Monday, May 10, 2010
medical news article: Versatility Of Amniotic Fluid Stem Cells
Versatility Of Amniotic Fluid Stem Cells
Main Category: Stem Cell ResearchAlso Included In: Diabetes; Urology / Nephrology; Genetics
Article Date: 25 Nov 2009
For the first time, scientists have demonstrated that stem cells found in amniotic fluid meet an important test of potential to become specialized cell types, which suggests they may be useful for treating a wider array of diseases and conditions than scientists originally thought.
Reporting in Oncogene, a publication of Nature Publishing Group, the research teams of Anthony Atala, M.D., director of the Wake Forest Institute for Regenerative Medicine, and Markus Hengstchläger, Ph.D., from the Medical University of Vienna, have shown that these amnion stem cells can form three-dimensional aggregates of cells known as embryoid bodies (EBs). It is believed that cells at this stage of development can be directed to become virtually any cell in the human body.
"This finding suggests that the amnion cells have greater potential than we originally thought and may be able to form many cell types," said Atala. "This could expand the number for diseases and conditions that they may be helpful for."
Atala's team is currently evaluating the cells for their potential to treat diabetes and kidney disease. They were the first to report success (Nature Biotechnology, Jan. 2007) in isolating stem cells from placenta and amniotic fluid, which surrounds the developing fetus. The current research is one of several projects designed to determine the potential of this new type of stem cell.
For the study, scientists generated two additional lines of stem cells from amniotic fluid using the same protocol developed by Atala's lab. They then investigated the incidence of EB formation in all three lines.
"Performing many independent experiments using different approaches, we demonstrate in the report that human amnion stem cells … can indeed form embryoid bodies," write the researchers in Oncogene. "Amnion cells are on the way to become an important source for both basic science and regenerative medicine."
In addition to the finding about EBs, the scientists identified a protein found inside cells (mTOR) as the regulator of EB formation. Hengstshläger, whose team was the first to provide evidence for the existence of stem cells in amniotic fluid, said that this finding may allow for new insights into the molecular mechanism of EB formation.
He said the cells may be a useful source for generating disease-specific stem cell lines for studying the differentiation process to determine what goes wrong in genetic diseases.
"These stem cells allow for studying the effects of mutations causing human genetic diseases on specific cell differentiation processes," he said.
Other potential advantages of the cells are that they can be grown in large quantities and are readily available during gestation and at the time of birth. "Whether these cells are as versatile as embryonic stem cells remains to be determined," said Atala, "but the current finding is certainly encouraging."
Atala stopped short of calling the cells pluripotent, which means the ability to form many cell types. He said while the cells meet some of the characteristics of pluripotency, such as versatility, they do not form tumors when implanted in animals, which is also considered a characteristic. The fact that the amnion cells are less likely to form tumors may be one advantage that they have over embryonic stem cells in their potential for clinical use.
Co-researchers were Alessandro Valli, Ph.D., Margit Rosner, student, Christiane Fuchs, MSc., Nicol Siegel, MSc., and Helmut Dolznig, Ph.D., from the Medical University of Vienna, Colin E. Bishop, Ph.D., from Wake Forest, and Ulrike Mädel, student, and Wilfried Feichtinger, M.D., from Wunschbaby Zentrum, in Vienna, Austria.
Source: Karen Richardson
Wake Forest University Baptist Medical Center
full access: PLoS ONE: Ovarian Cyst Fluid of Serous Ovarian Tumors Contains Large Quantities of the Brain Amino Acid N-acetylaspartate
Background
"In
humans, N-acetyl L-aspartate (NAA) has not been detected in other
tissues than the brain. The physiological function of NAA is yet
undefined. Recently, it has been suggested that NAA may function as a
molecular water pump, responsible for the removal of large amounts of
water from the human brain. Ovarian tumors typically present as large
cystic masses with considerable fluid accumulation....."
Arrayit Corporation Reports Strong Surge in Customer Demand for the Company's Leading Edge Life Sciences Microarray Instruments - financial news
Note: in prior new/press releases the Arrayit testing is still seeking FDA (U.S.) approval, this is not the same test as OVA1 which is the test for determining suspicion of ovarian cancer malignancy (search blog for further information on both)
"Arrayit microarrays and instruments offer richer content and greater sensitivity than competing platforms, and these attributes have allowed us to discover the world's only definitive pre-symptomatic biomarkers for ovarian cancer and Parkinson's Disease, as well as a new pharmaceutically important pathway in human biology that will be the subject of future announcements."
Cancer Diagnostics - Onko-Sure
Cancer Diagnostics
Our Onko-Sure™ in vitro diagnostic test enables physicians and their patients to effectively monitor and/or detect solid tumor cancers by measuring the accumulation of specific breakdown products in the blood called Fibrin and Fibrinogen Degradation Products (FDP). Onko-Sure™ is a simple, non‐invasive blood test used for the detection and/or monitoring of 14 different types of cancer including: lung (Oncologystat.com), breast, stomach, liver, colon, rectal, ovarian, esophageal, cervical, trophoblastic, thyroid, malignant lymphoma, and pancreatic. Onko-Sure™ can be a valuable diagnostic tool in the worldwide battle against cancer, the second leading cause of death worldwide. Onko-Sure™ serves the IVD cancer/oncology market which, according to Bio-Medicine.org is growing at an 11% compouned annual growth rate.
Onko-Sure™ is sold as a blood test for cancer in Europe (CE Mark certified), India, Taiwan, Korea, Vietnam, and in Chile (research use); approved in the U.S. for the monitoring of colorectal cancer (CRC); approved in Canada (by Health Canada) for lung cancer detection and lung cancer treatment monitoring; and in many key markets, has the significant potential to be used as a general cancer screening test.
MOHLTC - Nurse Practitioner-Led Clinics
Call for Applications – Wave 3
In announcing the Wave 3 Call for Applications, the Ministry is now accepting submissions to award the remaining 14 Nurse Practitioner-Led Clinics. The Ministry will receive applications until Friday, June 25, 2010. All applications must be received by 5:00 p.m. Friday, June 25, 2010. Late applications will not be considered...."
The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries.
Abstract
OBJECTIVE: The aim of this study was to investigate prognostic factors of patients with metastases to the ovaries from non-genital organs.
STUDY DESIGN: From September 1994 to December 2006, 158 patients with pathologically confirmed metastatic tumors to the ovaries at Samsung Medical Center (SMC) were included in this study. The data were obtained from the patients' medical records and pathology reports.
RESULTS: The primary tumor origin was mostly stomach (73 cases) and colon (61 cases). Krukenberg tumor (pathologically proven signet ring cell carcinoma) was found in 34 cases: stomach (25), colon (2), appendix (1), and unknown (6). ....However, age, bilateral tumors, chronology of diagnosis and mass size did not affect survival.
CONCLUSION: Cytoreductive surgery and post-operative adjuvant chemotherapy had a beneficial effect on survival in selected patients.
amednews: Specialty societies set new policy on drug company influence :: May 10, 2010
Note: these policies address only drug company influences
Medical News: Cancer Costs Double in Less than 20 Years - in Public Health & Policy, General Professional Issues
Note: over the past many years, the cost factors (no matter the country/politics) have formed a large part of cancer research, the one part which is always missing is what if it's me....IMHO obviously
full free access: (breast cancer)Tailored targeted therapy for all: a realistic and worthwhile objective against
"Targeted therapy for breast cancer was actually used, albeit unwittingly, as early as the late 1800s. Beatson first surgically removed the ovaries of women to treat metastatic breast cancer in 1896......"
Sunday, May 09, 2010
Ontario doctor learning new lessons as a patient -media article
"...For Dr. Sutherland, becoming a patient has taught him new lessons as a doctor. "I have learned many things as a patient – some good things and some bad things.."
Saturday, May 08, 2010
Clinical Care Options Oncology - Research Update on PARP Inhibition: Emerging Data in Breast, Ovarian, and Other Cancers - Virtual Presentation
Note: free access/register
| Research Update on PARP Inhibition: Emerging Data in Breast, Ovarian, and Other Cancers | |||
|
In this Interactive Virtual Presentation, William J. Gradishar, MD, FACP,
reviews the mechanism of PARP inhibition and its rationale as a
therapeutic pathway and describes recent data using novel PARP
inhibitors.
To begin this Interactive Virtual Presentation, click here.
Downloadable Slideset
The slideset that accompanies this Interactive Virtual Presentation is available for use as a self-study resource or in your own noncommercial talks. To download, click here.
This CME-certified Interactive Virtual Presentation is located online at:
http://clinicaloptions.com/Oncology/Treatment%20Updates/PARP%20Inhibition.aspx | ||
full access: Tumor Angiogenesis: Insights and Innovations (not specific to ovarian cancer)
"These two ongoing theories showcase the current problems in the field of antiangiogenic research in cancer. After several years of clinical trials, it appears that targeting one angiogenic factor is not enough to permanently halt neovascularization in most tumors. Although these results were initially disheartening, they also opened up the possibility of other angiostatic therapies.
Many clinical trials now use existing chemotherapeutic drugs or radiation along with antiangiogenic drugs. This two-front attack has had more
success than antiangiogenic drugs or chemotherapy alone in a majority of patients."
Decreased severity of ovarian cancer and increased survival in hens fed a flaxseed-enriched diet for 1 year
ConclusionsThese findings show that 10% flaxseed supplementation for 1 year in the laying hen results in a significant reduction in the severity of ovarian cancer, but no change in the incidence of the disease. Hens fed flaxseed had overall better health and reduced mortality. These findings may provide the basis for a clinical trial that evaluates the efficacy of flaxseed as a chemosuppressant of ovarian cancer in women.
Study Finds Breast Cancer Metastasis Increases After Estrogen And Progestin Hormone Therapies
Note: a second study published in Menopause/postmenopausal women/preclinical study
"Although Hyder said that the study was independent of whether or not the ovaries were intact, it's still unclear whether progestins have the same effects in pre-menopausal women.
"Especially if there's a family history of breast cancer, it's advisable not to take progestins. It's a difficult call that must be made on an individual basis by a physician," Hyder said...."
Friday, May 07, 2010
PMH breast cancer researchers link ovarian hormone to breast stem cells growth
Note: easier to read Medscape article from previous blog post
"Cancer researchers at Princess Margaret Hospital (PMH) have discovered that the ovarian hormone progesterone plays a pivotal role in altering breast stem cells, a finding that has important implications for breast cancer risk.......The findings, published online today in Nature (10.1038/nature09091; http://dx.doi.org/), are significant because reproductive history is among the strongest risk factors for breast cancer, says principal investigator Rama Khokha, a molecular biologist at Ontario Cancer Institute and the Campbell Family Cancer Research Institute, PMH. Other major known risk factors are age, genetics and breast density."
Risk Tools Limited in Their Ability to Predict Development of Breast Cancer including Editorial Comment
Article:
....Major Limitations Exist
According to the researchers, these models each have major limitations. Most notable is that the models rely on known risk factors, given that up to 60% of breast cancers occur in the absence of known risk factors. In addition, with the exception of the Gail model, these tools have not been well validated, and they also do not include nonhereditary risk factors. However, even the Gail model has limited ability to discriminate between individuals at risk, especially those in higher-risk groups, according to the study authors.
To date, no existing model is "totally able to discriminate between families that do and do not have mutations or between women who will and will not develop breast cancer," they write. "Steady and incremental improvement in the models are being made, but these changes require revalidation."
Other risk factors, such as mammographic density, weight gain, and serum steroid hormone measurements, are being considered for inclusion in the existing models. Studies are underway to determine if these factors are feasible and will improve breast cancer risk prediction, according to the study authors.
Editorial: Models Differ in Details
"The authors have provided a useful survey of the literature and have presented an informative summary of the risk factors used in various models," write Mitchell Gail, MD, PhD, and Phuong Mai, MD, from the National Cancer Institute, in a related editorial. Drs. Gail and Phuong caution, however, that the various models differ in important details and that physicians need to be cognizant of these differences.
"Promising directions include incorporating mammographic density, information on genotype or regulation of gene expression ... and more refined use of pathology data and biomarker data from biopsy samples," the editorialists add.
Clinical Significance of Microsatellite Instability in Sporadic Epithelial Ovarian Tumors
Abstract: CONCLUSION: MSI was infrequent in ovarian tumors, including both borderline and malignant tumors. MSI was found to be uncommon in sporadic ovarian tumors, even by using additional MSI markers. The clinical significance of MSI is not strong in patients with sporadic ovarian tumors.
Link to full text (pdf file):
DISCUSSION
....MSI is caused by mutations in the mismatchrepair genes (MMR). MSI has been implicated in the pathogenesis of colon, endometrial, and gastric
carcinomas that occur in the setting of HNPCC (Lynch Syndrome), and also in a subset of sporadic cancers such as upper urinary tract, stomach, colon, andendometrial carcinomas.
In ovarian cancers, the reported incidence of MSI ranges from 0 to 37%, depending on the number and type of markers. Sood et al. first
reported the incidence of MSI in ovarian cancer using the NCI criteria.....Therefore, further study of molecular events that are correlated with ovarian tumors is needed."
JNCI podcast: re: recent frutis/vegetable/cancer risk study
Note: scroll down the page - the link as below will automatically start
"JNCI Interview: Dr. Regina Ziegler discusses a large study suggesting that fruits and vegetables are associated with only a modest reduction in cancer risk."
Thursday, May 06, 2010
Progesterone induces adult mammary stem cell expansion : Nature
Note: in research; defining the role of progesterones
"Reproductive history is the strongest risk factor for breast cancer after age, genetics and breast density. Increased breast cancer risk is entwined with a greater number of ovarian hormone-dependent reproductive cycles, yet the basis for this predisposition is unknown..........The emerging role of MaSCs (mammary stem cells) in cancer initiation warrants the study of ovarian hormones in MaSC homeostasis. Here we show that the MaSC pool increases 14-fold during maximal progesterone levels at the luteal dioestrus phase of the mouse."
Assessing Health-Related Quality of Life in Gyneco... [Int J Gynecol Cancer. 2010] - PubMed result
Int J Gynecol Cancer. 2010 May;20(4):664-684.
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically Important Differences and Change.
Luckett T, King M, Butow P, Friedlander M, Paris T.
*Psycho-oncology Co-operative Research Group, School of Psychology, daggerCentre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, Sydney, New South Wales, Australia; double daggerDepartment of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia; section signAustralia New Zealand Gynaecological Oncology Group (ANZGOG), Sydney, New South Wales, Australia; and parallelSchool of Psychology, University of Sydney, Sydney, New South Wales, Australia.
Abstract
OBJECTIVES:: Researchers wishing to assess the health-related quality of life (HRQoL) of women with gynecologic cancers have a range of questionnaires to choose from. In general, disease-, treatment-, or symptom-specific questionnaires are assumed to be better able to identify between-group differences (sensitivity) and changes over time (responsiveness) than are cancer-specific or generic questionnaires. However, little work has tested this assumption in oncology. We set out to (a) identify all multidimensional HRQoL questionnaires used in studies with women with gynecologic cancer and (b) evaluate their track records in identifying minimal clinically important differences (MCIDs), with a view to making recommendations. METHODS:: We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires. We used 10% of the scale range as the threshold for an MCID. RESULTS:: We identified 1 generic (SF-36/SF-12), 3 cancer-specific (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] C30, Functional Assessment of Cancer Therapy-General [FACT-G], and short-form Cancer Rehabilitation Evaluation System [CARES-SF]), and 1 disease-specific (QOL-Ovarian Cancer Patient Version) HRQoL questionnaires and 5 disease-specific (QLQ-OV28, FACT-O for ovarian, QLQ-CX24, FACT-Cx for cervical and FACT-V for vulvar), 1 treatment-specific (FACT and Gynecologic Oncology Group-Ntx for neurotoxicity), and 2 symptom-specific (FACT-Anemia and Functional Assessment of Chronic Illness and Therapy [FACIT]-Fatigue) modules. Twenty-seven articles reported results from 26 studies in which an MCID had been identified. The FACIT's anemia and fatigue subscales were more sensitive, and the neurotoxicity subscale more sensitive and responsive than the FACT-G on at least 1 comparison. However, we found no evidence for superior performance by the FACT-G compared with the SF-36 or EORTC and FACIT disease-specific modules versus the QLQ-C30 and FACT-G. There was also little evidence to favor EORTC versus FACIT questionnaires or vice versa. CONCLUSIONS:: The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.
Atypical identification of Lynch syndrome by immunohistochemistry and microsatellite instability analysis on jejunal adenocarcinoma
Note: abstract/free full text (pdf)
*this case describes a patient with many different cancers in the family including breast cancer, MSH6 deficiency
"LS (Lynch Syndrome) has been traditionally described in terms of earlyonset colorectal and endometrial cancers. Although this remains a confirmed association, we are learning more about the variability of LS and the prevalence of other cancers associated with this condition. The majority of cases of LS are reported to be caused by MLH1 and MSH2 gene mutations, but as evaluation for this condition becomes more widespread and routine in cases beyond the classically reported presentation, it is likely that we will come to find that the prevalence of other mismatch gene mutations is much higher than previously suspected."
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial -- Trimbos et al., 10.1093/jnci/djq149 -- JNCI Journal of the National Cancer Institute
"Abstract:
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events........Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Commentary:
CONTEXT AND CAVEATS
Prior knowledge
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial -- Trimbos et al., 10.1093/jnci/djq149 -- JNCI Journal of the National Cancer Institute
Brief Communication
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial
Affiliations of authors: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands (BT); Medisch Centrum Rijnmond Zuid, Rotterdam, the Netherlands (PT); EORTC Data Centre, Brussels, Belgium (PT, CC, KV, AC); Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy (SP); Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands (MvdB); Department of Medical Oncology, Hospital Universitario San Carlos, Madrid, Spain (AC)
Correspondence to: Baptist Trimbos, MD, PhD, Department of Gynecology, Leiden University Medical Center, POB 9600, 2300RC Leiden, the Netherlands (e-mail: j.b.m.z.trimbos@lumc.nl).
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events. In the ACTION trial, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation (no further treatment). The original analysis found that adjuvant chemotherapy improved recurrence-free survival but not overall survival and found in a subgroup analysis that completeness of surgical staging was an independent prognostic factor, with better recurrence-free and overall survival among those with complete (optimal) surgical staging. After a median follow-up of 10.1 years, we analyzed the more mature data from the ACTION trial and found support for most of the main conclusions of the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy (hazard ratio of death = 1.89, 95% confidence interval = 0.99 to 3.60; overall two-sided log-rank test P = .05). More cancer-specific deaths were observed among nonoptimally staged patients (40 [27%] of the 147 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) than among optimally staged patients (seven [9%] of the 75 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) (two-sided 
| CONTEXT AND CAVEATS Prior knowledge In the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation. After a median follow-up of 5.5 years, adjuvant chemotherapy was associated with improved recurrence-free survival but not overall survival. In a subgroup analysis, better recurrence-free and overall survival were observed among those with nonoptimal surgical staging than those with optimal staging. Study design Long-term analysis of data from this trial after a median of 10.1 years of follow-up. Contribution The long-term analysis supported most conclusions from the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy. More cancer-specific deaths were observed among nonoptimally staged patients than among optimally staged patients. Implications Completeness of surgical staging among patients with early ovarian cancer was statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy was restricted to patients with nonoptimal surgical staging. Limitations The trial was not designed to compare different surgical staging procedures. Patients could not be prospectively stratified by surgical staging category. The study had a limited sample size. Quality of life was not studied. From the Editors |
Scleroderma-like cutaneous lesions induced by paclitaxel and carboplatin for ovarian carcinoma, not a single course of carboplatin, but re-induced and worsened by previously administrated paclitaxel (Taxol)
"ABSTRACT
Scleroderma-like cutaneous lesion as an adverse event from paclitaxel and carboplatin has been reported. No report shows the occurrence of scleroderma-like cutaneous lesions from a single course of carboplatin. The patient is a 67-year-old female, administered paclitaxel and carboplatin as neoadjuvant chemotherapy. Following four courses, scleroderma-like cutaneous lesions were demonstrated. Skin biopsy corresponded to histopathological findings of scleroderma. Immunological investigation shows only antinuclear antibodies are positive. The characteristic Raynaud's phenomenon of scleroderma and hemorrhagic spots on the cuticles were not found. Postoperatively, a single course of carboplatin treatment was given. Scleroderma-like cutaneous lesions re-induced and worsened. This is the first report detailing scleroderma-like cutaneous lesions induced by previously administrated paclitaxel that worsened by carboplatin."
Discussions/paper: U.S. - JCO: Accelerated Approval and Oncology Drug Development Timelines
"Based on the US Food and Drug Administration's own standards, our findings, and the criticism of others, it is reasonable to conclude that improvements in AA processes are needed. The US Food and Drug Administration should have an open debate about AA restructuring and perhaps develop an entirely new program that better addresses the context of oncology. Public discussion, augmented by open access to relevant data, is essential."
Population-Based Study of the Risk of Second Primary Contralateral Breast Cancer Associated With Carrying a Mutation in BRCA1 or BRCA2 JCO
"The risks of subsequent contralateral breast cancer are substantial for women who carry a BRCA1/BRCA2 mutation. These findings have important clinical relevance regarding the assessment of BRCA1/BRCA2 status in patients with breast cancer and the counseling and clinical management of patients found to carry a mutation."
Curis Reports First Quarter 2010 Financial news
"Genentech also reported in April that:
-- It expects results from ongoing Phase II clinical trials of GDC-0449 in first-line metastatic colorectal in mid-2010 and in advanced ovarian cancer during the second half of 2010."
Wednesday, May 05, 2010
Mothers We Love | Ovarian Cancer National Alliance - submit a story about your Mom
Note: with thanks to Helen Palmquist - http://www.ovariancancer.org/2010/04/12/Jean-Strauss/ along with the many Mom's profiled
Mothers We Love 
A case-control study of asthma and ovarian cancer
Arch Environ Occup Health. 2010 Apr-Jun;65(2):101-5.
"Epidemiologic studies have found inverse associations between allergy and the development of certain tumors. The authors sought to determine if there was an association between asthma and ovarian cancer......The results of this statewide (Florida) exploratory study suggest that individuals with asthma may have a lower risk of developing ovarian cancer than nonasthmatics.
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically....
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically Important Differences and Change
Methods: We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires.
Conclusions: The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.
Postoperative Pulmonary Embolism Including Asymptomatic Case... : International Journal of Gynecological Cancer
Conclusions: A substantial number of postoperative PEs were occult, and identification of high-risk patients and routine SpO2 level monitoring would reduce the diagnostic delay of PE after gynecologic surgery. Increasing age, longer operation time, and obesity were risks. The use of a perioperative intermittent pneumatic compression device in multimodal conditions might thus prevent PE. (pulmonary embolism/blood clot)
Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malig.........
Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malignancy Index
Hypothesis
Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center.
Conclusions: A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.
Systematic Lymphadenectomy for Survival in Epithelial Ovarian Cancer: A Meta-Analysis
Note: also see post of Dr Maurie Markman (blogger dat May 4th) for Editorial on this particular subject matter
Conclusions: These findings suggest the possibility that SL can improve OS in advanced-stage EOC. However, the efficacy of SL on OS is still unknown because of the lack of RCTs, which requires more relevant studies for investigating the role of SL in EOC
Survivin Small Interfering RNA Transfected With a Microbubbl... : International Journal of Gynecological Cancer
Conclusions: Delivery of survivin siRNA using a microbubble contrast agent combined with ultrasound exposure can effectively inhibit survivin expression and induce apoptosis, providing a new promising approach for siRNA delivery in vivo.
Cervical, Uterine Corpus, and Ovarian Cancer Mortality in Greece During 1980 to 2005: A Trend Analysis
"The increasing trend of uterine corpus and ovarian cancer mortality in older women suggests that development of well-organized tertiary centers for the implementation of modern therapeutic modalities is urgently needed."
The James Lind Alliance announces the launch of online Guidebook for priority setting in research | The Cochrane Collaboration
"Sir Iain Chalmers, co-founder of the JLA says: “It is surprising how difficult it is to find out how research funders decide what research to fund. What is clear is that patients, carers and ordinary ‘jobbing’ clinicians are only very rarely involved in these processes. That is probably one of the reasons that the little evidence there is reveals mismatches between the questions that interest researchers and the questions that interest patients and clinicians. The James Lind Alliance Guidebook will help people who want to try to bridge those gaps.”...cont'd
2010: Collateral damage: toxic effects of targeted antiangiogenic therapies in ovarian cancer : The Lancet Oncology (abstract only)
Note: abstract/full access is by subscription/$$
Removing ovaries may boost lung cancer risk: Study media article
"We found that women who experienced non-natural menopause are at almost twice the risk of developing lung cancer compared to women who experienced natural menopause," Anita Koushik, a researcher at the Universite de Montreal's Department of Social and Preventive Medicine, said in announcing her team's findings Tuesday.
"This increased risk of lung cancer was particularly observed among women who had non-natural menopause by having had both their ovaries surgically removed."
It's the second study this year to associate bilateral oophorectomy — removal of both ovaries — with higher odds of developing lung cancer...."
Abstract/full access; TIMP-1 and VEGF-165 serum concentration during first-line therapy of ovarian cancer patients
Abstract (provisional)
Background
Angiogenesis appears to play an important role in ovarian cancer. Vascular endothelial growth factor (VEGF) has recently been implicated as a therapeutic target in ovarian cancer. The tissue inhibitor of metalloproteinase 1 (TIMP-1) is involved in tissue invasion and angiogenesis. The application of serum TIMP-1 and VEGF to monitor primary therapy and predict clinical outcome of patients with ovarian cancer is unclear.
The role of initial maximal surgical cytoreduction in ovarian cancer still debated Dr Maurie Markman Editorial
"Although the world of surgery is not necessarily characterized by the utility of innovative clinical hypotheses being formally evaluated through the conduct of randomized phase-3 clinical trials, it will hopefully be the case that the gynecologic cancer surgical community will see the wisdom of further exploration of these important concepts in prospective well-designed and evidence-based clinical trials.
Our current and future patients deserve no less."
Global cancer research initiative (full access0
Note: full access is available/click on 'pdf' "For the majority of citizens worldwide, effective, nontoxic, culturally appropriate, and attainable care for cancer has not yet been defined."
When Reputation Trumps Evidence-based Outcomes :: article
"It’s in the interests of public health to try our best to measure what should guide our health decisions – and to measure what actually does."
Avoiding the worst in shingles - media article
"The zoster vaccine has demonstrated benefit in reducing the frequency and severity of zoster in elderly patients. It’s an attenuated vaccine, so should be used with caution in patients who have immunosuppression."
Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors -- Maitland et al. 102 (9): 596 -- JNCI Journal of the National Cancer Institute
Box 1. Summary recommendations
- Conduct and document a formal risk assessment for potential cardiovascular complications before vascular endothelial growth factor signaling pathway (VSP) inhibitor treatment. The assessment should include standardized blood pressure measurements (two separate sessions are suggested) and thorough history and examination to assess specific cardiovascular risk factors, and directed laboratory studies as indicated. (Table 2 summarizes the risk factors.) The purpose of this evaluation is to guide the physician and patient in determining the appropriate intensity of monitoring and control of blood pressure elevations. This provides an important opportunity to address comorbidities that through more attentive management could help prolong the patient's life and support more aggressive anticancer therapy.
- Recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy. Given the suspected importance of pretreatment intervention in the management of VSP inhibitor–induced blood pressure elevations, properly collected, objective, office measurements or more thorough evaluations for isolated office hypertension (also known as "white coat hypertension") should guide the risk assessment rather than patient and/or physician speculation and dismissal.
- Actively monitor blood pressure throughout treatment with more frequent assessments during the first cycle of treatment. The first cycle is typically when the bulk of the blood pressure elevation is expected to occur and when most patients unexpectedly present with elevations warranting treatment even in the absence of preexisting cardiovascular risk factors.
- The goal for hypertension control in patients receiving VSP inhibitor therapy is a maximum blood pressure of 140/90 mmHg, and efforts to reach this goal should begin before initiation of VSP inhibitor therapy. The recommendation for a goal of maintaining blood pressure less than 140/90 mmHg is based on prudence and consistency with general guidelines. As per the risk stratification considerations, targets should be adjusted lower for patients with multiple preexisting risk factors for adverse consequences of high blood pressure. For example, for patients with diabetes and/or chronic kidney disease, a goal blood pressure of less than 130/80 mmHg is the current public health recommendation.
- Manage blood pressure elevations aggressively to avoid the development of complications associated with excessive/prolonged elevations. Management requires attention to proper agent selection, dosing, and scheduling of follow-up to ensure efficacy and to control adverse effects of the antihypertensive agent. The panel suggests that at any time, if the oncologist or responsible medical team member has any difficulty in helping the patient progress to the goal blood pressure of 140/90 mmHg, consultation with the local hypertension specialist (cardiologist, nephrologist, endocrinologist, or certified hypertension specialist) should be obtained promptly.
FDA Finalizes REMS Program for ESAs,; Amgen Continues to Study Risks -- limited information in text/article
Note: extract of article - limited information (requires subscription/$$)
Editorial: Dietary Assessment and the Reliability of Nutritional Epidemiology Research Reports
".......The fact that Dahm et al. could not correct the fiber consumption odds ratios for these types of systematic biases casts a shadow over the interpretation of their reported inverse association.
Unfortunately, this shadow extends to virtually the entire body of the existing nutritional epidemiology literature and may well contribute to the fact that few associations between diet and cancer are regarded as established or probable (8).
The explicit use of biomarkers to correct nutritional epidemiology associations for systematic and random measurement error in dietary assessment seems a logical next step in the nutritional epidemiology research agenda..." cont'd
Magnitude of Overdiagnosis in Cancer Indicates Need for Strategies to Address the Problem -- 102 (9): NP -- JNCI Journal of the National Cancer Institute
Note: in general, not specific to ovarian cancer
CA 125 Algorithm for the Early Detection of Ovarian Cancer - Full Text View - ClinicalTrials.gov
Note: still recruiting as of Jan 2010 Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women
Oncology Pharmacists Can Help Cancer Survivors Cope (Pharmacy Practice News)
Note: requires registration/free to view
".........She also said that more education should be directed at cancer survivors so that they know where to go when they have a problem when they are not routinely managed by the cancer care team.
“It may not be their oncology pharmacist, it may be their primary care physician or their community pharmacy, but we must tell them that these symptoms can occur and that they should be addressed. Our role as educators shouldn’t simply be to tell them that their chemotherapy can cause nausea and vomiting; rather, I think it should be to tell them that they may experience symptoms..."cont'd
Tuesday, May 04, 2010
Anti-angiogenesis therapies: their potential in cancer management
Note: click on 'pdf' for (free) access to the full paper
abstract: Ovarian cancer: predictors of early-stage diagnosis
Conclusion
These findings suggest that, in addition to tumor biology, disparities in access to care may have a significant effect on the timely diagnosis of epithelial ovarian cancer
MicroRNA (miR-155) Linked To Shut-Down Of DNA-Repair Genes
In research:
"The study, led by researchers at the Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, shows that microRNA-155 (miR-155) can inhibit the activity of genes that normally correct the damage when the wrong bases are paired in DNA.
The loss or silencing of these genes, which are called mismatch repair genes, causes inherited cancer-susceptibility syndromes and contributes to the progression of colorectal, uterine, ovarian and other cancers."
"Overall, Croce says, "Our findings suggest that miR-155 expression might be an important stratification factor in the prognosis and treatment of cancer patients and provide an additional analytical test for exploring the etiology of microsatellite-instability tumors when the standard tests do not provide a conclusive diagnosis."
Preclinical safety data reports Natural S-equol has little effect on 2 reproductive hormones
"About 50 percent of Asians and 20 to 30 percent of North Americans and Europeans, who in general consume less soy than Asians, have the ability to produce equol. Studies in Japan have documented an association between milder menopausal symptoms in equol producers as compared to non-producers."
Monday, May 03, 2010
Computer-based system automatically tracks radiation dose exposure in patients receiving CT scan
"Computer-based-system-automatically-tracks-radiation-dose-exposure-in-patients-receiving-CT-scan. "The fact that Valkyrie works with older CT equipment is important. This is an immediate solution for almost all hospitals, many of which may not be able to upgrade their CT technology in the short or medium term," said Shih."
Sunday, May 02, 2010
Epigenetics of ovarian cancer: From the lab to the clinic.
Epigenetics: Study of how proteins and other molecules that bind to DNA and chromosomes can change gene expression without changing the DNA sequence
CONCLUSIONS: Although the epigenetics of ovarian cancer is still in its beginnings, it holds promising potential in early stage ovarian cancer detection, evaluation of prognosis/drug resistance and targeted cancer treatment.
(U.S.)Impact of a chemoresponse assay on treatment costs recurrent ovarian cancer
Abstract
OBJECTIVE: We sought to estimate mean costs of chemotherapy treatment for recurrent ovarian cancer with or without use of a chemoresponse assay.
STUDY DESIGN: We estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.
RESULTS: The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.
CONCLUSION: Assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy.
Differential sensitivity to platinum-based chemotherapy in primary uterine serous papillary carcinoma cell lines with high vs low HER-2/neu expression
Note: in the lab/uterine cancer
"Higher proliferative capability rather than increased drug resistance may be responsible for the adverse prognosis associated with HER-2/neu overexpression in USPC."
Is chemotherapy-induced neutropenia a prognostic factor in patients with ovarian cancer?
CONCLUSION: Chemotherapy-induced neutropenia was not a significant prognostic indicator in ovarian cancer patients treated with paclitaxel/carboplatin as first-line chemotherapy.
Saturday, May 01, 2010
Serum testosterone levels measured by isotope dilution-liquid chromatography-tandem mass spectrometry in postmenopausal women versus those in women who underwent bilateral oophorectomy
abstract: "A significant decrease was found in testosterone concentrations before and after bilateral oophorectomy, whereas no significant difference was found before and after natural menopause."
Friday, April 30, 2010
Primary peritoneal cancer after bilateral salpingo-oophorectomy in two patients with Lynch syndrome.
Primary peritoneal cancer after bilateral salpingo-oophorectomy in two patients with Lynch syndrome.
Obstet Gynecol. 2010 Feb
Authors: Schmeler KM, Daniels MS, Soliman PT, Broaddus RR, Deavers MT, Vu TM, Chang GJ, Lu KH
BACKGROUND: Women with Lynch syndrome or hereditary nonpolyposis colorectal carcinoma (HNPCC) have a 40-60% lifetime risk of endometrial cancer and a 7-12% lifetime risk of ovarian cancer. Risk-reducing surgery, including hysterectomy and bilateral salpingo-oophorectomy (BSO), is currently recommended once child bearing is complete. We describe two cases of primary peritoneal cancer after BSO in women with Lynch syndrome or HNPCC.
CASES:
The first patient was a 44-year-old woman who underwent hysterectomy with BSO for benign disease. She presented 12 years later with a pelvic mass and was diagnosed with a high-grade serous primary peritoneal cancer. Genetic testing showed a mutation in the MSH2 DNA mismatch repair gene.
The second case was a 58-year-old woman who had a hysterectomy and BSO for endometrial cancer. She developed a high-grade serous primary peritoneal cancer 8 years later and was found to have a mutation in the PMS2 DNA mismatch repair gene.
CONCLUSION: Women with Lynch syndrome or HNPCC should be counseled that they may be at risk for developing primary peritoneal cancer despite undergoing gynecologic cancer risk-reducing surgery. The magnitude of this risk remains to be determined.
PMID: 20093870 [PubMed - in process]
Gastroenterology and Endoscopy News - Inherited Colon and Rectal Cancer
"In Part 1 of this four-part series, we examine the clinical pathology and molecular biology of (Lynch Syndrome) hereditary nonpolyposis colorectal cancer (HNPCC). In Part 2, we will discuss screening and treatment, and the roles of the epidemiologist, the diagnostician and the surgeon."
An estimated 150,000 Americans may be carriers of the (Lynch Syndrome) HNPCC mutation(s) and have a 90% lifetime risk for developing some type of cancer. (MSH2/MSH6/MLH1/PMS2)
FDA Approval For Dendreon Provenge Immunotherapy Vaccine - pharma news/Australia "CVac"
"Dendreon is using cancer immunotherapies that use the patient's own immune system to treat cancer and the approval of Provenge represents a scientific and clinical advancement for the treatment of prostate cancer.
Prima BioMed, an Australian biotechnology firm focused on cancer immunotherapy, is using the technology to develop its CVac immunotherapy cancer vaccine for the treatment of ovarian cancer."
NIH AccrualNet - A Resource and Professional Community for Clinical Trial Accrual
Note: diagram shows the processes of clinical trials
ESAs (erythropoiesis-stimulating agents) not cost effective in cancer patients with anemia | HemOncToday
Blogger opinion: more concerning than cost is the recent research regarding increased mortality rates with the use of ESAs
"The use of erythropoiesis-stimulating agents to reduce the need for blood transfusions and improve quality of life in cancer patients with anemia was found to be economically unattractive by an analysis using the Canadian public health care system."
Previous work has shown that erythropoiesis-stimulating agents (ESAs) are preferred by patients compared with transfusion and can improve short-term disease-specific quality of life in patients with cancer, but there are concerns over toxicity and cost of the agents. Researchers created a decision analytic model incorporating resource utilization and health outcomes to test the cost-effectiveness of ESA use in patients with anemia related to cancer. Using a model cohort, treatment with epoetin resulted in incremental costs of $8,643 over 15 weeks compared to no ESA use. This gave an incremental cost per quality-of-life-year (QALY) gained of $267,000. Even when a model overemphasizing the potential benefits of ESAs was used, the cost per QALY gained remained greater than $100,000.
Finally, separate analyses were conducted using data from studies that followed the most recent American Society of Hematology/ASCO guidelines for ESA use; these guidelines are more conservative in their recommendations for using ESAs. The results did show lower costs than the base case, but the cost per QALY remained greater than $70,000. In three of 10 models, ESA use had more cost and less benefit than no ESA use.
“ESA use in patients with [anemia related to cancer] does not appear to be economically attractive, even when used in the more conservative fashion recommended by current guidelines,” the researchers wrote. “Available evidence suggests that using ESA to treat anemia related to cancer does not represent a good value for the money.”
link to abstract:
http://www3.interscience.wiley.com/journal/123359351/abstract?CRETRY=1&SRETRY=0
open access: The Canadian Facts from the Social Determinents of Health perspective - University of York
Social Determinants of Health:
The Canadian Facts
Juha Mikkonen and Dennis Raphael
Published in May 2010. ISBN 978-0-9683484-1-3
Summary
The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information – based on decades of research and hundreds of studies in Canada and elsewhere – is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience.
Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact.
Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date. Social Determinants of Health: The Canadian Facts considers 14 social determinants of health:
1. Income and Income Distribution
2. Education
3. Unemployment and Job Security
4. Employment and Working Conditions
5. Early Childhood Development
6. Food Insecurity
7. Housing
8. Social Exclusion
9. Social Safety Network
10. Health Services
11. Aboriginal Status
12. Gender
13. Race
14. Disability
The publication outlines why they are important; how Canada is doing in addressing them; and what can be done to improve their quality. The purpose of the document is to provide promote greater awareness of the social determinants of health and the development and implementation of public policies that improve their quality.
Abstract/free access: Curcumin induces chemo/radio-sensitization in ovarian cancer cells and curcumin nanoparticles inhibit ovarian cancer cell growth
Note: in research (cisplatin/radiation resistant cell lines)/highly technical
"This study demonstrates a novel curcumin pre-treatment strategy that could be
implemented in pre-clinical animal models and in future clinical trials for the effective treatment of chemo/radio-resistant ovarian cancers."
May 1/2010 - abstract/full access - Review: Practical considerations in ovarian cancer chemotherapy -- Therapeutic Advances in Medical Oncology
Note: this journal is offering free access (registration required)
EvidenceUpdates-Cochrane Collaboration review/commentaries: Self-monitoring and self-management of oral anticoagulation (Warfarin)
Note - warfarinCONCLUSIONS:
Compared to standard monitoring, patients who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. The number of thromboembolic events and mortality were decreased without increases in harms. However, self-monitoring or self-management were not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their general practitioner, and inability to complete training.
Thursday, April 29, 2010
Clinical Update - Ovarian Cancer (commentary - Australia)- Secondary cytoreductive surgery in the management of platinum-sensitive recurrent epithelial ovarian cancer ...
Note: abstract plus commentary from Australian specialist/Associate Professor Jim Nicklin; includes reference to upcoming trial results
Disruptive Women in Health Care » Blog » “News (Hot) Flash: Sex, Drugs and Menopause” Recap – 2010 Breakfast Series
Blog Note: at the time of the WHI publications, both clinical and media, this blogger attended several debates/seminars on the WHI. Along with others, we have finally been redeemed via this statement, albeit few listened.
"....Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, started off speaking about the Women’s Health Initiative. “There was a lot of misinterpretation, some of the results reported were incorrect,” she said. She quickly explained what they did, what was wrong, and what’s true today...."
Search of: ovarian cancer | Open Studies | received from 04/01/2010 to 04/29/2010 - List Results - ClinicalTrials.gov
quick search: ovarian cancer trials - recruiting - listed between Apr 1 - Apr 29th
press release: Comparison of available breast cancer risk assessment tools shows room for improvement
"All of these models have major limitations, say the authors. Most important is their reliance on known risk factors. Studies have shown that up to 60% of breast cancers arise in the absence of any known risk factors. Also, except for the Gail model, none of the models has been extensively validated, and most do not include nonhereditary factors. The Gail model has limited ability to discriminate between individuals at risk, especially those in higher-risk groups, according to the authors."
full free access: Editorial: Early Diagnosis of Hereditary Breast Cancer by Magnetic Resonance Imaging: What Is Realistic?
"....With respect to future perspectives, studies on tumor recurrence and mortality are important. All studies have shown that early detection of breast cancer, especially by MRI screening, is realistic, although only the Dutch and Norwegian studies had (nonrandomized) control groups. However, a downward shift of stage as a surrogate end point does not guarantee a survival benefit due to potential lead time and length time bias. Therefore, and in few of the absence of randomized trials, large prospective observational studies with long-term follow-up (
10 years) are needed to describe concrete survival effects on mortality reduction by screening, rather than rely on outcomes calculated by computer models based on tumor stage. Furthermore, the (potential) long-term adverse effects of yearly MRI screening for longer than 25 to 35 years from the age of 25 to 30 have to be evaluated, especially in regard to possible development of contrast-induced nephropathy."
Yale Cancer Genetic Counseling blog
Monday, April 19, 2010
Myriad raises price of BRCA testing, again.
On April 1, 2010 - three days after a court ruling that invalidated Myriad's patents on the BRCA1 and BRCA2 genes (associated with hereditary breast and ovarian cancer) the company increased their prices for genetic testing. Old cost =$3,770. New cost = $4,040 for full sequencing plus rearrangement testing.
Oncology Times: How Legal Services Are Supplementing the Psychosocial Work of the Cancer Care Team
Note: references several free services
Wednesday, April 28, 2010
CDC report: Genomics|Genetic Testing|EGAPP Recommendations|Lynch Syndrome
Centers for Disease Control and Prevention (U.S.)
April 2010: Genomics|Genetic Testing|EGAPP Recommendations|Lynch Syndrome
EGAPP Working Group Recommendation
Genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives
Approximately 3% of people who develop colorectal cancer have an autosomal dominant inherited condition known as Lynch syndrome, sometimes referred to as Hereditary Nonpolyposis Colorectal Cancer or HNPCC. Individuals with this condition have a greatly increased chance to develop colorectal and other cancers, especially under age 50. Screening for Lynch syndrome in all patients with newly diagnosed colorectal cancer has been proposed to improve outcomes for patients and/or family members.
EGAPP Recommendation Statement: The EGAPP™ Working Group found sufficient evidence to recommend offering genetic testing for Lynch syndrome to individuals with newly diagnosed colorectal cancer (CRC) to reduce morbidity and mortality in relatives. We found insufficient evidence to recommend a specific genetic testing strategy among the several examined.
Note: See website for access to the pdf files below (full free access):
- EGAPP Recommendation (PDF 220KB) (Jan 2009)
- Evidence Report (May 2007)
- Supplementary Evidence Report (PDF 664KB) (Jan 2009)
- CDC Summary of Lynch Syndrome EGAPP Recommendation (Apr 2010)
Abstract/full free access: Evolution and cancer: a mathematical biology approach
"This thematic series is concerned with various ways Evolution is intertwined with cancer. A group of cancer researchers and mathematical modelers, with an interest in the subject, was invited to contribute papers on topics ranging from carcinogenesis through progression of cancer through therapy." ....cont'd
Combination versus sequential cytotoxic chemotherapy in recurrent ovarian cancer: Time for an evidence-based comparison
Note: no abstract/subscriber based journal ($$)
Combination versus sequential cytotoxic chemotherapy in recurrent ovarian cancer: Time for an evidence-based comparison.
Markman M
Webcast/CME - Institute for Continuing Healthcare Education - Ovarian Cancer Screening and Management to Improve Patient Survival Apr 16, 2010
Webast/CME
OVERVIEW
Ovarian cancer is the leading cause of death from gynecologic malignancy and the fifth leading cause of cancer‐related death among women in the United States. The high mortality rate associated with ovarian cancer is due in part to the lack of effective screening strategies to detect the disease in early stages (I or II) when the cancer is confined to the ovary. Since symptoms associated with ovarian cancer are typically nonspecific, a clinical diagnosis is difficult to make until the disease has advanced. The Institute for Continuing Healthcare Education has identified a number of areas related to the screening, diagnosis, and treatment of ovarian cancer where education is vital in order to address the need for improvement in professional care.
SGO: Change in Antigen Predicts Ovarian Cancer Outcomes - in Meeting Coverage early stage ovarian cancer
"The Gynecologic Oncology Group (GOG) 157 trial provided an opportunity to examine the change in CA-125 and its relationship to outcomes in women with early-stage ovarian cancer. The trial involved 427 women with stage I-II epithelial ovarian cancer. They were randomized to receive three or six cycles of chemotherapy with carboplatin and paclitaxel.
All patients had detailed surgical staging before randomization. Chan said detailed information about CA-125 levels was available for 350 participants in the trial."
"There is a lack of data in early-stage ovarian cancer on the pattern of CA-125," said Chan. "Previous studies generally had no comprehensive staging and no central pathology review."
"An elevated level that declined to normal after the first cycle of chemotherapy was associated with recurrence-free and overall survival of 87% and 88%, respectively.
Patients with an elevated CA-125 before and after the first cycle of chemotherapy had recurrence-free survival of 68% and overall survival of 77%."
abstract: New technologies for the detection of circulating tumour cells.
"The vast majority of cancer-related death is due to the metastatic spread of the primary tumour. Circulating tumour cells (CTC) are essential for establishing metastasis and their detection has long been considered as a possible tool to assess the aggressiveness of a given tumour and its potential of subsequent growth at distant organs.
Conventional markers are not reliable in detecting occult metastasis and, for example, fail to identify approximately 40% of cancer patients in need of more aggressive or better adjusted therapies. Recent studies in metastatic breast cancer have shown that CTC detection can be used as a marker for overall survival and assessment of the therapeutic response. The benefits of CTC detection in early breast cancer and other solid tumours need further validation.
Moreover, optimal CTC detection techniques are the subject of controversy as several lack reproducibility, sensitivity and/or specificity. Recent technical advances allow CTC detection and characterization at the single-cell level in the blood or in the bone marrow. Their reproducibility propels the use of CTC in cancer staging and real-time monitoring of systemic anticancer therapies in several large clinical trials.
CTC assays are being integrated in large clinical trials to establish their potential in the management of cancer patients and improve our understanding of metastasis biology. This review will focus on the techniques currently used, the technical advancements made, the limitations of CTC detection and future perspectives in this field."
Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer
"These findings demonstrate the choice between BCS (breast conserving surgery) and mastectomy as initial treatment for breast cancer is a multifactorial decision with patient preference, surgical recommendation, and failure of BCS all playing an important role."
Analysis of 136 Ureteral Injuries in Gynecological and Obstetrics Surgery From Completed Insurance Claims
"...Most injuries were found postoperatively; only 17 were discovered during surgery. The investigators conclude from these findings that most if not all ureteral injuries occurring through negligence are potentially avoidable with use of established surgical practices, especially dissecting out the ureter when indicated."
Tuesday, April 27, 2010
abstract: Tumor Type and Substage Predict Survival in Stage I and II Ovarian Carcinoma: Insights and Implications
"Tumor grade has been the most accepted prognostic indicator of disease-specific survival among women with stage I and II ovarian carcinomas. Many investigators have included stage IB, grade 1 at diagnosis as low-risk disease and have suggested that women in this category should not receive adjuvant therapy. However, grading assignment appears to be unreliable because of problems with reproducibility and lack of consideration of biological differences between the different tumor types. Some investigators believe that classification based on tumor typing using new histopathological criteria was more reproducible than grade assignment and would more accurately reflect biological differences..."cont'd
Saskatchewan Science - National Biotech Competition awards - student award/ovarian cancer
"Brian, a Grade 11 student at John F. Ross Collegiate Vocational Institute, won the 2nd place prize for his project that found a green tea extract offered a potential new treatment for ovarian cancer."
full access: PLoS Medicine: Comparative Effectiveness Research: Challenges for Medical Journals
"We recognize that CER has the potential to substantially improve decision-making about existing and new approaches to health care. To fulfill this potential, researchers must adopt stringent methods, and medical journals must hold them to high standards of ethics, scientific rigor, and reporting."
AACR video and slides - Metastases Dr Danny Welch
Intro video: history/defining metastases; comparisons of different cancers (survival rates - slide 3); appropriate funding; genetics/multigenetic issues eg. RNAs; technology; metastatatic 'cascade'; 4 different types of pathways of tumour cells etc
full free access: Future Medicine - Aging Health - Antiaging medicine: what should we tell our patients?
"..Both Oprah Winfrey and Mehmet Oz are suing internet sites for using their names..."
The Empowered Patient: Report An Adverse Event/survey and website information
The Empowered Patient Coalition
Patient reporting site for medical errors is nowonline!
Dear Friends,
The Empowered Patient Coalition is
pleased to announce that a new survey for reporting adverse medical
events is now
permanently online at http://www.
Created
in collaboration with Consumers Union Safe
Patient Project, the survey aims to provide a snapshot of medical
harm as it is lived by those who undergo it, beginning with the
patient's initial procedure or treatment and continuing all the way
through the patient and family experience of the legal system.
Responses will be presented in de-identified, aggregated form at www.empoweredpatientcoalition.org.
This is an
international survey. Reports will be
displayed by country, and reports from the US and Canada will also be
tallied by state or province whenever the respondent provides such
information....cont'd
full free access:Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis — Ann Oncol
"Further research is needed to identify reasons for the heterogeneity in prevalence rates. It may be that tumour site, stage, and treatment as well as cultural factors may play a role, but this needs further investigation. In addition, a fair amount of oncological care takes place in outpatient settings. It would therefore be worthwhile to carry out another meta-analysis of studies, investigating the prevalence of mental disorders at that stage of cancer care."
End of life in cancer patients: drugs or words? — Ann Oncol
Note: editorial partial extract from full paper ($$)
interview with Dr Clarke-Pearson - gyn/oncology data 2009/2010 AACR/SGO
Daniel L. Clarke-Pearson, MD, chairman of the department of obstetrics and gynecology and Robert A. Ross Professor at the University of North Carolina School of Medicine, Chapel Hill, was recently elected the 42nd president of the Society of Gynecologic Oncologists.
HemOnc Today spoke with Clarke-Pearson about developments in gynecologic oncology in 2009 and important data presented at The Society for Gynecologic Oncologists’ 2010 Annual Meeting.
repost: Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study — Ann Oncol
Note: research specific to breast cancer patients
"Conclusions: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause."
Candidate gene association studies: successes and failures
Abstract
"Epidemiologic studies of twins indicate that 20-40% of common tumors such as breast, colorectal, and prostate cancers are inherited. However, the effect of high penetrance tumor susceptibility genes such as APC, BRCA1, BRAC2, MSH1, MLH2 and MSH6 only accounts for a small fraction of these cancers. Low to moderate penetrance tumor susceptibility genes likely account for the large remaining proportion of familial cancer risk...."
Monday, April 26, 2010
full free access: PLoS ONE: Genetic Analysis of the Early Natural History of Epithelial Ovarian Carcinoma
Conclusions/Significance
Together,
these data indicate that EOC frequently arises in ovarian cystic
inclusions, is preceded by an identifiable dysplastic precursor lesion,
and that increased cell proliferation, decreased apoptosis, and
aneuploidy are likely to represent very early aberrations in ovarian
tumorigenesis.
media item: Study Makes Strides in Understanding Ovarian Cancer (cysts/BRCA/sporadic)
Important: see post April 26th - full free access:
PLOS One: Genetic Analysis of the Early Natural History of Epithelial Ovarian Carcinoma
~~~~~~~~~~~~~~
Media article:
"This is the first study giving very strong evidence that a substantial number of ovarian cancers arise in inclusion cysts and that there is indeed a precursor lesion that you can see, put your hands on, and give a name to," lead author Jeff Boyd, chief scientific officer at Fox Chase Cancer Center in Philadelphia, said in a news release. "Ovarian cancer most of the time seems to arise in simple inclusion cysts of the ovary, as opposed to the surface epithelium."...cont'd
please read - for followers (blog)
April 26th, 2010: Apologies - tech issues - blog posts will be sporadic for the next day or so, please continue to check back for those not on auto-subscribe/feeds
Ontario Institute for Cancer Research Announces Three New Equity Investments -- TORONTO, April 26 /PRNewswire/ --
Note: press release has further information on the investments:
1)Novel Cellular Immunotherapy for Cancer;
2)Next Generation Biomarker Analysis Technology;
3)Rapid, Sensitive Technology for Biomarker Analysis
News: AACR: Nodectomy Helps in Carcinosarcoma - in Meeting Coverage, AACR
"Lymphadenectomy was associated with significant improvement in survival (P<0.001) in patients with ovarian and uterine carcinosarcomas, but the procedure was not performed as often in those with ovarian disease.
"Improved survival observed in the lymphadenectomy group argues in favor of routinely performing lymph node dissection in patients with uterine and ovarian carcinosarcoma," Gunjal Garg, MD, of Detroit Medical Center, and colleagues concluded in a poster presentation at the American Association for Cancer Research.
Carcinosarcomas are malignant mixed mullerian tumors. Carcinosarcomas that arise in the female genital tract are rare but associated with poor prognosis. Previous studies demonstrated that tumors of similar histology and originating in nearby organs might be biologically distinct entities because of involvement with different molecular pathways, Garg and colleagues noted..."cont'd
new journal (and index of abstracts) The Human Genome Organisation (HUGO)
The Human Genome Organisation (HUGO)
Sunday, April 25, 2010
BRCA1 and BRCA2 mutations across race and ethnicity: distribution and clinical implications
Abstract
PURPOSE OF REVIEW: To summarize evidence on the prevalence and spectrum of BRCA1 and BRCA2 BRCA1/2 mutations across racial and ethnic groups and discuss implications for clinical practice.RECENT FINDINGS: The prevalence of BRCA1/2 mutations is comparable among breast cancer patients of African, Asian, white, and Hispanic descent: approximately 1-4% per gene. Among ovarian cancer patients in North America, BRCA1/2 mutations are present in 13-15%. Between racial/ethnic groups, there are important differences in the spectrum of BRCA1 compared with BRCA2 mutations, in BRCA1/2 variants of uncertain significance, and in the accuracy of clinical models that predict BRCA1/2 mutation carriage.
SUMMARY: Given the significant prevalence of BRCA1/2 mutations across race/ethnicity, there is a need to expand and customize genetic counseling, genetic testing, and follow-up care for members of all racial/ethnic groups.
Odds Are, It's Wrong - Science News
Note: talks about statistics
“Determining the best treatment for a particular patient is fundamentally different from determining which treatment is best on average,” physicians David Kent and Rodney Hayward wrote in American Scientist in 2007."
Saturday, April 24, 2010
CHUM (Montreal) turns cancer patients away
"The crisis at Notre Dame Hospital, a renowned cancer treatment centre, has reached such acute proportions that hospital officials are sending letters to women diagnosed with gynecological cancer to seek treatment elsewhere – in hospitals in Quebec City and Trois Rivières....."
"In fit of anger, (Dr.) Sauthier penned an open letter to his colleagues accusing the Quebec Health Department, the Quebec College of Physicians and his hospital of ignoring best practices in favour of balancing the books.
"Ovarian cancer survivor Suzanne Poulet read Sauthier’s letter aloud after Health Minister Yves Bolduc lauded his department’s successes inbreast and colon cancer screening programs as well as anti-smoking legislation. “What about problems operating on women with gynecological cancer?” Poulet demanded. Such delays are “intolerable” and “unacceptable,” Bolduc responded. “It’s an emergency and we are in the process of fixing it.”
Read more: http://www.montrealgazette.com/health/CHUM+turms+cancer+patients+away/2945070/story.html#ixzz0lzEiOwCF
Medical News: AACR: No NSAID Link to Ovarian Cancer (data taken from California Teachers Study)
WASHINGTON -- Regular use of anti-inflammatory drugs did not reduce the risk of ovarian cancer, a large prospective cohort study showed.
Neither weekly nor daily use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) influenced the relative risk of ovarian cancer, California investigators reported here at the American Association for Cancer Research meeting.
But self-reported daily use of acetaminophen almost doubled the risk of ovarian cancer, they found.
"Our results do not support the hypothesis that these medications reduce the risk of ovarian cancer," Lei Duan, PhD, of City of Hope in Duarte, Calif., and colleagues concluded. "Conversely, the finding that daily acetaminophen use was associated with increased risk of ovarian cancer differs from previous studies and may warrant further investigation."...cont'd
Action Points:
- Explain to interested patients that regular use of aspirin or nonsteroidal anti-inflammatory drugs did not influence the risk of ovarian cancer.
- Explain that daily use of acetaminophen was associated with an increased risk of ovarian cancer.
- Explain that the findings were based on a retrospective review of a large database and therefore cannot prove that acetaminophen caused the increased risk of ovarian cancer.
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Review and revision of guidelines for ovarian cancer in Japan (abstract)
A survey of members of the Japan Society of Gynecologic Oncology revealed that 93% of the members use the present Guideline for Ovarian Cancer Treatment in practice.
Medical News: FDA Announces New Infusion Pump Safety Initiative - in Public Health & Policy, FDA General from MedPage Today
The FDA (U.S.) announced a new safety initiative Friday aimed at improving the safety of one of the most commonly recalled categories of medical devices: infusion pumps.
Uncertainty in Assessing Value of Oncology Treatments -- The Oncologist
abstract:
Patients, clinicians, payers, and policymakers face an environment of significant evidentiary uncertainty as they attempt to achieve maximum value, or the greatest level of benefit possible at a given level of cost in their respective health care decisions. This is particularly true in the area of oncology, for which published evidence from clinical trials is often incongruent with real-world patient care, and a substantial portion of clinical use is for off-label indications that have not been systematically evaluated.
It is this uncertainty in the knowledge of the clinical harms and benefits associated with oncology treatments that prevents postregulatory decision makers from making accurate assessments of the value of these treatments. Because of the incentives inherent in the clinical research enterprise, randomized control trials (RCTs) are designed for the specific purpose of regulatory approval and maximizing market penetration.
The pursuit of these goals results in RCT study designs that achieve maximal internal validity at the expense of generalizability to diverse real-world patient populations that may have significant comorbidities and other clinically mitigating factors.
As such, systematic reviews for the purposes of coverage and treatment decisions often find relevant and high-quality evidence to be limited or nonexistent. For a number of reasons, including frequent off-label use of medications and the expedited approval process for cancer drugs by the U.S. Food and Drug Administration, this situation is exacerbated in the area of oncology.....
"Until scientific advancements in treatment occur, significant gaps in real-world evidence will be pervasive in the area of oncology. This situation has negative consequences for a variety of players in health care, from patients and physicians to payers and policymakers. Addressing these gaps would result in better decisions that improve patient outcomes and reduce unnecessary costs."
Beyond Costs and Benefits: Understanding How Patients Make Health Care Decisions -- The Oncologist
CONCLUSION:
Physicians are increasingly recognizing that many medical decisions are not purely medical decisions, but hinge on patient preferences. This recognition of patients' preferences has raised the challenge of finding ways to communicate the costs and benefits of treatments in ways that patients not only comprehend, but can also integrate with their own values to help the clinician determine what treatment choice is best for that given patient.
quote of the day
"the one path for which there is no good alternative
is that of living and acting with integrity"
Radiation Research
open access - free: Imaging in Radiation Oncology: A Perspective -- The Oncologist
Note: not specific to ovarian cancer; paper addresses the importance of imaging techniques (ie; MRI/PET) while planning radiation therapies.
some excerpts:
- Shortly after the discovery of the x-ray in 1895, the potential therapeutic benefits of the x-ray and possible toxicities were realized. More than a century later, we continue to struggle with how to balance the intensity of cancer treatment toward increasing the chance of cure with the potential for normal tissue toxicity. Imaging has improved our understanding of the complexities of cancer biology, cancer diagnosis, staging, and prognosis, and it is an essential component of present-day radiation oncology practice. Progress in radiation oncology has occurred in parallel to advances in imaging.
- The primary decisions that radiation oncologists make daily are to decide who to treat, what to treat, what to avoid, and how to deliver the intended doses safely. Imaging is considered in each of these decisions. Although the steps described in sequence below often occur simultaneously, they feed back to each other. Predictions about uncertainties and response in a specific patient can be made from experience in treating a population of similar patients or as more is learned about the patients themselves (e.g., with imaging obtained during therapy).
- How to define the gross tumor volume and volumes at risk for containing microscopic disease (clinical target volumes [CTVs]) is not an easy task. Different imaging tools demonstrate inherently different representations of the tumor
In the News (U.S.) NCI will offer cancer e-care record for providers
"The EHR is based on a early reference implementation of the Patient Outcomes Data Service, an open source “ultra-light record” derived from standards of NCI’s Cancer Biomedical Informatics Grid (caBIG).
The record, which is set up to provide data on patient demographics, disease and treatment results, could be used by providers and even consumers for data exchange.
“Because we use standards, anybody can push it or receive it,” Buetow said in remarks at a conference sponsored April 12 by the World Health Care Congress
The specifications and the software are available now through the NCI site but are not consumer-friendly, Buetow said. NCI plans to make it easily accessible to providers and consumers who would want to use it, within 60 days.
NCI is working with SAIC and Microsoft on the project, he added"
Friday, April 23, 2010
New wellness center to open in Middletown | New England Business Bulletin
MIDDLETOWN, R.I. — Women & Infants Hospital is opening a new wellness center at 333 Valley Road in Middletown this month, as part of its Integrative Care Program.
Operating within the hospital's Program in Women's Oncology, the Center for Health and Well-Being will offer a menu of complementary therapies for oncology patients as well as wellness programming to appeal to all women.
"We will offer the full range of complementary therapies, traditional and innovative health and wellness programming, and a women's health library full of resource materials on a variety of topics, from cancer to infertility to post-partum depression," said Sandra Scuncio, director of the Integrative Care Program.
Lymphedema therapy, specialized massage for women who have had surgery for breast or gynecologic cancer, is one of the treatments that will be offered at the Middletown site. Others include acupuncture, therapeutic massage, reiki, hypnotherapy, guided imagery, reflexology, meditation, facials and skin care.
In addition, there will be programs dedicated to weight loss, exercise, and nutrition, plus lectures, a weight loss clinic and yoga sessions. Eventually, there are plans to offer counseling services for cancer patients.
Funding to establish Newport the site was provided through a grant from the van Beuren Charitable Foundation.
New Articles -- EvidenceUpdates
| Mujoomdar M Moulton K Nkansah E Positron emission tomography (PET) in oncology: a systematic review of clinical effectiveness and indications for use. Canadian Agency for Drugs and Technologies in Health (CADTH). 2010 Apr:1-36. (Review) |
| EXECUTIVE SUMMARY Context and Policy Issues In 2008, approximately 166,400 new cases of cancer were diagnosed in Canada. Radiological imaging modalities, including positron emission tomography (PET), are used in the diagnosis, staging, assessment of treatment response, and monitoring of recurrence of cancers. PET is a modality that is used to provide a three-dimensional image of functional changes in the body. PET can be used to track the deposition of radioactive molecules to sites in the body. The most common radioactive tracer is 2-[18F] Fluoro-2-deoxy- D-glucose (FDG). FDG is a glucose analogue that accumulates in tissues with high metabolic activity, such as tumour tissue. In addition to its use in cancer diagnosis, PET is commonly used to determine the stage or extent of disease for various types of cancers. The approach to treating the cancer will depend on the stage. Therefore, accurate information about diagnosis and staging is critical for planning the most appropriate treatment strategy. PET is also used to assess how a person is responding to treatment during or at the end of the treatment, and to monitor if the cancer has recurred after treatment. The use of PET is on the rise, and the number of possible indications for PET use is increasing. Access to PET varies across Canada. With an increasing number of Canadians being diagnosed with cancer each year, there is a need to review the evidence on the clinical effectiveness of PET for oncologic conditions compared with other imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI). Research Questions 1. What is the clinical effectiveness of positron emission tomography (PET) in oncology compared to computed tomography (CT) and magnetic resonance imaging (MRI) when used as an adjunct to CT or MRI? 2. What are the indications for PET use in oncology? Methods Published literature was obtained by crosssearching PubMed, MEDLINE, and Embase on the OVID search system between 2007 and December 4, 2008. Parallel searches were performed on The Cochrane Library (Issue 4, 2008), and the University of York’s Centre for Reviews and Dissemination (CRD) databases. Results were limited to English language publications only. Filters were applied to limit the retrieval to systematic reviews, health technology assessments (HTAs), meta-analyses, and guidelines. The websites of HTA and related agencies were searched, as were specialized databases such as those of the National Institute for Health and Clinical Excellence (NICE), ECRI Institute, and EuroScan. The Google search engine was used to search for information on the Internet. Two independent reviewers screened articles for selection. This report was peer-reviewed by two clinical experts. Summary of Findings Three HTAs were identified in our literature search. The first HTA assessed the clinical Positron Emission Tomography (PET) in Oncology: A Systematic Review of Clinical Effectiveness and Indications for Use v effectiveness of PET in breast, colorectal, head and neck, lung, lymphoma, melanoma, esophageal, and thyroid cancers. The use of FDG-PET for diagnosis, staging or restaging, and monitoring recurrence and treatment for each cancer type was evaluated. The authors concluded that the highest quality evidence on the clinical effectiveness of PET was in the detection of distant metastases, staging or restaging of colorectal cancer, detection of solitary pulmonary nodules, staging of non-small cell lung cancer (NSCLC), and restaging of Hodgkin disease. The second HTA reviewed the use of PET in monitoring the treatment response among women with breast cancer. The evidence suggested that PET may be useful in the identification of patients with advanced breast cancer who are not responding to neoadjuvant treatment and patients with metastatic disease who are responding to treatment. The third HTA examined the use of PET for monitoring the response to treatment of Hodgkin disease and non-Hodgkin lymphomas (NHLs). The authors concluded that a positive PET scan (specific uptake of FDG) during the monitoring of treatment of response is predictive of death or disease progression. Ten systematic reviews and three metaanalyses were indentified in our literature search. Overall, the systematic reviews and meta-analyses concluded that PET had the highest accuracy for the detection of cancers originating in the lung, pancreas, head and neck region, and cancers of unknown primary origin. PET was effective in the staging or restaging of breast cancer, colorectal cancer, esophageal cancer, head and neck cancer, lung cancer, lymphoma, and melanoma. The systematic reviews and meta-analyses described the clinical effectiveness of PET for the detection of lymphoma, residual or recurrent breast cancer, colorectal cancer, head and neck cancer, and thyroid cancer. PET was not |
Subscribe to:
Posts
(
Atom
)
