Top 10 most viewed in past 24 hrs:
Monday, April 30, 2012
Defining the Role of PET-CT in Staging Early Breast Cancer
Defining the Role of PET-CT in Staging Early Breast Cancer:
Abstract
Introduction. Currently, there is a lack of data on the role of combined positron emission tomography–computed tomography (PET–CT) in the staging of early invasive primary breast cancer. We therefore evaluated the role of 18F-fluorodeoxyglucose (18F-FDG)-PET–CT in this patient population.
Methods. We prospectively recruited 70 consecutive patients (69 women, one man; mean age, 61.9 ± 8.1 years) with early primary breast cancer for staging with 18F-FDG-PET–CT. All PET–CT images were interpreted by two readers (independently of each other). A third reader adjudicated any discrepancies. All readers had ≥5 years of specific experience. Ethics board approval and informed consent were obtained.
Results. The mean clinical follow-up was 22.7 ± 12.6 months. The primary tumor was identified with PET–CT in 64 of 70 patients. Of the unidentified lesions, surgical pathology revealed two intraductal carcinomas, one invasive tubular carcinoma, and three invasive lobular carcinomas. Undiagnosed multifocal breast disease was shown in seven of 70 patients. PET–CT identified avid axillary lymph nodes in 19 of 70 patients, compared with 24 of 70 confirmed during surgery. There were four patients who were axillary node positive on PET but had no axillary disease at surgery.
Five patients were reported with avid metastases. Two of those patients were treated for metastatic disease (nodal, lung, and liver in one and bone metastases in the other) following further imaging and clinical assessment. In the other three patients, lesions (lung, n = 1; pleural, n = 1; paratrachael node, n = 1) were subsequently diagnosed as benign lesions.
Conclusion. Integrated 18F-FDG-PET–CT may have a role in staging patients presenting with early breast cancer.
The Incidence of Ovarian Cancer In Transgendered Individuals | The LGBT Cancer Project -- Out With Cancer
The Incidence of Ovarian Cancer In Transgendered Individuals | The LGBT Cancer Project -- Out With Cancer
".... The incidence of ovarian cancer in LGBT transgendered individuals must be closely monitored and aggressively treated if the cancer is detected in that population. Transgendered individuals who have undergone an operation changing their gender from their original sexual orientation of female to male are facing the additional obstacle of being diagnosed with ovarian....."
Amazon.com: Memoir of a Debulked Woman: Enduring Ovarian Cancer (9780393073256): Susan Gubar: Books
Amazon.com: Memoir of a Debulked Woman: Enduring Ovarian Cancer (9780393073256): Susan Gubar: Books
Book Description
In this moving memoir, a renowned feminist scholar explores the physical and psychological ordeal of living with ovarian cancer.
Diagnosed with ovarian cancer in 2008, Susan Gubar underwent radical debulking surgery, an attempt to excise the cancer by removing part or all of many organs in the lower abdomen. Her memoir mines the deepest levels of anguish and devotion as she struggles to come to terms with her body’s betrayal and the frightful protocols of contemporary medicine. She finds solace in the abiding love of her husband, children, and friends while she searches for understanding in works of literature, visual art, and the testimonies of others who suffer with various forms of cancer.
Ovarian cancer remains an incurable disease for most of those diagnosed, even those lucky enough to find caring and skilled physicians. Memoir of a Debulked Woman is both a polemic against the ineffectual and injurious medical responses to which thousands of women are subjected and a meditation on the gifts of companionship, art, and literature that sustain people in need.
book reviews: New Perspectives From Cancer Patients - NYTimes.com
New Perspectives From Cancer Patients - NYTimes.com
".......That is Susan Gubar’s staggering, searing “Memoir of a Debulked Woman.” Ms. Gubar
may not be a health professional, but as a noted feminist critic (she
is an author of the influential 1970s classic “Madwoman in the Attic”),
she has certainly spent a career immersed in the meaning and functions
of the female body. In one of those inexplicably savage medical ironies,
she was felled in her early 60s by the worst of the “female” diseases: ovarian cancer. As is common, it had spread throughout her abdomen by the time of diagnosis.
Cases like Ms. Gubar’s are usually first treated with the surgical
removal of as much cancer as possible, along with all dispensable
abdominal organs that are affected or at risk. This is the “debulking”
of her title, and it is about as close to evisceration as civilians can
experience. It became her focal metaphor for the experience of sudden
dire illness, as all other interests drop away save “an overriding and
offensive obsession with one’s own physical vulnerability.” On a less
literary note, the procedure winds up bringing her almost more physical
grief than the cancer itself.
Ms. Gubar moves back and forth between poet and patient, with the
occasional sidestep into academic mode as she reviews writing by women
affected with similar illness. It is a difficult and potentially
cringe-making project.
But even the most skeptical and finicky reader — even the healthy
reader, even the healthy male reader — will not put this book down. Some
of its appeal comes from Ms. Gubar’s skill with textual analysis, and
some from various appealing verbal shenanigans (has anyone else found
and pondered the “mother” in chemotherapy,
for instance?). Most gripping, though, is her frank, courageous account
of life with a horrific postoperative infection in her large intestine
that came to involve the buttock area....
video/text: Leftover ovarian tissue after surgery can cause serious complications | Medical Alert-media
Blogger's Note: short video; not specific to ovarian cancer but note absence of menopausal symptoms
Leftover ovarian tissue after surgery can cause serious complications | Medical Alert - WBAL Home
paywalled: Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial : The Lancet Oncology
Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial : The Lancet Oncology
Interpretation
Our
findings provide reassurance for women with hysterectomy seeking relief
of climacteric symptoms in terms of the effects of oestrogen use for
about 5 years on breast cancer incidence and mortality. However, our
data do not support use of oestrogen for breast cancer risk reduction
because any noted benefit probably does not apply to populations at
increased risk of such cancer.
Lancet: [Cancer and Society] "A Monster Calls" (children's book)
[Cancer and Society] A Monster Calls:
The word “cancer” is not used once in A Monster Calls, but its influence is felt even before the first page. The story was conceived by children's author Siobhan Dowd, who died from breast cancer before being able to realise her vision. She did, however, leave behind the idea, the characters, and the beginning, from which Patrick Ness completed the story. The result is a harrowing and deeply engaging account of the heartbreaking effects that cancer has on the children of afflicted patients. It is by no means an easy tale to tell, but Ness's work has clearly resonated with young readers, whose votes awarded A Monster Calls the prestigious Red House Children's Book Award 2012.
Endometriosis and ovarian cancer – Authors' reply : The Lancet Oncology
Endometriosis and ovarian cancer – Authors' reply : The Lancet Oncology
"Both Vercellini and colleagues and Guo and
colleagues raise concerns about screening, with which we agree. Our
findings should not suggest to clinicians or the public that screening
for ovarian cancer should be implemented for women with endometriosis.
Rather, we hope that our work stimulates further research that can
refine risk groups related to endometriosis on the basis of anatomical
site, epidemiological risk factors, or molecular features. Vercellini
and colleagues raise an interesting point about atypical endometriosis,
but this diagnosis is not standardised or commonly used and can not be
addressed in epidemiological studies.
..................Regardless, the attenuated associations remain statistically
significant.
Commentary: Oestrogen and breast cancer: results from the WHI trial : The Lancet Oncology
Oestrogen and breast cancer: results from the WHI trial : The Lancet Oncology
"In The Lancet Oncology, the Women's Health Initiative (WHI) investigators report1 that receipt of conjugated equine oestrogen for a median of 5·9 years reduced the risk of invasive breast cancer by 23% compared with placebo (151 cases in 5310 women who received oestrogen vs 199 cases in 5429 controls; p=0·02). Women who did develop breast cancer after receipt of oestrogen had significantly reduced breast cancer-specific mortality (six deaths in the oestrogen group vs 16 deaths in controls; p=0·03) and all-cause mortality (30 deaths vs 50 deaths; p=0·04). This preventive effect occurred at all ages and continued beyond the period of oestrogen use, a carryover effect also noted in prevention trials of tamoxifen.2 ....Although modest, the WHI results are significant and raise important questions about their disparity with many observational studies and the mechanism of reported benefit with oestrogen therapy......
2012 Clinicopathological Features and Management of Cancers in Lynch Syndrome (easy to read)
Blogger's Note: nice, easy to read paper
Clinicopathological Features and Management of Cancers in Lynch Syndrome
Abstract
Lynch syndrome (LS) is characterized by an autosomal dominant inheritance of the early onset of colorectal cancer (CRC) and endometrial cancer, as well as increased risk for several other cancers including gastric, urinary tract, ovarian, small bowel, biliary tract, and brain tumors. The syndrome is due to a mutation in one of the four DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, or PMS2. The majority of LS patients and families can now be identified, and the underlying mutation detected using genetic diagnostics. Regular surveillance for CRC and endometrial cancer has proved beneficial for mutation carriers. However, screening for other tumors is also recommended even though experiences in the screening of these tumors is limited. Prophylactic colectomy, prophylactic hysterectomy, and bilateral salpingo-oophorectomy may be reasonable options for selected patients with LS. This paper describes the features and management of LS.
1. Introduction (The syndrome is due to a mutation in one of the four DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, or PMS2.)
2. Genetic Characteristics of Lynch Syndrome
3. Identification of Lynch Syndrome
4. Tumor Spectrum of Lynch Syndrome
5. Colorectal Cancer (>MLH1 and MSH2; <MSH6;)
6. Endometrial Cancer (MSH6 mutations are at higher risk)
7. Gastric Cancer (seems to be not different between different mutations)
8. Uroepithelial and Kidney Cancers (predominately MSH2)
9. Other Tumors
- 9.1. Ovarian Cancer Ovarian cancer has been shown to occur in excess in LS. Two Finnish studies [5, 45] have shown a lifetime risk for ovarian cancer in LS ranging between 9% and 12% compared to 1.3% in the general population. Recently, Watson et al. [6] reported a lifetime risk of 7% in a large series from four LS research centers. They also found that MSH2 family members had nearly twice the incidence rate observed in MLH1 family members, and the highest risk period for ovarian cancer was from age 40 to 55 years. Ovarian cancer in LS seems to have a better prognosis than that in the general population or in BRCA1/2 mutation carriers [59]. Information currently available is too limited to assess whether screening for ovarian cancer in LS mutation carriers has any advantages.
- 9.2. Carcinomas of the Biliary Tract and Pancreas (duodenum/jejunum)
- 9.3. Brain Tumors (higher in MSH2 than in MLH1)
10. Conclusions
(ovarian) reference:
59. E. M. Grindedal, L. Renkonen-Sinisalo, H. Vasen et al., “Survival in women with MMR mutations and ovarian cancer: a multicentre study in Lynch syndrome kindreds,” Journal of Medical Genetics, vol. 47, no. 2, pp. 99–102, 2010. View at Publisher · View at Google Scholar · View at Scopus
$8.68M in early researcher awards announced in Ontario | Laboratory Product News
$8.68M in early researcher awards announced in Ontario | Laboratory Product News
UNIVERSITY OF WATERLOO
Project title: Rational design of novel surface active compound for improving non-viral DNA transfection efficiencies. Lead researcher: Dr Shawn Wettig. Gene therapy uses DNA to treat disease. While it shows great promise, creating a delivery system to deliver DNA to specific areas in the body is a challenge. Dr Wettig is working to develop delivery systems, starting with one for ovarian cancer, the leading cause of death among gynecological cancers.
paywalled: Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies
Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies
published online 30 April 2012.
Purpose
To evaluate hematological toxicity after robotic stereotactic body radiosurgery (SBRT) for treatment of women with metastatic abdominopelvic gynecologic malignancies.Methods and Materials
A total of 61 women with stage IV gynecologic malignancies treated with abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3 divided consecutive daily doses) delivered by a robotic-armed Cyberknife SBRT system. Abdominopelvic bone marrow was identified using computed tomography-guided contouring. Fatigue and hematologic toxicities were graded by retrospective assignment of common toxicity criteria for adverse events (version 4.0). Bone marrow volume receiving 1000 cGy (V10) was tested for association with post-therapy (median 32 days [25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin levels, and platelet counts as marrow toxicity surrogates.Results
In all, 61 women undergoing abdominopelvic SBRT had a median bone marrow V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for metastatic disease. Bone marrow V10 did not associate with hematological adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue symptoms were self-reported among the 61 women within the first 10 days post-therapy, with fatigue resolved spontaneously in all 17 women by 30 days post-therapy. Neutropenia was not observed. Three (5%) women had a grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2, and 3 thrombocytopenias were documented in 3 women.Conclusions
Abdominopelvic SBRT provided ablative radiation dose to cancer targets without increased bone marrow toxicity. Abdominopelvic SBRT for metastatic gynecologic malignancies warrants further study.Journal of Experimental & Clinical Cancer Research | Abstract | Circulating microRNAs in cancer: origin, function and application
Journal of Experimental & Clinical Cancer Research | Abstract | Circulating microRNAs in cancer: origin, function and application
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
ReviewCirculating microRNAs in cancer: origin, function and application
Published: 30 April 2012
Abstract (provisional)
MicroRNAs (miRNAs) are a class of small non-coding RNAs that regulate gene expression
at the posttranscriptional level. The dysregulation of miRNAs has been linked to a
series of diseases, including various types of cancer. Since their discovery in the
circulation of cancer patients, there has been a steady increase in the study of circulating
miRNAs as stable, non-invasive biomarkers. However, the origin and function of circulating
miRNAs has not been systematically elucidated. In this review, we summarize the discovery
of circulating miRNAs and their potential as biomarkers. We further emphasize their
possible origin and function. Finally, we discuss the application and existing questions
surrounding circulating miRNAs in cancer diagnostics. Although several challenges
remain to be concerned, circulating miRNAs could be useful, non-invasive biomarkers
for cancer diagnosis.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Biomarkers in the circulation
"Circulating biomarkers undoubtedly play an increasingly significant role in clinicalapplications such as disease diagnostics, monitoring therapeutic effect and predicting recurrence in cancer patients. The currently used fluid-based biomarkers are primarily proteins, such as alpha-fetoprotein (AFP) [8], chromogranin A (CgA) [9], nuclear matrix
protein 22 (NMP 22) [10], carbohydrate antigen 125 (CA 125) [11]; enzymes, such as prostate specific antigen (PSA) [12]; and human chorionic gonadotropin (hCG) [13]. While these biomarkers provide an opportunity to analyze tumors comprehensively in an invasive
way, low sensitivity and specificity limit their clinical application. For example, serum levels of AFP are often elevated in hepatocellular carcinoma (HCC); however, this is also the case in germ cell tumors, gastric, biliary and pancreatic cancers.......
reference/cited (google):
23. Resnick KE, Alder H, Hagan JP, Richardson DL, Croce CM, Cohn DE: The detection of differentially expressed microRNAs from the serum of ovarian cancer patients using a novel real-time PCR platform. Gynecol Oncol 2009, 112:55–59.
paywalled: Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery (Lynch Syndrome, breast/ovarian BRCA 2....)
Blogger's Note: while full access is by subscription only, key words indicate 'high risk' categories not limited to Lynch Syndrome, BRCA 2; BRCA 2 - blogger's assumption based on genetics in absence of full text acccess)
Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery
Abstract
Pancreatic cancer (PC) is a highly lethal disease. Despite advances regarding the safety and long-term results of pancreatectomies, early diagnosis remains the only hope for cure. This necessitates the implementation of an intensive screening program (based mainly on modern imaging), which – given the incidence of PC – is not cost effective for the general population. However, this screening program is recommended for individuals at high-risk for PC development.Indications for screening include the following three clinical settings: hereditary cancer predisposition syndromes associated with PC, hereditary pancreatitis and familial pancreatic cancer syndrome. The aim of this strategy is to identify pre-invasive (precursor) lesions, which are curable. Surgery is recommended in the presence of recognizable lesion on imaging lesions. Partial (anatomic) pancreatectomy – depending on the location of the suspicious lesion – is the most widely accepted type of surgical intervention in this setting; occasionally, however, total pancreatectomy may be required, in carefully selected patients. Despite that experience still remains limited, there is evidence that this aggressive strategy allows early detection of neoplastic lesions, thereby improving the effectiveness of surgery and prognosis.
Keywords: Pancreas, Surgery, Cancer, PanIN, MCN, IPMN, Pancreatectomy, Total pancreatectomy, Screening
Abbreviations: PanIN, pancreatic intraepithelial neoplasia, IPMN, intraductal papillary mucinous neoplasm, MCN, mucinous cystic neoplasm, PJS, Peutz–Jeghers syndrome, FAMMM syndrome, familial atypical multiple mole melanoma syndrome, HNPCC, hereditary non-polyposis colon cancer (Lynch syndrome), HOBC, hereditary ovarian and breast cancer, VHL, von Hippel–Lindau, PD, pancreatoduodenectomy
financial news UK: Horizon lines up $multi-million cancer drug boom | Business Weekly | Technology | Biotechnology | Business news | Cambridge and the East of England
Horizon lines up $multi-million cancer drug boom | Business Weekly | Technology | Biotechnology | Business news
Horizon lines up $multi-million cancer drug boom
The UK pioneer is partnering US biopharma company H3 Biomedicine Inc in the venture. And Japanese giant Eisai, which has its European Knowledge Centre in Hatfield, will conduct any resulting clinical trials......Markus Warmuth, president and CEO, H3 Biomedicine said that the successful development of new personalised medicines depended on well validated and characterised targets and clearly defined patient populations.
“High attrition rates in clinical trials have been impacting industry for a while,” he said. “We believe that clinical success starts at target selection and validation.
“We have elected to work with Horizon because its tools will enable us to progress toward identifying the best possible targets for new drugs with the power to have meaningful therapeutic relevance. That may help us to increase clinical success rates and expedite the delivery of new therapies to the patients who need them.”
paywalled: Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis.
Intrapleural paclitaxel for malig... [Cancer Chemother Pharmacol. 2012] - PubMed - NCBI
Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis.
Abstract
INTRODUCTION:
Malignant pleural effusion (MPE) is a frequent complication in many types of tumors diminishing the patient's ability to perform activities. Despite various studies on talc treatment, some doubts about its safety and effectiveness remain, so the search for a more ideal intrapleural agent continues. We analyzed the effectiveness and safety of intrapleural paclitaxel in ovarian and breast cancer patients.CONCLUSION:
Intrapleural paclitaxel is a safe and effective palliative treatment for MPE from breast and ovarian cancers and may be integrated with systemic chemotherapy.Sunday, April 29, 2012
paywalled: Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?
Blogger's Note: a repost
Is comprehensive surgical staging needed... [Am J Obstet Gynecol. 2012] - PubMed - NCBI
Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma?
Abstract
OBJECTIVE:
Patients with ovarian cancer may have occult metastasis at the time of surgery. Our purpose was to determine the prevalence and sites of occult metastasis in epithelial ovarian cancer grossly confined to the ovary and examine the significance of routine omentectomy and peritoneal biopsies as part of a comprehensive staging procedure.STUDY DESIGN:
Data were retrospectively abstracted from patients presenting to University of Texas Southwestern Medical Center Hospitals from 1993 through 2009 with ovarian cancer without gross spread beyond the ovary who underwent comprehensive surgical staging.RESULTS:
A total of 86
patients with ovarian cancer grossly confined to the ovary who underwent
complete surgical staging were identified. Of patients, 29% were
upstaged following comprehensive surgical staging; 6% had metastatic
disease in uterus and/or fallopian tubes, 6% in lymph nodes, and 17% in
peritoneal, omental, or adhesion biopsies.
CONCLUSION:
Patients with epithelial ovarian cancer should continue to undergo comprehensive surgical staging, since it identifies occult metastasis in a significant number of patients.EvidenceUpdates: Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials including professional commentaries
Blogger's Note: registration is free, the benefit of this secondary site (BMJ) is the addition of professional comments
This month's most accessed articles -- EvidenceUpdates
Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials
paywalled: Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials : The Lancet
Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials : The Lancet
Summary
Background
Daily
aspirin reduces the long-term risk of death due to cancer. However, the
short-term effect is less certain, especially in women, effects on
cancer incidence are largely unknown, and the time course of risk and
benefit in primary prevention is unclear. We studied cancer deaths in
all trials of daily aspirin versus control and the time course of
effects of low-dose aspirin on cancer incidence and other outcomes in
trials in primary prevention.
Interpretation
Alongside
the previously reported reduction by aspirin of the long-term risk of
cancer death, the short-term reductions in cancer incidence and
mortality and the decrease in risk of major extracranial bleeds with
extended use, and their low case-fatality, add to the case for daily
aspirin in prevention of cancer.
paywalled: PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.
PET/CT scanning guided intensity-modulated radi... [Eur J Radiol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.MATERIALS AND METHODS:
Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.RESULTS:
Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).CONCLUSIONS:
PET/CT guided IMRT in recurrent
ovarian cancer patients improved the delineation of GTV and reduce the
likelihood of geographic misses and therefore improve the clinical
outcome.
paywalled: Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence
Low-dose non-enhanced CT versus full-dose contr... [Eur J Radiol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated (18)F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer.MATERIALS AND METHODS:
One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months.RESULTS:
Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods ...... The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT.CONCLUSION:
PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT.
Commentary: Does aspirin really reduce the risk of colon cancer? : The Lancet
Does aspirin really reduce the risk of colon cancer? : The Lancet
Does aspirin really reduce the risk of colon cancer?
The study by John Burn and colleagues1
is unquestionably a superb piece of work that opens the door to
formalised chemoprevention in young carriers of Lynch syndrome. However,
setting aside the fact that the primary intention-to-treat analysis was
not significant, there is a need to address whether these data are
applicable to others at need of chemoprevention.
Specifically,
the study included a predominantly young population with a mean age at
recruitment in the early 40s and a mean follow-up of 5 years. Therefore
the current age of participants is about 50 years. At this age, the
frequency and severity of aspirin complications is very low.2
Indeed the number of adverse events quoted in the paper's appendix is
only 21 in more than 400 aspirin-taking patients. Moreover, Rothwell and
colleagues3
have indicated that, for the general public or those at risk of more
common cancers, taking aspirin before 55 years of age will not have a
significant benefit. Furthermore, the mean period of treatment is just
more than 2 years and although this suggests an impressive effect, it
means that the long-term safety is unknown.4
In
conclusion, although this study is excellent news for patients with
Lynch syndrome, we need data from other large and long-term randomised
trials with cancer endpoints such as the AspECT trial to assess the
safety of aspirin in an older and more general population.5
paywalled - Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor - Guerriero - 2012 - Ultrasound in Obstetrics & Gynecology - Wiley Online Library
Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor - Guerriero - 2012 - Ultrasound in Obstetrics & Gynecology
Abstract
Objective
To
describe the gray-scale and color Doppler ultrasound features as well
as some clinical and biochemical features of metastatic ovarian tumors
according to the origin of the primary tumor in a large study
population,
Methods
This
was a retrospective analysis of 116 masses in 92 patients (mean age, 51
years) evaluated and treated at three European university centers for a
metastatic tumor in the ovary. All patients had undergone transvaginal
color Doppler ultrasound according to a standardized protocol prior to
surgery and tumor removal. Ultrasound features analyzed were
bilaterality, tumor volume, morphologic gray-scale appearance and color
score. CA 125 was also recorded.
Results
Primary tumor histological diagnosis was as follows: colon-sigmoid (n = 32), stomach (n = 28), breast (n = 20), uterus (n = 17), lymphoma (n = 4), liver-pancreas-biliary tract (n = 4) and miscellaneous (n
= 11). There were no differences in age, menopausal status or CA 125
values according to origin of primary tumor. Bilaterality was
significantly more frequent in stomach metastases (56%) in comparison
with colon-sigmoid and liver-pancreas-biliary tract metastases (18.5%
and 0%, respectively, P < 0.05). Median tumor volume was significantly lower in breast metastases (33.5 mL) compared with other metastases (P
< 0.05) except stomach metastases and metastatic tumors from the
miscellaneous group. Ovarian metastases from breast cancers were
significantly more frequently solid in comparison to stomach, colorectal
and uterine cancer metastases (95.0% vs. 60.8%, 46.8% and 70.6%,
respectively, P < 0.05), and tended to appear moderately or
highly vascularized. There were no differences in color score among all
groups, although the percentage of masses with abundant color was high
(50–82%).
Conclusions
Ovarian metastases derived from breast cancers tend to be small, solid and vascularized; they seem to be the only ovarian metastases whose primary tumor origin can be suspected by ultrasonography preoperatively. Color score does not seem to help suspect the origin of the primary tumor.Saturday, April 28, 2012
Medscape: Providers to Test Power of Apology in Malpractice Claims
Blogger's Note: of particular interest to PAHO/patient safety communities/risk management
Providers to Test Power of Apology in Malpractice Claims
Rivkin Center (Seattle) awards grant for cognitive study (ovarian cancer/chemobrain)
Blogger's Note: many ovarian cancer survivors who have gone before us would be happy with this news (Shirley Inveen, Sheryl Eisenbarth.....)
Rivkin Center awards grant for cognitive study:
CONGRATULATIONS DR. GRAY!
Heidi Gray, MD
University of Washington
Behavioral and neural indices of cognitive rehabilitation in ovarian cancer
Millions of ovarian cancer survivors live with residual symptoms of impaired thinking and impaired memory severe enough to interfere with basic activities of daily living and work. However, very little is known about how to treat problems in cognition. Pharmacologic interventions have only been modestly helpful, if at all, and not all patients desire or are able to take medications. Dr. Gray will examine the ability of a 7-week cognitive rehabilitation intervention to improve memory and thinking abilities in ovarian cancer survivors. In addition, the project will measure changes in brain activity patterns from the treatment using neuroimaging.
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press release: Moffitt Cancer Center researchers: Quality of life as important as quantity of life
Moffitt Cancer Center researchers: Quality of life as important as quantity of life
"The question of how well people are surviving cancer is as important as how long they survive cancer," .....
Prolonged fatigue after treatment
In a recent study published in Cancer, researchers from Moffitt found that when patients treated with chemotherapy or chemotherapy and radiation for breast cancer were compared to a control group who had not had cancer, the patients who had experienced chemotherapy and/or radiotherapy had more fatigue. These patients also had fatigue that lasted years after their therapy.
"This finding was contrary to our expectations," Jacobsen said. "Conventional thinking is that patients receiving chemotherapy would, over time, experience less fatigue and would eventually see their fatigue diminish to the levels of controls who had not had cancer, or to the level of fatigue they had prior to their chemotherapy.".......
Reply to W.R. Robinson from Chi: re: “Is the Easier Way Ever the Better Way? (ovarian cancer/neoadjuvant therapy/surgery/references...)
Blogger's Note: follows to prior posting/correspondence/dialogue; worthwhile reading this discussion/debate, note the common denominator in references
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Reply to W.R. Robinson
Reply to W.R. Robinson
- Corresponding author: Dennis S. Chi, MD, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail: gynbreast@mskcc.org.
+ Author Affiliations
We thank Robinson1 for his comments on our editorial, “Is the Easier Way Ever the Better Way?”2
Robinson disagreed with our article on two points. First, he stated
that it is “both disingenuous and unrealistic to… suggest
that fellowship-trained, Board-certified gynecologic
oncologists are not capable of operating on women with advanced ovarian
cancer.” Robinson also expressed concern that we were
suggesting that neoadjuvant chemotherapy (NACT) “somehow represents
a failure on the part of the physicians who are taking
‘the easy way out.'”
To the first point, we did not say that
fellowship-trained, Board-certified gynecologic oncologists are not
capable of operating
on women with advanced ovarian cancer. Rather, we
wanted to highlight that the number of patients who receive suboptimal
debulking
could be reduced by collaboration with other surgical
colleagues. Many gynecologic oncologists partner with urologists for
complex continent urinary conduits after pelvic
exenteration and with plastic surgeons for a myocutaneous flap after
radical
pelvic surgery, for example, and we believe that
patients with ovarian cancer should also be offered the potential
benefit
of subspecialty surgical consultation if it will
improve their overall survival. The complexity of preplanning surgical
consultations
for advanced ovarian cancer debulking surgery should
not be any different than for these other surgical collaborations.
It is incumbent on the gynecologic oncologist to ensure that pressures to minimize operating room and intensive care unit
usage do not compromise the surgical outcome for our patients.........
The author(s) indicated no potential conflicts of interest.
Friday, April 27, 2012
Correspondence: Neoadjuvant Chemotherapy (ovarian cancer) Is Rarely the Easy Way Out + references +discussion on gyn specialists/general surgeons
Blogger's Note: worthwhile reading/pondering...
~~~~~~~~~~~~~
Neoadjuvant Chemotherapy Is Rarely the Easy Way Out
To the Editor:
I appreciate the thoughtful analysis by Chi et al1 in the November 1 issue of Journal of Clinical Oncology,
in the article entitled, “Is the Easier Way Ever the Better Way?” Chi
et al make a very literate argument against using
neoadjuvant chemotherapy (NACT) for ovarian cancer,
continuing a discussion that has lingered among oncologists for more
than
25 years. The argument has heated up recently as a
result of several prospective studies, particularly that of Vergote et
al,2 which showed no difference in survival in patients treated with either primary surgery or NACT.
I must, however, disagree with Chi et al1
on two points. The first of these is the suggestion by the authors that
patients with stage IIIC/IV ovarian cancer should
routinely be referred to ultraspecialist centers
that are capable of performing advanced upper abdominal surgery. In
reality,
the great majority of patients with ovarian cancer
in the United States have been and will be treated in community settings
for the foreseeable future. The professional
societies that represent gynecologic oncology have for years strongly
recommended
that ovarian cancer be handled by
fellowship-trained gynecologic oncologists. This effort has met with
mixed success; in many
communities it is still the norm for women with
advanced ovarian cancer to be operated on by physicians with no special
oncologic
surgical training.......plus references:
paywalled: Data for cancer comparative effectiveness research - Meyer - 2012 - Cancer - Wiley Online Library
Data for cancer comparative effectiveness research
Abstract
Comparative effectiveness research (CER) can efficiently and rapidly generate new scientific evidence and address knowledge gaps, reduce clinical uncertainty, and guide health care choices. Much of the potential in CER is driven by the application of novel methods to analyze existing data. Despite its potential, several challenges must be identified and overcome so that CER may be improved, accelerated, and expeditiously implemented into the broad spectrum of cancer care and clinical practice. To identify and characterize the challenges to cancer CER, the authors reviewed the literature and conducted semistructured interviews with 41 cancer CER researchers at the Agency for Healthcare Research and Quality's Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Cancer CER Consortium. Several data sets for cancer CER were identified and differentiated into an ontology of 8 categories and were characterized in terms of strengths, weaknesses, and utility. Several themes emerged during the development of this ontology and discussions with CER researchers. Dominant among them was accelerating cancer CER and promoting the acceptance of findings, which will necessitate transcending disciplinary silos to incorporate diverse perspectives and expertise. Multidisciplinary collaboration is required, including those with expertise in nonexperimental data, statistics, outcomes research, clinical trials, epidemiology, generalist and specialty medicine, survivorship, informatics, data, and methods, among others.Recommendations highlight the systematic, collaborative identification of critical measures; application of more rigorous study design and sampling methods; policy-level resolution of issues in data ownership, governance, access, and cost; and development and application of consistent standards for data security, privacy, and confidentiality.
paywalled: Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness - European Journal of Cancer Care
Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness - European Journal of Cancer Care
Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness
UK
cancer survival has improved, leading to an increase in review patients
and pressure on clinics...... Acceptability: Final
evaluation (n= 103) was positive although many would like to
maintain face-to-face hospital contact. User involvement in website
design can ensure patient needs are met. A website model for follow-up
will suit some patients but others will prefer clinical contact.
paywalled: First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC)—a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG
Epirubicin (Brand name: Ellence)
~~~~~~~~~~~~~~~~~~~~~
First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC)—a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG
Background: The addition of anthracyclines to platinum-based chemotherapy may provide benefit in survival in ovarian cancer patients. We evaluated the effect on survival of adding epirubicin to standard carboplatin and paclitaxel.
Conclusion: The addition of epirubicin to standard carboplatin and paclitaxel treatment did not improve survival in patients with advanced ovarian, tubal or peritoneal cancer.
Thursday, April 26, 2012
paywalled: Coffee intake and breast cancer risk in the NIH-AARP diet and health study cohort - Gierach - 2011 - International Journal of Cancer - Wiley Online Library
Coffee intake and breast cancer risk in the NIH-AARP diet and health study cohort - International Journal of Cancer
"These findings from a large prospective cohort do not support a role of coffee intake in breast carcinogenesis."
UK: Advanced Solid Tumours Clinical Trial: Phase I Study of AT13148, a Novel AGC Kinase Inhibitor [Conditions: Advanced Solid Tumours; Interventions: AT13148]
Advanced Solid Tumours Clinical Trial: Phase I Study of AT13148, a Novel AGC Kinase Inhibitor [Conditions: Advanced Solid Tumours; Interventions: AT13148]
The purpose of this first clinical study of the noval
multiple AGC kinase inhibitor, AT13148, is to identify the recommended
dose for future studies in cancer patients by exploring the safety and
maximum tolerated dose and biological effects in patients with advanced
solid tumours...
Brief Summary
Official Title: “A Cancer
Research UK Phase I First in Man Study of the Novel AGC Kinase Inhibitor
AT13148 Given Orally in Patients With Advanced Solid Tumours.”
The purpose of this first clinical study of the noval multiple
AGC kinase inhibitor, AT13148, is to identify the recommended dose for
future studies in cancer patients by exploring the safety and maximum
tolerated dose and biological effects in patients with advanced solid
tumours.
- Study Type: Interventional
- Study Design: Masking: Open Label, Primary Purpose: Treatment
- Study Primary Completion Date: October 2015
Detailed Clinical Trial Description
AT13148 is a new drug which looks promising in laboratory
studies. We now wish to find out if it will be useful in treating
patients with cancer. AT13148 is a type of drug called a protein kinase
inhibitor. It blocks several different chemical messengers (enzymes)
called AGC kinase proteins. These chemical messengers are part of the
signaling process within cells which can make cells produce chemicals
that trigger and control cell growth and cell death. In some types of
cancer these chemical messengers are 'switched on' or 'switched off'
permanently due to changes in the genes of cells called "gene mutations"
leading to uncontrolled cancer cell growth. AT13148 targets multiple
protein kinases from three families of kinases unlike many of the other
protein kinase inhibitors currently being tested which target just one
or two kinases. This may mean that it will work better and in a wider
group of cancer patients. Patients will not be selected to take part
based on having these gene mutations for this first trial because we
want to learn more about which mutations are most important but this
would be the hope for future trials. The patient population anticipated
to benefit from this drug includes certain types of breast, prostate and
ovarian cancer which more commonly have these gene mutations.
26 APR 2012 - Nutrition and physical activity guidelines for cancer survivors - CA: A Cancer Journal for Clinicians - Wiley Online Library
Nutrition and physical activity guidelines for cancer survivors - CA: A Cancer Journal for Clinicians
".... After receiving a diagnosis of cancer, survivors soon find there are few clear answers to even the simplest questions, such as: Should I change what I eat? Should I exercise more? Should I gain or lose weight? Should I take dietary supplements? Cancer survivors receive a wide range of advice from many sources about foods they should eat, foods they should avoid, how they should exercise, and what types of supplements they should take, if any. Unfortunately, this advice is often inconsistent and not supported by data...."
Ovarian Cancer
Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States.4
Symptoms tend be nonspecific, making early detection difficult.
Consequently, most ovarian cancers are diagnosed at an advanced stage
when the prognosis is poor, with an overall 10-year survival rate of
39%.4 The role of lifestyle factors in ovarian cancer prognosis is largely unknown.138, 242 To our knowledge, only 3 studies139, 140, 243
have evaluated the role of dietary factors in ovarian cancer survival.
These 3 studies were based on prospective follow-up of the cases
participating in case-control studies and evaluated the association
between prediagnosis dietary intake and mortality outcomes. One study,
conducted in China, focused on the role of green tea and reported that a
higher frequency and quantity of green tea intake after diagnosis was
associated with better survival.243 The other 2 studies, conducted in Australia140 and the United States,139
suggested that prediagnosis dietary intake may influence the survival
experience of patients with ovarian cancer. Both studies tended to
support the association of fruit and vegetable consumption with better
survival. Dairy food intake was associated with poorer survival in one
of the studies,140 while in the other, only milk consumption and not total dairy food consumption was inversely associated with survival.139 Meat consumption was associated with better survival in the Australian study,140 and with lower survival in the study conducted in the United States.139
While these studies controlled for most relevant covariates, they did
not include treatment information. In addition, these studies did not
evaluate dietary intake after diagnosis. However, they do suggest that
dietary intake may influence ovarian cancer survival and warrant further
research in this area.
Only one study,
also following cases in a case-control study for mortality, has
evaluated the role of physical activity in ovarian cancer survival.244
Prediagnosis physical activity was ascertained as hours per week for 3
life periods (childhood, between ages 18-30 years, and in recent years).
The study also evaluated the role of changes in physical activity over
time. There was not much indication of an association with survival for
any of these variables, except for physical activity at aged 18 to 30
years, which seemed to be associated with better survival for women with
early stage ovarian cancer and with worse survival for women with an
advanced stage of disease at diagnosis.245
The
relationship between excess weight and ovarian cancer survival has been
evaluated by relatively few studies. Obesity may affect ovarian cancer
survival by having a negative impact on optimal surgical and cytotoxic
treatment and increasing the likelihood of postoperative complications.246 Overall, the literature evaluating the association between weight/BMI and ovarian cancer survival is limited and inconclusive.76, 242
Cohort studies evaluating the role of prediagnosis obesity obtained at
baseline on ovarian cancer mortality have generally found elevated
ovarian cancer mortality among obese women.234, 247
Other studies evaluating the role of prediagnosis BMI on ovarian cancer
survival by following cases in a case-control study or clinical trial
(using baseline data) have offered conflicting results.242
The role of postdiagnosis body size and weight changes on ovarian
cancer survival is largely unknown. Only one study has reported on
weight changes during chemotherapy and ovarian cancer survival and found
that, among patients with advanced ovarian cancer, weight loss during
chemotherapy was associated with worse prognosis; however, it is
difficult to determine whether this weight loss was involuntary or
intentional.248
In
summary, while the current evidence is limited and inconclusive, it
points to a possible role of dietary factors, physical activity, and
body size and weight changes in modulating ovarian cancer survival, and
for physical activity in improving the quality of life among ovarian
cancer survivors. Further studies are needed before public health
recommendations can be made.
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