetic tests.
Building on the knowledge gained from the ACCE project and existing U.S. recommendations for action, CDC started the EGAPP project. The intent is to both objectively assess selected tests and also to begin developing a model process for assessing all genetic tests in the future. An independent, non-federal, multidisciplinary working group is the focus of EGAPP. This working group is comprised of 13 people from the U.S. with expertise in areas such as evidence-based review, clinical practice, public health, laboratory practice, genomics, and health technology assessment.
EGAPP focuses on the process of assessing new genetic tests for their safety and usefulness. Outcomes to be considered include benefits and harms to the patient and family, as well as societal and public health issues (e.g., availability or access to testing, and adequacy of consumer and provider education).
EGAPP is commissioning evidence-based reviews of selected tests that have the potential for broad application and health impact. Genetic tests selected for review include ones that predict response to therapy, detect susceptibility for a disease in family members, or predict risk of certain diseases in healthy populations. In late 2005 EGAPP began evaluating genetic tests related to depression, colorectal cancer, and ovarian cancer. Evaluations of more tests began in the summer of 2006.
All of the evidence-based reviews conducted for EGAPP will include assessments of available information on analytic and clinical validity, and the impact of testing and subsequent interventions or treatments. Evidence reports, published summaries of evidence, and published EGAPP working group recommendations are proposed products of EGAPP.
Evidence-based reviews, which involve the systematic assessment of all of the current published, relevant medical literature, can include clinical trials and other studies of interventions. EGAPP also will consider emerging tests with limited information, as a way to identify gaps in available data.
It is expected that the EGAPP working group will include not only assessments of certain tests, but also reports on its methodological approaches to evaluating the selected tests.
Friday, June 26, 2009
Thursday, June 25, 2009
CDC's Office of Public Health Genomics Recruiting Docs for Survey on EGAPP Plans | The Sample | GenomeWeb
CDC's Office of Public Health Genomics Recruiting Docs for Survey on EGAPP Plans
June 25, 2009
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By Kirell Lakhman
CDC's Office of Public Health Genomics today said it is recruiting "health care providers from multiple disciplines" — genetic counselors, general practitioners, oncologists, surgeons, pathologists, gastroenterologists, nurse practitioners, physicians’ assistants — "to participate in a health message survey for educational materials on the new EGAPP recommendations for Lynch Syndrome genetic testing.
The survey, to be conducted in July and August, will take about one hour to complete, OPHG says. Participants are asked to contact Sara Bedrosian.
The results should be interesting if there's any truth to what most medical societies, genetic test marketers, and individual physicians claim to be the average doc's knowledge of genetics: roughly none.
Wednesday, June 24, 2009
Cancer agency hires new doctor - news item - Darlene Gray and ovarian cancer survivours of Saskatchewan - way to go!!!
Cancer agency hires new doctor: "Currently the agency, the Ministry of Health, the Saskatoon and Regina Qu'Appelle health regions and the University of Saskatchewan college of medicine and advocacy groups are working collaboratively to put together a more comprehensive program for gynecologic oncology in Saskatchewan, Popkin said."
Technology assessment and resource allocation for predictive genetic testing: A study of the perspectives of Canadian genetic health care providers
Conclusions
Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate.
Tuesday, June 23, 2009
Sunday, June 21, 2009
Evidence and Values: Requirements for Public Reimbursement of Drugs for Rare Diseases - a Case Study in Oncology
Conclusion:
There should be a greater commitment by reimbursement agencies to a fair and transparent decisionmaking process with appropriate community input. Criteria should be developed to validate surrogate
markers for rare diseases. It should also be acknowledged that the traditional measures of benefit in
economic studies do not incorporate all elements of social value. The need should be recognized to balance equity with an efficient use of resources.
Measuring Response with FDG-PET: Methodological Aspects
Note reference to PET/CT; 1 small mention of ovarian cancer
Prognostic relevance of c-MYC gene amplification and polysomy for chromosome 8 in suboptimally-resected, advanced stage epithelial OC: GOG
"CONCLUSIONS: c-MYC amplification and polysomy 8 have limited predictive or prognostic value in suboptimally-resected, advanced stage EOC treated with platinum-based combination chemotherapy."
Saturday, June 20, 2009
Hereditary non-polyposis colorectal cancer or Lynch syndrome: the gynaecological perspective.
Dr Karen Lu, MDA, also noted the same risk results regarding Endometrial cancer in Lynch Syndrome women.
Avoidable waste in the production and reporting of research evidence : The Lancet
Within specific health problems there is little research on the extent to which questions addressed by researchers match questions of relevance to patients and clinicians. In an analysis of 334 studies, only nine compared researchers' priorities with those of patients or clinicians
Friday, June 19, 2009
Validation of serum biomarkers for detection of early-stage ovarian cancer
Prospective
analysis of the panel in clinical setting is
needed next to validate this panel of
biomarkers as an effective screening tool
for ovarian cancer.
A randomized trial in ovarian cancer (OC) of early treatment of relapse based on CA125 level alone versus delayed treatment based on conventional clinical indicators
This is the Rustin study which was widely debated when presented at ASCO - the one key word in the conclusion (based on the abstract) is: "alone"
Thursday, June 18, 2009
OCATS press release: June 18, 2009 Ovarian/Gyn Cancer Patient Advocates in Saskatchewan
REGINA, June 18, 2009 – Today OCATS learned that Dr. Maryam Al-Hayki, Gynecologic Oncologist for southern Sask has been contracted to provide gynecologic cancer care services for the women of Southern Saskatchewan, including chemotherapy. Many details are yet to be determined and the group of gynecologic cancer patients look forward to hearing more from the Minister of Health Don McMorris. The Ministry, SaskHealth, Sask Cancer Agency and the Health Regions all working towards the implementation of a proper Gynecologic Oncology Program for Saskatchewan, with a Unit each in Regina and Saskatoon, and now with this contract; we hope that all four of Saskatchewan’s gynecologic cancer specialists will be retained for a long time to come. With this progress it is also hopeful that additional gynecologic oncologists can be recruited.
A long time request of the OCATS group to meet with the Minister of Health, Don McMorris has now been scheduled for Monday, June 29th at 11:00 a.m. A Director of OCATS, Darlene Gray said, “we are so relieved to hear that a contract has been extended to Dr. Al-Hayki and we hope it is a contract that will keep her here for a long time. Hopefully, this will result in immediate oncologist availability for patients of all cancers. Patients also need to be assured that a proper gyne oncology program is established to ensure the retention of both Dr. Al-Hayki and Dr. Brydon in Regina and the two specialists in Saskatoon. We are pleased but still have many questions.”
The OCATS group expects to hear more at a meeting with all the stakeholders including SaskHealth, Sask Cancer Agency, the health regions and the women’s cancer specialists this coming week as soon as all the participants can meet. Ms. Gray said, “We are very much appreciative of this opportunity to hear about the program in full and also to provide our input, since all we have right now is a theory. Women need to know that all the resources and funding will be in place to ensure the gynecologic oncology Units in Regina and Saskatoon will have all specialists, support staff, technical and diagnostic testing and tools are in place. We hope to see a plan for trained or a training program for technicians to run the new ultrasounds, pathology and educational instruments and programs required for a true gynecologic oncology program.”
Darlene was clear in stating that, “This has been a stressful time for the volunteers in our group and a very worrisome time for patients needing chemotherapy and other treatment, as it has been for the doctors and administrators. We are relieved, happy and a bit shell shocked. It’s comforting, for all I’m sure, to know that the specialists can go back to the business of treating patients. We want to thank the Ministry and all the bureaucracies involved for doing the right thing for women in Saskatchewan, current and future patients. We feel that once the administrators understood how urgent and critical the gynecologic cancer situation in Saskatchewan was, everyone moved very quickly to put a solution together. We hope to make our gratitude known at these upcoming meetings. Still, we feel that a patient’s experience must be included in the process and we look forward to providing that to the Minister of Health personally on June 29th, and to the team in the upcoming week. This is a wonderful beginning.”
For more information contact Darlene Gray in Regina at 306-775-1848, cell 529-3199 or in Fort San at 306-332-3957, or darlenegray@sasktel.net
Wednesday, June 17, 2009
Hormone Replacement Therapy: Real Concerns and False Alarms : The Cancer Journal
Hormone Replacement Therapy: Real Concerns and False Alarms : The Cancer Journal: "Hormone Replacement Therapy: Real Concerns and False Alarms"
Tuesday, June 16, 2009
Effect of Surgeon Training, Specialization and Experience on Outcomes for Cancer Surgery-a Systematic Review of the Literature
"RESULTS:
The 29 articles that met the inclusion criteria examined
nine different types of cancers including colorectal, ovarian,
melanoma, breast, bladder, lung, esophageal, gastric,
and hepatocellular.12–36 Fifteen different physician specialties
were assessed, including colorectal surgery,
transplant surgery, vascular surgery, dermatology, general
practitioners, plastic surgery, surgical oncology, hepatopancreaticobiliary,
urology, urologic oncology, thoracic
surgery, cardiothoracic surgery, obstetrics and gynecology,
gynecologic oncology, and general surgery. Four articles
examined outcomes based on the surgeon’s years of
experience. The main outcome measures assessed were
perioperative morbidity, mortality, recurrence, and longterm
survival. Characteristics and results of each study are
summarized in Table 1."
AJCC Cancer Staging Manual/Handbook Nov 2009 ($$)
"The AJCC Cancer Staging Manual and Handbook, prepared by the American Joint Committee on Cancer, are used throughout the world to facilitate the uniform description of neoplastic diseases.
The fully revised and updated 7th Edition is uniform between the AJCC and UICC and brings together all currently available information on staging of cancer at various anatomic sites and incorporates newly acquired knowledge on the etiology and pathology of cancer."
AJCC Cancer Staging Manual
http://www.springer.com/medicine/surgery/book/978-0-387-88440-0?cm_mmc=AD-_-Enews-_-CLM11050_V1-_-0
AJCC Cancer Staging Handbook
http://www.springer.com/medicine/surgery/book/978-0-387-88442-4?cm_mmc=AD-_-Enews-_-CLM11050_V1-_-0
Monday, June 15, 2009
Cancer Genome Sequencing--An Interim Analysis
Most significantly, however, the cancer genome sequencing strategy, as currently applied, fails to characterize the most relevant genomic features of cancer—the mutational heterogeneity within individual tumors.
Saturday, June 13, 2009
Friday, June 12, 2009
Thursday, June 11, 2009
Lung Cancer Risks Rise With Nanoparticles, Lung Cancer
Editorial comment (mine):
I had written concerning this issue before, but new info/repeat for newer members. Some years ago, I had spoken with a well known researcher while discussing family histories of ovarian cancer because in a small non-scientific study we had done, it seemed certain cancers were very prevelant and outside of what might be considered the norm. Lung cancer was one. The researcher at the time said that they believed there is was/is a genetic component between ovarian and lung cancer, aside from both being epithelial (the lining of an organ) cancers. It seems, although not specific, this article is starting to document these concerns/advances. Anyway, a FYI, but mostly it is because over years I have witnessed lung cancer patients being ostracized not only by the public by others. I hope some now take a reflective look when judging those most in need. Anyway, a bit off topic but I think it important not only for cancer communities but for all.
....................................................................................
http://www.emaxhealth.com/1075/99/31666/lung-cancer-risks-rise-nanoparticles.html
> More recent studies point to the cause of lung cancer as possibly genetic. While researchers insist environmental factors, such as smoking, asbestos exposure, etc., play a role in the development of the disease, there is growing evidence that the answer to the question is at the gene level.
Lung Cancer Risks Rise With Nanoparticles, Lung Cancer: "More recent studies point to the cause of lung cancer as possibly genetic. While researchers insist environmental factors, such as smoking, asbestos exposure, etc., play a role in the development of the disease, there is growing evidence that the answer to the question is at the gene level."
abstract: Palliative care in gyn oncology
Article Outline
Introduction
Pain relief
Nausea and vomiting
Constipation
Bowel obstruction
Recurrent ascites
Genital fistulas
Bleeding
Psychosocial issues
Conclusion
Further Reading
Sanofi-aventis Regeneron Announce Results from Phase 2 Study with Aflibercept (VEGF Trap) in Advanced Ovarian Cancer Patients with Recurrent Symptomatic Malignant Ascites
"The results of this Phase 2, placebo-controlled study demonstrate that aflibercept is a clinically active agent in patients with advanced ovarian cancer with symptomatic malignant ascites. However, given the small number of patients enrolled in this study and the fragile health status of these advanced ovarian cancer patients, who had a median survival of only about three to four months, it is difficult to definitively assess the overall clinical benefit that might be derived from treatment in the real-world clinical practice setting," stated George D. Yancopoulos, M.D., Ph.D., President of Regeneron Research Laboratories. "Therefore, we and sanofi-aventis have decided not to submit these Phase 2 data for accelerated approval in symptomatic malignant ascites.
We will focus our efforts on completing the current Phase 3 program which combines aflibercept with standard chemotherapy regimens for the treatment of earlier stage metastatic colorectal, non-small cell lung, pancreatic, and prostate cancers, which should begin delivering data in 2010."
Clear cell carcinoma compared to serous carcinoma in early ovarian cancer: same prognosis in a large randomized trial.
Title: Clear cell carcinoma compared to serous carcinoma in early ovarian cancer: same prognosis in a large randomized trial.
Author: Timmers PJ; Zwinderman AH; Teodorovic I; Vergote I; Trimbos JB
Journal: Int J Gynecol Cancer; 2009 Jan; 19(1):88-93. PubMed ID: 19258948
Abstract:
BACKGROUND: An analysis was performed comparing survival of patients with clear cell carcinoma (CCC) to patients with serous adenocarcinoma (SAC) in early ovarian cancer. Furthermore, a literature search was done to clarify the clinical and histopathological features of clear cell tumors of the ovary. METHODS: Between November 1990 and March 2000, 448 patients with ovarian cancer International Federation of Gynecology and Obstetrics stages I to IIa were enrolled in the European Organisation for Research and Treatment of Cancer-Adjuvant Chemotherapy in Ovarian Neoplasm Trial, a randomized study comparing adjuvant platinum-based chemotherapy to observation after surgical treatment in patients with early ovarian cancer. RESULTS: Sixty-three patients (14.1%) with CCC were compared with 156 patients (34.8%) with serous tumors. A significant difference was found in the International Federation of Gynecology and Obstetrics stage Ic with capsule rupture, 28 (44.4%) of 63 patients with CCC and 29 (18.6%) of 156 patients with SAC
Found: One in Three Billion : BC Cancer Agency The spelling mistake in the genetic code that causes a type of Ovarian Cancer
06/10: Found: One in Three Billion : BC Cancer Agency: "The spelling mistake in the genetic code that causes a type of Ovarian Cancer"
Wednesday, June 10, 2009
Tuesday, June 09, 2009
Raitt wanted credit for fixing 'sexy' isotope crisis: tape
Raitt wanted credit for fixing 'sexy' isotope crisis: tape: "sandipn, 09:09 AM EDT � Tuesday, June 9th, 2009
"What I think cannot be published. Cancer Survivor"
the key point: Making trials matter: pragmatic and explanatory trials and the problem of applicability
"....Readers need to know ‘who, what, when and where’...."
Monday, June 08, 2009
Sunday, June 07, 2009
Saturday, June 06, 2009
Friday, June 05, 2009
The Director's Notes for June 4, 2009 - National Cancer Institute
The Director's Notes for June 4, 2009 - National Cancer Institute: "Last Monday, I met with a new coalition of advocacy organizations concerned with a group of cancers - brain, esophagus, liver, lung, myeloma, pancreas, ovarian, and stomach - each with a survival rate of less than 50 percent. Representing 20 different organizations, the group presented data showing that 276,040 deaths (49.1 percent of the cancer deaths predicted in 2009) will come from those eight forms of cancer. The advocates are concerned that those same cancers only account for approximately 18 percent of the NCI funded research portfolio, and they seek a greater emphasis on these cancers........."
Thursday, June 04, 2009
Facebook | Ovarian Cancer Awareness & Treament in Saskatchewan (OCATS)
Facebook | Ovarian Cancer Awareness & Treament in Saskatchewan (OCATS)
June 2nd, 2009
OCATS has just become OCATS Inc., a non-profit organization in Sask. We are just this week applying for status as a charitable organization with the federal government. You could really help us out by becoming a formal member, this requires only a $10 fee and the complete an application which I can only send you by email or snail mail. Please consider helping us this way - not only would it help with our expenses but would also help us widen our base so we can raise awareness with a greater number of people. Thank you for your consideration.
Darlene, darlenegray@sasktel.net
Prospective study of physical activity and the risk of ovarian cancer
Conclusions Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women.
Clinical Care Options Oncology - 2009 American Society of Clinical Oncology Annual Meeting audio - re: CA125 Dr Thigpen
J. Tate Thigpen, MD, discusses important findings in ovarian cancer, including findings from the CALYPSO trial, outcomes of a study evaluating delayed or early treatment of patients with rising CA-125, and findings from a phase III trial of gemcitabine plus cisplatin and radiation in cervical cancer patients. (7 minutes)
Wednesday, June 03, 2009
NEJM -- A Strategy for Health Care Reform -- Toward a Value-Based System
NEJM -- A Strategy for Health Care Reform -- Toward a Value-Based System: "strategy centered on value. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what's right for patients."
Dr Maurie Markman's comments: re: CA125/survival ASCO....
Cancerwise | A blog featuring Cancer News and Insights from M. D. Anderson
Surveillance of CA-125 in Women With Advanced Ovarian Cancer
By Cancerwise Blogger on June 2, 2009 9:34 AM
By Maurie Markman, M.D., Vice President for Clinical Research, from ASCO 2009
The abstract from Rustin, et al, dealing with the clinical utility of routine surveillance of CA-125 in women with advanced ovarian cancer who attain a complete clinical remission following cytotoxic chemotherapy has the potential to change the standard management paradigm in this clinical setting.
This well-designed and conducted Phase III randomized trial revealed that patients who initiated treatment for recurrent disease solely based on an elevated CA-125 antigen (in the complete absence of any signs or symptoms of cancer) did not experience superior survival compared to women who experienced recurrence but whose therapy was started due to other manifestations of the malignancy (for example, a return of abdominal symptoms).
However, it is critically important to recognize what this study does not state.
First, there is no statement that patients treated in this trial failed to experience benefit from the treatment of recurrence, but only that it was possible to delay reintroduction of treatment until symptoms developed.
Second, there is no statement that CA-125 should be avoided in a patient who experiences symptoms. In fact, in this setting, a serum CA-125 level can be particularly helpful since symptoms of recurrent ovarian cancer can be quite non-specific. In a woman who has previously undergone a major abdominal surgical procedure, interference with bowel function (often due to adhesions) can appear to be due to progressive cancer when in reality the discomfort is secondary to the effects of the previous surgery.
The finding of a normal CA-125 antigen level in this situation can be helpful, while an elevated value would likely lead to future investigation (e.g., abdominal/pelvic CT scan) and possible re-introduction of anti-neoplastic treatment.
Adaptive Therapy -- reference to Carboplatin
Major Findings:
We present mathematical analysis of the evolutionary dynamics of tumor populations with and without therapy. Analytic solutions and numerical simulations show that, with pretreatment, therapy-resistant cancer subpopulations are present due to phenotypic or microenvironmental factors; maximum dose density chemotherapy hastens rapid expansion of resistant populations. The models predict that host survival can be maximized if "treatment-for-cure strategy" is replaced by "treatment-for-stability." Specifically, the models predict that an optimal treatment strategy will modulate therapy to maintain a stable population of chemosensitive cells that can, in turn, suppress the growth of resistant populations under normal tumor conditions (i.e., when therapy-induced toxicity is absent). In vivo experiments using OVCAR xenografts treated with carboplatin show that adaptive therapy is feasible and, in this system, can produce long-term survival.
Tuesday, June 02, 2009
Monday, June 01, 2009
Sunday, May 31, 2009
my response regarding Andy Pollack's patient views on the CA125 (prior to the science paper)
May 31st, 2009 submitted electronically:
The issue of ultimate survival benefit and the psychological impact of living with and dying with ovarian cancer are at odds with each other.
Ovarian cancer patients/caregivers, for the most part, understand the limitations of this only and less than effective monitoring/diagnostic tool. However, it is well established that the CA125 can forecast recurrent disease months in advance of current imaging tests (CT scans etc).
It is the psychological burden which is a mixed 'blessing' BUT it is the one thing which ovarian cancer patients hold onto because that is all that we have in the daily nanoseconds while dealing with ovarian cancer. It can be said and felt that some healthcare professionals are unable or unwilling to deal with the psychological impact of the CA125 due primarily from a time perspective (workload stresses).
In fact, until we have a better test for ovarian cancer, whether it is for screening high risk women or disease recurrence, this issue will never go away, irrespective of the science involved.
I believe that we need to say no to any further research regarding the CA125 because at this point we are simply regurgitating what is already know. It is important to move forward in the research and find sooner, rather than later, a test which will be more accurate for ovarian cancer. Illusive, but possible, if the coordinated and cooperative venues can be improved.
On a personal perspective, this will be my 10th year anniversary of disease-free/no recurrence clear cell ovarian cancer. This week I asked my family doctor (an exceptional physician) for a CA125 and even she raised her eyebrows at the request, but graciously proceeded with the requisition.
I consider myself well versed in the science of the CA125, but you see? It doesn't matter, the issue is personal, very personal.It is one of the burdens of the disease, assuming one survives ovarian cancer. Acknowledging the impact of the personal will relieve many science questions and management decisions.
Sandi Pniauskas
Letter of thanks for participation from NY Times journalist Andy Pollack - re: CA125 patient opinions
Sandi,
I have been overwhelmed with calls and emails from women offering thoughtful comments and telling of their own experiences. I used a couple in my article.
There are so many I might not be able to get back to everyone. So I was hoping you could send out a message, perhaps this message, thanking all of those women who so generously responded. The article should be on our website, http://www.nytimes.com, by Monday morning, probably Sunday night. There might be a way for readers to comment on the issue on our website.
Again, thanks for your help and to all the women who responded. I hope everyone does well in fighting this disease.
Best regards,
Andy Pollack
Biotechnology reporter
The New York Times
URGENT RESPONSE REQUIRED TODAY - CA125 Patients'/Caregivers' Views
Correspondence received today (May 31st, 2009:
Dear Sandi,
I cover biotechnology for the New York Times. I’m covering a study being presented at ASCO today showing that using CA-125 to check for recurrence and then treating when CA-125 starts to rise does not provide any survival benefit over just waiting for symptoms and starting treatment then. The lead investigator said there would thus be no need for women to constantly have their CA-125 tested, saying it only leads to anxiety and increased chemo without any benefit. He seemed to suggest that women, particularly in the US, have almost a “CA-125 psychosis’’ obsessing over their test scores. (This study does not refer to using CA125 to monitor therapy, only to detect recurrence.
I’m wondering if you or someone such as a woman with ovarian cancer would be willing to comment on this. Even if they don’t know the study results in detail I’m interested in the phenomenon, if it’s true, of constantly testing for CA-125.
The deadline is today so I would have to speak to people by about 5 p.m. eastern time today. My number is below so you or anyone can call me directly. Or reply by email.
Thanks for any help you can provide.
Best regards,
Andrew Pollack
Biotechnology reporter
The New York Times
917-679-5920
pollack@nytimes.com
Saturday, May 30, 2009
Informing women about HRT: the Consensus conference statement
Conclusions
This CC led to the identification of specific information drawbacks. Women are
exposed to messages that are often partial, non evidence-based nor transparently
developed. The structured and participative methodology of this CC allowed a
multidisciplinary perspective and a substantial lay people input.
Friday, May 29, 2009
Canadian Health Reference Guide: 23rd out of 32 countries: How Canada compares to Europe on health care
Dr. Björnberg pointed out that "Patients rights, access to information, and choice and services without delay are underdeveloped in Canada and deliver low value for the money spent."
Thursday, May 28, 2009
Wednesday, May 27, 2009
Tuesday, May 26, 2009
Survey of unaffected BRCA and mismatch repair (MMR) mutation positive individuals
"Results suggest fear of GD is prevalent, yet data do not support evidence that GD exists."
Southwest Oncology Group Trial S9912: Intraperitoneal cisplating and paclitaxel plus IV paclitaxel and PLD as priary chemo of small volume residual OC
"CONCLUSION: Both the overall trial outcome, and specifically the excessively severe systemic toxicity of this regimen would prevent its future development in this exact form."
Monday, May 25, 2009
Sunday, May 24, 2009
Saturday, May 23, 2009
Hope dies last
Hope dies last: "But Canadians with rare cancers aren't in as strong a position as those with common cancers, in part because they 'don't have a strong lobby group"
Thursday, May 21, 2009
Wednesday, May 20, 2009
Tuesday, May 19, 2009
Letter to Saskatchewan Minister of Health: Ovarian Cancer Awareness & Treatment in Saskatchewan
May 19, 2009
Honorable Don McMorris
Minister of Health
Government of Saskatchewan
Room 302, Legislative Building
2405 Legislative Drive
Regina, SK
S4S 0B3
Dear Minister McMorris:
It has been an interesting time since we first wrote to you November 2008, and since we provided our
recommendations for gynecological oncology care for the women of Saskatchewan earlier in the spring of 2008.
We have learned so much more about how the medical profession operates, how medical care is delivered in
Saskatchewan, about guidelines, standards and recommendations by governing bodies and other jurisdictions.
And thank you to the good help of Sophie Ferre of your office, we have initiated relationships with some of the core executives responsible for decision making regarding gynecological oncology in our province. And we will continue to do this of course.
Also since our beginning with your office our group has more than doubled and support for our work is coming from many different directions, and we are able to provide support for more patients and their families.
This is all very positive and provides us with hope and motivation to continue.
Also hopeful is the fact not one single person, professional, executive, representative we have met with is against our recommendations. In fact, quite the reverse is true. We have been told that our recommendations are essential to improved survival outcomes for a very lethal cancer, that our recommendations are credible, that other groups concerned about gynecologic cancers has similar recommendations.
While other jurisdictions in Canada may not have written recommendations such as ours, all jurisdictions in Canada except Saskatchewan provide the care we are looking for from gynecologic
oncology units including intraperitoneal chemotherapy (IP).
The reasons for not doing this yet vary and have included the gaps between bureaucracies prevent it in various ways (jurisdictions, funding), the government needs to agree to funding, awareness needs to be improved.
We fully expected that on May 14th the meeting between the Saskatchewan gynecologic oncologists and the various bureaucracies would lead to some positive announcements for the women in our province.
Rather, we hear that there has been an agreement to continue to discuss Gynecologic Oncology units only until June 30th. No agreement ensuring we would not be losing our two specialists in Regina. No announcement about working groups that involve patient input.
We understand that the Regina gynecologic oncologists have not changed their plans to close their office September 1st. And we want to know what is happening with new patients.
Throughout, we have been very patient but now we feel it is urgent that we meet with you, as we requested back in November.
Please, Minister McMorris, it is time for us to present our case to you and find out what the barriers are to keeping our specialists in Saskatchewan.
Thank you for your consideration. We feel this is an urgent matter and would appreciate hearing back from
you very soon.
Sincerely,
Darlene Gray
A Director Of
Ovarian Cancer Awareness & Treatment in Saskatchewan
OCATS
6438 – 7th Avenue N, Regina, SK, S4T 6X7, Ph 306-775-1848, Fx 306-775-1853, darlenegray@sasktel.net Facebook
Editorial: Prognostic Tools for Cancer Survival: A Secondary Role for Quality-of-Life Measurement
"...But let us not regress back to our old ways and attach
significance to HRQOL only in relation to our attachment to survival
as a clinical outcome. Measuring HRQOL should have value in its own
right. As the field evolves, it should acquire greater clinical importance
and expand the lessons we take away from clinical trials."
Monday, May 18, 2009
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary an
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary and Metastatic Carcinoma.
Sunday, May 17, 2009
Special Feature: Swing and Miss?!? Efforts in Front-line Ovarian Cancer Chemotherapy Development.
A closer look at the components of these positively sloped survival curves demonstrates that most of the benefit afforded women is in life gained in the presence of disease, rather than cure. Indeed, the cure rates from ovarian cancer have remained relatively flat over these 3 decades, adding no more than approximately 2 weeks per year in the overall gain of life expectancy. This is clearly due to the unmovable percentage of advanced stage cases still indicative of the most common clinical presentation (stage III/IV), and underscores the immense impact even a slight stage migration could have on the overall clinical performance of women with this disease.
The temporal stability of the Symptom Index among ...[Gynecol Oncol. 2009] - PubMed Result
- Gynecol Oncol. 2009 May 6
-
The temporal stability of the Symptom Index among women at high-risk for ovarian cancer.
Molecular Diagnostics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Exponent Health Sciences, Seattle, Washington, USA.
OBJECTIVE: To evaluate the temporal stability of self-reported symptoms known to be associated with ovarian cancer.
METHODS: This report is a longitudinal analysis of symptom reporting from 123 women who participated in the Seattle-based Ovarian Cancer Early Detection Study (OCEDS). The OCEDS population includes women at increased risk of ovarian cancer based on a family history of cancer or a BRCA I/II mutation. Data on symptoms were collected at two time points using a Symptoms Index that included abdominal pain, pelvic pain, feeling full quickly, inability to eat normally, abdominal bloating, and increased abdominal size.
RESULTS: There was a median of 101 days between the two time points, with a range of 72-332 days. The median age of the women was 51, with a range of 32-79 years. Abdominal bloating was the most commonly reported symptom at both time points. The symptom least commonly reported at the two time points was inability to eat normally. The Symptoms Index was negative at both time points for 86% of all women and positive at both time points for 2% of all women. There were no statistically significant patterns of change for symptom reporting between time points.
CONCLUSIONS: The Symptoms Index and women's report of abdominal pain, pelvic pain, feeling full quickly, unable to eat normally, abdominal bloating, increased abdominal size were stable between two time points in this sample. These findings provide evidence that longitudinal measurements of symptoms reporting by women in a screening study are likely to be reliable.
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary an
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary and Metastatic Carcinoma
Friday, May 15, 2009
Thursday, May 14, 2009
Wednesday, May 13, 2009
The temporal stability of the Symptom Index among women at high-risk for ovarian cancer.
Molecular Diagnostics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Exponent Health Sciences, Seattle, Washington, USA.
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| OBJECTIVE: To evaluate the temporal stability of self-reported symptoms known to be associated with ovarian cancer. METHODS: This report is a longitudinal analysis of symptom reporting from 123 women who participated in the Seattle-based Ovarian Cancer Early Detection Study (OCEDS). The OCEDS population includes women at increased risk of ovarian cancer based on a family history of cancer or a BRCA I/II mutation. Data on symptoms were collected at two time points using a Symptoms Index that included abdominal pain, pelvic pain, feeling full quickly, inability to eat normally, abdominal bloating, and increased abdominal size. RESULTS: There was a median of 101 days between the two time points, with a range of 72-332 days. The median age of the women was 51, with a range of 32-79 years. Abdominal bloating was the most commonly reported symptom at both time points. The symptom least commonly reported at the two time points was inability to eat normally. The Symptoms Index was negative at both time points for 86% of all women and positive at both time points for 2% of all women. There were no statistically significant patterns of change for symptom reporting between time points. CONCLUSIONS: The Symptoms Index and women's report of abdominal pain, pelvic pain, feeling full quickly, unable to eat normally, abdominal bloating, increased abdominal size were stable between two time points in this sample. These findings provide evidence that longitudinal measurements of symptoms reporting by women in a screening study are likely to be reliable. PMID: 19427026 | ||||||||
Tuesday, May 12, 2009
Monday, May 11, 2009
IAPO Member, the Lance Armstrong Foundation, invites you to join the LIVESTRONG Global Cancer Campaign | A global voice for patients includes pts
IAPO | IAPO Member, the Lance Armstrong Foundation, invites you to join the LIVESTRONG Global Cancer Campaign | A global voice for patients:
"Organizations and individuals making extraordinary commitments will be invited to share the stage with world leaders in a high profile display of unity against cancer."
Sunday, May 10, 2009
Saturday, May 09, 2009
Friday, May 08, 2009
Thursday, May 07, 2009
Wednesday, May 06, 2009
Cochrane Collaboration review/commentaries: Interventions for psychosexual dysfunction in women treated for gyn malignancy
| Comments from Clinical Raters |
|---|
GynecologyA very useful review that confirms the need for proper randomised studies to answer this important question. My misgivings on the apparent lumping of all gynaecological malignancies together is that it creates an obviously flawed impression that sexual problems after treatment of gynaecological cancer of any kind might have a common solution. |
Oncology - GeneralI was surprised to find that there was any evidence at all from randomised studies that addressed questions in this important area. The authors rightly draw attention to the paucity of evidence and its poor quality. As interest increases in what is now called cancer survivorship, we can anticipate an increasing need for solid evidence on which to base management for the complex difficulties experienced by patients successfully treated for cancer. This paper indicates that it is not going to be easy to assemble the necessary evidence. |
Screening Tests Missing Early Signs of Ovarian Cancer - Oncology Nursing News
Screening Tests Missing Early Signs of Ovarian Cancer - Oncology Nursing News
Comment:
S. Pniauskas
Please also, and importantly, reference the recently published early detection ovarian cancer clinical trial by Dr Jacobs from the U.K.. Further, Dr Jacobs completed a study of 22,000 women over a decade ago with the same results. So, nothing has changed even after all of this time which is very sad. So much time has elapsed, so many deaths and sufferings. A coordinated international effort is needed badly and while new research is hopeful, our ovarian cancer communities have faced extreme dissapointments with even new and 'apparent' early detection tests of recent years. It would be seriously disconcerting to know that another decade may lapse without any definitive results. This does not take away from the goodwill and integrity of the research/ers, but a more effective and coordinated effort is needed.
Tuesday, May 05, 2009
Monday, May 04, 2009
Sunday, May 03, 2009
Saturday, May 02, 2009
Peutz-Jeghers Syndrome: eMedicine Gastroenterology updated Apr 2009
Peutz-Jeghers Syndrome: eMedicine Gastroenterology: "Almost 50% of patients with Peutz-Jeghers syndrome (PJS) develop and die from cancer by age 57 years. The mean age at first diagnosis of cancer is 42.9 years, /– 10.2 years.
* The cumulative risk for developing any cancers associated with Peutz-Jeghers syndrome (PJS) in patients aged 15–64 years is 93%.
* The cumulative risks of developing a particular cancer from ages 15-64 years are as follows: esophagus, 0.5%; stomach, 29%; small intestine, 13%; colon, 39%; pancreas, 36%; lung, 15%; testes, 9%; breast, 54%; uterus, 9%; ovary, 21%; and cervix, 10%."
Review Transition from acute to chronic postsurgical pain: risk factors and protective factors
However, a rarely appreciated fact is that every chronic pain was once acute.
Wrong Approach to Obesity Can Alienate Patients - Physicians can unintentionally de-motivate black patients
Editorial note: it takes a study to understand this?
"patients may respond unexpectedly if approached in a manner they perceive as disrespectful, condescending, emotionless, or non-supportive,' the authors write."
Friday, May 01, 2009
Webcasts - AACR
Webcasts: "More than 90 hours of selected Annual Meeting talks will be made available as free online webcasts approximately 10 business days* after the AACR 100th Annual Meeting 2009 and will remain accessible for two years. Sessions that are to be webcast will include audio and, if available, slides from the talks.
Note: Only individual talks within a session that AACR has received permission to webcast will be included. For example, if there are four talks in a session and only two speakers give their permission to be webcast, then only those two talks will be made available.
*The Opening Plenary and the Spotlight on Breakthroughs in Cancer Research session will both be available as webcasts approximately 24 hours after they conclude."
Multiple Regions Of Chromosome 8 Found To Be Associated With Different Cancers
this link above is previous research (2008) regarding chromosome 8q24 region and it's wider scope of impact:
The authors' analysis suggests that there may be five distinct subregions within 8q24, separated by sites of frequent recombination, and each associated with different types of cancer. The first subregion is associated with an increased risk of prostate cancer but not with risk of breast, colorectal, or ovarian cancer. The second is associated only with an increased risk of breast cancer. The third subregion is associated with the risk of prostate, colorectal and ovarian cancers, but not breast, and subregions four and five were associated with prostate cancer, but not with the other three malignancies.
"We have shown there are at least five independent loci within this gene desert with different associations with particular cancers," the authors write. "Further studies of the region may identify additional loci associated with specific cancers and possibly refine our understanding of the mechanisms underlying the associations reported here."
Thursday, April 30, 2009
Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient
"Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient."
Wednesday, April 29, 2009
Wait times for chemotherapy in Ontario growing, say advocacy groups
Working On IT! a book in progress: Dana Martinez (husband Ron)
I don't mind making this journey as long as I know that I am helping someone else. Every Cancer survivor I have ever met, has felt this way. There is something that happens to you once you have Cancer, you become part of a larger family-- a family bound by a common thread- "survival".
Tuesday, April 28, 2009
Let Me In!
power point presentation: Let Me In!
access link below:
www.scribd.com/doc/13044110/Ovarian-Cancer-Let-Me-In
Ovarian Cancer: Let Me In!
"Doc, Should I See You or My Oncologist?" A Primary Care Perspective
“Doc, Should I See You or My Oncologist?” A
Primary Care Perspective on Opportunities and
Challenges in Providing Comprehensive Care for
Cancer Survivors
Monday, April 27, 2009
Saturday, April 25, 2009
Friday, April 24, 2009
A Rapid and Reliable Test for BRCA1 and BRCA2 Founder Mutation Analysis in Paraffin Tissue Using Pyrosequencing
The founder mutations in BRCA (BRCA1*185delAG, BRCA1*5382insC, and BRCA2*6174delT) account for 95% of the detectable BRCA mutations in breast and ovarian cancer families of Ashkenazi Jewish ancestry.
Thursday, April 23, 2009
Intercepting pelvic cancer in the distal fallopian tube: theories and realities
This review summarizes the recent data supporting the distal fallopian tube as an important site for serous carcinogenesis, stressing both the presence of a novel precursor (the p53 signature) and the application of this model to all women irrespective of BRCA status. The challenges and unmet needs unmasked by this paradigm shift in ovarian cancer research are discussed.
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Wednesday, April 22, 2009
Tuesday, April 21, 2009
April 21, 2009 - NCI Ovarian Cancer Markers Validated for Early Detection
NCI Cancer Bulletin for April 21, 2009 - National Cancer Institute: "The current guidelines of the U.S. Preventive Services Task Force do not recommend ovarian cancer screening with CA-125. Earlier this month another study using PLCO data concluded that screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages."
Monday, April 20, 2009
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
CO Early Release, published online ahead of print Apr 20 2009
Journal of Clinical Oncology, 10.1200/JCO.2008.20.4883
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
M. Elisabeth Del Giudice,* Eva Grunfeld, Bart J. Harvey, Eugenia Piliotis, and Sunil Verma
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre; Ontario Institute of Cancer Research and Cancer Care Ontario, Health Services Research Program; and Divisions of Hematology and Medical Oncology, Department of Medicine, Odette Cancer Centre, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: lisa.delgiudice@sunnybrook.ca
Purpose: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.
Methods: A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.
Results: A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.
Conclusion: With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
Press release: Cochrane Library free access to all Canadians
Ottawa, April 15, 2009— The Canadian Cochrane Network and Centre announces today
that everyone in Canada with access to the Internet will be able to view the full content of
The Cochrane Library, an on-line resource that provides evaluations on health
treatments.
The Canadian Cochrane Network and Centre, in partnership with the Canadian Health
Libraries Association, has successfully secured a national license to The Cochrane
Library. In essence, the license provides a subscription for every Canadian with access to
the Internet to benefit from the immense volume of health information found in The
Cochrane Library. Everybody will be one click away from the best available evidence on
the effectiveness of treatment procedures including which ones may be harmful.
Sunday, April 19, 2009
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Hum Pathol. 2009 Apr 13
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Ohishi Y, Oda Y, Kurihara S, Kaku T, Yasunaga M, Nishimura I, Okuma E, Kobayashi H, Wake N, Tsuneyoshi M.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Diagnostic Laboratory, Kyushu University Hospital at Beppu, Beppu 874-0838, Japan.
Hobnail-like cells, which suggest a diagnosis of clear cell carcinoma, are also focally observed in serous borderline tumor of the ovary, causing diagnostic confusion. However, the precise nature of hobnail-like cells in serous borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not hobnail-like cells in serous borderline tumor represent concomitant incipient clear cell neoplasms. First, we carefully reviewed hematoxylin and eosin slides taken from 115 ovarian tumors diagnosed as clear cell carcinoma (73 cases), mixed adenocarcinoma containing clear cell carcinoma (5 cases), and serous borderline tumor (37 cases) to clarify the frequency of coexistence of typical clear cell carcinoma and serous borderline tumor. Through the hematoxylin and eosin review, we paid special attention to the cytologic features of hobnail-like cells in serous borderline tumor and serous borderline tumor-like papillary areas in clear cell carcinoma. Second, we selected 19 serous borderline tumors and 16 clear cell carcinomas, in which hobnail-like cells were easily recognizable, and investigated the immunohistochemical expression of estrogen receptor and Wilms tumor gene protein. No coexistence of clear cell carcinoma and serous borderline tumor was evident in any of the above 115 ovarian tumors. Hobnail-like cells were focally positive for estrogen receptor and Wilms tumor gene protein in nearly all serous borderline tumors. Hobnail-like cells in all clear cell carcinomas were completely negative for estrogen receptor and Wilms tumor gene protein, although estrogen receptor expression was very focally observed (less than 5% area) in non-hobnail cells of only one clear cell carcinoma. In conclusion, hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms because (1) clear cell carcinoma and serous borderline tumor do not coexist and (2) hobnail-like cells in clear cell carcinoma and serous borderline tumor are immunophenotypically distinct. Recognition of our conclusion may protect a patient with "conspicuous hobnail-like cells in serous borderline tumor" from an erroneous overdiagnosis of "concomitant clear cell carcinoma admixed with serous borderline tumor."
Saturday, April 18, 2009
article: Guidelines needed for optimal vitamin D supplementation in cancer patients
"There may be specific benefits and harms associated with vitamin D supplementation in cancer patients that are not present in the general population, despite the fact that these benefits and harms have not been conclusively demonstrated,” Dr. Goodwin writes. “As a result, oncologists making recommendations to individual patients should take a cautious approach.”
Bias in the exchange of arguments: the case of scientists' evaluation of lay viewpoints- Public Understanding of Science
Note: a bit off topic but the last point taken:
"Abstract
Most perspectives on public participation share the notion that dialogues should be open, allowing participants to articulate and evaluate different views and knowledge claims. We hypothesize that participants' evaluation of claims may be biased because participants have a preference for a particular type or source of a claim. This would hamper an open dialogue.....
Contrary to our expectation, scientists evaluated claims of the public more positively than claims of experts."
The risk of colorectal cancer with symptoms at different ages and between sexes: a case-control study
Differences with age and sex are important; current guidance for referral ignores age
The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack
Table 1. Presenting symptoms and signs for 194 patients with colorectal cancer
Symptom Percentage of patients:
Fecal occult blood test positive 77
Rectal bleeding 58
Anemia* 57
Abdominal pain 52
Weight loss 39
Anorexia 27
Constipation 27
Altered stools 25
Fatigue 25
Diarrhea 22
Nausea and vomiting 22
Tenesmus 8
Mucus in stools 6
Rectal pain 5
Obstruction 4
Adapted from . Majumdar et al. [1].
*Anemia = a hemoglobin of <13.4g/dl in men or <12.3g/dl in women.
Friday, April 17, 2009
Inhibition of functional HER family members increases the sensitivity to docetaxel in human ovarian cancer cell lines.
In conclusion, a combination of docetaxel with inhibitors of HER family members, such as cetuximab plus pertuzumab, may be considered for a clinical trial in ovarian carcinomas with functional receptors.
Parity and the risk of breast and ovarian cancer in BRCA1 and BRCA2 carriers
This is the third independent study to find that, as in the general population, parity appears to be associated with protection from breast cancer in women with mutations in BRCA1 and BRCA2. Parity appears to be protective for ovarian cancer in BRCA1 mutation carriers, but its role in BRCA2 mutation carriers remains unclear. Whether later age at first birth is also protective for ovarian cancer in mutation carriers requires further confirmation.
Cochrane Collaboration: Interval debulking surgery for advanced epithelial
* Rates of toxic reactions to chemotherapy were similar in both arms (RR = 1.3, 95%CI: 0.4 to 3.6), but little information is available for other adverse events.
* Only one trial reported quality of life (QOL), which was generally similar in both treatment arms.
* No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists or was less extensive.
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
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