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Lymphedema For the Newly Diagnosed November 25, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer.
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bluebutterfly1    Lymphedema For the Newly Diagnosed

The immediate time period after being diagnosed with lymphedema can be a confusing and frightening time. In one sense, there may be relief…finally there is a name to this awful “thing” that has attacked your body. But there is also a bewildering amount of emotions, fear…questions of what do I do now and where do I turn to begin dealing with this condition.

I wanted to share a few ideas that hopefully can make this period a little smoother and help give a bit of direction.

hibiscushumming  Acceptance and Denial

You may go through a time when you try to say to yourself that this swelling will just go away by itself or that you don’t really have to do anything about it and that it may not matter much anyway.

But as hard as this is to say, the reality is that if you have lymphedema, it just isn’t going to go away by itself. It isn’t a medical condition that you can just ignore and hope for the best. While there is no present cure, there is treatment available that can help manage it and help you get back on track with your life.

It is so very important to understand this and to get into a treatment program as soon as you can.

Point to Ponder: Acceptance doesn’t mean surrender or giving up to lymphedema.

sunrise1801       Education – Being Proactive

As you may have already experienced, there is a great deal of ignorance in the medical profession about lymphedema. Sometimes, it takes years for a diagnosis and after even that is achieved, most doctors really don’t know what to do next.

That is why it is critical that we as lymphedema patients take the initiative and proactively educate ourselves on every aspect on the condition. You will want to find out what lymphedema is, what it does, what to expect from it, how to have the correct treatment and perhaps most important, how to have a full and meaningful life even with it.

You will also want to educate yourself so you will not fooled by or damaged by all the very bad misinformation out there regarding lymphedema and the lymph system. I’ve noticed that in the last couple years, the lymph system bas become a buzzword in the cyberworld and there a all too many uneducated and badly informed people trying to sell pills, potions and promises of quick cures. Unfortunately, often these supposed cures cause more damage and can even dangerous to your life.

The good thing is that there are many excellent websites that you can go to and find solid, credible, life giving information. In addition to Lymphedema People, there is The Lymphatic Research Foundation, theNational Lymphedema Network, Circle of Hope Lymphedema Foundation, Lymphovenous Canada, Lymphoedema Association of Australia and UKLymph to mention only a few.

Point to ponder: Knowledge is Empowerment. Remember the life you save, may be your own.

butterfly-on-zinnia     Compliance with Your Treatment Program

Once you have finally gotten that diagnosis, it is equally important that you get referral to a trained and certified (Lymphedema Association of North America standards) lymphedema therapist.

Lymphedema therapist are among our best friends and they actually do more on a day to day basis to help us then doctors actually do.

But, sadly as so many therapist will tell you, the number one reason their patients don’t get better or even experience a worsening of their lymphedema is the failure of the patient to be compliant with the proscribed treatment program.

We all understand the fatigue, the pain and the depression that can come with lymphedema. But, my friend, the truth is, is that it is up to you to work with your therapist – as a team to insured you get the most out of your treatment.

Point to ponder: It is your life and your responsibility to do all that you can to help yourself.

firedragon      Anger, Bitterness and Self pity

After that diagnosis you will go through a period of intense emotional conflict. You may swing from anger, feel bitter that this has happened to you and start feeling sorry for yourself.

Please understand, this is totally normal and yes, you do have a right to experience those feelings. Actually, if you didn’t, I would really be concerned for you.

But the key is not to stop with either of those emotions. They are to me, the triple malignancies of the spirit. They have destroyed more lives throughout history then all the medical conditions combined.

Work your way through them…keep pressing forward knowing that this terrible time of emotional struggle ends.

The following is something I do each morning and it really has made a difference in my life.

Point to Ponder: Every morning, before you start your day, ask God to help you be a source of joy, hope and encouragement to another person

winter-solstice-5-2003-l2      Don’t Stop Living Life

When you are first diagnosed, it is easy to be overwhelmed. You feel like your whole life is over with and you will never be able to do anything you love doing again.

Please, believe me when I say, that is simply not true. Lymphedema isn’t about giving up and quitting life, it is about adaptation. You may need to change how you do things, figure out new and less strenuous ways of working and in recreation. But it doesn’t eman to have to stop everything you are used to enjoying.

Besides, if that were true, why even be alive??

If you do find there may be one particular activity you can not do anymore, find another to replace it with.

It is impossible for me to spend all day (lol..even a couple hours) working in my garden. But, I am able to sit at a computer and reach out to help others with lymphedema.

There just are too many wonderful activities, hobbies and interests to pursue to crawl into a cave and hide.

Point to Ponder: If one dream is taken away, God will send another, even more special to replace it.

In conclusion, yes, it can be devestating to be diagnosed with and stricken by lymphedema. But, I honestly do believe, it ultimately comes down to how we choose to handle it. Do we choose to surrender or do we choose to have a meaningful and joyous life despite lymphedema.

LIFE IS A CELEBRATION OF THAT WHICH WE CAN DO, NOT A REQUIEM FOR THAT WE CAN NOT DO.

Pat

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Zeltia: files for approval of Yondelis for ovarian cancer in the US November 25, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Zeltia: files for approval of Yondelis for ovarian cancer in the US

24th November 2008
By Sarah Oduekun

Zeltia seeks to add second indication for Yondelis in recurrent ovarian cancer.

Zeltia/Johnson & Johnson are seeking US approval for Yondelis, following a pivotal Phase III trial in second-line ovarian cancer therapy. However, approval in this indication may only marginally increase the commercial potential of Yondelis, as competition from established platinum-based chemotherapy agents will restrict the drug’s market potential.

Zeltia has announced positive results from the pivotal Phase III trial (OVA-301) for its ovarian cancer treatment, Yondelis (trabectedin). The trial involved 672 patients with recurrent ovarian cancer who had received treatment with one platinum-based agent six months prior to trial entry. Patients were randomized to receive Doxil/Caelyx (pegylated liposomal doxorubicin; Johnson & Johnson/Schering-Plough) with or without Yondelis. The primary endpoint of the trial was progression-free survival, which was recorded at a median of 7.3 months for patients who received Yondelis and Doxil, compared to 5.8 months for those who received Doxil alone. Zeltia also reported increased response rates with the use of the Yondelis and Doxil combination (28%) versus Doxil alone (19%), as well as an improved toxicity profile.

Yondelis is a synthetic tetrahydroisoquinoline alkaloid, derived from the Caribbean sea squirt (Ecteinascidia turbinata). It binds to the minor groove of DNA, thereby interfering with cell division, gene transcription and DNA repair mechanisms. The drug received orphan drug designation from both the EMEA and the FDA for the second-line treatment of ovarian cancer in October 2003 and April 2005, respectively.

Ovarian cancer is the most frequent cause of gynecological cancer-related mortality. Incidence in the seven major markets is estimated to be just under 60,000 in 2008, 40% of which are US patients. Surgery is the primary treatment for ovarian cancer, and platinum-based chemotherapy is the standard of care for advanced patients. However, ovarian cancer patients often experience multiple tumor recurrence.

Yondelis’s chosen indication of platinum-sensitive patients who have received prior platinum-based treatment, however, exposes the drug to fierce competition. Because ovarian cancer is chemo-sensitive, patients are usually re-treated with the same platinum-based agents they initially received if they are still platinum-sensitive and more than six months have passed since the first treatment. Significantly, the use of generic drugs such as cisplatin and carboplatin will restrict clinicians from prescribing the more expensive Yondelis.

In addition, established drugs for this indication such as Doxil and Gemzar (gemcitabine; Eli Lilly) are more likely to be prescribed in this setting as clinicians are more familiar with them. Further competition to Yondelis’s market penetration may arise from late-stage pipeline drugs in this setting such as Avastin (bevacizumab; Genentech/Roche), which has shown promising results in Phase II trials.

Pharmaceutical Business Review

Sensitization of ovarian cancer cells to cisplatin bygenistein: the role of NF-kappaB November 25, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Sensitization of ovarian cancer cells to cisplatin bygenistein: the role of NF-kappaB

Platinum-resistance (PR) continues to be a major problem in the management of epithelial ovarian cancer (EOC). Response to various chemotherapeutic agents is poor in patients deemed PR.

Genistein, a soy isoflavone has been shown to enhance the effect of chemotherapy in prostate and pancreatic cancer cells in vitro and in vivo by reversing chemo-resistance phenotype. The goal of this study was to investigate the effects of combination therapy with genistein and cisplatin as well as other cytotoxic conventional chemotherapeutic agents in platinum-sensitive (PS) and resistant EOC cells.

Methods: The PS human ovarian cancer cell line A2780 and its PR clone C200 cells were pretreated with genistein, followed by the combination of genistein and either cisplatin, taxotere or gemcitabine. Cell survival and apoptosis was assessed by MTT and histone-DNA ELISA.

Electrophoretic mobility shift assay (EMSA) was used to evaluate NF-kappaB DNA binding activity. Western blot analysis was performed with antibodies to Bcl-2, Bcl-xL, survivin, c-IAP and PARP.

Results: Reduction in cell viability, and corresponding induction of apoptosis was observed with genistein pretreatment followed by combination treatment with each of the drugs in both cell lines. The PS cell line was pretreated for 24 hours; in contrast, the PR cell line required 48 hours pretreatment to achieve a response.

The anti-apoptotic genes c-IAP1, Bcl-2, Bcl-xL, survivin and NF-kappaB DNA binding activity were all found to be down-regulated in the combination groups.

Conclusions: This study convincingly demonstrated that the current strategy can be translated in a pre-clinical animal model, and thus it should stimulate future clinical trial for the treatment of drug-resistant ovarian cancer.

Author: Leigh A Solomon, Shadan Ali, Sanjeev Banerjee, Adnan R Munkarah, Robert T Morris and Fazlul H Sarkar
Credits/Source: Journal of Ovarian Research 2008, 1:9

Know your risk of breast-ovarian cancer syndrome November 23, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Know your risk of breast-ovarian cancer syndrome

By Cindy Ward (ward@wsbt.com)

Story Updated: Nov 21, 2008 at 6:01 PM EST

Early detection saves lives. This is even more important if you have a family history of breast cancer or ovarian cancer. Studies show there is a link between the two diseases.

Dr. Michael Method is a gynecological oncologist. He says having breast cancer can put you at increased risk for ovarian cancer over time and vice versa. It’s called breast-ovarian cancer syndrome.

“Anyone who has ovarian cancer is not only high risk of developing breast cancer, they’re much higher risk of being a carrier of the gene that actually predisposes them and their family to breast cancer,” Method explained.

The increased risk is connected to mutations in what are called the BRCA1 and BRCA2 genes. Knowing your risk gives you the advantage.

There is preventative action you can take. For instance, getting a mammogram at an earlier age, and doing your self-exam.

Remember, we’ve partnered with Saint Joseph Regional Medical Center to bring you the Pink Pack program.

Here’s how it works:

You pick a friend to be your Pink Pack Pal. Then you request a Pink Pack.

You’ll get a breast self-exam guide, a pen and a kitchen magnet — one for you and one for your Pink Pack Pal. We’ll remind you on the 22nd of every month to call your Pink Pal and remind her to do her breast self-exam. And remember to do yours the same day. Early detection saves lives.

Become a member of the Pink Pack right away — it could save a life.

wsbt/new

Thalidomide For Ovarian Treatment November 23, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Thalidomide For Ovarian Treatment

Nov. 22, 2008

Washington: Thalidomide, a drug banned in the 1950s for causing birth defects, is showing promise as a safe and effective treatment for women with recurrent ovarian cancer, according to a new study.

In the study, led by Levi Downs, Jr., M.D., assistant professor and a researcher of gynecologic oncology at the University of Minnesota Medical School and Cancer Center, Phase II clinical trial was randomized.

“For some women, ovarian cancer has become a chronic disease. The standard chemotherapy regimens can put recurrent cancer in remission, often more than once. However, when the cancer resists the standard treatments, we need new options for treatment,” Downs said.

The study compared the effectiveness and safety of the combination of thalidomide and topotecan, a chemotherapy often used for ovarian cancer, versus topotecan alone for treatment of recurrent epithelial ovarian cancer in patients who had received prior treatment.

Epithelial ovarian cancer is a disease in which cancer cells form in the tissue that covers the ovary.

In the study, 75 women were evaluated who were randomly assigned to receive either the combination of thalidomide and topotecan or only topotecan.

“We found that patients who received topotecan plus thalidomide showed an overall response rate of 47 percent compared to 21 percent response in patients who received only topotecan. In patients receiving topotecan plus thalidomide, 30 percent achieved a complete response, meaning the cancer went away, compared to 18 percent for patients only getting topotecan,” Downs said.

“Furthermore, patients getting topotecan plus thalidomide had a longer cancer-free period after treatment than those receiving topotecan alone. What all of this means is that while thalidomide may not cure ovarian cancer, it may broaden the treatment options available to physicians and provide more hope to women diagnosed with the cancer,” Downs added.

The study has been published in the journal Cancer.

OneIndia

New Treatment for Ovarian Cancer Shows Promise November 20, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Ovarian Cancer Cells Are Killed By Platinum-Phosphate Compounds

A new class of compounds called phosphaplatins can effectively kill ovarian, testicular, head and neck cancer cells with potentially less toxicity than conventional drugs, according to a new study published this week in the journal Proceedings of the National Academy of Sciences.

The compounds could be less harmful than current cancer treatments on the market such as cisplatin and carboplatin because they don’t penetrate the cell nucleus and attach to DNA, said lead author Rathindra Bose. Conventional drugs can interfere with the functions of the cell’s enzymes, which lead to side effects such as hearing and hair loss and kidney dysfunction.

Though scientists don’t fully understand the mechanism by which the phosphaplatins kill cancer cells, they suspect that the compounds bind to the cell surface membrane proteins and transmit a “death signal” to the interior of the cell, Bose said. The compounds are created by attaching platinum to a phosphate ligand, which can readily anchor to the cell membrane. Future studies will focus on identifying the exact process.

“The findings suggest a paradigm shift in potential molecular targets for platinum anticancer drugs and in their strategic development,” said Bose, a professor of biomedical sciences and chemistry and vice president for research at Ohio University who conducted the work while at Northern Illinois University.

The first drug developed for the treatment of ovarian and testicular cancers, cisplatin, was approved for use in 1982. Though it’s 95 percent effective, it works best during the early stages of the disease, and some patients develop a resistance to it. Two drugs introduced later, carboplatin and oxaliplatin (which is used for colorectal cancer), overcame some of those problems, but their potency can harm the immune system of patients, said Bose, who has been studying alternative compounds and targets for these cancers for 25 years.

Phosphaplatins have the potential to be more efficient, more targeted and create fewer side effects in the patient, Bose said. The new study shows that the phosphaplatins can kill ovarian cells at half of the dosage of conventional drugs, but are just as potent. Unlike cisplatin, which can decompose quickly and create additional toxic side effects through the decomposition products, the new compounds show no signs of degradation after seven days, he added.

A U.S. patent is pending on the work; two provisional patents have been filed. Bose and his colleagues next will test the compounds in mice models.

Co-authors of the study are Leila Maurmann of Kansas State University, and Robert Mishur, Linda Yasui, Shefalika Gupta, W. Scott Grayburn, Heike Hofstetter and Tara Milton, all of Northern Illinois University.

By: Ohio University – Wed, 11/19/2008 – 16:16

Straight talk about ovarian cancer November 16, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Straight talk about ovarian cancer

VIRGINIA R. MARTIN RN, AOCN, MSN

Nursing2005 April 2005 Volume 35 Number 4 Pages 36 – 41

Abstract

Learn how to help patients recognize and defeat this insidious malignancy.

Learn how to help patients recognize and defeat this insidious malignancy.

ACCORDING TO AMERICAN Cancer Society (ACS) estimates for 2005, 22,220 women will develop ovarian cancer and 16,210 will die of it. The leading cause of death from gynecologic cancer in the United States, ovarian cancer has historically had a poor prognosis, largely because over 70% of women affected have advanced disease at diagnosis.

But medical science is gaining ground. Thanks to improved diagnosis, staging, and treatments, 5-year survival improved from 37% in the 1970s to 53% in 1998. Let’s review how this insidious disease progresses, how you can help someone who has it, and what you need to know about promising screening methods that could lead to earlier detection and treatment.

Deep, changing organs

The ovaries are solid, slightly nodular, almond-shaped organs lying deep in the pelvis. Their hidden location, plus the fact that their size, shape, position, and histology change over a woman’s lifetime, help explain why ovarian cancer isn’t readily detected in the early stages. According to the National Comprehensive Cancer Network (NCCN), the median age at diagnosis is 63. This malignancy is rare in women under age 30.

Three major theories about the causes of ovarian cancer prevail:

* The incessant-ovulation theory zeroes in on how the monthly ovulatory cycle affects the ovaries. This theory holds that the epithelium may be more apt to mutate with each ovulation, so failure to break the cycle, as with pregnancy, increases the chance of mutation.

* The pituitary/gonadotropin hypothesis implicates elevated gonadotropin levels. Normally, the ovarian epithelium invaginates and forms inclusion cysts and clefts, but overstimulation by gonadotropins might trigger proliferation with subsequent malignant transformation.

* The inflammation theory considers monthly ovulation a possible cause of chronic inflammation and mutation in the epithelial cells that lead to ovarian cancer.

The causes of ovarian cancer are unclear, but genetic and endocrine factors raise the risk. (See How the problem starts .) The most significant link is a positive family history, which is present in 10% of women with the disease. Three hereditary syndromes in which ovarian cancer occurs more commonly affect certain families with a history of early breast and ovarian malignancies and hereditary nonpolyposis colorectal cancer.

Other factors associated with ovarian cancer include nulliparity, giving birth for the first time when over age 35, exposure to talc or asbestos, endometriosis, pelvic inflammatory disease, and living in a western industrialized country. On the bright side, researchers have identified seemingly protective factors, including a history of oral contraceptive use, giving birth before age 25, tubal ligation, breast-feeding, and hysterectomy.

Most commonly, ovarian cancer spreads via the peritoneal fluid that continuously circulates through the abdomen. Other routes for metastases are through the lymphatic fluid or by direct tumor extension. Bloodborne metastasis is rare, and this cancer rarely spreads beyond the abdomen, even when advanced.

Early signs

Retrospective studies indicate that over 70% of women with ovarian cancer have symptoms for 3 months or longer before diagnosis. But the early signs and symptoms can be nonspecific, including increased abdominal size, bloating, early satiety, abdominal pain, indigestion, vaginal bleeding, and changes in bowel and bladder habits. Because these symptoms can be vague, a woman may not pay much attention to them.

Teach your female patients to always investigate any of these symptoms if they occur.

When a woman does seek treatment and an ovarian mass is discovered, the clinical approach depends on clinical findings. If she’s premenopausal, the health care practitioner will probably monitor her for a few ovulatory cycles and investigate further if the mass doesn’t disappear. In a postmenopausal woman, any ovarian mass must immediately be investigated for cancer.

Diagnostic imaging and tumor markers

Diagnostic tests to detect ovarian cancer include the following:

* transvaginal and abdominal ultrasound. A transvaginal approach provides better visualization of the ovaries than the transabdominal method, but the location of the ovaries varies in each woman, so a combination of both approaches is recommended.

* computed tomography (CT) scan of the abdomen and pelvis

* a blood test for the tumor marker cancer antigen 125 (CA-125), which can be elevated in ovarian cancer. Although an ovarian mass can cause an elevated CA-125 level, so can endometriosis, pregnancy, liver disease, or fibroids, so the marker isn’t specific.

Additionally, a woman can have ovarian cancer and a normal CA-125 level; only 50% of women with stage I disease have an elevated level. For this reason, the CA-125 isn’t recommended as a screening tool for healthy women, but it can be useful in women with diagnosed ovarian cancer.

Surgery: First and foremost

Surgery is the mainstay of treatment for ovarian cancer, and a gynecologic oncologist has the most training to perform the exploratory laparotomy. The goals of surgery are to determine a definitive diagnosis, to stage the disease if cancer is present, and to remove as much of the tumor as possible. (See Staging ovarian cancer .) The procedure includes a total abdominal hysterectomy, bilateral salpingo-oophorectomy, scraping the abdominal surface of the diaphragm, peritoneal cytology, omentectomy, pelvic and para-aortic lymph node sampling, and peritoneal and random biopsies.

Although disease stage is the key prognostic factor for ovarian cancer, other factors influence outcome. They include the volume of cancerous tissue remaining after surgery, histologic type and grade, the woman’s age, and her overall condition or performance status. (See Rating performance .) A woman whose performance status is 0 to 2 is more likely to respond to chemotherapy, experience less toxicity, and have better outcomes. Findings associated with a poorer prognosis include a clear cell, mucinous, or poorly differentiated (unclear cell type) tumor, and diagnosis after age 69.

Is additional treatment warranted?

If your patient has well-differentiated stage IA or IB ovarian cancer that’s been surgically removed, she’s considered low risk and needs no further treatment. The oncologist will determine a follow-up plan.

Stage IA or IB ovarian cancer with a poorly differentiated tumor and stages IC, II, III, and IV disease are classified as high risk, and the patient requires chemotherapy. Scientists are still seeking the optimal regimen, but early clinical trials have shown that combination therapy with a platinum compound such as cisplatin or carboplatin is superior to using a single agent. The NCCN states that paclitaxel/carboplatin is the preferred regimen. (See Exploring chemotherapy options for other choices.)

A complete remission from cancer means all signs and symptoms disappear; remission after initial therapy that lasts 5 years may be considered a cure. Although 75% to 80% of women with ovarian cancer achieve a complete remission after initial therapy, 80% of them have a recurrence. Unfortunately, recurrent disease isn’t curable, so researchers are exploring strategies to prevent or delay recurrence, such as improved induction and maintenance regimens and the use of intraperitoneal chemotherapy.

Currently, intraperitoneal therapy is recommended only in the context of a clinical trial, but researchers have been studying it closely because ovarian cancer tends to stay in the abdomen. Study results show higher rates of progression-free survival and overall survival, but the challenges of administering therapy and managing toxicity are formidable.

Remission and monitoring

A typical woman with complete remission from ovarian cancer undergoes regular CA-125 monitoring and periodic abdominopelvic CT scans to check for recurrence. In most cases of recurrent disease, the CA-125 level rises above normal before the woman develops symptoms. Even when the CA-125 level is elevated, most oncologists don’t start chemotherapy unless a pelvic examination or abdominopelvic CT scan indicates disease recurrence; treating measurable disease lets the practitioner identify a response.

If a woman’s cancer recurs, her response to initial chemotherapy and the length of time until recurrence help determine subsequent therapy. If she achieved complete remission and didn’t have a recurrence for more than 6 months after completing initial therapy, her disease is considered drug sensitive and she’ll probably receive the same regimen.

Ovarian cancer that recurs less than 6 months after a woman achieves a complete remission is considered drug resistant . If the cancer doesn’t respond to initial therapy at all, it’s labeled drug refractory . Drug-resistant or drug-refractory disease is typically treated with a different agent, or the woman may be offered the option of participating in a clinical trial. If curing ovarian cancer isn’t possible, the patient may receive salvage therapy , which is chemotherapy to help manage symptoms and possibly prolong survival.

When recommending a treatment approach for recurrent disease, the oncologist considers the woman’s prior responses, quality of life, toxicity profile, current symptoms, disease volume, the ability of her gastrointestinal system to absorb drugs, her age, other illnesses, and social issues.

Radiation therapy may be included in the palliative treatment plan and may help if the patient has uncontrolled vaginal bleeding or pain. Radiation to the entire abdomen isn’t often considered because it’s toxic. For recurrent disease in a specific area, a radiation oncologist should outline a treatment plan. The goal of all palliative treatment is to balance the toxicities with quality of life.

Providing education and support

Research indicates that the more a patient feels threatened or harmed by cancer, the more education and support she needs. With ovarian cancer, her psychosocial and physical challenges might include advanced disease at diagnosis, repeated cycles of aggressive treatment, little respite from therapy, and a poor chance of survival. Your challenges are to address her psychosocial needs while preparing her for treatment and helping her manage adverse reactions to treatment and advanced disease.

Preoperatively, educate your patient and her family about the surgical procedure for ovarian cancer and what to expect afterward. Explain that after surgery, you’ll monitor her for infection, circulatory complications, fluid and electrolyte imbalances, and pain, and that you’ll work with the surgeon to manage any problems.

If your patient will receive chemotherapy, teach her and her family about the major adverse reactions. Explain how to prepare and respond if she develops fatigue, nausea, vomiting, hair loss, diarrhea, constipation, mucositis, neuropathy, arthralgia and myalgia, or myelosuppression.
Problems such as depression and anxiety are common when a patient faces serious illness and possible death. She may need help coping with such issues as premature menopause; loss of fertility; altered body image, sexual function, and family relationships; impaired functional capacity; financial problems; and loss of spiritual well-being.

Assess her for mood changes, feelings of worthlessness, inability to concentrate, fatigue, insomnia, impaired functioning, agitation, restlessness, and apprehensiveness. Review her medical history, current medications and treatments, nutritional status, pain rating, elimination pattern, and sexual history for factors that may contribute to depression.

Listen to her concerns and refer her to support services, such as the local chapter of the ACS. Managing her symptoms, participating in a support group, meeting with a mental health professional, and taking antidepressant or antianxiety medication all can help resolve depression and anxiety.

Finally, if cure isn’t an option, you can give your patient and her family tremendous support when you help them cope with end-of-life decisions and involve the hospice team when the time is right.

Managing the effects of advancing disease

Complications of advancing ovarian cancer can pose significant nursing challenges. Here’s a review of assessment findings and management strategies for common problems.

Ascites , accumulation of fluid in the peritoneal cavity, occurs when channels that normally remove fluid are blocked or when cancer cells prevent absorption of peritoneal fluid. Symptoms include early satiety, dyspnea, increased abdominal girth, constipation, and pain.

Suspect ascites if your patient has a protuberant abdomen with bulging flanks, an everted umbilicus, diminished bowel sounds, shiny or taut abdominal skin, and dullness to percussion in dependent areas of the abdomen. (For details, see “Assessing for Ascites” in the February issue of Nursing2005 .) An abdominal ultrasound usually confirms the diagnosis.
The treatment for ascites is removing the fluid. The oncologist may perform paracentesis in the office or in the radiology department with ultrasound guidance.

Intestinal obstruction involving the small or large intestine may plague a patient with progressing ovarian cancer. Tumor growth in the abdomen or adhesions can cause a partial or complete obstruction that interferes with peristalsis. An obstruction can be acute or chronic. Signs and symptoms of acute obstruction include acute abdominal distension and pain and projectile vomiting. Symptoms of chronic obstruction include abdominal distension and discomfort, constipation, and nausea and vomiting.

Hyperactive bowel sounds may be the first sign of acute intestinal obstruction as the bowel tries to move digestive contents past the blockage. Teach your patient to recognize problems and to immediately contact her health care provider if they occur.

A patient who develops an acute intestinal obstruction may need hospitalization and insertion of a nasogastric tube to decompress her bowel. Because a woman with advanced cancer may already be debilitated, surgery is considered only if conservative interventions fail or she’s in acute distress.

Deep vein thrombosis (DVT) is a risk for all cancer patients because of prolonged immobility, tumors that decrease or obstruct blood flow, and hypercoagulability associated with cancer. Common signs and symptoms include unilateral leg edema or pain accompanied by tenderness, warmth, and erythema. The treatment for DVT includes anticoagulation therapy and possibly placement of a filter in the inferior vena cava.

Malnutrition is one of the greatest challenges for a woman with ovarian cancer. Treatments or advancing disease may take away her appetite, causing her to lose weight. This wasting syndrome is called cancer cachexia , an advanced state of protein-energy malnutrition. Besides weight loss, signs of cancer cachexia include decreased subcutaneous tissue, edema, abdominal distension, dry skin, and behavioral changes such as irritability. Cancer patients with weight loss generally have poor performance status, poor response to chemotherapy, poor median survival, and possibly a greater infection risk.

Measures to protect the patient from malnutrition include treating the underlying problem, delaying chemotherapy, getting a nutrition consult, and medications (such as corticosteroids, megestrol, hydrazine, dronabinol, nabilone, oxandrolone, growth hormones, and medroxyprogesterone). Advise her to eat frequent, small meals served at room temperature; eliminate disagreeable food odors; get help with food preparation; and use nutritional supplements.

Lymphedema , an accumulation of lymphatic fluid in the interstitial tissue, occurs when the tumor blocks the lymphatic system or when lymph nodes have been removed. Lymphedema associated with ovarian cancer affects the legs. The affected leg maintains full sensation, but with edema, range of motion decreases and the skin feels tight to the patient.

Your patient should be referred to a knowledgeable practitioner in lymphedema management. The severity and grade of lymphedema determine the interventions, which may include range-of-motion exercises, meticulous skin care to reduce the risk of skin breakdown, elevation, massage or physical therapy to manually aid drainage, compression bandaging, or sequential pump therapy.

Pleural effusion occurs when the rate of pleural fluid production exceeds its removal rate from the pleural space, such as when a tumor invades the thoracic duct, or when ascites fluid seeps through the diaphragm. Signs and symptoms may include dyspnea, decreased or absent breath sounds, decreased tactile fremitus, or dullness to percussion. An effusion is treated by draining the fluid via thoracentesis or insertion of a tunneled indwelling pleural catheter.

What about screening and prevention?

Current screening methods for ovarian cancer aren’t sensitive or specific enough for routine use. A woman with a positive family history, however, should have a formal risk assessment with an extensive family history, education, risk estimation and counseling, optional genetic testing, and specific screening and prevention strategies. Screening strategies often include a rectovaginal pelvic exam, a CA-125 blood test, and transvaginal ultrasound.

Scientists are exploring the natural history of ovarian cancer to develop cost-effective, sensitive screening strategies. Researchers studying cell proteins are developing a test that tracks trends in multiple tumor markers specific for ovarian cancer. The first published study reported 18 of 18 stage I cancers and 63 of 66 healthy controls accurately identified, yielding 100% sensitivity and 95% specificity. A yet-unpublished study accurately identified 22 of 22 cases of early stage I disease, 81 of 81 cases of stage II to stage IV disease, and 68 of 68 cases of benign disease. The test must be validated and standardized before being used as a screening tool.

Prevention strategies for ovarian cancer may include a prophylactic bilateral oophorectomy in high-risk women who’ve finished childbearing. Other prevention strategies being used in clinical trials include the use of oral contraceptives and other drugs such as acetaminophen and the synthetic retinoid, fenretinide.

Finally, you have many opportunities to improve the outlook for ovarian cancer. Educate your female patients about the signs and symptoms and emphasize the importance of reporting “insignificant” symptoms that could be early warning signs. Early detection and treatment offer the best chance for survival.

Education, support, and hands-on care

Patient outcomes for ovarian cancer are getting better as detection and treatment methods improve. When you give a woman the education, support, and hands-on care she needs to combat this malignancy, you bolster her ability to successfully fight back.

How the problem starts

Three major categories of ovarian cancer have been identified:

Epithelial cancers , arising from the cells lining or covering the ovaries, account for 90% of ovarian malignancies. Epithelial cancers are further classified as serous (most common), endometrioid, clear cell, mucinous, and poorly differentiated.

Germ cell cancers start in cells destined to become ova.

Stromal cell cancers start in the connective tissue cells that hold the ovaries together and produce female hormones.

Staging ovarian cancer

Stage I: Tumor limited to the ovaries

IA , limited to one ovary, no tumor on the ovarian surface, no malignant cells in ascites or peritoneal washings, capsule intact

IB , limited to both ovaries, no tumor on the ovarian surface, no malignant cells in ascites or peritoneal washings, capsules intact

IC * , limited to one or both ovaries, tumor on ovarian surface, capsule ruptured, ascites or peritoneal washings containing malignant cells

Stage II: Tumor involving one or both ovaries with pelvic extension

IIA , extension or metastasis to the uterus or tubes, no malignant cells in ascites or peritoneal washings

IIB , extension to other pelvic tissues, no malignant cells in ascites or peritoneal washings

IIC * , pelvic extension, ascites fluid or peritoneal washings containing malignant cells

Stage III: Tumor involving one or both ovaries, peritoneal implants outside the pelvis or regional lymph node metastasis

IIIA , gross tumor limited to the true pelvis, negative nodes, microscopic peritoneal metastasis beyond the pelvis

IIIB , macroscopic peritoneal metastasis 2 cm or less in greatest dimension beyond the pelvis

IIIC , abdominal implants greater than 2 cm in greatest dimension or positive regional nodes

Stage IV: Tumor involving one or both ovaries, metastasis greater than 2 cm in greatest dimension beyond the pelvis. If pleural effusion is present, cytologic test results must be positive. Parenchymal liver metastases equals stage IV.

Rating performance

The Eastern Cooperative Oncology Group established the following scale to rate the effects of cancer and its treatments on the patient.

0 Normal activity, asymptomatic

1 Symptomatic, fully ambulatory

2 Symptomatic, in bed less than 50% of the time

3 Symptomatic, in bed more than 50% of the time but not bedridden

4 100% bedridden

SELECTED WEB SITES

National Ovarian Cancer Coalition

Ovarian Cancer National Alliance

SHARE: Self-help for Women with Breast or Ovarian Cancer

Women’s Cancer Network and CancerSource
Last accessed on March 3, 2005.

Virginia R. Martin is the clinical director of ambulatory care at Fox Chase Cancer Center in Philadelphia, Pa.

The author has disclosed that she has no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.

Exploring chemotherapy options

The current standard regimen for advanced ovarian cancer is paclitaxel (Taxol) and the platinum compound carboplatin. Alternatives are docetaxel (Taxotere) with carboplatin or paclitaxel with cisplatin, another platinum compound.

Recent clinical trials found no difference in survival between patients receiving carboplatin with either docetaxel or paclitaxel, but the docetaxel/carboplatin group had a greater incidence of myelosuppression. Those receiving paclitaxel/carboplatin had more neuropathy. Newer drugs being combined with carboplatin and paclitaxel are topotecan, liposomal doxorubicin, and gemcitabine.

The Gynecologic Oncology Group (GOG), a research group funded by the National Cancer Institute, is currently conducting a clinical trial for high-risk early-stage disease comparing three cycles of paclitaxel/carboplatin followed by surveillance versus paclitaxel alone weekly for 24 weeks. The GOG is also proposing a clinical trial on the use of carboplatin and paclitaxel combined with bevacizumab to treat advanced ovarian cancer.

To take this test online, visit: Nursing Center.com

SELECTED REFERENCES

Bookman MA, et al. Optimal therapy of advanced ovarian cancer: Carboplatin and paclitaxel vs. cisplatin and paclitaxel (GOG 158) and an update on GOG0 182-ICON5. International Journal of Gynecological Cancer . 13(6):735–740, November/December 2003.
Cunningham RS, Bell R. Nutrition in cancer: An overview. Seminars in Oncology Nursing . 16(2):90–98, May 2000.
Ferrell B, et al. Psychological well being and quality of life in ovarian cancer survivors. Cancer . 98(5):1061–1071, September 1, 2003.
Howell D, et al. Impact of ovarian cancer perceived by women. Cancer Nursing . 26(1):1–9, February 2003.
Howell D, et al. Women’s experience with recurrent ovarian cancer. Cancer Nursing . 26(1):10–17, February 2003.
Jemal A, et al. Cancer Statistics 2005. CA: A Cancer Journal for Clinicians . 55(1):10–30, January/February 2005.
Martin VR. Ovarian cancer. Seminars in Oncology Nursing . 18(3):174–183, August 2002.
Ozols RF. Future directions in the treatment of ovarian cancer. Seminars in Oncology . 29(1: Suppl. 1):32–42, February 2002.
Ozols RF, et al. Focus on epithelial ovarian cancer. Cancer Cell . 5(1):19–24, January 2004.

Source
Federation Internationale de Gynecologie et d’Obstetrique (International Federation of Gynecology and Obstetrics).

* Knowing whether rupture of the capsule was spontaneous or caused by the surgeon and whether peritoneal washings or ascites was the source of malignant cells helps the clinician decide whether a case should be categorized as stage IC or IIC. [Context Link]

Nursing Center.com

Small Needle Biopsy and Ovarian Cancer November 16, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Small Needle Biopsy and Ovarian Cancer

One of the more common biopies done for ovarian cancer is referred to as a small needle biopsy. It may also be referred to as a fine needle aspiration.

A procedure used more and more in the detection of cancers and in the biopsy of suspect areas is the needle aspiration. More commonly, patients refer to it as simply a “small needle biopsy.”

In the procedure, a small amount of tissue is removed and it can be used to make a diagnosis of a number of medical problems including cancer, infection or inflammation. Any lump, bump, growth or suspect area can have a small needle biopsy done.

In most hospitals, the most commonly biopsied organ is the breast. FNA, particularly in conjunction with clinical examination and mammography, is very useful in evaluating breast masses. Breast masses are common, but only a small percentage of these, in fact, have cancer. One of the other commonly biopsied organs is the thyroid. Thyroid nodules are also common and are only rarely the result of the cancer. FNA is also very useful in deciding what the thyroid nodules are due to. Lymph node FNA is the third most common area. This is most commonly used to detect metastatic cancer. The two most common nonpalpable organs that are biopsied are the liver and the lung. In these organs, the most common question is whether a nodule identified by x-ray is cancerous or not.

Because the procedure does not remove any lymph nodes nor does it destroy lymphatic vessels, I am a major supporter of this procedure to prevent lymphedema.

Hopefully, we can put an end to arm or leg swelling after cancer.

Implication for Pre-existing Lymphedema

I have advanced stage hereditary bilateral leg lymphedema. This has made getting a safe biopsy problematic for any cancer diagnoses

The good news is that this procedure is safe and effective for those already with lymphedema. In 2000, I had an ultrasound guided small needle biopsy of a right inguinal lymph node.

I developed no secondary complications and it had no negative affect on my leg lymphedema. The procedure was also accurate enough to diagnose lymphoplasmacytic lymphoma.

Thus far, I have not heard of any secondary lymphedema being caused by a needle biopsy.

Advantages of this procedure

It leaves lymph nodes intact taking only a minimal core sample. It is done on an outpatient basis with only a local anesthesia. Because it is minimally invasive, patients run a far less chance of experiencing complications or infections.

Disadvantages of this procedure

Excisional biopsies may be more accurate, depending on the condition being diagnosed.

Preparation for a needle biopsy

You may be told to restrict food and fluids for a certain period of time before the test depending on the area biopsied.

If you are taking any medications (prescription or over-the-counter), especially aspirin or blood thinners, it is important to inform your doctor before you have this exam.

Blood tests will be performed prior to the procedure to determine clotting factors, etc. These tests are no different then ones that might be performed for a larger excisional biopsy.

You will be asked to stop taking any blood anticoagulant medications.

During the biopsy

After you change into a hospital gown, vital signs (pulse, blood pressure) will be taken. Depending on the nature of the biopsy, an intravenous line (IV) may be placed in a vein in your arm. Medications to help decrease anxiety are often given by mouth or directly into your intravenous line before the biopsy is obtained.

You will be positioned so that the pathologist or radiologist has easy access to the area to be biopsied. The skin will be swabbed with an antiseptic solution, and you will receive a local anesthetic so you feel little pain.

An x-ray of the area will be done as needed before and, sometimes, during the biopsy. After the mass (tumor) is located, the doctor inserts a needle into it and withdraws a specimen of cells that are then sent to the lab. It is not uncommon to have multiple needles inserted. Several areas may need to be biopsied to ensure that samples from the suspicious area are obtained.

A lung biopsy, done in this manner, takes 30 minutes to 60 minutes. Breast and prostate needle biopsies take 30 minutes or less. A liver biopsy can take about 10 minutes to 15 minutes.

Possible Complications

Bleeding is the most common complication of this procedure. A slight bruise also may appear at the site of the biopsy. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine afterward. Only a small amount of bleeding should occur.

Other complications depend upon the area biopsied. Lung biopsies sometimes cause a collapsed lung.

This complication also can accompany biopsies in the upper abdomen near the base of the lung. About one quarter to one half of patients having lung biopsies may develop a small lung collapse. If there is a large lung collapse, it is treated successfully with a chest tube and suction in the hospital.

For biopsies of the liver, bile leakages and/or liver hematomas may occur, but these are quite rare. Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around thepancreas. Pain and infection may occur after a biopdy.

Deaths have been reported from internal (abdominal or chest) needle aspiration biopsies, but their occurrence is extremely rare. Your doctor is the best person to explain the risks and benefits associated with the type of biopsy that you undergo.(1)

(1) Health A to Z

Preparing for a Needle Aspiration Biopsy

This information will inform you and your family about a diagnostic procedure called a needle aspiration biopsy. It will explain the nature of this procedure and what to expect when you are scheduled for a needle aspiration biopsy.

What is a needle aspiration biopsy?

A needle aspiration biopsy is a procedure that helps your doctor diagnose and treat your illness. Thin needles will be inserted into a mass or lump to extract cells that will be examined under a microscope.

Fine needle aspiration biopsies are very safe, minor surgical procedures. Often, a major surgical biopsy can be avoided by performing a needle aspiration biopsy instead.

Sometimes, surgery is needed to treat complications of a needle aspiration biopsy. But in such a case, the patient would have had to undergo a similar surgical procedure to obtain a diagnosis had the needle aspiration biopsy not been attempted.

Why would I need a needle aspiration biopsy?

This type of biopsy is performed for one of two reasons:

1. A biopsy is performed on a lump or mass when its nature is in question.

2. For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies being conducted at the National Institutes of Health.

Your doctor will discuss why you need a biopsy as well as the risks and benefits of this procedure. All biopsies involve some risks, but they are requested because their potential benefits outweigh their risks. A needle aspiration biopsy is safer and less traumatic to your body than an open surgical biopsy.

Who will perform the biopsy?

The biopsy will be performed by a diagnostic radiologist, a doctor with special training in performing and inter-preting x-ray procedures and in performing biopsies using x-ray guidance. Another staff member, called a cytopathologist, will also be present. This person has expertise in identifying normal and abnormal cells. Your Clinical Center doctor usually will not be present when the biopsy takes place.

How will the biopsy be performed?

During this procedure, a very thin needle will be used to remove cells or other material from a tumor or mass in your body. These cells will then be given to the cytopathologist.

It will take several days for the cytopathologist to make a diagnosis, and one will not be given at the end of the biopsy. There may be times when a diagnosis cannot be made; not all cells removed during a needle aspiration biopsy can be identified with certainty.

What happens before a needle aspiration biopsy?

Several preparations are necessary before this procedure.

Do not take any aspirin or aspirin substitutes (ibuprofen, Motrin, Advil, Naprosyn) for 1 week before the procedure unless your doctor instructs you otherwise. You may take Tylenol. You will be asked not to eat for a specified time before the procedure. If an abdominal CT scan is to be done, you may be given a drink containing x-ray contrast material (dye). If intravenous contrast material is necessary, and you have an allergy to it, you will be given medication to counteract the effects of this material before the procedure. oSome routine blood work (blood counts, clotting profile) must be completed 2 weeks before the biopsy. oBleeding disorders will be managed before the procedure. oBlood thinners (anticoagulants) will be stopped for a period of time before the test. oAntibiotics may be given. Your Clinical Center doctor will inform you about any or all of these requirements.

After arriving at the Diagnostic Radiology check-in desk, you will be guided to the area where the biopsy will be performed. Please arrice 30 to 40 minutes before your scheduled time, especially if you know that oral contrast material will be needed. Because many people must work together during this procedure, your promptness is important. We will also do our best to perform the biopsy at the scheduled time.

What happens during the biopsy?

Shortly after you check in to the Diagnostic Radiology Department, you will meet the radiologist who will perform the biopsy. The radiologist will tell you about the procedure and will answer any questions you may have. You will then be asked to sign an informed consent form.

Preparation

After you change into a hospital gown, vital signs (pulse, blood pressure) will be taken. Then, depending on the nature of the biopsy, an intravenous line (I.V.) may be placed in a vein in your arm. Very anxious patients may want to be given sedation through this line. For patients with less anxiety, oral medication (Valium) can be prescribed to take before the procedure.

You will be awake and aware during this biopsy. It is important that you are able to respond when asked to take breaths or to assume certain positions.

Positioning

You will be positioned (usually lying on your front or on your back) so that the radiologist has easy access to the area for biopsy. The skin in this area will be swabbed with a cool antiseptic solution and draped with sterile surgical towels. After the antiseptic has been applied, do not touch the area.

The skin, underlying fat, and muscle will then be numbed with a local anesthetic.

Needle placement

The radiologist will choose an x-ray technique to locate the mass for biopsy. Needles will be passed into the mass. These needles may look alarming because they are quite long. However, they are very thin, and usually the whole length of a needle is not inserted.

You will notice that the needles may be inserted and withdrawn several times. There are many reasons for this:

One needle may be used as a guide, with the other needles placed along it to achieve a more precise position. Sometimes, several passes may be needed to obtain enough cells for the intricate tests which the cytopathologists perform.

oWhen the mass is small, several passes may be necessary to position properly the needle tip. You should expect about two to four needle passes during the biopsy.

After the needles are placed into the mass, cells will be withdrawn and given to the cytopathologist. When the cytopathologist has enough cells to work with, the biopsy will usually end. Your vital signs will be taken again, and you may return either to your patient care unit for observation or to the Radiology holding area to be observed for several hours. Outpatients will generally be observed for about 3 to 5 hours.

If you go home after the test, you must be driven home. Do not drive until the day after the procedure. Depending on the site of your biopsy, you should not plan on flying home the same day. If you must fly home immediately, please discuss this with your doctor.

Complications

As with any surgical procedure, complications are possible. Fortunately, major complications due to thin needle aspiration biopsies are fairly uncommon, and when complications do occur, they are generally mild. The kind and severity of complications depend on the organs from which a biopsy is taken or the organs gone through to obtain cells.

Pain

Biopsies cause some pain. While the perception of pain is subjective and varies from person to person, most patients feel that biopsies hurt a bit, but that they are tolerable.

To help ease any pain during the procedure, a local anesthetic will be given. Intravenous painkillers can be used, but most patients do not require them.

Please tell the radiologist if you feel pain during the procedure, and adjustments in the medications can be made. Often, just remaining calm and taking slow, deep breaths will make the discomfort more bearable.

After the procedure, mild painkillers such as Tylenol will control pain quite well. Aspirin or aspirin substitutes (Motrin, Naprosyn) should not be taken for 48 hours after the procedure (unless aspirin is prescribed for a cardiac or neurological condition).

Infection

Since sterility is maintained throughout the procedure, infection is rare. But should an infection occur, it will be treated with antibiotics.

Bleeding

Bleeding is the most common complication of this procedure. A slight bruise may also appear. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine after the procedure. Only a small amount of bleeding should occur.

During the observation period after the procedure, bleeding should decrease over time. If more bleeding occurs, this will be monitored until it subsides. Rarely, major surgery will be necessary to stop the bleeding.

Other complications

Other complications depend upon the body part on which the biopsy takes place.

Lung biopsies are frequently complicated by “pneumo-thorax” (collapsed lung). This complication can also accompany biopsies in the upper abdomen near the base of the lung. About one-quarter to one-half of patients having lung biopsies will develop pneumothorax.

Usually, the degree of collapse is small and resolves on its own without treatment. A small percentage of patients will develop a pneumothorax serious enough to require hospitalization and placement of a chest tube for treatment. Although it is impossible to predict in whom this will occur, collapsed lungs are more frequent and more serious in patients with severe emphysema and in patients in whom the biopsy is difficult to perform.

For biopsies of the liver, bile leakages may occur, but these are quite rare. Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around the pancreas.

Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare. Specific complications which might be expected from your particular biopsy will be explained to you before you sign the informed consent form.

The health care staff who will be working with you has extensive experience with this type of biopsy. The staff of the Diagnostic Radiology Department hopes that this information helps you and your family understand what will happen during your needle aspiration biopsy.

If you still have unanswered questions, do not hesitate to call on your doctor, nurse, or the staff of the Diagnostic Radiology Department.

Patient Information Publications

Various types of needle aspiration

This type of biopsy uses a needle to aspirate (draw out) fluid or tissue from a lump. Needle aspiration leaves no scarring, is less invasive and quicker than open excisional biopsy, and usually does not require stitches or a recovery period. The patient can resume regular activities immediately.

Techniques

Needle aspiration procedures include the following:

·Fine needle aspiration ·Core needle biopsy ·Vacuum-assisted biopsy ·Large core biopsy. Each procedure differs in how it is performed, the equipment used, the type of lesion it works best on, and the amount of tissue it removes. Unlike surgical biopsy, needle aspiration cannot remove the entire lesion and misdiagnosis can occur.

Fine Needle Aspiration

This procedure is performed under local anesthesia. The surgeon uses a fine hollow needle that is attached to a syringe to extract fluid from a cyst or cells from a solid lesion. The needle used in this procedure is very small (smaller than those used to draw blood). Several insertions are usually required to obtain an adequate sample. The procedure takes a few minutes and is often done in a doctor’s office.

If the lump cannot be felt, ultrasound may be utilized to help the physician guide the needle into the lesion.

There is no incision and a very small bandage is put over the site where the needle entered. Fine needle aspiration is the easiest and fastest method of obtaining a biopsy, and is very effective for women who have fluid filled cysts. However, the pathological evaluation can be incomplete because the tissue sample is very small. When used alone, about 10% of breast cancers may be missed. The effectiveness of this procedure depends on the skill of the surgeon or radiologist who performs it.

Core needle biopsy

This procedure is similar to fine needle aspiration, but the needle is larger, enabling a larger sample to be obtained. It is performed under local anesthesia and ultrasound or stereotactic mammography is used if the lump cannot be felt.

Three to six needle insertions are needed to obtain an adequate sample of tissue. A clicking sound may be heard as the samples are being taken and the patient may feel some pressure, but should not feel pain. The procedure takes a few minutes and no stitches are required.

Core needle biopsy may provide a more accurate analysis and diagnosis than fine needle aspiration because tissue is removed, rather than just cells. This procedure is not accurate in patients with very small or hard lumps.

Vacuum-assisted biopsy

This method utilizes a vacuum-like device to remove breast tissue. Local anesthesia is used and no incision is made. Stereotactic mammography is used to guide a breast probe to the lesion. Computers pinpoint the mass and suction draws out the breast tissue. The needle is inserted once to obtain multiple samples. In some cases, the entire lesion may be removed.

Vacuum-assisted biopsy is safe, reliable, and valuable for patients who are not candidates for other minimally invasive biopsy techniques and those who wish to avoid surgical biopsy. The procedure should be performed by a highly skilled radiologist or surgeon who is experienced and familiar with this method.

Large core biopsy

This procedure, also called advanced breast biopsy instrumentation (ABBI), is an alternative for patients who prefer a less invasive procedure than surgery. Large core biopsy is able to remove a sizeable specimen or an entire lesion using a surgical device and stereotactic mammography. It combines wire needle localization and the ability to remove a tissue specimen and allows the sample to be removed in one piece.

The Surgery Channel

How Is Ovarian Cancer Diagnosed? November 16, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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How Is Ovarian Cancer Diagnosed?

From the American Cancer Society

Consultation with a specialist

If your pelvic exam or other tests suggest that you may have ovarian cancer, you will need a doctor or surgeon who specializes in treating women with this type of cancer. A gynecologic oncologist is an obstetrician/gynecologist who is specially trained in treating cancers of the female reproductive system.

Imaging studies

Imaging methods such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound studies can confirm whether a pelvic mass is present. Although these studies cannot confirm that the mass is a cancer, they are useful if your doctor is looking for spread of ovarian cancer to other tissues and organs.

Ultrasound

Ultrasound (ultrasonography) is the use of sound waves to create an image on a video screen. Sound waves are released from a small probe placed in the woman’s vagina or on the surface of her abdomen. The sound waves create echoes as they enter the ovaries and other organs. The same probe detects the echoes that bounce back, and a computer translates the pattern of echoes into a picture. Because ovarian tumors and normal ovarian tissue often reflect sound waves differently, this test may be used to find tumors and determine whether a mass is solid or a fluid-filled cyst.

Computed tomography

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.

This test can help tell if the cancer has spread into your liver or other organs. CT scans are useful in showing how large the tumor is, what other organs it may be invading, whether lymph nodes are enlarged and if your kidneys or bladder are affected.

You may be asked to drink 1 to 2 pints of a liquid before the CT scan called “oral contrast.” This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye is injected. This helps better outline structures in your body.

The injection can cause some flushing (redness and warm feeling that may last hours to days). A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medicine can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT scans are not usually used to to biopsy (see biopsy in the section “Other tests”) an ovarian tumor, but they can be used to biopsy a suspected metastasis. For this procedure, called a CT-guided needle biopsy, the patient stays on the CT scanning table, while a radiologist moves a biopsy needle toward the location of the mass. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is removed and examined under a microscope.

CT scans take longer than regular x-rays and you need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and the most modern ones take only seconds.

Barium enema x-ray

This is a test to see whether the cancer has invaded the colon (large intestine) or rectum (it is also used to look for colorectal cancer). After taking laxatives the day before, the radiology technician puts barium sulfate, a chalky substance, into the rectum and colon. Because barium is impermeable to x-rays (impossible for x-rays to go through), it outlines the colon and rectum on x-rays of the abdomen. This test is rarely used now in women with ovarian cancer. Colonoscopy may be done instead.

Magnetic resonance imaging

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of the body. A contrast material might be injected into a vein (same as with a CT scan). MRI scans are not used often to look for ovarian cancer.

MRI scans are particularly helpful to examine the brain and spinal cord. MRI scans take longer than CT scans, — often up to 30 minutes or more. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia (fear of enclosed spaces). The machine also makes a thumping noise that you may find disturbing. Some places will provide headphones with music to block the sound.

Chest x-ray

This procedure may be done to determine whether ovarian cancer has spread (metastasized) to the lungs. This spread may cause one or more tumors in the lungs and often causes fluid to collect around the lungs. This fluid, called a pleural effusion, can be seen with chest x-rays.

Positron emission tomography (PET scan)

In this test radioactive glucose (sugar) is given to look for the cancer. Because cancers use glucose (sugar) at a higher rate than normal tissues, the radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive deposits. This test has can be helpful for spotting small collections of cancer cells. In some instances this test has proved useful in finding ovarian cancer that has spread. It is even more valuable when combined with a CT scan (PET/CT scan). Although PET scans can help find cancer when it has spread, they are expensive and many insurance companies will not cover the cost.

Laparoscopy

This procedure uses a thin, lighted tube through which a doctor can look at the ovaries and other pelvic organs and tissues in the area around the bile duct. The tube is inserted through a small incision (cut) in the lower abdomen and sends the images of the pelvis or abdomen to a video monitor. Laparoscopy provides a view of organs that can help plan surgery or other treatments and can help doctors confirm the stage (how far the tumor has spread) of the cancer. Also, doctors can manipulate small instruments through the laparascopic incision(s) to perform biopsies.

Colonoscopy

A colonoscopy is a way to examine the inside of the large intestine (colon). After the large intestine has been cleaned with laxatives, the doctor inserts a fiberoptic tube into the rectum and passes it through the entire colon. The images are sent to a video monitor. This allows the doctor to see the inside and detect any abnormalities. Colonoscopy can be uncomfortable, so the patient is sedated before the procedure. This test is more commonly used to look for colorectal cancer.

Biopsy

The only way to determine for certain if a growth is cancer is to remove a sample of the growth from the suspicious area and examine it under a microscope. This procedure is called a biopsy. For ovarian cancer, the biopsy is most commonly done by removing the tumor at surgery. It can be also be done during a laparoscopy procedure or with a needle placed directly into the tumor through the skin of the abdomen. Usually the needle will be guided by either ultrasound or CT scan. A needle biopsy is sometimes used instead of surgery if the patient cannot have surgery because of advanced cancer or some other serious medical condition.

In patients with ascites (collection of fluid inside the abdomen), samples of fluid can also be used to diagnose the cancer. In this procedure, called paracentesis, the skin of the abdomen is numbed and a needle attached to a syringe is passed through the abdomen wall into the fluid in the abdominal cavity. The fluid is sucked up into the syringe and then sent for analysis.

In all these procedures, the tissue obtained is sent to the pathology laboratory. There it is examined under the microscope by a pathologist, a doctor who specializes in diagnosing and classifying diseases by examining cells under a microscope and using other lab tests.

Blood tests

Your doctor will order blood counts to make sure you have enough red blood cells, white blood cells and platelets (cells that help stop bleeding). There will also be tests to measure your kidney and liver function as well as your general health status. Finally the doctor will order a CA-125 test. If the test result is elevated, consultation with a gynecologic oncologist is recommended.

American Cancer Society

Lymph Nodes Female November 16, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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The abdominal/pelvic region is rich in lymph nodes and a very complex lymphatic system. This shows the lymph nodes that are likely to be effected by ovarian cancer treaments, biopsies and radiation.

lymph_nodes_female

 

female-genitalia-nodes

 

pelvic-and-abdominal-nodes

 

pelvic-lymph-nodes

 

intestinal-lymph

 

lymphatis_system