Keywords (article) : Early onset colorectal cancer, Microsatellite instability, Lynch syndrome, Microsatellite stable colorectal cancer
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Wednesday, August 04, 2010
full free access: World Jnl Gastroenterology-Approach to early-onset colorectal cancer: Clinicopathological, familial, molecular and immunohistochemical characteristics
Low Frequency of Lynch Sydrome among Young Patients with Non-Familial Colorectal Cancer
Note: "young" referred to as those less than 50 yrs age
NCCN: online survey regarding patient assistance programs
NCCN Trends is a tool to help assess the opinions and habits of oncology patients, caregivers, case managers, and other groups. This survey includes questions about patient assistance programs. Results from this survey will help NCCN and the oncology community develop patient assistance programs and tools. To participate in this month's survey, click: http://www.surveymonkey.com/s.aspx?sm=Gjm3p1VQ7MPKULplsmwhTQ_3d_3d
Answering the questions should take less than five minutes. Submit your answers by August 18, and by September 18, all responders will find out what the most common answers were for each question. Only those individuals who participate will receive the results. All responses will be kept completely anonymous. Please note that the aggregate results of the survey may be used with third party collaborators, including those individuals who participate in the survey. The results will always be presented ONLY in the format of an aggregated data report where the responses and identification of individual responders will not be possible. If you do not wish to receive further e-mails through SurveyMonkey related to NCCN Trends surveys or any other NCCN surveys, please click here: NCCN Trends National Comprehensive Cancer Network 275 Commerce Drive, Suite 300 Fort Washington, PA 19034 +1 (215) 690-0300
Surgical management of ovarian disease in infants, children, and adolescents: a 15-year review
RESULTS: A total of 231 patients were evaluated in this study, with a mean age of 12.8 years (range, 3 weeks to 20 years). There were 221 (95.7%) benign lesions and 10 (4.3%) were malignant.
Targeting annexin A4 to counteract chemoresistance in clear cell carcinoma of the ovary
Take home message: Annexin A4 enhances cancer cell chemoresistance and is overexpressed in tumors of patients with ovarian CCC. Targeting of annexin A4 may represent a future strategy to counteract resistance to chemotherapy in ovarian CCC.
Upstaging pathologic stage I ovarian carcinoma based on dense adhesions is not warranted: A clinicopathologic study of 84 patients originally originally classified as FIGO stage II
Note: very interesting study, albeit abstract
Abstract
BACKGROUND:FIGO stage II ovarian cancer comprises 8% of ovarian cancers. It is a common but not universal practice to upstage densely adherent pathologic stage I tumors to stage II. FIGO guidelines are not clear, and data supporting this practice are sparse.
METHODS:
We retrospectively reviewed patients with stage II ovarian cancer and grouped them based upon histologic evidence of extraovarian extension. Tumors densely adherent to extraovarian structures but without histologic tumor outside the ovary were considered pathologic stage I. All others were considered surgical-pathologic stage II. Three histologic patterns of extraovarian tumor involvement were identified.
RESULTS:
Eighty-four patients were studied. Twenty-four patients had pathologic stage I disease and 60 had histologic evidence of extraovarian pelvic spread and were surgical-pathologic stage II. The 5-year survival for stage I was 100%, and the median survival was not reached. The 5-year survival for those with surgical-pathologic stage II disease was 56.8% and the median survival was 73months. There were no differences observed based upon pattern of extraovarian spread. The survival difference between pathologic stage I and surgical-pathologic stage II was significant (p<0.001). There were no differences seen in 5-year survival among surgical-pathologic stage II patients with serous, endometrioid or clear cell histologies (64.5%, 64.8% and 64.3% respectively).
CONCLUSION:
These retrospective data suggest that the practice of upstaging densely adherent pathologic stage I tumors to stage II may not be warranted. Cell type is not a prognostic factor in stage II.
Characteristics and survival associated with ovarian cancer diagnosed as first cancer and ovarian cancer diagnosed subsequent to a previous cancer
Abstract
Objective:To examine the risk of subsequent primary ovarian cancer among women diagnosed previously with cancer (subsequent cohort) and to compare demographic and tumor characteristics affecting overall survival of these women and women diagnosed with first primary ovarian cancer (index cohort).
Methods:
We identified the two cohorts of women using the 1973-2005 Surveillance, Epidemiology and End Results (SEER) result data. We calculated relative risk of subsequent primary ovarian cancer and estimated 5-year risks of dying (hazard-ratios) after diagnosis of the first or subsequent primary ovarian cancer in the two cohorts, respectively using Cox modeling.
Results:
Women diagnosed with index cancers of the corpus uteri, colon, cervix, and melanoma at age younger than 50 had increased risk of ovarian cancer within 5 years after diagnosis (p<0.05); young breast cancer survivors had continued risk beyond 20 years. In 5-year follow-up survival analysis, the factors associated with a better survival (p<0.05) were similar in both cohorts and included more recent diagnosis; localized or regional disease; age <50 years at diagnosis; and being white versus black. A lower risk of dying from mucinous, endometrioid, or non-epithelial tumors than from serous was seen after 15 months (p<0.01), or after 32 months from diagnosis of the index and subsequent cohorts, respectively. (clear cell??)
Conclusions:
Age, stage, and histology affect ovarian cancer survival. The increased risk of ovarian cancer over time, especially among breast and colon cancer survivors who are less than 50 years of age, suggests common etiologies and necessitates careful surveillance by health care providers and increased survivors awareness through educational efforts.
Tuesday, August 03, 2010
incoming President - Message from Annette Leal Mattern, President of the Board | Ovarian Cancer National Alliance
"I am greatly honored to be chosen to serve as President of the Board of Directors of the Ovarian Cancer National Alliance. It is an appointment that I accept with grave responsibility and great optimism. Most especially, I am encouraged by my colleagues, a board and staff of dedicated professionals who give their time and talents to this cause because they believe, as do I, that one day we will change the horror that is ovarian cancer....."cont'd
Also (background):
"Annette Leal Mattern, an ovarian cancer survivor and a member of the Ovarian Cancer National Alliance, was first diagnosed with the disease 23 years ago and has battled and survived reoccurrences ever since."
MabCure, Inc. Files Provisional Patent in the U.S. for Ovarian Cancer Antibodies - press release/financial news
"In a blinded study of 54 blood samples, MabCure's MAbs correctly diagnosed 16 of the 17 ovarian cancers with a diagnostic sensitivity of 94 percent and 100 percent specificity. The samples were comprised of 17 patients with ovarian cancer, 5 patients with benign tumors of the ovaries, 24 healthy young females and 8 males.
"Beyond the value of our test to diagnose ovarian cancer in a highly accurate manner and with no false positives, the potential value of our proprietary MAbs is also in helping to identify tumor-specific antigens or cancer-specific targets for the ultimate treatment of ovarian cancer," said Gonenne."
Genetic Alliance: Upcoming Advocates Partnership Program Opportunities sponsorship deadline August 20th
Upcoming Advocates Partnership Program Opportunities
Acceptance into the Advocates Partnership Program also includes:
- waived full registration to the NSGC Annual Conference and ASHG Annual Meeting
- reimbursement for up to $250 for transportation, hotel accommodations, or airfare
Now accepting applications for the Advocates Partnership Program at the NSGC Annual Education Conference – October 14-17 in Dallas, TX.
Deadline for applications: Friday, August 20, 2010
Applications will be accepted on a rolling basis; please apply early!
For the preliminary conference program, please go to: www.nsgc.org/conferences/aec.cfm.Applications will be accepted on a rolling basis; please apply early!
The culture of faith and hope. Patients' justifications for their high estimations of expected therapeutic benefit when enrolling in early phase oncology trials (abstract)
BACKGROUND:
Patients' estimates of their chances of therapeutic benefit from participation in early phase trials greatly exceed historical data. Ethicists worry that this therapeutic misestimation undermines the validity of informed consent.
CONCLUSIONS:
Expressions of high expected therapeutic benefit had little to do with reporting knowledge and more to do with expressing optimism. These results have implications for understanding how to obtain valid consent from participants in early phase clinical trials.
Access : Awareness of ovarian cancer risk factors, beliefs and attitudes towards screening -baseline survey of 21,715 women participating in the UK Collaborative Trial of Ovarian Cancer Screening : British Journal of Cancer
Note: this study shows awareness levels in women who were wishing to enroll in a clinical trial program as opposed to the numerous surveys which have been done in the general population eg. the results would differ
Background:
Women's awareness of ovarian cancer (OC) risks, their attitudes towards and beliefs about screening, together with misunderstandings or gaps in knowledge, may influence screening uptake.
Methods:
In total, 21 715 post-menopausal women completed questionnaires before randomisation into the UK Collaborative Trial of Ovarian Cancer Screening.
abstract: The impact of socioeconomic status on stage of cancer at diagnosis and survival. Cancer Aug 2, 2010 (does not include ovarian cancer)
"A population-based study in Ontario, Canada"
METHODS:
All incident cases of breast, colon, rectal, nonsmall cell lung, cervical, and laryngeal cancer diagnosed in Ontario during the years 2003-2007 were identified by using the Ontario Cancer Registry.
CONCLUSIONS:
Despite universal healthcare, SES remains associated with survival among patients with cancer in Ontario, Canada. Disparities in outcome were not explained by differences in stage of cancer at time of diagnosis.
Germline Genetic Variation, Cancer Outcome, and Pharmacogenetics -- abstract (references Lynch/BRCAs)
ABSTRACT
Studies of the role of germline or inherited genetic variation on cancer outcome can fall into three distinct categories. First, the impact of highly penetrant but lowly prevalent mutations of germline DNA on cancer prognosis has been studied extensively for BRCA1 and BRCA2 mutations as well as mutations related to hereditary nonpolyposis colorectal cancer syndrome (Lynch Syndrome). These mainly modest-sized analyses have produced conflicting results. Although some associations have been observed, they may not be independent of other known clinical or molecular prognostic factors. Second, the impact of germline polymorphisms on cancer prognosis is a burgeoning field of research. However, a deeper understanding of potentially confounding somatic changes and larger multi-institutional, multistage studies may be needed before consistent results are seen. Third, research examining the impact of germline genetic variation on differential treatment response or toxicity (pharmacogenetics) has produced some proof-of-principle results. Putative germline pharmacogenetic predictors of outcome include DPYD polymorphisms and fluorouracil toxicity, UGT1A1 variation and irinotecan toxicity, and CYP2D6 polymorphisms and tamoxifen efficacy, with emerging data on predictors of molecularly targeted or biologic drugs. Here we review data pertaining to these germline outcome and germline toxicity relationships. (full text requires $$/subscription)
Curis (financial news) - phase 11 advanced ovarian cancer results Aug 2010 (hedgehog pathway inhibitor)
CAMBRIDGE, Mass., Aug 03, 2010 (BUSINESS WIRE) -- Curis, Inc. /quotes/comstock/15*!cris/quotes/nls/cris (CRIS 1.75, -0.02, -1.13%) , a drug development company seeking to develop next generation targeted small molecule drug candidates for cancer treatment, today reported its financial results for the second quarter ended June 30, 2010.
"Although we were disappointed to announce during the second quarter of 2010 that the topline results from Genentech and Roche's Phase II clinical trial with the hedgehog pathway inhibitor GDC-0449 in metastatic colorectal cancer indicated that the trial did not meet its primary endpoint, we are encouraged that Genentech is testing GDC-0449 in two additional tumor types, which should provide more information on its potential in cancers where we believe the Hedgehog pathway acts via different mechanisms of action," said Dan Passeri, Curis' President and Chief Executive Officer. "We expect that results will be available from the Phase II advanced ovarian cancer trial in the very near term and that we will communicate the topline results within August...."cont'd
Editorial - Current Opinion in Oncology Sept 2010 issue (ovarian cancer/gyn)
In this issue, we present two generic themes: the first
relates to managing patients with ovarian cancer and Glenn McCluggage
presents an excellent review of the difficult area of diagnosing and
categorizing borderline tumours of the ovary. No multidisciplinary
meeting is complete without clinicians asking their pathologist
difficult questions relating to the significance of the different
appearances that can occur in this group of tumours and whether patients
should receive further staging and treatment and how they should be
followed up. Glenn McCluggage describes the clinical significance of the
different subtypes and appearances and he presents a very clear
exposition of the field which will be extremely helpful to clinicians.
In this issue, we also take a broad look at ovarian cancer in terms of a
review of current thoughts on first-line therapy from Dr D'Hondt and
colleagues and an article focused on relapsed disease. The era of
targeted therapies in oncology is well and truly upon us and ovarian
cancer is very much part of this therapeutic revolution with the
development of PARP inhibitors for patients with BRACA mutations and
defects. Data are emerging very quickly on the usefulness of PARP
inhibition and Stan Kaye and colleagues give an excellent summary of the
current position.
Gordon Rustin sets the results of his trial on early
versus late treatment of relapsed disease in the wider context of
follow-up strategies. The debate relating to the follow-up of patients
with ovarian cancer has always been one that has simmered in the
background but with the release of the data from Professor Rustin's
trial the whole issue of the management of patients following the
completion of first-line therapy, has become an area of great interest
and much argument. As a companion article, we have an excellent update
presented by Drs Moore and MacLaughlan on biomarkers in epithelial
ovarian cancer. This sets into context some of the recent data on new
biomarkers and their possible usefulness in the important area of
ovarian cancer screening.
Many of the most hotly argued controversies in cancer
relate to the treatment of patients with early disease. The balance
between not compromising potentially curative therapy and causing
unnecessary long-term morbidity in cured patients is one that can be
very difficult to ascertain because often the data are not mature or
available due to the lengthy follow-up required before definitive
answers emerge. We present controversies in three areas of
gynaecological malignancy relating to the management of early stage
disease namely vulva cancer, cervical cancer and endometrial cancer.
Professor van der Zee and colleagues describe the current status of
sentinel node biopsy for early stage vulva cancer and Drs Al-Mansour and
Verschraegen give a very complete review of the data relating to
locally advanced cervical cancer and give clinicians clear
recommendations. Finally, the issue of the management of lymph nodes in
uterine cancer is excellently discussed by Drs Delpech and Barranger.
This issue is very full with a lot of data presented but
the authors have described often very complex areas with real clarity
and the conclusions that they draw will help all of us who are
practising physicians in the area of gynaecological oncology manage our
patients better.
Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers JCO (abstract)
ABSTRACT
Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.
Abstract: Red meat and colorectal cancer: a critical summary of prospective epidemiologic studies.
"Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer."
Abstract: The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature.
"In conclusion, only a paucity of data is available about the effect of dietary and other lifestyle factors on colorectal cancer recurrence and survival. Thus far, no clear conclusions can be drawn. Future studies are warranted, particularly on postdiagnosis BMI and diet."
Sunday, August 01, 2010
clinical trial: Attitudes About Childbearing And Fertility With Inherited Breast And Ovarian Cancer Syndromes (HBOC) - Full Text View - ClinicalTrials.gov
Purpose
Objectives:
- To evaluate the attitudes and opinions of women undergoing genetic counseling for hereditary breast and ovarian cancer syndrome, both before and after testing, in regards to pregnancy and fertility
Search of: ovarian cancer | Open Studies | received on or after 07/01/2010 - List Results - ClinicalTrials.gov
| Found 9 studies with search of: | ovarian cancer | Open Studies | received on or after 07/01/2010 |
| Rank | Status | Study | ||||
|---|---|---|---|---|---|---|
| 1 | Recruiting | Study Comparing Tumor Debulking Surgery Versus Chemotherapy Alone in Recurrent Platinum-Sensitive Ovarian Cancer
| ||||
| 2 | Recruiting | Study With Wee-1 Inhibitor MK-1775 and Carboplatin to Treat Ovarian Cancer
| ||||
| 3 | Not yet recruiting | Study for Women With Platinum Resistant Ovarian Cancer Evaluating EC145 in Combination With Doxil® (PROCEED)
| ||||
| 4 | Not yet recruiting | Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage III or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer
| ||||
| 5 | Recruiting | Pemetrexed Disodium and Docetaxel in Treating Patients With Advanced Solid Tumors
| ||||
| 6 | Recruiting | Low-Fiber Diet or High-Fiber Diet in Preventing Bowel Side Effects in Patients Undergoing Radiation Therapy for Gynecological Cancer, Bladder Cancer, Colorectal Cancer, or Anal Cancer
| ||||
| 7 | Recruiting | Analysis of Tumors From Patients With Inherited Cancers Having Had Two Surgeries (Primary + Recurrent, or 2 Separate Types of Cancer)
| ||||
| 8 | Recruiting | Heated Chemotherapy for Cancers That Have Spread to the Chest Cavity
| ||||
| 9 | Recruiting | Deferasirox for Treating Patients Who Have Undergone Allogeneic Stem Cell Transplant and Have Iron Overload
|
Saturday, July 31, 2010
Medical News: FDA Warns of Cure-All Product Based on Bleach - in Product Alert, OTC from MedPage Today
"The FDA has warned consumers not to use a product called Miracle Mineral Solution -- which makes broad health claims -- because it's actually an industrial strength bleach.
"Consumers who have MMS should stop using it immediately and throw it away," the agency urged.
The FDA has received several reports of people who have suffered severe nausea, vomiting, and life-threatening hypotension after drinking a mixture containing the product.
Sometimes labeled as Miracle Mineral Supplement, MMS is 28% sodium chlorite. Its instructions call for consumers to mix it with citrus juice or another acidic substance.
An enormous variety of health claims are made for the product, including treatment of HIV, hepatitis, the H1N1 flu virus, common colds, acne, and cancer.
According to the FDA, the mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment.
At the doses consumers would ingest under these directions, this agent is known to cause nausea, vomiting, diarrhea, and symptoms of severe dehydration, the FDA said.
MMS is distributed on Internet sites and online auctions by multiple independent distributors with varying labels, the agency said..."cont'd
Press Release: Canada's Leading Ovarian Cancer "Patient" Advocate Speaks at Sask Conference
OCATS
Ovarian Cancer Awareness & Treatment in Saskatchewan
A SUPPORT & ACTION GROUP FOR ANYONE AFFECTED BY GYNECOLOGIC
CANCERS
M E D I A R E L E A S E
CANADA’S
LEADING OVARIAN CANCER “PATIENT” ADVOCATE SPEAKS AT SASK CONFERENCE
For Immediate Release
REGINA,
July 26, 2010 - Conference Co-Chairs Scott
Livingstone, CEO Sask Cancer Agency and Darlene Gray, President, OCATS, in
partnership with CNT Management Group, invite survivors, support people and the
medical community to the first ever Gynecologic Cancer Conference, Strategies
for Survival on September 24, 2010 at the Regina Inn. Early Bird registration fees available until the end of July
for this important event featuring some of the province’s most knowledgeable
specialists in female reproductive cancers. Experts will address clinical study trials for new drug
therapies, managing cancer recurrence, the emotional aspects of cancer
diagnoses, identifying families with hereditary risks, alternative and
complimentary therapies available and the roles of our nurses, general
practitioners, and pharmacists in cancer care delivery.
A conference highlight
will be a presentation by Canada’s leading ovarian cancer “patient” advocate, Sandi Pniauskas. Other experts presenting at the conference include the
following.
Dr.
Christopher Giede,
Gynecologic Oncologist at the Royal University Hospital, Saskatoon and the team
leader of Saskatchewan gynecologic oncology team of female reproductive cancer
specialists.
Dr.
Muhammad Salim,
Medical Oncologist at the Allan Blair Cancer Centre, Regina and the specialist
of all our Clinical Study Trials.
Dr.
Vicki Holmes,
Medical Director of the Women’s Mid-Life Health Centre in Saskatoon. Dr. Holmes
developed the concept of this centre and is the resident physician at the
centre.
Rosalee
Longmoore, RN,
a Registered Nurse for 34 years with a wide range of experience on all
Saskatchewan medical nursing issues.
Andrew
Gilbertson,
Pharmacist and owner of Hill Avenue Drugs, Regina, Regina’s first and currently only pharmacy that specializes
in compounding custom prescription medications.
Dr.
Heather Fox,
Naturopath, a health specialist with over 30 years experienced and a registered
doctor of Natural Medicine through the Examining Board of Natural Medicine
Practitioners, Canada.
Monica
Milas,
Personal Growth and Healing Services Counsellor and Therapist.
Wendy
Stoeber,
Genetic Counsellor at the Division of Medical Genetics, Royal University
Hospital, Saskatoon.
And a member of the Gynecologic Oncology Program Working Group,
Scott Livingstone, the new CEO of
the Sask Cancer Agency, will speak about Saskatchewan’s new Gynecologic
Oncology Program.
The conference will
include an exhibit hall marketplace and be followed by the OCATS Annual Benefit
Gala and Silent Auction featuring Jack Semple and presentation of the OCATS
2010 Catleya Award of Collaboration & Vision. Conference on-line registration at http://guest.cvent.com/EVENTS/Info/Summary.aspx?e=ce9c4a0f-157e-4a42-ab49-0f19dae902e3.
A group guestroom rate is available at the Regina Inn by asking for the OCATS
event. Discounted conference fees
available for OCATS members and all students. For more information please contact Darlene at 306-775-1848
or CNT Management Group Claire Bélanger-Parker
[claire.belanger-parker@cntgrp.ca].
For more info contact
Darlene Gray at OCATS at 306-775-1848, cell 529-3199 or darlenegray@sasktel.netdarlenegray@sasktel.net
#
# #
e-Patients: Changing the Health Care System in Real-Time Tuesday, September 21, 2010 Toronto (Note: fees)
Note: conference fees which would exclude most patients/e-patients from attending
e-Patients: Changing the Health Care System in Real-Time
Tuesday, September 21, 2010
Novotel Toronto Centre
45 The Esplanade
Toronto, Ontario M5E 1W2
Registration
Registration will take place on Tuesday, September 21, 2010,
at 8:30am at the Novotel Toronto Centre, 45 The Esplanade,
Toronto.
Space is not guaranteed, unless payment is received
prior to the event.Registration FeeMember (OHA/OHPA/MOHLTC):
$495.00 + HST $64.35 = Total $559.35
Non-member:
$980.00 + HST $127.40 = Total $1107.40
EvidenceUpdates: Cochrane Collaboration review: Vaccines for preventing influenza in healthy adults including professional commentaries and warning
CONCLUSIONS: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.
Also: link to the Cochrane Collaboration review (The Cochrane Library):
Background
Different types of influenza vaccines are currently produced worldwide. Healthy adults are presently targeted mainly in North America.
Objectives
Identify, retrieve and assess all studies evaluating the effects of vaccines against influenza in healthy adults
Authors' conclusions
Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
WARNING:
This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.Plain language summary
Vaccines to prevent influenza in healthy adults
Over 200 viruses cause influenza and influenza-like illness which produce the same symptoms (fever, headache, aches and pains, cough and runny noses). Without laboratory tests, doctors cannot tell the two illnesses apart. Both last for days and rarely lead to death or serious illness. At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Each year, the World Health Organization recommends which viral strains should be included in vaccinations for the forthcoming season.
Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.
Cochrane Collaboration review: Elastic compression stockings for prevention of deep vein thrombosis
Background
One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilisation of patients for various surgical and medical illnesses. Using graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT.
Objectives
To determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalised patients.
Authors' conclusions
GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own.Plain language summary
Elastic compression stockings for prevention of deep vein thrombosis during a hospital stay
Hospital patients can develop deep vein thrombosis (DVT) in the legs and pelvic veins immediately after surgery or if they are not mobile because of a medical illness. Symptoms vary from none to pain and swelling in the legs. A blood clot can move from the leg to the lungs with the danger of pulmonary embolism and death. Usually the DVT clears up or has long term effects such as high venous pressure in the leg, leg pain, swelling, darkening of the skin or inflammation.
DVT can be prevented using compression or drugs but drugs may cause bleeding, which is a particular concern in surgical patients. Graduated elastic compression stockings help prevent blood clots forming in the legs by applying varying amounts of pressure to different parts of the leg. Our review confirmed that graduated compression stockings reduce the risk of DVT in hospitalised patients. Our findings also suggest that wearing elastic stockings as well as receiving another method of prophylaxis has increased benefit. We identified 18 randomised controlled trials, eight comparing wearing stockings to no stockings and 10 comparing stockings plus another method with that method alone in patients undergoing surgery. The other methods used were Dextran 70, aspirin, heparin and mechanical sequential compression.
Friday, July 30, 2010
2010 Cochrane Collaboration Review: Drug therapy for the management of cancer-related fatigue
Blogger's disclaimer/comments:
1) consumer reviewer of this Cochrane Collaboration review;
2) a special appreciation to our own ovarian cancer survivors for their input/opinions on this issue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: included in the review were recent studies on the side effects of
erythropoietin and darbopoetin
Abstract
Background
This is an updated version of the original Cochrane review published in issue 1 2008 (Minton 2008). Cancer-related fatigue (CRF) is common, under-recognised and difficult to treat. There have been studies looking at drug interventions to improve CRF but results have been conflicting depending on the population studied and outcome measures used. No previous reviews of this topic have been exhaustive or have synthesised all available data.
Objectives
To assess the efficacy of drugs for the management of CRF.Authors' Conclusions
There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.
Plain language summary
Drugs for cancer-related fatigue
Fatigue associated with cancer is a significant problem. It can occur because of side effects of treatment or because of the disease itself. It can have a significant impact on a person's ability to function. The causes of fatigue are not fully understood and so it is very difficult to treat appropriately. This review has examined drug treatment for fatigue as it represents one of the ways this problem can be tackled. The review authors looked at trials in all types of cancer and at all stages of treatment. Fifty studies met the inclusion criteria but only 31 (7104 participants) were deemed suitable for detailed analysis as they explored fatigue in sufficient detail. They found mixed results with some drugs showing an effect on fatigue - most notably drugs that stimulate red blood cell production and also drugs that improve levels of concentration. Methylphenidate, a stimulant drug that improves concentration, is effective for the management of cancer-related fatigue but the small samples used in the available studies mean more research is needed to confirm its role. Erythropoietin and darbopoetin, drugs that improve anaemia, are effective in the management of cancer-related fatigue. However safety concerns and side effects from these drugs mean that they can no longer be recommended to treat cancer fatigue.
Thursday, July 29, 2010
abstract: Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer (meta-analysis)
CONCLUSIONS
Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.
Ranking prestige of medical diseases | KevinMD.com blogger + link to the study abstract Album/Westin authors
Note: the ranking list includes ovarian cancer but interestingly not breast
Soc Sci Med. 2008 Jan;66(1):182-8. Epub 2007 Sep 12.
Do diseases have a prestige hierarchy? A survey among physicians and medical students.
University of Oslo, Oslo, Norway. dag.album@sosiologi.uio.no
Abstract
Surveys have shown that the prestige of medical specialities is ordered hierarchically. We investigate whether similar tacit agreement in the medical community also applies to diseases, since such rankings can affect priority settings in medical practice. A cross-sectional survey was performed in three samples of physicians and medical students in Norway in 2002. A questionnaire was sent to 305 senior doctors (response rate, 79%), 500 general practitioners (response rate, 65%) and 490 final-year medical students (response rate, 64%). Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 different diseases as well as 23 medical specialities. Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukaemia and brain tumour were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest. Among specialities, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest. Our interpretation of the data is that diseases and specialities associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialities associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.abstract: (repost) Differences in tumor type in low-stage versus high-stage ovarian carcinomas
Int J Gynecol Pathol. 2010
Köbel M, Kalloger SE, Huntsman DG, Santos JL, Swenerton KD, Seidman JD, Gilks CB; Cheryl Brown (ovarian cancer survivour/deceased) Ovarian Cancer Outcomes Unit of the British Columbia Cancer Agency, Vancouver BC.
Department of Pathology, University of Calgary, Calgary AB, Canada T2N 2T9. martin.kobel@cls.ab.ca
Abstract
Although there are recognized differences in the type of ovarian carcinomas between those tumors diagnosed at low versus high stage, there is a lack of data on stage distribution of ovarian carcinomas diagnosed according to the current histopathologic criteria from large population-based cohorts. We reviewed full slide sets of 1009 cases of 2555 patients diagnosed with ovarian carcinoma that were referred to the British Columbia Cancer Agency over a 16-year period (1984 to 2000).
On the basis of the reviewed cases we extrapolated the distribution of tumor type in low-stage (I/II) and high-stage (III/IV) tumors. We then compared the frequencies with those seen in a large hospital practice.
The overall frequency of tumor types was as follows: high-grade serous-68.1%, clear-cell-12.2%, endometrioid-11.3%, mucinous-3.4%, low-grade serous-3.4%, rare types-1.6%. High-grade serous carcinomas accounted for 35.5% of stage I/II tumors and 87.7% of stage III/IV tumors.
In contrast, clear-cell (26.2% vs. 4.5%), endometrioid (26.6% vs. 2.5%), and mucinous (7.5% vs. 1.2%) carcinomas were relatively more common among the low-stage versus high-stage tumors.
This distribution was found to be very similar in 410 consecutive cases from the Washington Hospital Center. The distribution of ovarian carcinoma types differs significantly in patients with low-stage versus high-stage ovarian carcinoma when contemporary diagnostic criteria are used, with consistent results seen in 2 independent case series. These findings reflect important biological differences in the behavior of the major tumor types, with important clinical implications.
Vascular Endothelial Growth Factor Is a Promising ... [Mol Cancer Ther. 2010] - PubMed result
Mol Cancer Ther. 2010 Jul 27. [Epub ahead of print]
Vascular Endothelial Growth Factor Is a Promising Therapeutic Target for the Treatment of Clear Cell Carcinoma of the Ovary.
Mabuchi S, Kawase C, Altomare DA, Morishige K, Hayashi M, Sawada K, Ito K, Terai Y, Nishio Y, Klein-Szanto AJ, Burger RA, Ohmichi M, Testa JR, Kimura T.
Authors' Affiliations: 1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine; 2Department of Obstetrics and Gynecology, Osaka Police Hospital; 3Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan; 4Women's Cancer Program, 5Cancer Genetics and Signaling Program, and 6Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and 7Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan.
Abstract
This study examines the role of vascular endothelial growth factor (VEGF) as a therapeutic target in clear cell carcinoma (CCC) of the ovary, which has been regarded as a chemoresistant histologic subtype. Immunohistochemical analysis using tissue microarrays of 98 primary ovarian cancers revealed that VEGF was strongly expressed both in early-stage and advanced-stage CCC of the ovary. In early-stage CCCs, patients who had tumors with high levels of VEGF had significantly shorter survival than those with low levels of VEGF. In vitro experiments revealed that VEGF expression was significantly higher in cisplatin-refractory human CCC cells (RMG1-CR and KOC7C-CR), compared with the respective parental cells (RMG1 and KOC7C) in the presence of cisplatin. In vivo treatment with bevacizumab (Avastin) markedly inhibited the growth of both parental CCC cell-derived (RMG1 and KOC7C) and cisplatin-refractory CCC cell-derived (RMG1-CR and KOC7C-CR) tumors as a result of inhibition of tumor angiogenesis.The results of the current study indicate that VEGF is frequently expressed and can be a promising therapeutic target in the management of CCC. Bevacizumab may be efficacious not only as a first-line treatment but also as a second-line treatment of recurrent disease in patients previously treated with cisplatin.
Mol Cancer Ther; 9(8); OF1-12. (c)2010 AACR.
Prevalence of lymph node metastasis in primary mucinous carcinoma of the ovary
Abstract
OBJECTIVE:: To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas.
METHODS:: A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded.
RESULTS:: Patients with primary mucinous ovarian carcinomas were identified (n=107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n=27 pelvic and paraaortic, n=19 pelvic only, n=5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not.
CONCLUSION:: There were no cases of isolated lymph node metastases among women with primary mucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients.
LEVEL OF EVIDENCE:: III.
(link to 'levels of evidence': http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment
Wednesday, July 28, 2010
Future Oncology -- Summary: Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Drug Evaluation
Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Rudolph M Navari1,2
Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient characteristics (e.g., female gender, younger age, low alcohol consumption and history of motion sickness) are the major risk factors for CINV. This article provides a detailed description of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, which has been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy...... palonosetron in combination with dexamethasone demonstrated better control of delayed CINV in patients receiving highly emetogenic chemotherapy and had a similar safety profile. Owing to its efficacy in controlling both acute and delayed CINV, palonosetron may be very effective in the clinical setting of multiple-day chemotherapy and bone marrow transplantation.
Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI
"The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."
Team Continuum - Home - "What We're About" - (NY/Marathon)
Note: the Mission Statement is worthy of note, as a FYI.
What We're About
Team Continuum is dedicated to helping cancer patients and their families minimize the disruptions, hardships and uncertainties of everyday life so that they can focus on crucial medical care. We provide immediate and vital assistance - both practical and personal - every step of the way, such as paying household expenses, offering friendship and moral support, and funding health care facilities to enhance the delivery of care, communications and educational services.
Study Indicates Ginkgo biloba Does Not Reduce the Risk of Cancer [NCCAM Research Results]
Note: age specific/comments
Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach
Social Science & Medicine
abstract:
Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one’s access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival.
Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced.
Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994–1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.
Genetic Risk Score Associated With Breast Cancer Risk; Predictive of Type of Disease
>“In this large study including 10,306 women with breast cancer and 10,393 without the disease, we confirm that some of the more important common genetic variants for breast cancer have different effects on different tumor types.”
PLoS ONE: Functional Exploration of the Adult Ovarian Granulosa Cell Tumor-Associated Somatic FOXL2 Mutation p.Cys134Trp (c.402C>G)
Conclusions/Significance
Here, we confirm the specificity of the FOXL2 c.402C>G mutation in adult OGCTs and begin the exploration of its molecular significance. This is the first study demonstrating that the p.Cys134Trp mutant does not have a strong impact on FOXL2 localization, solubility, and transactivation abilities on a panel of proven target promoters, behaving neither as a dominant-negative nor as a loss-of-function mutation. Further studies are required to understand the specific molecular effects of this outstanding FOXL2 mutation.
2010 Conference | Ovarian Cancer National Alliance - video, pics, information
"In case you missed this year’s Conference, we have provided with you educational materials for you to print and disseminate in your local communities. You can also find video clips and pictures from the Conference using the teal button above. Please check back as this will be updated in the next few days."
Canadian Medicine: Little sympathy for lung cancer patients "Can't we do better?"
blogger's Note: really the question is not can we do better, but why we have not (aside from stigmatization aka: judging others) given:
1) science's apparent apolitical stance;
2) decision-makers' rationale (evidence based??);
3) politicization of science/results
"...Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?"
full access: Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers
"In eight out of 21 patients with bladder cancer, this was their first cancer diagnosis, whereas at this stage five of them developed another Lynch syndrome associated cancer at an older age. Therefore, early diagnosis of Lynch syndrome may prevent development of a second primary cancer..."
Recommendations for urothelial carcinomas surveillance in Lynch syndrome
-
Surveillance with a combination of ultrasound of the bladder and upper urinary tract, urinary cytology and sediment.
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In every MSH2 mutation carrier
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From age 40 and up
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Performed every 1–2 years
Indications and approach to surgical resection of lung metastases
J Surg Oncol. 2010
Aug 1;102(2):187-95.
Indications and approach to surgical resection of lung metastases.
Section of Surgical Oncology, Department of
Surgery, Penn State Hershey Cancer Institute, Penn State College of
Medicine, Hershey, Pennsylvania.
Abstract
Pulmonary metastasectomy is a curative option for selected patients with cancer spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration in a multidisciplinary setting when planning pulmonary metastasectomy include: adherence to established indications for resection, the surgical strategy including the use of minimally invasive techniques, pulmonary parenchyma preservation, and the role of lymphadenectomy.J. Surg. Oncol. 2010;102:187-195. (c) 2010 Wiley-Liss, Inc.
PMID: 20648593
[PubMed - in process]
Health Canada Warns Canadians about Buying Prescription Drugs Online from www.globalpharmacycanada.com - Health Canada Advisory 2010-07-27
Note: if your server (ISP) is from Canada then you are blocked from the globalpharmacycanada link Health Canada is informing Canadians about the potential dangers of buying prescription drugs online from www.globalpharmacycanada.com. The company responsible for the website recently removed Canadian access to it, but Canadians may have purchased from this website in the past. For more information, please visit: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_127-eng.php
The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research — Palliat Med
Abstract
Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic (‘meta-study’) review.
Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A ‘spirit to spirit’ framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.
Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer — Palliat Med
"...A little over half of hospice staff, 81/146 (56%) considered that weighing could cause patients to be upset.
However, 124/129 (96%) of patients with advanced cancer reported that they had never found the experience of being weighed in a healthcare facility upsetting.
Some 95/129 (74%) of patients weighed themselves at home and 89% would want to know if their weight was changing.
While there is reluctance on the part of many hospice staff to weigh patients, most patients with advanced malignancy in the hospital setting do not report weight measurement to be upsetting."
Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening - Radiology (abstract)
Results: One hundred eighteen women (mean age, 56.2 years), representing 4.1% of the screening cohort, had an indeterminate adnexal mass (108 unilateral, 10 bilateral; mean size, 4.1 cm) at prospective CT interpretation......No ovarian cancers were prospectively identified, although four cases of ovarian cancer developed subsequent to a negative adnexal finding at CT examination during a 15–44-month interval among the remaining 2751 women. cont'd
Materials and Methods: This study was institutional review board approved and HIPAA compliant. Informed consent was waived. The fate of indeterminate adnexal lesions identified at unenhanced CT in 2869 consecutive women (mean age, 57.2 years; age range, 50–97 years) undergoing colonography screening between April 2004 and December 2008 was evaluated.
Conclusion:
Incidental indeterminate adnexal lesions were relatively common at unenhanced CT (4.1%), but subsequent work-up revealed no ovarian cancers. Furthermore, a normal finding at CT was not protective against short-term development of ovarian cancer. More sophisticated risk factor assessment is needed to identify women at higher risk.
Tuesday, July 27, 2010
Colorectal adenomas in the lynch syndromes: Results of a colonoscopy screening program
Abstract
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.
One to 2-Year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families With Lynch Syndrome
Conclusions
With surveillance intervals of 1–2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2–3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.Risk and Epidemiological Time Trends of Gastric Cancer in Lynch Syndrome Carriers in The Netherlands
" Lifetime risk of developing gastric cancer was 8.0% in males vs 5.3% in females and 4.8% and 9% for MLH1 and MSH2 carriers, respectively."
Conclusions
Lynch syndrome mutation carriers have a substantial risk for gastric cancer, in particular patients with an MLH1 or MSH2 mutation. Family history for gastric cancer is a poor indicator for individual risk. Surveillance gastroscopy for Lynch syndrome patients carrying an MLH1 or MSH2 mutation should therefore be considered.
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