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Tuesday, July 31, 2012

Constitutive promoter methylation of BRCA1 and RAD51C in patients with familial ovarian cancer and early-.....



Constitutive promoter methylation of BRCA1 and RAD51C in patients with familial ovarian cancer and early-.....

Journal Genet. 2012 Jul 27

Abstract

Genetic defects in breast cancer susceptibility genes, most importantly BRCA1 and BRCA2 account for approximately 40% of hereditary breast and ovarian cancers. Little is known about the contribution of constitutive (soma-wide) epimutations to the remaining cases. We developed bisulfite pyrosequencing assays to screen > 600 affected BRCA1/BRCA2 mutation-negative patients from the German Consortium for Hereditary Breast and Ovarian Cancer for constitutive hypermethylation of ATM, BRCA1, BRCA2, RAD51C, PTEN, and TP53 in blood cells. In a second step, patients with ≥ 6% promoter methylation were analyzed by bisulfite plasmid sequencing to demonstrate the presence of hypermethylated alleles (epimutations), indicative of epigenetic gene silencing. Altogether we identified 9 (1.4%) patients with constitutive BRCA1 and three (0.5%) with RAD51C hypermethylation. Epimutations were found in both sporadic cases, in particular in 2 (5.5%) of 37 patients with early-onset breast cancer, and familial cases, in particular 4 (10%) of 39 patients with ovarian cancer. Hypermethylation was always confined to one of the two parental alleles in a subset (1240%) of the analyzed cells. Because epimutations occurred in cell types from different embryonal layers, they most likely originated in single cells during early somatic development. We propose that analogous to germline genetic mutations constitutive epimutations may serve as the first hit of tumor development. Because the role of constitutive epimutations in cancer development is likely to be largely underestimated, future strategies for effective testing of susceptibility to breast and ovarian cancer should include an epimutation screen.




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Open access - Multi-center evaluation of post-operative morbidity and mortality after optimal cytoreductive surgery for advanced ovarian cancer.



http://www.ncbi.nlm.nih.gov/m/pubmed/22844394/?i=4&from=ovarian%20cancer

Pre-targeting and direct immunotargetin - Open access



http://www.ncbi.nlm.nih.gov/m/pubmed/22844475/?i=3&from=ovarian%20cancer

Monday, July 30, 2012

Vermillion ovarian cancer test shows positive result



I thought you might be interested in this:

http://reut.rs/Q58BNC

I found this using the Thomson Reuters News Pro for iPhone app.

To install News Pro on your iPhone or iPad, visit:

http://reuters.com/mobile



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Vermillion ovarian cancer test shows positive result



http://reut.rs/Q58BNC

Health scare 'clouded views on HRT' - Health - Media



http://m.bognor.co.uk/news/health/health-scare-clouded-views-on-hrt-1-3968133


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Study investigates molecular markers in drug-resistant ovarian cancer



Study investigates molecular markers in drug-resistant ovarian cancer

A new study by TCD researchers investigates drug-resistant ovarian cancer cells. The findings which have been recently published in the international publication, PLoS One will increase understanding of molecular markers in drug-resistant ovarian cancer with a view to improving clinical treatment.

Worldwide there are more than 204,000 new cases of ovarian cancer each year, accounting for around 4% of all cancers diagnosed in women. For many cancers, including ovarian, chemotherapy remains the only treatment option. While chemotherapy has its success stories, the majority of ovarian cancer patients will go on to develop chemotherapy-resistant disease. Determining which chemotherapy drug to give a patient is a complicated process. Most decisions are made based on the type of cancer the patient has and how advanced it is. Currently, there is a shift towards individually tailoring chemotherapy to each patient. A personalised approach has improved treatment outcomes in breast cancer by targeting therapy according to its subtype.

In the case of ovarian cancer, research fellow and lead author Dr Britta Stordal says:
"If we can subdivide ovarian cancer patients into different resistance categories we can start personalising the treatment of this disease. The cost of patients receiving chemotherapy that they do not respond to is high, both personally for the patients and financially for the healthcare system. By understanding how chemotherapy resistance develops in ovarian cancer we can determine the best drug to prescribe to each patient. The individual tailoring of chemotherapy for relapsed patients can only improve cancer treatment in terms of increased response rates. "

The research studies drug-resistant ovarian cancer cells called IGROVCDDP. The cells were originally developed in a laboratory in the Netherlands. IGROV-1 cells, were firstly derived from an ovarian cancer patient. IGROV-1 cells were put through cycles of chemotherapy in the laboratory to simulate what a cancer patient receives in the clinic. The daughter cells produced are the IGROVCDDP cells, which were grown in tissue culture and examined as to how they became drug resistant.

IGROVCDDP cells are resistant to the two chemotherapy drugs used in the first line treatment of ovarian cancer, cisplatin and paclitaxel. By studying the IGROVCDDP cells we can identify genes and proteins that have changed and may be useful as molecular markers of chemotherapy resistance in the clinic. IGROVCDDP cells have many molecular markers of chemotherapy resistance and highlight the multiple mechanisms that can exist simultaneously in drug-resistant cancer cells. IGROVCDDP cells have increased levels of the drug-efflux pump, P-glycoprotein. This causes resistance to paclitaxel by pumping the drug out of the cancer cell. The study highlights that the P-glycoprotein can co-exist with multiple mechanisms of resistance to cisplatin. Cisplatin resistance is mediated in part by detoxification by the glutathione pathway and decreased uptake of drug into the cell. This is a step towards understanding how molecular markers of drug resistance interact and overlap in in ovarian cancer patients.

"We will now go on to examine molecular markers identified in IGROVCDDP in samples of tumours from ovarian cancer patients. Hopefully we will find markers that can separate patients who respond and those who do not respond to cisplatin and paclitaxel chemotherapy. Patients we think that will respond could be given the standard cisplatin/paclitaxel chemotherapy, and those who have a poor chance of responding could be given alternative treatment," concluded Dr Stordal.


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Study investigates molecular markers in drug-resistant ovarian cancer



http://www.news-medical.net/news/20120727/Study-investigates-molecular-markers-in-drug-resistant-ovarian-cancer.aspx

Sunday, July 29, 2012

Evaluation of HE4, CA125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass.



Evaluation of HE4, CA125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass.

Abstract

OBJECTIVE: Diagnostic factors are needed to improve the currently used serum CA125 and Risk of Malignancy Index (RMI) in differentiating ovarian cancer (OC) from other pelvic masses, thereby achieving precise and fast referral to a tertiary centre and correct selection for further diagnostics. The aim was to evaluate serum Human Epididymis protein 4 (HE4) and the Risk of Ovarian Malignancy Algorithm (ROMA) for these purposes.

METHODS: Serum from 1218 patients in the prospective ongoing pelvic mass study was collected prior to diagnosis. The HE4 and CA125 data were registered and evaluated separately and combined in ROMA and compared to RMI.

RESULTS: 809 benign tumors, 79 borderline ovarian tumors, 252 OC (64 early and 188 late stage), 9 non-epithelial ovarian tumors and 69 non-ovarian cancers were evaluated. Differentiating between OC and benign disease the specificity was 62.2 (CA125), 63.2 (HE4), 76.5 (ROMA) and 81.5 (RMI) at a set sensitivity of 94.4 which corresponds to RMI=200. The Areas Under the Curve (AUC) were 0.854 (CA125), 0.864 (HE4), 0,897 (ROMA) and 0.905 (RMI) for benign vs. early stage OC. For premenopausal benign vs. OC AUC were 0.925 (CA125), 0.905 (HE4), 0.909 (ROMA) and 0.945 (RMI).

CONCLUSION: HE4 and ROMA increase differentiating OC from other pelvic masses, even in early stage OC. ROMA might be valuable as a first line biomarker for selecting high risk patients for referral to a tertiary centre and further diagnostics. Further improvements of HE4 and ROMA in differentiating pelvic masses are still needed, especially regarding premenopausal women.

Copyright © 2012. Published by Elsevier Inc.

Although bone pain in osteoporosis and skeletal metastasis is an expected consequence of fracture, there are other underlying causes responsible. Our study demonstrated that ovarian cancer G-protein-coupled receptor 1 detected extracellular protons in MG63 cells, and regulated osteoblast functions, such as prostaglandin E2 production, in response to acidic circumstances. In this work, we measured inositol phosphate production, intracellular Ca(2+) concentration, prostaglandin E2 production, and cyclic adenosine monophosphate accumulation in MG63 cells exposed to extracellular acidification. Extracellular acidity induced a transient increase in Ca(2+) concentration and inositol phosphate production. Acidification also induced prostaglandin E2 production, resulting in cyclic adenosine monophosphate accumulation. A small interfering RNA specific for the ovarian cancer G-protein-coupled receptor 1 markedly inhibited these proton-induced actions in MG63 cells. These results indicated that the involvement of ovarian cancer G-protein-coupled receptor 1 in acidic extracellular environment may be an underlying mechanism responsible for bone pain in osteoporosis or bone metastasis without clinically proved fractures.

Copyright © 2012. Published by Elsevier Ltd.


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Evaluation of HE4, CA125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass.



Final overall survival results of phase III GCIG CALYPSO trial of pegylated liposomal doxorubicin and carboplatin vs paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients.



http://www.ncbi.nlm.nih.gov/m/pubmed/22836511/?i=4&from=ovarian%20cancer

A phase I trial of dasatinib, a Src-family kinase Inhibitor, in combination with paclitaxel and carboplatin in patients with advanced or recurrent ovarian cancer.



http://www.ncbi.nlm.nih.gov/m/pubmed/22837181/?i=3&from=ovarian%20cancer

Wednesday, July 25, 2012

The Implications of Age and Comorbidity on Survival Following Epithelial Ovarian Cancer: Summary and Results from a Centers for Disease Control and Prevention Study.



The Implications of Age and Comorbidity on Survival Following Epithelial Ovarian Cancer: Summary and Results from a Centers for Disease Control and Prevention Study.




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The management of small-cell carcinomas of the gynecologic tract.



The management of small-cell carcinomas of the gynecologic tract.




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A critical assessment of SELDI-TOF-MS for biomarker discovery in serum and tissue of patients with an ovarian mass



A critical assessment of SELDI-TOF-MS for biomarker discovery in serum and tissue of patients with an ovarian mass




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Cancer treatment according to BRCA1 and BRCA2 mutations.



Cancer treatment according to BRCA1 and BRCA2 mutations.




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Endometriosis in menopause



Endometriosis in menopause: a single institution experience.




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Peritoneal washing cytologic analysis of ovarian serous tumors of low malignant potential to detect peritoneal implants and predict clinical outcome.



Peritoneal washing cytologic analysis of ovarian serous tumors of low malignant potential to detect peritoneal implants and predict clinical outcome.




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Friday, July 20, 2012

Multiple Gastric Metastases from Ovarian carcinoma diagnosed by endoscopic u/s with fine needle aspiration



Multiple Gastric Metastases from Ovarian Carcinoma Diagnosed by Endoscopic Ultrasound with Fine Needle Aspiration.

Case Rep Gastrointest Med. 2012;2012:610527. Epub 2012 Jul 

Abstract

Metastasis to the stomach from nongastric tumors is a rare event. We present a case of ovarian cancer metastasis to the gastric wall that presented as multiple subepithelial gastric lesions. A 55-year-old female with known stage III b serous ovarian cancer was admitted to the hospital with melena and anemia. A 1.5 to 2 cm subepithelial mass with superficial overlying erosion in the antrum was seen in Esophagogastroduodenoscopy (EGD). Initial endoscopic mucosal biopsies were normal. An Endoscopic Ultrasound (EUS) was performed, which revealed two subepithelial lesions with the typical appearance of a gastrointestinal stromal tumor. Fine needle aspiration (FNA) of both masses revealed papillary adenocarcinoma from an ovarian papillary serous adenocarcinoma. This is the first reported case of multiple gastric metastatic lesions from ovarian cancer diagnosed by EUS 



Thursday, July 19, 2012

Ovarian cancer: emerging molecular-targeted therapies




Ovarian cancer: emerging molecular-targeted therapies

Review

Authors: Sourbier C

Published Date June 2012 Volume 2012:6 Pages 147 - 154

Carole Sourbier

Rockville, MD, USA

Abstract: With about 22,000 new cases estimated in 2012 in the US and 15,500 related deaths, ovarian cancer is a heterogeneous and aggressive disease. Even though most of patients are sensitive to chemotherapy treatment following surgery, recurring disease is almost always lethal, and only about 30% of the women affected will be cured. Thanks to a better understanding of the molecular mechanisms underlying ovarian cancer malignancy, new therapeutic options with molecular-targeted agents have become available. This review discusses the rationale behind molecular-targeted therapies and examines how newly identified molecular targets may enhance personalized therapies for ovarian cancer patients. 







Combined panel of serum human tissue kallikreins and CA-125 for the detection of epithelial ovarian cancer (see link for full text)



http://www.gyneoncology.or.kr/journal/viewJournal.html?year=2012&vol=23&num=3&page=175


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Cancer treatment and survivorship statistics, 2012




You have free access to this content

Cancer treatment and survivorship statistics, 2012

CA: A Cancer Journal for Clinicians

CA: A Cancer Journal for Clinicians

Volume 62Issue 4pages 220–241July/August 201
2






Treating Ovarian Cancer « Mayo Clinic Podcasts July 2012



http://podcasts.mayoclinic.org/2012/07/19/treating-ovarian-cancer/

Viral Genetics Begins Phase 1 Clinical Trial for Ovarian Cancer - MarketWatch



http://www.marketwatch.com/story/viral-genetics-begins-phase-1-clinical-trial-for-ovarian-cancer-2012-07-19

Cancer biomarkers re-evaluated



Cancer biomarkers re-evaluated

09:25, Medicine & Health/Cancer


The combination of genomic data and protein measurements in patient samples will speed up the discovery of clinically relevant cancer biomarkers. Credit: istockphoto

(Medical Xpress) -- Researchers from ETH Zurich have developed a procedure to test the clinical benefits of cancer biomarkers. The method could radically shorten the path from the lab to their application.

Protein biomarkers, especially those that circulate in the blood plasma or urine and can therefore be obtained without any major intervention, are vital in personalised medicine. Biomarkers help in detecting diseases in hospitals at an early stage, classifying them, selecting the suitable treatment and monitoring the treatment response.

Thanks to major advancements in proteomic and genomic research and modelling biological processes on the computer, researchers have discovered over a thousand potential protein biomarkers in recent years. Knowledge of the complete gene sequences of individual cancer patients is also on the rise, which will boost the number of possible biomarkers further.

Long list of candidates

However, the majority of the protein biomarkers proposed and recorded in the literature do not progress beyond the status "potential". "The list of candidates for biomarkers has grown longer and longer, but the number approved for clinical use has stagnated," sums up Ruth Hüttenhain, a postdoc from the group headed by professor of molecular systems biology Ruedi Aebersold. After all, in order to gauge whether biomarker candidates are clinically relevant in the first place, they have to be measured and validated in large cohorts of patient samples. The main reason why the development of new biomarkers for clinical use has not progressed is the lack of a verification procedure for most biomarker candidates.

Ruth Hüttenhain and Martin Soste, the first authors of a study that has just been published in Science Translational Medicine, have thus developed a strategy to measure potential biomarkers rapidly on a large scale and verify their clinical uses. The method is based on a targeted mass spectrometric, high-throughput technology, which can determine proteins that are present in biological samples at any particular point in time in a reliable and reproducible way. For this procedure, mass spectrometric coordinates, so-called assays, need to be developed beforehand for every protein.

Test process quickly narrows down list

In their study, the researchers developed assays for 1,157 potential biomarkers, the abundances of which change in different human cancer tissues and which are related to mutated genes that drive the development of cancer. The researchers ultimately tested their assays on blood and urine samples taken from cancer patients and healthy individuals. The scientists were able to detect over 180 different biomarkers in the blood plasma, the concentration of which reached the range of a billionth of a gram per millimetre of fluid. In the urine samples, the systems biologists found over 400 different biomarker proteins.

With the aid of the assays, the list of possible biomarkers can be narrowed down swiftly and efficiently. While these cannot be used directly in a cancer diagnosis, they bridge the gap between basic research and clinical applicability. "We hope that we are advancing studies on cancer biomarkers with our work and helping promising candidates to be used clinically," says the postdoctoral student. To enable other researchers to benefit from the groundwork, the ETH-Zurich scientists have placed all the assays in a publicly accessible database that can be expanded rapidly and easily to include newly discovered biomarker candidates.

Case study on ovarian cancer confirms approach

A case study on the recognition of ovarian cancer confirms the ETH-Zurich researchers' approach in that it verified potential biomarkers in blood plasma. To this end, the researchers not only measured the biomarker candidates described in the literature, but also new biomarkers that they predicted with computational models based on genomic data. "Using the blood plasma measurements, interestingly some of the predicted biomarkers produced extremely promising results for the classification of ovarian cancer patients," stresses Ruth Hüttenhain. The results therefore underscored the great potential of the mass spectrometric method for validating new protein biomarkers. The study also describes an insightful link between cancer, genetic data and proteome measurements to determine the acute status of patients.

The ETH-Zurich researchers see a general strategy in their approach to link studies on gene and protein interactions more strongly. Due to the connection between the genes and gene products, the proteins, involved in tumour formation, the researchers can predict new, previously unknown biomarker candidates on the computer that can be tested with the aid of mass spectrometric assays in patient samples. "Our new method can be used to validate the proposed biomarker candidates in all patient samples," says Martin Soste. The strategy of developing highly specific verification procedures for disease-relevant proteins can also be applied to other diseases.

More information: Hüttenhain R, et al. Reproducible quantification of cancer-associated proteins in body fluids using targeted proteomics. Sci. Transl. Med. 4, 142ra94 (2012).

Provided by ETH Zurich



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Four Abstracts on ChemoFx® to Be Presented at IGCS Annual Meeting | Business Wire



http://www.businesswire.com/news/home/20120718005953/en/Abstracts-ChemoFx%C2%AE-Presented-IGCS-Annual-Meeting

EU Commission backs open-access science publishing



http://reut.rs/LoI7RF

Wednesday, July 18, 2012

JAMA Network | JAMA: The Journal of the American Medical Association | Screening Women for Ovarian Cancer Still Does More Harm Than Good



http://jama.jamanetwork.com/article.aspx?articleid=1187925


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Resveratrol Exerts Differential Effects in vitro and vivo against ovarian cancer cells



Resveratrol Exerts Differential Effects in Vitro and in Vivo against Ovarian Cancer Cells.




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Population-based cancer registration in Indonesia



Population-based cancer registration in indonesia




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Adjuvant Chemotherapy for Stage I Ovariian carcinoma: Is it necessary for stage 1A?



Adjuvant Chemotherapy for Stage I Ovarian Clear Cell Carcinoma: Is it Necessary for Stage IA?




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Social Influences on Clinical Outcomes of patients with ovarian cancer



Social Influences on Clinical Outcomes of Patients With Ovarian Cancer.





Wednesday, July 11, 2012

Cisplatin plus paclitaxel and maintenance of (Avastin) bevacizumab on tumour progression, dissemination, and survival of ovarian carcinoma xenograft models



Cisplatin plus paclitaxel and maintenance of bevacizumab on tumour progression, dissemination, and survival of ovarian carcinoma xenograft models:
 July 2012  doi:10.1038/bjc.2012.261

Background:
Bevacizumab is being incorporated as first-line therapy with standard-of-care chemotherapy on epithelial ovarian carcinoma (EOC). We investigated bevacizumab combined with chemotherapy on tumour progression and mouse survival in EOC xenograft models.
Methods:
Bevacizumab was administered concomitantly with cisplatin plus paclitaxel (DDP+PTX), continued after induction (maintenance) or started after chemotherapy. The effect on tumour progression was monitored by bioluminescence imaging (BLI) (1A9-luc xenograft). Tumour dissemination into the peritoneal organs and ascites formation (HOC22 xenograft) was evaluated by histological analysis at the end of treatment (interim) and at euthanasia (survival). The effects on overall survival (OS) were investigated in both EOC models.
Results:
Bevacizumab with PTX+DDP delayed tumour progression in mice bearing EOC xenografts. OS was significantly extended, with complete responses, by bevacizumab continued after stopping chemotherapy in the HOC22 xenograft. Bevacizumab alone inhibited ascites formation, with only limited effect on tumour burden, but combined with PTX+DDP reduced ascites and metastases. Bevacizumab started after induction with PTX+DDP and maintained was equally effective on tumour progression and survival on 1A9-luc xenograft.
Conclusion:
Bevacizumab combined with chemotherapy not only affected tumour progression, but when administered as maintenance regimen significantly prolonged survival, reducing ascites, and tumour dissemination. We believe our findings are consistent with the clinical results and shed light on the potential effects of this kind of treatment on tumour progression.


paywalled: Preferences for outcomes associated with decisions to undergo or forego genetic testing for Lynch syndrome



Preferences for outcomes associated with decisions to undergo or forego genetic testing for Lynch syndrome

Abstract

BACKGROUND:

Current guidelines recommend offering genetic testing for Lynch syndrome to individuals whose tumors suggest this condition and to relatives of affected individuals. Little is known, however, regarding how patients view the prospect of such testing. In addition, data on preferences (utilities) for the potential outcomes of testing decisions for use in cost-effectiveness analyses are lacking.

METHODS:

Time tradeoff utilities were elicited for 10 potential outcomes of Lynch syndrome testing decisions and 3 associated cancers from 70 participants, representing a range of knowledge about and experiences with Lynch syndrome.

RESULTS:

Highest mean utilities were assigned to scenarios in which only the assessor's sibling had Lynch-associated colorectal cancer (ranging from 0.669 ± 0.231 to 0.760 ± 0.220). Utilities assigned to scenarios in which the assessor had Lynch-associated colorectal cancer ranged from 0.605 ± 0.252 to 0.682 ± 0.246, whereas the lowest mean utilities were assigned to 2 of the general cancer states (0.601 ± 0.238 and 0.593 ± 0.272 for colorectal and ovarian cancer respectively). Only 43% of the sample assigned higher values to undergoing Lynch testing and receiving negative results versus foregoing Lynch testing, whereas 50% assigned higher values to undergoing rather than foregoing surgery to prevent a subsequent cancer.

CONCLUSIONS:

Genetic testing for Lynch syndrome, regardless of results, can have profound effects on quality of life; the utilities we collected can be used to incorporate these effects into cost-effectiveness analyses. Importantly, preferences for the potential outcomes of testing vary substantially, calling into question the extent to which patients would avail themselves of such testing if it were offered to them. Cancer 2012. © 2012 American Cancer Society


Podcast/RSS video: Lynch Syndrome Educational Support Workshop | Memorial Sloan-Kettering Cancer Center (68 min.)



Podcast/RSS video: Lynch Syndrome Educational Support Workshop | Memorial Sloan-Kettering Cancer Center

Runtime
68:00
Medical experts from Memorial Sloan-Kettering discuss Lynch syndrome, a genetic disorder that can cause colon and other cancers.

Medicine 2012 update ovarian cancer



http://emedicine.medscape.com/article/255771-treatment


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Tuesday, July 10, 2012

paywalled: Gynecologic Oncology Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer



Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer

 Abstract


Background  

To analyze the impact of radical cytoreductive surgery—as part of primary tumor debulking—on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.

Methods  

Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC–IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.

Results  

Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients..........

Conclusions  

No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.

 

Sunday, July 08, 2012

10 years after hormone therapy study: What doctors know now – USATODAY.com



10 years after hormone therapy study: What doctors know now – USATODAY.com

"It's been 10 years since researchers of the Women's Health Initiative, a large randomized, controlled trial on hormone therapy sponsored by the National Institutes of Health, announced their first findings: that the health risks outweighed the benefits of estrogen plus progestin hormone therapy (HT) in postmenopausal women. Since then, additional research has advanced the understanding of the benefits and risks. JoAnn Manson, one of the study's lead investigators and a professor of medicine at Harvard Medical School, is the president of the North American Menopause Society. She spoke with USA TODAY's Janice Lloyd about what women need to know to get through the challenging time and to protect their health......

Hospital safety - review



http://m.cbsnews.com/fullstory.rbml?catid=57468081&feed_id=999&videofeed=999


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Mismatch Repair Protein Deficiency - sebaceous carcinoma




Mismatch Repair Protein Deficiency is Common in Sebaceous Neoplasms and Suggests the Importance of Screening for Lynch Syndrome.


Ovarian metastases resection from extra - PubMed Mobile



http://www.ncbi.nlm.nih.gov/m/pubmed/22759383/?i=4&from=ovarian%20cancer&filter=loattrfree%20full%20text


"CONCLUSION: Ovarian metastases are more commonly seen to originate from primary gastrointestinal tract. The prognosis of ovarian metastasis is dismal and the benefit of ovarian metastatectomy is limited. Those with combined metastasis outside ovaries, locally invasion and massive intraoperative ascites were independent factors for predicting unfavorable overall survival. The identification of the primary tumor is required to plan for adequate treatment for this group of patients."

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Impact of Complete Cytoreduction



http://www.ncbi.nlm.nih.gov/m/pubmed/22766983/?i=4&from=ovarian%20cancer


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paywalled: Dairy foods and nutrients in relation to risk of ovarian cancer and major histological subtypes - Merritt - International Journal of Cancer - Wiley Online Library



Dairy foods and nutrients in relation to risk of ovarian cancer and major histological subtypes 

Abstract

Inconsistent results for the role of dairy food intake in relation to ovarian cancer risk may reflect the potential adverse effects of lactose, which has been hypothesized to increase gonadotropin levels, and the beneficial anti-proliferative effects of calcium and vitamin D. Using data from the New England case-control study (1909 cases; 1989 controls) we examined dairy foods and nutrients in relation to risk of ovarian cancer overall, histological subtypes, and rapidly fatal versus less aggressive disease. We used logistic regression and polytomous logistic regression to estimate odds ratios and 95% confidence intervals. In models that were simultaneously adjusted for total (dietary plus supplements) calcium, total vitamin D and lactose, we observed a decreased overall risk of ovarian cancer with high intake of total calcium (Quartile 4 (Q4, >1319 mg/day) vs. Quartile 1 (Q1, <655 mg/day), odds ratio (OR)=0.62, 95% Confidence Interval (CI)=0.49 - 0.79); the inverse association was strongest for serous borderline and mucinous tumors. High intake of total vitamin D was not associated overall with ovarian cancer risk, but was inversely associated with risk of serous borderline (Q4, >559 IU/day vs. Q1, <164 IU/day, OR=0.51, 95% CI=0.34-0.76) and endometrioid tumors (Q4 vs. Q1, OR=0.55, 95% CI=0.39-0.80). We found no evidence that lactose intake influenced ovarian cancer risk, or that risk varied by tumor aggressiveness in the analyses of intake of dairy foods and nutrients. The overall inverse association with high intake of calcium, and the inverse associations of calcium and vitamin D with specific histological subtypes warrant further investigation.

paywalled: Phenotype and Polyp Landscape in Serrated Polyposis Syndrome: A Series of 100 Patients From Genetics Clinics (Lynch Syndrome...)



 define: hyperplastic

What is a hyperplastic colon polyp?

                    ~~~~~~~~~~~~~~~~~~~~~~~~~~

Phenotype and Polyp Landscape in Serrated Polyposis Syndrome: A Series of 100 Patients From Genetics Clinics


Abstract

Serrated polyposis syndrome (SPS), also known as hyperplastic polyposis, is a syndrome of unknown genetic basis defined by the occurrence of multiple serrated polyps in the large intestine and associated with an increased risk of colorectal cancer (CRC). There are a variety of SPS presentations, which may encompass a continuum of phenotypes modified by environmental and genetic factors. To explore the phenotype of SPS, we recorded the histologic and molecular characteristics of multiple colorectal polyps in patients with SPS recruited between 2000 and 2010 from genetics clinics in Australia, New Zealand, Canada, and the United States. Three specialist gastrointestinal pathologists reviewed the polyps, which they classified into conventional adenomas or serrated polyps, with various subtypes, according to the current World Health Organization criteria. Mutations in BRAF and KRAS and mismatch repair protein expression were determined in a subset of polyps. A total of 100 patients were selected for the study, of whom 58 were female and 42 were male. The total polyp count per patient ranged from 6 to 150 (median 30). The vast majority of patients (89%) had polyposis affecting the entire large intestine. From this cohort, 406 polyps were reviewed. Most of the polyps (83%) were serrated polyps: microvesicular hyperplastic polyps (HP) (n=156), goblet cell HP (n=25), sessile serrated adenoma/polyps (SSA/P) (n=110), SSA/P with cytologic dysplasia (n=28), and traditional serrated adenomas (n=18). A further 69 polyps were conventional adenomas. BRAF mutation was mainly detected in SSA/P with dysplasia (95%), SSA/P (85%), microvesicular HP (76%), and traditional serrated adenoma (54%), whereas KRAS mutation was present mainly in goblet cell HP (50%) and in tubulovillous adenoma (45%). Four of 6 SSA/Ps with high-grade dysplasia showed loss of MLH1/PMS2 expression. CRC was diagnosed in 39 patients who were more often found to have a conventional adenoma compared with patients without CRC (P=0.003). Patients with SPS referred to genetics clinics had a pancolonic disease with a high polyp burden and a high rate of BRAF mutation. The occurrence of CRC was associated with the presence of conventional adenoma.

Saturday, July 07, 2012

paywalled- Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis



Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis


Abstract

Background

Paclitaxel is commonly given as a 3-h infusion every 3 weeks for a variety of malignancies. Several randomized clinical trials comparing weekly paclitaxel with Q3-week (Q3W) have produced mixed results in terms of efficacy and toxicity creating controversy about the ideal dose and schedule.

Methods

A literature search using PubMed, Cochrane Library, and Proceedings of the American Society of Clinical oncology from 1995 to 2011 was performed..........Moderators of cancer types, ethnicity, and paclitaxel dose ratio were analyzed for primary dependent variables.

Results

Ten trials were included....

Conclusion

Weekly paclitaxel has a favorable toxicity profile compared to the current standard of Q3W paclitaxel.

Dietary Acrylamide Intake and the Risk of Lymphatic Malignancies: The Netherlands Cohort Study on Diet and Cancer



Dietary Acrylamide Intake and the Risk of Lymphatic Malignancies: The Netherlands Cohort Study on Diet and Cancer

"..Recent analyses within the NLCS, the Nurses’ Health Study, and a Danish cohort study [11], [12], [13], [14] showed a positive association for endometrial, ovarian, and estrogen receptor-positive breast cancer, suggesting that disturbance of sex hormonal balances may be a mechanism of acrylamide carcinogenesis, which can also be suggested based on the rat carcinogenicity assays [7], [8]. Although it cannot be concluded from the present study, hormonal imbalances might be a mechanism of acrylamide carcinogenesis for lymphatic malignancies as well....

Occupational cancer in Britain - ovarian, breast and cervical



Occupational cancer in Britain

"The following paper reviews the three cancers in women: breast, cervical and ovarian. There is no overlap between the cancers and exposure circumstances, and thus all are considered and described separately. Data for male breast cancer are much more limited and will not be considered here."


Wednesday, June 20, 2012

Cruciferous Vegetables and Cancer Prevention - National Cancer Institute



Cruciferous Vegetables and Cancer Prevention - National Cancer Institute

paywalled: Nanocarrier systems for delivery of siRNA to ovarian cancer tissues, Expert Opinion on Drug Delivery



Nanocarrier systems for delivery of siRNA to ovarian cancer tissues, Expert Opinion on Drug Delivery


Expert opinion: Gene silencing therapy based on siRNA represents a possible opportunity for treatment of ovarian cancer patients. However, this approach requires selection of suitable nanocarriers that can safely and effectively deliver siRNA to the target site to induce its effect. Very little work has been done in this field; therefore, it is a good direction for future development.





paywalled: Cochrane Review - Removal of nail polish and finger rings to prevent surgical infection.



Cochrane Database Syst Rev. 2012 May 16;5:CD003325.

Removal of nail polish and finger rings to prevent surgical infection.

Abstract

BACKGROUND:

Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.

OBJECTIVES:

To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.

MAIN RESULTS:

We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.

AUTHORS' CONCLUSIONS:

No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

Characteristics and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Patients with Cancer Treated with Vancomycin: 9-Year Experience at a Comprehensive Cancer Center - The Oncologist



Abstract

Abstract Background. Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) can cause significant morbidity and mortality in patients with cancer. However, data on outcomes of patients treated with vancomycin are lacking.
Methods. We identified 223 patients with cancer who developed MRSA BSIs between January 2001 and June 2009 and were treated with vancomycin. Treatment failure was defined as death within 60 days of infection, persistent bacteremia ≥5 days, fever ≥4 days, recurrence or relapse, and secondary MRSA infection.
Results. The treatment failure rate was 52% (116 of 223 patients). These patients were more likely to have been hospitalized, been treated with steroids within the previous 3 months, developed acute respiratory distress syndrome, required mechanical ventilation, required intensive care unit care, and community-onset infections (all p < .05). Risk factors for MRSA-associated mortality (27 of 223 patients; 12%) included hematologic malignancy and hematopoietic stem cell transplantation, community-onset infection, secondary BSI, MRSA with minimum inhibitory concentration (MIC) ≥2.0 μg/mL, mechanical ventilation, and a late switch to an alternative therapy (≥4 days after treatment failure; all p < .05). On multivariate analysis, mechanical ventilation and recent hospitalization were identified as independent predictors of vancomycin failure, and community-onset infection, secondary BSIs, and MIC ≥2 μg/mL were identified as significant predictors of MRSA-associated mortality.
Conclusions. We found a high treatment failure rate for vancomycin in patients with cancer and MRSA BSIs, as well as a higher mortality. A vancomycin MIC ≥2 μg/mL was an independent predictor of MRSA-associated mortality. An early switch to an alternative therapy at the earliest sign of failure may improve outcome.

paywalled: Causes of death of mutation carriers in Finnish Lynch syndrome families.



Fam Cancer. 2012 Jun 9. [Epub ahead of print]

Abstract

Lynch syndrome (LS) is an autosomal dominant cancer syndrome including increased life-long risk for colorectal (CRC) and endometrial (EC) cancer, but also for cancers of other types. The risk for CRC is up to 70-80 % and for EC up to 50-60 %. Due to screening and early diagnosing the mortality related to CRC and EC seems to be low. In spite of many studies on surveillance of mutation carriers, there is no comprehensive evaluation on causes of death in LS families. The disease history and cause of death of all the deceased, tested mutation carriers and their mutation negative relatives in the Finnish LS families (N = 179) was examined utilizing hospital records and relevant national registries. Out of 1069 mutation carriers 151 had succumbed; 97 (64 %) from cancer. Out of 1146 mutation-negative family 44 members had died; 11 (25 %) of them from cancer. In 12 (7.7 %) of the deceased mutation carriers no cancer had been diagnosed. The mean age of death from cancer was 63.2 years vs. 68.8 years from non-cancer causes. Only 7.9 % of the patients with CRC had died from CRC and 5 % of those with EC, respectively. 61 % of the cancer deaths were related to extra-colonic, extra-endometrial cancers. The cumulative overall and cancer specific death rates were significantly increased in Mut+ compared to Mut- family members. Even surveillance yields decrease in the life-long risk and mortality of the most common cancers CRC and EC in LS, almost all mutation carriers will contract with cancer, and two thirds of the deceased have died from cancer. This should be taken in account in genetic counseling. Mutation carriers should be encouraged to seek help for abnormal symptoms.

Monday, June 18, 2012

paywalled - Survival of ovarian cancer patients in Germany in the early 21st century: a period analysis by age, histology, laterality, and stage



European Journal of Cancer Prevention:

Abstract

Population-based studies on ovarian cancer providing survival estimates by age, histology, laterality, and stage have been sparse. We aimed to derive the most up-to-date and detailed survival estimates for ovarian cancer patients in Germany. We used a pooled German national dataset including data from 11 cancer registries covering 33 million populations. A total of 21 651 patients diagnosed with ovarian cancer in 1997-2006 were included. Period analysis was carried out to calculate the 5-year relative survival (RS) for the years 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was observed, with a decrease in the 5-year RS from 67% in the age group 15-49 years to 28% in the age group 70+ years. Furthermore, the prognosis varied markedly by histology, laterality, and stage, with the age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise specified) to 81% (for stromal cell carcinoma), reaching 46% for unilateral and 32% for bilateral carcinoma and reaching 82% for Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for FIGO stage III, and 18% for FIGO stage IV. No improvement in survival could be observed for any of the subgroups in the period between 2002 and 2006. Our analyses suggest that an improvement in the 5-year RS for ovarian cancer may have stagnated in the early 21st century and underline the need for a more effective translation of therapeutic innovation into clinical practice.

CDC- Cancer Survivorship Twitter Chat Tuesday, June 19th 2-3 pm EDT



Join Us! Cancer Survivorship Twitter Chat Tomorrow



CDC's Division of Cancer Prevention and Control (DCPC) will host a Twitter chat about cancer survivorship on Tuesday, June 19 from 2:00 to 3:00 pm EDT.

Subject matter experts Blythe Ryerson and Dr. Elizabeth Rohan will answer questions. Visit DCPC's Twitter account at twitter.com/CDC_Cancer. You can follow the chat using the hashtag #CDCCancerChat, and you can send questions for the chat using that hashtag now.


Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

Imperfect measure of hospital safety - CIHI



Imperfect measure of hospital safety

Imperfect measure of hospital safety

  1. CMAJ
The failure to include hospital-acquired infections or medication errors as a performance indicator limits the utility of the Canadian Institute for Health Information’s (CIHI) new hospital benchmarking tool, critics say....


Figure

Predisposed to risk but not change CMAJ (genetic testing series)




......Of course, considering that the predictive power of genetic testing tends to be underwhelming, perhaps it’s no surprise that personalized genetic information induces more shoulder shrugs than lifestyle changes. “One of the challenges is that people are behaving rationally, to a degree, when they don’t change their behaviours. These genetic tests aren’t very predictive,” says Timothy Caulfield, a Canada Research Chair in Health Law and Technology who teaches in the law faculty and school of public health at the University of Alberta. “If you find you have a health risk of 2% instead of 1%, that type of risk is lost in the noise of risk in your life.” 

Editor’s note: Sixth of a multipart series on genetic testing.


Part 1: Separating hype from reality in the era of the affordable genome (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4143).
Part 2: Popping the genetics bubble (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4142).
Part 3: Who should hold the keys to your DNA? (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4141).
Part 4: A race-based detour to personalized medicine (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4133).
Part 5: Race and genetics in the doctor’s office (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4134).

Substantially Modified Ratios of Effector to Regulatory T Cells During Chemotherapy in Ovarian Cancer Patients Return to Pre-Treatment Levels at Completion: Implications for Immunotherapy



Published: 18 June 2012
(This article belongs to the Special Issue Cancer Vaccines and Immunotherapy)
Abstract:  
Ovarian cancer is the leading cause of death from gynaecological malignancy. Despite improved detection and treatment options, relapse rates remain high. Combining immunotherapy with the current standard treatments may provide an improved prognosis, however, little is known about how standard chemotherapy affects immune potential (particularly T cells) over time, and hence, when to optimally combine it with immunotherapy (e.g., vaccines). Herein, we assess the frequency and ratio of CD8+ central memory and effector T cells as well as CD4+ effector and regulatory T cells (Tregs) during the first 18 weeks of standard chemotherapy for ovarian cancer patients. In this pilot study, we observed increased levels of recently activated Tregs with tumor migrating ability (CD4+CD25hiFoxp3+CD127−CCR4+CD38+ cells) in patients when compared to controls. Although frequency changes of Tregs as well as the ratio of effector T cells to Tregs were observed during treatment, the Tregs consistently returned to pre-chemotherapy levels at the end of treatment.

Tuesday, May 29, 2012

SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017 Strategic Plan - Partnership Against Cancer Canada (does not include ovarian/gyn)




Blogger's Note: search of 'ovarian'/'ovary'/'gyn' yields null results

SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017  Strategic Plan - Canada

CONTENTS
2 MESSAGE FROM THE CHAIR AND CEO
4 EXECUTIVE SUMMARY
1. 2012–2017 Strategic Plan
10 THE GROWING CHALLENGE OF CANCER
16 ADVANCING A SHARED VISION
34 2012–2017 STRATEGIC FRAMEWORK
38 STRATEGIC PRIORITIES
52 CORE ENABLING FUNCTIONS
2. 2012–2017 Business Plan
64 PLANNING FOR RESULTS
70 STRATEGIC PRIORITIES
103 CORE ENABLING FUNCTIONS
3. Moving Forward Together
122 TRANSFORMING CANCER CONTROL

Ovarian Cancer and Us - blogger's note



short sabbatical - blog postings to return in ~ one week - thanks!

Journal of Experimental & Clinical Cancer Research |- Chemotherapy and skin reactions



Journal of Experimental & Clinical Cancer Research  Chemotherapy and skin reactions

Research

Chemotherapy and skin reactions

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 Journal of Experimental & Clinical Cancer Research 2012

Published: 28 May 2012

Abstract (provisional)

Background

New chemotherapic agents and new protocols in oncology have led to an increasing survival rate in patients affected by tumors. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of patients' quality of life. Appropriate management of skin toxicity associated with chemotherapic agents is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes.

Methods

We have clinically examined 100 patients affected by cancer, determining type, frequency, treatment, and evolution of side effects related to chemotherapy.

Results

The prevalent cutaneous side effects in patients undergoing chemotherapy are skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical cases are reported in detail.

Conclusion

Oncological therapies have become more selective and have low systemic toxicity because of their high specificity, but cutaneous side effects are common and may worsen the quality of life of these patients.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

paywalled: Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line



Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line chemotherapy

Abstract

Aim:  Several previous reports showed that irinotecan hydrochloride plus cisplatin (CPT-P) was a candidate first-line chemotherapy regimen for clear cell adenocarcinoma of the ovary (CCC). However, long-term survival in CCC patients treated with CPT-P as first-line chemotherapy remains to be determined. The aim of the present study was to evaluate the long-term results of CPT-P as first-line chemotherapy for CCC.
Material and Methods:  We performed a retrospective review of 31 patients with CCC who were treated with CPT-P between 1996 and 2004.
Results:  The median follow-up period was 91 months.........
Conclusion:  The long-term results suggest CPT-P as a candidate in first-line chemotherapy for CCC in not only stage I, but also in optimally debulked stage II-IV patients with pT1/pT2 disease.


HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today



HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today


Action Points


  • A systematic review of papers published since 2002 (post-WHI study) found that the risks of hormone replacement therapy still outweighed any benefits in primary prevention of chronic conditions.
  • Point out that both estrogen plus progestin and estrogen alone prevented fractures, but increased the risk of stroke, thromboembolic events, gallbladder disease, and urinary incontinence.

Earlier detection of bone loss may be in future



Earlier detection of bone loss may be in future

“Right now, pain is usually the first indication that cancer is affecting bones. If we could detect it earlier by an analysis of urine or blood in high-risk patients, it could significantly improve their care,” Fonseca said.

Monday, May 28, 2012

Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics - media (c-38 bill/Canadian healthcare)



Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics

"When it comes to politics, Canadians are generally an apathetic bunch. Often, a controversy will brew and within a week or two we forget about it and move on.
It appears Bill C-38 is one issue we're not willing to let go....

Jobs, Growth and Long-term Prosperity Act

An Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012 and other measures

 

C-38: What it means for health care (media)


IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer.



IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer

"Taken together, IL-13Rα2 is involved in cancer metastasis through activation of ERK/AP-1 and that targeting IL-13Rα2 might not only directly kill primary tumors but also prevent cancer metastasis."

Health News - Enhanced data access to benefit cancer researchers and patients



Health News - Enhanced data access to benefit cancer researchers and patients

Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment





 Neurocognitive function impairment after wholebrain radiotherapy for brain metastases: actual assessment


 Conclusion
......The results of this review will enable physicians to inform
patients about benefits and risks of these two treatment options.

paywalled: Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients



Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients:
Abstract
Aim
To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.
Methods 
A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.
Results  
All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal, one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the 11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death in four patients (36%).
Conclusion  
Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment with bevacizumab should immediately be discontinued.