Interactive Map: (U.S.) AHRQ comparing healthcare stats quality etc

NHQR/DRnet - Select State

 This newly integrated website provides a unified Web tool for investigating information presented in the National Healthcare Quality and Disparities Reports. It allows users to drill down from the broadest picture of healthcare quality and disparities on the national and state levels

 

Principles of Treatment for Borderline, Micropapillary Serous, and Low-Grade Ovarian Cancer

abstract

Borderline ovarian tumors (BOTs) are less common than epithelial ovarian cancers (EOCs). Low-grade EOCs (LG-EOCs) occur even less frequently than BOTs. After primary therapy, recurrence rates of BOTs and LG-EOCs are significantly lower and the stage-adjusted survival is higher than for high-grade EOCs. Thus, determining the best management in terms of traditional ovarian cancer staging and debulking procedures is more challenging and has been recently brought to question. This article reviews the particulars of BOTs and LG-EOCs, their similarities and differences, and how they are best managed and treated, and emphasizes the major role of surgery and the controversial role of chemotherapy. Because these tumors disproportionately affect younger women, this review addresses ovarian preservation in circumstances when fertility or hormonal preservation is desired. 

(less common histopathologies) Ovarian Cancer, V1.2016, NCCN Clinical Practice Guidelines

Ovarian Cancer
  
Abstract

This selection from the NCCN Guidelines for Ovarian Cancer focuses on the less common ovarian histopathologies (LCOHs), because new algorithms were added for LCOHs and current algorithms were revised for the 2016 update. The new LCOHs algorithms include clear cell carcinomas, mucinous carcinomas, and grade 1 (low-grade) serous carcinomas/endometrioid epithelial carcinomas. The LCOHs also include carcinosarcomas (malignant mixed Müllerian tumors of the ovary), borderline epithelial tumors (also known as low malignant potential tumors), malignant sex cord-stromal tumors, and malignant germ cell tumors.

Footnotes

Please Note

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Ovarian Cancer are not printed in this issue of JNCCN but can be accessed online at NCCN.org.

A doctor learns what food means to her patients (eg. NG tubes...)

medical news

When we finally removed the (NG)  feeding tubes from this patient’s throat, the first thing he said was “I haven’t eaten anything in weeks!” The senior doctor reminded him of the role of that feeding tube.

Doctors and patients aren’t always on the same page.

Metformin in ovarian cancer therapy: A discussion

open access
 

Preclinical Studies of Metformin and Ovarian Cancer

Metformin's indirect effect on ovarian cancer

Several preclinical studies demonstrate the metformin's indirect effect on OVC, the mechanism of which includes the inhibition of hepatic gluconeogenesis and increasing peripheral glucose uptake,^{[45],[46],[47]} subsequently resulting in lower glucose, insulin, and IGF-1 levels in circulation.^[48],[49] Hyperglycemia attenuates metformin sensitivity in OVC while stimulating the OVC progression.^[50],[51] Similarly, in hyperinsulinemia, IGF-1 levels also stimulate the risk of OVC by activating PI3K/Akt/mTOR pathway, through IGF-1R signaling.^{[37],[52],[53],[54]} A careful observation of the above data also suggested that the metformin cannot play an indirect effect in nondiabetic patients.^[55]

Conclusion
The epidemiologic and preclinical data evaluated in this review are supportive of the use of metformin for the prevention and treatment of OVC. Preclinical evidence suggests that metformin possesses anticancer effects on OVC. Results of clinical studies, although a few, suggest that using metformin, pertaining to its cumulative dose and duration of therapy, is associated with a decreased incidence of OVC in diabetic population. In addition, it is also found to be associated with a better survival of OVC patients with diabetes. There are many unanswered questions though, including: (1) Whether metformin has anti-cancer activity in nondiabetics? (2) Whether we can use tumor genetic profiling to identify patients who are most likely to benefit from metformin treatment? (3) Considering the supra-clinical doses of metformin used in preclinical in vitro models to obtain an antineoplastic effect, should the optimal dose of metformin for OVC be revised and/or should it need a new route of drug delivery? (4) Do the serious side effects of supra-clinical doses or long-term therapy of metformin exist? If so, how to avoid these side effects? Future studies are hoped to warrant such questions, the results of which should be of value in determining metformin as a standard line of treatment for OVC patients.

FDA Alert: Opioid Pain or Cough Medicines Combined With Benzodiazepines: Drug Safety

(U.S.) FDA Requiring New Boxed Warnings About Serious Risks and Death
 August 31, 2016

ISSUE: FDA review has found that the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths.  Opioids are used to treat pain and cough; benzodiazepines are used to treat anxiety, insomnia, and seizures. In an effort to decrease the use of opioids and benzodiazepines, or opioids and other CNS depressants, together, FDA is adding Boxed Warnings, our strongest warnings, to the drug labeling of prescription opioid pain and prescription opioid cough medicines, and benzodiazepines. See the Drug Safety Communication for a listing of all approved prescription opioid pain and cough medicines, and benzodiazepines and other CNS depressants.
FDA conducted and reviewed several studies showing that serious risks are associated with the combined use of opioids and benzodiazepines, other drugs that depress the CNS, or alcohol (see the FDA Drug Safety Communication for a Data Summary).......

                         ~~~~~~~~~~~~~~~~~~~~~~~~~

(list) Drugs that contain benzodiazepines

Death, bankruptcy and longer wait times: Ottawa warned about more private health care

Politics - CBC News

Dr. Matthew Yurgelun on Next Steps in Understanding CRC Mutations (BRCA)

video (0:51 min)

 Matthew B. Yurgelun, MD, instructor in Medicine, Harvard Medical School, discusses the next steps in study looking at BRCA1 and BRCA2 mutations and other genetic markers in colorectal cancer.

The study examined over 1000 individuals with colorectal cancer who were seen at the Dana Farber Cancer Institute, and ultimately consented to participation in a sample registry. It found that 10% of patients had pathogenic mutations in one or more cancer susceptibility genes and 7.1% of patients had a mutation in the non-Lynch syndrome cancer susceptibility gene. The most common mutations that were found beyond Lynch syndrome were BRCA1 and BRCA2, which was surprising, says Yurgelun.

Next steps in this study will be to further evaluate the significance of some of these surprise mutations.

There are a lot of genes that are now being tested for where the full spectrum cancer risk that mutations in these genes confer is not understood, says Yurgelun.

The spectrum of cancer risk linked to some genes may be wider than traditionally though, and larger studies looking specifically at whether or not these mutations mean the same things when found in a non-traditional fashion, need to be conducted, he says.
 

Brian Hodges (UHN) is awarded the Karolinska Institutet Prize for (eg. simulated patients) Research in Medical Education

media

Simulated consultations: a sociolinguistic perspective

Full Text

  Whilst simulation undoubtedly has a place in formative learning for professional communication, the simulated consultation may distort assessment of professional communication These sociolinguistic findings contribute to the on-going critique of simulations in high-stakes assessments and indicate that further research, which steps outside psychometric approaches, is necessary.

                                        ~~~~~~~~~~~~~~~~~~~~~~~~~~~

•  In health care, a simulated patient (SP), also known as a standardized patient, sample patient , or patient instructor, is an individual trained to act as a real patient in order to simulate a set of symptoms or problems.
•  McMaster University > CSBL > Standardized Patient Program - Hamilton
  simulation.mcmaster.ca/spp.html
  A standardized patient is a healthy person who is trained to realistically and accurately reproduce a history, physical and/or emotional medical scenario that a real patient would present.
•  Standardized Patient Program | - Toronto
  www.spp.utoronto.ca/
  The Standardized Patient Program (SPP), University of Toronto is a dynamic educational resource dedicated to enhancing all facets and levels of health ... 

  • Standardized Patient Program - Johns Hopkins Medicine
  www.hopkinsmedicine.org › Simulation Center › Training
  Standardized patient simulation involves the use of individuals trained to portray the roles of patients, family members or others to allow students to practice ...

Cochrane - Featured Review: Interventions to reduce corruption in the health sector

Cochrane


Scarce evidence, but pointers to promising strategies to fight corruption in  health care
Corruption can occur in any area of the health sector, and happens when people abuse their own position to benefit themselves, their organization, or other people close to them. It can take many forms, including bribes, theft, or giving incorrect or inaccurate information deliberately. Healthcare officials, for instance, may steal healthcare funds; hospital administrators may change patient records to increase hospital fees; doctors may accept gifts or hospitality from pharmaceutical companies in exchange for using their products; and patients may try to bribe hospital staff to avoid treatment queues. Corruption can therefore take money away from health care, lead to poorer quality care, or make access to health care unfair, and often affects poor people the most.

A team of Cochrane authors based in Chile, India, Norway, and the USA worked with Cochrane Effective Practice and Organisation of Care to assess the effectiveness of strategies to reduce corruption in the health sector.

Molecular alterations in indolent, aggressive and recurrent ovarian low-grade serous carcinoma

Abstract
 

Aims

The clinical course of patients with low-grade serous carcinoma (LGSC) can be substantially different. The purpose of this study was to explore whether molecular or pathological features could identify patients that follow a more aggressive course.

Conclusion

Despite limited case numbers, it appears that current molecular testing is inferior in predicting outcome of LGSCs compared to a pathological parameter or protein expression. Prediction of outcome based on the primary tumour may be confounded by additional acquired changes over time.

Ovarian cancer study dropouts had worse health-related QOL/psychosocial symptoms at baseline and over time

abstract:
Ovarian cancer study dropouts had worse health-related quality of life and psychosocial symptoms at baseline and over time

Conclusions

Poorer HRQOL and higher depression at baseline, and final HRQOL, anxiety, depression and optimism scores were predictive of time of dropout. These results highlight the importance of collecting auxiliary data to inform careful and considered handling of missing PRO (Patient Reported Outcomes) data during analysis, interpretation and reporting.

(2016) Radiation Therapy for Recurrent Clear-Cell Cancer of the Ovary

abstract

Objective: Given the relative chemo-resistant nature of clear-cell gynecologic cancers, we investigated the utility of radiation therapy (RT) to treat recurrent clear-cell carcinoma (CCC) of the ovary.

Methods: A retrospective chart review of patients with recurrent CCC managed from 1994-2012 was conducted at 2 academic medical centers. Demographic and clinicopathologic factors were abstracted and evaluated using Pearson [chi]2 or t tests, Kaplan-Meier and Cox regression analyses.

Results: Fifty-three patients had recurrent CCC, and 24 (45.3%) of these patients received RT. There were no significant differences in age, stage, optimal cytoreduction, platinum response, or the percentage of patients that received more than 3 regimens of chemotherapy between the 2 groups. Patients who received RT for recurrent CCC were more likely to have had a focal recurrence (62.5% vs 10.3%, P <= 0.001) and to have undergone secondary cytoreduction (70.8% vs 10.3%, P <= 0.001). Of patients who received RT, 73.9% underwent surgery with or before their treatment. Five-year survival after recurrence was significantly higher in the group that received RT, 62.9% versus 18.8% (P = 0.002). In a multivariate analysis, platinum-sensitive disease and RT were associated with improved survival from recurrence, (hazard ratio, 0.26; 95% confidence interval, 0.08-0.81; P = 0.02 and hazard ratio, 0.28; 95% confidence interval, 0.09-0.90, P = 0.03, respectively).

Conclusions: In this cohort of patients with recurrent CCC, platinum-sensitive disease and RT are associated with improved survival. However, it is important to note that the majority of these patients underwent surgery along with RT, and it may be that the benefit of RT is limited to those who undergo secondary cytoreduction.

The Use of "Optimal Cytoreduction" Nomenclature in Ovarian Cancer Literature: Can We Move Toward a More Optimal Classification System?

abstract

Objectives: The objective of this study is to explore how cytoreductive surgical outcomes such as residual disease (RD) and use of the term "optimal cytoreduction" (OCR) have changed over time in the ovarian cancer literature.

Conclusions: Optimal cytoreduction terminology remains ambiguous and inconsistently used in the ovarian cancer surgical literature. On the basis of this literature review, we propose a novel classification system to categorize RD without reference to OCR while accurately and succinctly identifying meaningful clinical subgroups and minimizing bias.

Gene Wilder spent decades raising awareness for the ovarian cancer that claimed wife Gilda Radner’s life

media

September is Ovarian Cancer month (U.S./Canada)

OCNA

 

(crystal clear? not so fast) IARC: Absence of Excess Body Fat Lowers Risk of Many Cancers

IARC: Absence of Excess Body Fat Lowers Risk of Many Cancers

 "The review certainly concluded crystal clear, as you say, that obesity causes cancer," Graham Colditz, M.D., M.P.H., who chaired the IARC review group, told HealthDay. "And hence the conclusion that there is cancer prevention through avoiding obesity."

Unequal representation of genetic variation across ancestry groups creates healthcare inequality in the application of precision medicine

Unequal representation of genetic variation across ancestry groups creates healthcare inequality in the application of precision medicine | Genome Biology | Full Text
 

Conclusions

These analyses illustrate how unequal representation of genetic variation can negatively affect present genomic interpretation in individuals of non-European ancestry. While the results are unsurprising given our understanding of population genetics, there are still important lessons. Firstly, these data show that it is instructive to assess the allele frequencies of non-European cases in their matched ancestry group(s). Secondly, increasing diversity of geographic ancestry and sample size among sequenced reference cohorts greatly ameliorates the problem (Fig. 1).

Given that sample sizes are about to explode with the US national initiative and other large-scale international sequencing studies, it is vital that we ensure the most equitable distribution of the generation of genomic data possible. Enriching our knowledge of genetic variation in different ancestry groups remains the most effective solution to this problem. With initiatives like the recently announced Precision Medicine Initiative (PMI) Cohort Program, this must be recognized as a high priority for the field as we move towards an era where precision medicine is a reality. If not, genomics could further contribute to healthcare inequalities.

Conundrums in the management of malignant ovarian germ cell tumors

abstract:
Conundrums in the management of malignant ovarian germ cell tumors: Toward lessening acute morbidity and late effects of treatment

 One of the most extraordinary stories in the chronicles of gynecologic cancers has been that of malignant ovarian germ cell tumors. Prior to the mid-1960s, most patients died of disease. Fifty years later, most survive. Precisely because high cure rates are achievable, the concentration over the past decade has been on minimizing toxicity and late effects. The present review focuses on five areas of interest related to the management of malignant ovarian germ cell tumors that highlight the different therapeutic strategies practiced by pediatric and gynecologic oncologists: 1) primary surgery, 2) surgery alone (surveillance) for patients with FIGO stage IA disease, 3) postoperative management of FIGO stage IC-III disease, 4) postoperative management of pure immature teratoma, and 5) postoperative management of metastatic pure dysgerminoma. All of these topics share a common overarching theme: Lessening acute morbidity and late effects of treatment.

(no colon history) Mismatch Repair Protein Expression in Clear Cell Carcinoma of the Ovary: Incidence and Morphologic Associations in 109 Cases. - PubMed - NCBI

(repost/abstract)
Mismatch Repair Protein Expression in Clear Cell Carcinoma of the Ovary: Incidence and Morphologic Associations in 109 Cases

Same Data; Different Interpretations - open access (ex. lung, ovarian, breast)

Same Data; Different Interpretations

Interpretation of oncology clinical trial data are not always straightforward or consistent. Similar trial results with disparate interventions may be interpreted differently by the oncology community. One of the main reasons for this discrepancy is the debate regarding what is the appropriate end point for demonstration of efficacy of cancer drugs. There is no doubt that overall survival (OS) is the best parameter to judge the utility of any intervention, and it is free from bias in ascertainment and measurement¹; but for conditions with few treatment options and dire outcomes, the need for new agents is high and the oncology community sometimes settles on a surrogate end point that, in many cases, is progression-free survival (PFS).² It is easy to understand why PFS is favored among the researchers: It occurs early and is not influenced by postprogression therapy. At the same time, it would make little sense to have an agent that reduces chances of dying of cancer but increases off-target deaths; hence, the need for verification of OS. Phase III trials that report on significant PFS benefits without OS prolongation become the apples of discord in the oncology community. In this commentary, we present three examples from lung, ovarian, and breast cancers and demonstrate how the oncology community interprets similar data differently. Finally, we take our best guess as to why this phenomenon happens. 

 Ovarian Cancer: Angiogenesis Inhibitors and Dose-Dense Chemotherapy

Several attempts have been made to build on the success of the platinum-taxane combination for treating advanced or metastatic ovarian cancer, but none have been met with irrefutable success. Of those various strategies, two are the most common and the most debated: dose-dense treatment schedule and addition of an angiogenesis inhibitor to the combination.

The feasibility and efficacy of a dose-dense schedule (weekly paclitaxel v every-3-week paclitaxel) was demonstrated in the Japanese Gynecologic Oncology Group (JGOG) 3016 trial, a study among 637 Japanese patients.¹⁰ This trial showed that weekly paclitaxel improved both PFS and OS. The OS advantage was not trivial; it was a sizable 38-month extension (100.5 months v 62.2 months; HR, 0.79; P = .039). However, the global oncology community adopted the addition of bevacizumab but has largely ignored the dose-dense paclitaxel schedule. Perhaps, the large benefit with weekly paclitaxel prompted clinicians to disbelief and wanting further confirmation; yet, it is hard to imagine clinicians believed a larger benefit would altogether vanish, rather than merely be attenuated........

 

 

We cannot also ignore the deep issues beyond clinical data that result in discrepancies in cancer care, such as politics, emotional overlay, lobbying, and advocacy of support groups. Although we explore three instances of discrepancies in the treatment of three similar cancer settings in this paper, many discrepancies exist in cancer care. When bevacizumab was revoked for breast cancer, support groups and patient advocates protested against the decision, but when ¹³¹I-tositumomab was withdrawn from marketing, it died silently. Thus, our attitudes toward cancer care are multifactorial. As oncologists, however, we should push for uniformity in the interpretation of clinical trial results and try to achieve as much consistency in our practice as possible. Consistency would be a virtue for cancer care.

Time to Diagnosis of Second Primary Cancers among Patients with Breast Cancer (BRCA)

pdf

Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Philosophy Public Health

Abstract
Many breast cancer diagnoses and second cancers are associated with BRCA gene
mutations. Early detection of cancer is necessary to improve health outcomes,
particularly with second cancers. Little is known about the influence of risk factors on time to diagnosis of second primary cancers after diagnosis with BRCA-related breast cancer. The purpose of this cohort study was to examine the risk of diagnosis of second primary cancers among women diagnosed with breast cancer after adjusting for BRCA status, age, and ethnicity. The study was guided by the empirical evidence supporting the mechanism of action in the mutation of BRCA leading to the development of cancer. Composite endpoint was used to define second primary cancer occurrences, and Kaplan- Meier survival curves were used to compare the median time-to-event among comparison groups and BRCA gene mutation status. Cox proportional hazards was used to examine the relationships between age at diagnosis, ethnicity, BRCA gene mutation status, and diagnosis of a second primary cancer. The overall median time to event for diagnosis of
second primary cancers was 14 years. The hazard ratios for BRCA2 = 1.47, White = 1.511, and American Indian/Hawaiian = 1.424 showed positive significant associations between BRCA2 mutation status and risk of diagnosis of second primary colorectal, endometrial, cervical, kidney, thyroid, and bladder cancers. Data on risk factors for development of second cancers would allow for identification of appropriate and timely screening procedures, determining the best course of action for prevention and treatment, and improving quality of life among breast cancer survivors.

Second cancers: For the purpose of this study, second cancer refers to any cancer
that a patient experienced after initial diagnosis with BRCA1- or BRCA2-related breast cancer.

(stigma/early integration) Perceptions of palliative care among patients with advanced cancer and their caregivers

 Grounded Theory is an inductive methodology. Although many call Grounded Theory a qualitative method, it is not. It is a general method. It is the systematic generation of theory from systematic research. It is a set of rigorous research procedures leading to the emergence of conceptual categories.
                                     ~~~~~~~~~~~

abstract

Background: Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers.

Methods: After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis. 

Results: A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants’ initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as “ongoing care” that improved their “quality of living” but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting. 

Interpretation: There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful. 

related: (no abstract/requires paid subscription to view)
 Commentary

• • Anthony J. Caprio

  Palliative care: renaming as supportive care and integration into comprehensive cancer care

  Can. Med. Assoc. J. 2016 188:711-712; doi:10.1503/cmaj.160206
  • Full Text
  • Full Text (PDF)

Treato: Ovarian Cancer - Risks, Symptoms and Leading Causes

Treato
 

Ovarian Cancer

131,098 Discussions

 

 

 

Patient Assistance Programs "Culprits" of Rising Drug Prices

open access
PAP Series: Patient Assistance Programs "Culprits" of Rising Drug Prices 


....“If pharmaceutical companies want more credit for providing discounts for high-cost drugs, they are going to have to improve their relationships with patients, which could be achieved through further education about how much the companies invest in getting a new drug to market,” said Pamela Batzel, Treato's Senior Director of Consulting Services.

Treato is a big-data “social listening” company that uses natural language processing content-analysis algorithms to sift and initially analyze patients' online conversations about prescription drugs on social-media platforms like Facebook and Twitter, and dozens of patient discussion forums, mainly for drug company clients. Then human analysts follow up with content analyses of subsets of the captured conversations.....

Lipid profile of platelets and platelet-derived microparticles in ovarian cancer

open access

Background

Ovarian cancer patients have a high risk of developing venous thrombosis. The membrane lipid bilayer of platelets and platelet-derived microparticles (PMP) provides a platform for assembly of coagulation proteins and generation of blood clots.

Conclusion

Our results support a procoagulant lipid profile of platelets in ovarian cancer patients that can play a role in the increased risk of venous thrombosis in these patients.....

General significance

As far as we are aware, our study is the first study on platelet lipidomics in ovarian cancer. The importance of our findings for the future studies are: 1) a similar change in lipid profile of platelets and PMP may be responsible for hypercoagulability in other cancers, and 2) plasma level of high-risk lipids for venous thrombosis may be useful biomarkers.

(maybe) Effects of cigarette smoke extracts on the progression and metastasis of human ovarian cancer cells

abstract:
Effects of cigarette smoke extracts on the progression and metastasis of human ovarian cancer cells via regulating epithelial-mesenchymal transition

Highlights

•

Cigarette smoke extracts (CSEs) increased ovarian cancer cell proliferation.

•

CSEs increased the migratory and invasive propensity of ovarian cancer cells.

•

CSEs regulated the protein expression of cell cycle, EMT, and metastasis related markers.

•

CS might pose a potential risk of ovarian cancer progression.

---

Cigarette smoke (CS) contains over 60 well-established carcinogens, and there are strong links between these carcinogens and smoking-induced cancers. In this study we investigated whether three types of cigarette smoke extracts (CSEs), 3R4F (standard cigarette), CSE1 and CSE2 (two commercial cigarettes), affect the proliferation, migration, and invasive activity of BG-1 human ovarian cancer cells. All three types of CSEs increased BG-1 cell proliferation at nicotine concentrations of 1.5 μM–2.1 μM in a cell viability assay. The protein expressions of cyclin D1 and cyclin E1 were increased, while p21 and p27 expression was decreased by Western blot assay. However, they did not show a consistent dose-dependent tendency. The protein expressions of Bax and p53, pro-apoptotic genes, were also decreased by CSEs. The expression of E-cadherin, an epithelial marker, was reduced in the treatment of CSEs while the expression of its reverse transition marker, N-cadherin, was slightly increased by CSEs containing 2.1 μM of nicotine, but a statistical significance was not observed. Epithelial-mesenchymal transition (EMT)-associated transcriptional factors, Snail and Slug, were also up-regulated by treatment with CSEs, indicating that CSEs can increase the EMT process in BG-1 ovarian cancer cells. In addition, CSEs increased the migratory and invasive propensity of cancer cells. These functional alterations were associated with changes in metastasis-related gene expression. Upon exposure to CSEs, the expression of MMP-9 and cathepsin D was increased. Taken together, we confirmed that CSEs increased the growth, migration, and invasion of human ovarian cancer cells by regulating cell cycle, apoptosis, EMT, and metastasis related cellular markers and signaling proteins. Based on the results, cigarette smokers of women might be at a higher risk of ovarian cancer than non-smokers.

Patient-Centered Care? Not for This Patient ("emotional torture: + comments)

Medpage Today

Fertility drugs and cancer: a guideline (ovarian + LMP, breast, endometrial)

abstract

 Methodological limitations in studying the association between the use of fertility drugs and cancer include the inherent increased risk of cancer in women who never conceive, the low incidence of most of these cancers, and that the age of diagnosis of cancer typically is many years after fertility drug use. Based on available data, there does not appear to be a meaningful increased risk of invasive ovarian cancer, breast cancer, or endometrial cancer following the use of fertility drugs. Several studies have shown a small increased risk of borderline ovarian tumors; however, there is insufficient consistent evidence that a particular fertility drug increases the risk of borderline ovarian tumors, and any absolute risk is small. Given the available literature, patients should be counseled that infertile women may be at an increased risk of invasive ovarian, endometrial, and breast cancer; however, use of fertility drugs does not appear to increase this risk.

(Lynch syndrome patients) Impact of Ureteroscopy Prior to Nephroureterectomy for Upper Tracturothelial Carcinoma on Oncologic Outcomes- Beyond the Abstract.

Blogger's Note: not specific to Lynch Syndrome but to surgical technique quandries

Impact of Ureteroscopy Prior to Nephroureterectomy for Upper Tracturothelial Carcinoma on Oncologic Outcomes- Beyond the Abstract

  Currently, there are conflicting data in literature assessing the association between URS and risk of intravesical recurrence, with most studies, like ours, consisting of small cohorts and adjusting for different covariates. A multi-institutional study would clarify whether a significant association between URS (ureteroscopy) and IR (intravesical tumor recurrences) till exists once more measured covariates are adjusted for. Results from such a study could aid treating physicians when deciding whether the benefits of pre−NU URS, including more accurate staging and possible endoscopic ablation, outweigh the increased risk of post−NU IR.

 Upper tract urothelial cell carcinoma (UTUC) is challenging to diagnose, stage, and manage. Historically, radical nephroureterectomy (NU) was performed for clinical suspicion of UTUC based primarily on imaging, with or without positive cytology. In the modern era, after the development of modern endoscopy techniques, many urologists will perform ureteroscopy (URS) prior to NU with diagnostic or therapeutic intent. The concern with this procedure is that it can disturb the tumor microenvironment and increase pyelovenous pressure with reports in the literature of disease progression following URS (1-4). Although these reports are anecdotal, it has led some urologists to advocate against upper tract instrumentation prior to NU. To address this concern, we compared the oncologic outcomes of patients with UTUC and no history of bladder cancer treated at our institution who were managed with and without URS prior to NU.....

Tackling cardiac toxicity of anticancer therapies

Science news

Currently, under- or over-diagnosis of cardiovascular disease sometimes results in failure to prevent adverse events or inappropriate interruption of a potentially life-saving anticancer treatment. "We need to be clear when it's a must to stop the treatment, when we should reduce the dose, or when we can continue with the therapy," said Professor Zamorano. "This position paper provides guidance in this area."

Laparoscopic Staging for Apparent Stage I Epithelial Ovarian Cancer: Analysis of the NCI Data Base (U.S.)

abstract

BACKGROUND:

While advances in minimally invasive surgery have made laparoscopic staging technically feasible in stage I epithelial ovarian cancer, the practice remains controversial due to an absence of randomized trials and lack of high-quality observational studies demonstrating equivalent outcomes.

OBJECTIVE:

This study seeks to evaluate the association of laparoscopic staging with survival among women with clinical stage I epithelial ovarian cancer.

STUDY DESIGN:

We used the National Cancer Data Base to identify all women who underwent surgical staging for clinical stage I epithelial ovarian cancer diagnosed from 2010-2012. The exposure of interest was planned surgical approach (laparoscopy versus laparotomy) and the primary outcome was overall survival. The primary analysis was based on intention-to-treat: all women whose procedures were initiated laparoscopically were categorized as having had a planned laparoscopic procedure regardless of subsequent conversion to laparotomy. We used propensity methods to match patients who underwent planned laparoscopic staging with similar patients who underwent planned laparotomy based on observed characteristics. We compared survival among the matched cohorts using the Kaplan-Meier method and Cox regression. We compared extent of lymphadenectomy using the Wilcoxon rank-sum test.

RESULTS:

Among 4,798 eligible patients, 1,112 (23.2%) underwent procedures which were initiated laparoscopically, of which 190 (17%) were converted to laparotomy. Women who underwent planned laparoscopy were more frequently white, privately insured, from wealthier zip codes, received care in community cancer centers, and had smaller tumors that were more frequently of serous, and less often of mucinous histology than those who underwent staging via planned laparotomy. After propensity score matching, time to death did not differ between patients undergoing planned laparoscopic versus open staging (Hazard Ratio=0.77, 95%CI=0.54-1.09; p=0.13). Planned laparoscopic staging was associated with a slightly higher median lymph node count (14 versus 12, p=0.005). Planned laparoscopic staging was not associated with time to death after adjustment for receipt of adjuvant chemotherapy, histological type and grade, and pathologic stage (Hazard Ratio 0.82, 95% CI 0.57-1.16).

CONCLUSION:

Surgical staging via planned laparoscopy versus laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer.

A case report of Hepatoid Carcinoma of the Ovary with peritoneal metastases treated with cytoreductive surgery/HIPEC

open access:
A case report of Hepatoid Carcinoma of the Ovary with peritoneal metastases treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy without systemic adjuvant therapy

Table1
The timeline of diagnosis, treatment, and follow up of our patient.

Article Outline

1. Case report
2. Discussion
3. Conflicts of interest
4. Funding
5. Ethical approval
6. Consent
7. Author contribution
8. Guarantor
9. References

Highlights

• •
  Hepatoid Ovarian Carcinoma (HCO) is rare diagnosis usually treated with debulking and adjuvant chemotherapy with a palliative intent.
• •
  Complete cytoreduction followed by HIPEC has been discussed as a potential curative option in absence of extraperitoneal disease.
• •
  The role of adjuvant chemotherapy is yet to be determined. In our case, a comparable disease-free survival was achieved without adjuvant therapies.