Nutrition for women who are having surgery for ovarian cancer | Cochrane Summaries

Cochrane Summaries

Background: 

Women with ovarian cancer have been shown to be at significant risk of malnutrition with incidence rates described as being between 28% to 67%. Nutrition interventions may improve clinical outcomes positively, nutritional status or quality of life measures in this patient group.

Objectives: 

This review was conducted to assess the effects of nutrition interventions during the perioperative period for women with ovarian cancer.

Search strategy: 

Electronic searches were conducted of the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 7), Medline (1946 to July week 4 2012), Embase (1980 to 2012 week 31), DARE (to 7th August 2012) AMED (1985 to April 2012), BNI (1992 to April 2012), CINAHL (to April 2012). We also searched trials databases, conference proceedings and related citation lists. Reference listings were handsearched. No restrictions were applied on language or date.

Selection criteria: 

Randomised controlled trials (RCTs) in which women 18 years and over with any stage of ovarian cancer, including recurrent cancer, were in the perioperative phase of treatment and received any type of nutrition intervention.

Data collection and analysis: 

Titles and abstracts were screened by two review authors with study selection discussed by a team. Pairs of review authors worked independently on data collection and compared findings.

Main results: 

A total of 4092 titles were screened and 14 full text reports reviewed; a single small study met the inclusion criteria. In the included RCT, 40 women (35 with ovarian cancer) had extensive elective surgery including bowel resection for treatment of gynaecological malignancy. Randomisation was made to either early oral feeding (oral fluids in the first 24 hours, solid foods on the following day) or to a 'traditional' feeding regimen where oral fluids and foods were delayed until there was evidence of bowel function. Most women in the early feeding group (14/18) were able to resume eating solid food one day after surgery. This resulted in a significantly shorter hospital stay with no increase in postoperative complications or change in quality of life measures in comparison with the women on the 'traditional' feeding regimen. The incidence of nausea and vomiting during the postoperative stay was similar in both groups and was noted in slightly more than half of the women. Overall survival was evaluated until 30 days following discharge from hospital; in this period, there was one death of a woman who had been in the 'traditional oral feeding' group, cause of death was not noted. We assessed risk of bias and found no high risk of bias was identified in the methodology and reporting of the included study, although there was an increased risk of bias due to the small size of the study in which not all of the women had ovarian cancer.

Authors' conclusions: 

Although women with ovarian cancer have been shown to be at risk of malnutrition, there is a lack of evidence derived from RCTs evaluating the identification, assessment and treatment of malnutrition during the perioperative phase of treatment. There is evidence from one small study that some women with ovarian cancer undergoing surgery with associated bowel resection may safely commence oral fluids within 24 hours of surgery and solid foods on the following day. Further research is required, including a RCT, to generate guidance concerning the treatment of malnutrition in this patient group.

This record should be cited as: 

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S. Perioperative nutrition interventions for women with ovarian cancer. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD009884. DOI: 10.1002/14651858.CD009884.pub2

Assessed as up to date: 

July 31, 2013

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.lyJdxSQ8.dpuf

Nutrition for women who are having surgery for ovarian cancer New

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S

Published Online: 

September 11, 2013

Women who have ovarian cancer, (a cancer which develops in the two organs (ovaries) that produce eggs in women) are more likely to have difficulties with food and with eating a nourishing diet in comparison to women with other types of gynaecological cancers. One reason may be because the symptoms of ovarian cancer can be difficult to recognise. Women may have a lack of interest in food, feel full, feel sick or have a painful or swollen abdomen. Some women become thinner in parts of their bodies while becoming bigger around their abdomen due to an abnormal build up of fluid or large tumours. There may be no change in body weight or weight may increase, this can make it difficult to know which women are developing problems due to a poor food intake.
Women who are unable to eat and drink well are at risk of becoming malnourished and may then have more complications from the treatments for ovarian cancer than women who are not malnourished. It is recommended that people who are having difficulties with eating and drinking should be identified and helped when they receive hospital care. Currently, there is no agreed method for finding and treating nutritional problems for women with ovarian cancer.
In this review, the authors looked for studies (randomised controlled trials (RCTs)) from around the world to find out how women with ovarian cancer were assessed to see if they were eating and drinking well and what help they may be given with nutrition before or after surgery. A lack of information was found on this topic.
One RCT was found where a small group of women (40 including 35 with ovarian cancer) requiring extensive elective surgery for gynaecological cancer including surgery to the gut, were able to restart eating normal foods on the day after surgery. They were able to leave hospital earlier and did not have more complications in the month after surgery than women who were not allowed to resume eating normal foods until at least three days after the operation.
More studies are needed to confirm whether restarting normal eating one day after surgery can be recommended for women having surgery for ovarian cancer. More research is needed to provide information about how to identify and treat problems of malnutrition in women with ovarian cancer.

Show Abstract (click to read)

Health topics: 

Cancer > Gynaecological > General techniques & complications

Gynaecology > Cancer > General techniques & complications

More like this

• Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancer
• Drains versus no drains after pelvic lymphadenectomy to prevent lymphocyst formation in patients with gynaecological cancer
• Interventions for psychosexual dysfunction in women treated for gynaecological malignancy
• Is there an increased risk of ovarian cancer in women treated with drugs for subfertility?
• Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with a gynaecological cancer

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.QEyx1Yrf.dpuf

Nutrition for women who are having surgery for ovarian cancer New

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S

Published Online: 

September 11, 2013

Women who have ovarian cancer, (a cancer which develops in the two organs (ovaries) that produce eggs in women) are more likely to have difficulties with food and with eating a nourishing diet in comparison to women with other types of gynaecological cancers. One reason may be because the symptoms of ovarian cancer can be difficult to recognise. Women may have a lack of interest in food, feel full, feel sick or have a painful or swollen abdomen. Some women become thinner in parts of their bodies while becoming bigger around their abdomen due to an abnormal build up of fluid or large tumours. There may be no change in body weight or weight may increase, this can make it difficult to know which women are developing problems due to a poor food intake.
Women who are unable to eat and drink well are at risk of becoming malnourished and may then have more complications from the treatments for ovarian cancer than women who are not malnourished. It is recommended that people who are having difficulties with eating and drinking should be identified and helped when they receive hospital care. Currently, there is no agreed method for finding and treating nutritional problems for women with ovarian cancer.
In this review, the authors looked for studies (randomised controlled trials (RCTs)) from around the world to find out how women with ovarian cancer were assessed to see if they were eating and drinking well and what help they may be given with nutrition before or after surgery. A lack of information was found on this topic.
One RCT was found where a small group of women (40 including 35 with ovarian cancer) requiring extensive elective surgery for gynaecological cancer including surgery to the gut, were able to restart eating normal foods on the day after surgery. They were able to leave hospital earlier and did not have more complications in the month after surgery than women who were not allowed to resume eating normal foods until at least three days after the operation.
More studies are needed to confirm whether restarting normal eating one day after surgery can be recommended for women having surgery for ovarian cancer. More research is needed to provide information about how to identify and treat problems of malnutrition in women with ovarian cancer.

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.QEyx1Yrf.dpuf

Nutrition for women who are having surgery for ovarian cancer New

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S

Published Online: 

September 11, 2013

Women who have ovarian cancer, (a cancer which develops in the two organs (ovaries) that produce eggs in women) are more likely to have difficulties with food and with eating a nourishing diet in comparison to women with other types of gynaecological cancers. One reason may be because the symptoms of ovarian cancer can be difficult to recognise. Women may have a lack of interest in food, feel full, feel sick or have a painful or swollen abdomen. Some women become thinner in parts of their bodies while becoming bigger around their abdomen due to an abnormal build up of fluid or large tumours. There may be no change in body weight or weight may increase, this can make it difficult to know which women are developing problems due to a poor food intake.
Women who are unable to eat and drink well are at risk of becoming malnourished and may then have more complications from the treatments for ovarian cancer than women who are not malnourished. It is recommended that people who are having difficulties with eating and drinking should be identified and helped when they receive hospital care. Currently, there is no agreed method for finding and treating nutritional problems for women with ovarian cancer.
In this review, the authors looked for studies (randomised controlled trials (RCTs)) from around the world to find out how women with ovarian cancer were assessed to see if they were eating and drinking well and what help they may be given with nutrition before or after surgery. A lack of information was found on this topic.
One RCT was found where a small group of women (40 including 35 with ovarian cancer) requiring extensive elective surgery for gynaecological cancer including surgery to the gut, were able to restart eating normal foods on the day after surgery. They were able to leave hospital earlier and did not have more complications in the month after surgery than women who were not allowed to resume eating normal foods until at least three days after the operation.
More studies are needed to confirm whether restarting normal eating one day after surgery can be recommended for women having surgery for ovarian cancer. More research is needed to provide information about how to identify and treat problems of malnutrition in women with ovarian cancer.

Show Abstract (click to read)

Health topics: 

Cancer > Gynaecological > General techniques & complications

Gynaecology > Cancer > General techniques & complications

More like this

• Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancer
• Drains versus no drains after pelvic lymphadenectomy to prevent lymphocyst formation in patients with gynaecological cancer
• Interventions for psychosexual dysfunction in women treated for gynaecological malignancy
• Is there an increased risk of ovarian cancer in women treated with drugs for subfertility?
• Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with a gynaecological cancer

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.QEyx1Yrf.dpuf

Nutrition for women who are having surgery for ovarian cancer New

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S

Published Online: 

September 11, 2013

Women who have ovarian cancer, (a cancer which develops in the two organs (ovaries) that produce eggs in women) are more likely to have difficulties with food and with eating a nourishing diet in comparison to women with other types of gynaecological cancers. One reason may be because the symptoms of ovarian cancer can be difficult to recognise. Women may have a lack of interest in food, feel full, feel sick or have a painful or swollen abdomen. Some women become thinner in parts of their bodies while becoming bigger around their abdomen due to an abnormal build up of fluid or large tumours. There may be no change in body weight or weight may increase, this can make it difficult to know which women are developing problems due to a poor food intake.
Women who are unable to eat and drink well are at risk of becoming malnourished and may then have more complications from the treatments for ovarian cancer than women who are not malnourished. It is recommended that people who are having difficulties with eating and drinking should be identified and helped when they receive hospital care. Currently, there is no agreed method for finding and treating nutritional problems for women with ovarian cancer.
In this review, the authors looked for studies (randomised controlled trials (RCTs)) from around the world to find out how women with ovarian cancer were assessed to see if they were eating and drinking well and what help they may be given with nutrition before or after surgery. A lack of information was found on this topic.
One RCT was found where a small group of women (40 including 35 with ovarian cancer) requiring extensive elective surgery for gynaecological cancer including surgery to the gut, were able to restart eating normal foods on the day after surgery. They were able to leave hospital earlier and did not have more complications in the month after surgery than women who were not allowed to resume eating normal foods until at least three days after the operation.
More studies are needed to confirm whether restarting normal eating one day after surgery can be recommended for women having surgery for ovarian cancer. More research is needed to provide information about how to identify and treat problems of malnutrition in women with ovarian cancer.

Show Abstract (click to read)

Health topics: 

Cancer > Gynaecological > General techniques & complications

Gynaecology > Cancer > General techniques & complications

More like this

• Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancer
• Drains versus no drains after pelvic lymphadenectomy to prevent lymphocyst formation in patients with gynaecological cancer
• Interventions for psychosexual dysfunction in women treated for gynaecological malignancy
• Is there an increased risk of ovarian cancer in women treated with drugs for subfertility?
• Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with a gynaecological cancer

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.QEyx1Yrf.dpuf

Nutrition for women who are having surgery for ovarian cancer New

Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S

Published Online: 

September 11, 2013

Women who have ovarian cancer, (a cancer which develops in the two organs (ovaries) that produce eggs in women) are more likely to have difficulties with food and with eating a nourishing diet in comparison to women with other types of gynaecological cancers. One reason may be because the symptoms of ovarian cancer can be difficult to recognise. Women may have a lack of interest in food, feel full, feel sick or have a painful or swollen abdomen. Some women become thinner in parts of their bodies while becoming bigger around their abdomen due to an abnormal build up of fluid or large tumours. There may be no change in body weight or weight may increase, this can make it difficult to know which women are developing problems due to a poor food intake.
Women who are unable to eat and drink well are at risk of becoming malnourished and may then have more complications from the treatments for ovarian cancer than women who are not malnourished. It is recommended that people who are having difficulties with eating and drinking should be identified and helped when they receive hospital care. Currently, there is no agreed method for finding and treating nutritional problems for women with ovarian cancer.
In this review, the authors looked for studies (randomised controlled trials (RCTs)) from around the world to find out how women with ovarian cancer were assessed to see if they were eating and drinking well and what help they may be given with nutrition before or after surgery. A lack of information was found on this topic.
One RCT was found where a small group of women (40 including 35 with ovarian cancer) requiring extensive elective surgery for gynaecological cancer including surgery to the gut, were able to restart eating normal foods on the day after surgery. They were able to leave hospital earlier and did not have more complications in the month after surgery than women who were not allowed to resume eating normal foods until at least three days after the operation.
More studies are needed to confirm whether restarting normal eating one day after surgery can be recommended for women having surgery for ovarian cancer. More research is needed to provide information about how to identify and treat problems of malnutrition in women with ovarian cancer.

- See more at: http://summaries.cochrane.org/CD009884/nutrition-for-women-who-are-having-surgery-for-ovarian-cancer#sthash.QEyx1Yrf.dpuf

PR, ER expression may predict outcomes in certain ovarian cancers + commentary (repost)

 Hematology Oncology

"....The analysis included 1,742 women with high-grade serous disease, 110 with low-grade serous cancer, 207 with mucinous disease, 484 with cancer of the endometrioid, and 390 with clear-cell disease.
Researchers observed an association between PR expression and increased disease-specific survival among women with endometrial disease (log rank P<.0001) and high-grade serous disease (log rank P=.0006). Researchers also observed an association between ER expression and improved disease-specific survival (log rank P<.0001).
Researchers did not observe significant associations for mucinous, clear-cell or low-grade serious disease.....
 

The ASCO Post: September Is National Ovarian Cancer Awareness Month

The ASCO Post

During September, we observe National Ovarian Cancer Awareness Month to recognize those who have died and recommit ourselves to helping the women who are fighting for their health. Every year, more than 20,000 women in the United States are diagnosed with ovarian cancer, which is the fifth leading cause of cancer death for women and accounts for more than 14,000 deaths a year.
The Administration advances scientific research to improve prevention, diagnosis and treatment. When ovarian cancer is found in its early stages, treatment is most effective, but there is currently no proven method to screen for ovarian cancer in women.
The Affordable Care Act is making health care more accessible and providing important protections for women. Insurers must cover at no out-of-pocket cost an annual well-woman visit, which is a good time for women to discuss their concerns about ovarian cancer with their health care provider. The law also guarantees coverage for genetic counseling and testing for certain women at high risk for ovarian cancer.
Also, in 2014, the health law makes it illegal to deny coverage or charge more if a woman has ovarian cancer or other pre-existing condition.
Information for the public about the risks and symptoms of ovarian and other gynecologic cancers is available from the Centers for Disease Control and Prevention at http://www.cdc.gov/cancer/ovarian/
index.htm ■

Kathleen Sebelius is Secretary of the Department of Health and Human Services.

 

Progesterone and Estrogen Receptor Expression Are Prognostic Markers for Endometrioid and High-Grade Serous Ovarian Cancer

Blogger's Note: see prior post of the original; (Lancet Oncology); 2nd (easier to read) posting below 

The ASCO Post

Study Details

In the study, 12 studies participating in the Ovarian Tumor Tissue Analysis consortium contributed tissue microarray sections and clinical data from women who had been diagnosed with invasive serous, mucinous, endometrioid, or clear-cell carcinomas of the ovary. For a patient to be eligible, tissue microarrays, clinical follow-up data, age at diagnosis, and tumor grade and stage had to be available. PR and ER status was assessed by central immunohistochemistry analysis done by blinded pathologists. PR and ER staining was defined as negative (< 1% tumor cell nuclei), weak (1% to < 50%), or strong (≥ 50%).
A total of 2,933 women with invasive epithelial ovarian cancer were included in the analysis, consisting of 1,742 with high-grade serous carcinoma, 110 with low-grade serous carcinoma, 207 with mucinous carcinoma, 484 with endometrioid carcinoma, and 390 with clear-cell carcinoma.

PR and ER Expression
PR and ER expression differed among ovarian cancer subtypes. The proportion of tumors that stained positive (weak or strong) for PR was highest for endometrioid carcinoma (67%) and low-grade serous carcinoma (58%), intermediate for high-grade serous carcinoma (31%), and lowest for mucinous carcinoma (17%) and clear-cell carcinoma (8%).
More tumors stained positive for ER than for PR in all subtypes, with the proportion of ER-positive tumors being highest for low-grade serous carcinoma (87%) and high-grade serous carcinoma (81%) and lowest for mucinous carcinoma (21%) and clear-cell carcinoma (20%). For ER-positive tumors, coexpression of PR was most likely for endometrioid carcinoma (82%) and least likely for high-grade serous carcinoma (34%) and clear-cell carcinoma (32%).
The proportion of tumors that were ER- or PR-positive or both was highest for low-grade serous carcinoma (91%), high-grade serous carcinoma (84%), and endometrioid (82%) tumors and lowest for mucinous carcinoma (23%) and clear-cell carcinoma (21%).....

.....They further noted that the magnitude of these effects is similar to the protective effect of germline BRCA mutations on ovarian cancer survival and that the effects were stronger than the observed associations of grade and extent of residual disease with survival in endometrioid carcinoma.
The authors concluded, “PR and ER are prognostic biomarkers for endometrioid and high-grade serous ovarian cancers. Clinical trials, stratified by subtype and biomarker status, are needed to establish whether hormone-receptor status predicts response to endocrine treatment, and whether it could guide personalized treatment for ovarian cancer.”

Thursday, September 19 at 3:00 pm EDT “Ask the Experts” Live Chat on Ovarian Cancer | Ovarian Cancer National Alliance

Live Chat

A New Agenda for a Post–Health Reform Landscape - The Commonwealth Fund

The Commonwealth Fund

With the Affordable Care Act bringing new health insurance coverage options to millions, and a wide range of payment and delivery reforms under way, U.S. health care is at a turning point. In light of this change, The Commonwealth Fund has chosen to redefine its grantmaking and research focus. The new direction comes eight months after David Blumenthal, M.D., joined The Commonwealth Fund as the seventh president of the 95-year-old philanthropy.
As Dr. Blumenthal explains in a blog post, "The new focus is the result of eight months of staff work and dozens of conversations with outside experts―leaders in the worlds of policy, care delivery, academia, and philanthropy, to name just a few. It explicitly takes into account the rapidly changing environment that defines our health care system―shifting demography, rising costs, the ongoing implementation of the health reform law, the spread of information technology―and it offers a 'next step' on the path toward high performance."
Building on a long history of work to strengthen the U.S. health system and learn from innovative models, Commonwealth Fund staff and grantees will concentrate on tracking the results of the Affordable Care Act, improving how health care is delivered to the sickest patients, ensuring access and improving quality of care for low-income, minority, and immigrant populations, and supporting breakthroughs in health care. The Commonwealth Fund will also expand its policy analysis to focus more explicitly on controlling health care costs, improving Medicare, and tracking the nation’s health system performance.
The Fund’s work going forward will be organized into four program areas:
Health Care Coverage and Access: Work in this area will continue to inform the successful implementation of the Affordable Care Act and support initiatives to expand health insurance and access to care, with a focus on coverage gaps that will not be addressed by the health reform law.
Health Care Delivery System Reform: Work in this area will promote the broad delivery system changes necessary to improve patient outcomes and control costs, focusing initially on those with high health care costs and needs and vulnerable populations. Four levers for improving care will be used: payment reform, primary care, coordinated care systems, and Medicare.
International Health Policy and Practice Innovations: The Fund will continue the work of its longstanding International Program in Health Policy and Practice Innovations, with an enhanced focus on efforts to learn from successful interventions abroad and to establish health system benchmarks through its annual international survey and international symposium on health care policy.
Breakthrough Health Care Innovations: The Fund will develop a new infrastructure to identify, evaluate, and shape new ideas that can potentially disrupt the health care system in positive ways. Information technology–enabled consumer engagement and clinical processes; frugal innovations, or innovations at work in developing countries; and next-generation health care provider incentives are among the topics that will be explored.
The Commonwealth Fund will continue to produce scorecards tracking the performance of the health system in achieving the goals of improving quality, access, and health outcomes, maintain its online Data Centers, and engage federal and state health policymakers by convening briefings and conferences. The Mongan Commonwealth Fund Fellowship Program in Minority Health Policy, Harkness Fellowships in Health Policy and Practice, and other fellowship programs will also continue.
Read Dr. Blumenthal’s perspective on the Fund’s new agenda in a blog post and learn more about his vision of a high-performing health system in a new video.....
 

CTV News | Canadian Cancer society to charge patients fee for ride service

News Video - Top National News Headlines

PACE GLOBAL

PACE GLOBAL - open access (see pdf)

The PACE Cancer Perception Index: A Six-Nation, Public Opinion Survey of Cancer Knowledge and Attitudes, polled 4,341 individuals, including the general population (3,009), cancer patients (663) and caregivers (669), from August 28 to October 4, 2012. Survey participants were from six countries: the United States, France, Germany, Italy, Japan and the United Kingdom.^*
 
PACE (Patient Access to Cancer care Excellence), a Lilly Oncology initiative, commissioned the survey. PACE is an emerging global network of collaborations between industry and other sectors intended to improve public policies that determine the accessibility, speed and value of progress against cancer. The PACE network includes a Global Council of internationally renowned patient advocacy, medical, policy, scientific and health care industry leaders. Following are survey highlights...... (one excerpt as below)


 

Evaluation of Rare Variants in the New Fanconi Anemia Gene ERCC4 (FANCQ) as Familial Breast/Ovarian Cancer Susceptibility Alleles - Osorio - Human Mutation - Wiley Online Library

abstract

Recently, it has been reported that biallelic mutations in the ERCC4 (FANCQ) gene cause Fanconi anemia (FA) subtype FA-Q. To investigate the possible role of ERCC4 in breast and ovarian cancer susceptibility, as occurs with other FA genes, we screened the 11 coding exons and exon–intron boundaries of ERCC4 in 1573 index cases from high-risk Spanish familial breast and ovarian cancer pedigrees that had been tested negative for BRCA1 and BRCA2 mutations and 854 controls. The frequency of ERCC4 mutation carriers does not differ between cases and controls, suggesting that ERCC4 is not a cancer susceptibility gene. Interestingly, the prevalence of ERCC4 mutation carriers (one in 288) is similar to that reported for FANCA, whereas there are approximately 100-fold more FA-A than FA-Q patients, indicating that most biallelic combinations of ERCC4 mutations are embryo lethal. Finally, we identified additional bone-fide FA ERCC4 mutations specifically disrupting interstrand cross-link repair.

"Uselessness of doctor ratings" - Health News Watchdog

Health News Watchdog

The analysis of microsatellite instability in extracolonic gastrointestinal malignancy.

abstract

SUMMARY:

Microsatellite instability (MSI) is a genetic feature of sporadic and familial cancers of multiple sites and is related to defective mismatch repair (MMR) protein function. Lynch syndrome (LS) is a familial form of MMR deficiency that may present with a spectrum of MSI positive cancers including gastrointestinal (GI) malignancies. The incidence of high level MSI (MSI-H) in colorectal carcinoma is well defined in both familial and sporadic cases and these tumours portend a better overall prognosis in colorectal carcinoma (CRC). There are certain morphological features that suggest MSI-H CRC and international guidelines have been established for the evaluation of MSI in CRC. The prevalence and morphological features of extracolonic GI MSI-H tumours are less well documented. Furthermore, it is unclear whether the guidelines for the assessment of MSI in CRC are appropriate for application to extracolonic GI malignancies. This review aims to summarise the recent literature on MSI in extracolonic LS-related GI tract malignancies with special attention to the assessment of the MMR system by evaluation of specific microsatellite markers and/or immunohistochemical evaluation of MMR protein expression. The reported prevalence of sporadic and LS-related MSI-H tumours along with their associated unique morphological patterns and related prognostic or therapeutic implications will be discussed.

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(Myriad) Utah company argues (again) for patents related to breast cancer genes | The Salt Lake Tribune

media

Lawsuit » Company asks judge to halt competitors from selling DNA testing products.  

Versatile microRNAs choke off cancer blood supply, suppress metastasis | MD Anderson Cancer Center

media

A family of microRNAs (miR-200) blocks cancer progression and metastasis by stifling a tumor’s ability to weave new blood vessels to support itself, researchers at The University of Texas MD Anderson Cancer Center report today in Nature Communications.

Patients with lung, ovarian, kidney or triple-negative breast cancers live longer if they have high levels of miR-200 expression, the researchers found.
Subsequent experiments showed for the first time that miR-200 hinders new blood vessel development, or angiogenesis, and does so by targeting cytokines interleukin-8 (IL-8) and CXCL1.
“Nanoparticle delivery of miR-200 blocked new blood vessel development, reduced cancer burden and inhibited metastasis in mouse models of all four cancers,” said Anil Sood, M.D., professor of Gynecologic Oncology, senior author of the study.
The team’s findings highlight the therapeutic potential of nanoparticle-delivered miR-200 and of IL-8 as a possible biomarker for identifying patients who might benefit from treatment. Sood said safety studies will need to be completed before clinical development can begin..........

Checking up on patient experiences with ovarian cancer

Scope Blog

Merck, AstraZeneca in Ovarian Cancer Deal - Oral WEE1 Kinase Inhibitor ( (MK-1775))

med news

Merck and AstraZeneca Enter License Agreement for Investigational Oral WEE1 Kinase Inhibitor
Therapy for Cancer

WHITEHOUSE STATION, N.J. & LONDON--(BUSINESS WIRE)--Merck (NYSE: MRK), known as MSD outside the United States and Canada, and AstraZeneca (NYSE: AZN) today announced a worldwide licensing agreement for Merck’s oral small molecule inhibitor of WEE1 kinase (MK-1775). MK-1775 is currently being evaluated in Phase IIa clinical studies in combination with standard-of-care therapies for the treatment of patients with certain types of ovarian cancer......

Hereditary breast cancer: ever more pieces to the polygenic puzzle (note references to BRCA's/Lynch syndrome/risk estimates)

Introduction

Hereditary breast cancer has been formally investigated since the middle of the 19th century
[1-3]. About thirty years ago, epidemiological and genetic linkage studies of multiple-case
families have guided the identification of TP53 mutations as a cause of Li-Fraumeni
Syndrome [4-6] and of BRCA1 and BRCA2 as first genes in which mutations strongly
predispose to breast and ovarian cancer [7,8]. There are further rare syndromes which include
the occurrence of breast cancer as part of the disease spectrum, and the underlying genes have
been identified by positional cloning. Apart from Li-Fraumeni Syndrome, these include
Cowden Disease (PTEN) [9,10], Peutz-Jeghers Syndrome (LKB1/STK11) [11,12], Lynch
Syndrome  (+Muir Torre) (MSH2,MLH1) [13], Bloom’s Syndrome (BLM) [14] and Ataxia-Telangiectasia (ATM) [15]. In addition, familial lobular breast cancer has been associated with germ-line
mutations in CDH1, the gene for E-cadherin [16,17]. Although the above-mentioned
syndromes are rare, they need to be kept in mind if a breast cancer patient presents with a
more complex disorder or suspicious family history...........

Table 1 Genes with intermediate to high penetrance mutations for breast cancer

Combination Metronomic Oral Topotecan and Pazopanib: A Pharmacokinetic Study in Patients with Gynecological Cancer

Abstract

Background: Combination metronomic topotecan plus pazopanib is active against preclinical models of gynecological cancer. Both agents are substrates for ATP-binding cassette family transporters so there is an increased likelihood for pharmacokinetic (PK) drug-drug interactions. Patients and Methods: PK analyses of topotecan were performed during three cycles of a phase I dose-escalation study of metronomic topotecan and pazopanib in consenting adult patients with gynecological cancer. Concentration time data were analyzed using a population PK approach. Results: Twenty-one patients were evaluable for serial PK studies. Considerable inter- and intra-patient variability was observed in the PK parameters, attributable primarily to highly variable oral bioavailability. No difference in topotecan disposition was detected between administration cycles, nor between the off- versus on-pazopanib studies. 

Conclusion: The lack of a statistically significant drug-drug interaction agrees with preclinical findings suggesting that pazopanib does not influence the PK of metronomic topotecan. No adjustment of low dose metronomic topotecan dosing is merited when used in conjunction with pazopanib.

Information by Drug Class > New Safety Measures Announced for Extended-release and Long-acting Opioids

New Safety Measures Announced for Extended-release and Long-acting Opioids

[9/10/2013]
FDA announces a set of significant measures to enhance the safe and appropriate use of extended-release and long-acting (ER/LA) opioids. These actions include proposed class-wide safety labeling changes and new postmarket requirements for all ER/LA opioid analgesics. FDA also responded to two citizen petitions.

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Related Information

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“It’s our DNA, we deserve the right to test!” A content analysis of a petition for the right to access direct-to-consumer genetic testing

Abstract

BI 860585 Dose Escalation Single Agent and in Combination With Exemestane or With Paclitaxel in Patients With Various Advanced and/or Metastatic Solid Tumors

Status: Not yet recruiting

clinical trial - phase 1

New bill allows Californians to directly access physical therapist services

medical news

The Elephant and the Blind Men: Making Sense of PARP Inhibitors in Homologous Recombination Deficient Tumor Cells (technical)

open access

Introduction

Poly(ADP-ribose) polymerase (PARP) inhibitors are currently undergoing extensive testing as potential anticancer agents (1–13). These drugs were initially developed as modulating agents that could enhance the cytotoxicity of DNA damaging treatments such as ionizing radiation and temozolomide (1, 12, 14). Interest in these agents was heightened by the demonstration that BRCA1- and BRCA2- (BRCA1/2-) mutant cancer cells are selectively killed by single-agent PARP inhibitor treatment (15, 16). Consistent with these preclinical observations, the PARP inhibitor olaparib has exhibited substantial single-agent activity in BRCA1/2-mutant breast and ovarian cancer (17–21). Nonetheless, fewer than 50% of patients with BRCA1/2-mutant cancers respond to these drugs, raising important questions about identifying patients most likely to derive benefit from PARP inhibition (22, 23). With this in mind, extensive efforts have been directed at further refining the mechanism of cytotoxicity of PARP inhibitors and elucidating mechanisms of resistance...........

.....In high-grade serous ovarian cancer, for example, BRCA1 and BRCA2 mutations are found in roughly 15% of cases, with mutations in another dozen or more HR genes found in an additional 10–15% of cases (87–89). While some of these mutations are familial, as many as half appear to be sporadic (89, 90). These mutations and the resulting genomic instability are a hallmark of high-grade serous ovarian cancer (90). Likewise, mutations in BRCA1, BRCA2, PALB2, and other components with the HR pathway are common in familial and certain subtypes of sporadic breast cancer, particularly triple negative breast cancer (91–93). PTEN is deleted or silenced in over 50% of endometrial cancers and a substantial fraction of glioblastomas and prostate cancers (94–97).........

The Elephant and the Blind Men

Like the blind men examining the elephant, each of these models emphasizes a different aspect of PARP1 biology. Just as none of the blind men in the parable could provide a complete description of the elephant, we believe that the present models explain certain facets of PARP inhibitor-induced lethality but also leave some questions unanswered.......

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Climb4Life raises awareness of ovarian cancer - media (Sean Patrick - founder)

Climb4Life 


"......(Sean) Patrick established the HERA Women's Cancer Foundation that would fund medical research and help women learn about their bodies in order to catch the early warning signs of the cancer.
"She named the foundation HERA, which, of course is the Greek goddess of women and the wife of Zeus and was considered the protector of women," Curley said. "HERA — is also an acronym for health, empowerment, research and awareness."
As with any foundation, money is needed to fulfill its mission, so Patrick (deceased) started the Climb4Life Utah event 12 years ago.......
 

Microsatellite Instability Analysis for the Screening of Synchronous Endometrial and Ovarian Cancer in Lynch Syndrome

Abstract

We report on a case of synchronous endometrial and ovarian cancer in a patient with Lynch syndrome. An endometrial biopsy performed during routine screening revealed microsatellite instability (MSI) and loss of expression of human mutL homolog-1 (MLH1) and postmeiotic segregation increased-2 (PMS2) in a setting of complex hyperplasia. Whereas gynaecological screening including clinical examination, pelvic ultrasound, and endometrial biopsy, has not proven its benefit, our case report points out the place of MSI analysis and immunohistochemical investigation of mismatch repair protein expression in endometrial samples during gynaecological screening.

Histologic Evaluation of Prophylactic Hysterectomy and Oophorectomy in Lynch Syndrome (repeat post)

Abstract
 

Women with Lynch syndrome (LS) are at increased risk for endometrial (EC) and ovarian carcinoma (OC). Current surveillance recommendations for detection of EC and OC in LS patients are not effective. Small studies have shown that prophylactic hysterectomy and bilateral salpingo-oophorectomy (P-TH-BSO) are the most effective and least expensive preventive measures in these patients. Data regarding histologic findings in prophylactic specimens in these patients are lacking. All LS patients who underwent P-TH-BSO at the Memorial Sloan-Kettering Cancer Center from 2000 to 2011 were identified. Slides were evaluated for the presence of endometrial hyperplasia (EH), EC, OC, or any other recurrent histologic findings. Twenty-five patients were identified, with an age range of 36 to 61 years. Fifteen patients had a synchronous or prior colorectal carcinoma, and 2 patients had a history of sebaceous carcinoma. Focal FIGO grade 1 endometrioid ECs were detected in 2 patients; 1 was 54 years of age (MSH2 mutation; superficially invasive), and the other was 56 years of age (MLH1 mutation; noninvasive). Focal complex atypical hyperplasia, unassociated with carcinoma, was seen in 3 patients, ages 35 and 45 (MLH1 mutations) and 53 years (MSH2 mutation). One patient (44 y, with MSH2 mutation) was found to have a mixed endometrioid/clear cell OC and simple EH without atypia. The OC was adherent to the colon but did not show distant metastasis. In our study, P-TH-BSOs performed because of the presence of LS revealed incidental EC and/or EH in 24% of cases and OC in 4%. The ECs were low grade, confined to the endometrium, and seen in patients older than 50 years. Prophylactic hysterectomy allows detection of early lesions in LS; these lesions appear to be small and focal. This small series of prophylactic hysterectomies may provide some clues about LS-associated endometrial carcinogenesis.