Preoperative Identification of Synchronous Ovarian and Endometrial Cancers: The Importance of Appropriate Workup

Preoperative Identification of Synchronous Ovarian and Endometrial Cancers: The Importance of Appropriate Workup

Objective: For treatment of patients with both endometrial and ovarian cancer, it is important to discriminate between 2 primary tumors and metastatic disease. Currently, criteria are based on postoperative findings. The aim of this study was to determine whether clinical parameters can discriminate between these groups preoperatively and whether a practical guideline could improve appropriate workup and treatment.
Methods: A total of 45 patients with a diagnosis of both endometrium and ovarian cancer between 1998 and 2009 and were included for analysis. Clinical and pathological data were obtained, and initial CA-125 was registered; patients had a diagnosis of 2 primary tumors or tumors with metastasis. All patients were reclassified according to workup and treatment.
Results: Patients with synchronous primary tumors were significantly younger, presented more often with abnormal uterine bleeding, and had a lower initial CA-125 than both metastatic groups (P < 0.05). With age and CA-125 included in a polytomic logistic regression model, 83.3% of diagnoses could be classified correctly. In 15 of 17 patients presented with adnexal mass, workup was incomplete owing to lack on information of the endometrial status. In patients presenting with abnormal uterine bleeding, 13 of 21 patients had an incomplete workup leading to staging laparotomy secondary to initial surgical treatment in 2 patients.
Conclusions: Patients with synchronous endometrial and ovarian cancers are young, often present with abnormal uterine bleeding and have a low initial CA-125. Adequate workup with attention to both ovarian and endometrial status, especially in young patients with a wish to preserve fertility, is important to make the right decision for treatment.
Copyright (C) 2012 by IGCS and ESGO

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ScienceDirect.com - Cancer Letters - Ovarian ascites-derived Hospicells promote angiogenesis via activation of macrophages

Ovarian ascites-derived Hospicells promote angiogenesis via activation of macrophages

http://www.sciencedirect.com/science/article/pii/S0304383512004181

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Ovarian Cancer Test Not Worth Risk, Advisory Panel Says - Bloomberg

http://mobile.bloomberg.com/news/2012-09-11/ovarian-cancer-test-not-worth-risk-advisory-panel-says.html


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Author Insight: When Prescription Drugs Become Available Over-the-Counter, Their Ads Fall Silent on Risks | news@JAMA

http://newsatjama.jama.com/2012/09/11/author-insight-when-prescription-drugs-become-available-over-the-counter-their-ads-fall-silent-on-risks/


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Cancer Treatment Information, Chemotherapy, Radiation Oncology, and Surgery | OncoLink clinical trial matching service

http://www.oncolink.org/treatment/trials.cfm?utm_content=sandipn%40sympatico.ca&utm_source=VerticalResponse&utm_medium=Email&utm_term=OncoLink%20Clinical%20Trial%20Matching%20Service&utm_campaign=OncoLink%20eNews%20September%202012content


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Fwd: OncoLink eNews September 2012 survivor care survey

Survivor Care

Too often, cancer survivors learn to live with the pain and pitfalls of this disease simply because they can't find the right resources. The Lance Armstrong Foundation launched the 2012 Cancer Survivor Survey to help them build and refine programs that offer tangible support to survivors. If you currently have cancer or have been treated for cancer:

Take the survey and let your voice be heard

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Begin forwarded message:

From: "OncoLink eNews" <OncoLink_eNews@mail.vresp.com>
Date: 11 September, 2012 1:32:09 PM EDT
To: sandipn@sympatico.ca
Subject: OncoLink eNews September 2012
Reply-To: "OncoLink eNews" <reply-1cc49a2d25-678cc187bf-b2a7@u.cts.vresp.com>

Survivor Care

Too often, cancer survivors learn to live with the pain and pitfalls of this disease simply because they can't find the right resources. The Lance Armstrong Foundation launched the 2012 Cancer Survivor Survey to help them build and refine programs that offer tangible support to survivors. If you currently have cancer or have been treated for cancer:

Take the survey and let your voice be heard

New Ovarian Cancer Screening Guidelines Highlight Lack Of Options For Women - The Huffington Post

http://www.huffingtonpost.com/mobileweb/2012/09/11/ovarian-cancer-screening_n_1871385.html


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World Trade Center Cancer Cases: Government Includes Cancer Patients as Eligible for Care After Breathing Toxic Dust from 9/11 Attacks - ABC News

http://abcnews.go.com/m/story?id=17203690


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Sept. 11 anniversary to be marked without politicians' speeches

"Sept. 11 anniversary to be marked without politicians' speeches ".
This article is on the Web at:
http://www.680news.mobi/article.aspx?content_id=400251


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Screening for ovarian cancer - chart: clinical summary (task force

http://annals.org/data/Journals/AIM/PAP/539FF1.png


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Japan: Intraperitoneal Therapy For Ovarian Cancer With Carboplatin Trial - Full Text View - ClinicalTrials.gov

Intraperitoneal Therapy For Ovarian Cancer With Carboplatin Trial - Full Text View - ClinicalTrials.gov

PLoS ONE: Development of Multiplexed Bead-Based Immunoassays for the Detection of Early Stage Ovarian Cancer Using a Combination of Serum Biomarkers

PLoS ONE: Development of Multiplexed Bead-Based Immunoassays for the Detection of Early Stage Ovarian Cancer Using a Combination of Serum Biomarkers

Abstract 

CA125 as a biomarker of ovarian cancer is ineffective for the general population. The aim of this study was to evaluate multiplexed bead-based immunoassay of multiple ovarian cancer-associated biomarkers such as transthyretin and apolipoprotein A1, together with CA125, to improve the identification and evaluation of prognosis of ovarian cancer.........

Maximal Cytoreduction in Patients With FIGO Stage IIIC to Stage IV Ovarian, Fallopian, and Peritoneal Cancer in Day-to-Day Practice: A Retrospective French Multicentric Study

Maximal Cytoreduction in Patients With FIGO Stage IIIC to Stage IV Ovarian, Fallopian, and Peritoneal Cancer in Day-to-Day Practice: A Retrospective French Multicentric Study:

Objectives:
To evaluate the outcome of maximal cytoreductive surgery in patients with stage IIIC to stage IV ovarian, tubal, and peritoneal cancer regarding overall survival (OS) and disease-free survival (DFS).

Materials and Methods:
Five hundred twenty-seven patients with stage IIIC (peritoneal) and stage IV (pleural) ovarian, fallopian tube, and peritoneal carcinoma underwent surgery between January 2003 and December 2007 in 7 gynecologic oncology centers in France. Patients undergoing primary and interval debulking surgery were included, whichever the number of chemotherapy cycles. The extent of disease, type of surgical procedure, and amount of residual disease were recorded. A multivariate analysis of the outcome was performed, taking into account the stage, grade, and timing of surgery.

Ovarian Cancer Screening Has No Benefit, Panel Says - NYTimes.com

Ovarian Cancer Screening Has No Benefit, Panel Says - NYTimes.com

Nicole Urban on Canary's Ovarian Cancer Research Program | Canary Foundation

Nicole Urban on Canary's Ovarian Cancer Research Program | Canary Foundation

 <iframe width="640" height="360" src="http://www.youtube.com/embed/Rlh2AM7Yo3E?feature=player_embedded" frameborder="0" allowfullscreen></iframe>

(ENCODE) blog: Most of what you read was wrong: how press releases rewrote scientific history | Ars Technica

Most of what you read was wrong: how press releases rewrote scientific history | Ars Technica:

This week, the ENCODE project released the results of its latest attempt to catalog all the activities associated with the human genome. Although we've had the sequence of bases that comprise the genome for over a decade, there were still many questions about what a lot of those bases do when inside a cell. ENCODE is a large consortium of labs dedicated to helping sort that out by identifying everything they can about the genome: what proteins stick to it and where, which pieces interact, what bases pick up chemical modifications, and so on. What the studies can't generally do, however, is figure out the biological consequences of these activities, which will require additional work. Yet the third sentence of the lead ENCODE paper contains an eye-catching figure that ended up being reported widely: "These data enabled us to assign biochemical functions for 80 percent of the genome." Unfortunately, the significance of that statement hinged on a much less widely reported item: the definition of "biochemical function" used by the authors.....

Current Oncology - Cancer Knowledge Network

Current Oncology - Cancer Knowledge Network
 Cancer Knowledge Network: Phase 2
"We are excited to announce that this fall the implementation of CKN’s Phase 2 will begin!!
When we launched CKN just over a year ago, our goal was to provide a peer-reviewed resource emanating from our journal Current Oncology which would provide practical information for dissemination amongst patients, oncologists, nurses, residents, and other health care providers. We exceeded our initial expectations as the quality of contributions from a wide variety of writers has attracted over 200,000 viewers worldwide. We’ve been focusing on and plan to continue developing our Oncofertility, Survivorship, and Integrative Medicine sections to enable our readers to make informed decisions about their cancer therapies and their options as they reintegrate themselves into their lives post-treatment. We will continue to dedicate ourselves to providing this peer reviewed information in a timely way.
Our Phase 2 is all about the delivery of this information so it reaches oncologists and patients when they need it, whether they are in clinic, at work, at home or traveling abroad. While CKN is only a click away on any device, we will be introducing additional ways for our readers to access the specific information they are looking for, and enable them to instantly share it with their patients, colleagues, students or family members. We will also be developing protocols to make CKN readily available to general practitioners, family physicians and pharmacists who are also very important players in the overall circle of care for patients.
Over the course of our Phase 2, CKN will continue to provide an important lifeline for our readers when they need it most."

Sept 10, 2012: JAMA news - Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women « news@JAMA

Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women « news@JAMA

September 10, 2012

Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women

Filed under: Gynecology,Ovarian Cancer,Women's Health — Mike Mitka @ 4:01 pm

The US Preventive Services Task Force says that annual screening for ovarian cancer with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen CA-125 is not recommended for asymptomatic women who do not have known risk factors for the disease.

The US Preventive Services Task Force (USPSTF) said that it cannot recommend annual screening for ovarian cancer in asymptomatic women because such testing does not reduce the number of deaths from the disease. The recommendation, which appears today in the Annals of Internal Medicine, does not apply to women with known ovarian cancer risk factors.

The recommendation is in line with the positions of major medical and public health organizations, which also discourage screening for ovarian cancer in the general population.

Ovarian cancer has the highest mortality rate of all gynecological malignancies and is the fifth leading cause of cancer death among women. It is also fairly rare in the general US population, with about 13 per 100 000 women developing the disease. Because the prevalence of ovarian cancer is low, routine screening is problematic because for the majority of women who have a positive test result, the result is a false positive. In such cases, screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have this malignancy.

The task force recommendation is a reaffirmation of its 2004 statement on ovarian cancer screening and incorporates interpretation of clinical trial results that have become available since then. The task force highlighted a 2011 study of 78 216 women assigned to annual screening (using transvaginal ultrasonography and testing for the serum tumor marker CA-125) or usual care. Ovarian cancer was diagnosed in 212 women (5.7 per
10 000 person-years) in the screening group and 176 (4.7 per 10 000 person-years) in the usual care group. But the increased number of ovarian cancer cases diagnosed in the group that was screened compared with the group receiving usual care was not significant, and there was no significant difference between the 2 groups with respect to the death rate. The study also found 3285 women with false-positive results, 1080 of whom underwent surgical follow-up, with 163 experiencing at least 1 serious complication.

Women with known risk factors for ovarian cancer, such as certain genetic mutations, Lynch syndrome, or a family history of ovarian cancer, should discuss the benefits and harms of screening with their physicians, the task force said. The use of oral contraceptives, pregnancy, breastfeeding, bilateral tubal ligation, and removal of the ovaries all reduce ovarian cancer risk.

Interpretation of single and serial measures of HE4 and CA125 in asymptomatic women at high risk for ovarian cancer

Interpretation of single and serial measures of HE4 and CA125 in asymptomatic women at high risk for ovarian cancer

Abstract

Background. 

Human epididymis protein 4 (HE4) is approved for clinical use with CA125 to predict epithelial ovarian cancer (EOC) in women with a pelvic mass or in remission after chemotherapy. Previously reported reference ranges for HE4 are inconsistent. 

Methods. 

We report positivity thresholds yielding 90%, 95%, 98% and 99% specificity for age-defined populations of healthy women for HE4, CA125 and Risk of Malignancy Algorithm (ROMA), a weighted average of HE4 and CA125. HE4 and CA125 were measured in 1780 samples from 778 healthy women aged >25 years with a documented deleterious mutation, or aged >35 years with a significant family history. Effects on marker levels of a woman's age, ethnicity and epidemiologic characteristics were estimated, as were the population-specific means, variances and within- and between-woman variances used to generate longitudinal screening algorithms for these markers. 

Results. 

CA125 levels were lower with Black ethnicity (p=0.008). Smoking was associated with higher HE4 (p=0.007) and ROMA (p<0.019). Continuous oral contraceptive use decreased levels of CA125 (p=0.041), and ROMA (p=0.12). CA125 was lower in women age ≥55, and HE4 increased with age (p<0.01), particularly among women age ≥55. 

Conclusions. 

Due to the strong effect of age on HE4, thresholds for HE4 are best defined for women of specific ages. Age-specific population thresholds for HE4 for 95% specificity ranged from 41.4 pmol/L for women age 30 to 82.1 pmol/L for women age 80. Impact. Incorporation of serial marker values from screening history reduces personalized thresholds for CA125 and HE4 but is inappropriate for ROMA.

ISRCTN statistics – trends in clinical trial registration - BioMed Central blog

ISRCTN statistics – trends in clinical trial registration - BioMed Central blog

ISRCTN statistics – trends in clinical trial registration

Smitha Vadakkeparambil on July 27, 2012 at 4:22 am - 0 Comments

How many trials recruiting in the UK have been publicly registered in 2011? In which disease area is the highest number of registered trials? Which countries apart from the UK are represented in the ISRCTN Register? In answer to those frequently asked questions, the ISRCTN Register, made of over 10,800 records, has launched a page providing some insight on its content. The data is up to the end of June 2012 and the statistics will be updated at regular intervals.
The statistics include a breakdown of the disease areas represented in the ISRCTN Register – top areas include cancer, mental health and cardiovascular trials...........

Read the latest news and highlights from Current Controlled Trials

You can read the latest one at http://www.controlled-trials.com/news/newsletter Sign up to receive these updates by sending a blank email to join-cct-updates@news.biomedcentral.com

Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response

Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response:



Objective: This study aimed to assess the ability of 3 criteria of rising CA-125 levels within the reference range to predict recurrence in patients with ovarian, primary peritoneal, and tubal carcinomas after complete clinical response to initial treatment.

Material and Methods: Included were patients diagnosed during 1998 to 2008 who fulfilled the following criteria: CA-125 levels of 35 U/mL or greater at diagnosis and recurrence, full primary treatment with a complete clinical and radiographic response, follow-up according to schedule, and at least 2 CA-125 results within the reference range during follow-up. Three criteria of rising CA-125 values within the reference range were used for the prediction of recurrence: (1) an absolute increase of 5 U/mL or higher from the nadir value at completion of chemotherapy, (2) early signal of progressive disease criterion, and (3) a rise to an absolute level of 20 U/mL or greater.

Results: Of 82 patients who satisfied study inclusion criteria, 58 (70.7%) had disease recurrence. Early signal of progressive disease and a rise to an absolute level of 20 U/mL or greater were highly statistically significant predictors of disease recurrence (odds ratio, 12.62 [95% confidence interval, 2.71-58.7], P = 0.0012; and odds ratio, 6.7 [95% confidence interval, 2.18-20.54], P = 0.001, respectively) and preceded recurrence by a median of 3 and 3.3 months, respectively.

Conclusions: Our data indicate that the early signal of progressive disease criterion and a single rise to an absolute level of 20 U/mL or greater within reference limits are highly predictive of clinical recurrence, although the latter is simpler to use. However, whether this is of practical clinical value remains to be proven. Copyright (C) 2012 by IGCS and ESGO

On the Prevalence and Causes of Oncologist Burnout

On the Prevalence and Causes of Oncologist Burnout

Universal health coverage series from The Lancet

http://www.news-medical.net/news/20120910/Universal-health-coverage-series-from-The-Lancet.aspx


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73% of patients worry about medical errors, poll says - amednews.com

http://www.ama-assn.org/amednews/2012/09/03/prsc0904.htm


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Patient Engagement is the Blockbuster Drug of the Century"

http://www.forbes.com/sites/davechase/2012/09/09/patient-engagement-is-the-blockbuster-drug-of-the-century/


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Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis

Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis

Abstract

Purpose  

To analyze the patterns of recurrence and the prognostic impact of ovarian metastases (OM) in a population of women with colorectal
peritoneal carcinomatosis (CRPC) treated with curative intent.

Methods  

Data from all consecutive women with CRPC who underwent curatively intended complete cytoreductive surgery (CRS) plus intraperitoneal
chemotherapy at our institution were retrieved from a prospective database. A bilateral oophorectomy or a complementary unilateral
oophorectomy was systematically performed during CRS.

Results  

From 1994 to 2009, among 105 women who underwent CRS plus intraperitoneal chemotherapy for CRPC, 62 (60 %) had OM. Women with
and without OM had comparable peritoneal cancer index (PCI) scores (10 vs. 12, respectively, p = 0.09). After a median follow-up of 60 (range 5–145) months, median overall survival of women with OM did not differ statistically
from that of women without OM (respectively, 36 and 40 months; p = 0.75). Relapses occurred in 82 % of the patients, distributed similarly between the two groups except for retroperitoneal
lymph node recurrence, which occurred in 19 patients (18 %), including 18 with OM. The only predictive factor for a retroperitoneal
relapse was a history of OM (p = 0.0012).

Conclusions  

Retroperitoneal lymph node recurrence seems to be linked to OM originating from colorectal cancer and could worsen the prognosis.
A systematic lymphadenectomy could be evaluated in women with isolated OM or very limited peritoneal carcinomatosis to analyze
the incidence of invaded lymph nodes and study its potential benefit on survival.

• Content Type Journal Article
• Category Colorectal Cancer
• Pages 1-6
• DOI 10.1245/s10434-012-2623-9
• Authors
  
  
  • Clarisse Eveno, Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France
  • Diane Goéré, Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France
  • Peggy Dartigues, Department of Biopathology, Institut Gustave Roussy, Villejuif Cedex, France
  • Charles Honoré, Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France
  • Frédéric Dumont, Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France
  • Dimitri Tzanis, Department of Surgical Oncology, Institut Gustave Roussy, Villejuif Cedex, France
  • Léonor Benhaim, Department of Surgical Oncolo...

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Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Abstract

Purpose  

PET/MR has the potential to become a powerful tool in clinical oncological imaging. The purpose of this prospective study
was to evaluate the performance of a single T1-weighted (T1w) fat-suppressed unenhanced MR pulse sequence of the abdomen in
comparison with unenhanced low-dose CT images to characterize PET-positive lesions.

Methods  

A total of 100 oncological patients underwent sequential whole-body ¹⁸F-FDG PET with CT-based attenuation correction (AC), 40 mAs low-dose CT and two-point Dixon-based T1w 3D MRI of the abdomen
in a trimodality PET/CT-MR system. PET-positive lesions were assessed by CT and MRI with regard to their anatomical location,
conspicuity and additional relevant information for characterization.

Results  

From among 66 patients with at least one PET-positive lesion, 147 lesions were evaluated. No significant difference between
MRI and CT was found regarding anatomical lesion localization. The MR pulse sequence used performed significantly better than
CT regarding conspicuity of liver lesions (p < 0.001, Wilcoxon signed ranks test), whereas no difference was noted for extrahepatic lesions. For overall lesion characterization,
MRI was considered superior to CT in 40 % of lesions, equal to CT in 49 %, and inferior to CT in 11 %.

Conclusion  

Fast Dixon-based T1w MRI outperformed low-dose CT in terms of conspicuity and characterization of PET-positive liver lesions
and performed similarly in extrahepatic tumour manifestations. Hence, under the assumption that the technical issue of MR
AC for whole-body PET examinations is solved, in abdominal PET/MR imaging the replacement of low-dose CT by a single Dixon-based
MR pulse sequence for anatomical lesion correlation appears to be valid and robust.

• Content Type Journal Article
• Category Original Article
• Pages 1-8
• DOI 10.1007/s00259-012-2236-3
• Authors
  
  
  • Felix P. Kuhn, Department of Medical Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
  • David W. Crook, Department of Medical Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
  • Caecilia E. Mader, Department of Medical Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
  • Philippe Appenzeller, Department of Medical Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
  • G. K. von Schulthess, Department of Medical Radiology, University Hospital...

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7 Controversial Pink Products for Breast Cancer Awareness - Breast Cancer Center - Everyday Health

7 Controversial Pink Products for Breast Cancer Awareness - Breast Cancer Center - Everyday Health

" The breast cancer pink ribbon is one of the most recognizable symbols in the world. But is our obsession with "pink" products doing more harm than good in the quest for a cure?....

Home | UK Cochrane Centre - NHS

Home | UK Cochrane Centre

 

 For Cochrane Contributors

• • For the General Public
  • For Healthcare Professionals
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• About the UKCC
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• Cochrane UK
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• News

Metastatic Mucinous Ovarian Cancer and Treatment Decisions Based on Histology and Molecular Markers Rather Than the Primary Location

Metastatic Mucinous Ovarian Cancer and Treatment Decisions Based on Histology and Molecular Markers Rather Than the Primary Location

Abstract

Approximately 22,000 cases of ovarian cancer occur each year in the United States, and likely fewer than 2000 cases of mucinous ovarian cancers. Although 90% of patients with mucinous ovarian cancer present with stage I disease and have curative surgeries, advanced-stage disease is known to have a poor response to standard platinum- and taxane-based chemotherapy. Despite limited enthusiasm, standard chemotherapy is still recommended for most patients with advanced-stage mucinous malignancies of the ovary. This report presents an unusual case of a woman with HER2-positive metastatic mucinous carcinoma of the ovary treated with chemotherapy regimens typically used for colorectal malignancies, followed by epidermal growth factor receptor–targeted therapies.

Determinants of the decision to perform prophylactic oophorectomy in association with a hysterectomy for a benign condition

Determinants of the decision to perform prophylactic oophorectomy in association with a hysterectomy for a benign condition

Publication year: 2012
Source:Maturitas
Clara Plusquin, Maxime Fastrez, Jean Vandromme, Serge Rozenberg
Background The decision to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition is complex. Aim To assess the determinants of the decision to proceed to a prophylactic BSO during a hysterectomy for a benign condition. Materials and methods We collected demographic and clinical data, including age, menopausal status and risk of ovarian cancer. Using a regression model we analysed the decision perform a prophylactic BSO in women successively admitted for a hysterectomy for a benign condition, in relation to the collected demographic and clinical data. Results Data were collected for 43 women, aged between 37 and 65 years (mean age 48.6 years, SD 6.9), on the day before their hysterectomy. Thirty-six (84%) had a total hysterectomy and 7 (16%) a subtotal hysterectomy; 40 (93%) had a laparoscopic procedure. Prophylactic BSO was significantly associated with age: none of the women aged under 40 years had the procedure, compared with 8% of those aged 41–45 years, 29% of those aged 46–50 years and 83% of those aged 51 years or more (χ ² =23; P <0.001). Of the postmenopausal women, 67% had a prophylactic BSO, compared with 24% of the premenopausal women (χ ² =6; P <0.047). In this small series of patients no relationship was found between the decision to perform a BSO and the risk of ovarian cancer. Age was the only significant variable in the regression model (pseudo R ² Nagelkerke=0.6, P <0.05). Conclusion The physician's recommendation to perform an elective BSO at the time of a hysterectomy for a benign condition is strongly influenced by the patients' age.

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Ureteral Injury in Laparoscopic Gynecologic Surgery

Ureteral Injury in Laparoscopic Gynecologic Surgery

(4,948 views) Special Ovarian Cancer Women at One True Media - share slideshow

Special Ovarian Cancer Women at One True Media - share slideshow

 Special Ovarian Cancer Women - Our Global Ovarian Cancer Community
  4948 views

Patients with Lynch Syndrome Mismatch Repair Gene Mutations Are at Higher Risk for Not Only Upper Tract Urothelial Cancer but Also Bladder Cancer. (repost) - MSH2

Patients with Lynch Syndrome Mismatch Repair Gene M... [Eur Urol. 2012] - PubMed - NCBI

Eur Urol. 2012 Aug 2. [Epub ahead of print]

Patients with Lynch Syndrome Mismatch Repair Gene Mutations Are at Higher Risk for Not Only Upper Tract Urothelial Cancer but Also Bladder Cancer.

Skeldon SC, Semotiuk K, Aronson M, Holter S, Gallinger S, Pollett A, Kuk C, van Rhijn B, Bostrom P, Cohen Z, Fleshner NE, Jewett MA, Hanna S, Shariat SF, Van Der Kwast TH, Evans A, Catto J, Bapat B, Zlotta AR.

Source

Department of Surgical Oncology, Urology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Lynch syndrome (LS), or hereditary nonpolyposis colorectal cancer, is caused by mutations in mismatch repair (MMR) genes. An increased risk for upper tract urothelial carcinoma (UTUC) has been described in this population; however, data regarding the risk for bladder cancer (BCa) are sparse.

OBJECTIVE:

To assess the risk of BCa in MMR mutation carriers and suggest screening and management recommendations.

DESIGN, SETTING, AND PARTICIPANTS:

Cancer data from 1980 to 2007 were obtained from the Familial Gastrointestinal Cancer Registry in Toronto for 321 persons with known MMR mutations: mutL homolog 1, colon cancer, nonpolyposis type 2 (E. coli) (MLH1); mutS homolog 2, colon cancer, nonpolyposis type 1 (E. coli) (MSH2); mutS homolog 6 (E. coli) (MSH6); and PMS2 postmeiotic segregation increased 2 (S. cerevisiae) (PMS2). OUTCOME MEASUREMENTS AND

STATISTICAL ANALYSIS:

Standardized incidence ratios from the Ontario Cancer Registry, using the Surveillance Epidemiology and End Results public database, were used to compare cancer risk in patients with MMR mutations with the Canadian population. Microsatellite instability analysis and immunohistochemistry (IHC) of the MMR proteins were also performed and the results compared with matched sporadic bladder tumors.

RESULTS AND LIMITATIONS:

Eleven of 177 patients with MSH2 mutations (6.21%, p<0.001 compared with the Canadian population) were found to have BCa, compared with 3 of 129 patients with MLH1 mutations (2.32%, p>0.05). Of these 11 tumors, 81.8% lacked expression of MSH2 on IHC, compared with the matched sporadic cases, which all displayed normal expression of MSH2 and MLH1. The incidence of UTUC among MSH2 carriers was 3.95% (p<0.001), and all tumors were found to be deficient in MSH2 expression on IHC. Mutations in the intron 5 splice site and exon 7 of the MSH2 gene increased the risk of urothelial cancer. Limitations include possible inflated risk estimates due to ascertainment bias.

CONCLUSIONS:

LS patients with MSH2 mutations are at an increased risk for not only UTUC but also BCa and could be offered appropriate screening.

European Association of Urology 2012: Guidelines on Upper Urinary Tract Urothelial (re: Lynch Syndrome)

http://www.uroweb.org/gls/pdf/06_UUTUCC.pdf

"....There are familial/hereditary cases of UUT-UCCs linked to (Lynch Syndrome) hereditary nonpolyposis colorectal
carcinoma (HNPCC) (14). Among patients with UUT-UCCS, these cases can be detected during a medical
interview. Indeed, the cancer is likely to be hereditary if the patient is < 60 yr of age and/or has a personal or
family history of an HNPCC-type cancer (15,16). These patients should undergo DNA sequencing to identify
hereditary cancers that have been misclassified as sporadic cancers by insufficient clinical data. The presence
of other HNPCC-associated cancers should also be evaluated. These patients should be closely monitored,
and genetic counselling is advocated (15,16)......"

Blogger's Note: search blog using search terms...

For ovarian cancer patients and women patients in general, this blog can be searched for similar articles on the pelvic exam issues (eg. ethics, informed consent, respect, duty of care, integrity...). In addition there is substantial research and dialogue on pelvic exams completed without informed (or any) consent while the patient is under anesthesia (sedated). Irrespective of the issue and discourse on the semantics of training purposes etc, the issue of respect, dignity afforded the patient and informed consent obviously remains an outstanding issue not appreciated by many. A topic, obviously and unfortunately,  which deserves further attention in the public arena in order to effect some final change at, of course, the clinical level. 
As I discovered, it is not difficult to search cyberspace,  to view less than flattering and respectful opinions - tasteless jokes as well, concerning women having pelvic exams while under anesthesia. 
In fairness, this is not just a women's issue.

The authors respond: Consent requirements for pelvic examinations

The authors respond

CMAJ September 4, 2012 vol. 184 no. 12 doi: 10.1503/cmaj.112-2052

• © 2012 Canadian Medical Association or its licensors
• All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

• Letters

The authors respond

1. Elaine Gibson, LLM,
2. Jocelyn Downie, SJD

+ Author Affiliations

1. The Health Law Institute, Dalhousie University, Halifax, NS

Margaret Morris has missed the point of our article.1^,2 We agree that some residents conduct pelvic examinations solely for therapeutic purposes (i.e., they are fully trained in conducting such examinations and the only purpose for the examination is the care of the patient) and the policy statement does not fail in relation to such residents. However, Morris ignores the fact (explained in our article) that some residents are conducting pelvic examinations solely for training purposes, or for a combination of therapeutic and training purposes. Our considered view, grounded in a careful review of the relevant law, is that patients must be asked for explicit consent to a resident’s performing a pelvic examination in whole or in part for training purposes. On this narrow point we took issue with the revisions to the policy statement3 because of its shift from covering residents and medical students in this context to only covering medical students. We argued, and continue to hold, that residents should either be added back into the policy statement in relation to the conduct of pelvic examinations for training purposes, or a separate policy for residents (requiring disclosure of purpose and explicit consent for such examinations) should be developed.

We share Morris’ goals of achieving “the best possible care for women in the academic environment” and ensuring that “all health professionals providing care for women are adequately trained.” However, we do not agree that calling for disclosure of training purposes and explicit consent in residents performing pelvic examinations for training purposes can be characterized as “needlessly raising anxiety in the public and putting the clinical academic process in jeopardy.” In a study conducted at the Calgary Pelvic Floor Disorders Clinic, a majority of women surveyed indicated that they would consent to a pelvic examination for training purposes if asked.4 Further, even if the result would be fewer patients agreeing to have such examinations conducted, this is no justification for overriding legal rights and ignoring ethical responsibilities.

References

1. ↵
   1. Morris ML

   . Consent requirements for pelvic examinations [letter]. CMAJ 2012;184:1393.

   FREE Full Text
2. ↵
   1. Gibson E,
   2. Downie J

   . Consent requirements for pelvic examinations performed for training purposes. CMAJ 2012;184:1159–61.

   FREE Full Text
3. ↵
   1. Liu KE,
   2. Shapiro J,
   3. Robertson D,
   4. et al

   . Pelvic examinations by medical students. J Obstet Gynaecol Can 2010;32:873–5. Available: www.sogc.org/guidelines/documents/gui246PS1009E000.pdf (accessed 2011 Apr. 27).
4. ↵
   1. Wainberg S,
   2. Wrigley H,
   3. Fair J,
   4. et al

   . Teaching pelvic examinations under anaesthesia: What do women think? J Obstet Gynaecol Can 2010;32:49–53.

   Medline

Consent requirements for pelvic examinations

CMAJ September 4, 2012 vol. 184 no. 12 doi: 10.1503/cmaj.112-2061

• © 2012 Canadian Medical Association or its licensors
• All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

• Letters

Consent requirements for pelvic examinations

1. Margaret L. Morris, MD, President

+ Author Affiliations

1. The Association of Academic Professionals in Obstetrics and Gynaecology, Ottawa, Ont.

The board of the Association of Academic Professionals in Obstetrics and Gynaecology (APOG, formerly the Association of Professors of Obstetrics and Gynaecology of Canada) wishes to respond to the CMAJ article by Gibson and Downie,1 which revisits the issue of consent prior to pelvic examination. As the academic organization responsible for support for the academic missions in undergraduate and postgraduate training in obstetrics and gynecology, we have serious concerns.

“Medical trainees” was changed to “medical students” in the revised guidelines,2 which identifies the medical student’s role in pelvic examination as a learner. The new document is patient-focused and clearly defines informed consent on the part of the medical student and the entire gynecologic surgical team. The document ensures that patients are fully informed about the medical student’s role as a learner during clinical care and that patients may opt out of being a participant in the teaching of pelvic examination skills.

Gibson and Downie1 expressed concerns about the comprehensiveness of the guideline with regard to the exclusion of residents as medical trainees. Residents are physicians who are qualified medical practitioners and are deemed to have developed their pelvic examination skills to the point where they are able perform them independently — as well as offer supervision to learners. Residents are employed under contract by provincial bodies responsible for residency programs. Under ethical obligations set down by provincial governing bodies, qualified physician residents provide care only with patient consent. Residents certainly continue to learn and acquire experience as do all obstetrician–gynecologists who have already completed their training. The principle of lifelong learning is important for all physicians.

Our Association welcomes input and membership from all interested stakeholders including those from the legal community. We strive to achieve the best possible care for women in the academic environment, while fulfilling our commitment to ensure all health professionals providing care for women are adequately trained. Ideally, this should be carried out in a safe environment for both the learner and the patient without needlessly raising anxiety in the public and putting the clinical academic process in jeopardy. A collaborative approach between legal colleagues and physicians would be much more productive toward achieving this goal.

References

1. ↵
   1. Gibson E,
   2. Downie J

   . Consent requirements for pelvic examinations performed for training purposes. CMAJ 2012;184:1159–61.

   FREE Full Text
2. ↵
   1. Liu KE,
   2. Shapiro J,
   3. Robertson D,
   4. et al

   . Pelvic examinations by medical students. J Obstet Gynaecol Can 2010;32:873–5. Available: www.sogc.org/guidelines/documents/gui246PS1009E000.pdf (accessed 2011 Apr. 27).

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Replies to Consent requirements for pelvic examinations performed for training purposes

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Analysis:

• Elaine Gibson and
• Jocelyn Downie

Consent requirements for pelvic examinations performed for training purposes CMAJ July 10, 2012 184:1159-1161; published ahead of print March 26, 2012, doi:10.1503/cmaj.110725

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1. Response to APOG Letter of May 14, 2012

   • Elaine Gibson, Associate Director
   • Jocelyn Downie

   Health Law Institute, Dalhousie University
   We are writing in response to the letter to the editor by Margaret Morris on behalf of the Board of the Association of Professors of Obstetrics and Gynaecology of Canada (APOG) dated May 14, 2012, which was in turn a response to our CMAJ article of March 26, 2012. Ms Morris has missed the point of our article. We agree with Ms Morris that More...
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   Published June 1, 2012

2. Response to Consent Requirements for pelvic examinations performed for training purposes as they revisit the issue of consent prior to pelvic examination.

   • Margaret L. Morris, President Academic Professionals in Obstetrics and Gynecology

   APOG
   The board of APOG is writing in response to the article by Ms. Gibson and Ms. Downie, Consent requirements for pelvic examination performed for training purposes as they revisit the issue of consent prior to pelvic examination. As the academic organization responsible for support for the academic missions in undergraduate and postgraduate More...
   Submit response
   Published May 14, 2012

3. Regulatory policy requires specific consent

   • Robert J. Byrick, President

   College of Physicians and Surgeons of Ontario
   I write on behalf of the College of Physicians and Surgeons of Ontario, in response to the recent article in CMAJ "Consent requirements for pelvic examinations performed for training purposes" (CMAJ, March 26, 2012). We appreciate that the authors of this article were only commenting on new policy guidelines from More...
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   Published March 28, 2012

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