Recommended Adult Immunization Schedule --- United States, 2011 including those with health conditions- Fig. 2

FIGURE 2. Vaccines that might be indicated for adults, based on medical and other indications --- United States, 2011

Alternate Text: The figure above shows vaccines that might be indicated for adults, based on medical and other indications in the United States for 2011.

NOTE: The above recommendations must be read along with the footnotes on pages 3--4 of this schedule.

Clinical practice guidelines as marketing tools -- Collier 183 (3): E141 -- Canadian Medical Association Journal

Blogger's Note: bias exist no matter the source, what does matter is the degree and ultimately the intent (ethics)
 ....................................................................................
"If the guidelines are funded by government or private donors, a bias toward recommending particular pharmaceuticals may not be present."

Andrew's Blog » Cancer Survivorship and Fear

Fear. For us it is not clinical routine. It is our lives on the line at diagnosis or at a checkup.

abstract: The use of Chinese herbal medicine to improve quality of life in women undergoing chemotherapy for ovarian cancer: a double-blind placebo-controlled randomized trial with immunological monitoring — Ann Oncol

Background: This study aimed to evaluate traditional Chinese medicine (TCM) in improving quality of life (QOL), reducing chemotoxicity and modulating immune function in patients undergoing chemotherapy.  

Review Article: A Systematic Review of Cancer-Related Fatigue Measurement Questionnaires

Discussion:
Most tools had been validated in mixed populations and are relatively insensitive to differences in fatigue to cancer stage. Most instruments are burdensome for those with advanced cancer.


Conclusions:
In all, 40 CRF instruments were identified. Validity and reliability varied by questionnaire. The ideal item numbers, scale, and domains are not established and may be population dependent.

Warfarin (Coumadin)- fp notebook update

Coumadin (Warfarin Sodium) Drug Information: User Reviews, Side Effects, Drug Interactions and Dosage at RxList

Coumadin

• Coumadin Drug Description
• Coumadin Indications & Dosage
• Coumadin Side Effects & Drug Interactions
• Coumadin Warnings & Precautions
• Coumadin Overdosage & Contraindications
• Coumadin Clinical Pharmacology
• Coumadin Medication Guide
• Coumadin Consumer
• Coumadin Patient

Check Your Warfarin | C3: Colorectal Cancer Coalition

abstract: Prognostic and predictive relevance of CA-125 at primary surgery of ovarian cancer(early/advanced stages)

ESMO: Community Oncology: Ensuring the Best Standards of Care

“The important thing is that community oncologists should not work alone. They should be part of a network and participate in a common reflection and also work with others in clinical research. In France, community oncologists work closely with university hospitals or big cancer centers and are in contact with larger teams. National and international guidelines are followed and ensure that patients receive quality treatment.”

abstract: Pleural Effusion Detected at CT prior to Primary Cytoreduction for Stage III or IV Ovarian Carcinoma: Effect on Survival

Purpose: To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer.

abstract : Red and processed meat consumption and risk of ovarian cancer: a dose-response meta-analysis of prospective studies : British Journal of Cancer

Conclusion:

Results from this dose-response meta-analysis suggest that red and processed meat consumption is not associated with risk of ovarian cancer. Although a lower consumption of red and processed meat may offer protection against other types of cancer, other interventions are needed to reduce the risk of ovarian cancer.

David Moher - Systematic Reviews & Prospero Register | Open Medicine Blog-PROSPERO International

PROSPERO - International prospective register of systematic reviews

PROSPERO is an international database of prospectively registered systematic reviews in health and social care. Key features from the review protocol are recorded and maintained as a permanent record in PROSPERO. This will provide a comprehensive listing of systematic reviews registered at inception, and enable comparison of reported review findings with what was planned in the protocol.

Substantial changes to the review questions or methods

• It can be difficult to decide whether an update to a review is in fact a new review. There is little published guidance on this. PROSPERO adopts a pragmatic approach. If changes to the review questions or methods are so substantial that they require major changes to the original protocol, this should be regarded as a new review rather than an update.

Examples that would constitute a new review

• addition of new treatment comparisons
  e.g. direct comparison of different drugs, when the old review included only comparisons of drug with placebo
• substantial changes to the population being studied
  e.g. adding adults to a review that was previously restricted to children
• exclusion criteria in the old review become inclusion criteria in the new review
• introduction of new analysis techniques
  e.g. a switch from aggregate data meta-analyses to individual participant meta-analyses.
  

If in doubt, a new record for a new review should be created. This will minimise the complexity of the editing to the original record in PROSPERO and make it easier for users to distinguish between the original review and the later version. Links between the new and original review can be added in the registration form.

Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective Randomized Trial of Oral Sodium Phosphate Solution vs Single Sodium Phosphate Enema (including safety issues)

Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective Randomized Trial of Oral Sodium Phosphate Solution vs Single Sodium Phosphate Enema

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Abstract

Study Objective

To compare the effect of mechanical bowel preparation using oral sodium phosphate (NaP) solution vs single NaP enema on the quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures.

The Art of Oncology series (ASCO) full free access: Negotiations and Love Songs

full free access: (2010) MSH6 and PMS2 mutation positive Australian Lynch syndrome families: novel mutations, cancer risk and age of diagnosis of colorectal cancer

Background

Approximately 10% of Lynch syndrome families have a mutation in MSH6 and fewer families have a mutation in PMS2. It is assumed that the cancer incidence is the same in families with mutations in MSH6 as in families with mutations in MLH1/MSH2 but that the disease tends to occur later in life, little is known about families with PMS2 mutations. This study reports on our findings on mutation type, cancer risk and age of diagnosis in MSH6 and PMS2 families..........cont'd

"Lynch syndrome is an autosomal dominantly inherited cancer syndrome characterised by early onset epithelial cancers. Patients with Lynch syndrome have an increased risk of developing malignancies during their lifetime, at a mean age of disease onset that is significantly lower than that observed in the general population. In addition to the high risk of developing CRC, Lynch syndrome patients are also at risk of developing malignancies in a variety of organs that include the uterus, small bowel, stomach, ovary, bladder, pancreas and the urinary tract [2,3]."

Groundbreaking Australian Study Examines Treatment For Women With Ovarian Cancer

....More Than A Month To Record Ovarian Cancer Diagnosis In One In 10 Cases

Perspectives: Sleep Deprivation, Elective Surgical Procedures, and Informed Consent — NEJM (including commentaries)

EvidenceUpdates: Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients including commentaries

Note: secondary link below w/o commentaries BUT full free access, also see Table 1 for risk factors including malignancies:

Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients

(why it's important)

"With an annual incidence of 1 to 2 per 1,000 inhabitants, deep vein thrombosis (DVT) is relatively rare in primary care, but it is feared for its associated morbidity and mortality if left untreated...."

Oncology STAT on IP chemo & dense dose regime | Cancer Survivors Network (discusses Avastin, Taxol, (Japanese study), clear cell, IP....)

Ovarian Cancer—New Thinking on Old Regimens

2011 Feb 23, Nelson Teng

Rare Disease Day 2011 - Find out what is happening in your country

website TCGA Cancer Genomics + 20 cancer study (including ovarian) updated Jan 2011

About Cancer Genomics

Explore information and resources to improve your understanding
of cancer genomics, the importance of tumor samples in genomic
research and the role of cancer genomics in personalized medicine.

plus:

Cancers Selected for Study

Following the success of The Cancer Genome Atlas (TCGA)
Pilot Project, NIH announced in September 2009 that it is
investing $275 million in TCGA over the next two years of
this five-year program to chart the genomic changes
involved in more than 20 types of cancer. To date,
TCGA has achieved comprehensive sequencing,
characterization, and analysis of the genomic changes
in the brain cancer, glioblastoma multiforme, and
ovarian cancer.

CANCER TISSUES BEING COLLECTED FOR POTENTIAL STUDY

Last Updated: January 16, 2011 Expand All | Collapse All

Central Nervous System (Brain)

Cancer Type	Sample Collection Complete	Data Publicly Available
Glioblastoma Multiforme

Breast

Cancer Type	Sample Collection Complete	Data Publicly Available
Breast Lobular Carcinoma
Breast Ductal Carcinoma

Gastrointestinal

Cancer Type	Sample Collection Complete	Data Publicly Available
Colon Adenocarcinoma
Rectal Adenocarcinoma
Stomach Adenocarcinoma

Gynecologic

Cancer Type	Sample Collection Complete	Data Publicly Available
Ovarian Serous Cystadenocarcinoma
Uterine Corpus Endometrial Carcinoma

Head and Neck

Cancer Type	Sample Collection Complete	Data Publicly Available
Head and Neck Squamous Cell Carcinoma
Thyroid Carcinoma

Hematologic

Cancer Type	Sample Collection Complete	Data Publicly Available
Acute Myeloid Leukemia

Thoracic

Cancer Type	Sample Collection Complete	Data Publicly Available
Lung Adenocarcinoma
Lung Squamous Cell Carcinoma

Urologic

CME/Conference Management - Lynch Syndrome Patient Conference - MD Anderson Cancer Center Apr 2, 2011

Lynch Syndrome Patient Conference

April 2, 2011-Saturday 9 a.m. – 3 p.m.

Hyatt Regency Hill Country
9800 Hyatt Resort Drive
San Antonio, Texas

Registration fee: $20. prior to March 11th, 2011

Commentary: microRNAs in stage I epithelial ovarian cancer : The Lancet Oncology

"In epithelial ovarian cancer (EOC), miRNA-expression profiles have been described that are associated with different characteristics of ovarian cancer (eg, tumour subtype, stage, histological grade, prognosis, and therapy resistance)........However, these studies should focus on pure histotypes, as EOC is thought to be a heterogeneous disease in which some histotypes are completely different entities all together, with different response outcomes to standard treatment. Another confounding factor for prognostic marker discovery might be exposure to platinum-based combination chemotherapy. Preferably, only patients who did not receive chemotherapy should be analysed for PFS. Because stage I EOC samples are relatively rare, we encourage additional studies to be done by international consortia. With the above-mentioned considerations in mind, valid miRNA biomarkers will be identified that can be of use in the clinic, and help to personalise treatment."

clinical trial recruiting: Women Who Are At Risk Or May Have Lynch Syndrome - Full Text View - ClinicalTrials.gov

ClinicalTrials.gov Identifier: NCT00508573

Estimated Enrollment:	1000
Study Start Date:	May 2007
Estimated Primary Completion Date:	May 2012 (Final data collection date for primary outcome measure)

abstract: Challenging cases encountered in colorectal cancer screening for Lynch syndrome reveal novel findings: nucleolar MSH6 staining and impact of prior chemoradiation therapy

abstract: Familial Tumors of the Uterine Corpus

Abstract

Women with Lynch syndrome are at considerable risk for developing endometrial carcinoma, but current screening guidelines for detection of Lynch syndrome focus almost exclusively on colorectal carcinoma. Lynch syndrome associated colorectal and endometrial carcinomas have some important differences with implications for screening strategies. These differences are discussed in this review, along with the most effective screening criteria and testing methods for detection of Lynch syndrome in endometrial carcinoma patients.

full free access: The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study

Association between miR-200c and the survival of patients with stage I epithelial ovarian cancer: a retrospective study of two independent tumour tissue collections : The Lancet Oncology

Interpretation

miR-200c has potential as a predictor of survival, and is a biomarker of relapse, in stage I EOC.

full free access: Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women, February 23, 2011 JAMA

Conclusion Among older women, treatment with a bisphosphonate for more than 5 years was associated with an increased risk of subtrochanteric or femoral shaft fractures; however, the absolute risk of these fractures is low.

Treatment-Related Mortality With Bevacizumab in Cancer Patients, February 2, 2011— JAMA review - 2.5 vs 1.7 % risk not dependent on type of solid tumor/dose

Data Synthesis: A total of 10 217 patients with a variety of advanced solid tumors from 16 RCTs were included in the analysis. The overall incidence of FAEs with bevacizumab was 2.5% (95% CI, 1.7%-3.9%). Compared with chemotherapy alone, the addition of bevacizumab was associated with an increased risk of FAEs, with an RR of 1.46 (95% CI, 1.09-1.94; P = .01; incidence, 2.5% vs 1.7%). This association varied significantly with chemotherapeutic agents but not with tumor types or bevacizumab doses.

Ovarian Cancer Biomarkers for Molecular Biosensors: Medscape review including commentary

video/text: Hysterectomy and Cardiovascular Disease: Conserve the Ovaries?

Dermatological Manifestations of Cancer Syndromes in Children: Medscape (full free access) Lynch Syndrome/others

Note: See Table 1 for syndromes/familial genetics

When the Doctor's Wife Has Breast Cancer - NYTimes.com

Abstract: Persistent Noncompliance With the Work-Hour Regulation (patient safety)

Note:
the Transportation Industry has been dealing with 'hours of service'
issues for decades    (same issues/different industry - fatigue)

 NOTE: A new Hours-of-Service (HOS) Proposed Rulemaking was published
on December 29, 2010. For details, visit the HOS Proposed Rule page to view the complete rulemaking, summary of changes, FAQs, and other related information.

Health-related quality of life and cancer clinical trials — Therapeutic Advances in Medical Oncology

"...Health-related quality of life has become a more accurate predictor of survival than some other clinical parameters, such as performance status. The overall outlook for the routine assessment of patient-reported outcomes in clinical trials is assured and, eventually, it is likely to become a standard part of clinical practice. ...."

Feb 21st, 2011: Ovarian cancer - Cancer Network (worth reading/overview of ovarian cancer)

Note: good overview of ovarian cancer biology, treatments, genetics, diet, environment, hormonal factors...

By Stephen C. Rubin, MD, Paul Sabbatini, MD, and Akila N. Viswanathan, MD, MPH | February 21, 2011

Expert Perspectives in Oncology: Contemporary Approaches in Targeting Angiogenesis prIME Oncology

Note: requires registration to view (free), also speaks about ICON 7 (ovarian cancer/avastin trial) Module Six Practical Considerations in Patient Management Involving Antiangiogenic Therapy

St. Gallen Satellite Symposium titled,: “‘Perplexing Questions in Early Breast Cancer: Answers from the Experts | prIME Oncology

Note: requires registration to view (free)

Meeting Overview
We are pleased to invite you to our St Gallen Satellite Symposium titled, “Perplexing Questions in Early Breast Cancer: Answers from the Experts," to be held on 17 March 2011 in St Gallen, Switzerland.

During this interactive meeting, leaders in the field will discuss clinical issues in the field of early breast cancer.

Women's health: Yearly pelvic exams' effectiveness questioned - latimes.com

Note: 'old' news

Prima BioMed Receives Regulatory Scientific Advice on CVac Phase III Trial -- SYDNEY, Feb. 18, 2011 /PRNewswire/ --

"......The trial will be conducted on 750 patients in a double blind placebo controlled study randomized 1:1 of CVac vs. Standard of Care (currently there is no approved maintenance therapy for ovarian cancer), across multiple sites in Europe, the US and Australia....."

Why negative studies are good for health journalism, and where to find them - Gary Schwitzer's HealthNewsReview Blog

Letter to the Editor: Unexpected gastrointestinal toxicity from Docetaxel/Carboplatin/Erlotinib followed by maintenance Erlotinib treatment for newly diagnosed stage III/IV ovarian cancer, primary peritoneal, or fallopian tube cancer

Note: no abstract/pay-per-view (subscription req'd $$$)

full free access (pdf): Frequencies of BRCA1 and BRCA2 mutations among 1,342 unselected patients with invasive ovarian cancer (Ontario, Canada study including demographics)

Abstract

BACKGROUND: The heritable fraction of ovarian cancer exceeds that of any other common adult cancer. Most inherited cases of ovarian cancer are due to a germline mutation in BRCA1 or BRCA2. It is important to have an accurate estimate of the proportion of ovarian cancer patients who carry a mutation and the specific factors which predict the presence of a mutation.

METHODS: We tested a population-based series of 1342 unselected patients diagnosed with invasive ovarian cancer between 1995-1999 and 2002-2004 in Ontario, Canada, for germline mutations in BRCA1 and BRCA2. The two genes were tested in their entirety, using a range of techniques, including multiplex ligation-dependent probe amplification (MLPA).

RESULTS: Among the 1342 women, 176 women carried a mutation (107 in BRCA1, 67 in BRCA2, and two in both genes) for a combined mutation frequency of 13.3%. Seven deletions were identified using MLPA (3.9% of all detected mutations). The prevalence of mutations was particularly high among women diagnosed in their forties (24.0%), in women with serous ovarian cancer (18.0%) and women of Italian (43.5%), Jewish (30.0%) or Indo-Pakistani origin (29.4%). A mutation was seen in 33.9% of women with a first-degree relative with breast or ovarian cancer and in 7.9% of women with no first-degree relative with breast or ovarian cancer. No mutation was seen in women with mucinous carcinoma.

CONCLUSIONS: BRCA1 and BRCA2 mutations are common in women with invasive ovarian cancer. All women diagnosed with invasive non-mucinous ovarian cancer should be considered to be candidates for genetic testing.

Wound complications after gynecologic cancer surgery (risk factors)

CONCLUSIONS: Wound complications are common in gynecologic oncology. Further studies should explore whether risk factor modification decreases complications.

Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: Final results from CAL

Note: side effects

INTERPRETATION: ZA every 3 months is well tolerated and prevents rapid bone loss in premenopausal women that develop CIOF. Giving ZA with rather than 1 year after the start of adjuvant chemotherapy is the preferred sequence to prevent bone loss.

press release: (MUC1) Genus Oncology, LLC Announces Initiation of Phase I Trial of GO-203-2c phase 1 solid tumors

Helping social research make a difference - full free access (science and the arts)

Drawing Out Cancer With Biomarkers

By improving sensitivity, the fraction of false negatives decreases; by increasing specificity, the fraction of unnecessary biopsies falls as well. It is time for us to use all of our molecular tools side-by-side in diagnosing and measuring the progression of cancer.

Platinum-based adjuvant chemotherapy on moderate - and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution exper

Background Although the optimal management of women with FIGO stages I and II epithelial ovarian cancer (EOC) is still controversial, platinum-based adjuvant chemotherapy (CT) is the mainstay of treatment. Suboptimal survival results have led to major efforts to identify prognostic factors, improve surgical staging and develop adjuvant therapies to improve patients' outcomes.

Patients and methods We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed.

Results One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4).

Conclusions The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value.

Lynch Syndrome and MYH-Associated Polyposis: Review and Testing Strategy. Goodenberger M, Lindor NM.

Abstract

Individuals with Lynch syndrome have an increased risk for colorectal cancer, endometrial cancer, and other associated cancers such as gastric cancer, ovarian cancer, urothelial cancers, hepatobiliary tract cancer, brain cancer, cancer of the small intestine, pancreatic cancer, and particular skin cancers.
Lynch syndrome caused by defects in DNA mismatch repair genes, and diagnostic testing for Lynch syndrome begins with microsatellite instability and immunohistochemical analysis on the tumor specimen followed by germline genetic testing and possibly further studies on the tumor. MYH-associated polyposis syndrome is a recently characterized, autosomal recessive, polyposis syndrome caused by biallelic mutations in the MYH gene. Individuals carrying 2 copies of the mutation have a significantly increased risk of polyposis, colorectal cancer, upper gastrointestinal polyps and additional features commonly seen in familial adenomatous polyposis syndrome. Genetic testing for MYH mutation is complicated by the phenotypic overlap of MYH-associated polyposis with other colorectal cancer syndromes. This study serves to clarify the best testing approach.

Surgical management of bowel obstruction in gynaecological malignancies.

Abstract

PURPOSE OF REVIEW: Bowel obstruction in gynaecological malignancies continues to present clinical challenges and a multidisciplinary approach to discuss management is crucial. Surgery, usually with palliative intent, is associated with significant morbidity and mortality. There is an absence of level 1 evidence and national guidelines, and only limited quality-of-life data.
RECENT FINDINGS: Acute bowel obstruction in gynaecological cancer patients is rare and surgery is associated with a higher morbidity and mortality rate. Less commonly, emergency bowel obstruction cases will have had radiotherapy or recent chemotherapy, which also increases surgical morbidity and mortality. However, most often, bowel obstruction in irradiated gynaecological cancer patients is not due to cancer. Ovarian cancer is the most common malignancy. Caution is needed in those EOC patients with ascites, short treatment-free interval, acute abdomen and chemoresistance. Comorbidities are frequent. The decision for surgery should be made on an individual basis. Palliative care input is important early in patient management as for most patients the surgical goal is palliation and not cure. There is still a paucity of published data on quality-of-life assessments.
SUMMARY: There is a need to identify those patients who may benefit from palliative surgical intervention and those who will not. Ideally, agreed national guidelines should be produced and regularly reviewed.

Undetectable antimüllerian hormone levels and recovery of chemotherapy-induced ovarian failure in women with breast cancer on an oral aromatase inhibitors

Abstract

OBJECTIVE: Knowledge of the menopause status of a woman with breast cancer is important for good clinical practice. Long-lasting amenorrhea is frequent in this population, often for reasons other than definitive menopause. Antiestrogens like tamoxifen or oral aromatase inhibitors (AIs) may reactivate the ovary causing vaginal bleeding, menstruation, pregnancy, and unopposed endometrial stimulation. In contrast to tamoxifen, AIs are not active against breast cancer in the presence of functional ovaries. Antimüllerian hormone (AMH) is a potential marker of residual ovarian function that can predict not only the onset of menopause but also chemotherapy-induced amenorrhea (CIA) and fertility. We assess the value of AMH in women who recovered from CIA on an AI.

Retrospective study of the impact of pharmacogenetic variants on paclitaxel toxicity and survival in patients with ovarian cancer.

PURPOSE: Paclitaxel has a broad spectrum of anti-tumor activity and is useful in the treatment of ovarian, breast, and lung cancer. Paclitaxel is metabolized in the liver by CYP2C8 and CYP3A4 and transported by P-glycoprotein. The dose-limiting toxicities are neuropathy and neutropenia, but the interindividual variability in toxicity and also survival is large. The main purpose of this study was to investigate the impact of genetic variants in CYP2C8 and ABCB1 on toxicity and survival.
METHODS: The 182 patients previously treated for ovarian cancer with carboplatin and paclitaxel in either the AGO-OVAR-9 or the NSGO-OC9804 trial in Denmark or Sweden were eligible for this study. Genotyping was carried out on formalin-fixed tissue. The patients' toxicity profiles and survival data were derived from retrospective data. CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T were chosen a priori for primary analysis; a host of other variants were entered into an exploratory analysis.
RESULTS: Clinical data and tissue were available from a total of 119 patients. Twenty-two single nucleotide polymorphisms (SNPs) in 10 genes were determined. Toxicity registration was available from 710 treatment cycles. In the primary analysis, no statistically significant correlation was found between CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T and neutropenia, sensoric neuropathy, and overall survival.
CONCLUSION: CYP2C8*3 and the ABCB1 SNPs C1236T, G2677T/A, and C3435T were not statistically significantly correlated to overall survival, sensoric neuropathy, and neutropenia in 119 patients treated for ovarian cancer with paclitaxel/carboplatin.

Sugars in diet and risk of cancer in the NIH-AARP diet and health study

Abstract

Prospective epidemiologic data on the effects of different types of dietary sugars on cancer incidence have been limited. In this report, we investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies.
Participants (n = 435,674) aged 50-71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ)......... We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma ; added fructose was associated with risk of small intestine cancer ; and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer.
Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.

Long-term clinical and immunological effects of p53-SLP® vaccine in ovarian cancer patients

Abstract

Vaccine-induced p53-specific immune responses were previously reported to be associated with improved response to secondary chemotherapy in small cell lung cancer patients. We investigated longterm clinical and immunological effects of the p53-SLP® vaccine in recurrent ovarian cancer patients. Twenty patients were immunized with the p53-SLP® vaccine between July 2006 and August 2007.
Follow-up information on patients was obtained. Clinical responses to secondary chemotherapy after p53-SLP® immunizations was determined by computerized tomography and/or tumour marker levels (CA125). Disease-specific survival was compared with a matched historical control group. Immune responses were analysed by flow cytometry, proliferation assay, IFN-γ ELISPOT and/or cytokine bead array. Lymphocytes cultered from skin biopsy were analysed by flow cytometry and proliferation assay.
Of twenty patients treated with the p53-SLP® vaccine, seventeen were subsequently treated with chemotherapy. Eight of these volunteered another blood sample. No differences in clinical response rates to secondary chemotherapy or disease-specific survival were observed between immunized patients and historical controls (p=0.925, resp. p=0.601). P53-specific proliferative responses were observed in 5/8 patients and IFN-γ production in 2/7 patients. Lymphocytes cultured from a prior injection site showing inflammation during chemotherapy did not recognise p53-SLP®. Thus treatment with the p53- SLP® vaccine does not affect responses to secondary chemotherapy or survival, although p53-specific T-cells do survive chemotherapy.

Phase II Clinical Study of the Combination Chemotherapy Regimen of Irinotecan Plus Oral Etoposide for the Treatment of Recurrent Ovarian Cancer

OBJECTIVE: To evaluate the efficacy and safety of the combination chemotherapy regimen of irinotecan plus oral etoposide for the treatment of patients with recurrent ovarian cancer after previous treatment with platinum and taxane agents.
PATIENTS AND METHODS: A total of 42 patients with recurrent ovarian cancer who had an evaluable lesion and provided informed consent for participation in the present study were analyzed. Irinotecan was administered intravenously at a dose of 60 mg/m on days 1 and 15. Etoposide was administered orally at a daily dose of 50 mg/body weight from days 1 to 21. A 28-day period comprised one cycle. The tumor response, adverse events, progression-free survival, and overall survival were examined. Tumor response was evaluated based on the Response Evaluation Criteria in Solid Tumors and the serum CA125 levels (Gynecologic Cancer Intergroup criteria). Adverse events were assessed according to the NCI-CTCAE (version 3.0).
RESULTS: Partial response was observed in 21 patients, stable disease in 14 patients, and progressive disease in 7 patients. The response rate was 50.0%, and the clinical benefit (partial response + stable disease) rate was 83.3%. Hematological toxicities of at least grade 3 severity included leukopenia in 21 patients (50.0%), neutropenia in 22 patients (52.4%), thrombocytopenia in 1 patient (2.4%), anemia in 9 patients (21.4%), and febrile neutropenia in 3 patients (7.1%). Nonhematological toxicities of at least grade 3 severity included queasy feeling in 5 patients (11.9%), vomiting in 3 patients (7.1%), and diarrhea in 2 patients (4.8%). Acute myeloid leukemia occurred in one patient (2.4%).
CONCLUSIONS: It is suggested that combination chemotherapy with irinotecan plus oral etoposide offers significant clinical benefit to patients with recurrent ovarian cancer previously treated with platinum and taxane agents.

Diagnostic performance of urgent referrals for suspected gynaecological malignancies.

PURPOSE: The objective of this study was to investigate the outcome of the urgent referrals with suspected gynaecological malignancy.
CONCLUSION: The overall predictive value of two-week wait referrals for suspected gynaecological malignancies is low. Refinement of the current referral guidelines is required with particular emphasis in the premenopausal women where the diagnostic performance of the urgent referrals is significantly poorer.

Studying Therapy Response and Resistance in Mouse Models for BRCA1-Deficient Breast Cancer

Gynecological Cancers. [Methods Mol Biol. 2011]

Abstract

The clinical problems raised in patients presenting with all forms of gynecological malignancy are currently addressed using conventional cross-sectional imaging, usually MRI. In general, F-18 FDG PET-CT has not been shown to have a clinical role in any of these cancers at presentation, although studies are under way to use this form of metabolic imaging to predict prognosis and the response to treatment. Although F-18 FDG PET-CT is superior to conventional imaging techniques, it is only moderately sensitive in demonstrating lymph node metastasis preoperatively, and is inadequate for local staging of patients with endometrial cancer. In ovarian cancer, F-18 FDG PET-CT provides an accurate assessment of the extent of disease, particularly in areas difficult to assess for metastases by CT and MRI such as the abdomen and pelvis, mediastinum, and supraclavicular region. F-18 FDG PET-CT is a sensitive method of detecting pelvic and para-aortic lymph nodal disease in cervical cancer, and appears to be superior to MRI and CT despite the limitations in identifying small foci of disease. In the main, as elsewhere in patients with cancer, the value of PET-CT is in identifying and defining the extent of recurrent disease, in distinguishing between posttreatment fibrosis and recurrence, and possibly in monitoring response to therapy.

Non-Curable Tumours of the Female Genital Tract: Therapeutic Options in Bowel Stenosis and Bleeding

BACKGROUND: ......  Ovarian cancer is in particular associated with peritoneal carcinomatosis or local tumour progression entailing different intestinal complications.
.

most recent top 5 popular blog views (just curious?)

Inequity in access to cancer care: a review of the... Jan 18, 2011 OXiGENE Inc. (OXGN) Enters into Collaborative Agre... Feb 14, 2011 abstract: Phase II study evaluating consolidation ... Feb 5, 2011 A Fighting Spirit Won’t Save Your Life - NYTimes.c... Jan 30, 2011 Cancer Epigenetics - 2010 - CA (includes discussio... Jan 17, 2011

full free access: Quality in Cancer Diagnosis (table 1 gyn)

Table 1. Diagnostic Steps for Gynecologic and Nongynecologic Specimens

Ovarian Cancer Surgery, Why Should A Woman Have A Gynecologic Oncologist...

full free access: Lessons From the Adjuvant Bevacizumab Trial on Colon Cancer: What Next?

"........Finally, how should we consider the use of antiangiogenic therapy in general in the adjuvant setting? Will VEGF blockade ever suffice when administered as single antiangiogenic agent in combination with chemotherapy, or will we need to combine bevacizumab with other antiangiogenic agents? Although an easy solution at this stage would be to lose interest in the therapeutic potential of antiangiogenic therapy in the adjuvant setting because of these initial disappointing results, the more challenging way forward will require a better understanding of the underlying mechanisms of why bevacizumab treatment differs so much in the adjuvant setting versus the macrometastatic setting. Only by achieving this goal will it be possible to make a more informed decision on this important matter"

abstract: Disease course patterns after discontinuation of bevacizumab (Avastin): pooled analysis of randomized phase III trials

also note: secondary link source including professional commentary

 http://plus.mcmaster.ca/EvidenceUpdates/NewArticles.aspx?Page=1&ArticleID=38192#ArticleComments

Abstract:

Purpose:     Preclinical studies have suggested accelerated tumor growth, local invasion, and distant metastasis after withdrawal of treatment with some antiangiogenic agents. To investigate whether discontinuation of bevacizumab treatment is associated with accelerated disease progression or increased mortality, we retrospectively analyzed five randomized, placebo-controlled phase III studies in 4,205 patients with breast, colorectal, renal, and pancreatic cancer.

Conclusion This retrospective analysis of five placebo-controlled clinical trials does not support a decreased time to disease progression, increased mortality, or altered disease progression pattern after cessation of bevacizumab therapy.

Footnotes

• Supported in part by F. Hoffmann-La Roche, Basel, Switzerland.
• Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
• Clinical trial information can be found for the following: NCT00738530.

CRD Summary/Commentary: Increased ovarian cancer risk associated with menopausal estrogen therapy is reduced by adding a progestin

original link source: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009104538

Reference: Cancer 2009; 115(3): 531-539

Source: DARE

 

Date published: 15/02/2011 14:53

Summary

by: Hazel Burnham
 

CRD Summary: The authors concluded that oestrogen therapy use increased ovarian cancer in a duration-dependent manner; adding progestins appeared to reduce this effect to some extent. The conclusions appeared to be supported by the evidence but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
CRD Commentary: The review question was stated and appropriate inclusion criteria were defined. Limiting the search to English language published studies identified in one database plus references and linked articles may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. However, no evidence of publication bias was found. Methods used to select studies and extract data were not described, so it is not known whether efforts were made to reduce reviewer errors and bias. Study validity was not assessed, so results from these studies and any synthesis may not be reliable.
Other than duration of oestrogen-only therapy/oestrogen plus progestin therapy use, no information was provided about participants. No information was provided about which potential confounders were adjusted for in individual studies. Data were pooled using meta-analysis and heterogeneity was assessed. Studies were predominantly observational and adjustments were made for potential confounders. The authors’ conclusions appeared to be supported by the evidence, but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.

About this library entry

Category: 6.4.1 Female sex hormones | Cancer: gynaecological | Menopause / hormone replacement therapy (HRT)

NeLM area: Evidence > Medication Safety

DARE abstract

Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for Advanced Epithelial Ovarian Cancer — J. Natl. Cancer Inst.

Thus, increasing dose intensity of cisplatin does not improve PFS or OS compared with standard chemotherapy.

full free access: How Research Influences Policy Makers: Still Hazy After All These Years — J. Natl. Cancer Inst. Steven Lewis (author)

"Libraries have been written about the theory and practice of public policy making. Yet, this enormous scholarship has proved insufficient to lift the veil of mystery and idiosyncrasy that shrouds the art of decision making. The heady ambition to turn both clinical practice and health policy into evidence-based bastions of rationalist decision making has been downgraded; the vocabulary is now “evidence-informed,” and the realm of admissible evidence has been greatly expanded to include preferences, political contingencies, and psychology (1). This newfound conceptual modesty and nuance does not suggest that we should abandon efforts to understand decision-making processes and to enhance the role of research-based evidence in policy. It merely confirms the complexity, contingency, and messiness of the terrain............This leads to a second issue: the definition of “use.” The questionnaires simply asked whether the respondents intended to use the brief. We do not know what “use” means.." cont'd

abstract: Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin(cytoreductive surgery/HIPEC)

BACKGROUND: The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown.
METHODS: This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed.
RESULTS: The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.

(full free pdf file access) Endometriosis-Associated Ovarian Carcinomas — NEJM

abstract: Metastatic neoplasms of the ovaries: a clinicopathological study of 97 cases (metastatic breast, GI neoplasms....)

OBJECTIVE: To present the clinicopathological features of metastatic ovarian neoplasms with emphasis in the diagnostic challenge.
METHODS: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined.
RESULTS: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract.
CONCLUSION: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.

abstract: The spread pattern of right and left epithelial ovarian cancers

OBJECTIVE: No attention has been paid in the past to the spread pattern of right and left epithelial carcinomas of the ovaries. We aimed to investigate the incidence, spread pattern and distribution of lymph node metastasis in epithelial ovarian cancer (EOC), comparing right versus left EOC of any stage, where the contralateral ovary is apparently and histologically tumor-free.

full access: Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol

Discussion

This study attempts to settle the debate on the desirability of informing patients with cancer. In contrast to several earlier studies, we will actually deliver information on treatment options to patients at the point of decision making.
Trial registration: NTR1113

Bisphosphonates in Oncology. [Bone. 2011]

abstract: Clinical characteristics of borderline ovarian tumors and stage I epithelial ovarian cancer: an analysis of 143 cases

abstract: Tubal ligation and the risk of ovarian cancer: review and meta-analysis — Hum Reprod Update (serous/mucinous/endometrioid)

BACKGROUND The reduction of ovarian cancer (OC) risk in women with a history of tubal ligation (TL) has been reported repeatedly, mostly on small populations. We have aimed to provide a critical overview of the studies available to date and to conduct a meta-analysis.

METHODS There were 40 relevant studies identified. The studies were divided into two groups for strict and extended meta-analysis, respectively. Subgroup analysis was performed for age, time dependency since TL, histological types of OC and BReast CAncer (BRCA) mutation.

RESULTS Meta-analysis of 13 strictly selected studies showed a reduced risk of epithelial OC by 34%. The protective effect of TL was confirmed even in a subgroup of women 10–14 years after the procedure. The risk reduction was confirmed for the endometrioid (RR = 0.40) and serous (RR = 0.73) cancers but not for mucinous.

CONCLUSIONS The review of relevant articles, as well as the meta-analysis of selected studies, yields consistent data on a significant reduction of OC risk in women who had undergone TL. The results of this meta-analysis should provide an impulse for further research on the etiology of ovarian epithelial cancers, focusing particularly on the importance of retrograde transport of endometrial cells.

summary: Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer phase 111 MIMOSA trial

Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer

Rachel N Grisham​‌¹, Jonathan Berek​‌², Jacobus Pfisterer​‌³ & Paul Sabbatini​‌^†1

Ovarian cancer remains the leading cause of death due to gynecologic malignancies. Most patients present with advanced disease at the time of diagnosis. Although many have a good initial response to surgical debulking and platinum-based chemotherapy, relapse is common, with the eventual development of chemotherapy resistance. Innovative treatments are needed in the remission setting to prolong the disease-free interval or prevent recurrence. Abagovomab is a murine monoclonal anti-idiotypic antibody (molecular wieght: 165–175 kDa) that functionally imitates the tumor-associated antigen, CA-125. It has been shown to be well tolerated and to induce a sustained immune response in initial Phase I and II clinical trials. An ongoing, double-blind, placebo-controlled, multicenter, Phase III trial (MIMOSA) completed its double-blind period in December 2010 and will compare abagovomab maintenance therapy to placebo, which will definitively determine the efficacy of this immunotherapeutic approach in patients with ovarian cancer.

full free access: Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial. Ann Fam Med. 2011 (includes ovarian cancer)

PURPOSE: We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message. ....cont'd for full free access

OXiGENE Inc. (OXGN) Enters into Collaborative Agreement with NCI for Cancer Drug - Intl Business Times (Zybrestat/Avastin))

OXiGENE Inc., a clinical-stage biopharmaceutical company focused on developing novel therapeutics to treat cancer and eye diseases, has entered into a cooperative research and development agreement with the National Cancer Institute’s (NCI) Cancer Therapy Evaluation Program (CTEP) to collaborate on the conduct of a randomized phase 2 trial of OXiGENE’s ZYBRESTAT in combination with bevacizumab in patients with relapsed ovarian cancer.....cton'd

Questioning Need for Routine Pelvic Exam - WSJ.com

full free text: The safety implications of missed test results for hospitalised patients: a systematic review -- BMJ Quality and Safety (references World Alliance for Patient Safety)

Introduction

The World Alliance for Patient Safety recently identified poor test follow-up as one of the major processes contributing to unsafe patient care.1 Failure to follow up test results increases the risk of missed or delayed diagnoses. This may produce suboptimal clinical outcomes2–8 with potential medicolegal implications.9–12......

.........All seven studies explored the impact on patient outcomes31–33 35–38 which included no negative effects,31 a delayed diagnosis from a missed x-ray report,37 one case of missed positive Chlamydia where the patient subsequently developed pelvic inflammatory disease,36 inappropriate or unnecessary antibiotics prescribed,35 missed cancer diagnoses33 and death.38.....cont'd

What Is A Patient? A Doctor’s Perspective - Better Health

full free access: Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial

Effect of Occult Metastases on Survival in Node-Negative Breast Cancer — NEJM

Conclusions

Occult metastases were an independent prognostic variable in patients with sentinel nodes that were negative on initial examination; however, the magnitude of the difference in outcome at 5 years was small (1.2 percentage points). These data do not indicate a clinical benefit of additional evaluation, including immunohistochemical analysis, of initially negative sentinel nodes in patients with breast cancer. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003830.)

European Journal of Human Genetics - Abstract of article: On the origin and diffusion of BRCA1 c.5266dupC (5382insC) in European populations

"The BRCA1 mutation c.5266dupC was originally described as a founder mutation in the Ashkenazi Jewish (AJ) population. However, this mutation is also present at appreciable frequency in several European countries, which raises intriguing questions about the origins of the mutation. We genotyped 245 carrier families from 14 different population groups (Russian, Latvian, Ukrainian, Czech, Slovak, Polish, Danish, Dutch, French, German, Italian, Greek, Brazilian and AJ) for seven microsatellite markers and confirmed that all mutation carriers share a common haplotype from a single founder individual.............Our results illustrate that (1) BRCA1 c.5266dupC originated from a single common ancestor and was a common European mutation long before becoming an AJ founder mutation and (2) the mutation is likely present in many additional European countries where genetic screening of BRCA1 may not yet be common practice."

The rise of the genome bloggers : Nature News (not amateurs)

“They are not amateurs. They are far from being amateurs.”

full free access: Genomics and the Continuum of Cancer Care — NEJM (long article covering differing concerns)

abstract only: Update in Hormone Therapy Use in Menopause -- Journal of Clinical Endocrinology & Metabolism

abstract: HE4 and CA125 as a diagnostic test in ovarian cancer: prospective validation of the Risk of Ovarian Malignancy Algorithm

Conclusion:
This independent validation study demonstrated similar performance indices to those recently published. However, in this study, HE4 and ROMA did not increase the detection of malignant disease compared with CA125 alone. Although the initial reports were promising, measurement of HE4 serum levels does not contribute to the diagnosis of ovarian cancer

abstract: High prevalence of symptoms associated with ovarian cancer among Australian women

Background:  Symptoms associated with ovarian cancer are often vague and non-specific, such as abdominal bloating and pain. Presently, nothing is known about the prevalence of these symptoms among women in the community.
Aims:  To identify the prevalence and correlates of symptoms associated with ovarian cancer in a nationally representative sample of Australian women. Methods:  Women answered questions about symptoms associated with ovarian cancer via computer-assisted telephone interviews. Binomial regression was used to assess the association between reporting symptoms, demographic characteristics and sexual problems.
Results:  Data on 2235 women aged 18-70 who had not had an oophorectomy or hysterectomy were analysed. Prevalences of symptoms were abdominal bloating 52%, abdominal pain 37%, increased abdominal size 30%, pelvic pain 29%, feeling full quickly 18% and unable to eat normally 15%. One-third of women (32%) reported three or more symptoms, 2% reported all six and 32% of women reported none. Severe symptoms were generally reported by <10% of women reporting symptoms, and symptoms usually persisted for 5 days or less a month. Older women were less likely to report symptoms, as were women who had been pregnant. There was an association between symptoms and sexual difficulties whereby women who reported multiple ovarian cancer symptoms were more likely to report sexual problems.
Conclusions:  There is a high prevalence of ovarian cancer symptoms in the Australian community. Because of this, awareness campaigns will likely impact a large number of women who do not have ovarian cancer.

(no abstract) Peritoneal fibrosis leading to small bowel obstruction two years after first-line intraperitoneal chemotherapy for optimally debulked ovarian cancer Australian

DOI: 10.1111/j.1479-828X.2010.01230.x

Issue

Australian and New Zealand Journal of Obstetrics and Gynaecology

Volume 51, Issue 1, pages 91–92, February 2011

abstract: Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudinal study

Define: C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation (an acute-phase protein). ...
en.wikipedia.org/wiki/C-reactive_protein
Abstract

BACKGROUND: Evidence suggests that inflammation may be associated with increased risk of ovarian cancer but there is paucity of studies investigating this association, especially using over-time changes in inflammatory biomarkers.

MATERIALS AND METHODS: We conducted a prospective population-based case-control study nested within the Finnish Maternity Cohort (FMC). Within the FMC, 170 women with ovarian cancer who had donated serum samples to the cohort twice, ≥1 year apart, before cancer diagnoses were identified. One control per case was matched for age, parity and sampling date.

RESULTS: Comparing the highest with lowest tertiles, the odds ratio (OR) of ovarian cancer using the first set of serum samples (mean lag time to cancer diagnosis 9.0 years) was 1.62 [95% confidence interval (CI) 0.93-2.83]. However, analysis conducted using the second set of serum samples donated closer to cancer diagnosis (mean lag time 6.4 years) revealed a significantly increased risk of ovarian cancer comparing extreme tertiles of C-reactive protein (CRP) concentrations; OR 1.96 (95% CI 1.11-3.4). Over time, increases in individuals' CRP concentrations were also associated with increased risk; OR 1.90 (95% CI 1.12-3.23).

CONCLUSION: The results suggest that inflammation may precede ovarian cancer since increasing CRP concentrations, both across tertiles and longitudinally at the individual level, were associated with increased risk.

Table of Contents — January 2011, 22 (suppl 1) — Hereditary Breast and Ovarian Cancer: Risks and Challenges 10–12 September 2009: Bari, Italy

Note: numerous papers, full free access

abstract: Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey

"...Treatment in a referral center was an independent prognostic factor for overall survival hazard ratio, 0.83 (confidence interval 0.70-0.98).  
Conclusion. Patients with stage IIIC and IV ovarian cancer benefit from treatment in a tertiary referral center."

abstract: Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey

abstract: Trends in incidence of borderline ovarian tumors in Denmark 1978-2006

Note: other research is of the same opinions (see prior blog posts) that incident rates of ovarian cancer are in fact not reducing (eg. population...)


Conclusions. The incidence rate of borderline ovarian tumors increased significantly in Denmark in 1978-2006. In line with results from ovarian cancer, Denmark had a higher incidence rate of borderline ovarian tumors compared with the other Nordic countries in 1978-2006.

abstract: A systematic review of gynecological cancer surveillance in women belonging to Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome) fa

Conclusions.
Currently available published studies on gynecological cancer surveillance in women with HNPCC do not adequately allow for evidence-based clinical decisions. Detection of endometrial cancer or hyperplasia in nonsymptomatic women belonging to a HNPCC family is improved by adding routine endometrial sampling along with transvaginal ultrasound for surveillance visits. No benefit was shown for ovarian cancer surveillance.

abstract: A patient presenting nasal septum perforation during bevacizumab-containing chemotherapy for advanced breast cancer (and colorectal/ovarian) see Blogger's note

Blogger's note:  

nasal perforations (while rare) has been widely reported in patient social networks and vastly under-reported by institutions, as evidenced by the incidence rates per this abstract; this is not a new issue/concern

Abstract: 

Nasal septum perforation is a rare but described complication of the anti-angiogenetic agent bevacizumab. ........ The patient denied use of cocaine or other intranasal irritants. ........ Thus far 8 other cases of bevacizumab-related nasal septum perforation have been published: 5 patients with colorectal cancer, 2 patients with breast cancer and 1 with ovarian cancer.....cont'd

abstract: Recreational physical activity and ovarian cancer

CONCLUSIONS: Our data provide weak evidence in support of beneficial effects of physical activity on ovarian cancer risk and survival, but results should be interpreted cautiously because of the lack of a clear dose response relation with higher levels of exercise and the likely misclassification of self-reported activity.

abstract: Morbidity of diaphragmatic surgery for advanced ovariannext term cancer: Retrospective study of 148 cases

Conclusions

Diaphragmatic surgery achieved complete removal of the tumour but resulted in pulmonary complications in addition to complications of radical surgery.

full free access: Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers — Ann Oncol (stage/cell type)

Note: tables for survival data (longterm) eg. cell types

"....The Gynecology Tumour Group of our institution has elected to continue to advise the use of CRT in women with stage Ic and II endometrioid and mucinous lesions, and all stage I and II clear cell disease, on the basis of these data and a recently published analysis of histotype-specific outcomes [32]. However, RT will be targeted to the pelvis, with consideration of extending the field to include paraaortic nodes if stage IIc (given the higher rate of occult nodal involvement reported for this stage [26]). RT will be dropped from our prescription for those with serous tumors.

Our findings also bring into question the nonselective surgical and CT approaches that have characterized ovarian cancer care and are of potential clinical importance for those with other tumors, which have been collectively defined by presumed organ of origin rather than underlying biological features"

full free access abstract + full paper: Social and ethical implications of BRCA testing — Ann Oncol

Abstract:
"Oncologists are asked with increasing frequency to counsel their patients with respect to the medical, psychological and social repercussions of genetic testing for cancer susceptibility that may have been prescribed by physicians or carried out through direct-to-consumer tests. This article critically reviews the main ethical and social implications of BRCA testing, focusing on genetic responsibility and genetic discrimination. Genetic responsibility toward oneself and others is a highly debated implication of genetic testing for cancer predisposition that requires broad considerations of the boundaries between individual and community rights and a reappraisal of the notion of autonomy as relational. Physicians’ duty to warn ‘at risk’ relatives can be an ethical quandary, yet confidentiality is key to the patient–doctor relationship. Mutation carriers may be subject to different forms and degrees of genetic discrimination and many individuals at risk have forgone BRCA testing to avoid potential discrimination. The scientific and medical community, together with patients and the public, has actively engaged against genetic discrimination. The legislation in many countries now protects against genetic discrimination by insurance companies and employers. Legal and regulatory issues are not the final answer to discrimination and profound cultural changes are required to create understanding and acceptance of all differences...."

media - Light sentence would spare sex doc’s victims (unconcious female patients)

videotaped a naked and unconscious patient after removing her hospital gown

abstract: Analysis of postoperative complications associated with the use of anti-adhesion sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier after cytoreductive surgery for ovarian, fallopian tube and peritoneal cancers

Conclusions

HA-CMC adhesion barrier placement at the time of optimal cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer is not associated with major postoperative complications but may be associated with increased risk of pelvic abscess

abstract: A new index of priority symptoms in advanced ovarian cancer

Note: advanced ovarian cancer study

Ovarian cancer patient surveillance after curative-intent initial treatment

Nearly 25% of Women With Early Ovarian Cancer Not Given Recommended Biopsies - US News and World Report

"The Lab - Avoiding Research Misconduct: (video) Office of Research Integrity: The Lab. An Interactive Video on Avoiding Misconduct

"To participate in this interactive experience, go to:

http://ori.hhs.gov/TheLab

This interactive film is an extremely rich and substantively educational resource for teaching/learning research integrity and ethics. It deals with the issue of research misconduct. Filmed in a university research environment, it makes excellent use of the best knowledge and science regarding ethical decision-making and the responsible conduct of research. The video simulation allows users to assume the role of a graduate student, post-doc, research administrator, or PI and make decisions that affect the integrity of research."

Medscape: 'Unrealistic Optimism' Plagues Early-Phase Oncology Trials

Patients' Association of Canada

Patient Led, Patient Governed Promoting and enhancing the patient voice in health care

NCI Cancer Bulletin: Coming Home to Roost: The Self-Seeding Hypothesis of Tumor Growth

The ROMA (Risk of Ovarian Malignancy Algorithm) for estimating the risk of epithelial ovarian cancer in women presenting with pelvic mass: is it really useful? (HE4/CA125/pre-post menopausal)

Conclusions: The ROMA is a simple scoring system which shows excellent diagnostic performance for the detection of EOC in post-menopausal women, but not in pre-menopausal women. Moreover, the dual marker combination of HE4 and CA125 (ROMA) does not show better performance than HE4 alone.

European cancer mortality predictions for the year 2011 — Ann Oncol

Note: see Tables for differing countries within EU

Global cancer statistics - 2011 - A Cancer Journal for Clinicians - Wiley Online Library

CORRECT(2/4): Roche CEO Defends Avastin Cancer Drug, Despite Scrutiny - WSJ.com

Less is Better in Early Stage Breast Cancer Care - ABC News

full free access: Journal of Oncology — Review Article: Potential Markers for Detection & Monitoring of Ovarian Cancer Feb 8, 2011

  Note:  pdf file


Conclusions and Emerging Trends in Biomarkers for Ovarian Cancer

"The ultimate aim of effective screening techniques is to bring about a reduction in mortality form ovarian cancer. As early detection continues to be vital in ovarian cancer patients, biomarkers may hold the key to unlocking effective screening strategies for the general population. It is also important to identify screening techniques with low false positive rates and high positive predictive value so that the number of negative surgical interventions can be minimized. Since our currently available single markers are not highly sensitive or specific, a combination of markers may be utilized as a profile for risk assessment. The current problem with screening panels is that the improvement in sensitivity usually correlates with a decrease in specificity, making the target positive predictive value hard to obtain. The multimodal screening profiles of the genetic markers could be utilized in the future for risk assessment, early diagnosis, prognosis and response to therapeutic treatment. Recent literature reports state that the screening is only recommended for the high risk population identified as those with a family history of the disease, women with BRCA1 and BRCA2 mutations, or with hereditary non polyposis colorectal cancer. Recent literature reports also emphasize that the different subtypes of ovarian cancer may have different genetic biomarker expression profiles. Current randomized controlled screening trials are directed towards finding the best molecular and genetic markers for the specific histology of the ovarian tumor with the most impact on reduction in morbidity and mortality. The tumor markers identified in these trials may also lead to novel targets for antitumor therapy."

full free access: Review Article: Cancer Stem Cells and Epithelial Ovarian Cancer

"This paper highlights the current experimental approaches that have been used in the field and discusses their limitations, with specific emphasis on the identification and characterisation of the CSC population in epithelial ovarian cancer."

UPDATE 2-Avastin helps ovarian cancer patients live longer | Reuters

Abstract: Peutz-Jeghers syndrome: a study of long-term surgical morbidity and causes of mortality

"Patients with Peutz-Jeghers syndrome (PJS) require lifelong multidisciplinary care for gastrointestinal polyposis and increased risk of cancer.

...The cause of death was unknown in 4 patients, but was due exclusively to malignancies in all other patients, most commonly due to metastatic gynecologic cancer (5)...."

abstract - BRCA1 mutations and colorectal cancer in Poland

"This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer."

abstract: Treatment-Related Mortality With (Avastin) Bevacizumab in Cancer Patients JAMA (alone vs combo)

Data Synthesis "A total of 10 217 patients with a variety of advanced solid tumors from 16 RCTs were included in the analysis...."