Ovarian cancer forms outside ovaries March 3, 2012Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: fallopian tubes, HGSC, high grade serous cancer, ovarian cancer, ovaries
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Ovarian cancer forms outside ovaries
Sat Mar 3, 2012
In a startling revelation, a new study has found that the deadliest type of ovarian cancer, high grade serous cancer (HGSC), which accounts for 90 per cent of deaths, often starts in the fallopian tubes rather than the ovaries. If the symptoms are recognised early enough, it can be diagnosed and treated effectively, say the findings of the DOvE (Diagnosing Ovarian Cancer Early) study, led by a research team from the McGill University Health Centre (MUHC), Canada, and published in a recent issue of The Lancet Oncology. The study could revolutionise the way the disease is diagnosed.
The study also found that women over 50 years who suffer from bloating, high urinary frequency, abdominal or pelvic discomfort are about 10 times more likely to have ovarian cancer than those who do not.
The DOvE project was initiated in May 2008 to assess symptomatic women for ovarian cancer early, when chances of recovery are highest. During the pilot phase of the study, 1,455 women aged 50 years or more were assessed. As a result, cancers were diagnosed earlier, when 73 per cent of women could benefit from complete surgery, leaving no visible disease.
Dr Lucy Gilbert, Director of Gynaecologic Oncology at the MUHC and principal investigator of the DovE study conducted over a period of four years says, “Each year 2,16,000 women worldwide are diagnosed with ovarian cancer, and 70 per cent of them will die unless we act on the information we have without delay. We encourage healthcare professionals around the world to be aware that high grade serous cancer often starts in the fallopian tubes. So the traditional tests — ultrasound scan of the ovaries and the one-off CA125 blood test — are not enough to diagnose high grade serous cancer (HGSC) in time.
“As the killer variety of ovarian cancer is not really cancer of the ovary, we have to rethink the current diagnostic test, or these cancers will be missed,” adds Dr Gilbert, who is also an Associate Professor of Medicine at McGill University.
At Mumbai’s Tata Memorial Cancer Centre, Dr Amita Maheshwari, Associate Professor of Gynaecologic Oncology, agrees that the study is important and certain variant cancers can arise in the fallopian tubes. “There are 28,000 new cases of ovarian cancer every year in the country as against 1.34 lakh new cases of cervical cancer and one lakh new cases of breast cancer,” she says, adding that early detection is important and, sadly, there are no cost effective screening tests for ovarian cancer.
Dr Hemant Tongaonkar, gynaecologic oncologist at Mumbai’s Hinduja Hospital and Research Centre, says that since the early symptoms of ovarian cancer are vague and mimic other conditions, the DoVE study had been taken up to develop a probability tool for detection.
Dr A Nanda Kumar, Director of the National Cancer Registry Programme, Bangalore, says that due to the high mortality, the aetiology of the cancer of the ovary has been the subject of several investigations. Experts agree that ovarian cancer is less common but more deadly. Kumar says this is because we do not have a screening test and most cancers are diagnosed in the advanced stage.
Exclusive Patents on the BRCA Genes: Adding Burden to an Already Overburdened Cancer Community March 2, 2012Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: BRAC2, BRCA1, cancer, gene, genetics, patents, patient care
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By Sue Friedman, Executive Director, Facing Our Risk of Cancer Empowered (FORCE)
As part of the ACLU’s Taking Back Our Genes campaign , guest blogger Sue Friedman, the Executive Director of FORCE, describes the adverse impact the exclusive patents on BRCA1 and BRCA2 have on the cancer community.
It is our position that the awarding of exclusive patents for the BRCA1 and BRCA2 genes to Myriad Genetics has adversely affected access to care and research specific to hereditary breast and ovarian cancer, adding additional burden to our already overburdened hereditary cancer community. For that reason, we support the litigation challenging the BRCA gene patents and filed an amicus brief with the U.S. Supreme Court with other patient advocacy groups.
In our 13 years of advocating for and serving the hereditary cancer community, we have seen firsthand the adverse effects of exclusive gene patenting.
Exclusive licensing of BRCA testing stifles research, including:
Research on PARP inhibitors, targeted therapy for BRCA-associated cancer: We believe that the BRCA gene patent has had a profound impact by delaying and slowing the development of targeted cancer therapies for people with BRCA mutations. PARP inhibitors are a class of drugs that were developed based on scientists’ knowledge of how hereditary cancers develop in people with BRCA mutations. The drugs showed activity and early studies were promising in several types of hereditary cancers including breast, ovarian, and prostate. PARP inhibitor research has been ongoing since 2005, and today, seven years later, the drugs have yet to gain FDA approval. After meeting with the FDA, we were told that for targeted therapies that benefit a distinct population (such as people with a BRCA mutation) to receive FDA approval, they require that any companion laboratory test identifying a target population must be FDA approved as well. BRACAnalysis — Myriad’s test for BRCA mutations is not FDA-approved. Myriad is a CLIA-approved laboratory; they were never required to receive FDA approval in order to market their test, and it doesn’t appear that they have plans to seek FDA approval. Because Myriad holds the patent on the gene, no other lab can develop an FDA-approved test to identify BRCA mutation carriers.
Research that helps determine which BRCA genetic changes are deleterious and which are not: BIC (Breast Information Core) is a large international consortium organized by the National Human Genome Research Institute (NHGRI), which is part of the National Institutes of Health. BIC’s goal is to provide critical research to determine gene changes that may be cancer-causing versus those which aren’t. Around 2004, Myriad stopped contributing data to the BIC database. About 7 percent of BRCA tests return with an inconclusive result and data from BIC is used to help better classify these variants to determine if they are cancer-causing. According to a 2010 article in the Genomics Law Report, Myriad quietly stopped contributing data to BIC in favor of building its own database to retain a competitive advantage over other gene testing companies once their patent runs out.
Exclusive licensing negatively impacts BRCA test interpretation: Myriad’s decision to no longer contribute to the BIC database has impeded the interpretation of a type of inconclusive test result known as a Variant of Uncertain Significance (VUS). Once the patent does expire, the fact that Myriad no longer contributes mutation information to the BIC consortium will limit other laboratories’ ability to interpret certain test results. A 2011 article from the New York Times suggested that withholding this data may provide a competitive benefit to Myriad over other laboratories after their patent expires. But it comes at the cost of critical information that could help provide information to families that have inconclusive genetic test results right now.
The excessive cost of testing limits access and negatively affects clinical care: There is now evidence-based information demonstrating that identifying those who have the highest risk for breast and ovarian cancer can lower breast, ovarian, and all-cause mortality through genetic testing and surgical prevention. The cost of prevention, both in dollars and human lives, is less than the cost of treating cancer once it is diagnosed. Yet, people are being denied access to critical health information due to the excessive cost of BRCA testing. Financial assistance for BRCA testing is limited, especially for people who have any type of health insurance. With patent exclusivity and a monopoly on the test, Myriad has increased the cost of their test even as the cost of genetic technology and gene sequencing has gone down. The full-sequencing BRCA testing costs about $3,500, making it cost-prohibitive for many people. Further, Myriad charges an additional $750 for expanded testing known as BART to look for mutations known as large rearrangements in some people who test negative with full BRCA sequencing.
You can learn more about FORCE’s advocacy here.
And if you agree that human genes should not be patented, please join us in Taking Back Our Genes.
March Is Ovarian Cancer Awareness Month March 2, 2012Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: awareness, CA125, early detection, estrogen, hormone balance, hysterectomy, oestrogen, ovarian cancer, symptoms, UK
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March Is Ovarian Cancer Awareness Month
Although the majority of the 6,500 women diagnosed with ovarian cancer in the UK each year are menopausal, it is not solely confined to that group as younger women are also at risk.
The good news is that with early detection the survival rate is good with seven out of ten women treated will survive for five or more years. The bad news is that some of the symptoms are similar to those seen in more common conditions, like irritable bowel syndrome (IBS) so your doctor may find it hard to diagnose.
What Can You Do?
Awareness is key, because to help your doctor diagnose ovarian cancer you need to monitor your body and report any symptoms as soon as you spot them. Also, cervical screening tests (smear tests) will not help to detect ovarian cancer so don’t rely on getting a clear result from that indicating you are clear of ovarian cancer.
Women need to learn to recognise the symptoms and go to see their doctor as soon as possible if they have any of the following consistently over a month and they don’t go away:
Persistent pelvic or abdominal pain
Increased abdominal size/persistent bloating (not the normal blow up around a period that comes and goes)
Difficulty eating or feeling full quickly
Urinary symptoms such as more frequent or urgent need to pee
Those are the most common symptoms, but sometimes there can be other such as:
Changes in bowel habit
Extreme fatigue (feeling very tired)
Unexplained weight loss
If you regularly experience any of these symptoms and they are not normal for you then please don’t hesitate but go and see your doctor. They may be nothing, but it is important to be checked out. It will help your doctor if you also keep a note of your symptoms such as when they occur and if related to specific events. They will also want to know if there is any history of ovarian or breast cancer in your immediate family.
What Treatment Is Available?
First your doctor may suggest a CA125 blood test and, depending upon the results, they may order an internal scan. Alternatively, they may refer you to a specialist gynaecology unit for investigation, or if they do not think ovarian cancer is a likely cause they may ask you to return if your symptoms do not clear over a period of time.
Treatment normally involves chemotherapy and/or surgery – usually a total hysterectomy. If this is the case then supplemental bio-identical progesterone will help to counter the effects of this sudden surgical menopause.
Reducing Your Risk
Having a healthy hormone balance is essential and monitoring yourself for symptoms of oestrogen dominance, and tackling them would certainly be a good start. This article by Dame Dr Shirley Bond outlines them here and a diet that reduces other risk factors such as animal fats and refined sugar and replaces them with more plant-based foods, complex carbohydrates and fibre will also be of benefit.
Cancer misdiagnosis claim refuted March 2, 2012Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: gynecological cancer, jhon radcliff hospital, middiagnosis, misdiagnosis, ovarian cancer, oxford
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HOSPITAL bosses have disputed claims that three ‘serious’ cases were misdiagnosed by gynaecological departments in Oxford.
The claim was made by an anonymous GP in a survey by a doctors’ magazine.
He told GP journal Pulse he knew of three ‘serious’ cases which had been misdiagnosed by the gynaecological department at the John Radcliffe Hospital – including one of a patient with ovarian cancer.
He said: “We wrote a letter. All we wanted was something back saying ‘let’s look at this’. Instead we got a five-sentence reply saying ‘under Nice guidelines we did nothing negligent’.”
Sir Jonathan Michael, chief executive of the Oxford UniversityHospitals Trust, said: “The trust has robust processes in place to ensure that high standards of clinical care are delivered in our hospitals. If at any time a GP or patient feels that the standard of care received from our trust falls short of their expectations, we urge them to raise these through the appropriate channels.
“It is impossible to comment on such anecdotal comments given anonymously but the trust would be more than happy to address the concerns.”
Let’s hear it for medical care in Oxford
Ovarian sentinel node: is it feasible? March 1, 2012Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: ovarian cancer, ovary, Radioisotope, sentinel node biopsy
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Ovarian sentinel node: is it feasible?
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland. email@example.com
To examine whether the intraoperative combined injection technique is feasible in locating the sentinel node(s) of the ovary.
In 16 patients with high-risk uterine cancer and normal postmenopausal ovaries, technetium isotope and blue dye were injected in the right or left ovary during laparotomy, respectively. During the operation, the pelvic and para-aortic lymphatic areas were searched, and the number, method of detection, and location(s) of the hot and/or bluenode(s) were recorded.
One to 3 sentinel nodes per patient were identified in all but 1 patient (15 of 16, 94%). The sentinel nodes (n = 30) were all located in the para-aortic area. The sentinel nodes of the left ovary were mainly (9 of 14, 64%) located above the inferior mesenteric artery level, as the most sentinel nodes of the right ovary (15 of 16, 94%) were found below the inferior mesenteric artery level (P = 0.001). There were no contralateral or bilateral sentinel nodes.
The combined intraoperative injection technique with radioisotope and blue dye is fast enough to identify the ovarian sentinel node(s). The stained nodes were consistently located on a certain lymphatic area. The sentinel nodeconcept for the early ovarian cancer deserves more attention.
Click on the link for further information on Sentinel Node Biopsy
Tags: egg, human ovaries, reproductive technology, stem cell
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While this post isn’t about ovarian cancer, per se, it may provide some encouragement to those who have recently been diagnosed and/or starting treatment.
Stem Cell Finding Could Expand Women’s Lifetime Supply of Eggs
Research might lead to new reproductive technologies, older pregnancies, researchers say
Monday, February 27, 2012
(HealthDay News) — Researchers report that they’ve isolated stem cells from adult human ovaries that can mature into eggs that may be capable of fertilization.
The lab findings, which upend longstanding scientific theory, could potentially lead to new reproductive technologies and possibly extend the years of a woman’s fertility.
It was long believed that women were born with a lifetime supply of eggs, which was depleted by menopause. But a growing body of research — including a new paper from Massachusetts General Hospital — suggests egg production may continue into adulthood. The study is published in the March issue of Nature Medicine.
“Fifty years of thinking, in every aspect of experiments, of interpreting the results, and of the clinical management of ovarian function and fertility in women was dictated by one simple belief that turns out to be incorrect,” said lead study author Jonathan Tilly, director of the hospital’s Vincent Center for Reproductive Biology. “That belief was the egg cell pool endowed at birth is a fixed entity that cannot be renewed.”
Dr. Avner Hershlag, chief of the Center for Human Reproduction at North Shore-LIJ Health System in Manhasset, N.Y., said the study is “exciting” but emphasized the work is still very preliminary.
“This is experimental,” Hershlag said. “This is a beginning of perhaps something that could bring in new opportunities, but it’s going to be a long time in my estimation until clinically we’ll be able to actually have human eggs created from stem cells that make babies.”
The same team at Mass General caused a stir in 2004 when it published a paper in Nature reporting that female mice retain the ability to make new egg cells well into adulthood.
In both mice and humans, the vast majority of egg cells die through a process called programmed cell death, or apoptosis, the body’s way of eliminating unneeded or damaged cells. For humans, that process is dramatic. Female fetuses have about 6 to 7 million eggs at about 20 weeks’ gestation, a little more than 1 million at birth, and about 300,000 by puberty.
Studying mice egg cells and follicles, the tiny sacs in which stem cells become eggs, the Mass General researchers discovered something that didn’t make mathematical sense.
Most prior research had focused on counting the healthy eggs in the ovaries, and then made assumptions about how many had died from that, Tilly said. But his lab looked at it the opposite way and focused on cell death.
“We found far too many eggs were dying than could be accounted for by the net change in the healthy egg pool,” Tilly said. “We reasoned that maybe the field had missed something.” They wondered if stem, or precursor cells, were repopulating the ovaries with new eggs.
Initially, the findings were met with skepticism, according to the study authors, but subsequent research bolstered the conclusions.
Those included a 2009 study from a team in China, published in Nature Cell Biology, that isolated, purified and cultured egg stem cells from adult mice, and subsequently introduced them into mice ovaries that were rendered infertile. The infertile mice eventually produced mature oocytes that were fertilized and developed into healthy baby mice.
Studies showing that women had the same capacity as mice were lacking, however.
In this study, Tilly’s team used tissue from Japanese women in their 20s and 30s with gender identity disorder, who had their ovaries removed as part of gender reassignment surgery.
The researchers isolated the egg precursor cells and inserted into them a gene from a jellyfish that glows green, then inserted the treated cells into biopsied human ovarian tissue. They then transplanted the human tissue into mice. The green fluorescence allowed researchers to see that the stem cells generated new egg cells.
Tilly said the process makes evolutionary sense. “If you look at this from an evolutionary perspective, males have sperm stem cells that continually make sperm. Because species propagation is so important, we want to make sure it’s the best sperm, so don’t want sperm sitting around for 60 years waiting to get used,” he said. It makes no sense from an evolutionary perspective that “females will be born with all the eggs they will have and let them sit there,” he noted.
Hershlag, meanwhile, said much remains to be overcome.
“Ultimately, in our field only one thing counts,” he said, “and that is if you can make an egg that can make a healthy baby.”
SOURCES: Jonathan Tilly, Ph.D., director, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston; Avner Hershlag, M.D., chief, Center for Human Reproduction, North Shore-LIJ Health System, Manhasset, N.Y.; Feb. 26, 2012, Nature Medicine, online