Recent progress in the treatment and prevention of cancer-related lymphedema - Shaitelman - 2014 - CA: A Cancer Journal for Clinicians - Wiley Online Library

open access

Lymphedema Beyond Patients With Breast Cancer

Patients with other solid tumors requiring treatment that adversely affects lymphatic function are also at significant risk of developing lymphedema. Unfortunately, relatively few studies have investigated lymphedema in these patient populations. For example, a recent systematic review identified only 47 studies that assessed non-breast cancer-related lymphedema, and most of those studies were retrospective.[50] The following subsections provide an overview of the current body of published literature regarding the incidence of lymphedema as a result of the treatment of nonbreast malignancies......

 One recent systematic review highlighted several areas in the delivery and cost of lymphedema treatment that might benefit from changes in health policy. Stout et al[239] identified 8 articles about health care delivery models and 6 articles about economic and cost analyses. They found that although evidence-based care for the diagnosis and treatment of lymphedema is limited, much of the burden to facilitate diagnosis and referral for effective care is placed on the patient. The authors also found that, compared with patients who do not have lymphedema, patients with lymphedema have significantly higher hospitalization rates, higher rates of medical services use, lower QOL, and significantly higher indirect costs. However, the study had a low level of evidence and yielded only speculative findings.

Circulating tumor cells and circulating tumor DNA for precision medicine: dream or reality?

open access

 Abstract

 Next-generation sequencing studies have provided further evidence to support the notion that cancer is a disease characterized by Darwinian evolution. Today, we often fail to capture this evolution and treatment decisions, even in the metastatic setting, are often based on analysis of primary tumor diagnosed years ago. Currently, this is considered a major reason for treatment failures in cancer care. Recent technological advances in the detection and characterization of circulating tumor cells and circulating tumor DNA might address this and allow for treatment tailoring based on real-time monitoring of tumor evolution. In this review, we summarize the most important recent findings in the field, focusing on challenges and opportunities in moving these tools forward in clinical practice......

1. Ann Oncol (2014) 25 (12): 2304-2313. doi: 10.1093/annonc/mdu480 First published online: October 21, 2014

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Prioritizing targets for precision cancer medicine

open access (technical)

 Abstract

The implementation of cancer genomic testing into the clinical setting has brought major opportunities. However, as our understanding of cancer initiation, maintenance and progression improves through detailed cancer genomic studies, the challenges associated with driver identification and target classification in the clinical setting become clearer. Here, we review recent insights into cancer genomic testing in the clinical setting, and suggest a target classification approach that considers the levels of evidence supporting the prioritization of tumour drivers for therapeutic targeting in light of complex cancer clonal and sub-clonal structures and clinical successes and failures in the field. We argue that such classification approaches, together with transparent reporting of both positive and negative clinical data and continued research to identify the sub-clonal dynamics of driver events during the disease course, will facilitate inter-trial comparisons, optimize patient informed consent and provide a critically balanced evaluation of genomic testing in clinical practice....... 

This Article

1. Ann Oncol (2014) 25 (12): 2295-2303. doi: 10.1093/annonc/mdu478 First published online: October 24, 2014

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In year two, MD Anderson Moon Shots Program begins to spin off innovation | MD Anderson Cancer Center

media

Personalized surgery
A new protocol for determining which ovarian cancer patients should proceed to surgery upfront and which need presurgical chemotherapy has radically increased the rate of complete surgical removal of tumors, an accomplishment that improves patient survival.

Under the MD Anderson algorithm developed by the moon shot, a patient receives a less-invasive laparoscopic evaluation, during which two surgeons independently rank the cancer’s spread to other organs. The resulting score guides the treatment decision.

Previously, virtually all new patients had surgery to explore the extent of disease and to remove as much of it as possible. Worldwide, this practice results in 20 to 30 percent of these patients achieving “complete gross resection.” In the first 155 cases in which the algorithm was followed, complete resection was achieved 89 percent of the time......

MD Anderson’s David M. Gershenson, MD, Receives IGCS’s Award for Excellence in Gynecologic Oncology

David M. Gershenson

Houston, Texas -- For his myriad clinical, organizational and scientific accomplishments in the field of gynecologic oncology and the health and well-being of women, David M. Gershenson, M.D. has been recognized with the International Gynecology Cancer Society’s (IGCS) Award of Excellence.......

Dietary acrylamide and cancer risk: An updated meta-analysis

abstract

The debate on the potential carcinogenic effect of dietary acrylamide is open. In consideration of the recent findings from large prospective investigations, we conducted an updated meta-analysis on acrylamide intake and the risk of cancer at several sites.

Up to July 2014, we identified 32 publications. We performed meta-analyses to calculate the summary relative risk (RR) of each cancer site for the highest vs. lowest level of intake and for an increment of 10 µg/day of dietary acrylamide, through fixed-effects or random-effects models, depending on the heterogeneity test. Fourteen cancer sites could be examined. No meaningful associations were found for most cancers considered.

The summary RRs for high vs. low acrylamide intake were 0.87 for oral and pharyngeal, 1.14 for esophageal, 1.03 for stomach, 0.94 for colorectal, 0.93 for pancreatic, 1.10 for laryngeal, 0.88 for lung, 0.96 for breast, 1.06 for endometrial, 1.12 for ovarian, 1.00 for prostate, 0.93 for bladder, and 1.13 for lymphoid malignancies. The RR was of borderline significance only for kidney cancer (RR=1.20; 95% confidence interval, CI, 1.00-1.45).

All the corresponding continuous estimates ranged between 0.95 and 1.03, and none of them was significant. Among never-smokers, borderline associations with dietary acrylamide emerged for endometrial (RR=1.23; 95% CI, 1.00-1.51) and ovarian (RR=1.39; 95% CI, 0.97-2.00) cancers. This systematic review and meta-analysis of epidemiological studies indicates that dietary acrylamide is not related to the risk of most common cancers. A modest association for kidney cancer, and for endometrial and ovarian cancers in never smokers only, cannot be excluded.

FIGO: Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer

abstract

OBJECTIVE:

The objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.

MATERIALS AND METHODS:

We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages.......

CONCLUSIONS:

The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

testosterone in women - Google Scholar

search results since 2013

(Lynch Syndrome patients) Editorial: ‘Discontent is the first necessity of progress’ (upper tract urothelial carcinoma)

BMJ Editorial

This study from Kaag et al. [1] investigates predictors of renal functional decline after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). They evaluate early (2 months) and late (6 months) predictors of renal functional decline, finding that on a multivariable model only age at surgery and preoperative renal function were independently associated with early postoperative function. This is an intuitive finding whereby we expect older patients and those with lower renal function to have a more dramatic decrease in renal function after RNU......


References
1 Kaag M, Trost L, Thompson RH et al. Pre-operative predictors of renal function decline following radical nephroureterectomy for upper tract urothelial carcinoma. BJU Int 2014; 114: 674–9

FDA Puts Partial Hold on CytRx Cancer Drug Trials (Aldoxorubicin)

media

 By Reuters Staff

November 19, 2014

(Reuters) - CytRx Corp said the U.S. Food and Drug Administration placed a hold on enrolling new patients in clinical trials of its experimental cancer drug after a patient died, sending the company's shares down 11% in premarket trading.
The patient received the drug, aldoxorubicin, under the company's expanded access program that makes promising drugs and devices available to patients with serious diseases who do not qualify for the trials.
Patients already enrolled in the trials, currently in mid stage, will continue receiving the treatment, CytRx said.
The company said it would change its inclusion and exclusion criteria for new patients and add additional patient screening assessment, at the request of the FDA.
Aldoxorubicin is an improved version of the chemotherapy agent, doxorubicin, and it does not cause the side effects associated with doxorubicin such as heart muscle damage at higher doses and gastrointestinal disorders.
This means aldoxorubicin can be administered in higher doses than doxorubicin.
Aldoxorubicin is being tested for treating soft tissue sarcoma, small cell lung cancer, pancreatic cancer and a type of brain tumor.

The prevalence and outcomes of frailty in older cancer patients: a systematic review

 Note: only 1 study included ovarian cancer patients (2007) with no outcomes reported:

(reference: Wedding [38] 2007 Germany 180 Outpatient Haematological, gastrointestinal,
lung, breast,ovary, other)

open access (download pdf)


 To our knowledge, this is the first review of the prevalence and outcomes of frailty in
older cancer patients. Three recent reviews [42–44] have investigated the use of
geriatric assessment in older cancer patients, mainly focusing on diagnostic accuracy, but none have investigated the identification of frailty to predict outcomes.

Conclusion

More than half of older cancer patients have pre-frailty or frailty and these patients are at increased risk of chemotherapy intolerance, postoperative complications and mortality. The findings of this review support routine assessment of frailty in older cancer patients to guide treatment decisions, and the development of multidisciplinary geriatric oncology services. 

A new approach to integrate toxicity grade and repeated treatment cycles in the analysis and reporting of phase I dose-finding trials

Abstract

 More than 50% of phase I adverse drug reactions occur after the first cycle of treatment and moderate toxicities are an important source of information to investigate increasing probability of toxicity over time. Appropriate statistical modelling can be used to evaluate per cycle probability of moderate or severe toxicity, and cumulative probability of severe toxicity. Three situations were identified: Constant probability of toxicity over time and numerous repeated cycles provide a major gain in the precision of the estimate of the risk of toxicity at the RPD2. Increased risk of toxicity with time and numerous repeated cycles support reassessment of the RP2D that would be safe over the treatment period.

Background Safety assessment beyond the dose-limiting toxicity evaluation period provides relevant information to define the recommended phase II dose (RP2D) of a new treatment. We retrospectively analyzed three phase I trials to illustrate two indicators: per cycle probability of graded toxicity and cumulative probability of severe toxicity over the treatment period.

Patients and methods Data were collected from two continual reassessment method (CRM) trials (T1: aviscumine in solid tumors with short time on treatment; T2: erlotinib+radiotherapy in brainstem gliomas with longer time on treatment) and one 3+3 design (T3: liposomal doxorubicin+cyclophosphamide combination in ovarian carcinoma). The probability of severe and moderate or severe toxicity per cycle was estimated at each dose level

Body fatness at adolescence, adult attained height and the development of tumours among persons with Lynch syndrome

World Cancer Research Fund

Plain language abstract

Background
Persons with Lynch Syndrome (LS) have an inherited mutation in certain genes, which results in a substantial increased lifetime risk of cancer. They are mainly at risk of cancer of the large bowel or of the uterus, but also of a range of other cancers, such as cancer of the ovaries, stomach, small bowel, pancreas, urinary tract, brain and possibly breast. Many of these types of cancer have convincingly been associated with greater body fatness and probably/convincingly with height in the general population. The influence of these factors on cancer risk may already start during childhood and adolescence. Linear growth and accumulation of both lean and fat tissue during that critical period, represented by height and body mass index (BMI) at age 18-20 years, has never been investigated in relation to overall cancer risk among persons with LS.
Aims and Objectives
We propose to study BMI at age 18-20 years and height in relation to risk of overall, large bowel and uterus cancer among persons with LS. In addition, we will evaluate these relationships within specific subgroups, such as in men and women separately.

(Lynch Syndrome) High prevalence of MMR deficiency in prostate cancers

abstract

The question of whether prostate cancer is part of the Lynch syndrome spectrum of tumors is unresolved. We investigated the mismatch repair (MMR) status and pathologic features of prostate cancers diagnosed in MMR gene mutation carriers. Prostate cancers (mean age at diagnosis = 62 ± SD = 8 years) from 32 MMR mutation carriers (23 MSH2, 5 MLH1 and 4 MSH6) enrolled in the Australasian, Mayo Clinic and Ontario sites of the Colon Cancer Family Registry were examined for clinico-pathologic features and MMR-deficiency (immunohistochemical loss of MMR protein expression and high levels of microsatellite instability; MSI-H).

Tumor MMR-deficiency was observed for 22 cases [69 %; 95 % confidence interval (CI) 50-83 %], with the highest prevalence of MMR-deficiency in tumors from MSH2 mutation carriers (19/23, 83 %) compared with MLH1 and MSH6 carriers combined (3/9, 33 %; p = 0.01). MMR-deficient tumors had increased levels of tumor infiltrating lymphocytes compared with tumors without MMR-deficiency (p = 0.04). Under the assumption that tumour MMR-deficiency occurred only because the cancer was caused by the germline mutation, mutation carriers are at 3.2-fold (95 % CI 2.0-6.3) increased risk of prostate cancer, and when assessed by gene, the relative risk was greatest for MSH2 carriers (5.8, 95 % CI 2.6-20.9). Prostate cancer was the first or only diagnosed tumor in 37 % of carriers. MMR gene mutation carriers have at least a twofold or greater increased risk of developing MMR-deficient prostate cancer where the risk is highest for MSH2 mutation carriers. MMR IHC screening of prostate cancers will aid in identifying MMR gene mutation carriers

Google notes the growing impact of older articles

News

The lung-restricted marker napsin a is highly expressed in clear cell carcinomas of the ovary

abstract

 From PhenoPath Laboratories, PLLC, Seattle, WA, and CellNetix Pathology and Laboratories, Seattle, WA. cisacson@cellnetix.com.

OBJECTIVES:

We recently observed expression of the "lung" marker napsin A in ovarian clear cell carcinomas and therefore sought to determine the extent of napsin A expression in a subset of ovarian neoplasms.

METHODS:

We identified an archival series of ovarian clear cell carcinomas (n = 36), serous borderline tumors (n = 21), high-grade serous carcinomas (n = 37), and endometrioid adenocarcinomas (n = 29). Using standard immunohistochemical techniques on whole sections of formalin-fixed, paraffin-embedded specimens, we employed a panel of antibodies: napsin A (IP64), estrogen receptor (SP1), WT-1 (6F-H2), PAX-8 (BC12), and TTF-1 (SPT24).

RESULTS:

Thirty-six of 36 clear cell carcinomas showed napsin A expression, typically in a uniform pattern. None of the serous borderline tumors or high-grade serous carcinomas manifested napsin A expression. Napsin A was expressed in three (10%) of 29 endometrioid adenocarcinomas, generally in a focal pattern.

CONCLUSIONS:

Our study showed that napsin A is an extremely sensitive (100%) marker of ovarian clear cell carcinomas and exhibits very high specificity (100%) in distinguishing clear cell carcinomas from high-grade serous carcinomas and serous borderline tumors and 90% specificity in discriminating clear cell carcinomas from endometrioid carcinomas.

Cancer antigen 125 after delivery in women with a normal pregnancy

abstract

OBJECTIVE:

To establish reference intervals for cancer antigen 125 (CA-125) in women with expected normal pregnancy, delivery, and early postpartum period.

DESIGN:

Prospective observational study.

POPULATION:

Eight hundred and one women with expected normal pregnancies were investigated. Of these, 640 delivered vaginally, 82 by emergency cesarean section, and 79 by elective cesarean section; 720 women had uncomplicated pregnancies.

METHODS:

Samples were collected at gestational weeks 13-20, 21-28, 29-34, 35-42, during labor, and on first and second day postpartum. Reference intervals were calculated for each gestational period as recommended by the International Federation of Clinical Chemistry and Laboratory Medicine.

MAIN OUTCOME MEASURES:

Concentration of serum CA-125 during the gestational period and around delivery.

RESULTS:

CA-125 was fairly stable below 35 U/mL during pregnancy but increased markedly during vaginal delivery, to a minor degree during emergency cesarean section, and only slightly during elective cesarean section. In the early postpartum period, CA-125 decreased with an apparent half-life of 24 h.

CONCLUSIONS:

The CA-125 cut-off value (<35 U/mL) used for non-pregnant women can be used for women during pregnancy after gestational week 13 as a supplement to ultrasound evaluation of ovarian cysts. The wide range of CA-125 concentration during normal pregnancies makes it unlikely that small fluctuations in CA-125 can be clinically useful for identifying other conditions. Measuring CA-125 around the time of delivery is not recommended. Gestational age-specific reference intervals during normal pregnancy are not needed.

Relevance and efficacy of breast cancer screening in BRCA1/2 60 years+

abstract

Annual MRI and mammography is recommended for BRCA1/2 mutation carriers to reduce breast cancer mortality. Less intensive screening is advised ≥60 years, although effectiveness is unknown. We identified BRCA1/2 mutation carriers without bilateral mastectomy before age 60 to determine for whom screening ≥60 is relevant, in the Rotterdam Family Cancer Clinic and HEBON: a nationwide prospective cohort study. Furthermore, we compared tumour stage at breast cancer diagnosis between different screening strategies in BRCA1/2 mutation carriers ≥60. Tumours >2 cm, positive lymph nodes, or distant metastases at detection were defined as “unfavourable.”

Of 548 BRCA1/2 mutation carriers ≥60 years in 2012, 395 (72%) did not have bilateral mastectomy before the age of 60. Of these 395, 224 (57%) had a history of breast or other invasive carcinoma. In 136 BRCA1/2 mutation carriers, we compared 148 breast cancers (including interval cancers) detected ≥60, of which 84 (57%) were first breast cancers. With biennial mammography 53% (30/57) of carcinomas were detected in unfavourable stage, compared to 21% (12/56) with annual mammography (adjusted odds ratio: 4·07, 95% confidence interval [1.79-9.28], p = 0.001). With biennial screening 40% of breast cancers were interval cancers, compared to 20% with annual screening (p = 0.016). Results remained significant for BRCA1 and BRCA2 mutation carriers, and first breast cancers separately.

Over 70% of 60-year old BRCA1/2 mutation carriers remain at risk for breast cancer, of which half has prior cancers. When life expectancy is good, continuation of annual breast cancer screening of BRCA1/2 mutation carriers ≥60 is worthwhile.

Impact of a paternal origin of germline BRCA1/2 mutations on the age at breast and ovarian cancer diagnosis

abstract

Three studies have reported that BRCA1/2 mutations of paternal origin confer an earlier age at breast cancer diagnosis compared with maternal origin. The primary aim of this study was to investigate the impact of parental origin of BRCA1/2 mutations on age at breast and ovarian cancer diagnosis.

This study included 577 female BRCA1/2 mutation carriers. All BRCA1/2 mutation carriers belonged to families registered between 1993 and 2011 at the Oncogenetic Clinic at Skånes University Hospital, Lund, Sweden. Cox proportional hazard ratios were used to analyze time to breast or ovarian cancer diagnosis. A novel finding was that carriers of BRCA1 mutations of paternal origin were 4 years older at age of ovarian cancer (P = 0.009) compared with those carrying a BRCA1 mutation of maternal origin. BRCA1 carriers with mutations of paternal origin were 4 years younger at breast cancer diagnosis (P = 0.017) compared with those carrying a BRCA1 mutation of maternal origin, which is in agreement with three previous studies. Both findings were adjusted for of year of inclusion, birth date, and oral contraceptive pill use. No associations between parental origin of BRCA2 mutations and time to breast or ovarian cancer diagnosis were found. An attempt to handle a potential selection bias regarding use of oral contraceptives was made using multiple imputations by chained equations. The observed age difference may allow a greater understanding of mechanisms associated with the differences in cancer penetrance in BRCA1/2 mutation carriers, some of which may depend on paternal origin.

Endogenous androgens and risk of epithelial invasive ovarian cancer by tumor characteristics

abstract

 The role of endogenous androgens and sex hormone-binding globulin (SHBG) in ovarian carcinogenesis is poorly understood.

Epithelial invasive ovarian cancer (EOC) is a heterogeneous disease and there are no prospective data on endogenous androgens and EOC risk by tumor characteristics (histology, grade, stage) or the dualistic model of ovarian carcinogenesis (i.e. type I vs. type II, leading to less or more aggressive tumors).

We conducted a nested case–control study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort evaluating androgens and SHBG and invasive EOC risk by tumor characteristics. Female participants who provided a blood sample and were not using exogenous hormones at blood donation were eligible (n = 183,257). A total of 565 eligible women developed EOC; two controls (n = 1,097) were matched per case. We used multivariable conditional logistic regression models. We observed no association between androgens, SHBG and EOC overall. A doubling of androstenedione reduced risk of serous carcinomas by 21% (odds ratio (OR)log2 = 0.79, 95% confidence interval [CI] = [0.64–0.97]). Moreover, associations differed for low-grade and high-grade carcinomas, with positive associations for low-grade and inverse associations for high-grade carcinomas (e.g. androstenedione: low grade: OR_log2 = 1.99 [0.98–4.06]; high grade: OR_log2 = 0.75 [0.61–0.93], p_het  ≤ 0.01), similar associations were observed for type I/II tumors.

This is the first prospective study to evaluate androgens, SHBG and EOC risk by tumor characteristics and type I/II status. Our findings support a possible role of androgens in ovarian carcinogenesis. Additional studies exploring this association are needed.

HIPEC ROC I: A phase 1 study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postop IV platinum-based chemo in pts with platinum-sensitive recurrent OC

abstract

This phase I study tested the safety, feasibility, pharmacokinetics and pharmacodynamics of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion (HIPEC) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC) undergoing secondary cytoreductive surgery followed by postoperative platinum-based intravenous chemotherapy. Twelve patients with operable, recurrent platinum-sensitive EOC (recurrence ≥6 months after first-line therapy) were included according to the classical 3+3 dose-escalation design at three dose levels—60, 80 and 100 mg/m². After surgical cytoreduction, a single dose of cisplatin was administered via HIPEC for 90 min at 41–43°C.

Postoperatively, all patients were treated with standard intravenous platinum-based combination chemotherapy. One of six patients experienced a dose-limiting toxicity (grade 3 renal toxicity) at a dose of 100 mg/m². The remaining five patients treated with 100 mg/m² tolerated their treatment well. The recommended phase II dose was established at 100 mg/m². The mean peritoneal-to-plasma AUC ratio was 19·5 at the highest dose level. Cisplatin-induced DNA adducts were confirmed in tumor samples.

Common postoperative grade 1–3 toxicities included fatigue, postoperative pain, nausea, and surgical site infection. The ability to administer standard intravenous platinum-based chemotherapy after HIPEC was uncompromised. Cisplatin administered as HIPEC at a dose of 100 mg/m² has an acceptable safety profile in selected patients undergoing secondary cytoreductive surgery for platinum-sensitive recurrent EOC. Favorable pharmacokinetic and pharmacodynamic properties of HIPEC with cisplatin were confirmed at all dose levels, especially at 100 mg/m². The results are encouraging to determine the efficacy of HIPEC as a complementary treatment in patients with EOC.

Canadians want patient online healthcare options

 Longwoods


Eight in 10 Canadian adults want online access to their own health information yet fewer than one in 10 currently have it, according to a new study published in HealthcarePapers.
The gap is just as wide for other patient online services, such as booking appointments, e-visits, or requesting prescription renewals or refills online; Canadians want them all, but most aren't getting them......

mobile friendly: http://ovariancancerandus.blogspot.com

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Do Movember and other charity campaigns really help raise awareness?

medical news

Swiss biotech starts breakthrough anti-cancer clinical trial based on active immunotherapy - MVX-ONCO-1

medical news

.... The phase 1 trial in Geneva is due for completion in the middle of 2015. Assuming a successful outcome, the company plans to conduct multi-centre clinical phase IIa trials in Europe in 2015-2017. The goal is to establish the cancer-specific treatment efficacy and safety of MVX-ONCO-1 in larger lung, ovarian and pancreatic cancer patient populations. The company is conducting a new financing round with existing and new private investors to support these clinical programs.......

About MVX-ONCO-1
MaxiVAX' novel Immuno-Oncology therapy is based on triggering the patient's own natural immune response mechanism via an innovative and proprietary technology in order to eliminate the cancer cells. MVX-ONCO-1 has been classified as an Advanced Therapeutic Medicinal Product by the European Medicines Agency.
MVX-ONCO-1 consists of a two-component system:
1) Vaccine: administered by sub-cutaneous injection, this uses the patient's own irradiated cancer cells as vaccine antigens, with a key benefit of using the entire set of tumor antigens from the patient's cell
2) Immune boosting agent: an immune boosting agent (GM-CSF: granulocyte-macrophage colony stimulating factor) is continuously delivered via encapsulated cells. The capsule, a small hollow fibre, is placed underneath the skin at the same site as the vaccine injection.
The vaccine and the immune-booster are both being administered 6 times over a period of 8 weeks in this first clinical trial.

Clinicopathological heterogeneity in ovarian clear cell adenocarcinoma: a study on individual therapy practice (Japan)

abstract


 Ovarian clear cell adenocarcinoma (CCA) has been believed to be a lethal histological subtype of an epithelial ovarian adenocarcinoma (EOA); its precursor has been assumed to be endometriosis. However, it has been reported that CCAs occasionally exhibit different clinical behaviors, suggesting that CCAs might not belong to a single category. We focused on CCAs combined with other histological types of EOAs; we re-evaluated the pathology of 46 CCAs and divided them into two subgroups: 35 CCAs alone (pure-type CCAs); and 11 CCAs with other histological types, endometrioid adenocarcinomas (EAs) or/and serous adenocarcinomas (SAs) (mixed-type CCAs). Immunohistochemical analysis for expression of ARID1A, p53, PTEN, Annexin 4, hepatocyte nuclear factor-1β (HNF-1β), and WT-1 was employed.

We identified that patients with endometriosis were younger than those without endometriosis in pure-type CCAs (P < 0.005). In mixed-type CCAs, the immunohistochemical-staining patterns revealed internal transition of each histological component. In pure-type CCAs, expressions of ARID1A and p53 were mutually altered, and altered expression of p53 was associated with worse prognosis than that of ARID1A (P < 0.001). Our results provide evidence that CCAs would have clinicopathological heterogeneity, determining the patient's prognosis. Furthermore, immunohistochemical analysis may shed light on the selection of appropriate treatment, including chemotherapy.

Quality of Cancer Pain Management: An Update of a Systematic Review of Undertreatment of Patients With Cancer

abstract

Conclusion Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity. 

Prognosis and Conditional Disease-Free Survival Among Patients With Ovarian Cancer

abstract

Purpose Traditional disease-free survival (DFS) does not reflect changes in prognosis over time. Conditional DFS accounts for elapsed time since achieving remission and may provide more relevant prognostic information for patients and clinicians. This study aimed to estimate conditional DFS among patients with ovarian cancer and to evaluate the impact of patient characteristics. 

Patients and Methods Patients were recruited as part of the Hormones and Ovarian Cancer Prediction case-control study and were included in the current study if they had achieved remission after a diagnosis of cancer of the ovary, fallopian tube, or peritoneum (N = 404). Demographic and lifestyle information was collected at enrollment; disease, treatment, and outcome information was abstracted from medical records. DFS was calculated using the Kaplan-Meier method. Conditional DFS estimates were computed using cumulative DFS estimates. 

Results Median DFS was 2.54 years (range, 0.03-9.96 years) and 3-year DFS was 48.2%. The probability of surviving an additional 3 years without recurrence, conditioned on having already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%, 80.5%, 90.4%, 97.0%, and 97.7%, respectively. Initial differences in 3-year DFS at time of remission between age, stage, histology, and grade groups decreased over time. 

Conclusion DFS estimates for patients with ovarian cancer improved dramatically over time, in particular among those with poorer initial prognoses. Conditional DFS is a more relevant measure of prognosis for patients with ovarian cancer who have already achieved a period of remission, and time elapsed since remission should be taken into account when making follow-up care decisions.

Footnotes

• (6.29 minutes) Listen to the podcast by Dr. Iasonos at www.jco.org/podcasts

Impact of Spin in the Abstracts of Articles Reporting Results of Randomized Controlled Trials in the Field of Cancer: The SPIIN Randomized Controlled Trial

abstract

Purpose We aimed to assess the impact of spin (ie, reporting to convince readers that the beneficial effect of the experimental treatment is greater than shown by the results) on the interpretation of results of abstracts of randomized controlled trials (RCTs) in the field of cancer.

Conclusion Spin in abstracts can have an impact on clinicians' interpretation of the trial results.

Racial and Ethnic Disparities in Patient-Provider Communication, Quality-of-Care Ratings, and Patient Activation Among Long-Term Cancer Survivors

abstract

Purpose We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. 

Methods In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample........

Conclusion Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors.

PISCES Trial: The End Does Not Always Justify the Means (patient preferences)

Note: interesting commentary-  debatable of course (not specific to OC but an example of research/patient preferences

Correspondence

Original study

American Society of Clinical Oncology Policy Statement on Medicaid Reform

open access

imbedded video (Lynch Syndrome patients) Colon Cancer Surgery Live on Twitter (Dr Shady Ashamalla et al)

I

Follow @Sunnybrook #SBcancer - Sunnybrook Hospital

Note: (repost) also included is short video: Dr Shady Ashamalla  

 

Oncolytic measles virus expressing the sodium iodide symporter to treat drug-resistant ovarian cancer

abstract


Edmonston vaccine strains of measles virus (MV) have significant antitumor activity in mouse xenograft models of ovarian cancer (OvCa). MV engineered to express the sodium iodide symporter gene (MV-NIS) facilitates localization of viral gene expression and offers a tool for tumor radiovirotherapy......

.....Here we report results from a clinical evaluation of MV-NIS delivery in patients with taxol and platinum resistant OvCa. MV-NIS was given intraperitoneally every 4 wk for up to 6 cycles. ........... Our findings support further clinical evaluation of MV-NIS as an effective viral immunotherapy.

open access: (EMBRACE) Germline mutation in BRCA1 or BRCA2 and ten-year survival for women diagnosed with epithelial ovarian cancer

open access
(see below)

Purpose:To analyse the effect of germline mutations in BRCA1 and BRCA2 on mortality in ovarian cancer patients up to ten years after diagnosis. 

Conclusions: BRCA1/2 mutations are associated with better short-term survival, but this advantage decreases over time and, in BRCA1 carriers is eventually reversed. This may have important implications for therapy of both primary and relapsed disease and for analysis of long-term survival in clinical trials of new agents, particularly those that are effective in BRCA1/2 mutation carriers. 

 Published OnlineFirst November 14, 2014; doi: 10.1158/1078-0432.CCR-14-2497

1. » Abstract
2. Full Text (PDF)
3. Supplementary Data

Perioperative blood transfusion in gyn oncology surgery

abstract
  
Highlights

•

13.8% of gynecologic surgical patients received a perioperative blood transfusion.

•

Transfusion is independently associated with increased perioperative morbidity.

•

Transfusion increases risk of perioperative mortality and surgical site infections.

---

Objective

To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in ovarian cancer surgery.

Targeting HER2 in ovarian and uterine cancers: Challenges and future directions

abstract

 Highlights

•

Targeting HER2 has been extensively studied in ovarian and uterine carcinomas.

•

These cancers yielded negative trials—contrasting with breast and gastric cancers.

•

Future studies include HER2 resistance mechanisms and identifying predictive biomarkers.

The effect of neighborhood-level socioeconomic status on racial differences in ovarian cancer treatment (Chicago)

abstract

Background

Less than half of women with ovarian cancer and blacks specifically receive therapy adherent to National Comprehensive Cancer Network (NCCN) guidelines. The purpose is to assess the effect of neighborhood-level socioeconomic status (SES) on black-white treatment differences in a population-based analysis in a highly-segregated community
 Highlights

•

Racial inequality exists in receipt of even the most basic level of oncologic care for OVCA in Cook County, Illinois

•

Neighborhood-level concentrated advantage appears to play a role in receipt of chemotherapy, but not in receipt of surgery

•

Inequality in treatment for OVCA persisted despite adjustment for both individual-level clinical factors and neighborhood-level SES (concentrated affluence and disadvantage)

Diabetes mellitus and ovarian cancer: More complex than just increasing risk

abstract

Conclusions

EOC patients with DM have poorer survival than patients without diabetes; this association is independent of obesity. Metformin use did not affect outcomes. The pathophysiology of this observation requires more inquiry.

Highlights

•

Diabetes mellitus (DM) is increasingly prevalent in our obese society.

•

DM confers poorer outcomes in some cancers, but there is little data regarding its relationship to ovarian cancer.

•

DM was associated with worse outcomes regardless of BMI in our population.

A qualitative study of ovarian cancer survivors' perceptions of endpoints and goals of care (OCNA/SHARE)

Abstract

Conclusions

An objective measure of treatment success meaningful to survivors, physicians and regulators is, at present, elusive and may not exist. Ideally, future trial design would place equal weight on quantitative and qualitative measures and include information about goals of treatment.

 Highlights

•

Concepts important to ovarian cancer survivors include communication with one's physician and expectations changing with position along the treatment continuum.

•

While all survivors identify communication with one's physician as essential, only 14% reported having such communication prior to treatment decisions.

•

Survivors prefer an individualized approach to care focusing on quality of life instead of chronologic increments of survival.

---

Objectives

A survey of the Ovarian Cancer National Alliance revealed a communication gap between physicians and survivors. This qualitative study explored the space between perceptions in hopes of better defining treatment endpoints meaningful to treating physicians and their patients.

Methods

A focus group of ovarian cancer survivors (n = 22) was assembled via the survivor support network SHARE. A physician-guided session explored expectations of treatment, perceived outcomes, toxicity thresholds and decision making. The session was recorded, transcribed and coded. Common themes were identified and used to perform intra-case analysis by two independent reviewers.

Results

The main themes identified were barriers to communication, importance of frequent communication between patient and physician regarding goals, and expectations of treatment changing with position along the treatment continuum. One hundred percent of participants identified communication with their physician as an essential element in determining treatment course. However, only 14% reported having a discussion about goals, values and perceptions with their physician preceding treatment decisions. Participants reported that the terms progression free and overall survival held minimal significance for them and instead they preferred an individualized approach to care focusing on quality of life. Many women underreported side effects with reasons ranging from fear of dose reductions and additional tests to forgetting about symptoms due to anxiety.

Conclusions

An objective measure of treatment success meaningful to survivors, physicians and regulators is, at present, elusive and may not exist. Ideally, future trial design would place equal weight on quantitative and qualitative measures and include information about goals of treatment.

(comprehensive review) Extracolonic Manifestations of Lynch Syndrome (research bias towards colorectal/uterine)

 Note: previously linked to abstract

open access

 Gastric Cancer

 Breast Cancer

 Urothelial and Other Urological Cancers

 Pancreaticobiliary Cancer

 Small Bowel Cancer

 Brain Cancers

 Skin Cancer

 Hematopoietic Malignancies

 Sarcoma

 Summary

Our understanding of Lynch syndrome has evolved over time and continues to do so. The spectrum of extracolonic malignancies appears to be more diverse than once understood, and is very much different than the initial descriptions. In addition to well-documented malignancies, there is a growing list of other cancers that warrant inclusion in Lynch syndrome. At the same time, the role of extracolonic malignancies is evolving, as the index cancers may not be colorectal or other commonly seen cancers. Numerous factors determine the frequency of Lynch-associated cancers. These include geography, ethnicity, gender, and underlying genetic mutation. In addition, the responsible mutations and the diagnostic tools we use to define at risk individuals have changed. Although more MMR mutations have been recently identified, all mutations are not yet known. Finally, MMR mutations may not be the only pathway to Lynch syndrome, since the emergence of EpCAM, germ-line hypermethylation of MLH1, and possibly CHEK2. It is unclear if these genes also act in a comodulating role or in fact represent a separate Lynch-like syndrome. What is clear is that our index of suspicion must be higher. Population-based screening is needed to truly understand the incidence, phenotype, and scope of affected families. The role of extracolonic malignancies, within that screening, will be very prominent as the heterogeneity of expressed cancers becomes more evident.

#ovariancancers

Lynch Syndrome in patients with clear cell and endometrioid cancers of the ovary

abstract

 Highlights

• •Women with clear cell/endometrioid ovarian cancer are at risk for Lynch Syndrome.
• •Synchronous and metachronous malignancies are more common in these patients.
• •Screening for MMR expression is recommended in patients under 53 with these tumors

#ovariancancers

2014 Distinct gene expression profiles in ovarian cancer linked to Lynch syndrome - Springer

open access (technical)

Introduction

Lynch syndrome is estimated to cause 2–4 % of ovarian cancer. Recognition of these cases is challenging, and many of the 9,000 ovarian cancers annually estimated to develop as part of Lynch syndrome probably escape detection. Whereas sporadic ovarian cancer and hereditary cancer caused by BRCA1 and BRCA2 gene mutations develop at a mean age of 65–70 years, typically show serous histopathology and present at advanced tumor stages [1, 2], ovarian cancer linked to Lynch syndrome typically develops at a mean age of 45 years as early-stage tumors of the endometrioid and clear cell histologic subtypes [2–7]. Lynch syndrome is caused by germline mutations in the mismatch-repair (MMR) genes MLH1, MSH2, MSH6 and PMS2. Carriers of disease-predisposing mutations are estimated to be at 7–12 % life-time risk for ovarian cancer, at 50–80 % risk for colorectal cancer and at 40–60 % risk for endometrial cancer [5, 8, 9]. Recognition of ovarian cancers linked to Lynch syndrome tumors is important since family members at risk can be offered surveillance and/or prophylactic measures that reduce morbidity and mortality, not least from the more commonly occurring colorectal cancers.

In ovarian cancer, the different histopathologic subtypes have been suggested to constitute separate disease entities with differences related to biological features, treatment response and prognosis [10, 11].......

#ovariancancers

Changes in specialists' perspectives on cancer genetic testing, prophylactic surgery and insurance discrimination: then and now

Cabstract

J Genet Couns. Epub 2013 Jul 13.

We surveyed cancer genetics specialists in 1998 to learn what they would do if at 50% risk to carry a BRCA or Lynch syndrome mutation. We chose to repeat our study 14 years later, to examine how perspectives have changed with the extensive data now available. In July 2012 we surveyed the National Society of Genetic Counselors (NSGC) Cancer Special Interest Group via an internet based survey. We found statistically significant increases in the percentage of specialists who: would undergo BRCA testing (p = 0.0006), opt for prophylactic bilateral mastectomy (p =0.0001), opt for prophylactic removal of their uterus and ovaries for Lynch syndrome (p =0.0057 and P = 0.0090, respectively), and bill testing to insurance (p >0.0001). There were also statistically significant decreases in the percentage of participants who would have their colon removed for Lynch syndrome (p = 0.0002) and use an alias when pursuing testing (p > 0.0001). Over the past 14 years there has been a major change in perspective amongst cancer genetic specialists regarding genetic testing, prophylactic surgery and insurance discrimination.

FDA Alert: Mayhem: Public Notification - Undeclared Drug Ingredients

FDA Alert:

 ISSUE: FDA is advising consumers not to purchase or use Mayhem, a product labeled as a dietary supplement that is promoted to increase appetite and muscle growth, because it contains an undeclared corticosteroid and antihistamine. FDA laboratory analysis found that Mayhem contains dexamethasone, a corticosteroid commonly used to treat inflammatory conditions, and cyproheptadine, a prescription antihistamine used for seasonal allergy treatment.

Consumers are advised that corticosteroid use can impair a person’s ability to fight infections, cause high blood sugar levels, muscle injuries and psychiatric problems. When corticosteroids are taken for a prolonged period, or at high doses, they can suppress the adrenal gland and cause withdrawal symptoms with abrupt discontinuation. Antihistamines may cause drowsiness and affect mental alertness.....

Statin use and risk for ovarian cancer

Abstract
 

Background:Limited data suggest that statin use reduces the risk for ovarian cancer.
Methods:Using Danish nationwide registries, we identified 4103 cases of epithelial ovarian cancer during 2000-2011 and age-matched them to 58 706 risk-set sampled controls. Conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for epithelial ovarian cancer overall, and for histological types, associated with statin use.
Results:We observed a neutral association between ever use of statins and epithelial ovarian cancer risk (OR=0.98, 95% CI=0.87-1.10), and no apparent risk variation according to duration, intensity or type of statin use. Decreased ORs associated with statin use were seen for mucinous ovarian cancer (ever statin use: OR=0.63, 95% CI=0.39-1.00).
Conclusions:Statin use was not associated with overall risk for epithelial ovarian cancer. The inverse association between statin use and mucinous tumours merits further investigation.

British Journal of Cancer (2014), 1-5. doi:10.1038/bjc.2014.574 www.bjcancer.com.

Novel and recurrent BRCA2 mutations in Italian breast/ovarian cancer families widen the ovarian cancer cluster region boundaries to exons 13 and 14

abstract

Hereditary breast and ovarian cancer are mainly linked to mutations in BRCA1 and BRCA2 genes which confer a similar cumulative risk of developing breast cancer. Importantly, while BRCA2 mutation carriers generally have a lower cumulative risk for ovarian cancer, mutations clustered in the central portion of BRCA2 are associated with a higher proportion of ovarian compared with breast cancer cases. The boundaries of this ovarian cancer cluster region (OCCR) have been tentatively defined within a 3.3 kb region of BRCA2 exon 11, and herein, we reassessed these boundaries using our series of Italian breast/ovarian cancer families.

The Yolk Sac Tumor: Reflections on a Remarkable Neoplasm and Two of the Many Intrigued By It

abstract


One of the most remarkable of human neoplasms, the yolk sac tumor, is reviewed, emphasizing its histologic diversity and differential diagnosis, occurrence at many sites, and the shared passion for this unique neoplasm of Dr Gunnar Teilum (who deserves almost all credit for delineation of the nature of the tumor and its features) and Dr Aleksander Talerman (who made his own contribution to our knowledge of it) and the friendship it helped forge between these 2 distinguished pathologists. In a unique series of articles, beginning in the early 1940s, Teilum delineated the distinctive features of the neoplasm and recognized that it was 1 of 2 initially included as "mesonephroma ovarii" by Dr Walter Schiller in 1939 (the second we now know as clear cell carcinoma). Teilum named the tumor "endodermal sinus tumor" because it came to his attention that papillary formations common in the yolk sac tumor resembled the endodermal sinuses of the rat placenta. He focused on the histogenesis of the tumor and its morphologic features culminating in a classic paper in Cancer in 1959. Although Teilum and others recognized that yolk sac tumor could be a component of mixed germ cell tumors, Talerman was one of the first to emphasize that, particularly in the testis, it was common to see yolk sac tumor as a component of a mixed germ cell tumor. Teilum, working in Copenhagen, and Talerman, when the former was alive, working in Rotterdam, developed a warm friendship in part due to their great interest in the yolk sac tumor, although it also extended to other areas of gonadal neoplasia and indeed beyond the boundaries of medicine when they shared time together. The typical histologic features of the yolk sac tumor are the reticular-microcystic patterns Teilum described, but various other patterns, including solid and even rarer ones such as glandular and hepatoid, are now well known. There are some interesting variations in the age distribution of this tumor at various sites: for example, vaginal examples are almost restricted to children under 2 years of age; those of the testis that are pure also occur mostly in young boys (average age about 20 months) but are occasionally seen in later years; ovarian examples peak at about 19 years of age; mediastinal forms are mostly restricted to young adult males. Brief consideration is also given to the occurrence of this tumor at well-known extragonadal sites such as retroperitoneum, mediastinum, and pineal as well as more exotic locations. Note is made of the recently emphasized occurrence of the yolk sac tumor on the background of a somatic neoplasm, most often endometrioid carcinoma of the ovary. Given the wide ranging and fascinating clinical and pathologic aspects of the neoplasm, it is no surprise that it continues to be a source of great interest to any pathologist who sees one or more examples, and we are indebted to Dr Teilum for his monumental studies and to Dr Talerman for his own contributions.

Coping With Cancer: Examining the Supports Available to Women With Gynecologic Cancer at Saskatoon Cancer Center

abstract

Smith SN¹, Chizen D, Agrawal A.

Author information

• ¹*College of Medicine, University of Saskatchewan; and †Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.

OBJECTIVE:

When women are diagnosed and treated for gynecologic cancer, they must find ways to cope. Cancer is both a physically and emotionally challenging disease. This study aims to identify existing coping strategies in women diagnosed with gynecologic cancer throughout their cancer journey and to add to these supports to help women cope with their cancer.

METHODS:

Women with gynecologic cancer were interviewed individually according to focus group principles during scheduled clinic visits at Saskatoon Cancer Center to identify coping strategies following diagnosis and treatment of cancer. Interviews were used to inform researchers before preparing a survey about coping with cancer. During 8 weeks, women receiving care were surveyed. Questions explored diagnosis, therapy phase, feelings, attitudes, and support.

No Cognitive Difference Between Early, Late Estrogen Therapy

medscape



....She also pointed out that the study's findings provide reassurance regarding the lack of cognitive harm in the older group especially, tracing back to the trend seen in the Women’s Health Initiative.
She told Medscape Medical News that although she usually does not start older women on estrogen, it is still an option for some who are still having hot flashes. "You have to individualize [treatment]."
The study was supported by the National Institute on Aging. Dr Mack and Dr Nachtigall have disclosed no relevant financial relationships.
North American Menopause Society (NAMS) 2014 Annual Meeting. Presented October 17, 2014. Abstract S-12.

If the Mountain Does Not Come to Mohammad: The Significance of Guest Operations for Early Stage Ovarian Cancer

abstract

Background:
In women with early ovarian cancer (EOC), comprehensive surgical staging is known to enhance ovarian cancer outcomes and requires specific surgical competence. Given that centralization of care remains a topic of continuing debate, a system of "guest operations" was introduced ...... 

A case of ovarian yolk sac tumor associated with endometrioid adenocarcinoma

open access

Introduction

Ovarian yolk sac tumor (YST) is characterized by endodermal differentiation, and represents approximately 20% of malignant germ cell neoplasms. The age distribution of patients reported with YST ranges from 16 months to 46 years, but most patients are under 30 years of age (Talerman and Vang, 2011). YST is often found admixed with other types of germ cell neoplasm, but YST associated with epithelial ovarian carcinoma is extremely rare......

MTV reality star Diem Brown dies at 32 (from ovarian cancer)

Diem Brown dies at 32

FDA Approves Avastin for Recurrent Ovarian Cancer (U.S.)

Medpage


Published: Nov 14, 201WASHINGTON -- The FDA has approved the angiogenesis inhibitor bevacizumab (Avastin) for use in combination with paclitaxel to treat platinum-resistant recurrent #ovarian cancer.
The approval was based on results of an international, phase III, randomized trial to compare paclitaxel alone with paclitaxel plus bevacizumab. Known as AURELIA, the trial involved 361 women whose ovarian cancer had recurred less than 6 months after their most recent platinum-based chemotherapy regimen.
The trial had a final endpoint of progression-free survival (PFS), and the results demonstrated a 62% reduction in the hazard for progression or death in patients who received bevacizumab.........

Patient Experience vs. Evidence-Based Medicine

Medpage

Action Points

• This perspective piece criticizes a recent New York Times opinion essay for failing to properly define evidence-based medicine.
• The author feels that evidence-based medicine does not ignore anecdote or clinical experience, but merely weights those findings in a hierarchy of evidence.

open access - May 2014: Ovarian Cancer (Cancer Network)

open access

Overview

Despite the fact that it is highly curable if diagnosed early, ovarian cancer causes more mortality in American women each year than all other gynecologic malignancies combined. An estimated 21,980 new cases of this cancer will be diagnosed in the United States in 2014, and about 14,270 women will die.

Notable advances in chemotherapy and surgery over the past several decades have begun to translate into improved survival. According to American Cancer Society data, the 5-year overall survival rate from ovarian cancer has increased significantly, from 37% in the mid-1970s to 46% in the mid-2000s (P < .05). Recent data from the National Cancer Institute show a similar increase in stage-specific survival. It is expected that data from the current decade, reflecting continued improvements in chemotherapy and surgery, will continue this trend.
This chapter will focus on epithelial cancers of the ovaries, which account for about 90% of ovarian malignancies......

The evolution of colorectal cancer genetics—Part 2: clinical implications and applications

open access

The risk of CRC in LS is approximately 60-85% depending on which MMR gene is involved. Patients with MLH1 and MSH2 mutations have a higher risk of cancer, with diagnosis at a younger age, compared to MSH6 and PMS2 mutations (25,26). MLH1 mutation carriers have a higher risk of CRC, while MSH2 carriers have a higher rate of multiple primary extracolonic cancers, to include brain (glioblastoma), ovarian, stomach, hepatobiliary, urinary tract, breast, and prostate cancers (27-32). Colonoscopy screening decreases the risk of a second CRC by 62% when patients have routine surveillance (33). It is rare for colonoscopy to miss a polyp >10 mm. However, for polyps between 1-5 mm, up to 35% can be overlooked (34). With this knowledge, prophylactic colectomy may be ideal for some patients, requiring only a subsequent yearly rectal surveillance. Prophylactic colectomy before the age of 25 has been associated with the greatest increase in life expectancy when compared to older patients and those where surgery was performed after a CRC diagnosis (35). It is still widely debated about recommendations for a prophylactic colectomy. It is important to evaluate the patient for both emotional and physical perspectives, understand his or her MMR mutation status, and ensure that a genetic counselor is actively engaged with the decision making process. In women who present with uterine cancer, prophylactic colectomy can be considered in addition to the surgical treatment of gynecologic diseases, if the patient is being managed in a comprehensive manner (36). Prophylactic hysterectomy and bilateral salpingo-oophorectomy is a prudent option given limited endometrial and extremely poor ovarian cancer screening (36).......

Completeness of pedigree and family cancer history for ovarian cancer patients (Korea)

abstract

OBJECTIVE:

To investigate the completeness of pedigree and of number of pedigree analysis to know the acceptable familial history in Korean women with ovarian cancer.

Anaesthesia: accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

open access

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

Table 1. NAP5 suggestion for describing sedation definitions from a patient's perspective, as part of a process of consent.

	What will this feel like?	What will I remember?	What's the risk related to the sedation drugs?
Not sedated; awake	I am awake, possibly anxious. There may be some mild discomfort (depending on the what I am having done)	Everything	Zero: not applicable
Minimal sedation	I am awake and calm. There may be some mild or brief discomfort	Probably everything	Very low risk
Moderate sedation	I am sleepy and calm but remain in control. I may feel some mild discomfort	I might remember some things	Low risk
Deep sedation	I am asleep. I will not be in control	Probably very little	Higher risk. My breathing may stop when I am asleep –and I may need help to breathe – a tube might be inserted into my nose, mouth or windpipe. I will need oxygen and special monitoring
Anaesthesia	I am deeply ‘asleep’ and unable to respond	Very unlikely to remember anything	High risk (but the presence of an anaesthetist is designed to increase safety). My breathing may stop and my blood pressure and heart rate may fall. I will need a specialist doctor to look after my breathing and support my blood pressure and heart rate. I will need oxygen and special monitoring and equipment