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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
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