Egypt: Outcome of fertility preserving surgery in early stage ovarian cancer

Blogger's Note: it is not clear if the 2 patients lost in follow-up was due to death or lack of communication

Two patients (6.7%) were lost during follow up

abstract

AIM:

To assess the role of fertility preserving surgery in treatment of patients with stage IA, G1 or G2 ovarian carcinoma without adjuvant chemotherapy.

PATIENTS AND METHODS:

From 2006 to 2008, a prospective non-randomized study recruited 150 women, with suspicious early malignant ovarian mass.

RESULTS:

Among the 150 explored patients, only 43 (28.6%) patients underwent exploration. Only 32/150 (21.3%) patients had proven stage IA, either G1 or G2, epithelial ovarian cancer. Among the 32 patients, 22 (68.7%) patients were nullipara while 10 (32.1%) had one child. All patients had unilateral tumors; 26 (81.25%) patients had G1 and 6 (18.75%) patients had G2 tumors; 24/32 (75.0%) tumors were serous, 6/32 (18.7%) were mucinous and 2/32 (6.2%) were endometrioid, and none was clear cell type. The median follow up period was 58.5months (ranged: 48-72months). Two patients (6.7%) were lost during follow up; data will be presented for the remaining 30 patients. One patient, at 27th month of follow up, had open abdominal exploration to investigate abnormal pelvic mass on routine ultrasound follow up examination. Frozen section revealed recurrent invasive mucinous tumor. She underwent radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease, for the remaining 29months of the follow up period. Neither distant metastases nor mortality were reported among our patients.

CONCLUSION:

Fertility preserving surgery can be considered a safe treatment strategy in patients with stage IA, G1 or G2 ovarian carcinoma.
 

(Paris) Complications of presumed benign ovarian tumors

abstract

The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.

 

(Paris) Ovarian tumor markers of presumed benign ovarian tumors

abstract

Cancer Antigen 125 (CA125) and Human Epididymis Protein 4 (HE4) are the most studied ovarian tumor markers. Their diagnostic performance for identification of ovarian cancer are superior to CA19-9, CA72-4, and carcinoembryonic antigen, which are no more recommended for the diagnosis of presumed benign ovarian tumor. HE4 (>140pmol/L) is superior to CA125 (>30U/mL) in terms of specificity and positive likelihood ratio. CA125 and HE4 can be combined into an algorithm ROMA, or associated to clinical information (composite index), biological data (OVA1) or imaging (Risk for Malignancy Index (RMI), LR2). ROMA algorithm is an exponential equation combining plasmatic concentrations of HE4 and CA125. ROMA is more sensitive and less specific than HE4 in predicting epithelial ovarian cancer. ROMA is more accurate in post-menopausal women. The performance of ROMA is lower than the ultrasound model LR2 in differentiating malignant from benign ovarian tumors, whatever the hormonal status. The composite index combining CA125 with a symptoms index (pain, abdominal distension, bloating, difficulty eating) has a good sensitivity in a screening program, but because of a 12% false positive rate, ultrasound is required before management. The RMI algorithm is based on serum CA125, ultrasound findings (septation, solid zones, metastases, ascite, bilaterality) and menopausal status. RMI is less sensitive, but more specific than ROMA or OVA1 for the classification of ovarian masses. The addition of HE4 to RMI seems to be the most accurate. The subjective evaluation of ovarian cysts by sonography and color Doppler is better than ROMA and RMI algorithms, and not affected by the hormonal status.

 

Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience (Istanbul)

abstract

BACKGROUND:

To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis.

MATERIALS AND METHODS:

All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified.

RESULTS:

Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement.

CONCLUSION:

All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.

 

Tumor Mutation Burden Forecasts Outcome in Ovarian Cancer with BRCA1 or BRCA2 Mutations

open access (technical)


Background
Increased number of single nucleotide substitutions is seen in breast and ovarian cancer genomes carrying disease-associated mutations in BRCA1 or BRCA2. The significance of these genome-wide mutations is unknown. We hypothesize genome-wide mutation burden mirrors deficiencies in DNA repair and is associated with treatment outcome in ovarian cancer.

......."Our results are based on a relatively small set of patients carrying BRCA1 ...and BRCA2 mutations, and should be considered hypothesis generating until confirmed in a larger cohort. In addition, tumors may possess de novo mechanisms leading to resistance to chemotherapy and targeted treatments. Our preliminary results suggest low tumor Nmut may identify BRCA-associated primary tumors in which the original deficiency of BRCA1 and BRCA2 pathways, including impaired DNA repair, is compensated for by alternative pathways."

Conclusions
Tumor Nmut (non-synonymous exome mutations) was associated with treatment response and with both PFS and OS in patients with high-grade serous ovarian cancer carrying BRCA1 or BRCA2 mutations. In the TCGA cohort, low Nmut predicted resistance to chemotherapy, and for shorter PFS and OS, while high Nmut forecasts a remarkably favorable outcome in mBRCA-associated ovarian cancer. Our observations suggest that the total mutation burden coupled with BRCA1 or BRCA2 mutations in ovarian cancer is a genomic marker of prognosis and predictor of treatment response. This marker may reflect the degree of deficiency in BRCA-mediated pathways, or the extent of compensation for the deficiency by alternative mechanisms.




 

Editorial: Conventional evaluations of improvement interventions: more trials or just more tribulations?

open access

......Many of the challenges we regard as unique to QI (quality improvement) in fact exist in clinical research and have been recognised for decades.22 In some cases, we need to choose the right time for an RCT (once the intervention is sufficiently mature). In other cases, we may need to adopt alternative designs, such as step-wedge randomisation, to accommodate the realities of implementing complex interventions in the midst of other institutional activities or adaptive randomisation to minimise the number of sites assigned to the control group. But, we also have to remember that many of the misgivings we feel as providers of healthcare asked to participate in RCTs of improvement interventions echo those made by patients all the time. Our enthusiasm for assignment to active treatment carries no more weight than theirs. Rather than so often avoiding multi-site RCTs in QI, we may just need to find the right spoonful of sugar for ourselves when we end up in the control group. 

Characteristics of Adverse Drug Events Originating During the Hospital Stay, 2011 (U.S)

Characteristics 

Highlights

The most common specifically identified causes of ADEs that originated during the hospital stay in 2011 were steroids, antibiotics, opiates and narcotics, and anticoagulants. Nearly 8 in 1,000 adults aged 65 years or older experienced one of the four most common ADEs during hospitalization. Compared to adults aged 18-44 years, infants had a lower rate and older adults had a higher rate of ADEs across all four causes. Children aged 1-17 had a higher rate of ADEs involving antibiotics but lower rates of ADEs involving steroids and anticoagulants. Females had a higher rate of ADEs involving opiates and narcotics and a lower rate of ADEs involving anticoagulants compared to males. Compared to privately insured patients, Medicare-covered patients had higher rates and Medicaid-covered patients had lower rates across the four ADE causes. Patients treated in urban teaching hospitals had higher rates of ADEs involving antibiotics and opiates/narcotics compared to those treated in urban nonteaching hospitals. Patients treated in private, not-for-profit hospitals had higher rates for most ADE causes compared to those treated in public or private, for-profit hospitals. Patients in the Midwest had higher in-hospital ADE rates for all four ADE causes compared to patients in any other region.

Table 1. Characteristics of the most frequent specific causes of adverse drug events originating during the hospital stay, selected States, 2011 

Genes in Life | Answering your questions about genetics and your health.

Genes in Life

Spotlight On Whole Genome Sequencing

What is whole genome sequencing? How is it used, and how does it apply to you? Learn more on the Genes in Life blog, and have your questions answered by our featured experts!....

 

Salads, wraps recalled due to E. coli threat

media

No Advantage With Asymptomatic Screening for Ovarian Cancer

Clinical Oncology News 

Novogen, Yale Launch Venture to Develop Ovarian Cancer Drugs (CanTx)

GEN | News Highlights

In phase III trial, bevacizumab prolongs progression-free survival for ovarian cancer

IMNG Oncology Report

(repost) Learn More About Cancer: Lifestyle Link (evidence or not) By Cancer Site | American Institute for Cancer Research (AICR)

American Institute for Cancer Research (AICR)

By Cancer Site

Evidence shows that our risk for many types of cancer is related to diet, physical activity and weight. But for some types, it is not yet possible to determine if lifestyle plays a role. This does not mean such links are impossible, simply that more research is needed.
The AICR/WCRF Expert Report and Continuous Update Project examines the evidence linking various lifestyle factors to cancers at 17 different body sites using a rigorous and objective process called Systematic Literature Reviews (SLRs).

Strong Evidence of Lifestyle Link

For 12 of these cancers, strong evidence emerged that diet, weight and physical activity can raise or lower risk. They are:

• Colorectal Cancer — Updated Content
• Breast Cancer — Updated Content
• Endometrial (Lining of the Uterus) Cancer — Updated Content
• Esophageal Cancer — Updated Content
• Gallbladder Cancer
• Kidney Cancer
• Liver Cancer
• Lung Cancer
• Cancers of the Mouth, Pharynx and Larynx
• Pancreatic Cancer
• Prostate Cancer — Updated Content
• Stomach Cancer

No Strong Evidence of a Lifestyle Link

The expert panel also examined the available evidence for five other cancers using the same exacting SLR method. The results are as follows*:

• Cervical Cancer
  The expert panel concluded that there is as yet no strong evidence that any aspect of diet, physical activity and weight influences the risk of cervical cancer.
• Bladder Cancer
  The expert panel concluded that there is as yet no strong evidence that any aspect of diet, physical activity and weight influences the risk of bladder cancer.
• Ovarian Cancer
  To date, the strongest evidence linking any aspect of lifestyle to this cancer is related to adult attained height. This does not mean that being tall is a cause of ovarian cancer, however. Instead, it is believed that various genetic, hormonal and nutritional factors that contribute to adult attained height are likely the true underlying causes of ovarian cancer.
• Skin Cancer
  That skin cancer is directly caused by excessive sun exposure is well-established. The expert panel specifically examined the evidence linking skin cancer to aspects of diet, weight and physical activity. No strong evidence emerged, with the exception of arsenic in drinking water, for which a probable link to skin cancer was found.
• Nasopharyngeal Cancer
  This cancer is rare in the United States but common in Southern China. The panel, which examined the global evidence, concluded that consumption of Cantonese-style salted fish is probably a cause of this cancer.

Other Cancers

For the following cancers, evidence was too limited to examine using SLRs. For this reason, the Panel did not issue conclusions about them, but flagged the need for further research on possible lifestyle links*.

• Thyroid Cancer
• Testicular Cancer
• Lymphoma (Hodgkin’s and Non-Hodgkin’s)
• Leukemia
• Multiple Myeloma
• Cancers of the Musculoskelatal System (Liposarcoma, fibrosarcoma, osteosarcoma, myosarcoma)
• Cancers of the Nervous system (Glioblastoma, meningoma, sellar tumor, cranial tumor, spinal nerve tumor, central nervous system lymphoma)

---

*NOTE: Although there is currently insufficient evidence to definitively determine if these cancers are related to diet, weight and physical activity, AICR funds innovative research involving these cancers that seeks to find and map such links.

 

Testing the Limits of 'Terminal'

NYTimes.com

Treatment of Dexamethasone-Induced Hiccup in Chemotherapy Patients by Methylprednisolone Rotation

abstract

Background. Dexamethasone-induced hiccup (DIH) is an underrecognized symptom in patients with cancer, and little information is available about its treatment. The aims of this study were to investigate the feasibility of methylprednisolone rotation as treatment and to confirm the male predominance among those with cancer who experienced DIH during chemotherapy.

Methods. Persons with cancer who experienced hiccups during chemotherapy treatment and who were receiving treatment with dexamethasone were presumed to have DIH. The following algorithmic practice was implemented for antiemetic corticosteroid use: rotation from dexamethasone to methylprednisolone in the next cycle and dexamethasone re-administration in the second cycle of chemotherapy after recognition of hiccups to confirm DIH. All other antiemetics except corticosteroid remained unchanged. Patients (n = 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively.

Results. Hiccup intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration (68.44 minutes vs. 1.79 minutes) were significantly decreased after rotation to methylprednisolone, while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median dose of dexamethasone and methylprednisolone were 10 mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed complete resolution of hiccups after methylprednisolone rotation in the next cycle. Of these 34 patients, 25 (73.5%) had recurrence of hiccups after dexamethasone re-administration. Compared with baseline values, hiccup intensity (NRS: 5.24 vs. 2.44) and duration (66.43 minutes vs. 22.00 minutes) were significantly attenuated after dexamethasone re-administration. Of the 40 eligible patients, 38 (95%) were male.

Conclusion. DIH during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. We also identified a male predominance of DIH. Further prospective studies are warranted.

Truly Deeply rebrands ovarian cancer charity, OCRF - mUmBRELLA

silver ribbon

FDA Documents Paint Disturbing Picture Of Burzynski Cancer Clinic (antineoplastons)

Burzynski Cancer Clinic

....Earlier this year, the FDA finally visited the Burzynski Clinic to take a peek around. Through FOIA request, a number of bloggers have been looking over the documents for a few months, but now they have been released publicly.  The findings are very disturbing and paint a picture of a clinic that fails to follow even basic practices to protect patients.  Among the published observations:....... 

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

open access

 "We developed an analytic framework (Appendix Figure 1 of the Supplement) with 4 key questions that we adapted from a 2006 review by Huang and colleagues (6). Our full report describes our methods in detail (7). We specifically sought studies of the following vitamins and minerals: vitamins A, B₁, B₂, B₆, B₁₂, C, D, and E; calcium; iron; zinc; magnesium; niacin; folic acid; β-carotene; and selenium. We included studies that evaluated single, paired, and combinations of three or more vitamins and minerals; we use the term “multivitamin” to refer to these combinations of vitamins and minerals."



.....In conclusion, we found no evidence of an effect of nutritional doses on CVD, cancer, or mortality in healthy individuals without known nutritional deficiencies for most supplements we examined. In most cases there are insufficient data to draw any conclusion, although for vitamin E and β-carotene a lack of benefit is consistent across several trials. We identified 2 multivitamin trials that both found lower overall cancer incidence in men (19, 21). Both these trials were both methodologically sound, but the lack of an effect for women (albeit in 1 trial), the borderline significance in men in both trials, and the lack of any effect on CVD in either study makes it difficult to conclude that multivitamin supplementation is beneficial."


 

Acetyl-L-Carnitine Hydrochloride in Preventing Peripheral Neuropathy in Patients With Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cavity Cancer, or Fallopian Tube Cancer Undergoing Chemotherapy - Full Text View - ClinicalTrials.gov

ClinicalTrials.gov

This study has been withdrawn prior to enrollment. 

A Double-Blind, Randomized Phase II Study to Evaluate the Safety and Efficacy of Acetyl-L-Carnitine in the Prevention of Sagopilone-Induced Peripheral Neuropathy

Acetyl-L-Carnitine

Background. Peripheral neuropathy (PN) is a recognized side effect of microtubule-targeting agents and the most clinically relevant toxicity observed with the epothilone sagopilone (SAG). Studies suggest that acetyl-L-carnitine (ALC) may prevent chemotherapy-induced PN. We conducted a prospective, placebo (PBO)-controlled, double-blind, randomized trial to investigate the safety and efficacy of ALC for the prevention of SAG-induced PN.

Methods. Patients with ovarian cancer (OC) or castration-resistant prostate cancer (CRPC) and no evidence of neuropathy received SAG (16 mg/m² intravenously over 3 hours every 3 weeks) with ALC (1,000 mg every 3 days) or placebo (PBO). The primary endpoint was incidence of PN within six or fewer cycles in both treatment groups. 

Results. Overall, 150 patients enrolled (98 OC patients, 52 CRPC patients), with 75 per treatment arm. No significant difference in overall PN incidence was observed between treatment arms. The incidence of grade ≥3 PN was significantly lower in the ALC arm in OC patients. Median duration of neuropathy was similar between treatment arms. The best overall response (according to the modified Response Evaluation Criteria in Solid Tumors), response according to tumor markers, time-to-event variables, and discontinuations because of adverse events (AEs) were comparable between treatment arms. 

Conclusion. Administration of ALC with SAG did not result in a significant difference in overall PN incidence compared with a PBO. OC patients in the SAG/ALC arm had a significantly lower incidence of grade 3 or 4 PN compared with OC patients in the SAG/PBO arm.

 

Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study | Varsi | Journal of Medical Internet Research

JMIR--Patients

Background: The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients.
Objective: The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service.
Methods: This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC.
Results: Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems.
Conclusions: Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use.

 

JMIR--Analysis of the Purpose of State Health Departments' Tweets: Information Sharing, Engagement, and Action | Thackeray | Journal of Medical Internet Research

Tweets

Conclusions: This is the first study to assess the purpose of public health tweets among state health departments. State health departments are using Twitter as a one-way communication tool, with tweets focused primarily on personal health. A state health department Twitter account may not be the primary health information source for individuals. Therefore, state health departments should reconsider their focus on personal health tweets and envision how they can use Twitter to develop relationships with community agencies and partners. In order to realize the potential of Twitter to establish relationships and develop connections, more two-way communication and interaction are essential. 

Attachment Theory and Spirituality: Two Threads Converging in Palliative Care?

Aopen access

 Introduction
The goal of palliative care is to improve the quality of life of terminally ill patients by preventing or relieving them from suffering. Relieving suffering does not only mean to insulate patients from physical pain. There are many more aspects which contribute to the patient’s wellbeing such as social, psychological, and spiritual support [1]. This is why palliative medicine has to take a multidisciplinary approach to patient care. In the present paper, two important concepts come into focus, both founding a multivariate understanding of the patient’s needs and challenges in the palliative situation: attachment theory and the concept of spirituality. Attachment Theory is a concept that is concerned with human relationship behavior in situations of loss, separation, or helplessness and can help to understand the patient’s behavior, needs, and challenges [2, 3]. The patient’s spirituality in health care and research is addressed by the field of Spiritual care. spiritual care is an interdisciplinary and cross-cultural discipline [4] in health care that scientifically addresses the spiritual and religious needs of patients and has become a part of medical care and education. Both concepts have been treated by palliative research in diverse the and multiform ways, as we will propound in the overview of research literature in the following section. But no effort has been made to integrate them into one theoretical framework in reference to the palliative context. The aim of this paper is to discuss the relevance of both concepts to palliative care, in order to develop a theoretical foundation for both aspects of the palliative situation..... 

Research results in big savings for cancer treatment (neurotoxicity/oxaliplatin/magnesium/calcium)

healthnews

"....An intervention to counter the neurotoxic effects of a chemotherapy treatment for cancer has been withdrawn after research showed it was ineffective.

This resulted in big savings in the cost of the intervention and in treatment time by nurses, at Auckland City Hospital’s medical oncology service, one of the largest cancer treatment centres in Australasia.
Medical oncologist and doctoral student clinician Catherine Han carried out the research at the University of Auckland and Auckland City Hospital, as part of her work investigating the origins of neurotoxicity from oxaliplatin chemotherapy treatment. Her research is funded for three years by a Health Research Council Clinical Research Training fellowship for $250,000 awarded in 2012.
Research into the effectiveness of the calcium and magnesium infusions given to cancer patients to counter the neurotoxic effects of chemotherapy treatment with oxaliplatin showed it was not working.
“Catherine’s research showed clearly that the magnesium and calcium infusion does not work, and has led to a change in clinical practice in our cancer treatment centre at Auckland Hospital,” says her research supervisor, Associate Professor Mark McKeage who is a clinical pharmacologist and cancer specialist, and a co-director of the University-based Auckland Cancer Society Research Centre....

Olaparib Enters Phase III Clinical Testing

Olaparib

"After halting development of its PARP inhibitor olaparib nearly 2 years ago, AstraZeneca is reviving the drug and launching two phase III trials based on a retrospective analysis of phase II data that showed a marked effect in ovarian cancer patients with a BRCA mutation."

Compartment syndrome after gynecologic operations: evidence from case reports and reviews

abstract

"Compartment syndrome (CS) of the lower leg is a rare but severe complication of operations in the lithotomy (LT) position after urologic, gynecologic and general surgery. A delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. The pathophysiology is still not fully understood but it is believed that ischemia as a result of increased compartment pressure and decreased perfusion pressure may lead to CS. The type of leg support and intraoperative hypotension have been discussed as risk factors but evidence is mainly based on case reports and expert opinion. Studies suggest that time spent in the LT position and the addition of head-down tilt are associated with CS. As these positions are routinely applied during various gynecologic procedures, forensically CS has to be considered as a specific complication of gynecologic surgery in the LT position. Despite the low incidence there is a need for prospective studies and guidelines for its prevention.

Sixteen case reports describing 19 cases of CS following gynecologic surgery in lithotomy position were found during a literature search. This review is based on 14 of these case reports (17 cases), which describe a postoperative compartment syndrome in a previously healthy leg. We summarize the reported cases and literature on CS after gynecologic procedures in order to increase awareness among medical staff and to give careful recommendations regarding perioperative management based on available information."

 

Anatomy and Physiology: The 5 Unsung Heroes of the Abdominal Cavity

Anatomy and Physiology (excellent graphics)

1. Gallbladder: The Bile Keeper

2. Renal Pyramids: Cleansing Masters

3. Pancreas: Digestion Wunderkind

4. Adrenal Glands: Endocrine Celebrity

5. Cecum: Miss Congeniality (of the Abdomen)

 

 

 

Religiosity and Spirituality and the Intake of Fruit, Vegetable, and Fat: A Systematic Review

open access

Conclusion
Overall, the denominational studies showed that religious denomination is significantly related to fruit, vegetable, and fat intake. Specifically, the Adventists consumed more fruit and vegetable and less fat than non-Adventists. However, the relationship between the degree of R/S and dietary intake is mixed. The results of this review suggest that future research on R/S and diet may help explain the possible mechanism between religion and health. Methodology more sophisticated than observational studies is required. Longitudinal study methodologies (while still often observational) may enhance our understanding of underlying mechanisms. As religion is important for many people and affects their diet, improved methodological quality of R/S and diet research will surely shed more light on this area. 

(video) BBC - Future - Health - A doctor's touch

TED Quotes 

The most important innovation in medicine to come in the next 10 years: the power of the human hand. — Abraham Verghese

 

Dartmouth researcher finds novel genetic patterns that make us rethink biology and individuality

Health News
 Hanover, NH—Professor of Genetics Scott Williams, PhD, of the Institute for Quantitative Biomedical Sciences (iQBS) at Dartmouth's Geisel School of Medicine, has made two novel discoveries: first, a person can have several DNA mutations in parts of their body, with their original DNA in the rest—resulting in several different genotypes in one individual—and second, some of the same genetic mutations occur in unrelated people.....


(open access):
Click here to see the full paper at PLOS Genetics 

Cancer-related neuropathic pain in out-patient oncology clinics: a European survey

open access

Background

Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain.

Methods

An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians' clinical assessments after examining the completed PD-Q.

Results

A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients.

Conclusions

Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty. 

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

close  

Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making

abstract

Objectives

To systematically review patient-reported barriers and facilitators to shared decision making (SDM) and develop a taxonomy of patient-reported barriers.

Methods

Systematic review and thematic synthesis. Study findings/results for each included paper were extracted verbatim and entered into qualitative software for inductive analysis.

Results

Electronic and follow-up searches yielded 2956 unique references; 289 full-text articles were retrieved, of which 45 articles from 44 unique studies met inclusion criteria. Key descriptive themes were grouped under two broad analytical themes: how the healthcare system is organized (4 descriptive themes) and what happens during the decision-making interaction (4 descriptive themes, 10 sub-themes). Predominant emergent themes related to patients’ knowledge and the power imbalance in the doctor-patient relationship. Patients need knowledge and power to participate in SDM–knowledge alone is insufficient and power is more difficult to attain.

Conclusions

Many barriers are potentially modifiable, and can be addressed by attitudinal changes at the levels of patient, clinician/healthcare team, and the organization. The results support the view that many patients currently can’t participate in SDM, rather than they won’t participate because they do not want to.

Practice implications

Future implementation efforts should address patient-reported factors together with known clinician-reported barriers and the wider organizational context.

 

How can we explain physician accuracy in assessing patient distress? A multilevel analysis in patients with advanced cancer

abstract

Objective

To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression.

Methods

Twenty-eight physicians assessed their patients’ distress level on the distress thermometer, while patients (N = 201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out.

Results

Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA.

Conclusion

This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA.

Practice implications

Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns.

 

‘What they’re not telling you’: A new scale to measure grandparents’ information needs when their grandchild has cancer

abstract

Conclusions

Grandparents of children with cancer desire more information for their own reassurance, to reduce their reliance on ‘second-hand’ information from their grandchild's parents and to improve the support they provide their families. Grandparents strongly endorse the development of grandparent-targeted educational resources.

 

Gender-specific quality of life after cancer in young adulthood: a comparison with the general population

young adulthood

Conclusions

Results clearly indicate that young adult cancer patients have a reduced quality of life in comparison with the general population even long after the treatment of their disease is complete. Women had a lower quality of life than men. Age-specific interventions should be offered that lead to improvements in quality of life for this age group. And future studies should clarify what factors lead to women’s quality of life being worse than men’s.

 

Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis

abstract

Types of tumor associated with the highest VTE risk are hematologic  cancers,followed by lung,pancreatic,stomach,ovarian,uterine,bladder,and brain

 tumors.

Implications for Practice:

This large observational study of unselected patients receiving cancer 

chemotherapy demonstrates considerably greater rates of venous 

thromboembolism (VTE) than commonly reported in patients accrued to clinical trials.The risk of VTE appears to increase progressively over the year following initiation of treatment. Cancer patients

developing VTE also experience a greater risk of major bleeding and greater health care costs than patients without VTE.

Patients considered at high risk for VTE should be considered for 

thromboprophylaxis after assessing the balance of potential benefits and harms.

 

 

 

 

Progesterone receptor PROGINS and +331G/A polymorphisms confer susceptibility to ovarian cancer: a meta-analysis based on 17 studies

abstract

Progesterone and its receptor, progesterone receptor (PGR), have been widely studied for their roles in the onset and development of ovarian cancer. Although numerous epidemiological studies have focused on the association of PGR PROGINS and +331G/A polymorphisms with ovarian cancer susceptibility, presently, available results remain controversial, in part due to low sample sizes. Thus, a meta-analysis is required to evaluate this association. A literature search of PubMed, Embase, Web of Science, CNKI, and CBM databases was performed to retrieve eligible studies published before August 15, 2013. Summary odds ratios (ORs) with 95 % confidence intervals (CIs) were used to evaluate the strength of this association. All analyses were done using STATA 12.0 software (Stata Corp., College Station, TX, USA). Seventeen case-control studies with a total of 6,365 cases and 9,998 controls were identified. While no statistically significant association between the PROGINS allele and ovarian cancer risk was found in an overall analysis, a stratified analysis revealed that for Caucasians, never-oral contraceptive (OC) users, and serous tumor patients, there were statistically significant ORs for ovarian cancer risk associated with the mutated PROGINS allele. No significant association, however, between the +331G/A polymorphism and ovarian cancer susceptibility was observed in the overall analyses and subgroup analyses based on ethnicity and histological type. This meta-analysis provides evidence that the PROGINS allele occurs more frequently in ovarian cancer patients and especially in non-OC users and serous cancer patients, indicating that PROGINS may be a risk modifier. No significant association between the +331G/A polymorphism and ovarian cancer was found, even in stratified analyses by ethnicity and histological type. More detailed and well-designed studies are still needed to confirm the role of the PROGINS allele in ovarian cancer development.

 

A study of ovarian cancer biomarker amplification using ultrasound for early stage detection

open access

Highlights

•

We amplify ovarian cancer biomarkers by using ultrasound for early stage detection.

•

Ultrasound at 1 MHz, 0.3 W cm⁻² and 50% duty cycle is applied on ovarian cancer cells (SKOV3).

•

After 5 min sonication, the CA125 and CA19-9 levels are increased by 2.02 and 4.21-fold respectively.

 

Monoclonal antibody-based immunotherapy of ovarian cancer: targeting ovarian cancer cells with the B7-H3-specific mAb 376.96

abstract

Highlights

•

The mAb 376.96 defined B7-H3 epitope is expressed by chemosensitive and chemoresistant ovarian cancer cells, as well as patient tumors

•

mAb 376.96 enhanced the cytotoxicity of Sunitinib in vitro

•

Further studies are warranted examining B7-H3 as a potential target of mAb-based immunotherapy in ovarian cancer

 

Cleveland Clinic - Quantitative Health Sciences - Risk Calculators

Risk Calculators

 This information is provided by Cleveland Clinic as a convenience service only to physicians and is not intended to replace the physicians' medical advice. Please remember that this information, in the absence of a visit with a physician's patient, must always be considered as an educational service only and are not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure or recommendations for a given patient. CCF makes no representation or warranty concerning the accuracy or reliability of this information and does not warrant the results of using this tool. In no event shall CCF be liable for any damages, direct, indirect, consequential or otherwise, relating to the use of this information or this tool.

Topics:

Acute Coronary Syndrome
Benign Prostatic Hyperplasia:
Bladder Cancer
Brain Cancer
Breast Cancer
Colorectal Cancer
Complex Colorectal Surgery
Suspected Coronary Artery Disease
Cardiac Surgery
Type 2 Diabetes
Gastric Cancer
Suspected Kidney Cancer
Chronic Kidney Disease
Oral Cancer
Ovarian Cancer
Pancreatic Cancer
Penile Cancer
First Pregnancy
Prostate Cancer
Sarcoma
Thyroid Cancer
Total Joint Replacement

Pulitzer Prize Winner Anna Quindlen Advises Physicians to Learn Who Their Patients Are

Pulitzer Prize 

Antioxidant vitamins and magnesium and the risk of hearing loss in the US general population

Abstract

Market Removal of Ponatinib Raises Questions, Concerns

Medscape

Prevalence and characteristics of moderate to severe fatigue

abstract

BACKGROUND

The effective management of fatigue in patients with cancer requires a clear delineation of what constitutes nontrivial fatigue. The authors defined numeric cutpoints for fatigue severity based on functional interference and described the prevalence and characteristics of fatigue in patients with cancer and survivors.

METHODS

In a multicenter study, outpatients with breast, prostate, colorectal, or lung cancer rated their fatigue severity and symptom interference with functioning on the M. D. Anderson Symptom Inventory numeric scale of 0 to 10. Ratings of symptom interference guided the selection of numeric rating cutpoints between mild, moderate, and severe fatigue levels. Regression analysis identified significant factors related to reporting moderate/severe fatigue.

RESULTS

The statistically optimal cutpoints were ≥ 4 for moderate fatigue and ≥ 7 for severe fatigue. Moderate/severe fatigue was reported by 983 of 2177 patients (45%) undergoing active treatment and was more likely to occur in patients receiving treatment with strong opioids (odds ratio [OR], 3.00), those with a poor Eastern Cooperative Oncology Group performance status (OR, 2.00), those who had > 5% weight loss within 6 months (OR, 1.60), those who were receiving > 10 medications (OR, 1.58), those with lung cancer (OR, 1.55), and those with a history of depression (OR, 1.42). Among survivors (patients with complete remission or no evidence of disease, and not currently receiving cancer treatment), 29% of patients (150 of 515 patients) had moderate/severe fatigue that was associated with poor performance status (OR, 3.48) and a history of depression (OR, 2.21).

CONCLUSIONS

The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate/severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue. 

A Patient with Recurrent Ovarian Clear Cell Adenocarcinoma and Chronic Kidney Disease Exhibited Complete Response to Paclitaxel plus Carboplatin (Japan)

abstract

A 41-year-old woman receiving hemodialysis 3 times a week for chronic kidney disease caused by interstitial nephritis was referred to our hospital because of a pelvic mass and subsequently underwent primary surgery . The patient was diagnosed with FIGO stage Ic(b)clear cell adenocarcinoma. She did not receive postoperative chemotherapy. However, 9 months after surgery, ascites and a pelvic mass developed, on the basis of which recurrence was confirmed. She received combination chemotherapy with paclitaxel plus carboplatin(TC). Paclitaxel was administered at 175mg/m2, and the carboplatin dosage was calculated by the Calvert formula. The glomerular filtration rate was considered to be 0, and the target area under the plasma concentration versus time curve was 5. Hemodialysis was performed 24 hours after the infusion of carboplatin. After 6 courses of combination chemotherapy, complete response was confirmed by computed tomography. The patient developed grade 3 neutropenia, grade 1 sensory neuropathy , and grade 2 alopecia, but the other adverse events were mild. In conclusion, TC combination chemotherapy was well tolerated and generated a good response in a patient with recurrent ovarian clear cell adenocarcinoma who was receiving hemodialysis for chronic kidney disease.

 

Communication of Clinically Useful Next-Generation Sequencing Results to At-Risk Relatives of Deceased Research Participants: Toward Active Disclosure?

Correspondence - open access

Preventing Ovarian Cancer through Genetic Testing: a Population-Based Study

abstract

"Genetic testing for BRCA1 and BRCA2 gene mutations, in conjunction with preventive oophorectomy for mutation carriers, may be used to prevent a proportion of invasive ovarian cancers (‘personalized medicine’). We evaluated the potential utility of this approach at a population level by reviewing the pedigree information and genetic test results from 1,342 ovarian cancer patients in Ontario. Of the 1,342 patients tested, 176 patients had a BRCA1 or BRCA2 mutation; of these, 48 women would have qualified for testing prior to the development of cancer based on the eligibility criteria in place for the province of Ontario. In summary, 48 of 1,342 unselected cases of ovarian cancer (3.6 %) might have been prevented if genetic testing criteria were universally applied to all women in Ontario at risk for ovarian cancer."

Recalls, Market Withdrawals, & Safety Alerts > Bailey’s Choice Expands Product Recall of Dog Treats in Georgia

Dog Treats in Georgia

Small fallopian tube carcinoma with extensive upper abdominal dissemination: a case report (Portugal)

a case report - open access

Introduction

Fallopian tube carcinoma is a rare gyncological malignancy with low accuracy detection preoperatively. The symptoms are unspecific and imaging can be misleading. Since it was first described in 1847, there have been only a little over 2000 case reports.

Case presentation

This case report describes a 66-year-old Caucasian woman who presented with progressive diffuse abdominal pain, without other symptoms. After abdominopelvic magnetic resonance imaging, she was sent to the Portuguese Oncology Institute of Oporto with the suspicion of peritoneal carcinomatosis of unknown primary tumor. Due to a pelvic palpable mass (calcified giant uterine fibroid) she was directed to the Gynecology team. Surgery was performed and a large mass in her upper abdomen was identified. The extemporary examination revealed a high-grade adenocarcinoma. During surgery a small change of color and consistency of her left fallopian tube was noted and unilateral adnexectomy was performed. After pathologic and immunohistochemistry tests, the diagnosis of fallopian tube carcinoma with peritoneal dissemination was made.

Conclusions

This case is very unique in the way that a small primary fallopian tube carcinoma was able to disseminate to the upper abdominal quadrant with little pelvic dissemination. The symptoms and imaging were unspecific. Although a rare occurrence, we should not forget fallopian tube carcinoma in the differential diagnosis of peritoneal carcinomatosis, even in the absence of Latzke's triad (symptoms).

 

Epidermal Growth Factor Receptor (EGFR), HER2 and Insulin Growth Factor Receptor-1 (IGFR-1) Status in Ovarian Adult Granulosa Cell Tumours

abstract

Aims

Adult granulosa cell tumours (AGCTs) are uncommon ovarian sex cord-stromal tumours which recur following surgical removal in up to 50% of patients. Treatment options for recurrent and advanced stage AGCTs are limited with poor response to chemotherapy and radiotherapy. We aimed to assess the Epidermal Growth Factor Receptor (EGFR) (HER1), HER2 and Insulin Growth Factor Receptor-1 (IGFR-1) status in AGCTs with a view to investigating whether these receptors might be potential therapeutic targets in these neoplasms.

Methods And Results

Immunohistochemical staining for EGFR, HER2 and IGFR-1 was undertaken in 31 AGCTs. Tumour DNA was also analysed for mutations in the tyrosine kinase domain of EGFR (exons 18-21) by Cobas mutation RT-PCR. 23/31 (74%) AGCTs showed some degree of EGFR expression, generally with cytoplasmic or mixed membranous and cytoplasmic staining of variable intensity. 11/27 (41%) cases exhibited strong membranous and cytoplasmic expression of IGFR-1. HER2 expression was not seen. No mutations were found in exons 18-21 of the EGFR gene in hotspots of therapeutic relevance.

Conclusions

This study raises the possibility that anti-EGFR and/or anti-IGFR-1 therapies may be potential agents in ovarian AGCTs and this requires further study. Lack of known mutations within the tyrosine kinase domain of EGFR suggests that EGFR-related tyrosine kinase inhibitors may not be useful therapeutically.

 

15 facts about health care in Canada - media

15 facts 

How well is our health system working? · Canada

CIHI

About

Look at the big picture across Canada to see how health systems perform in the provinces and territories, or check out your city or even your local hospital.

Explore the five areas of performance measurement that Canadians told us were most important to them…

 

NHS England » NHS England launches major exercise to shape the future of specialised services

NHS England-future of specialised services

The scoping event will be held in London on 9 December. Anybody who is interested in being involved in the debate about the future of specialised services and wishes to apply for a place should email dorothy.chen@shca.info. 

Safety Alerts for Human Medical Products > Low Molecular Weight Heparins: Drug Safety Communication - Recommendations to Decrease Risk of Spinal Column Bleeding and Paralysis

Safety Alert

Using empathy to use people: Emotional intelligence and manipulation | The Moral Universe

Using empathy to use people

The Moral Universe

---

Dialogues on the psychology of right and wrong

The Moral Universe Home

Canadian Doctors for Medicare: Fraser Institute report on wait times flawed

Canadian Doctors for Medicare E-News November 2013 

CDM: Fraser Institute report on wait times flawed

Dr. Ryan Meili questions the usefulness of the Fraser Institute’s latest report on wait times in the National Post.

The Fraser Institute’s annual wait times report is based on a survey, not objective data, and it looks only at specialists providing elective surgeries, ignoring Canada’s good record with acute and emergency surgeries. Respondents are therefore self-selected, and responses are solicited with the incentive of winning an iPad.

CDM knows that this isn’t a credible way to gather data on wait times. We can be doing better on wait times, but we should be looking at the evidence, not surveys of a self-selected group, to tell us how we’re doing.


 National Post

But some question the Fraser Institute report and the conclusions of its authors.
“It is the same old sky-is-falling report,” said Dr. Ryan Meili, a family physician in Saskatoon who is vice-chairman of Canadian Doctors For Medicare.
“Wait times don’t get shorter when you introduced more delivery of care outside of the public system, they get longer. You don’t just draw patients away from the public system, you also draw away providers,” he said.
Dr. Michael Rachlis, a health policy analyst associated with the Canadian Health Coalition, a pro-universal-healthcare organization, said the co-payment plans from abroad “which allow some people to jump the queue” is not the answer to Canada’s wait times.
“We do tend to wait too long but it has nothing to do with us having a public system. It has a lot to do with how we organize services,” Dr. Rachlis said. “We can eliminate virtually every wait time by better management.”
The institute’s (Fraser) questionnaire was sent to practitioners between the beginning of January and the end of April. The response rate to the surveys was 21%.

 

Life insurance and genetic test results: a mutation carrier's fight to achieve full cover Australia

Medical Journal of Australia

PHG Foundation | New York Genome Centre opens

New York 

Genomics England and the 100,000 genomes « Genomes Unzipped

England

Characteristics, treatment and prognostic factors of patients with gynaecological malignancies treated in a palliative care unit at a university hospital

abstract

Background: Limited clinical data have been published on patients suffering from advanced gynaecological malignancies treated in palliative care units, and little is known about prognostic factors. 

Methods: In a retrospective study, the data of 225 patients with breast, ovarian and cervical cancer treated in the palliative care unit of a university hospital between 1998 and 2009 were assembled. Clinical aspects and baseline symptoms, laboratory parameters, the clinical course, and outcome were evaluated. 

Results: 225 patients (497 cases; cancer diagnoses: breast 79%, ovarian 13%, and cervix 8%) were included in the analysis. The main symptoms were weakness/fatigue (71%), pain (65%), anorexia/nausea (62%), and dyspnea (46%). Pain control was achieved in 85% of all cases, satisfying control of other symptoms in 80%.

Viva La Evidence - youtube (song)

Correspondence: Low–Molecular Weight Heparin Prophylaxis Should Not Be Recommended Even in Highly Selected Patients With Solid Cancer Receiving Outpatient Chemother

open access

 

CA72-4 ovarian cancer -(unspecifiied date) Search

quick search results

Is CA72-4 a Useful Biomarker in Differential Diagnosis between Ovarian Endometrioma and Epithelial Ovarian Cancer?

open access

Abstract

Background. Surgical excision of ovarian endometriomas in patients desiring pregnancy has recently been criticized because of the risk of damage to healthy ovarian tissue and consequent reduction of ovarian reserve. A correct diagnosis in cases not scheduled for surgery is therefore mandatory in order to avoid unexpected ovarian cancer misdiagnosis. Endometriosis is often associated with high levels of CA125. This marker is therefore not useful for discriminating ovarian endometrioma from ovarian malignancy. The aim of this study was to establish if the serum marker CA72-4 could be helpful in the differential diagnosis between ovarian endometriosis and epithelial ovarian cancer.
Methods. Serums CA125 and CA72-4 were measured in 72 patients with ovarian endometriomas and 55 patients with ovarian cancer.
Results. High CA125 concentrations were observed in patients with ovarian endometriosis and in those with ovarian cancer. A marked difference in CA72-4 values was observed between women with ovarian cancer (71.0%) and patients with endometriosis (13.8%) ( ).
Conclusions. This study suggests that CA72-4 determination can be useful to confirm the benign nature of ovarian endometriomas in women with high CA125 levels.

1. Introduction

Endometriosis is a common chronic disease, affecting 5–10% of women in reproductive age [1]. The disease is characterized by the presence and growth of endometrial tissue outside the uterine cavity, often associated with infertility and pelvic pain and that tends to recur [2–5]. Endometriosis can be diagnosed by clinical and ultrasound examinations (US), but the most accurate procedure to confirm the diagnosis is laparoscopy that allows visualization of lesions and histological confirmation [6].

Endometriosis is a benign disease but it shares several characteristics with invasive cancer. Cancer antigen 125 (CA125) is a tumor marker used for the differential diagnosis in a postmenopausal woman with an adnexal mass [7]. However, in premenopausal age, CA125 is characterized by a low diagnostic specificity, as abnormally high concentrations can be found in malignancies of different origin including nonovarian gynecological cancer [8], in women with nongynecological diseases such as tuberculosis and liver cirrhosis, and also in pelvic inflammatory disease, uterine fibroids, or physiological conditions such as pregnancy or different phases of the menstrual cycle [9, 10]. In patients with endometriosis, CA125 levels can be high. In fact, CA125 is the most extensively investigated and used peripheral biomarker for monitoring the disease [11]. Thus, CA125 has a limited role in the differential diagnosis between endometriosis and ovarian cancer due to the lack of specificity [12]..... 

Overcome Challenges in Screening for Ovarian Cancer

medscape

Cancer Drug Trial Put on Partial Hold After Death (Curis - CUDC-427)

CUDC-427 Phase 1 Trial Placed on Partial Clinical Hold by FDA

"The current open-label, single-agent, dose escalation Phase 1 study of CUDC-427 was initiated in the third quarter of 2013 in patients with advanced and refractory solid tumors or lymphomas."

Bevacizumab-induced transient sixth nerve palsy in ovarian cancer: A case report

abstract

"We report a case of transient sixth nerve palsy after systemic administration of bevacizumab. Two days after systemic administration of bevacizumab in conjunction with gemcitabine and carboplatin in a 67-year-old woman with recurrent primary ovarian cancer, the patient developed sixth nerve palsy. After bevacizumab was stopped, the complete left sixth nerve palsy resolved spontaneously over the course of 3 months. This is the first reported case of bevacizumab-induced cranial sixth nerve palsy in the treatment of gynecologic malignancy."


 

Prevalence of Occult Gynecologic Malignancy at the Time of Risk Reducing and Non Prophylactic Surgery in Patients with Lynch Syndrome

abstract

Purchase $39.95

---

Highlights

•

Surgeons should consider the possibility of malignancy in patients with Lynch syndrome who are undergoing risk-reducing surgery.

•

Surgeons should consider pre-operative testing and sending operative specimens for frozen pathology to determine the need for staging.

---

Objective: The primary aim of this study was to determine the prevalence of occult gynecologic malignancy at the time of risk reducing surgery in patients with Lynch Syndrome. A secondary aim was to determine the prevalence of occult gynecologic malignancy at the time of surgery for non-prophylactic indications in patients with Lynch Syndrome.

Methods: A retrospective review of an Inherited Colorectal Cancer Registry found 76 patients with Lynch syndrome (defined by a germline mutation in a DNA mismatch repair gene) or hereditary nonpolyposis colorectal cancer (HNPCC) (defined by Amsterdam criteria) who had undergone hysterectomy and/or salpingo-oophorectomy for a prophylactic or non-prophylactic indication. Indications for surgery and the prevalence of cancer at the time of each operation were reviewed.

Results: 24 of 76 patients underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy for Lynch syndrome or HNPCC. In 9 of these patients, a benign indication for surgery was also noted. 4 of 24 patients (17%, 95% CI = 5-38%) were noted to have cancer on final pathology. 20 of 76 patients (26%) undergoing operative management for any indication were noted to have occult malignancy on final pathology.

Conclusions: Patients should be counseled about the risks of finding gynecologic cancer at the time of prophylactic or non-prophylactic surgery for Lynch syndrome and HNPCC, and the potential need for additional surgery.

 

Prognostic value of baseline survival determined for 11 types of cancer

science news

Nov. 6, 2013 — Results of an EORTC study published in Cancer point out the prognostic value of baseline recorded health-related quality of life for survival for eleven types of cancer: brain, breast, colorectal, esophageal, head and neck, lung, melanoma, ovarian, pancreatic, prostate, and testicular cancer. For each cancer site, at least one health-related quality of life parameter provided additional prognostic information over and above the clinical and sociodemographic variables.....

 "nausea and vomiting for ovarian cancer"

abstract
 A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites

BACKGROUND

The objective of this study was to examine the prognostic value of baseline health-related quality of life (HRQOL) for survival with regard to different cancer sites using 1 standardized and validated patient self-assessment tool.

METHODS

In total, 11 different cancer sites pooled from 30 European Organization for Research and Treatment of Cancer (EORTC) randomized controlled trials were selected for this study. For each cancer site, univariate and multivariate Cox proportional hazards modeling was used to assess the prognostic value (P < .05) of 15 HRQOL parameters using the EORTC Core Quality of Life Questionnaire (QLQ-C30). Models were adjusted for age, sex, and World Health Organization performance status and were stratified by distant metastasis.

RESULTS

In total, 7417 patients completed the EORTC QLQ-C30 before randomization. In brain cancer, cognitive functioning was predictive for survival; in breast cancer, physical functioning, emotional functioning, global health status, and nausea and vomiting were predictive for survival; in colorectal cancer, physical functioning, nausea and vomiting, pain, and appetite loss were predictive for survival; in esophageal cancer, physical functioning and social functioning were predictive for survival; in head and neck cancer, emotional functioning, nausea and vomiting, and dyspnea were predictive for survival; in lung cancer, physical functioning and pain were predictive for survival; in melanoma, physical functioning was predictive for survival; in ovarian cancer, nausea and vomiting were predictive for survival; in pancreatic cancer, global health status was predictive for survival; in prostate cancer, role functioning and appetite loss were predictive for survival; and, in testis cancer, role functioning was predictive for survival.

CONCLUSIONS

The current results demonstrated that, for each cancer site, at least 1 HRQOL domain provided prognostic information that was additive over and above clinical and sociodemographic variables.