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Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer. February 24, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
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Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer.

Feb 2012

Sanli YTurkmen CBakir BIyibozkurt COzel SHas DYilmaz ETopuz SYavuz EUnal SNMudun A.


Departments of aNuclear Medicine bRadiology cObstetrics and Gynecology dBiostatistics and Medical Informatics ePathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.



The aim of this study was to evaluate the diagnostic value of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (F-FDG) PET/CT in comparison with MRI for the detection of recurrent ovarian cancer.


Forty-seven patients with suspected ovarian cancer recurrence after total ablative or cytoreductive surgery, as well as neoadjuvant or adjuvant chemotherapy, who had undergone F-FDG PET/CT imaging were recruited for the present study. All patients also underwent MRI within a month of F-FDG PET/CT for the same purpose. Recurrent cancer in the abdomen and pelvis was evaluated in each of the 47 patients and classified as either distant metastasis or local pelvic recurrence involving the vaginal stump, peritoneal implants, supradiaphragmatic region, and/or abdominal and pelvic lymph nodes. Special attention was paid to peritoneal implants. These were divided into five groups according to size of the implants: less than 0.5 cm (group 1), 0.5-1 cm (group 2), 1-2 cm (group 3), 2-3 cm (group 4), and larger than 3 cm (group 5). PET/CT findings were compared with abdominopelvic MR findings. Statistical analysis was carried out using the Wilcoxon signed rank test.


Thirty-nine of 47 patients were found to have recurrent ovarian cancer. Both PET/CT and MRI were negative for recurrence in six patients. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET/CT were 97.5, 100, 100, 87.5, and 97.8%, respectively, whereas those of MRI were 95, 85.7, 97.4, 75, and 93.6%, respectively. For the peritoneal implants in groups 2 and 3, the sensitivity, negative predictive value, and diagnostic accuracy values of PET/CT were significantly better than those of MRI (P<0.05).


The present study revealed that PET/CT is similar to conventional MRI for the detection of recurrent ovarian cancer. PET/CT has greater accuracy in the detection of small-to-medium-sized (<2 cm) peritoneal implants compared with MRI. This may affect surgical decision making.




Epigenetics in ovarian cancer. February 24, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer.
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Epigenetics in ovarian cancer.


Seeber LMvan Diest PJ.


Department of Reproductive Medicine and Gynaecology, Gynaecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.


Ovarian cancer is the most lethal gynecological cancer. Due to few early symptoms and a lack of early detection strategies, most patients are diagnosed with advanced-stage disease. Most of these patients, although initially responsive, eventually develop drug resistance. In this chapter, epigenetic changes in ovarian cancer are described. Various epigenetic changes including CpG island methylation and histone modification have been identified in ovarian cancer. These aberrations are associated with distinct disease subtypes and present in circulating serum of ovarian cancer patients. Several epigenetic changes have shown promise for their diagnostic, prognostic, and predictive capacity but still need further validation.In contrast to DNA mutations and deletions, epigenetic modifications are potentially reversible by epigenetic therapies. Promising preclinical studies show epigenetic drugs to enhance gene re-expression and drug sensitivity in ovarian cancercell lines and animal models.

Ovarian Cancer Treatment Resources, Internet Support Groups, Online Resources February 18, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
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Ovarian Cancer Treatment Resources

Inclusion in the list does not constitute an endorsement of any individual, provider, hospital or medical facility

Dana-Farber Cancer Institute—Ovarian Cancer
Information about treatment, clinical trials, screening, and prevention.

Learn more about nuclear medicine and the use of molecular imaging for cancer patients.

Get Palliative Care
Provides information about palliative care, which focuses on relieving pain, stress, and other symptoms of serious illness.

M.D. Anderson Cancer Center
Provides information about integrated programs in cancer treatment, clinical trials, education programs and cancer prevention.

Memorial Sloan-Kettering Cancer Center
Provides information about treatment for ovarian cancer in addition to research and support for cancer patients and researchers.

National Comprehensive Cancer Network
Clinical recommendations and information about events and resources.

National Lymphedema Network
Education and guidance for lymphedema patients, health care professionals and the general public on primary and secondary lymphedema.

Radiation Therapy Answers
Information about radiation therapy from physician members of the American Society for Therapeutic Radiology and Oncology. Help finding a radiation oncologist.

RxList—The Internet Drug Index
Provides information about prescription drugs to consumers and health care professionals.

Understanding the Approval Process for New Cancer Treatments
Information on the role of the FDA in the approval process for new cancer treatments.

Internet support groups (listservs or chat rooms) are free email or chat room discussions on specific topics of interest. Email subscribers receive copies of emails sent by any members of the group to the listserv. Some active groups generate dozens of messages a day. If you subscribe to the “digest” mode, you will receive one email containing all of the messages posted that day. Email discussion groups are an excellent way to connect with people in similar circumstances.

Chat rooms can be either “live” chats or bulletin board-type chats. A live chat is similar to walking into a room where a discussion is already taking place except you will be typing your messages. In a bulletin board-type chat room, a participant may post a message, and others will usually respond right below that message. With any of these support groups, you may elect to participate or just observe by reading the messages of others and the responses that their messages generate.

 ACOR (Association of Cancer Online Resources) hosts dozens of cancer email discussion groups. Discussion groups hosted by ACOR include OVARIAN–an unmoderated discussion list with over 1,000 subscribers. ACOR also has discussion groups on CANCER, CANCER-FATIGUE, CANCER-PAIN, CANCER-PARENTS, and dozens of others. ACOR offers a convenient automatic subscription feature for discussion mailing lists at http://www.acor.org. Click on mailing lists (on the left nav bar) then click on the group you are interested in joining.

The National Ovarian Cancer Coalition (NOCC) hosts a chat area for women with ovarian cancer. To participate, go to www.ovarian.org/ and click on “Chat” listed under “Support” on the left nav bar. They have a feature that allows participants to schedule chat events on particular topics. The NOCC also hosts multiple listservs on various topics including a resource list, awareness list, caregiver’s list, humor list, and others. To subscribe, click on “Mailing lists” under “Support” on the left nav bar.

OncoLink, at the University of Pennsylvania, has an online FAQ (document answering frequently asked questions) about cancer listservs athttp://oncolink.org/resources/faq/listserv.html. If you would like to learn a bit more about them and get answers to some specific questions, this is a good place to start.

Online Resources

  • CancerGuide. 
    Steve Dunn, a cancer survivor, clearly explains cancer types and staging, chemotherapy, pathology reports, and the pros and cons of researching your own cancer. He recommends books, includes inspirational patient stories, and has links to many of the best cancer sites on the Web. CancerNet
  • http://cancernet.nci.nih.gov/
    An NCI sponsored comprehensive source of cancer information including types of cancer, treatment options, clinical trials, genetics, coping, support, resources, and cancer literature. CancerNet is one of the most comprehensive information sources for cancer patients on the Net. CanSearch: Online Guide to Cancer Resources
  • www.cansearch.org/canserch/canserch.htm
    Service of the National Coalition for Cancer Survivorship that leads you step-by-step through an online search. 
  • Clinical Trials
    A consumer-friendly database sponsored by the National Institutes of Health that provides information on more than 4,000 federal and private medical studies involving patients at more than 47,000 locations nationwide. Conversations
  • www.ovarian-news.com/
    International newsletter for women fighting ovarian cancer. Gilda Radner Familial Ovarian Cancer Registry
  • http://rpci.med.buffalo.edu/departments/gynonc/grwp.html
    Roswell Park Cancer Institute hosts an international registry of families with two or more members with ovarian cancer. They promote ovarian cancer research and offer a help line, education, and peer support for women with a high risk of ovarian cancer. OncoLink
  • www.oncolink.org/specialty/gyn_onc/ovarian/
    University of Pennsylvania cancer specialists founded OncoLink in 1994 to help cancer patients, families, healthcare professionals, and the general public get accurate cancer-related information at no charge. It contains information on ovarian cancer, causes, treatment options, hormones, symptom management, causes, psychosocial support and personal experiences. PubMed
  • www.ncbi.nlm.nih.gov/PubMed
    The National Library of Medicine’s free search service provides access to the 9 million citations in MEDLINE (with links to participating on-line journals) and other related databases. Also includes FAQs, news, and clinical alerts. Ovarian Cancer Research Notebook
  • www.slip.net/~mcdavis/ovarian.html
    The OCRN is a comprehensive list of articles on treatment for ovarian cancer that contains approximately 3,000 documents. It is maintained and upgraded by the National Ovarian Cancer Association of Toronto, Canada.The Women’s Cancer Networkwww.wcn.org
  • Site developed by the Society of Gynecologic Oncologists to help prevent, detect, and conquer cancer in women. It has cancer information, a bookstore, survivor stories, links to other web sites, and a helpful find-a-doc feature.

courtesy: Ocononurse.com 

Ovarian Cancer Resources Education, Genetics Information, Financial and Legal Support February 18, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
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Cancer Resources Education, Genetics Information, Financial and Legal Support:

A Single Light
Searchable database of cancer-related Web sites.

American Cancer Society
Information on cancer, research, advocacy, and community programs and services.

American Pain Foundation
Online toolkit for assessing pain as a part of a treatment plan.

Association of Cancer Online Resources
Collection of online communities that provide information for cancer survivors.

Comprehensive listing of credible Web sites for those affected by cancer.

Cancer information from the American Society of Clinical Oncology.  Offers podcasts, feature articles, and links to current news.

Educational programming and information for health care professionals, cancer patients, and their family members.

Offers the latest news, research, and information on prevention, detection, and treatment of ovarian cancer, as well as interactive decision support tools.

Centers for Disease Control and Prevention
CDC, in collaboration with the Department of Health and Human Services’ Office on Women’s Health, established the Inside Knowledge: Get the Facts About Gynecologic Cancer campaign to raise awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar.

Foundation for Women’s Cancer
Brochures and other educational material for women who have or who are at risk of developing a gynecologic cancer. For a complete list of Foundation survivor courses click here.

Gilda Radner Familial Ovarian Cancer Registry
An international registry of families with two or more relatives with ovarian cancer.  Offers a helpline, education, cancer information and peer support for women with a high risk of ovarian cancer.

Health Finder
Government and nonprofit health and human services information.  Links to carefully selected information and Web sites from over 1,500 health-related organizations.

Johns Hopkins Pathology’s Ovarian Cancer Web
Provides information, personal stories, and an online community.  Gives specific information about each individual ovarian tumor type.

Living with Cancer
Information about how to manage common problems faced by those living with cancer.

Multinational Association of Supportive Cancer Care

National Cancer Institute
Information about cancer topics, genetics, clinical trials, research, and statistics.  Helpful links as well as online assistance with Nation Cancer Institute’s information and cancer-related resources.

National Coalition for Cancer Survivorship
Offers audio Cancer Survival Toolbox and information about finding resources online.

National LGBT Cancer Network
Information for survivors and health care providers about increased cancer risks, decreased screening rates, and unique survivability issues of lesbian, gay, bisexual and trans gender cancer survivors and those at risk.

National Ovarian Cancer Coalition (NOCC)
Offers information about ovarian cancer as well as a helpline (1-888-682-7426) for support.

Cancer-related information for cancer patients, families, health care professionals, and the general public.

Ovarian Cancer Canada
Provides support, education, and research as well as a toll free support line.

The University of Texas MD Anderson Cancer Center: The Anderson Network
Online information and downloadable PDFs about prevention, diagnosis, treatment, and support.

Women’s Cancer Network – Ovarian Cancer
An interactive Web site about gynecologic cancer, helping women to understand more about the disease, learn about treatment options, and gain access to new or experimental therapies.

Genetics Support

Financial and Legal Support

Cancer Care
Professional support services to people with cancer, caregivers, children, loved ones, and the bereaved.  Offers help finding counseling and financial support.

Links to financial and legal resources and government agencies.

Clinical Trials and Insurance Coverage: A Resource Guide
Information on insurance coverage for clinical trials from the National Cancer Institute.

Corporate Angel Network
Help arranging free air transportation for cancer patients traveling to treatment using empty seats on corporate jets.

Bridge of Blessings
Information and application for women with cancer in need of financial assistance.

Family and Medical Leave Act Advisor
Provides information on the Family and Medical Leave Act.  Lists questions to help determine the rights of employees and employers.

Federal Trade Commissioner
Information about a Federal Trade Commissioner brochure issued to advise the terminally ill who are considering selling their life insurance policies in order to pay bills.

Look Good…Feel Better
Help from a free, non-medical, brand-neutral, national public service program supported by corporate donors to offset appearance-related changes from cancer treatment.

Official government information about Medicaid and Medicare.

Official government information for people with Medicare.

Mercy Medical Airlift
Information about this nonprofit organization dedicated to serving people in situations of compelling human need through the provision of charitable air transportation.

Oncolink—An Introduction to Viatical Settlements
Offers information and resources for the seriously ill who are considering selling their life insurance policy to a viatical settlement company.

Patient Advocate Foundation
An active liaison between patient and insurer, employer and/or creditor.  Information about resolving a patient’s insurance, job retention and/or debt crisis matters through case managers, doctors and attorneys.

Rise Above It
Provides grants and scholarships to young adult survivors and care providers who face financial, emotional, and spiritual challenges.

Team Continuum
Assists with basic needs that ease the financial stress patients and their families face by paying bills (electric, phone, water, gas, etc.), rent, tutoring, small toys, transportation and other incidental needs that arise.

The National Collegiate Cancer Foundation
Provides services and support for young adults diagnosed with cancer.  Offers need-based financial support for young adult survivors pursuing higher education.

courtesy: Ovarian Cancer.org

Paraneoplastic thrombocytosis in ovarian cancer. Paraneoplastic thrombocytosis in ovarian cancer. February 18, 2012

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, Uncategorized, uterine cancer, vaginal cancer.
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Paraneoplastic thrombocytosis in ovarian cancer.

Feb 2012

Stone RLNick AMMcNeish IABalkwill FHan HDBottsford-Miller JRupaimoole RArmaiz-Pena GNPecot CV,Coward JDeavers MTVasquez HGUrbauer DLanden CNHu WGershenson HMatsuo KShahzad MMKing ER,Tekedereli IOzpolat BAhn EHBond VKWang RDrew AFGushiken FCollins KDeGeest KLutgendorf SKChiu W,Lopez-Berestein GAfshar-Kharghan VSood AK.


Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1439, USA.



The mechanisms of paraneoplastic thrombocytosis in ovarian cancer and the role that platelets play in abetting cancer growth are unclear.


We analyzed clinical data on 619 patients with epithelial ovarian cancer to test associations between platelet counts and disease outcome. Human samples and mouse models of epithelial ovarian cancer were used to explore the underlying mechanisms of paraneoplastic thrombocytosis. The effects of platelets on tumor growth and angiogenesis were ascertained.


Thrombocytosis was significantly associated with advanced disease and shortened survival. Plasma levels of thrombopoietin and interleukin-6 were significantly elevated in patients who had thrombocytosis as compared with those who did not. In mouse models, increased hepatic thrombopoietin synthesis in response to tumor-derived interleukin-6 was an underlying mechanism of paraneoplastic thrombocytosis. Tumor-derived interleukin-6 and hepatic thrombopoietin were also linked to thrombocytosis in patients. Silencing thrombopoietin and interleukin-6 abrogated thrombocytosis in tumor-bearing mice. Anti-interleukin-6 antibody treatment significantly reduced platelet counts in tumor-bearing mice and in patients with epithelial ovarian cancer. In addition, neutralizing interleukin-6 significantly enhanced the therapeutic efficacy of paclitaxel in mouse models of epithelial ovarian cancer. The use of an antiplatelet antibody to halve platelet counts in tumor-bearing mice significantly reduced tumor growth and angiogenesis.


These findings support the existence of a paracrine circuit wherein increased production of thrombopoietic cytokines in tumor and host tissue leads to paraneoplastic thrombocytosis, which fuels tumor growth. We speculate that countering paraneoplastic thrombocytosis either directly or indirectly by targeting these cytokines may have therapeutic potential. (Funded by the National Cancer Institute and others.).

Treatment of recurrent epithelial ovarian cancer. September 17, 2009

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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.


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

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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

Annette Mattern: What Every Woman Should Know About Ovarian Cancer January 4, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Annette Mattern: What Every Woman Should Know About Ovarian Cancer

“How do I know if I have ovarian cancer?” the question most asked by women about the disease that, for years, was called the silent killer. Ovarian cancer is the fifth leading cause of cancer-related death among U.S. women and yet, most women know very little about it.
What you should know:

1. Every woman is at risk.
2. One is 72 women will develop ovarian cancer; one in 95 women will die from it.
3. Increased risk factors:
• Personal history of breast cancer
• Family history of breast or ovarian cancer.
• BRCA1 or BRCA2 genes, responsible for 5-10% of ovarian cancers. Women of Ashkenazi Jewish descent are at higher risk of carrying these mutations.
4. There is no screening tool, not even the PAP, so it is critical that women recognize the symptoms as early as possible.
• Stage I recurrence rate is only 10%.
• Stage III or IV (about 75% of cases) recur 85-95% of the time. Their 5-year survival rate is only 46%.
5. 95% of women with ovarian cancer experience symptoms, 90% at early stage. Symptoms:
• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full too quickly
• Urinary urgency or frequency

Other symptoms: fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities.

What you should do:

If you exhibit persistent symptoms for more than a few weeks and this is not normal for your body, see a gynecologist. Your exam may include a CA-125 blood test, pelvic exam, and a trans-vaginal ultrasound. The only conclusive way to determine if it is cancer is by performing a biopsy.

Help spread the word.

Most women with ovarian cancer were misdiagnosed for years while their cancer spread. An earlier diagnosis is a woman’s best hope for a good prognosis.

Bio notes:
Annette Mattern is a 21-year survivor of ovarian cancer and recently survived breast cancer. She is the founder and president of the Ovarian Cancer Alliance of Arizona and serves on the board of directors of the Ovarian Cancer National Alliance. Her book on survival, Outside The Lines of Love, Life, and Cancer, is available on http://www.amazon.com.

Links: http://www.ocaz.org

Tragic results of suboptimal gynecologic cancer operations. January 4, 2009

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Tragic results of suboptimal gynecologic cancer operations.

Eur J Gynaecol Oncol. 2008

Kuyumcuoğlu U, Kale A.
Department of Obstetrics and Gynecology, Dicle University School of Medicine Diyarbakir, Turkey.

OBJECTIVE: The goal of this study was to analyze gynecological cancer patients who underwent suboptimal or failed surgeries with unsatisfactory and undesired results.

STUDY DESIGN: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery.

RESULTS: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis, 2 had bladder metastasis); two patients died due to bladder metastasis, one patient died six days after surgery due to a pulmonary embolism in the suboptimal cytoreduction group, and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7%) had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Suboptimal surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis in the optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening in the suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group, and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during followup and we could not reach them using their phone or address information.

CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase “primum non nocere” means and should refer patients to a gynecological oncology center without performing any surgery. Optimal gynecologic surgery can only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists’ surgical experience and expertise in developing and undeveloped countries.

Editor’s Note:

This is critical, especially now that we are seeing such a significant rise in leg swelling (leg lymphedema) amongst gynecologic cancer survivors. One of the earliest documented papers I ran accross was Leg Lymphedema from a Botched Abdominal Surgery – and this was published back in 1963 – Pat O’Connor

PMID: 19115691 [

Prospective study of physical activity and the risk of ovarian cancer. January 4, 2009

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Prospective study of physical activity and the risk of ovarian cancer.

Dec 2008

Leitzmann MF, Koebnick C, Moore SC, Danforth KN, Brinton LA, Hollenbeck AR, Schatzkin A, Lacey JV.
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd, Rockville, MD, 20892, USA, michael.leitzmann@klinik.uni-regensburg.de.


Available studies on physical activity and ovarian cancer have produced inconsistent findings, with some previous studies reporting a positive association between vigorous physical activity and ovarian cancer risk.


We prospectively investigated the relations of self-reported moderate and vigorous physical activity to ovarian cancer in a cohort of 96,216 US women aged 51-72 years at baseline, followed from 1996-1997 to 31 December 2003.


During seven years of follow-up, we documented 309 cases of epithelial ovarian carcinoma. In analyses adjusted for age, the relative risks (RRs) of ovarian cancer for individual and joint combinations of moderate and vigorous physical activity such as entirely inactive, neither moderate nor vigorous physical activity, moderate physical activity only, vigorous physical activity only, and both moderate and vigorous physical activity were 0.88, 1.0 (reference), 0.89, 1.05, and 1.08 (95% confidence interval (CI) = 0.81-1.43, respectively. After multivariate adjustment, the relation was essentially unchanged (RR comparing women with both moderate and vigorous physical activity to those with neither moderate nor vigorous physical activity = 1.10; 95% CI = 0.82-1.48). The null association between physical activity and ovarian cancer persisted in subgroups of women as defined by body mass index, parity, oral contraceptive use, menopausal hormone therapy, family history of ovarian cancer, and other variables (all p values for interaction >0.05).

CONCLUSIONS: Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women..

PMID: 19116765 [PubMed – as supplied by publisher]