jump to navigation

Family History and Women With Ovarian Cancer: Is it Asked and Does it Matter?: An Observational Study. February 13, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: , , , , ,
1 comment so far

Family History and Women With Ovarian Cancer: Is it Asked and Does it Matter?: An Observational Study.

Feb 2012

Lanceley AEagle ZOgden GGessler SRazvi KLedermann JASide L.

Source

*UCL EGA Institute for Women’s Health, Department of Women’s Cancer Research, University College London; †Institute of Clinical Education, Warwick Medical School, and MedicalTeaching Centre, University of Warwick, Coventry; ‡Women’s Clinic, Southend University Hospital NHS Foundation Trust, Essex; and §Gynaecological Cancer Centre, University College London Hospital NHS Foundation Trust and ∥¶Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, UK.

Abstract

OBJECTIVE:

The objective of the study was to determine how many women in an ovarian cancer (OC) study cohort had a family history (FH) recorded in their case notes and whether appropriate action was taken on the basis of that FH.

METHODS:

This was a review of patient case-note data of women in a randomized controlled trial of follow-up after primary treatment for OC. Available case notes of 114 women recruited at 3 UK gynecologic cancer centers in a 2-year period between January 2006 and 2008 were examined. Case-note entries for the period from first hospital consultation to 2 years after completion of primary treatment were included. Outcome measures were (1) recording of an FH of cancer in the case notes, (2) whether appropriate action had been taken on the basis of the FH in those women with affected relatives, and (3) characterizing insufficient FH records.

RESULTS:

Family history was not consistently recorded. Although FH was recorded in the majority of women, 14 women had no FH recorded. In 63 women, the FH was recorded as not significant, and in 15 cases, FH information was insufficient to complete a risk assessment. Twenty-two women had significant FH meeting criteria for specialist genetics referral. In 15 of these 22 cases, the relevant history suggestive of hereditary breast cancer and OC (due to BRCA1 or BRCA2 mutations) or Lynch syndrome had been documented, but no action was recorded, and its significance was not appreciated.

CONCLUSIONS:

These data indicate that training in recognizing relevant FH is needed for clinicians looking after women with OC. Research is necessary to determine the barriers in taking and interpreting an FH and to determine the optimal time for broaching FH issues during a woman’s care pathway. This will improve the accuracy of FH recording and ensure families with OC have access to appropriate surveillance and genetic testing.

International Journal of Gynecological Cancer

Advertisements

A Surveillance Conundrum: A Case of 4 Distinct Primary Malignancies in a BRCA-1 Mutation Carrier. February 13, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: , , , ,
add a comment

A Surveillance Conundrum: A Case of 4 Distinct Primary Malignancies in a BRCA-1 Mutation Carrier

Ricci SShafer ANerenstone SMandavilli SSorosky J.

University of Connecticut (S.R.), Farmington Hartford Hospital (A.S., S.N., S.M., J.S.), Hartford, CT.

Abstract 

Women with HBOC syndrome present a unique challenge to the oncology community, as will many genetic cancersyndromes yet to be discovered as genetic testing increases in availability. Issues of management and, most importantly, implication are yet to be elucidated. After a diagnosis of epithelial ovarian carcinoma lifelong follow-up is recommended. Given the high recurrence rate and dismal long term prognosis of advanced epithelial ovarian carcinoma this recommendation is more often than not moot. There are no clear guidelines or recommendations for surveillance designed for women with disease free survival greater than five years. This case presents a unique scenario of a woman with predictable disease that remains unpreventable.

PubMed

 

Hereditary ovarian cancer February 13, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
Tags: , , , , , , ,
add a comment

While this little article dates to 2009, it is just as relevant  today  with the ongoing research into finding any genetic causes for ovarian cancer:

Hereditary ovarian cancer.

Jan 2009

Russo ACalò VBruno LRizzo SBazan VDi Fede G.

Source

Department of Surgery and Oncology, Regional Reference Center for the Biomolecular Characterization and Genetic Screening of Hereditary Tumors, Università di Palermo, Palermo, Italy. lab-oncobiologia@usa.net

Abstract

At least 10% of ovarian tumors are hereditary and associated with highly penetrant, autosomal, dominant genetic predisposition. Three clinical manifestations of hereditary ovarian cancer have been identified: site-specific ovarian cancer, hereditary breast and/or ovarian cancer (HBOC) and hereditary non-polyposis colorectal cancer (HNPCC) syndromes. BRCA germline mutations account for more than 90% of all hereditary epithelial ovarian tumors whereas most of the remaining 10% are caused by MLH1 and MSH2 mutations, which are susceptibility genes of HNPCC. Genetic testing is available for each of the three hereditary syndromes above mentioned. The recommendations for OC surveillance in high-risk women having a strong family history or BRCA mutation carriers include transvaginal pelvic ultrasound with color Doppler and serum CA125 every 6 months. Bilateral salpingo-oophorectomy appears to be effective to reduce the risk of ovarian cancer in BRCA mutation carriers. Hysterosalpingo-oophorectomy should be considered in HNPCC women who undergo surgery for colorectal carcinoma.

Elsevier

Keywords: Hereditary ovarian cancerBRCAHNPCCGenetic testingProphylactic surgery

Understanding the Lymph System October 28, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , , , , , ,
add a comment

Understanding the Lymph System

I thought it would be helpful for readers to understand the lymph system, the anatomy, what it does, and how it helps with immunity.

Listed below are information pages that should be quite helpful and each page has many additional links for more a more in depth study.

Anatomy of the Lymph System

Lymphatic System Functions

Lymphatic System and Immunity

Pathology of the Lymph Nodes and Lymphoma

Lymph Nodes

Lymph Fluid

Efficacy and Toxicity of Belotecan With and Without Cisplatin in Patients With Recurrent Ovarian Cancer. September 17, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , , , ,
add a comment

Efficacy and Toxicity of Belotecan With and Without Cisplatin in Patients With Recurrent Ovarian Cancer.

Am J Clin Oncol. 2009 Sep 10

Nam EJ, Kim JW, Kim JH, Kim S, Kim SW, Jang SY, Lee DW, Jung YW, Kim YT.
From the *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women’s Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea; and daggerDepartment of Gynecologic Oncology, Kwandong University College of Medicine, Seoul, Korea.

OBJECTIVE: This study was performed to determine the safety and efficacy of belotecan, a new camptothecin analogue and potent topoisomerase I inhibitor, with and without platinum in patients with recurrent ovarian cancer.
METHODS: Fifty-three patients with recurrent or persistent ovarian cancer were enrolled between March 2005 and March 2008. Eligible patients received 0.5 mg/m of intravenous (IV) belotecan on days 1 to 5, every 3 weeks belotecan monotherapy (B) or 50 mg/m of IV cisplatin on day 1 plus 0.3 mg/m of IV belotecan on days 1 to 5, every 3 weeks (belotecan plus cisplatin combination therapy [BP]).

RESULTS: Of the 53 treated patients, 34 received BP and 19 received B. Thirty-four patients had platinum-sensitive (PS) disease and 19 had platinum-resistant disease. The overall response of the 53 patients was 37.7% (20/53). According to regimen, the response rate in the BP group was 47.1% (16/34) and that of the B group was 21.1% (4/19). BP had better response (66.7%, 14/21) than B (15.4%, 2/13) for PS disease (P = 0.004), but it was not superior in terms of progression-free survival (BP, 6 month; B, 7 months). Grade 3 or 4 toxicity was less common in B than in BP.

CONCLUSION: Both BP and B seems to be effective and safe regimens for patients with PS or platinum-resistant recurrent ovarian cancer. These results warrant further prospective randomized trials. Both BP and B seems to be effective and safe regimens for patients with PS or platinum-resistant recurrent ovarian cancer.

Lippincott, Williams & Wilkins

Treatment of recurrent epithelial ovarian cancer. September 17, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , ,
add a comment

Treatment of recurrent epithelial ovarian cancer.

Ther Clin Risk Manag. 2009 Aug

Pisano C, Bruni GS, Facchini G, Marchetti C, Pignata S.
Oncologia Medica, Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori, Napoli, Italy.

Epidemiologic analysis reveals that the mortality rate from ovarian cancer is continuously decreasing due to the improvement of surgery and chemotherapy. However, the prognosis of ovarian cancer patients is still unsatisfactory overall considering that only 30% of patients are alive after five years. In fact, although surgery and first-line systemic chemotherapy induces complete and partial response in up to 80% of patients with about a 25% pathological complete remission rate, recurrences occur in the majority of patients. The role of surgery in recurrent disease has been recently studied and many patients can receive an optimal secondary cytoreduction. Most of the recurrent patients are subject to a number of treatment regimens that, although palliative in nature, are also able to prolong survival. Important results have been obtained in particular in platinum-sensitive recurrent disease where a platinum-based chemotherapy is able to prolong progression-free survival and overall survival. Overall, our armamentarium for the treatment of progressive or recurrent ovarian cancer is significantly richer than in the past, and in many patients it is possible to achieve our goal of controlling the chronic behavior of the disease.

PubMed

Expanding the public health research agenda for ovarian cancer. September 17, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , , , ,
add a comment

Expanding the public health research agenda for ovarian cancer.

J Womens Health (Larchmt). 2009 Sep

Trivers KF, Stewart SL, Peipins L, Rim SH, White MC.

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. ktrivers@cdc.gov

Since the year 2000, the Centers for Disease Control and Prevention (CDC) has undertaken an active public health research agenda in ovarian cancer, focused mainly on research related to earlier recognition of symptoms, methods for earlier diagnosis, and optimization of treatment and end-of-life care. Much of this work was guided by external input from two workshops in 2000 and 2002 with ovarian cancer experts in clinical and epidemiological research, public health leaders from federal and state agencies, and ovarian cancer survivors. In November 2008, the CDC convened a third informal workshop of experts to comment on CDC’s work to date and to help expand the public health research agenda for the future. The purpose of the workshop was to identify and discuss urgent and emerging issues related to ovarian cancer and how public health organizations, and specifically CDC, might address these issues through research. This article provides a summary of some of the issues discussed and potential areas for future research, including genetic, screening, and diagnostic tests for ovarian cancer; ways of improving the quality of care for patients; symptom recognition; public awareness; and other emerging issues related to ovarian cancer.

PubMed

Sentinel node biopsy is an effective option for early-stage cervical cancer May 31, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , , , ,
add a comment

Sentinel node biopsy is an effective option for early-stage cervical cancer

Published: 31/05/2009

A prospective multicenter study conducted by researchers in France suggests that the majority of women with early-stage cervical cancer can safely undergo sentinel node (SN) biopsy – a technique in which only one to three lymph nodes are removed to determine whether cancer has spread – in lieu of the traditional, more invasive pelvic lymph node removal. This study, presented at the American Society of Clinical Oncology 2009 meeting, showed that SN biopsy was just as useful as full pelvic lymph node removal for identifying even small amounts of cancer cells that spread to lymph nodes in atypical areas of the pelvis.

“Sentinel node biopsy is a good option for women with cervical cancer because it enables us to remove fewer lymph nodes to get information about cancer spread, and could decrease the risk of complications from surgery, such as lymphedema,” said Dr. Fabrice Lecuru, professor at George Pompidou European Hospital in Paris, and the study’s lead author. “Previous studies have shown that sentinel node biopsy can be used to assess cancer spread in usual areas of the pelvis, but our findings add to this growing body of research by showing that this approach is also effective for identifying cancer spread in less common areas of the pelvis and the abdomen. This approach may become a new standard of care for early-stage cervical cancer.”

Ten to 15 per cent of patients with early-stage cervical cancer experience recurrence. Some are due to lymph nodes that were missed during surgery or because of undetected cancer spread to other lymph nodes. During standard surgery, several pelvic lymph nodes are removed and examined for the presence of cancer cells. During SN biopsy, however, a blue dye and radioactive substance that can be traced with imaging techniques are used to locate the first lymph node (the sentinel node) where cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no other lymph nodes should be removed. Since the removal of lymph nodes may impair lymphatic drainage and cause uncomfortable swelling in the legs called lymphedema, doctors have been assessing SN biopsy (which is routinely used for breast cancer and melanoma patients) to see if it can be used to gauge cervical cancer spread.

Prior studies have shown that SN biopsy can be used in cervical cancer patients to predict cancer spread to lymph nodes in the pelvis most likely to contain cancer cells. But in this study, Dr. Lecuru and his colleagues also evaluated the biopsy of sentinel nodes in atypical areas of the pelvis in 128 women with early-stage cervical cancer who also had full pelvic lymph node removal for comparison. They then analysed sentinel nodes for micrometastastic cancer (0.2 to 2 mm in size) and isolated tumour cells as well as areas of cancer greater than 2 mm (macrometastases).

After analysing these nodes, researchers demonstrated that full pelvic lymph node removal and its associated complications could have been avoided in 81.2 per cent of women. Researchers also found that in nearly 40 per cent of women, SN biopsy alone would have provided additional, important information about patients’ disease; for example, SN biopsy was more useful than routine techniques for showing that lymphatic drainage occurred via unusual pathways to less commonly explored areas of the pelvis or of the abdomen, and for detecting micrometastases or isolated tumour cells.

eCancerMedicalScience

Body Weight Makes No Difference in Ovarian Cancer Survival May 25, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags: , , , , ,
add a comment

Body Weight Makes No Difference in Ovarian Cancer Survival

By Todd Neale, Staff Writer, MedPage Today
Published: December 30, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

BIRMINGHAM, Ala., Dec. 30 — Obese patients with epithelial ovarian cancer do not appear to have worse survival than their slimmer counterparts, a retrospective chart review showed.

Obese and non-obese patients had similar progression-free survival (17 versus 11 months, P=0.14) and overall survival (48 versus 40 months, P=0.37) following primary cytoreductive surgery that resulted in similar rates of optimal debulking, Kellie Matthews, M.D., of the University Alabama at Birmingham, and colleagues reported online in Gynecologic Oncology.

All patients received chemotherapy administered according to their actual body weight. Often, chemotherapy is administered based on ideal weight, which may lead to insufficient doses for obese patients, according to the researchers.

Some past studies have suggested that obesity is an independent predictor of lower survival in patients with epithelial ovarian cancer, but others have not. Few have included information on differences in rates of optimal debulking between obese and non-obese patients, the researchers said.

To explore the issue, they reviewed charts for 304 patients with FIGO stages II to IV epithelial ovarian cancer from a gynecologic oncology database from 1996 to 2005.

All patients underwent primary cytoreductive surgery followed by IV taxane and platinum-based chemotherapy dosed according to actual body weight.

Nearly a quarter (23.4%) were obese and the rest had a body mass index of less than 30 kg/m2.

Obese and non-obese patients had similar disease stage, grade, and histology, rates of platinum sensitivity, and administration of chemotherapy.

Obese patients were significantly more likely to be younger than 65 (P=0.02) and to be black (P=0.01).

There were no significant differences between the groups in estimated blood loss, time spent in the operating room, or operative complications. Only wound complications were more common in the obese group (11% versus 2%, P<0.001).

Rates of optimal debulking — defined as a lack of residual tumors greater than 1 cm in diameter — were similar in obese and non-obese patients (52% versus 51%, P=0.88), in spite of potential challenges to the surgical treatment of obese patients.

Such potential difficulties include comorbid chronic illnesses, administration of anesthesia, operative complications, and technical challenges, the researchers said.

“This demonstrates that any disadvantage obesity affords in the treatment of ovarian cancer is likely not related to the surgeon’s ability to achieve optimal cytoreduction,” the researchers said.

Although obese patients had a lower recurrence rate (68% versus 79%, P=0.04), there were no significant differences in progression-free and overall survival between the two groups.

The authors acknowledged that the study had several limitations, including the retrospective design, a trend toward poorer outcomes in underweight women that could not be compared with outcomes in obese women because of small patient numbers, potential selection bias, and optimal debulking rates that were lower than those found in other studies.

MedPage Today

Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data. May 25, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
Tags:
add a comment

Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data.

Ann Surg Oncol. 2009 May 21

Ghezzi F, Cromi A, Uccella S, Siesto G, Zefiro F, Bolis P.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy, fabio.ghezzi@uninsubria.it.

BACKGROUND: Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service.

METHODS: Data from 383 consecutive women undergoing surgery for the treatment of an apparently early-stage gynecologic cancer between 2000 and 2008 were analyzed. Integration of minimally access surgery for the treatment of invasive malignancies began with borderline ovarian tumors in 2001 and proceeded sequentially to include endometrial, ovarian, and cervical cancer patients.

RESULTS: The annual proportion of laparoscopic cases has increased significantly over the study period from 7.7% in 2001 to 90.9% in 2008 (P < 0.0001 for trend). A temporal trend toward reduction in estimated blood loss was observed in both endometrial cancer and cervical cancer patients (P < 0.0001). There was a significant decrease in the percentage of patients requiring blood transfusions [18 (17.1%) during the period 2000-2002, 19 (13.6%) during 2003-2005, and 8 (5.8%) during 2006-2008; P = 0.005 for trend]. Length of hospital stay has decreased significantly over time for all disease sites (P < 0.0001 for endometrial and cervical cancer; P = 0.02 for ovarian cancer). No difference was found in median operative time, number of lymph nodes harvested, complication rates, 1- and 2-year disease-free survival, and overall survival when data of subsequent time periods were compared.

CONCLUSIONS: Substantial utilization of laparoscopy in the existing practice of a gynecologic oncology service provided benefits to patients without detrimental effects on clinical outcomes. The relatively short follow-up time of laparoscopic cases disallows firm conclusions on long-term survival.

SpringerLink