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PET
Scans Best at Spotting Vaginal Cancer-(HealthDay News-06/07/2005)
Positron emission tomography (PET) scans detect vaginal cancer more often
than CT scans, says a study by researchers at Washington University School
of Medicine in St. Louis.The study
found that PET picked up twice as many primary tumors and cancerous lymph
nodes in vaginal cancer patients as did CT scans. The findings appear in
the July 1 issue of the International Journal of Radiation Oncology. Vaginal cancer
is relatively rare, making up 3 percent of all gynecological malignancies,
according to the American Cancer Society. Like cervical cancer, it is linked to
infection with the human papillomavirus (HPV) and is highly curable if
detected early, before it has spread.
The St. Louis
team said their study results suggest that the use of PET would allow for
much more accurate diagnosis of vaginal cancer, leading to better
treatment decisions. Currently in the United States, Medicaid, Medicare
and many private health insurers specify CT only for the diagnosis and
monitoring of vaginal cancer. Until the U.S.
Centers for Medicaid and Medicare Services (CMS) reviews and approves the
procedure, vaginal cancer patients will most likely not be evaluated using
PET scans, the study authors said. However, they're hopeful their findings
will help encourage CMS acceptance of PET scans for vaginal cancer
patients. "CT scans are
useful in many cases, but they have a limit to their resolution," study
author Dr. Perry W. Grigsby, a professor of radiation oncology and
radiology, said in a prepared statement. "When you're evaluating lymph
nodes for cancer using CT, the node has to be at least a centimeter for it
to be considered abnormal. But PET scans can detect much smaller nodes
that have cancerous cells."
[Top]
A
cancer warning that should not be ignored-(ET-04/07/2005)
Postmenopausal bleeding could be a sign of endometrial cancer, says
Dr. Judith Reichman, and it should be taken seriously.
Q: I’m 54 and haven’t had
my period for a year and a half, but now it seems to have come back within
the last week. Should I be worried?
A: This could indeed be a
worrisome symptom. If you’re not on hormone replacement therapy and
haven’t bled for a year, doing so puts you in the diagnostic category of postmenopausal bleeding. This could be a warning sign for a type
of uterine cancer called endometrial cancer, which develops in the uterine
lining. It is the most common cancer of our reproductive organs, but,
thankfully, is also the least fatal.
Testing for endometrial cancer. This situation mandates a visit to your gynecologist.
(You can start with your regular healthcare practitioner, but a referral
should be made.) You should then undergo a regular speculum exam to ensure
that the bleeding is not due to a polyp or growth in the cervix. (I assume
you’ve had regular Pap smears and they’re normal.) Your doctor may want to
do an ultrasound to see if the uterine lining appears thickened or uneven,
and she may even consider injecting fluid through a catheter into the
lining during the ultrasound to see if there are polyps or fibroids
projecting inward.
Unless your doctor can reassure you that the
endometrium is thin (like a pencil line), an endometrial sampling should
be performed. Usually, a narrow, hollow tube (canula) is inserted through
the cervix into the endometrial cavity. This tube is attached to a
syringe-like device used to suction out cells from the lining. Or,
alternatively, a small amount of fluid can be inserted and withdrawn to
obtain the cells. Many doctors will use a local anesthetic to make this
more comfortable, though the procedure usually causes little more than
short-term cramping. The minute amount of tissue obtained during the
sampling is then sent to a pathologist and checked for abnormal buildup of
glands (hyperplasia), with or without cell abnormality (atypia).
Abnormality could mean cancer. If there is no sign of atypia, the bleeding you’re
experiencing may have been caused by over-stimulation of these glands from
your body’s production of estrogen. The latter does not stop simply
because you are menopausal. Hormones produced by the adrenal glands can be
converted to estrogen compounds by fat cells. The more fat cells you have,
(in other words, if you are overweight or obese) the more hormones undergo
estrogen conversion. If the stimulation is overly aggressive, the glands
eventually become “confused” and atypia occurs.
Atypia can be a precursor to actual cancer and
should probably be further investigated through a procedure in which a
small instrument is inserted into the endometrium in order to see its
entire surface, and further biopsies are taken. Or your doctor may feel a
hysterectomy is the next best course of action. There is no question that
if cancer is found, you should undergo a hysterectomy, at which time the
ovaries and some lymph nodes should also be removed to see if the cancer
has spread. This can be done using a laparoscope if the cancer is
diagnosed at an early stage.
Going from out-of-the-blue bleeding to worst case
scenario: if cancer has invaded a major portion of the uterine muscle or
spread to other organs, then radiation, chemotherapy and/or high doses of
progestin may be necessary.
The
chances are, your bleeding is not cancer and may indeed be due either to
“old” follicles in an ovary waking up and producing estrogen, or to
atrophy (thinning) of the uterine lining or vagina, causing the erosion of
a small blood vessel. If, however, the diagnosis of endometrial cancer
is made, take comfort in the fact that 96 percent of women who undergo
appropriate therapy will be alive and without recurrence five years later.
[Top]
Doctors
hail ovarian cancer test-(Yahoo News-03/07/2005)
UK doctors say they have found an easier way to
diagnose ovarian cancer. By passing a needle up through the vagina, the Manchester University
researchers were able to take a sample of ovarian tissue for testing. They said it is better than passing a needle through the abdomen, and
less invasive than cutting a woman open to find the tumour. The method was well tolerated by the 14 women in the British Journal of
Obstetrics and Gynaecology study.
Ovarian cancer is often diagnosed late because the symptoms can be
vague and go unnoticed. It may not be until the tumour has reached a relatively large size that
the woman will spot that there is something wrong. However, before chemotherapy can be started, it is necessary to make
sure that the diagnosis is correct. Conventionally, this has involved cutting open the abdomen or passing a
needle through the abdomen, guided by ultrasound or computer tomography
(CT) scanning, to get to the ovary.
Both methods have disadvantages
- surgery is invasive and there is a risk that other organs will be punctured
if a needle is passed through the abdomen. Both require anaesthesia. Dr
Rebecca Faulkner and colleagues believe a better way is to pass a needle
through the vagina. They tested the method in 14 women and achieved a
successful biopsy in 12 of them. None of the women had any bleeding complications
or other serious side effects. Some experienced slight discomfort, but
this settled as soon as the procedure was completed. Four required mild
pain relief. Dr Faulkner said: "In many cases of ovarian cancer,
chemotherapy is now being given prior to surgery. This technique offers
a convenient means of confirming the diagnosis without requiring full
surgery, though patients for this procedure need to be carefully selected."
She said it was best used when the tumour was relatively large and could
be felt through the vaginal walls on examination. It would not be suitable,
however, for very early cancers because there is a risk that the cancer
can be spread locally as the needle is withdrawn from the tumour.
Mr Peter Bowen-Simpkins
from the Royal College of Obstetricians and Gynaecologists said: "This
is a major step forward in the treatment of a common gynaecological cancer,
avoiding the need for major diagnostic surgery at a most distressing time.
This applies to women with more advanced disease, which account for about
70-80% of cases. We can avoid a really big operation and get on with treatment."
Dr Elaine Vickers of
Cancer Research UK said: "We welcome the results of this small study.
Anything that could improve the diagnosis or treatment of ovarian cancer
is a step forward.
[Top]
Test
to spot early ovarian cancer-(Yahoo News-25/06/2005)
A new blood test may
save lives by detecting ovarian cancer at an early stage when treatment
is most likely to be successful. The test, developed by Yale School of
Medicine, can pick up the disease before symptoms develop. Ovarian cancer
has been called the "silent killer" because by the time symptoms
become apparent it is often difficult to treat. Details are published
in Proceedings of the National Academy of Sciences. However, the test
will require refinement before it is widely used, as, at this stage, it
is only 95% accurate.
Just under 7,000 women
are diagnosed with ovarian cancer each year in the UK. A large proportion
- almost 4,700 - will die of the disease.
The new test relies on
detecting four key proteins - leptin, prolactin, osteopontin, and insulin-like
growth factor II - associated with the disease. Looking for raised levels
of these proteins led to ovarian cancer being identified with 95% accuracy
in a test group of more than 200 women. Each of the proteins had previously
been suggested as a possible cancer biomarker. But
the Yale researchers found that looking for each protein in isolation
could not be relied upon to detect cancer. Lead
researcher Dr Gil Mor said the new test had the potential to be of great
use. He said: "Early diagnosis can help prolong or save lives, but
clinicians currently have no sensitive screening method because the disease
shows few symptoms."
However, the researchers
accept their test needs further work, as even a 5% failure rate could
potentially lead to large numbers of women being misdiagnosed. Dr James
Mackay, a consultant clinical genetic oncologist with Cancer Research
UK, said: "This is an interesting research finding. The next stage
in investigating this would be to use these markers in a prospective study
either of high-risk women or a randomised study of women at normal risk."
[Top]
Tracking
ovarian cancer using a blood test to measure the disease's progress-(Yahoo
News 07/12/2004)
Ovarian cancer
can be hard to track because it spreads more diffusely through the body than
other types of cancers that often grow as solid tumors. The standard method
for tracking ovarian cancer and measuring how well the cancer is responding
to treatment has been to use CT scans, ultrasounds, or other imaging
techniques. However, a new report from researchers in Denmark suggests that,
at least in later-stage ovarian cancer, a blood test may be more a more
accurate measure of whether the cancer is growing or shrinking.
What the researchers wanted to know: Do
imaging techniques or blood tests better measure the progress of late-stage
ovarian cancer?
What they did: Women with ovarian cancer who
were registered in the Copenhagen Database for Ovarian Carcinoma were
included in the study if they had later-stage ovarian cancer, were tested
with both imaging and blood screening, and had been treated at least twice
with specific, commonly used chemotherapy drugs. Sixty-eight patients in the
registry fulfilled the inclusion criteria. The scientists analyzed the
results of imaging scans and blood tests done on each woman after her second
round of chemotherapy. Specifically, they looked at a blood test that
measures the levels of a substance called cancer antigen 125 (CA-125); 90
percent of women with ovarian cancer have high levels of this antigen. The
researchers followed women who had both of these tests for several years to
see which better predicted their chance of survival.
What they found: Using the CA-125 blood test
to measure the response of the cancer to therapy was a better way to predict
how long the women would survive than the imaging scans. When women who had
been through several rounds of chemotherapy had both of these tests done, a
blood test showing decreased levels of CA-125 better predicted whether the
women would live longer than imaging scans showing a decrease in tumor size.
What it means to you: This study argues for
the use of blood tests instead of imaging scans, which are what an
international panel of cancer experts recommends. Both can be good tools,
but the blood test is much cheaper and less time consuming. However, levels
of CA-125 can be elevated for other reasons than ovarian cancer, for example
pregnancy, so it is more often used in postmenopausal women and as a marker
for treatment rather than as a diagnostic tool. Also, some women with
ovarian cancer don't have elevated levels of CA-125.
Caveats: These women were all treated with a
specific chemotherapy regimen, paclitaxel and platinum compound in the first
round and topotecan and paclitaxel in the second round. Because the therapy
used can skew the blood test results, this study may not apply to women
treated with a different regimen. In addition, a reduction in CA-125 levels
does not always mean that tumors have shrunk and thus may not be a reliable
predictor of the cancer's remission all the time.
[Top]
Ovarian
Cancer Does Have Early Warning Signs, Mayo Clinic And Olmsted Medical Center
Find-(Yahoo News-19/11/2004)
Results from an Olmsted Medical Center and
Mayo Clinic study analyzing symptoms recorded in the medical records of
ovarian cancer patients suggest ovarian cancer, long considered
asymptomatic until late-stage cancer develops, does in fact have early
symptoms, including urinary incontinence and abdominal pain. "Ovarian
cancer is called 'the silent killer,'" says Barbara Yawn, M.D.,
director of research at Olmsted Medical Center and the study's lead
investigator. "We know now that there are symptoms, yet it appears
that women ignore them and physicians don't recognize the potential
urgency of evaluating the symptoms."
The most common symptom found in the
records of the 107 ovarian cancer patients studied was crampy abdominal
pain. Abdominal pain and urinary urgency, frequency or incontinence were
the most commonly documented symptoms in women who had Stage I and II, the
early stages, of ovarian cancer. In patients with Stages III and IV
cancer, the later stages, abdominal pain and increased abdominal girth
were the most commonly documented symptoms. Fewer than 25 percent of the
symptoms would be considered unique to ovarian cancer or related directly
to the reproductive pelvic organs: the uterus, fallopian tubes, cervix and
ovaries. The study found the following factors associated with a longer
time to diagnosis of patients' ovarian cancer: delays in women seeking
medical care, health care system issues, competing medical conditions,
physicians' failure to follow up, and women not returning for follow-up.
Brigitte Barrette, M.D., a Mayo Clinic
gynecologist and study investigator, found the commonality of urinary
leakage symptoms among the ovarian cancer patients particularly
interesting. "My surprise with our findings was at the urinary
incontinence, because it's not something that has been reported
often," she says. "Sudden or marked change in urinary leakage
was a symptom. So, incontinence problems that develop over a period of
just a few weeks are something to pay attention to."
The difficulty in differentiating symptoms
of abdominal pain and urinary incontinence as ovarian cancer predictors
lies in the many different diseases or conditions to which these symptoms
may point. "Many of the symptoms are more common in other conditions,
such as irritable bowel syndrome or colon cancer," says Dr. Yawn.
Looking for ovarian cancer is a bit like looking for a zebra in a field of
horses. "Someone can go to the doctor with bloating, and usually the
physician will investigate for the common things," says Dr. Barrette.
"It's like when someone goes to the emergency room with a headache.
Most of the time, it's not a stroke. But, that should be considered."
Due to the fact that the symptoms
identified in this study can be indicative of many conditions, Drs. Yawn
and Barrette suggest that women and their doctors be particularly alert to
incontinence and abdominal pain that do not improve with treatment.
"When a woman goes in to see her doctor with these abdominal, urinary
or pelvic symptoms and the tests for the most common causes are negative,
the workup needs to continue," says Dr. Yawn. "Ovarian cancer
must be considered. If the symptoms persist and there is not a clear
reason, you need to look further." At a minimum, the symptoms require
a pelvic examination with an ultrasound and a blood test for ovarian
cancer if they do not resolve or do not have another very clear diagnosis
within weeks -- not months, agree Drs. Yawn and Barrette.
Another barrier to catching ovarian cancer
early is that the cancer's progression is almost entirely in the body's
interior. "The diagnosis is so tricky because there is room in the
abdomen, and an ovary can grow, form a big mass and progress without the
patient even noticing," says Dr. Barrette. "You can't feel it
from the outside -- it's inside, and we in the medical community don't
have any screening test specifically for ovarian cancer." Drs. Yawn
and Barrette indicate that the symptom of abdominal pain most likely
originates from pressure from the tumor or from fluid in the abdomen
prompted by the tumor's presence. Urinary incontinence is most likely due
to the tumor's pressing on the bladder and causing increased pressure
within the abdomen, prompting urine loss. Dr. Yawn explains that from the
data collected in this study, the investigators are unable to draw
conclusions about whether catching a patient's symptoms early in the
progression of ovarian cancer will make a difference in the treatability
of her cancer. Prior studies addressed that issue.
"We know if ovarian cancer is detected
at an earlier stage, the survival is about 90 percent; we know that an
early stage can make a difference," says Dr. Yawn. Dr. Barrette points
out, however, that ovarian cancer can progress from stage to stage in
a matter of months, making it far more aggressive than malignancies such
as breast cancer. Ovarian cancer occurs in 1 out of 70 women.
[Top]
New
Protein May Be Biomarker for Ovarian Cancer- (Medinews-17/08/2004)
A recent study has found
significantly higher levels of a protein called EphA2 in ovarian cancer
cell lines and malignant tumors than in
noncancerous cell lines and benign ovarian masses. The results were
reported in the August 1, 2004, issue of Clinical Cancer Research. Data
from the study showed that laboratory models and clinical specimens of
ovarian cancer had high levels of AphA2. At least 76% of the invasive
ovarian tumor samples in the study overexpressed EphA2, with the highest
levels consistently found on the most aggressive cancers. Also, high
levels of EphA2 were shown to contribute to cancer progression and may
predict poorer patient outcome and survival.
EphA2 is also overexpressed by
other types of human cancers, including melanoma, breast, and prostate
cancer. The fact that the highest levels have been found on the most
aggressive cancer cells is consistent with evidence linking EphA2 to
clinical features of metastasis. Researchers have found that EphA2
functions differently on malignant cells than it does on normal cells.
These differences may lead to the selective targeting of cancer cells
while minimizing toxicity in normal cells. The study was conducted by
scientists at the M.D. Anderson Cancer Center at the University of Texas
(Houston, USA). The identification of a biomarker that could predict
disease progression is promising to those of us fighting this disease in
the clinic as well as the lab, said lead author Anil K. Sood, M.D.,
associate professor, gynecologic oncology at M.D. Anderson. We now have a
rationale for developing a strategy to target this protein, EphA2, to
increase patient survival.
Researchers at MedImmune
(Gaithersburg, MD, USA) have built a body of scientific evidence
demonstrating the role of EphA2 as well as the potential for EphA2
antibodies and vaccines to specifically treat or prevent certain cancers.
They believe the development of products targeting EphA2 might result in
better outcomes for ovarian cancer patients. In light of data linking high
levels of EphA2 with poor survival, this [study] emphasizes the potential
opportunity that targeted intervention could provide in the battle against
the most deadly forms of this disease, noted Peter Kiener, D.Phil., vice
president, research, MedImmune.
[Top]
Diesel
fumes linked to ovarian cancer-(Medical News Today-16/08/2004)
A new study has linked exhaust
fumes from diesel-powered vehicles to an increased risk of ovarian cancer.
Research published in the International
Journal of Cancer assessed the risk of leukemia and cancers of the
esophagus, ovary, testes, kidney, and bladder associated with engine
exhaust. There was an increased risk ratio (RR) for ovarian cancer with
increasing cumulative exposure (CE) to diesel exhaust.
[Top]
Hopkins
scientists use blood proteins to detect ovarian cancer-(Yahoo News-16/08/2004)
Johns Hopkins Kimmel Cancer
Center researchers have designed a blood test to detect ovarian cancer
using three proteins found in common in the blood of women with the
disease. Their preliminary studies with the new test suggest a molecular
signature exclusive to this deadly cancer, known for its ability to remain
undetected and spread quickly. The Hopkins test, described in the August
15 issue of Cancer Research, identifies the proteins as a truncated form
of transthyretin, a fragment of ITIH4 and apolipoprotein A1, teased out
with a rigorous evaluation of protein patterns present in blood samples
from ovarian cancer patients at several U.S. and international hospitals.
Other research groups are evaluating ovarian cancer blood tests that use
protein profiles consisting of tens of thousands of unidentified
molecules.
"By identifying a select
group of biomarkers specific to ovarian cancer, we not only know the
proteins we are dealing with, but we can trace them back to alterations in
the genetic code of ovarian cancer cells," says Daniel W. Chan,
Ph.D., professor and director of the Biomarker Discovery Center at Johns
Hopkins. "We are focusing on the markers for which we have good
biological reasoning behind their selection, and hope to expand the panel
of markers to catch as many variations in ovarian cancer proteins as
possible."
This research was funded by the
National Cancer Institute and Ciphergen Biosystems, which has licensed the
test. Chan and his co-workers emphasize that the test will not be
commercially available for screening the population at large until
completion of further validation studies in larger groups of patients. And
even then, Chan notes, it is never going to be possible for a blood test
to correctly diagnose 100 percent of cancerous tumors 100 percent of the
time. "The goal is to come as close as possible to that by using this
test in combination with other available diagnostic tools." They
believe, however, that with some refinements it may already have use for
helping determine whether a pelvic mass is ovarian cancer.
In a systematic search to find
the most promising blood proteins for their test, the Hopkins scientists
conducted a multicenter study and screened a total of 195 blood samples
from two groups of ovarian cancer patients, healthy people, and patients
with benign ovarian tumors. A sophisticated bioinformatics program was
used to select proteins present at unusually high or low levels in ovarian
cancer samples as compared with normal or benign. Samples in the two
groups were analyzed separately to account for differences in patient
populations and sample collection techniques. Then, researchers compared
protein profile results in these two groups and ultimately narrowed the
search for potential marker candidates to the three proteins, one of which
(ITIH4) is commonly found at high levels in ovarian cancer and the other
two at lower levels.
"Typically, only half of
early-stage ovarian cancer patients have high blood levels of a standard
marker called CA125," says Zhen Zhang, Ph.D., associate professor of
pathology at Johns Hopkins. "But combining CA125 with our new markers
may improve early detection capabilities."
The new proteins were screened
against a separate collection of blood samples from patients with normal
and cancerous tissues. Of 23 patients with early-stage ovarian cancer, the
three protein markers plus CA125 correctly identified cancer 74 percent of
the time (17 of 23) as compared to 65 percent (15 of 23) with CA125 alone.
Although the sample size was too small for this difference to be
statistically significant, the scientists conducted further studies
lowering the cutoff value for CA125 to below current standards. The new
test plus CA125 as well as CA125 alone detected 83 percent (19 of 23) of
the cancers. In addition, the new test plus CA125 correctly identified
healthy samples 94 percent of the time (59 of 63) as compared to 52
percent (33 of 63) for CA125 alone.
To verify that the candidate
markers were specific to ovarian cancer, the scientists also compared
results of the protein profiles with a separate group of blood samples
from 142 Johns Hopkins ovarian, breast, colon, prostate cancer patients
and healthy people. Protein markers from Hopkins' ovarian cancer samples
matched those from the other two groups of blood samples. Breast, colon
and prostate cancer samples exhibited levels of the three proteins closer
to those of normal patients, indicating that the markers are exclusive to
ovarian cancer. The scientists will conduct further studies to map all
three proteins to the genetic pathways linked to ovarian cancer
development and combine the blood test with radiologic tools such as
ultrasound. They also will search for more proteins to add to the current
panel of markers.
[Top]
Ovarian
cancer sheds tumor suppression with loss of estrogen receptor- (Medical
News Today-16/08/2004)
An important receptor for
estrogen in ovarian cells has been shown to suppress tumor growth,
according to a new study published in the August 15 issue of the journal
Cancer Research. When ovarian tumors develop, however, the number of these
receptors--known as estrogen receptor beta (ER beta)--diminishes,
encouraging these tumors to advance toward malignancy and metastasis. This
disappearing act may help explain why ovarian cancers are often typically
resistant to anti-estrogen drugs including Tamoxifen.
"Ovarian cancer is
remarkably lacking in response to antiestrogens such as Tamoxifen,"
Gwendal Lazennec, Ph.D., research group leader in molecular and cellular
endocrinology of cancers at Inserm U540, Montpellier, France. "We
hypothesized that this may be due to the selective decrease that we
observed in the expression of message for ER beta in tumors from ovarian
cancer patients."
Tumors from 58 ovarian cancer
patients contained less messenger RNA for the ER beta than found in
ovarian samples from healthy patients, said Lazennec, whose team included
scientists from France and Italy. To understand how the loss of ER beta
affected the ovarian cells during cancer progression, the gene for ER beta
was replaced in ovarian cancer cell lines that no longer expressed the
estrogen-triggered nuclear receptor. The ER beta reintroduced into the
cancer cell lines did not share the classic functions attributed to
estrogen receptors, including induction of progesterone receptor
expression and fibuline-1C, and it's ability to decrease the expression of
the cyclin D1 gene was completely opposite of it's counterpart, ER beta.
Furthermore, the restored ER beta induced apoptosis, or cell death, in the
ovarian cancer cells.
"ER beta appears to have
important regulatory functions in the control of the proliferation and
motility of ovarian cancer," Lazennec said. "With the loss of ER
beta in ovarian cells, ovarian cancers shed the restrictive properties of
this steroid receptor in the regulation of cell growth, death and
motility. The loss of ER beta expression appears to be an important event
leading to the development of ovarian cancer."
[Top]
Animal
research suggests that stress may increase risk of uterine cancer-(Yahoo
News-09/07/2004)
Research in monkeys
suggests the possibility that stress may increase risk for the most common
type of uterine cancer, according to a report from Wake Forest University
Baptist Medical Center. The study results also suggest that two drinks
a day won't increase breast or endometrial cancer risk for postmenopausal
women who don't take estrogen. The results are reported in the current
issue of Menopause, the journal of the North American Menopause Society.
"The results from this study tell us that we need to look much more closely
at the effects of stress and socioeconomic status on risk for endometrial
and breast cancer in women," says Carol Shively, Ph.D., professor of comparative
medicine at Wake Forest Baptist. "The outcome of this study is a precautionary
tale," said Kathleen Grant, Ph.D., (co-author), in an editorial about
the research. "Social stress, perhaps caused by increases in social isolation
and hostile social experiences, or lack of control over social interactions,
may place postmenopausal women at risk for breast and endometrial cancer."
Shively and colleagues
studied the effects of stress and moderate alcohol consumption on breast
and endometrial tissue, which is the lining of the uterus. They evaluated
type and quantity of cells, density of tissue, number of dividing cells,
and number of progesterone and estrogen receptors. Levels of sex steroids,
such as estrogen, and adrenal steroids, such as cortisol, were also measured.
All of these may be markers for cancer risk. For the study, postmenopausal
female monkeys were placed in groups so they would naturally establish
a social hierarchy from dominant to subordinate. Previous research has
shown that subordinate monkeys have increased heart rates, more of the
stress hormone cortisol and more cardiovascular disease. The current study
showed that compared to dominant monkeys, the socially stressed subordinate
monkeys were at increased risk for endometrial cancer, which affects 1
percent to 2 percent of women and is most common in older women. "We know
that lower social status is stressful for both humans and monkeys," said
Shively. "This study shows that in monkeys, social stress was associated
with cellular changes that may increase endometrial cancer risk."
The subordinate monkeys
also had changes in their breast tissue, but these were not as significant
as the uterine changes. "There may be an effect, but it's not as strong
as in the uterus," said Shively. The researchers also looked at the effects
of moderate alcohol consumption on risk for breast and endometrial cancer.
In humans, several large studies have found that alcohol consumption,
even in moderate doses, appears to increase the risk of breast cancer.
However, the studies relied on women's self-reports of how much they drank.
Research shows that most people don't accurately report their alcohol
consumption. The monkey study was designed to directly compare postmenopausal
monkeys who drank a moderate and controlled amount of alcohol with those
who didn't drink alcohol. Half of the monkeys were trained to voluntarily
consume two drinks of alcohol every weekday for 26 months. There was no
difference in the cancer markers between the two groups.
"The research suggests
that moderate alcohol consumption in postmenopausal women not taking hormone
therapy may not be harmful to health," said Shively. She pointed out that
the results might not apply to women who undergo hormone therapy, or to
premenopausal women. Researchers believe that alcohol may increase estrogen
levels in women whose bodies still produce estrogen. Increased levels
of estrogen are associated with higher risk of breast cancer. Shively
also noted that researchers don't know how alcohol consumption affects
other types of postmenopausal therapies, such as raloxifene, tamoxifen
or soy.
[Top]
Doctors
don't agree on diagnosis of uterine cancer-(cancerfacts.com-02/06/2004)
To a woman whose
doctor suspects uterine cancer, it may seem that a biopsy should provide
a definitive answer as to whether it is cancer. A new study, however,
shows that pathologists who evaluate the biopsies disagree 60 percent
of the time regarding a uterine cancer diagnosis. The study conducted
by a consortium of research institutions, called the Gynecologic Oncology
Group, and headed by Dr. Cornelia Trimble of Johns Hopkins Kimmel Cancer
Center, will be presented at the 40th annual American Society of Clinical
Oncology. The researchers are expected to call for new standards for collecting
and classifying biopsies to improve the accuracy of diagnoses. "This study
brought into sharp focus the fact that it is very difficult to make an
accurate diagnosis from uterine biopsies," Trimble said in a prepared
statement. "Yet, women receiving a diagnosis of atypical endometrial hyperplasia
(suspicious masses) face complete removal of their wombs through hysterectomy.
So, we suggest these patients get a second opinion from a pathologist
who specializes in gynecology."
Cancer of the uterus
is the most common cancer affecting the female reproductive tract in the
United States. It is diagnosed from biopsied uterine or endometrial cells
that indicate the presence of cancer or precancerous lesions called atypical
endometrial hyperplasia (AEH). Trimble and colleagues in the national
cooperative GOG set out to get a baseline estimate of the percentage of
actual cancers found in hysterectomy samples of women diagnosed with AEH
biopsies. The baseline, reported to be anywhere from 17 to 52 percent,
would provide information needed to design studies to find non-surgical
treatments for AEH that preserve fertility in young patients or eliminate
the need for surgery in women with diabetes, hypertension or other complicating
disorders. But, after reviewing biopsies from 289 patients classified
as AEH, they were surprised to find a high degree of disagreement with
the initial diagnosis of most of the biopsies. In their review, the GOG
investigators downgraded the biopsy diagnoses to "less than AEH," which
falls into a range of benign disorders, in 25.6 percent of cases. They
upgraded the AEH diagnosis to cancer in 29.1 percent cases, and were unable
to agree on a diagnosis in 5.5 percent of the biopsies. The investigators
agreed with the diagnosis of AEH in only 39.8 percent of cases. The overall
baseline estimate of women who also had cancer present in their corresponding
hysterectomy specimen was 42 percent. Underscoring the level of disagreement
and difficulty in making an accurate diagnosis, even with the GOG review,
was the fact that cancer was found in corresponding hysterectomy specimens
of 14 of 74 downgraded AEH biopsies, 45 of 115 AEH-diagnosed biopsies,
54 of 84 AEH specimens upgraded to cancer, and in 10 of 16 cases where
there was no agreement.
Although guidelines
for distinguishing benign endometrial biopsies from AEH and cancer have
been accepted by the World Health Organization and Society of Gynecologic
Pathologists, Trimble and her colleagues noted that the classification
system has not undergone the same rigorous evaluation as other lesions,
such as cervical cancer. Trimble and the GOG investigators are developing
more precise classification guidelines. "We will be looking at these data
more closely to determine why there was such disagreement in the diagnosis
and find a better system for classifying and grading these biopsies, including
using improvements in molecular markers to help identify better ways to
diagnose uterine cancer," says Trimble.
[Top]
Hope
for Women who lose fertility due to cancer therapy-(Times of India-10/03/2004)
Surgeons reported
cautious progress from efforts to help women who suffer the heartache
of losing their fertility after undergoing cancer treatment. Hundreds
of thousands of women each year go through early menopause after radiotherapy
or chemotherapy that attacks cancer cells but can also destroy ovarian
tissue. Most often there is no time for patients to undergo ovarian stimulation
to recover eggs that can then be frozen, in the hope of carrying out in
vitro fertilization (IVF) after the treatment has been carried out. Some
have their ovaries removed and frozen in the hope that, some day, the
organs may be successfully transplanted, a goal that has so far neen bafflingly
elusive. Reporting in The Lancet, a team of doctors in America say they
have implanted stored ovarian tissue into the abdomen of a 36-year-old
woman; and coaxed it into providing eggs, one of which later developed
into an embryo through IVF. The embryo was transplanted into the woman's
uterus but the pregnancy did not succeed. The patient had an ovary frozen
just before she went in for therapy for breast cancer at the age of 30.
Six years later, the ovary was thawed out and 15 pieces transplanted beneath
the skin in her lower abdomen and she was given hormone stimulants. The
tissue had about 11,000 follicles-the microscopic buds that can become
eggs-that would normally supply a year's fertility. After three months,
the tissue began to function and over the following eight months, the
doctors recovered at least 20 eggs.
[Top]
Late
childbirth cuts cancer risk-(Yahoo News-15/07/2004)
Women who give birth
in their late 30s have a lower risk of developing ovarian cancer, research
suggests. University of Southern California scientists found women who
gave birth after the age of 35 had a 58% lower risk than those who never
had a child. Women who had children earlier in life also had a lower risk
- but the effect was less pronounced. Giving birth before 25 cut the risk
by 16%. The research is published in the journal Fertility and Sterility.
It also found that women who gave birth before the age of 30 had a 45%
lower risk. And women who had four or more children had a 64% lower risk
than women who had never given birth.
The researchers interviewed
477 ovarian cancer patients and 660 healthy women. Researcher Dr Malcolm
Pike said previous research has also shown that having children late in
life also protects against cancer of the endometrium - the lining of the
uterus. He believes that a surge in the hormone progesterone may help
protect against both types of cancer. In addition, the birthing process
probably clears the uterus of aging cells that are more likely to become
cancerous, he said.
Dr Pike said that
if the exact mechanism could be pinned down, it could help scientists
develop ways to prevent ovarian cancer. Dr Robert Schenken, president-elect
of the American Society for Reproductive Medicine, which publishes the
journal, agreed. He said: "The next challenge is to map out the mechanism
of the last birth's effect on the ovaries. "It would be a major advance
in cancer prevention if, as the authors suggest, these findings lead to
the development of a chemoprevention approach for women at high risk for
ovarian cancer."
Dr Emma Knight, of
Cancer Research UK, told BBC News Online previous research had also suggested
that having children may protect women against ovarian cancer. However,
she said: "This information needs to be viewed in a wider context as we
know that delaying the birth of a first child increases the risk of breast
cancer. "Moreover, all these risks are relatively small and women should
not be overly concerned about them. "It will be interesting to investigate
the mechanisms behind these observations, with the hope that they will
lead to new ways of preventing, diagnosing and treating cancer in the
future." Nearly 7,000 women in the UK are diagnosed with ovarian cancer
every year. The lack of obvious symptoms means that many cases are diagnosed
at a late stage and only around a third of women survive for five years
or more after diagnosis.
[Top]
Moffitt's
Rebecca Sutphen, M.D., Authors Biomarker Study, Potential Breakthrough
in Screening for Ovarian Cancer-(Yahoo News-01/07/2004)
A study of hundreds
of women from four hospitals showing that lysophospholipids are present
in high levels in women with ovarian cancer but low in healthy women -
a major finding - could lead to a simple blood test for ovarian cancer.
This is a welcome development because lack of an effective screening test
for ovarian cancer creates high mortality rates. "This finding could be
incredibly important in our fight against ovarian cancer," says Rebecca
Sutphen, M.D., of H. Lee Moffitt Cancer Center || Research Institute,
principal author of the three-year study funded by the American Cancer
Society whose results are published in the July 7 issue of Cancer Epidemiology,
Biomarkers & Prevention. "Two thirds of the patients are diagnosed when
the cancer is already advanced - Stage 3 or 4. At that point, the cure
rate is only in the range of 25 percent. The problem has always been that
we have no early detection strategy," she explains. "Almost all healthy
women have low levels" of lysophospholipids while the vast majority of
ovarian cancer patients "have high levels of these substances."
The lysophospholipids
were first identified as a potential biomarker by Yan Xu of the Cleveland
Clinic, also an author of the current study titled "Lysophospholipids
Are Potential Biomarkers of Ovarian Cancer." According to Sutphen, the
Moffitt collaboration, which included the University of South Florida
Health Sciences Center, is the first study to confirm Xu's hunch. The
results were possible because collection and transport of blood samples
(in contrast to earlier studies) employed exacting standards for delivery
and processing prior to liquid chromatography/mass spectroscopy assay.
In 93 percent of the cases, the blood test was an accurate predictor of
whether the woman had ovarian cancer. Less than four percent of the 117
women studied could be characterized as "false positives." But before
the blood test is used as a mass screening tool, researchers should "find
a combination of markers to get the accuracy rate up to 100 percent,"
Sutphen says.
[Top]
Marshall
Edwards, Inc., Names Second Study Site in Multi-National Ovarian Cancer
Trial of Investigational Anti-Cancer Drug Phenoxodiol-(PRNewswire-14/06/2004)
The Royal Women's
Hospital in Melbourne, Australia, today became the second site to enroll
cancer patients in a study of the ability of phenoxodiol, to restore the
sensitivity of ovarian cancer cells to the standard chemotherapies, paclitaxel
and cisplatin. The trial is also being conducted at Yale-New Haven Hospital,
Connecticut. Researchers are evaluating phenoxodiol for its ability to
enhance the anti-cancer effect of standard chemotherapies, as well as
restore sensitivity in cancers that have become refractory to standard
chemotherapies. In the laboratory, phenoxodiol has been found to boost
dramatically the ability of low doses of chemotherapy to treat ovarian
cancer.
This trial follows
a successful Phase I/II study conducted at Yale-New Haven Hospital that
looked at phenoxodiol as a monotherapy in late-stage ovarian cancer patients.
Researchers from Yale reported at the American Association of Cancer Research
conference in April 2004, that subsequent to that trial, four of five
patients classified as being refractory to paclitaxel showed a substantial
response as determined by Rustin criteria on re-challenge with paclitaxel
following a course of phenoxodiol therapy. Patients in this study will
have late-stage ovarian cancer that has become refractory to the standard
first-line chemotherapies -- paclitaxel and cisplatin. A refractory cancer
is one that continues to grow despite chemotherapy.
Women on the trial
will be randomized to one of three treatment arms -- (1) paclitaxel only,
(2) paclitaxel plus phenoxodiol, and (3) cisplatin plus phenoxodiol. The
paclitaxel-only treatment arm has been included to confirm the refractory
status of the cancers, which is a requirement for regulatory approval
of drug registration. Women in the paclitaxel-only arm will be offered
phenoxodiol plus paclitaxel combination treatment once their refractory
status is confirmed. The development of chemo-resistance in cancers has
been associated with the over-production within cancer cells of the anti-apoptotic
protein, XIAP(2). Phenoxodiol has been found in the laboratory to restore
chemo- sensitivity by removal of XIAP, an effect that is restricted to
cancer cells.
Michael Quinn, M.D.,
who is leading the study at the Royal Women's Hospital, said, "This is
an opportunity that we hope will provide a benefit for women who have
become unresponsive to chemotherapy. Currently we can offer nothing in
the way of therapy for these patients, but the promising clinical response
that the Yale University Medical School doctors obtained with phenoxodiol
in refractory patients gives us cause to hope that that will change."
Phenoxodiol is an investigational drug and, as such, is not marketed in
the United States.
[Top]
Study
Finds Early Symptoms Of Ovarian Cancer-(ET--08/06/2004)
New research demonstrates
ovarian cancer shows itself through what are often obvious and recurring
symptoms, yet, many women don't recognize them. This is a frustrating
disease for physicians and a scary disease for women because when it is
detected, often it is already in its advanced stages. The research shows
the signs are there, and they could help save lives if they are noticed
earlier. Those with a true cancer usually had symptoms that occurred every
day, which is unusual with benign diseases. Women with ovarian cancer
were significantly more likely to have pelvic pain, abdominal pain, difficulty
eating, increased abdominal size, and urinary urgency or the feeling to
go compared to women without cancer. The combination of bloating, increased
abdominal size and urinary tract symptoms was seen in 43 percent of cases.
The research, published
in the latest Journal of the American Medical Association, shows two-thirds
of women with ovarian cancer have symptoms that recur. While many of these
symptoms are seen in numerous conditions, it's the number experienced
and the frequency of them that raises a red flag. "If you take a history
immediately after the diagnosis of ovarian cancer and you ask patients
did you have these symptoms and you ask them well for how long, it's usually
between three and six months, not more than six months," said Dr. Carmel
Cohen, of Mount Sinai School of Medicine.
The study is important
because there are still no adequate screening tests to detect ovarian
cancer. "The pelvic examination is the first screening test, but it is,
in fact, not very precise in terms of detecting early ovarian cancer,"
Cohen said. "When I finally did get the news I was totally shocked because
I had stage three ovarian cancer," Robin Zarel said. Zarel knew she was
at risk for ovarian cancer because of her history of breast cancer a 1½
years earlier. Despite the fact all the tests had come back negative she
was concerned. "I had a lot of frequent urination, I had very minor bloating,
which I mentioned to a doctor and but it was so slight he really didn't
think anything of it," Zarel said. But if a woman looks for the signs
of the disease there is the promise of earlier diagnosis and better chances
at long-term survival. "You need to kind of pay attention to your body,
to any changes in your body," Zarel said.
[Top]
Blood
Test Could Improve Ovarian Cancer Survival-(Reuters-17/05/2004)
A simple blood test
may help to improve survival rates for ovarian cancer by revealing which
patients are likely to develop a resistance to chemotherapy drugs. Professor
Robert Brown, of Glasgow University in Scotland, told a cancer conference
that he and his colleagues found that the body can switch off genes that
enable chemotherapy to kill cancer cells if the tumor reappears after
initial treatment. The blood test would enable doctors to identify patients
who are likely to respond to additional treatment following a recurrence,
or those who could benefit from soon-to-be tested drugs that are designed
to turn the genetic switch back on. "It is the first time this test has
been used in this manner," Brown said in an interview. "We're using it
in ovarian cancer patients to look at mechanisms of how tumors become
resistant to chemotherapy and to show associations with patient survival
following chemotherapy."
Blood tests have been
used in other types of cancer to detect the genetic changes, known as
gene methylation, that can occur in tumors. Patients who do not acquire
methlyation of a particular gene survive longer. About 190,000 cases of
ovarian cancer and 114,000 deaths occur each year. Eastern Europe, Scandinavia,
the United States and Canada have the highest rates of the disease, according
to the International Agency for Research on Cancer (IARC) in Lyon, France.
The five-year survival rate is about 40 percent because the illness is
often not diagnosed before it has spread. In early results from 500 ovarian
cancer patients in an international trial of the test, Brown and his team
found signs of gene methylation. "We are seeing acquisition of this mechanism
that switches genes off, and secondly that acquisition of the mechanism
that switches genes off is associated with poorer survival in the patients,"
said Brown, a molecular biologist who presented his findings at a meeting
of senior researchers at the charity Cancer Research UK in Harrogate,
northern England. He added that it is important to identify patients who
could benefit from new drugs, known as demethylating agents, which would
be given in conjunction with chemotherapy after a relapse. "By switching
these genes back on...you will sensitise the tumors to chemotherapy,"
said Brown.
[Top]
New
Trial to Evaluate Phenoxodiol as Chemo-Sensitizing Agent in Patients With
Chemo-Resistant Ovarian Cancer-(PRNewswire-21/04/2004)
Marshall Edwards,
Inc.has commenced a multi-center, multi-national clinical trial that will
study the ability of the investigational anti-cancer drug, phenoxodiol,
to restore the sensitivity of ovarian cancer to the standard chemotherapies,
paclitaxel and cisplatin. The first site to enroll patients for this study
is Yale-New Haven Hospital, New Haven, Connecticut. The second enrollment
site will be announced in June 2004. Laboratory studies have shown that
phenoxodiol has the ability to restore sensitivity to standard chemotherapies
in ovarian cancer cells that have been obtained from women whose tumors
had previously become resistant to those drugs. Subsequent to a just-completed
Phase I/II study, the prelude to this study, some women with recurrent
ovarian cancers that were either resistant or refractory to standard chemotherapies
such as paclitaxel, showed encouraging evidence of restoration of sensitivity
to paclitaxel following phenoxodiol therapy, despite the fact that the
two drugs were not used in the manner considered to be ideal in order
to achieve reversal of chemo-resistance.
The new study will
enroll at Yale 40 patients with recurrent, late-stage ovarian and primary
peritoneal cancers that have become refractory to taxane- based (paclitaxel,
docetaxol, taxotere) and/or platinum-based (cisplatin, carboplatin) drugs.
Refractory cancers are those that acquire resistance to a particular drug
to the extent that the cancers grow in the face of treatment with that
drug. The two main objectives of the study are to establish the degree
to which phenoxodiol reverses chemo-resistance, and to compare the relative
efficacies of paclitaxel and cisplatin in combination with phenoxodiol.
The treatment regime will comprise an injection of phenoxodiol on two
consecutive days, followed by a single weekly injection of paclitaxel
or cisplatin immediately following the second phenoxodiol treatment. This
will be administered over a treatment cycle of 6 weeks, with cycles to
be repeated until a response is obtained. Another objective of the study
is to determine the dosage of paclitaxel or cisplatin that will minimize
toxicity when used in combination with phenoxodiol.
The dosage of these
two chemotherapies will be reduced as required until toxicity no greater
than Grade 1 is achieved. Grade 1 toxicity is the lowest of 4 levels of
toxicity as defined by the National Cancer Institute's Toxicity Classification
Criterion. Toxicities of Grade 3 or higher are commonly encountered with
dosages of such therapies required to achieve an anti-cancer effect. Researchers
believe that phenoxodiol will restore the sensitivity of the chemo-resistant
cancer cells to the extent that paclitaxel and cisplatin can achieve a
significant anti-cancer effect with only minimal side-effects. The primary
clinical end-points being sought are a reduction in tumor mass and blood
levels of tumor markers (CA 125 and CA19.9), and an improvement in clinical
status and survival at 6 and 12 months. Phenoxodiol reverses chemo-resistance
through its ability to degrade anti- apoptotic proteins such as XIAP and
c-FLIP that serve to block the ability of tumor cells to undergo apoptosis
via the Fas death receptors.
[Top]
Finding
the First Signs of Ovarian Cancer Molecular, cellular changes may point
to early stages of disease, new research finds-(HealthDayNews-13/04/2004)
Specific molecular
and cellular changes in the ovary may someday help doctors detect ovarian
cancer at an early stage, says a Temple University study in the April
issue of Gynecologic Oncology. There is no accurate test for early detection
of ovarian cancer, and it's often diagnosed only after it's reached an
advanced stage. In this study, Temple researchers compared the healthy
ovaries of women with ovarian cancer to ovaries in women without cancer.
"Our study suggests that the 'normal' ovaries of women with ovarian cancer
have not only structural changes, but also molecular changes that are
less frequently found in the ovaries of healthy women," senior author
Dr. Enrique Hernandez, a professor and chairman of obstetrics and gynecology,
said in a prepared statement. He and his team identified structural changes
in the cells of the ovary lining and molecular changes that involved higher
levels of a protein that prevents cell death. "This study and others like
it are building the foundation for better methods of early detection of
ovarian cancer. If we are able to identify early changes along the path
by which a normal ovarian cell turns into a cancerous ovarian cell, we
might be able to develop a test to detect the disease earlier, even before
it becomes cancerous," Hernandez said
[Top]
Housework,
walking lowers cancer, death risk-(Daily Times, Pakistan -05/04/2004)
Housework may be a
hated chore but it can reduce the risk of a certain form of uterine cancer,
US and Chinese researchers reported. And a second study showed that patients
with breast cancer who exercised regularly were more likely to survive.
The reports, presented at the annual meeting of the American Association
for Cancer Research in Orlando, Florida, strengthen other findings that
show exercise lowers the risk of several forms of cancer, as well as heart
disease and diabetes. "Exercise in adulthood was associated with nearly
a 20 percent reduction in endometrial cancer risk," a team led by Charles
Matthews of the Vanderbilt University Medical Center in Nashville, Tennessee,
told the meeting. "Our results support the idea that the risk of cancer
can be reduced by maintaining an active lifestyle," Matthews added in
a statement. Matthews and colleagues at the Shanghai Cancer Institute
in China found that walking and household chores reduced the risk of endometrial
cancer by as much as 40 percent.
They studied 974 women
in Shanghai aged 30 to 69 and compared them to women of a similar age.
The women were asked about current exercise as well as how much they exercised
as teen-agers. Women who walked more than 60 minutes a day and who did
four or more hours of housework a day had a 30 percent lower risk of endometrial
cancer - a cancer of the lining of the uterus. "In recent years, we have
accumulated strong evidence that an active lifestyle can reduce the risk
of colon and breast cancer. Now we are finding that physical activity
may also reduce risk of endometrial cancer," Matthews said.
Having too much body
fat can increase the risk of endometrial cancer but Matthews said exercise
may counter some of this risk. Matthews' team did a second study in Shanghai
on breast cancer but found the effects were less clear. They
surveyed 1,459 breast cancer patients and 1,556 women without breast cancer.
The heavier women were always at higher risk. As with endometrial cancer,
exercise seemed to offset some of the increased risk caused by being fat.
"At this juncture, obesity prevention offers one of the few viable options
for breast cancer prevention," the researchers said. A second team, at
Brigham and Women's Hospital and Harvard University, showed that exercise
increased the survival of women with breast cancer. "We already knew that
exercise improves the quality of life after a breast cancer diagnosis,"
Dr. Michelle Holmes, who led the study, said in a statement.
They studied 2,296
breast cancer patients taking part in a large health study of nurses,
following them from 1986 until they died or until June 2002. The more
the women exercised, the better their chances of beating the breast cancer.
Women who walked an hour a week or did the equivalent were 19 percent
less likely to die and women who managed three hours a week were 54 percent
less likely to die of breast cancer. But the benefits dropped off - more
exercise than that did not result in better survival. "We were able to
show that even a moderate amount of physical activity improved the odds
of surviving breast cancer," Holmes said. "It is especially heartening
for women recovering from breast cancer to know that the benefit is as
readily accessible as walking for 30 minutes on most days of the week."
-Reuters
[Top]
Fox
Chase Cancer Center research reveals how COX-2 causes ovarian cancer-(Yahoo
News-28/03/2004)
Fox Chase Cancer
Center scientists have identified how an enzyme called COX-2 may promote
the development of ovarian tumors, adding further insight into the mechanism
of COX-2 inhibitors and the prevention of this highly lethal disease.
The data was presented today at the 95th Annual Meeting of the American
Association for Cancer Research in Orlando, Fla. "We have found that the
over-expression of COX-2 correlates with the loss of the basement membrane
in ovarian epithelium cells, thus promoting cancer," said Mike (Xiang-Xi)
Xu, Ph.D., who heads the Fox Chase team in this research. "A COX-2 inhibitor
may reduce the loss of basement membrane and thus decrease cancer risk."
Previous research had shown that COX-2 inhibitors such as aspirin and
other non-steroidal anti-inflammatory drugs (NSAIDs) slow the growth of
tumors, particularly of the breast and colon, but only now are researchers
beginning to understand how COX-2 inhibitors work in thwarting cancer.
In the ovaries and
other tissues, basement membrane provides a scaffold to which cells called
epithelial cells adhere in an organized fashion, Xu explained. When there
is no basement membrane, the epithelial cells become disorganized and
unregulated and may undergo transformation from a normal to cancerous
state. Xu added that basement membrane is also lost during ovulation,
which may help explain the association between frequent ovulation and
higher ovarian cancer risk. Ovarian cancer claims the lives of over 14,000
women each year in the United States, making it the most lethal of all
gynecologic malignancies. A strong family history of ovarian or breast
cancer is evident in about 5 to 10 percent of ovarian cancer cases. While
an average woman's risk of getting ovarian cancer is only about 1.4 percent
over her lifetime, the risk increases to between 15 and 60 percent if
two or more first-degree relatives (parents, siblings or children) have
developed ovarian, breast or a certain type of bowel cancer. The important
role of inheritance has led many women with a family history of breast
or ovarian cancer to have their breasts and ovaries removed as a means
of preventing the development of cancer. Xu and his colleagues studied
the tissues removed during prophylactic oophorectomy (removal of the ovaries)
for clues about the precancerous changes that go on in the cells.
One of the cell proteins
they analyzed was COX-2, a physiologically important enzyme that plays
a role in ovulation as well as in antibacterial, immunologic and inflammatory
processes. COX-2 has also been shown to stimulate tumor cell division
and angiogenesis (new blood vessel formation) and to inhibit a type of
programmed cell death called apoptosis, which helps control the growth
of tumors. Xu's analysis of the ovarian tissue specimens showed that as
the level of COX-2 increases, it appears to promote the loss of basement
membrane. Treatment with COX-2 inhibitors may prevent the development
of cancer cells. In fact, the National Cancer Institute will launch a
human clinical trial of COX-2 inhibitors.
Mary B. Daly, M.D.,
Ph.D., director of Fox Chase's Cancer Control Program, is heading the
multi-center trial, which will include Fox Chase as one of its sites.
Fox Chase has one of four Specialized Programs of Research Excellence
(SPORE) in Ovarian Cancer, established by the NCI in 1999. Understanding
what happens in ovarian cells before they become cancerous is important
not only because it may lead to preventive therapies but also because
it may lead to the identification of markers of the disease that will
be useful for diagnosis and for assessing treatment results. One of the
reasons for the high death rate among women who develop ovarian cancer
is that diagnosis often is delayed until late stages of the disease.
[Top]
Human
Papillomavirus Tied to Oral Cancer-(Reuters Health-10/12/2003)
Human papillomavirus
(HPV), a virus associated with cervical cancer, also appears to be involved
in cancer of the mouth and oropharynx (the part of the throat that includes
the lower part of the tongue and the tonsils), research suggests. Study
author Dr. Rolando Herrero of the Costa Rican Foundation for Health Sciences,
San Jose, told Reuters Health that it's possible that "HPV vaccines currently
under development could be effective at preventing HPV-related oral cancer."
The study included
1415 patients with cancer of the mouth, 255 with cancer of the oropharynx,
and 1732 cancer-free controls. HPV DNA was found in tissue samples of
close to 4 percent of cancers of the mouth and 18 percent of cancers of
the oropharynx. Such findings were more common in subjects who reported
having more than one sexual partner or who practiced oral sex. HPV can
be sexually transmitted. Overall, DNA for HPV 16, the most common HPV
in genital tumors, was found in roughly 94 percent of HPV DNA-positive
cancer patients. The presence of antibodies against HPV 16 L1, E6, or
E7 was associated with a significant increased risk of cancers of the
mouth and the oropharynx. These findings suggest to the researchers that
HPV appears to play a role in the development of many cancers of the oropharynx
and possibly a small subgroup of cancers of the mouth. The study appears
in the December 3rd issue of the Journal of the National Cancer Institute.
[Top]
Hormones
May Raise Risk of Ovarian Cancer-(AP-30/09/2003)
Estrogen-progestin
pills do not reduce the risk of ovarian cancer and might even increase
it, according to a study that raises more red flags about a once widely
accepted treatment for women going through menopause. "It's more bad news"
for hormones, said American Cancer Society epidemiologist Dr. Carmen Rodriguez.
The findings came from the federally funded Women's Health Initiative
study, part of which was abruptly halted in 2002 because of evidence that
estrogen-progestin pills raise the risk of breast cancer, heart attacks
and strokes. Previous findings on hormone pills and ovarian cancer have
been inconsistent. Some studies, especially those involving estrogen-only
pills, showed an increased risk. But some doctors have theorized that
combination pills would reduce the risk because they contain hormones
similar to those in birth control pills, which have been shown to lower
the odds.
The new analysis
found that 32 of the 16,608 participants developed ovarian cancer during
about 5 1/2 years of follow-up. There were 20 cases in women who took
hormones and 12 in those on dummy pills. The difference is not statistically
significant because the cancer was so rare, but the trend is worrisome,
said lead author Garnet Anderson, of the Fred Hutchinson Cancer Research
Center in Seattle. The analysis appears in the Journal of the American
Medical Association. "If women have no menopausal symptoms, they should
not be taking" hormone pills, Anderson said. The analysis is "probably
the best we have so far," said Rodriguez, though questions remain because
so few women developed the rare cancer.
Wyeth Pharmaceuticals,
which makes the Prempro pills used in the study, downplayed the results.
"It does not prove that there's any kind of causal relationship," Wyeth's
Dr. Victoria Kusiak said. Women's Health Initiative data also have linked
hormones with an increased risk of dementia, adding to confounding evidence
that the pills might contribute to the very ailments they once were thought
to prevent. Hormone pills are approved for relieving hot flashes, night
sweats and other temporary problems of menopause, as well as for preventing
bone-thinning osteoporosis. Wyeth has been saying since the first Women's
Health Initiative results were published in 2002 that hormones remain
an effective treatment for menopausal symptoms, and Kusiak reiterated
that women seeking relief should take the lowest possible dose for the
shortest possible duration. The company estimates that 1 million women
were still taking Prempro pills as of June, down from 3.4 million before
the study was halted. An arm of the government study involving estrogen-only
pills is continuing.
[Top]
Woman
Warns Others Of Her 'Silent Killer'-(Yahoo News-04/09/2003)
Katie Paul, 53, was
diagnosed with ovarian cancer two-and-a-half years ago. Her husband, Bob,
and dog, Monty, have been her life support since the beginning. "I woke
up in the recovery room to the news that I had ovarian cancer, so needless
to say we incredibly shocked and stunned," she said. Surgery for another
problem led to the discovery. After six rounds of chemo, her case was
showing promise, but she recently relapsed. "I feel very good," she said.
"I feel very positive, but I know there's no guarantee." More than 14,000
thousand women are expected to die from ovarian cancer this year in the
United States, and another 25,000 will get the disease. Experts say women
have an 85 percent chance of survival if ovarian cancer is detected in
stage one, but there's only a 30 percent chance if its detected in stage
three -- and most cases are discovered in stage three. That's why it's
called a silent killer. Seventy-five percent of women finally go to the
doctor when they've got stage three ovarian cancer.
Dr. Julian Schink
of UW Hospital's Gynecologic Oncology Department said more women have
a better chance to survive today than they once had. "In 1975, about 30
percent of women were alive five years later, now its 45 percent," Schink
said. Years of research show risks are higher if there's cancer in the
family or if a woman does not have children, but there's still no screening
-- that's still a few years away, Schink said. For now, women can just
be aware of the symptoms, including abdominal swelling, a feeling of pressure
in the pelvic area, weight change and nausea.
Paul said she felt
some of those symptoms in time. For now, she is trying to live her life
with hope. "You can't control a lot of things," Schink said. "You can
be concerned, but don't let it interfere with day-to-day and enjoyment
of it." The average age for ovarian cancer is 61, but Schink said it occurs
in women in their 30s to 50s, and he even has an 18-year-old patient.
September is Ovarian Cancer Awareness Month.
[Top]
Ovarian
Cancer Survival Improved With Paclitaxel and Cisplatin-(Yahoo News-15/07/2003)
Updated results from
the European Organisation for Research and Treatment of Cancer (EORTC)
55931 Intergroup Trial suggest that survival of women with advanced ovarian
cancer is improved by the use of a combination of paclitaxel, sold comercially
as Taxol(R), and cisplatin in comparison to cyclophosphamide and cisplatin
therapy. The results from EORTC 55931 Intergroup Trial were presented
for the first time on October 22, 2002. The trial included 680 women who
were followed-up for a total of 6.5 years, another 3.5 years after closure
of the study. Dr. Martine J. Piccart, from the Jules Bordet Institute
in Brussels, Belgium, is enthusiastic about these results. "When we completed
the Intergroup trial in 1997, we were pleased with the main results of
an additional overall survival of 10 months with the Taxol combination,
a significant finding for patients who have a life expectancy that is
very low," Piccart said. "So when we see that 34 percent of our patients
are still alive after 6.5 years we are obviously encouraged by these results,"
Piccart continued.
The results from
this trial confirm the superiority of the paclitaxel-containing regimen
already seen in the GOG-111 trial -- research conducted in the early 90s,
which showed that after 6.5 years, 27 percent of patients receiving the
paclitaxel and cisplatin combination were still alive, compared to 16
percent on the cyclophosphmide and cisplatin regimen. Ovarian cancer is
the sixth most common cancer among women worldwide and the fifth leading
cause of cancer deaths in women. Globally almost a quarter of a million
women are diagnosed with the disease each year, and 115,000 die due to
ovarian cancer. One out of 57 women will develop ovarian cancer. It is
often called the silent killer because its symptoms can be subtle, leading
to a delayed diagnosis and poorer prognosis, and only 25 percent of cases
are diagnosed in the early stages. If ovarian cancer is detected early,
however, the 5-year survival rate is approximately 95 percent. "To see
that 34 percent of patients are still alive after 6.5 years can only bring
additional optimism to patients and doctors that we are a step nearer
in fighting this deadly disease through the use of the best possible treatments,"
according to Professor Jan B Vermorken, M.D., Ph.D., Chairman of the Gynaecologic
Cancer Intergroup.
[Top]
Combo
Therapy Recommended for Ovarian Cancer-(Reuters-19/06/2003)
Combination chemotherapy
can improve the survival of women who have suffered a relapse of ovarian
cancer, cancer doctors said. Scientists at Britain's Medical Research
Council found that combining the drug paclitaxel and platinum chemotherapy
was more effective than conventional chemotherapy. Paclitaxel is produced
by the drug company Bristol-Myers Squibb under the brand name Taxol. "This
is the first time that large-scale clinical trials have shown that combination
chemotherapy can increase survival rates for women with relapsed ovarian
cancer," said Dr. Jonathan Ledermann, of University College London, who
led the British arm of the international trials.
Fifty-seven percent
of the 800 women in two parallel trials in Britain, Italy, Germany, Norway
and Switzerland who had the combined therapy were alive two years later
compared to 50 percent of women who were on conventional treatment. "These
are significant results that represent a step forward in treating this
group of women," said Ledermann, who reported his findings in The Lancet
medical journal. He added that all women who relapsed more than six months
after completing a first course of chemotherapy should be considered for
the combination treatment of platinum and paclitaxel.
Ovarian cancer, the
fourth most common cancer in women, has been dubbed the silent killer
because 65-75 percent of cases are diagnosed when the disease is advanced.
Symptoms include nausea, weigh loss and abdominal swelling and pain. If
the disease has spread beyond the ovaries and nearby tissue, the 5-year
survival rate is about 20 percent. It is usually treated with surgery
and chemotherapy.
[Top]
Ovarian
Cancer Research stirs hope of earlier diagnosis for ovarian cancer-(Seattle
Times medical reporter-25/06/03)
Seattle scientists
have taken an important initial step in the development of a test for
diagnosing ovarian cancer. It could help save thousands of women's lives
each year by getting them into treatment earlier. Using a new biomarker
for the cancer, investigators at the Pacific Northwest Research Institute
are optimistic the technique they are testing can help identify the disease
in its earliest stage. In about three-fourths of women, ovarian cancer
isn't detected until it is too late for long-term survival. "We hope we'll
be able to diagnose more cases in the early stages ... and that will save
lives," said Dr. Ingegerd Hellstrom, lead author of the study reported
in the July 1 edition of the national journal Cancer Research.
Much additional research
must be conducted on the technique, but the test has attracted the interest
of a commercial diagnostics company. Hellstrom said the test could be
available within five years and perhaps be combined with other tests,
one already in use, to better identify the deadly disease. The test uses
a protein, HE 4, that is secreted into the blood by ovarian-cancer tumors.
Hellstrom and her colleagues developed antibodies that seek out the protein
in a laboratory test of the blood. Scientists at the Fred Hutchinson Cancer
Research Center, the Marsha Rivkin Center for Ovarian Cancer Research
at Swedish Medical Center and the Institute for Systems Biology, all in
Seattle, collaborated in the research.
About 25,400 women
in the United States will be diagnosed this year with ovarian cancer,
and an estimated 14,300 will die, according to the American Cancer Society.
About one-fourth of cases are diagnosed in the early stages, when the
chances of survival are much better. Ovarian cancer is difficult to diagnose
because the tumors are usually deep in the ovaries and difficult to detect.
Symptoms usually do not appear until the cancer is advanced. And an existing
blood test in widespread use, which looks for a protein called CA 125,
often is unreliable for two reasons: Other ovarian conditions also produce
the protein, and about 20 percent of cancerous tumors don't produce enough
to be detected.
Kimberlea Sheldon,
45, a Duvall mother of two, had no symptoms when a magnetic-resonance-imaging
(MRI) test for a leg problem two years ago showed she had ovarian cancer.
Nor did her mother have a clue of the illness when she was diagnosed just
two months before she died, the day after Mother's Day this year. Sheldon,
who went through two difficult surgeries and six months of chemotherapy
but is doing well, said yesterday the new research is a wonderful development.
Maybe other women won't have to go through what I went through," she said,
fighting tears. "If it will help (protect) my daughters, how awesome ...
and maybe my little sister won't have to go through it either."
In the Seattle study,
blood samples from 121 women were tested: 37 who had ovarian cancer, 19
who had benign ovarian cysts and 65 who were healthy. The test yielded
no false positives, and it was about equal to the CA 125 test in picking
up truly positive samples. False positives can lead to expensive and painful
exploratory surgery to learn if the patient has cancer. "I think the test
looks very promising. It goes that way ... toward a better, early diagnosis
and a correct diagnosis," said Hellstrom, who has been researching the
HE 4 protein since 1998.
The protein was discovered
in 1991 and later was linked to ovarian cancer by Michel Schummer, now
at the Institute for Systems Biology. Hellstrom sees the test being used
primarily for women already at risk for ovarian cancer: those with a family
history of the disease, women who have never been pregnant, elderly women
and those who have had breast cancer. Genes linked to breast cancer also
are linked to ovarian cancer. Hellstrom and other scientists say the best
use of the test will be to combine it with other tests: the CA 125 test
and a test for another protein, MPF/mesothelin, which also appears promising
for diagnosing ovarian cancer or mesothelioma, a cancer of the membranes
of the lungs, stomach or heart. Still other protein markers could be explored
for finding as many markers as possible for the disease, she said. "We
are looking at groups of different tests, and HE 4 is certainly an excellent
candidate. ... Using a combination of (tests) is one of the most promising
approaches to detecting the disease earlier," said Dr. Robert Bast, a
scientist at the University of Texas M.D. Anderson Cancer Center, Houston,
whose lab did the basic research for the CA 125 test. Hellstrom and her
colleagues next will test the HE 4 marker on blood samples from 800 women,
including some with benign ovarian cysts, some with cancer and some who
are healthy.
[Top]
Tracking
Down Endometrial Cancer-(HealthScoutNews-19/05/2003)
Checking for mutations
in a certain gene in younger women who have endometrial cancer may help
identify families who are at risk for inherited cancers. That's the claim
of researchers at Washington University School of Medicine in St. Louis.
Their study of 441 women with endometrial cancer found that at least 1.6
percent of women with endometrial cancer have mutations in a gene called
MSH6. That frequency is comparable to that for the most common inherited
form of colon cancer. Further research suggests that mutations in the
MSH6 gene may be associated with a higher chance that the women and members
of her family will develop certain kinds of cancer later in life. The
study appears in a recent issue of the Proceedings of the National Academy
of Sciences.
The findings suggest
more women than previously believed have mutations that indicate they
have an inherited susceptibility to cancer. The findings may also explain
why cancer seems to run in families that don't have mutations in other
genes associated with cancer susceptibility. Endometrial cancer is the
most common gynecologic cancer and the fourth most common cancer in women.
About 39,300 women in the United States were diagnosed with endometrial
cancer last year, and 6,600 died from it.
[Top]
Younger
Women Live Longer with Ovarian Cancer-(Reuters Health-20/05/2003)
Although ovarian
cancer is one of the most deadly forms of cancer, new research suggests
that how long women live with the condition depends greatly on how old
they are when diagnosed. Among a sample of women diagnosed with an advanced
form of the most common type of ovarian cancer between 1984 and 2001,
almost half of those younger than 45 were alive five years later, a finding
seen in only 22 percent of women older than 45. Furthermore, half of women
younger than 45 lived longer than 54 months, while half of patients older
than 45 did not survive 34 months after diagnosis. These findings indicate
that age matters when predicting how long a woman will live after being
told she has ovarian cancer, according to Dr. John K. Chan of the University
of California, Irvine, and colleagues.Survival
in young ovarian cancer patients "is double that of older patients," Chan
told Reuters Health. "It's terrific news for younger patients," he added.
Ovarian cancer is
considered a very lethal disease. Most cases are diagnosed when the cancer
has already spread beyond the ovaries and is difficult to treat. In 2002,
an estimated 23,100 American women were diagnosed with ovarian cancer,
and 14,000 died from the disease. Chan and his colleagues presented their
findings during the recent annual meeting of the American College of Obstetricians
and Gynecologists in New Orleans. They obtained the results by following
104 women diagnosed with an advanced form of epithelial ovarian cancer,
the most common form of the disease. Roughly half of the women were younger
than 45 when diagnosed. In terms of why age might make a difference in
how long women survive with epithelial ovarian cancer, Chan said that
younger women are generally healthier than older women, and that can influence
how well they cope with treatment. Healthier women are likely to be able
to handle more-aggressive treatment for the cancer, the researcher said,
increasing their chances of fighting off the disease.
However, when Chan
and his colleagues accounted for the influence of women's health at the
time of diagnosis, they found that young women still tended to live longer
with the disease. This suggests that the makeup of the tumors may differ
in younger and older women, Chan explained. "There's something about (younger
women's) tumors ... that makes these tumors respond better to treatment,
or makes them less aggressive," he said. He noted that previous studies
have investigated the effect of age on prognosis in ovarian cancer, but
none has looked at the role of age in advanced epithelial ovarian cancer,
the most deadly and aggressive form of the disease. The current findings
suggest that younger patients diagnosed with advanced epithelial ovarian
cancer should be treated differently from older patients, according to
Chan. Younger patients "should be treated aggressively ... because their
age confers for a good prognosis," he said.
[Top]
Women
Now Living Longer with Ovarian Cancer-(Reuters Health-03/02/03)
A woman with ovarian
cancer is now more likely than ever to live for years after her diagnosis,
researchers announced. Based on analysis of information collected on roughly
33,000 women diagnosed with ovarian cancer, the investigators discovered
that the chance of a woman living two years after her diagnosis has increased
25% between 1973 and 1997, while the chance of her living five years after
diagnosis went up 15%. As it stood at the end of the study, a woman's
chance of living two years after an ovarian cancer diagnosis was 62%,
and 43% for living at least five years after being diagnosed. "It's a
small improvement, it's a small change, but it's positive," study author
Dr. Adnan Munkarah of Wayne State University in Detroit told Reuters Health.
However, African-American
women and women at least 60 years old tend to live fewer years after a
diagnosis of ovarian cancer than other women, Munkarah added, and more
research is needed to narrow those gaps. Munkarah and his colleagues presented
their findings during the Society of Gynecologic Oncologists' Annual Meeting
on Women's Cancer in New Orleans. Ovarian
cancer is considered to be a very lethal disease. Most cases are diagnosed
when the cancer has already spread beyond the ovaries and is difficult
to treat. In 2002, an estimated 23,100 American women were diagnosed with
ovarian cancer and 14,000 died from the disease.
In an interview,
Munkarah explained that there are likely many reasons why women are now
living longer with ovarian cancer. For one, diagnosed women now receive
platinum-based chemotherapy drugs such as cisplatin, which have improved
success rates in treating ovarian cancer, he said. Munkarah added that
recent evidence has shown that even women with ovarian cancer that has
spread throughout their bodies can benefit from surgery to remove the
bulk of the disease. As such, more women are now being offered surgery,
he said, and doing better as a result. Many women still die every year
of ovarian cancer, Munkarah noted, a sign that more improvements in diagnosis
and care are still needed. New therapies other than chemotherapy may help
future generations survive longer with the disease, the researcher noted.
In addition, currently very few women with ovarian cancer seek help from
a cancer doctor who specializes in ovarian cancer, since the concept of
specializing in oncology is relatively new, he noted. Once people become
more aware that these doctors exist, Munkarah said, survival rates might
improve even further.
[Top]
Study:
Even larger ovarian cysts have low cancer risk-(USA TODAY-03/02/03)
The risk of cancer
developing in ovarian cysts as large as 4 inches in diameter is so low
that surgery is not necessary as long as they are regularly checked by
ultrasound, according to research being presented today. Ovarian cancer
is the second most common gynecologic malignancy in the USA. Most cases
are not diagnosed until they are advanced, making ovarian cancer the fifth
most lethal malignancy in U.S. women. Increasingly, doctors have been
using transvaginal sonography, in which an ultrasound probe is inserted
into the vagina to screen for ovarian cancer. Sonography also is used
when a pelvic exam suggests that ovaries are enlarged. Though transvaginal
ultrasound can detect ovarian cancer early, it also identifies other abnormalities,
such as cysts, which might not be noticed otherwise.
Previously, doctors
didn't think that postmenopausal women developed ovarian cysts. Once such
cysts were discovered, women often had them removed. In recent years,
though, studies have suggested that cysts less than 2 inches in diameter
were unlikely to be malignant and needed only to be monitored with sonography.
The new finding, presented at a meeting of the Society of Gynecologic
Oncology in New Orleans, indicates that cysts as large as 4 inches in
diameter can be safely followed with sonography.
The 15-year University
of Kentucky study of 15,106 women 50 and older involves annual screening
with transvaginal sonography. Over time, screening detected at least one
fluid-filled ovarian cyst smaller than 4 inches in diameter in 18% of
participants. More than two-thirds of the cysts were smaller than 1.2
inches in diameter. After the cysts were detected, researchers followed
the women with sonography every three to six months for an average of
just over six years. They wanted to ensure that the cysts did not develop
any changes suggesting cancer, such as tiny projections or solid areas.
The researchers found that more than two-thirds of the cysts disappeared,
usually within six months. Out of the 2,761 women with cysts, 79 had surgery
because their cyst did not go away or was causing pain, and 54 had their
ovaries removed during a hysterectomy or other surgical procedure. None
of the women was found to have ovarian cancer.
''If you are not
going to come back and be followed, then you need it out, particularly
if it's persisting,'' says senior author John van Nagell, an American
Cancer Society professor of clinical oncology at the University of Kentucky
Markey Cancer Center in Lexington. Anna Parsons, an associate professor
of obstetrics and gynecology at the University of South Florida in Tampa,
says she routinely uses sonography to examine patients' ovaries during
a pelvic exam. She has followed some cysts for more than 10 years and
notes that the size of van Nagell's study is reassuring. ''You have to
understand that ultrasound depends on the person doing the scan,'' Parsons
says. ''But this is a pretty easy call with good quality machinery and
good quality scanning.''
[Top]
Some
Ovarian Cancer Survivors Can Retain Fertility-(Reuters Health-05/02/03)
Women with a certain
type of ovarian cancer can be treated with surgery and chemotherapy and
still go on to have healthy children later in life, new research shows.
The study involved women with malignant germ cell tumors, an uncommon
type of ovarian cancer that is usually diagnosed in adolescence or the
early 20s. These tumors develop from the cells that produce eggs, and
most are noncancerous. Those that are cancerous are treated with surgery
to remove one or both ovaries followed, in most women, by chemotherapy.
In women who have just one ovary removed, there have been some concerns
about whether they would be able to conceive and bear healthy children.
"Patients with this disease and their family members should be reassured
about the high chance of retaining the patient's ability to conceive and
have normal children after conservative surgery and combination chemotherapy,"
Dr. Peter Schwartz and colleagues at Yale University School of Medicine
in New Haven, Connecticut, write in Obstetrics & Gynecology.
The study involved
86 women treated between 1975 and 1995. In this group of women, 64 had
just one ovary removed. Follow-up surveys by mail or phone with these
64 women revealed that 38 had tried to get pregnant and 29 were successful.
Even some women whose cancer has spread outside the ovaries before being
treated were able to get pregnant, according to the report. Of the 38
children born to these women, follow-up information was available for
16, none of whom had birth defects. "To date, children born to these patients
have not experienced an increased risk for congenital malformations or
developmental abnormalities," the researchers write.
The study also found
that four patients who were treated for cancer before having had their
first menstrual period went on to menstruate normally after treatment.
One of these women attempted to conceive later and was successful. "This
information is extremely important to parents of young girls diagnosed
with malignant germ cell tumors of the ovary who are concerned about their
daughters' future reproductive function," the study authors said. Fertility-sparing
surgery is sometimes also performed on young women with very early stages
of other types of ovarian cancer.
[Top]
Chemo
May Keep Ovarian Cancer at Bay-(Reuters Health-20/01/03)
Two large, newly
released European studies suggest that women with early-stage ovarian
cancer may do better if they receive chemotherapy immediately after undergoing
surgery. Both studies found chemotherapy reduced the risk of a cancer
recurrence. One found the treatment increased survival, but the other
did not. However, the studies are not the final word on the benefits of
chemotherapy following surgery, said Dr. Debbie Saslow, of the American
Cancer Society, who was not involved in either study. "Women still need
to discuss their particular situations with their doctors and decide about
which course of treatment may be best for them," she told Reuters Health.
Currently, women
diagnosed with early-stage ovarian cancer tend to have surgery and if
the cancer comes back, additional surgery and chemotherapy are recommended,
according to Saslow, director of breast and gynecologic cancer at the
American Cancer Society. In about 50% of cases, women with early-stage
cancer experience a relapse after surgery. Previous studies have shown
that some women with early-stage ovarian cancer can be cured by surgery
alone and therefore can avoid the devastating side effects of chemotherapy.
One important factor is to determine how far the disease has progressed
so an informed decision can be made, Slaslow explained.
In the first study,
the International Collaborative Ovarian Neoplasm Collaborators led by
Dr. Mahesh Parmar of the Medical Research Council Clinical Trials Unit
in London, England looked at 477 women who either had chemotherapy after
surgery or had surgery alone. After five years, women who received chemotherapy
had a 9% greater overall survival (79% versus 70%) and an 11% greater
chance of not having a recurrence of their cancer (73% versus 62%), according
to the report published in the Journal of the National Cancer Institute.
In the second study,
448 women with early-stage ovarian cancer had either chemotherapy and
surgery or had surgery alone. In this study, after 5.5 years no difference
in overall survival was detected between the two groups of women. However,
women who got chemotherapy were less likely to have their cancer come
back, according to the study's lead author, Dr. J. Baptist Trimbos of
Leiden University Medical Center in The Netherlands and colleagues. Overall,
76% of patients treated with chemotherapy were recurrence-free compared
with 68% of patients not treated with chemotherapy.
In an accompanying
editorial Dr. Robert C. Young of the Fox Chase Cancer Center in Philadelphia,
Pennsylvania, writes that the two trials "add important information" on
the subject, "but leave some critical issues unresolved." While the two
studies would seem to be "definitive proof" of the benefit of chemotherapy,
"they are not," he writes. The trials included a mix of patients, some
with a poor prognosis and others with a better prognosis, based on the
types of tumors they had. The studies do not help determine which women
can be spared chemotherapy, according to Young. More research needs to
be conducted to better identify women "who do not require additional therapy,
while also seeking to improve therapy in patients who do."
[Top]
New
Clue to Outlook for Ovarian Cancer-(HealthScoutNews-15/01/03)
Women with advanced
ovarian cancer whose tumors contain T-cells live longer than women whose
tumors lack these important infection-fighting white blood cells. The
findings, which appear in The New England Journal of Medicine, may one
day change the way treatments are structured for ovarian cancer patients.
According to the American Cancer Society, more than 14,000 women die of
ovarian cancer every year. As with other cancers, the survival odds increase
dramatically the earlier the malignancy is caught. If the cancer has not
spread beyond the ovaries, 95 percent of women will still be alive in
five years. Overall, however, only slightly more than half the women diagnosed
with ovarian cancer will survive beyond five years.
Although there has
already been a lot of work involving tumor-infiltrating T- cells, particularly
with other types of cancers, the prognosis for patients was unclear. "As
far as ovarian cancer was concerned, people have demonstrated that tumor-infiltrated
lymphocytes [white blood cells] could indicate tumor immune response,
but no one knew if they played a role in determining [the] course of the
disease," says Dr. George Coukos, senior study author and director of
the gynecologic malignancy research programs at the University of Pennsylvania.
"What we are showing for the first time is that, indeed, tumor-infiltrating
lymphocytes that indicate tumor immune response play an important role.
They have a dramatic effect."
In this study, the
researchers evaluated 186 frozen tissue specimens from advanced ovarian
carcinomas to see whether the T-cells were present. The results were striking:
The five-year overall survival rate for patients whose tumors contained
T-cells was 38 percent. For patients who did not have the cells, that
number plummeted to 4.5 percent. Women with tumor-infiltrating T-cells
lived without a progression of their cancer for almost four times as long
as patients without the telltale cells. Their survival rate was 2.8 times
longer. The results held fast regardless of what kind of treatment the
woman had received. "We found that the prognostic power of lymphocytes
is completely independent of chemotherapy and surgery," Coukos says.The
news was even better for a subset of patients who had their tumors surgically
removed and who had a complete response to chemotherapy. "If these patients
also had lymphocytes, the long-term survival is extraordinary," Coukos
says. "We found up to a 70 percent survival rate at 10 years, which is
unheard of in ovarian carcinoma."
What does this mean
for cancer patients? "We have a new marker that can predict the outcome,"
Coukos says. "The idea is that it can potentially help us to tailor the
therapies for specific patients. Right now, we're treating everybody the
same way and people may respond well but they may not respond and then
we're stuck." Some courses of chemotherapy suppress the immune system
while others don't. The presence or absence of T-cells could influence
which type to use. An added advantage is that the test to determine the
presence of lymphocytes is a simple one. "Any pathology lab can do it,"
Coukos says. "That is the first step. It opens a huge door basically to
new therapeutics," Coukos says. "It really provides a strong rationale
that we should be very actively looking for immune therapies in ovarian
cancer. What we are really showing is that there is an immune response
and that that immune response makes a difference."
The next goal is
to reproduce the 70 percent survival rate found in that subset of patients
in all patients. "We need to try to make everybody look that good," Coukos
says. However, don't look for these improvements tomorrow. "It's a good
piece of work, but these results are very preliminary," cautions Dr. Giuseppe
Del Priore, assistant director of gynecologic oncology at New York University
Medical Center and director of the Cancer and Fertility Society. "Vaccine
trials in many sites like melanoma have been somewhat successful, but
in other tumors, not so successful. Even direct infusion of these types
of cells into patients has not been universally successful." "We proceed
in tiny steps," he adds. "There is not going to be a home run hit anytime
soon in ovarian cancer, but that doesn't mean we shouldn't stop trying
and keep advancing slowly."
[Top]
Hormone
Linked to Higher Risk of Ovarian Cancer-(Reuters Health-29/10/2002)
High levels of a
protein called insulin-like growth factor (IGF)-I may increase women's
risk of developing ovarian cancer before age 55, the results of a new
study suggest. Measuring IGF-I levels is unlikely to be useful as a screening
test for ovarian cancer, according to the study's lead author, Dr. Rudolf
Kaaks, of the International Agency for Research on Cancer in Lyon, France,
however, the discovery of elevated levels of the growth factor in women
with ovarian cancer raises the possibility that diet, which can increase
IGF-I, may be involved.
Ovarian cancer is
highly treatable in its early stages, but the cancer is rarely caught
early, in part because its symptoms, such as bloating and abdominal discomfort,
can signal any number of problems. Also, there is no good screening test
for ovarian cancer, so more than two thirds of cases are not detected
until after cancer has spread outside the ovaries. Once ovarian cancer
spreads, the 5-year-survival rate is only 29%. Because detecting ovarian
cancer before it spreads can be life-saving, the scientific search is
on for ways to detect the disease. Some preliminary studies have found
that IGF-I levels are higher than normal in ovarian tumors, and there
is some evidence that IGFBP-3, a protein that transports IGF-I, is reduced
in ovarian cancer. In the new study, Kaaks and his colleagues tested the
connection between IGF-I, IGFBP-3 and ovarian cancer in women enrolled
in several long-term health studies.
The study included
132 women with ovarian cancer and 263 healthy women who were matched by
age. Based on blood samples taken at least one year before women were
diagnosed with cancer, the researchers did not detect any overall link
between levels of IGF-I or IGFBP-3 and ovarian cancer. However, for women
who received a cancer diagnosis before age 55, levels of IGF-I but not
IGFBP-3 seemed to affect cancer risk. Among the younger women, those with
the highest levels of IGF-I were almost five times more likely to be diagnosed
with ovarian cancer than women with the lowest levels. The study did not
examine how IGF-I may increase the risk of ovarian cancer, but the investigators
suggest several possibilities in their report in the International Journal
of Cancer.
The growth factor
could promote tumor growth by increasing the proliferation of cells, as
well as by inhibiting the mechanism that instructs defective cells to
kill themselves. Another possibility, according to the report, is that
IGF-I may somehow interact with hormones or ovulation in premenopausal
women. "I doubt whether elevated IGF-I would ever be useful as a marker
for ovarian cancer screening," Kaaks said. It is "unlikely," that high
levels of IGF-I would be caused by a preclinical ovarian tumor. "Rather,
we think that elevated IGF-I levels are due to other causes preceding
ovarian cancer development." He explained that many factors, including
nutrition, affect blood levels of IGF-I. "It is possible," Kaaks said,
"that the elevated IGF-I in women at increased risk of ovarian cancer
was a result of nutritional factors. Circulating IGF-I might thus provide
a physiologic link between a Western lifestyle, characterized among other
things by a diet rich in energy and animal protein, and ovarian cancer
risk." He noted that the risk of ovarian cancer is much higher in industrially
developed countries than in developing nations.
[Top]
More
Evidence Aspirin May Prevent Ovarian Cancer-(Reuters Health-02/10/2002)
Previous research
has suggested that people who take aspirin may reduce their risk of developing
ovarian cancer, and a new examination of the interaction between aspirin
and ovarian cancer cells adds further support to this conclusion. Drs.
Janet G. Drake and Jeanne L. Becker of the University of South Florida
College of Medicine in Tampa found that treating ovarian cancer cells
with aspirin inhibited growth of the cancer cells. Past studies have suggested
aspirin may prevent the development of other cancers, such as those originating
in the breast or colon. Finding drugs that can prevent ovarian cancer
is especially important, the authors note, since most women with the condition
have few or no symptoms, and are not diagnosed until the later stages
of the disease.
During the study,
reported in Obstetrics & Gynecology, Drake and Becker exposed ovarian
cancer cells to low and high concentrations of aspirin. They found that
a low dose of aspirin (1 millimole per liter) barely stemmed the spread
of ovarian cancer cells. However, a dose of aspirin five times higher
inhibited the cancer cells by 68%.
The investigators
also determined whether the ovarian cancer cells contained HER-2/neu,
a protein that is sometimes found in abnormally large amounts in ovarian,
breast and endometrial cancer cells. High levels of the protein may mean
a poor prognosis when found in women's breast cancer tissue, but the role
HER-2/neu plays in ovarian cancer remains unclear. Drake and Becker found
that treating cells with the highest aspirin dose reduced HER-2/neu expression
to less than a quarter of its original level. Furthermore, adding a therapy
targeted to block the action of the HER-2/neu receptor reduced tumor cell
growth by 82%. Although the mechanism by which aspirin inhibits ovarian
cancer cell growth remains unclear, Drake and Becker write that the drug
may stem the spread of the disease by reducing cyclooxygenase, an enzyme
often present at high levels in cancers of the colon, breast and stomach.
[Top]
Surgery
Beats Screening to Cut Cancer Risk -Study-(Reuters-26/09/2002)
Watching her mother
die of ovarian cancer and knowing that a genetic mutation increased the
odds that she would face the same fate convinced Tracey Barraclough to
take action. Rather than opt for yearly mammograms and ultrasound screening,
Barraclough decided at the age of 38 to have her ovaries and breasts removed
rather than live with the constant fear of the disease that killed her
mother, grandmother and great-grandmother. "I wanted to stop the chain
that was obviously going through my family," she told a news conference.
"There's more to being a woman than boobs."
Barraclough is among
the about one in 800 women who have a mutation in the BRCA1 gene which
gives them as high as an 85 percent chance of developing breast cancer
and a 60 percent risk of ovarian cancer. Removing healthy ovaries and
breasts because of the risk of disease is considered a radical move but
research reported in The Lancet medical journal shows it reduces the risk
of breast cancer by 90 percent and cuts the odds of developing ovarian
cancer 24-fold.There
isn't a 100 percent guarantee because surgeons may not be able to remove
all of the tissue.
Dr. Richard Kennedy
and Dr. Paul Harkin, of Queen's University in Belfast, Northern Ireland,
reviewed results of international studies looking at prevention techniques
for women with the BRCA1 mutation to raise awareness of what options are
available. Their results showed surgery reduced the risk of disease more
than annual screening, or using the drug Tamoxifen, which are the other
choices for women with the genetic defect. Kennedy said women can develop
cancer between the annual screenings and Tamoxifen may not work in all
patients."Surgery
to remove a woman's breasts and ovaries may seem like a drastic step,
but we have to remember that the women involved in these studies are at
a very high risk of breast and ovarian cancer," said Harkin. "Some women
decide to undergo surgery because it gives them peace of mind, others
prefer to watch and wait," he added.
Alexis Haines has
decided not to wait. The 49-year-old was treated for breast cancer two
years ago. Since then she has learned that she, like her two sisters who
also had the disease, has the BRCA1 mutation. "It's like a dark cloud
following you around," is how she described it. Haines has also chosen
surgery and will have reconstruction with breast implants. She said implants
are accepted as a mean to enlarge the breasts of actresses, models and
celebrities, so why shouldn't they also help women reduce their risk of
cancer.
Kennedy emphasized
that the choice lies with the women themselves but he believes they should
be given the best information to allow them to make informed decisions.
Faults in the breast cancer genes BRCA1 and BRCA2 account for between
two and five percent of all breast cancer cases but for most families
where four or more members are affected. Genetic screening is recommended
for women with three close relatives diagnosed with breast or ovarian
cancer, or two close relatives who developed either illness before 60
or someone whose mother and sister had cancer before the age of 40.
[Top]
High
Calcium Intake May Lower Ovarian Cancer Risk (Reuters Health-02/09/2002)
Women whose diet
includes plenty of calcium-rich dairy foods may have a lower risk of ovarian
cancer, preliminary study findings suggest. The investigators found that
women with the highest intake of dairy products were 54% less likely to
be diagnosed with ovarian cancer than their peers who consumed the least
dairy food. While more research is needed to identify the specific components
in dairy foods that might benefit women, "these results suggest that intake
of low-fat milk, calcium, or lactose may reduce the risk of ovarian cancer,"
according to Dr. Marc T. Goodman from the University of Hawaii in Honolulu
and colleagues.
Goodman added that
the daily recommendation that women include 1,000 milligrams (mg) to 1,200
mg of calcium in their daily diet might be enough to lower their ovarian
cancer risk. "As part of their general health, women should be advised
to monitor dietary calcium intake levels to reduce osteoporosis and other
diseases related to this nutrient. If women maintain recommended levels
of calcium intake, a concomitant benefit might be to reduce their risk
of ovarian cancer," he said in an interview with Reuters Health.
Previous research
on the relationship between ovarian cancer and dairy food consumption
has had mixed results. To investigate, Goodman and colleagues interviewed
558 women with ovarian cancer and 607 healthy women about their eating
and lifestyle habits, use of hormones, and reproductive and medical history.
Women who consumed the most dairy products overall, including low-fat
and skim milk, were the least likely to be diagnosed with ovarian cancer
regardless of their ethnic group. Consumption of whole milk was not associated
with a lower risk, however, according to the report in the American Journal
of Epidemiology. And the researchers found no relationship between a woman's
intake of yogurt, cheese or ice cream and her ovarian cancer risk.
Higher intake of
both calcium and lactose--the primary type of sugar in dairy foods--also
appeared to lower ovarian cancer risk. Lactose, Goodman's team explained,
may increase calcium absorption and promote the growth of bacteria that
keep cancer-causing compounds at bay. The findings, if confirmed by other
studies, may provide women with a tool to lower their risk of an often-deadly
cancer. While ovarian cancer is highly treatable in its early stages,
it is rarely diagnosed early, in part because symptoms such as bloating
and abdominal pain can signal any number of problems. Once ovarian cancer
spreads to other sites, the 5-year-survival rate is only 29%. "Although
these results are intriguing, we cannot rule out the possibility that
both calcium and lactose are surrogates for another, unidentified component
of dairy foods," the researchers conclude. In other findings, there was
no relationship between total calorie, fat, carbohydrate or protein intake
and ovarian cancer risk.
[Top]
A
Little Help from Friends May Slow Cancer Progress (Reuters Health-28/08/2002)
People who have
more support from friends and neighbors may produce less of a growth factor
that can foster cancer spread, according to a study of ovarian cancer
patients. While there is strong evidence that stress, social support and
other behavioral factors can affect a person's immune system, there has
been no research on whether such factors can affect a person's production
of vascular endothelial growth factor (VEGF). VEGF helps new blood vessels
to form around tumors, which allows tumors to grow and spread more easily.
And higher levels of VEGF have been linked to worse survival among ovarian
cancer patients.
To investigate whether
there might be a link between VEGF levels, social support and depression,
Dr. Susan K. Lutgendorf of the University of Iowa in Iowa City and colleagues
studied 24 women with ovarian cancer and 5 women with non-cancerous pelvic
masses. The cancer patients had not yet had surgery for the condition.
The higher a patient's level of social well-being, the researchers found,
the lower her VEGF level. More support from friends and neighbors, as
well as less distance from friends, were both linked to lower levels of
the growth factor, according to the report in Cancer. While women who
reported more feelings of helplessness or worthlessness had higher VEGF
levels, depression in general was not related to VEGF levels, the investigators
found. "The exciting thing about these findings is that they open up the
possibility of a new mechanism by which psychological factors may be related
to cancer progression--that is, through effects on factors related to
angiogenesis," Lutgendorf told Reuters Health. While the study had a number
of limitations, the authors concede, the results "point to the possibility
of novel pathways between biobehavioral factors and tumor angiogenesis."
And, said Lutgendorf, "these findings open up a new area of research into
mechanisms underlying these relationships."
[Top]
Early
Breast Cancer Linked to Increased Ovarian Cancer Risk (HealthScoutNews-28/08/2002)
Women diagnosed
with breast cancer before age 40 who also have a family history of either
breast or ovarian cancer are at a much greater risk of getting ovarian
cancer than are young breast cancer patients without such a family history.
That's the finding of a new Swedish study that also suggests these high-risk
women should be followed closely, offered counseling and perhaps consider
removal of their ovaries as a preventive measure. A report on the research
appears on the Web site of The Lancet.
Dr. Kjell Bergfeldt
and his colleagues from the Karolinska Institute in Stockholm followed
more than 30,00 women, all under age 70, when they were diagnosed with
breast cancer. Then they obtained information about the medical histories
of 146,000 of the women's first-degree relatives, including parents, children
and siblings. While it is known that women with breast cancer who have
mutations in the so-called breast cancer genes, BRCA1 and BRCA2, are at
increased risk for ovarian cancer, these mutations are rare, the authors
note. So, the researchers decided to evaluate family history to see whether
that might help them account for risk beyond having the breast cancer
genes.
After six years of
follow up, they found that women diagnosed with breast cancer were twice
as likely to get ovarian cancer as women in the general population. Family
history boosted the risk even more. Those women with breast cancer diagnosed
before age 40 and a family history of breast cancer had a five- or six-fold
increased risk for ovarian cancer. Women with breast cancer and a family
history of ovarian cancer had a 17-fold increased risk for ovarian cancer,
compared with the general population. Put another way, women with breast
cancer and a family history of ovarian cancer have an almost 10 percent
risk of getting ovarian cancer before age 70. In contrast, about 1 percent
of American and northern European women are at risk for getting the disease
before their 70th birthday.
Women at high risk
for ovarian cancer should be closely followed by their doctors and offered
counseling, Bergfeldt says. "Since the purpose of the counseling is to
achieve early detection of a severe disease, the counseling should be
performed by a physician, preferably a gynecologist familiar with ultrasound
imaging," he says.
Ultrasound is one
method used to detect ovarian cancer, which will be diagnosed in about
23,000 women this year in the United States, according to the American
Cancer Society. Identifying women at risk for ovarian cancer is particularly
crucial because the disease is difficult to detect early, even with ultrasound
and pelvic exams and a blood test that detects antigens that fight off
ovarian tumors. Preventive removal of the ovaries, called a prophylactic
oophorectomy, should also be discussed, Bergfeldt says. "If there will
be discussion concerning removal of the ovaries, I think that additional
experts should be included, that is, oncologists and specialists in genetics.
Even psychologists might be included, since removal of healthy organs
for prophylactic reasons is a difficult decision."
How willing are women
in this high-risk group to undergo ovary removal? "It is difficult to
answer such a question," Bergfeldt says. "Every individual handles risk
estimates concerning their health in different ways. Some are willing
to be very radical and take every opportunity to reduce the risk, while
others are not."
The study supports
what experts in the field have suspected and provides a practical way
for doctors to assess their patient's risk, says Dr. Robin Farias-Eisner,
a gynecologic oncologist and associate professor of obstetrics and gynecology
at the David Geffen School of Medicine at University of California, Los
Angeles. "This study supports the concept that there is a connection between
unknown genes and cancer susceptibility for ovarian cancer, and that in
the absence of these [as yet] unknown genetic risk factors, we can use
family history of breast or ovarian cancer as a predictor of those individuals
at risk," he says. "BRCA 1 and BRCA 2 account for less than 5 percent
of all breast cancer patients [risk]," he adds. To account for other risks,
Farias-Eisner and others are working to identify the biomarkers that increase
risk. "A biomarker is a gene that is turned on in the presence of disease
such as ovarian cancer," he explains. Next, the latest findings should
be replicated by other researchers, Farias-Eisner says.
[Top]
One
Drug May Be Best for Ovarian Cancer (HealthScoutNews-15/08/2002)
Women with ovarian
cancer can expect the same benefit from a single drug as they can from
combination therapy, yet with fewer side effects, a new study has found.
The drug, called carboplatin, is often used in combination with paclitaxel,
or Taxol, to treat ovarian tumors, the sixth leading cancer killer of
women in the western world. However, the new research found carboplatin
alone is no less effective than the combo therapy or another multi-drug
blend, while causing fewer serious adverse reactions.Even so, neither
carboplatin -- sold as Paraplatin by the U.S. drug firm Bristol-Myers
Squibb -- nor the joint regimens could stave off recurrences of ovarian
cancer for more than about 1.5 years, on average. Five years after starting
treatment, more than half of the 2,074 women treated in the trial were
dead.
"The results of the
study are a huge disappointment," says study co-author Dr. Christopher
Poole, a cancer expert at the University of Birmingham in England. "The
benefits of Taxol used in this way are much smaller than we'd hoped or
imagined." Poole says he and his fellow researchers were initially "incredulous"
at the results of the trial, so much so that they delayed writing them
up until they could be sure of what they'd found. A report on the findings
appears in The Lancet.
The research project
involved 130 clinical centers in eight nations, a massive undertaking.
The initial group of 2,074 women was split into three groups for their
first-line treatment: one received Paraplatin and Taxol, also a Bristol-Myers
Squibb product; one received Paraplatin alone; and members of the last
group were given a standard three-drug cocktail known as CAP. Paraplatin
is approved in this country for advanced ovarian cancer, and as part of
a combination regimen. It does not have official U.S. Food and Drug Administration
sanction for use as a first-line treatment. After an average of 51 months
of follow-up, 1,265 women had died. The rates of survival in the three
groups were effectively identical. The therapies performed equally, too,
when it came to three-year survival, running between 35 percent and 36
percent. Nor were there differences in how long it took for the tumors
to relapse.
However, women who
received Paraplatin alone generally reported fewer serious side effects,
such as hair loss, fever and loss of sensation in their skin, than those
on combination therapies. That, the researchers say, is a strong enough
argument for choosing the single injection over the multi-drug regimens
if survival differences aren't an issue. Poole says the findings suggest
combination therapies may somehow interfere with the action of platinum-based
drugs like Paraplatin. He and his colleagues are now trying to learn if
using Paraplatin followed by Taxol might not prove a better treatment
for ovarian tumors.
Experts in the United
States, however, are skeptical of the study's conclusions. Judith Hopkins,
a cancer nurse at the University of California, Irvine, says the latest
results probably wouldn't change clinical practice in this country, which
is to offer the combination of Taxol and Paraplatin. "Certainly if somebody
can show that there truly is no difference [between one drug and two or
more] and we all believe that, it would be reasonable to consider" the
single medication regimen. "But right now we are not going to jump on
the bandwagon," Hopkins says.
Dr. Maurie Markman,
director of the Cleveland Clinic Cancer Center, had even stronger words:
"I reject the idea totally that a single drug is equivalent to two drugs."
Markman says the latest study is vulnerable to a major criticism that
might be fatal to its conclusions: It took place at so many clinics that
controlling the quality of both the pathology tests and the cancer surgeries
at each was impossible. "What people are going to do in Great Britain
[and other countries from the study], I don't know," Markman says. "But
in the U.S., I would hope that no one takes it seriously."
However, Poole defended
the trial, and said the quality control criticism may in fact be a strength
of the study design. Most cancer drug trials are conducted at elite academic
institutions, he says, and therefore don't reflect the typical doctor's
practice. The fact that the latest study was so large, international and
included so many clinics "ought to increase your confidence in the robustness
of the data," Poole says
[Top]
More
data link longtime estrogen use with ovarian cancer (Associated Press-17/07/2002)
A week after breast
cancer and heart attacks were strongly linked to hormone replacement therapy,
government scientists reported finding that long-term estrogen use may
increase the risk of ovarian cancer. The new National Cancer Institute
research involving 44,241 postmenopausal women found that those who used
estrogen-only supplements for 10 to 19 years had an 80 percent higher
risk of developing ovarian cancer than women who didn't use hormone treatments.
The results, which echo two recent studies, were published in the Journal
of the American Medical Association.
The risk increased
with length of use; a threefold risk was found in women who used estrogen
for 20 or more years. Despite the increased risks, the researchers noted
that ovarian cancer was rare, occurring in 329 women during the 1979-1998
study. The results are similar to findings in a large American Cancer
Society ( news - web sites) study published a year ago in JAMA, but that
research did not include information on hormone users after 1982. In April,
Swedish researchers linked ovarian cancer to estrogen-only as well as
estrogen-progestin use. The new study also looked at ovarian cancer risks
in users of combined supplements but those results were inconclusive,
said cancer institute researcher James V. Lacey Jr., the lead author.
The study came just
a week after another government study in JAMA linked long-term use of
combined supplements to heart attacks and breast cancer. Those results
halted part of the highly regarded Women's Health Initiative study, though
the researchers are continuing to examine the health effects of estrogen-only
use in postmenopausal women. The cancer institute's ovarian cancer findings
are based on data from telephone interviews and periodic questionnaires
about hormone use and the development of ovarian cancer. Most of the estrogen-only
users had had hysterectomies; combined therapy has been recommended for
women with intact wombs because estrogen alone can cause uterine cancer.
In a JAMA editorial, Dr. Kenneth Noller of Tufts University said that
while such "observational" studies don't prove cause and effect, the ovarian
cancer results "should be worrisome enough for clinicians to consider
carefully whether to suggest estrogen-only" supplements.
[Top]
Gene
Pattern Predicts Uterine Cancer Relapse Risk-(Reuters Health-05/06/2002)
Women who have a
particular genetic pattern in endometrial cancer cells may be more likely
to relapse after treatment compared with other patients, according to
new research findings. What's more, African-American women with this type
of cancer--which forms in the lining of the uterus--may be at a higher
risk of a relapse than white patients. The genetic pattern is based on
DNA methylation--a process used by healthy cells to deactivate certain
genes, but which tends to spin out of control in tumor cells. The investigators
discovered that tumor cells that contain relatively low levels of DNA
methylation are less likely than tumors with higher levels of methylation
to recur, perhaps pointing the way towards a technique to detect who is
most at risk of relapse. Doctors may give such patients more aggressive
treatment, such as radiation, and steer women at lower risk to less aggressive
treatment, avoiding the side effects and cost associated with the additional,
unnecessary therapies, the authors note.
Endometrial cancer,
or cancer of the lining of the uterus, is the most common malignancy of
the female reproductive organs, according to the American Cancer Society.
Around 39,300 US women will develop endometrial cancer this year, 6,600
of whom will die of the disease. Women who are diagnosed early have a
much greater chance of survival. However, that near-perfect cure rate
plummets in women who are diagnosed after the cancer has spread to neighboring
lymph nodes or other body regions. Unfortunately, most women discover
their endometrial cancers at an intermediate stage, when the tumors have
spread to deeper muscle layers in the uterus, but have not yet reached
the lymph nodes. In cases where the cancer remains confined to the uterus,
doctors will simply remove the organ.
However, a small
percentage of women with intermediate tumors are at risk of a relapse
of their cancer from undetectable tumor cells that have already spread
beyond the uterus. In cases where the cancer is detected when it has clearly
advanced beyond the uterus, doctors will administer additional treatment,
usually radiation. However, radiation can cause serious side effects in
up to one fifth of patients who receive it--so what to do in patients
with intermediate cancers, who may or may not need additional therapy?
In the June issue of Cancer, Dr. Matthew A. Powell of Washington University
School of Medicine in St. Louis, Missouri, and colleagues examined risk
of recurrence of endometrial cancer in 215 women, including 39 African
Americans. Powell and his team matched risk to the pattern of DNA methylation
in regions called rDNA, which encode for ribosomes, the structures that
connect amino acids to form proteins. In a test of cells from endometrial
tumors, the investigators found that healthy cells contained relatively
little DNA methylation in the rDNA--not a surprising finding. However,
tumor cells that exhibited extremely high levels of rDNA methylation tended
to come from cancers that were much less likely to recur than those with
tumor cells that contained lower levels of rDNA methylation. Low rDNA
methylation in tumor cells was also much more common in African-American
women than in whites, perhaps explaining why black women are twice as
likely as white patients to die from their endometrial cancers, Powell
and colleagues suggest.
[Top]
Tamoxifen
Tied to Rare but Deadly Uterine Cancer (HealthScoutNews-05/06/2002)
Tamoxifen, the most
widely taken breast cancer drug, has been linked to more than three dozen
deaths from aggressive uterine tumors, prompting a more forceful package
warning to women who would use it. The Food and Drug Administration said
that between 1978 and April 2001, at least 43 women in the United States
and another 116 abroad developed uterine sarcomas after taking tamoxifen.
Of those, 38 died of the cancers, many of which were advanced when diagnosed.In
recognition of the risk, tamoxifen packaging now bears a "black box" warning,
the FDA's highest alert for prescription drugs. In addition to cautioning
women about the risks of womb cancer, the box also warns them about tamoxifen's
previously identified risks of lung clots and strokes.
However, officials
and experts stressed that women with invasive breast cancer shouldn't
stop taking tamoxifen. Rather, they said, the labeling change, which occurred
last month, is aimed at women who are considering the drug as a way to
prevent the disease or those with a localized tumor called ductal carcinoma
in situ. In both groups, its value isn't certain. "For women who have
had invasive breast cancer, their risk of recurrence is much greater than
a potential risk of tamoxifen, and the benefits of tamoxifen are well-established,"
said Dr. Susan Honig, an FDA official. Honig and two colleagues at the
agency laid out the link between tamoxifen and uterine sarcoma, as well
as the labeling changes, in a letter in the New England Journal of Medicine.
By writing to the journal, the officials hoped to reach the widest possible
group of doctors, since tamoxifen is now prescribed by not only cancer
specialists but other physicians, too.
Tamoxifen, sold as
Nolvadex by AstraZeneca Pharmaceuticals, is an anti-estrogen that blocks
the growth-promoting effects of the hormone on breast tissue. But the
drug also acts like estrogen on other tissues in the body, including the
uterus, where it has been shown to boost the risk of a different form
of uterine tumor called endometrial cancer. Endometrial cancer typically
occurs in the lining of the womb and triggers bouts of bleeding that prompt
a visit to the doctor, so it's generally caught earlier than uterine sarcomas,
which typically appear in deeper muscle and don't cause such obvious symptoms.
According to the FDA, the incidence of uterine sarcoma in women who've
taken tamoxifen is between eight and 17 times higher than it is in the
population as a whole. The disease is believed to affect between one and
two women per 100,000 in this country. The average age of the women who
developed the tumors was 63 in the United States and 65 in Europe. They
had been using the drug for an average of five years.
"This certainly should
not be a factor in any woman taking tamoxifen to treat breast cancer,"
said Wickerham, who noted that the drug reduces the risk of death from
the disease by about 25 percent. However, he added, it could be more important
to women considering the drug to prevent breast tumors, or those with
in situ tumors, for whom the survival benefit of tamoxifen hasn't been
proved. In 1998, the NCI announced the results of a major tamoxifen study
involving 13,000 women who were healthy but at risk of getting breast
cancer. It said that those taking tamoxifen were 45 percent less likely
to contract the disease than those taking a placebo. Soon after the announcement,
the FDA approved the use of tamoxifen as a preventive.
[Top]
Some
Hormone Therapies May Increase Ovarian Cancer Risk (HealthScoutNews-02/04/2002)
Conventional wisdom
has long held that hormone therapy protects women against ovarian cancer.
Now, a new Swedish study refutes that wisdom by showing some forms of
the therapy may actually increase a woman's risk of this killer disease.
Reporting in the Journal of the National Cancer Institute, Swedish researchers
say two particular types of hormone replacement therapy (HRT) -- estrogen
alone and estrogen with limited use of progestins, the synthetic form
of progesterone -- are at the center of the new finding: Both types of
therapy may increase the risk of epithelial ovarian cancer, a form of
the disease involving cells covering the outer surface of the ovaries.
American doctors,
however, say there is little for women in the United States to fear, because
both of these HRT formulas have not, for the most part, been prescribed
in the country for more than 10 years. In fact, the study of more than
4,000 Swedish women found those who used the traditional American form
of HRT, consisting of a daily dose of a combined estrogen/progestin formula,
had no increase in ovarian cancer. This was not the case, however, for
those using either estrogen alone or a "sequential" estrogen-progestin
formula. Sequential therapy consists of using estrogen alone for a portion
of the month, followed by the addition of progestin for one to two weeks
of the monthly cycle. Although the authors write that the greatest increase
in ovarian cancer was seen in women who used these two forms of HRT for
10 years or more, they also point out that the overall number of those
affected was very small -- about two to three women out of every 1,000.
For gynecologic oncologist
Dr. Giuseppe Del Priore, not only are these numbers small, they should
be of little concern to American women. "With ovary cancer, the trend
seems to be that HRT has no effect or even protective effects, and that
includes studies on epithelial ovarian cancer," says Del Priore, acting
head of gynecologic oncology at New York University Medical Center. For
the most part, American doctors stopped prescribing sequential progestins
as a form of HRT a decade or more ago, he adds. The use of estrogen-only
therapy for women with a uterus went out of favor long before that, he
says. "Today, the most commonly prescribed form of HRT in America uses
a continuous estrogen-progestin formula -- and this current dosing schedule
seems to be protective against ovarian cancer or at least does not appear
to increase the risk. For those who may still be using sequential progestin,
Del Priore says there is still little to fear: "This is just one study,
and you don't want to take it out of context."
The study relied
on the very extensive Swedish cancer registry, a nationwide government
database of patients. Using this data, researchers identified 655 women
with epithelial ovarian cancer and compared them to 3,899 cancer-free
women, all between the ages of 50 and 74. Each of the women completed
extensive questionnaires on their use of HRT and on other lifestyle factors
that might influence cancer risks.
What the researchers
found: In women who had their uterus and used estrogen alone for 10 years,
there was a 43 percent increased risk of ovarian cancer compared to women
who never used estrogen therapy. Those who had their uterus removed but
retained their ovaries suffered no ill effects from estrogen therapy.
This backs up studies published last year in the Journal of the American
Medical Association, which found that women who used estrogen therapy
for more than 10 years had double the risk of ovarian cancer. Perhaps
more importantly, the Swedish group also found that women who had used
estrogen combined with sequential progestin were up to 54 percent more
likely to develop epithelial ovarian cancer than those women who never
used this therapy.
The encouraging news:
The Swedes also found women who used the kind of HRT most often prescribed
to women in the United States did not experience any increased risk of
ovarian cancer. In addition, because the increased risks were so modest,
the authors don't suggest women change their HRT regimens based on the
new finding. Del Priore definitely agrees. "This study is something to
take note of, but nothing to be alarmed over," he says.
In an interview about
their research, the study authors said women should take into account
all the benefits of HRT when deciding what to use. But they add, "If our
findings are replicated, it would be valuable to consider the epithelial
ovarian cancer risk increase associated with the use of certain HRT regimens,
especially given the prevalence of HRT use and the poor prognosis of epithelial
ovarian cancer."
[Top]
Study
Links Blood Disorder to Ovarian Cancer (HealthScoutNews-19/03/2002)
A potential link
between ovarian cancer and a blood clotting disorder could help doctors
recognize which women require aggressive tumor treatment to survive. Dr.
Beth Karlan of Cedars Sinai Medical Center in Los Angeles says her research
has uncovered a connection between women who had an aggressive form of
ovarian cancer and a blood clotting disorder known as thrombocytosis.
"The women in our study who had developed thrombocytosis also had a more
aggressive form of ovarian cancer, and did not respond as well to treatments,"
Karlan says. The link between the two conditions occurred often enough
to be a cause for concern, she says. "It was too large a number of women
that were affected for it to be serendipitous.
But other cancer
specialists say Karlan's research is little more than speculation, and
additional research must be done to see if such a link really exists.
Karlan presented her findings at the annual meeting of the Society of
Gynecologic Oncologists this week in Miami Beach, Fla.
Thrombocytosis is
a dramatic increase in the number of blood platelets, which are manufactured
in bone marrow and help your blood to clot. The overproduction of platelets
can be a temporary response to changes in body chemistry or the reaction
to a disease, either in the bone marrow itself or another part of the
body. But in Karlan's theory, it's not just the excess platelets that
are causing problems.
Because these platelets
also emit substances called growth factors, which help tumors grow, she
believes the more platelets you have, the more aggressive your ovarian
cancer can be -- to the point where it may not respond to treatment as
effectively as it should. "What we don't know at this point is which comes
first, the cancer or the thrombocytosis," says Karlan.
For example, she
says she's not sure whether overly aggressive cancer cells signal the
bone marrow to produce more platelets, thus "feeding" the tumor with more
growth factors, or if the action of the platelets is independent of the
cancer itself.
It's this ambiguity
that leaves oncologists like Dr. David Spriggs questioning the significance
of the finding. "My argument is that it is a single retrospective study.
So while it is an interesting observation, it is one that is going to
need to be confirmed by other centers in order to make certain that this
is truly an important observation," says Spriggs, chief of the Developmental
Chemotherapy Service at Memorial Sloan-Kettering Cancer Center in New
York City. "It's not clear that thrombocytosis is going to become an important
risk factor measure, or that the theory will hold up when looked at by
other researchers," Spriggs adds.
Karlan's study involved
examining medical records of 183 women who underwent surgery for ovarian
cancer. Forty-one of those women were found to have thrombocytosis prior
to surgery. Karlan believes it's not merely coincidence that these same
41 women also had higher levels of CA125 -- a blood indicator of ovarian
cancer -- as well as more advanced cancer and "higher grade tumors." The
cancer also spread more often to nearby lymph nodes in those women who
had thrombocytosis. "This was just too obvious a finding to ignore; it
was greater than would occur by chance," says Karlan. In addition, after
surgery almost half of the 41 women with thrombocytosis were found to
have a significant degree of residual cancer. Of the 142 patients who
did not have thrombocytosis, only four had significant residual cancer.
Finally, says Karlan,
the presence of thrombocytosis also appeared to affect the length of time
a woman remained cancer-free after surgery. For those who did not have
the disorder, it was approximately 49 months before cancer reappeared;
for those with thrombocytosis, it was 38 months, she says. "Ultimately,
the women who did not have thrombocytosis survived 15 months longer than
the women who did have the disorder, indicating again an important link
to the aggressiveness of the cancer and the ability to respond to treatment,"
Karlan adds. Karlan hopes her findings may help give doctors a clue as
to which patients are more likely to have lingering cancer cells and possibly
require more aggressive treatment. And there could be medications on the
horizon to control platelet production, she says.
Spriggs remains less
convinced of the findings' significance, but believes the research is
worth following. "While I think it's worthy of further research, it's
just too early to say one way or the other what role, if any, it will
play in the treatment of ovarian cancer," he says. Based on this single
finding, he says he "does not consider thrombocytosis a marker for ovarian
cancer, or an indication of a tumor's aggressiveness or ability to respond
to treatment."
[Top]
Death
Risk Higher in Black Ovarian Cancer Patients-(Reuters Health-14/03/2002)
Although white women
in the US are more likely to develop ovarian cancer, African Americans
diagnosed with the disease may face a higher risk of death, research indicates.
The study of more than 13,000 women diagnosed with ovarian cancer between
1988 and 1997 found that black women were 30% more likely than whites
to die of any cause. Overall, African Americans lived about 10 months
less than white women, according to findings published in the March 15th
issue of Cancer.
Ovarian cancer is
among the deadliest of cancers because it may produce no clear symptoms
early on and is rarely caught before it has advanced. There has been some
evidence that survival is even poorer among African-American women.
In this latest study,
Dr. Jill S. Barnholtz-Sloan and colleagues at Karmanos Cancer Center in
Detroit, Michigan, found that black women faced a higher risk of death
from any cause even when they accounted for factors such as the patient's
age and the stage of the cancer at diagnosis. The racial difference was
"more pronounced" among older women with more advanced disease, which
accounts for some of the overall racial disparity in survival, Barnholtz-Sloan
told Reuters Health. The patients' ages ranged from younger than 40 to
80 and older.
However, Barnholtz-Sloan
said, the reasons for the survival difference are not completely clear
because her team lacked information on important factors such as income,
course of treatment and access to healthcare. They did find that black
women were less likely than whites to receive surgery for their cancer,
but again the reasons are unknown, according to Barnholtz-Sloan. She and
her colleagues call for further research into the factors that underlie
their findings.
The results are based
on data from a national cancer database that collects information on all
new cancer diagnoses in several US regions. There were nearly 12,300 ovarian
cancer cases among white women, and 800 among African Americans included
in the study.
[Top]
The
Push for Early Detection of Ovarian Cancer-(Health Scout News-10/03/2002)
Of all the cancers
that can strike a woman, ovarian cancer isn't that common. Yet, it's among
the most deadly. Like all cancers, the earlier ovarian cancer is detected,
the easier it is to treat and the higher the survival rate. However, ovarian
cancer is tough to spot in the beginning. Often, women have minor symptoms
-- or no symptoms at all -- until the cancer has reached an advanced stage.
Several recent discoveries,
however, have given researchers hope that a breakthrough in detection
will come in the near future. "Given modern methodology, there is a good
chance that we will find something sooner rather than later for early
detection of ovarian cancer," says Dr. Eddie Reed, an ovarian cancer specialist
and former National Cancer Institute researcher. "The news should be hopeful."
Researchers have
designed a computer program that looks for distinctive patterns of proteins
in blood; it appears to be a promising new screening tool for early detection
of ovarian cancer. In its first test, the computer analysis of "proteomic
patterns" was 100 percent accurate in detecting ovarian cancer and 95
percent accurate in determining that women with other diseases did not
have cancer of the ovaries, according to a recent report in The Lancet.
Such a test -- particularly a noninvasive one -- would be welcome, experts
say. Researchers at the National Cancer Institute, the Food and Drug Administration
and Correlogic Systems, Inc., a private company, developed the technique.
The results of the
first test "are certainly good enough to justify further evaluation,"
says Dr. David A. Fishman, director of the National Ovarian Early Detection
Program at Northwestern University, a study participant.
There are other promising
developments. Epidemiologist Sara H. Olson's recent study found that women
with ovarian cancer do experience certain, though subtle, symptoms. Being
aware of those symptoms could lead to earlier detection of the disease,
she explains. In her study, Olson examined 419 women, aged 40 to 70. Forty
percent of them had ovarian cancer -- some early-stage, some late-stage
-- and 60 percent were cancer-free. She found that 71 percent of the women
with cancer reported constant feelings of bloating in the abdomen, compared
to only 9 percent of those without the disease. In addition, 52 percent
of women with the cancer reported abdominal or lower back pain, while
only 15 percent of the control group did. Finally, nearly half the women
with the cancer said they lacked energy, while only 16 percent of the
healthy women reported fatigue.
"If women are better
educated [about these symptoms], they could think about going to the doctor,"
says Olson, a staff member at Memorial Sloan-Kettering Cancer Center in
New York City. Her study appeared in a recent issue of the journal American
College of Obstetricians and Gynecologists.
Unlike other female
cancers, such as those of the breast and cervix, there is no definitive
way yet to detect ovarian cancer in its early stages. So, although ovarian
cancer isn't that common -- it ranks fifth in incidence among cancers
affecting women, with approximately 23,000 new cases each year -- it causes
14,000 deaths annually. By comparison, there are 190,000 new cases of
breast cancer each year -- and 40,000 deaths, according to the American
Cancer Society.
Currently, there
are two tools available for detection of ovarian cancer, but neither is
effective at early detection, doctors say. The first, a transvaginal ultrasound,
can spot suspicious abnormalities in the ovaries. The second is a blood
test for a protein -- called CA 125 -- that is present in higher-than-normal
levels in ovarian tumors. However, the ultrasound isn't considered reliable
for early screening because it's often unable to detect new tumors. The
CA 125 test also isn't dependable because it isn't known how early in
the development of a tumor the protein levels rise, experts say.
However, effective
tools for the diagnosis of early-stage ovarian cancer could be available
in just a few years, cancer experts say. One of the most promising was
detailed in a recent issue of the Journal of the National Cancer Institute.
Doctors at Boston's Brigham and Women's Hospital have found the enzyme
prostasin is present in significantly higher levels in both early-stage
and late-stage ovarian tumors. While more research is needed, the hope
is a simple test will soon be available to detect the higher-than-normal
prostasin levels in early-stage cancer victims. "We only had 200 samples,
and need to screen 1,000 women for more accurate information, but it's
hopeful," says Samuel Mok, director of the gynecologic oncology laboratory
at Brigham and Women's and lead author of the report.
It was in the Brigham
lab that the CA 125 test was devised. Mok says that since the discovery
of prostasin, he and his colleagues have found two other proteins that
could be possible "markers," or warning flags, for early-stage ovarian
cancer. "I don't believe that one marker is enough. We need more tests
for specificity. But the CA 125 test, in combination with tests for several
markers, could detect [ovarian cancer] in the early stages," he says.
Such tests might be available within in two to five years, Mok estimates.
[Top]
Hope
for cancer therapy -(Yahoo News-05/03/2002)
Advances in mixing
anti-cancer drugs could soon lead to more effective treatment for the
disease and offer an alternative to conventional chemotherapy, scientists
say. Cancer Research UK scientists in Birmingham say they now have a better
understanding of how different drugs can be used to destroy cancer cells.
The scientists have discovered that different drugs kill cancer cells
in different ways. They believe using complementary drugs, which target
cancer cells in different ways, could help to stop tumours becoming resistant
to treatment.
Anti-cancer drugs
work by flicking a "suicide switch" within each cancer cell. Resistance
to the drugs develops when one such switch becomes jammed. The team focused
on ovarian cancer, which often responds to chemotherapy initially before
developing resistance to it at a later stage. The scientists removed cells
from ovarian tumours, grew them in the laboratory and treated them with
a range of anti-cancer drugs. Their findings should improve their understanding
of cell death mechanisms. Knowing the exact mechanism could lead to a
more effective use of combinations of chemotherapy treatments and could
be tailored for each cancer in each patient.
Scientists also hope
that choosing drugs to target several different switches all at once could
prevent a tumour from developing resistance to treatment. Team leader
Professor Lawrence Young said: "Our research has allowed us to find out
which switches are targeted by different drugs, so that we can learn to
mix and match far more effectively than is currently possible." Professor
Young and his colleagues also believe that further research into how drugs
cause cancer cells to commit suicide could pave the way for new types
of treatment.
They found treating
drug-resistant cancer cells with cell death molecules seemed to re-activate
suicide switches that had become jammed, restoring sensitivity to chemotherapy.
One cell death molecule which triggers a number of suicide switches is
CD95L. Researchers inserted this into a virus, which they then used to
infect drug-resistant cancer cells. The cell death molecule short-circuited
the cells' jammed suicide switches, knocking them into suicide mode even
though some of the switches had not been flicked.
Professor Young said:
"In the future, it might be possible to directly treat cancer cells with
these death molecules, effectively using them as anti-cancer drugs."
Professor Gordon McVie,
joint director of Cancer Research UK, said: "Professor Young's research
could have a double benefit for cancer patients. It should allow doctors
to make much better use of existing drugs, by using them in the combinations
in which they'll be most effective. And it may also lead to a new breed
of drugs that work differently from conventional chemotherapy."
[Top]
Blood
test may spot ovarian cancer: Study-(Times of India Online-06/02/2002)
A simple blood test
may identify ovarian cancer at its earliest stage, when its hardest to
spot but at its most curable, a preliminary study suggests. Currently,
around three-quarters of women with ovarian cancer are diagnosed in advanced
stages of the disease, when they have only about a 20 per cent chance
of surviving five years. But if the disease is caught early, the five-year
survival is around 95 per cent.
So providing a way
to routinely identify the disease in its "Stage I" phase "could have a
dramatic impact in what is now a very deadly cancer," said Dr. Elise Kohn,
study author. Kohn is clinical director of a joint program of National
Cancer Institute and the Food and Drug Administration that focuses on
proteomics, the study of the proteins inside cells. Scientists from those
two agencies and elsewhere present their results in a report published
online today by The Lancet.
They tried their
test on blood samples from 50 women with ovarian cancer and 66 women without
the disease. The test correctly identified all 50 samples from the cancer
patients, including all 18 samples from women with Stage I disease. And
it recognized 63 of the 66 samples that were non-cancerous. The experimental
test measures the levels of five proteins found in the blood. The combined
result in a blood sample is used to indicate the presence of cancer, said
Emanuel Petricoin of the FDA, lead author on the paper.
Dr. Lance Liotta
of the National Cancer Institute, senior investigator on the study, said
the results are "a first step. Now the test must be studied with larger
numbers of women and in different medical centres "to make sure it's as
good as we hope it can be."
[Top]
Fertility
Drugs Not Linked to Higher Risk of Ovarian Cancer-(Times of India Online-26/01/2002)
Women who take fertility
drugs are not at a higher risk for ovarian cancer, according to an analysis
of research on nearly 13,000 women, the largest study of the issue to
date, researchers said. "For more than a decade, controversy has surrounded
the relationships among infertility, fertility drug use and the risk of
ovarian cancer," said Dr. Roberta Ness, associate professor of epidemiology
at the University of Pittsburgh Graduate School of Public Health, and
principal author of the study. The study appears in the American Journal
of Epidemiology.
The researchers compared
women who had fertility problems and took fertility drugs with women who
also had fertility problems but did not take fertility drugs. They found
that women who had used fertility drugs were not more likely to develop
ovarian cancer than those who had never used fertility drugs. This analysis
helps put to rest questions regarding fertility drugs, which have become
more popular as women have children at later ages and treatment improves,
Ness said.
Women long have been
stuck with difficult decisions regarding fertility treatment, she said,
"where on one hand they are desperate to have children. They want to do
whatever they can to increase their chances. And on the other hand, they're
thinking to themselves, 'Oh my God, I'm going to take this drug, and I'm
going to increase my risk for developing one of the most terrible cancers
known to women.'"
Investigators analyzed
interview data on infertility and fertility drug use from eight studies
conducted between 1989 and 1999 in the United States, Denmark, Canada
and Australia. The studies included 5,207 women with ovarian cancer, and
7,705 women without ovarian cancer.
The results showed
that women who spent more than five years trying to conceive, regardless
of whether they were taking fertility drugs, were at a 2.7-times higher
risk for ovarian cancer than those who tried for less than one year. "Two
things will come from this study," Ness told Reuters. "One is that (women)
will be less afraid. They don't have to walk around with anxiety for the
next 20 or 30 years. And the other thing we've done here is moved the
concern from drugs to biology. (We've specified) what it is about the
biology that may be the most worrisome."
The study pointed
out a link between ovarian cancer and certain causes of infertility, specifically,
endometriosis and unknown causes of infertility. Endometriosis is a condition
in which cells from the uterine lining, or endometrium, migrate to various
sites throughout the pelvis and attach to other organs, causing inflammation
and pain, as well as infertility.
In the study, infertility
was defined as prolonged unsuccessful episodes of trying to conceive,
and by seeking medical help in conceiving. The study suggested that some
women who receive fertility treatments develop ovarian cancer because
of underlying conditions that cause infertility, not because of the treatments
themselves. Likewise, infertile women who were most likely to develop
ovarian cancer were those whose infertility resulted from endometriosis
or from unknown causes. "We are actively working to better understand
what are now unknown causes of infertility," said Ness. "Understanding
this better will give us a window into the biology behind ovarian cancer
and it will help to define the women in this high-risk group."
[Top]
US
trial to study abortion pill as cancer therapy (Times of India Online-17/01/2002)
Patients were being
enrolled in the first clinical trial to study whether mifepristone, the
abortion pill also known as RU-486, may treat certain types of endometrial
cancer, researchers said. The University of Texas M D Anderson Cancer
Center in Houston aims to enroll 37 women with types of tumors that scientists
think might shrink when treated with mifepristone. The trial is the first
to study mifepristone as a potential anti-cancer therapy since the Food
and Drug Administration approved the controversial drug in September 2000
for ending early-term pregnancies, the university said.
Advanced endometrial
cancer is hard to treat. About 36,000 new cases of endometrial cancer
were reported in the United States in 2000, and 6,500 women died from
the disease that year.
Researchers theorize
that mifepristone may fight tumors that have receptors for the hormone
progesterone by binding to those receptors, and also by blocking growth
of new blood vessels that cancer cells need to survive, said Dr. Lois
Ramondetta, the lead investigator on the trial. "We have evidence in the
lab that (mifepristone) kills or decreases the growth of hormone-sensitive
tumors," Ramondetta said in an interview.
The M D Anderson
trial will enroll patients with cancers known as recurrent and/or advanced
endometriod carcinomas or low-grade endometrial stromal sarcoma. Patients
must have progesterone-receptor positive tumors to participate. If mifepristone
shows benefits in those cases, additional studies may be done in endometrial
cancer and other hormone-associated cancers such as ovarian, prostate
and breast cancer, Ramondetta said.
Three studies outside
of the United States have shown measurable responses to mifepristone in
patients with advanced breast cancer, M D Anderson said in a statement.
[Top]
High-progestin
pill guards against ovarian cancer-(Times of India Online-02/12/2001)
Women taking birth
control pills that contain high levels of progestin may have a better
chance of avoiding ovarian cancer than women taking low-progestin oral
contraceptives, US researchers said. The findings by a group of scientists
led by Joellen Schildkraut of Duke University Medical Center appear in
the January 2 issue of the Journal of the National Cancer Institute.
Past studies have
suggested that using oral contraceptives for three or more years may be
associated with a 30 to 50 percent lower risk of developing ovarian cancer,
according to scientists. One study said decreased risk could be linked
to the pill's estrogen and progestin content, but the exact relationship
between hormone concentration and ovarian cancer risk remained unclear.
In the new study, Schildkraut and her colleagues analyzed oral contraceptive
use among 390 women between the ages of 20 and 54 years, who had been
diagnosed with epithelial ovarian cancer.
The authors separated
the women into four categories depending on the contraceptives they used:
high progestin and high estrogen; high progestin and low estrogen; low
progestin and high estrogen; and low progestin and low estrogen. They
found out that women taking low progestin-high estrogen contraceptives
were more than twice as likely to develop ovarian cancer than women who
took high progestin-high estrogen contraceptives, according to the study.
Meanwhile, women taking low progestin-low estrogen contraceptives were
60 percent more likely to develop ovarian cancer, and women taking no
contraceptives at all were nearly three times as likely to develop ovarian
cancer than women relying on high progestin-high estrogen pills.
The scientists believe
the reduction in ovarian cancer risk was likely related to the concentration
of progestin. The concentration of estrogen in the formulations did not
appear to be related to ovarian cancer risk. But the authors noted that
the oral contraceptives they studied existed more than 20 years ago and
that newer birth control pills were less potent and, therefore, might
be less likely to reduce the risk of ovarian cancer.
[Top]
Scientists
break through cancer shield-(Cancer info-17/07/2001)
Scientists have discovered
a method of overcoming resistance to chemotherapy, which could lead to
more effective treatments for cancer. Cancers are often initially sensitive
to chemotherapy, but over time many build up resistance that prevents
the treatment working. The researchers at Glasgow University have succeeded
in breaking through this "shield" of cancer cells by "switching on" genes
that allow the resistance to develop.
When chemotherapy-resistant
ovarian and colon cancer cells were treated with a drug called decitabine
they became sensitive to treatment and could be killed more easily. A
clinical trial is now planned to see if the drug, which has been tested
in the laboratory, can help patients.
Professor Bob Brown,
from the university’s Beatson Institute, said: "There’s nothing more frustrating
than a cancer that appears to be responding to chemotherapy, only to build
up resistance against it. "But drugs such as decitabine should help to
overcome that resistance, allowing cancers to be treated more effectively."
Prof Brown, the chief
researcher of the study funded by the Cancer Research Campaign, said cancer
cells built up resistance by learning how not to commit suicide. Chemotherapy
fools the DNA repair system in cells to stimulate cells to kill themselves.
If a system called mismatch repair, which detects errors in DNA and makes
sure that genes don’t get mutated goes wrong, then cells become resistant
to the treatment. Prof Brown’s team concentrated on finding out exactly
how cancer cells come to lose mismatch repair, and how, by restoring the
system, they can be made sensitive once more. The problem occurs when
a genetic switch is turned off through a process called DNA methylation.
Decitabine reverses methylation, causing the cells to be vulnerable to
chemotherapy once again.
"This may only be
the tip of the iceberg. Recent advances in the way we study DNA methylation
in the human genome are uncovering many important genes which may be targets
for these kinds of drugs," said Prof Brown.
Results from the research
will be presented today at the Genomic Regulation and Cancer conference
co-hosted by the Cancer Research Campaign in Glasgow. The event brings
together experts from Britain, America and Europe to discuss how the unravelling
of the human genome will impact on the ways cancer is researched, treated
and cured. Dr Mary Berrington, the Cancer Research Campaign’s Science
Information Manager, said: "Chemotherapy is a powerful weapon against
cancer, but too often it loses its effectiveness as tumours develop resistance."
"Professor Brown’s
research not only sheds light on how this resistance can occur, but may
have also shown us an effective way of reversing the process, potentially
making many cancers once again sensitive to treatment." Dr Lesley Walker,
director of cancer information at the Cancer Research Campaign, said drug
resistance was an important issue, which affected the treatment of many
cancer sufferers. She said progress was desperately needed in the treatment
of lung, pancreas and stomach cancers, where tumours were intrinsically
resistant to chemotherapy. "If we didn’t have resistance to drugs then
the drugs we already have would cure most people," she said. "It is a
really key area. People have not appreciated how important methylation
is for locking cells. "So this development is going to be quite important.
Chemotherapy - and targeted treatment - is going to be the big hope for
the future."
Meanwhile, a new cancer
test, which it is claimed can detect the earliest signs of more than 13
types of cancer 84 per cent of the time, is to be made available via a
network of private practitioners across the UK. The blood test, known
as DR-70, detects the condition before it has progressed to the stage
where treatment is ineffective, according to its developers. The Derby-based
firm DR-70(UK) Ltd said it was ideal for people with a family history
of cancer and for people in remission.
However, Dr Walker
said she would like to see more published data on the test, especially
analysis of how sensitive it was as an early warning system. She said
she was concerned about the possibility of someone without cancer testing
positive and then having to undergo extensive hospital examination to
prove there were no cancerous cells. "We do not really know how sensitive
it is and whether it would give you an early warning sign of cancer developing,"
she said.
[Top]
Cancer
warning over HRT drug-(Cancer info-06/07/2001)
A drug used as hormone
replacement therapy (HRT) may actually encourage the growth of some kinds
of ovarian cancer. Laboratory tests on cancer cells found that Raloxifene,
a commonly prescribed drug in the UK, stimulated growth in those sensitive
to the effects of the female hormone estrogen. The drug is given to help
women who have had their ovaries removed in an effort to beat the cancer,
and are subsequently vulnerable to post-menopausal problems such as bone
thinning.
Now, however, there
is the suggestion that it might, in some cases, accelerate the re-growth
of cancers from any cells left behind by treatment. Doctors say it would
therefore be unwise for any woman with an "estrogen positive" ovarian
cancer, in which the cells have "receptors" which are sensitive to the
hormone, to be given the drug.
The warning was sounded
at the European Society of Human Reproduction and Embryology conference
in Lausanne. Dr David Tourgeman, an assistant professor of obstetrics
and gynecology at the University of Southern California-Keck School of
Medicine in Los Angeles, took cells from an ovarian cancer and exposed
them to the same concentration of Raloxifene that might be produced by
a standard 60mg dose.
He found it caused
the cells to proliferate, growing faster than they would under normal
conditions. Dr Tourgeman said: "To our knowledge, it is the first time
that the effect of Raloxifene on ovarian cell lines has been evaluated.
"Currently, there is much debate amongst oncologists whether the presence
of estrogen receptors on ovarian cancers necessarily means that estrogen
itself will stimulate the growth or reappearance of the tumour, and ovarian
cancer is not generally considered a contra-indication to prescribing
estrogen-replacement therapy."
However, he said that
as many as 60% of some kinds of ovarian tumours would be responsive to
estrogen, and that a cautious approach was necessary. "Raloxifene may
not be a good alternative to estrogen-replacement therapy in women with
estrogen positive ovarian cancer." Even with this mind, he said, it might
be premature to withhold completely estrogen-replacement therapy from
patients, as the benefits for bone density and heart protection were considerable.
[Top]
Long-Term
Use of Estrogen Linked to Ovarian Cancer-(Cancer Info-05/04/2001)
Women who use estrogen
for more than 10 years to ease the effects of menopause have twice as
high a risk of dying from ovarian cancer as those who did not, researchers
reported. However, the overall risk of fatal ovarian cancer is low. Long-term
postmenopausal estrogen replacement therapy doubles it from about 1 percent
to 2 percent over a lifetime and no single recommendation applies to all
women.
The study followed
211,581 postmenopausal women from 1982 to 1996 and found that those who
used estrogen for more than a decade had an increased risk of ovarian
cancer. Women who used estrogen for less than 10 years had no increased
risk, and those who did use it for long periods and then stopped saw the
risk decline with time.
Postmenopausal women
generally have less estrogen in their bodies, and this can put them at
higher risk for osteoporosis and heart disease. Estrogen replacement therapy
can counter these risks. But some studies have shown that estrogen therapy
increases the risk of endometrial cancer, or cancer of the uterine lining.
A combination therapy using estrogen plus the hormone progesterone or
its synthetic version, called progestin, may offset the uterine cancer
risk but could be associated with increased breast cancer risk if used
over the long term. Most of the women in the study were taking only estrogen,
rather than estrogen plus progestin. It is not known what the addition
of progestin to the estrogen will do on ovarian cancer risk. It may happen,
as with endometrial cancer, that the risk goes down, or like with breast
cancer, that the risk is higher.
Women must balance
risks and benefits from the various therapies. Women should discuss their
health with their doctors, taking into account their risk for coronary
heart disease, breast cancer and ovarian cancer. But there is not any
contra-indication for a short-term use of hormone replacement therapy
and it certainly improves the quality of life.
[Top]
Estrogen,
Ovarian Cancer Linked-(Cancer Info-22/03/2001)
Women who take estrogen
for 10 years or longer after menopause substantially increase their risk
of dying of ovarian cancer compared with women who do not take the hormone,
according to a study released yesterday. During the 14-year study of more
than 211,000 post-menopausal women, those who had been taking the hormone
for a decade or more at the start of the project had more than twice the
death rate from ovarian cancer seen in women who had not taken estrogen.
Women who had taken estrogen for less than 10 years had a slightly higher
risk than nonusers, but the difference was not statistically significant.
Previous studies of
estrogen use and ovarian cancer have yielded inconsistent findings, although
some have suggested cancer risk might be increased in long-term users.
The new study is the largest so far and the only one to question women
about risk and then follow them for an extended period, monitoring cancer
deaths.
Although cancer of
the ovary is rare, it is particularly serious because in most cases, the
tumor has spread by the time it is detected. A woman at average risk has
about a 1 in 59 chance of developing ovarian cancer sometime during her
life, compared with a 1 in 9 lifetime chance of breast cancer. Cancer
of the ovary kills about 14,000 women in the United States annually.
Experts said the new
findings are likely to further complicate women's already difficult decisions
about whether to take hormones after menopause. An estimated 8.6 million
post-menopausal women in the United States take combination hormone therapy
with estrogen and progestin, and an additional 12 million (who have had
hysterectomies) take estrogen alone.
The study is very
important because of its size and raises concern that, although very rare,
ovarian cancer might be something that you would need to consider in deciding
whether to take hormones after menopause.
Besides relieving
short-term menopausal symptoms such as hot flashes and sleep disturbances,
estrogen helps prevent the bone-thinning common in older women and has
been found in several studies to reduce the death rate from heart disease,
as well as lowering overall mortality.
However, a woman's
decision about taking estrogen has become increasingly difficult in recent
years as evidence emerged that it was not risk-free. Taking estrogen without
progestin increases a woman's risk of cancer of the endometrium, the lining
of the uterus, while studies published last year suggest that taking combination
hormone therapy significantly increases the risk of breast cancer, especially
after several years of treatment. Estrogen also increases the risk of
blood clots and gallstones. Women who have been on hormones for many years
and those considering long-term treatment may wish to discuss the findings
on ovarian cancer with their doctors to determine whether the benefits
for them outweigh the risks.
Certainly there is
not any problem with using hormone therapy for a short period of time.
Decisions about long-term treatment will depend on the health profile
of the woman. Not all women will have the same benefits from estrogen
or combination therapy.
The findings come
from the Cancer Prevention Study, an American Cancer Society project that
recruited 1.2 million people in 1982. Participants filled out a detailed
questionnaire on lifestyle and possible cancer risk factors. From 1982
to 1996, researchers periodically obtained information from death certificates
and tabulated cancer deaths among the participants. A total of 944 women
in the study died of ovarian cancer during the follow-up period, including
255 who had reported taking hormones after menopause and 689 who had not.
The researchers did not obtain information on the types of hormones taken,
but at the time the study began, it was still common for doctors to prescribe
estrogen alone rather than estrogen plus progestin.
Women who had been
on estrogen for 10 or more years at the start of the project had 2.2 times
the death rate from ovarian cancer found in those who had never taken
the hormone. Among former users who reported taking the hormone for 10
or more years, the death rate was 1.6 times that seen in nonusers. Once
a woman stopped taking estrogen, her risk of ovarian cancer appeared to
decrease gradually with time. Estrogen stimulates cell growth and division
in the ovaries, but the precise mechanism by which its use after menopause
may increase cancer risk is not known.
In contrast with post-menopausal
estrogen, a history of taking birth control pills earlier in life has
been clearly shown to reduce the risk of ovarian cancer. Women who have
borne children are also at lower risk, as are women who have had a tubal
ligation. A family history of ovarian cancer is a risk factor, but most
women with ovarian cancer don't have a family history. It is very hard
to know what to do with this information, because screening modalities
to detect ovarian cancer at an early stage are not good.
Women should keep
in mind that ovarian cancer is rare. While the study suggests that there
is an increased risk after 10 years of estrogen use, the overall likelihood
for a woman developing ovarian cancer is very low.
[Top]
Potent
platinum cancer drug shows promise-(Cancer Info-21/12/2000)
Clinical trials of
a new platinum-based cancer drug could hold promise for many cancer patients,
in particular the nearly 25,000 women in the United States who each year
develop ovarian cancer. Platinum is front-line therapy for ovarian and
testicular cancer. One of the principal platinum drugs, cisplatin, is
effective but ovarian cancer cells quickly become resistant to the drug.
In mice, the new platinum medication showed activity against cisplatin-resistant
ovarian cancer. Code-named BBR3464, it belongs to a new class of platinum
drugs. The new drug is also significantly more potent than cisplatin,
which means much lower doses and lower overall toxicity.
In Phase I studies
of 47 cancer patients completed in Europe last year, the new class of
drugs also showed preliminary signs of activity against pancreatic cancer,
melanoma and lung cancer. Phase II clinical trials, which could involve
more than 200 patients, are underway in Europe and the United States.
One study will deal specifically with ovarian cancer.
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Update
on ovarian cancer-(Times of India-14/08/2000)
Ultrasound screening
is effective at identifying early ovarian cancer. Ovarian cancer has a
very poor prognosis, largely because it is difficult to detect in its
early stages. If found early however, it is generally responsive to treatment.
Researchers have developed a standard regimen of ultrasound imaging to
detect ovarian cancer and tested it in more than 183,000 women over the
course of 10 years. The screening takes less than a minute and women whose
ovaries were found to exceed the sizes citedin the study’s standards were
referred for secondary screening. 320 went on to have surgery. 22 ovarian
tumours were detected and 2 others which had spread. 17 of the 22 primary
tumours were classified as Stage I, the most treatable form. All these
women survived. There were no false positive diagnoses and no cases of
ovarian cancer were subsequently reported in women whose tests were negative.
The regimen may be
more effective for some types of ovarian cancers, and may be more cost
effective if used with blood markers that may signal ovarian cancer.
[Top]
Heredity
cancer less fatal-(Times of India-04/05/00)
Women whose ovarian
cancer is tied to heredity survive longer than women for whom the disease
is not, apparently because the cancer cells in the first group are more
susceptible to chemotherapy, researchers have reported. The study has
significance for further approaches to treatment.
[Top]
Gene
therapy cures ovarian cancer woman – (TOI-03/02/00)
British doctors have
used gene therapy to cure a woman dying from ovarian cancer. It marks
the first successful use of gene therapy against any cancer and could
lead to cures for other forms of the disease. Cancerous tissues were infected
with a simple cold virus that had been modified to carry human genetic
material to stop cancer cells from multiplying. The treatment was administered
four years ago when the woman was critically ill but it has taken until
now to be sure she is cancer free.
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