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Ovarian cancer has often been referred to as a 'silent killer', but new preliminary findings from an Australian study show the disease is in fact not silent - these latest data show most women (83 per cent) experience at least one symptom of ovarian cancer in the year prior to their diagnosis.

The study also revealed 17 per cent of women waited more than three months after the onset of their symptoms before visiting their doctor, with 8 per cent waiting more than six months.

"The most common reason for the delay was an assumption that the symptoms were not serious, with many women attributing them to another medical condition or the natural process of ageing," said Dr Helen Zorbas, CEO, National Breast and Ovarian Cancer Centre.

The study by National Breast and Ovarian Cancer Centre in collaboration with the Queensland Institute of Medical Research, examined the pathways taken by 1500 Australian women to their diagnosis of ovarian cancer, strengthening the case for women to be aware of the symptoms of the disease.

"As there is no screening test for ovarian cancer, the first step to diagnosis is a woman identifying symptoms which are persistent and unusual for her and seeking medical attention. It is therefore vital that women are aware of the symptoms to look out for," said Dr Zorbas.

The symptoms of ovarian cancer include:

- abdominal bloating
- abdominal or back pain
- appetite loss or feeling full quickly
- changes in toilet habits
- unexplained weight loss or gain
- indigestion or heartburn
- fatigue

  The most common symptoms, experienced by half of the study participants, were abdominal symptoms such as fullness and pain. Bloating, bowel or urinary symptoms were reported by approximately one third of participants.

"We know many women will experience these symptoms as part of everyday life," said Dr Zorbas. "But if any of these symptoms are unusual for you and they persist, it is important to see your doctor. No one knows your body like you do."

This year about 1300 women will be diagnosed with ovarian cancer in Australia. More than half of women diagnosed do not survive five years after their diagnosis. More than 70 per cent of women are diagnosed at an advanced stage, where the cancer has spread and is difficult to treat successfully.

National Breast and Ovarian Cancer Centre is funded by the Australian Government and works with consumers, health professionals, cancer organisations, researchers and governments to improve care and cancer control in breast and ovarian cancer. Queensland Institute of Medical Research coordinates the Epidemiology core of the Australian Ovarian Cancer Study. The Australian Ovarian Cancer Study is a collaborative research program between clinicians, scientists, patients and advocacy groups aimed at improving the prevention, diagnosis, and treatment of ovarian cancer.

Source
Bree Stevens
Senior Communications & Policy Officer
National Breast and Ovarian Cancer Centre
Level 1, Suite 103, 355 Crown Street SURRY HILLS NSW 2010
Telephone + 61 2 9357 9402 Mobile 0438 209 833 Facsimile + 61 2 9357 9477
http://www.nbocc.org.au

Like to eat meat? Consider this unappetizing truth: When you gulp down a nice juicy steak or hamburger, you are contributing to tumor-fueling inflammation in your body.In fact, eating a diet rich in red meat has long been linked to a host of ills including an increased risk of several types of cancer. But what is it about meat consumption that could impact cancer growth? Now scientists at the University of California, San Diego School of Medicine, have found a mechanism that explains how eating red meat, as well as milk, could spur the growth of malignancies. The new study, headed by Ajit Varki, M.D., suggests that inflammation resulting from a molecule introduced through eating these foods could make cancer grow. The research is set for upcoming publication in the Proceedings of the National Academy of Sciences (PNAS).Dr.Varki, UC San Diego School of Medicine distinguished professor of medicine and cellular and molecular medicine and co-director of the UCSD Glycobiology Research and Training Center, and his research team studied a non-human glycan, or sugar molecule, known as N-glycolylneuraminic acid (Neu5Gc). Although this molecule is not produced naturally in the human body, it’s incorporated into human tissues if you eat red meat. The body then develops antibodies against Neu5Gc – and this immune response could potentially trigger a low-grade chronic inflammation, spurring the growth of cancer. In a statement prepared for the media, Dr. Varki explained it has been recognized by scientists for some time that chronic inflammation can stimulate cancer progression."We've shown that tumor tissues contain much more Neu5Gc than is usually found in normal human tissues. We therefore surmised that Neu5Gc must somehow benefit tumors,” Dr. Varki said in the press statement. So the scientists came up with this hypothesis: The fact that Neu5Gc accumulates in human tumors despite circulating anti-Neu5Gc antibodies suggests a low-grade, chronic inflammation has developed, and caused the tumor to grow. To test this idea, the researchers worked with specially bred mice. The animals lacked the Neu5Gc molecule , just as humans do before they eat red meat and the molecule is absorbed into their bodies, and they had tumors.Anti-Neu5Gc antibodies were given to half of the mice . In those animals, the antibodies induced inflammation and their cancers started growing faster. In the control group comprised of mice that were not treated with antibodies, their tumor growth was far less aggressive.Building on previous research that has shown that humans who take non-steroidal anti-inflammatory drugs (commonly known as NSAIDs) have a reduced risk of cancer, the researchers tried giving NSAIDs to the mice with cancerous tumors fueled by anti-Neu5Gc antibodies. The result? The anti-inflammatory treatment blocked the effect of the Neu5Gc antibodies and the tumors became smaller."Taken together, our data indicate that chronic inflammation results from interaction of Neu5Gc accumulated in our bodies from eating red meat with the antibodies that circulate as an immune response to this non-human molecule – and this may contribute to cancer risk," Varki said in the media statement.For anyone interested in reducing inflammation through natural, non-drug methods, here are seven top strategies to incorporate into your lifestyle:1. Stop eating meat and dairy products.2. Concentrate on a Mediterranean flavored style of eating with lots of fruits, vegetables, whole grains , olive oils and nuts. Research has shown these foods lower inflammation levels.3. Don’t smoke and avoid those who do – second hand smoke can contribute to inflammation.4. Know your oils. Avoid all inflammation-causing trans-fats, hydrogenated and partially hydrogenated oils as well as saturated animal fats. Instead, add inflammation-fighting omega-3 oils like flaxseed, canola and walnut oil to your diet.5. Lose weight if you need to. Research has shown that a waist that measures over 40 inches in a man or over 35 inches in a woman is a sign of probable high inflammation.6. Don’t skimp on sleep. Previous studies have concluded less than six hours of sleep can result in inflammation .7. De-stress. Try yoga, meditation, walking and other forms of exercise. Staying continually stressed out means your body is releasing excess, inflammation-promoting stress hormones . Schedule a minimum of 20 minutes a day to let your worries go.

National Cancer Intelligence Network Press Release
Women living in the most deprived areas of England are nearly twice as likely to be diagnosed with cervical cancer than their affluent counterparts – according to a report presented by national cancer director Professor Mike Richards at the Britain Against Cancer conference today (Tuesday).
The report, published by the National Cancer Intelligence Network (NCIN), reveals a 'deprivation gap' that researchers believe is mainly fuelled by a lower uptake of cervical screening in deprived areas.
All cases of cancer diagnosed between 1995 and 2004 were included in this nation-wide analysis of the effect of deprivation on cancer incidence, including more than 25,000 cases of cervical cancer.
In the most deprived areas* of England, there were 12 women per 100,000 diagnosed with cervical cancer between 2000 and 2004. In the most affluent areas, only 6 per 100,000 women were diagnosed with the disease during the same time period.
Professor David Forman, NCIN information lead who is based at the University of Leeds, said: "These striking figures show there is still much more that needs to be done to tackle cancer in low-income communities.
"Cervical cancer is a largely preventable disease – the national screening programme will pick up most cases before they even develop into cancer. Our figures suggest that women living in poorer areas are less likely to attend cervical screening than women who are better-off, so they are more likely to develop the disease.
"Higher rates of smoking in most deprived areas and the earlier onset of sexual activity also contribute to the higher rates of cervical cancer."
Currently, women in England aged 25 to 64 are invited for cervical screening every three to five years. In 2006, around 20 per cent of women in England invited for cervical screening did not attend, and previous research** has shown that women in deprived areas are around 40 per cent less likely to attend. Screening can pick up on important changes to cells before cervical cancer develops.
Sara Hiom, director of health information at Cancer Research UK, said: "It's extremely worrying that your income and where you live can have such a significant effect on your risk of cancer. It's clear that much more needs to be done to encourage women from low-income communities to attend cervical screening."
Women living in deprived areas were 129 per cent more likely to be diagnosed with cervical cancer between 1995 and 1999. This figure was 106 per cent between 2000 and 2004. Although this drop is not statistically significant, doctors hope this downwards turn will continue.
Professor Mike Richards, who will present the report on behalf of the NCIN, said: "Reducing inequalities in cancer incidence and uptake of cancer services is a key aim set out in the Cancer Reform Strategy. Collecting and understanding data like this is a crucial first step in achieving this goal. The NHS Cancer Screening Programme is working with the Improvement Foundation, to improve the uptake of cervical screening in poor areas through targeted pilot programmes. The lessons learnt from this work due in 2009, will be shared with Strategic Health Authorities and local screening programmes to develop best practice."
Professor Julietta Patnick CBE, director of NHS Cancer Screening Programmes, said: "This is a helpful report shedding light on the relationship between cancer and deprivation. Over recent years we have seen a downward trend in women taking up their screening invitation, especially younger women and those in deprived inner city areas, and the reasons for this are difficult to determine. Cervical screening saves around 4,500 lives a year, and it is important for women to consider this when deciding whether or not to accept their invitation."
Sara Hiom added: "Most cases of cervical cancer are caused by HPV – a sexually transmitted virus – and smoking increases the chances of the virus causing cancer. Greater awareness of the link with smoking and, most importantly, of cervical screening are all key to reducing the risk of cervical cancer in deprived areas. Cancer Research UK is investing in research to understand how to improve public health and cervical screening coverage in low-income groups."
ENDS
For media enquiries please contact the NCIN press office on 020 7061 8300 or, out-of-hours, the duty press officer on 07050 264 059.
Notes to editors:
* The report separated England into five groups, graded from the least deprived to the most deprived. Each cancer patient was put into a group based on their postcode of residence, using a standard national measure of deprivation.
** Time dependent response to invitation for cervical screening. Richardson et al. NHS Cervical Screening Publications, Publication No 29. March 2007
In September 2008, the rollout of the Human Papillomavirus (HPV) vaccination programme – which protects against two strains of HPV that cause over 70 per cent of cases of cervical cancer – began for girls aged 12-13. For more information, visit CancerHelp UK.
In the UK, around 2,800 women are diagnosed with cervical cancer each year, and around 1,000 women die from the disease.
For more information on cervical screening, visit CancerHelp UK.
The report looked at the association of all of the common cancers with deprivation. Overall, people living in deprived areas were 19 per cent more likely to be diagnosed with any type of cancer between 1995 and 1999. This figure was 15 per cent between 2000 and 2004. The difference between figures was not statistically significant. Apart from cervical cancer, several others showed a similarly strong association with deprivation, including head and neck, lung, stomach and liver cancer.

Advanced-Stage Ovarian Cancer Patients with BRCA Live Longer, May Respond Better to Standard Treatment
Majority of Women with Ovarian Cancer Unaware BRCA Testing is AvailableTwo abstracts underscoring the importance of testing for BRCA1/2 mutations in women with ovarian cancer were presented at this week's Society of Gynecologic Oncologists 39th Annual Meeting on Women's Cancers, by researchers from The University of Texas M. D. Anderson Cancer Center. In the first study, a multicenter research team led by M. D. Anderson found advanced- stage ovarian cancer patients with non-Ashkenazi Jewish BRCA (non-AJ BRCA) mutations experience longer progression-free and overall survival rates compared to those with sporadic ovarian cancer. The data confirms previous research which reported that among ovarian cancer patients of Ashkenazi-Jewish heritage, BRCA1/2 mutations (AJ BRCA) are associated improved long-term survival. For this study, researchers examined 85 advanced-stage ovarian cancer patients with non-AJ BRCA mutations and 116 patients who did not express any type of BRCA mutation. Compared to patients without BRCA mutations, non-AJ BRCA carriers had longer progression-free survival of 19.0 vs. 27.8 months and improved overall survival of 65.6 vs. 101.4 months. Non-AJ BRCA patients had a 2.15 times greater odds of complete response to initial chemotherapy response over sporadic, non-carrier patients. Karen Lu, M.D., associate professor in the Department of Gynecologic Oncology at M. D. Anderson and senior author on the study said the difference in survival rates indicate that individuals with BRCA mutations might respond better to standard chemotherapy for ovarian cancer. "Thus, it becomes increasingly valuable to know a patient's BRCA status to guide and personalize treatment decisions," Lu said. Majority of Patients Unaware BRCA Testing Available A second study conducted at M. D. Anderson concluded that, despite being available for more than 10 years, a majority of women with ovarian cancer were unaware genetic counseling and testing for BRCA1/2 mutations was an option. Of the 225 ovarian cancer patients surveyed, 56 percent had not heard of BRCA testing. This lack of awareness was more profound in minorities - 69 percent of Hispanic and 88 percent of African American respondents were unaware of BRCA testing compared to 52 percent of white women. "Patients typically associate genetic testing with benefiting family members and offspring," Lu said. "Both of these studies illustrate that it is equally important for the cancer patient to get information from their doctors about genetic testing because it not only has implications for their family, but their own treatment and prognosis." She said that more than 85 percent of ovarian cancer patients surveyed would be willing to undergo BRCA testing if it would affect their care, but the cost of testing may be a barrier. "Currently, oncologists are inconsistent in their testing for BRCA mutations. Based on the treatment implications of our findings and the surprisingly low knowledge that such testing is available, we recommend developing ways to systematically evaluate every ovarian cancer patient for BRCA," Lu said. A family history of breast and/or ovarian cancer is reported in approximately five percent to 15 percent of ovarian cancer cases, with BRCA1/2 mutations expressed in a significant proportion of these cases. In addition to Lu, researchers contributing to the abstract on BRCA survival advantage include lead author Robin Lacour, M.D., Molly Daniels, M.S., Shannon Westin, M.D., Larissa Meyer, M.D., Charlotte Sun, Dr.P.H., Diana Urbauer, M.S., Pedro Ramirez, M.D., Diane Bodurka, M.D., David Gershenson, M.D., all of M. D. Anderson. Others include Veena Choubey and Stephanie Blank, M.D., New York University Medical Center; Heather MacDonald, M.D. and Lynda Roman, M.D., University of Southern California Medical Center; Jacob Estes, M.D. and Mack Barnes, M.D., University of Alabama Birmingham; Deanna Teoh, M.D. and Beth Ann Powell, M.D., University of California at San Francisco Medical Center; Rebecca Brooks, M.D., David Mutch, M.D. and Sherri Babb, M.S., Washington University (St. Louis) Medical Center; Shana Wingo, M.D. and John Schorge, M.D., The University of Texas Southwestern Medical Center at Dallas. On the BRCA genetic testing abstract, with Lu other authors include: Lacour, Kristin White, Molly Daniels, Shannon Westin, Larissa Meyer, Catherine Burke, W.H.N.P., Kimberly Burns, W.H.N.P., Shiney Kurian, W.H.N.P., Nicki.Webb, W.H.N.P., Terri Pustilnik, M.D., Diana Urbauer, Charlotte Sun, Diane Bodurka, David Gershenson of M. D. Anderson.

The Role of Radiotherapy in the Management of Ovarian CancerArticle by: Nagendra Sai Koneru, M.D., Anthony Fyles, M.D., William Small Jr., M.D.What is Radiation Therapy?Radiation oncology is a branch of medicine that manipulates ionizing radiation to treat cancer and other benign diseases. The goal of radiation therapy is to eradicate cancer cells through the delivery of a measured dose of radiation to a precisely defined tissue volume, while attempting to minimize damage to any healthy surrounding tissue. In ovarian cancer radiation oncologists work closely with gynecologic oncologists, who are the primary surgical oncologists that treat ovarian cancer, and medical oncologists. Both medical and gynecologic oncologists deliver chemotherapy.Radiation kills cancer cells by damaging the DNA. Tumor cells often have impaired repair mechanisms that are normally found in healthy cells. Thus, tumor cells can be inherently sensitive to radiation effects. Damage to DNA can occur by direct interaction of radiation with a cell’s DNA or indirectly by the creation of free radicals that are produced by the interaction of radiation and water within the cell.Radiation oncologists use linear accelerators to deliver radiation to a patient. Linear accelerators are treatment machines that selectively create high-energy radiation beams which are then directed at a specific target. Epidemiology of Ovarian CancerThere are three primary types of ovarian cancer. Epithelial ovarian cancer comprises approximately 80%-90% of ovarian cancer and will be the subject of this review. Germ and stromal tumors represent the remaining 10-20%. There are numerous risk factors for ovarian cancer and can include lower number of pregnancies, nulliparity and infertility [3]. Oral contraceptive use has been shown to reduce the risk of ovarian cancer [4]. Women who have a family history of breast cancer or ovarian cancer are at increased risk. Gene mutations in BRCA1 and BRCA2 have been observed in many of these families. Hereditary non-polyposis colon cancer (HNPCC) is a genetic syndrome that has been associated with colon, endometrial and ovarian cancer.Detection/ScreeningRoutine screening for ovarian cancer has not been recommended because there have been no reliable markers for detecting early epithelial ovarian cancer [1,5] although routine gynecologic care should still be recommended. The tumor marker CA-125 has been found to be helpful in ovarian cancer screening. The combination of a pelvic exam, transvaginal ultrasound and a blood test for CA-125 can be offered for women who are symptomatic or at high risk [1,5].Clinical PresentationEpithelial ovarian cancer does not present with specific signs or symptoms. Patients most commonly present with abdominal distention, however, heartburn, nausea, and lower abdominal pain can also manifest [5].Ovarian cancer is often metastatic or spread beyond the ovaries at presentation and confined to the ovary in only 23% of cases [6]. The peritoneum is a multilayered membrane which lines the abdominal cavity, and supports and covers the organs within it. The most common route of spread is through the peritoneum (transperitoneal) and the disease is confined to the abdominal cavity in 85% of patients [6]. However, ovarian cancer may also spread through the blood or lymphatics.The Federation of International Gynecologists and Obstetrics (FIGO) has grouped ovarian cancer into four primary stages. Stage I disease is limited to the ovaries. Stage II involves tumor spread in the pelvis beyond the ovaries. Stage III involves spread outside the pelvis but confined within the abdominal cavity or inguinal nodes. Stage IV disease involves tumor in one or both ovaries with distant metastasis, such as the liver parenchyma or lungs. Microscopically the aggressiveness of the tumor is classified according to its grade, ranging from 1 to 3. Grade 1 shows the least aggressiveness, while grade 3 shows the most.Overall 5 year survival, including all stages for ovarian cancer, is 53% [1]. For early stage disease, the 5 year survival is 94.7%. For intermediate stage disease, the 5 year survival is 72% [1]. For late stage, the 5 year survival is 30.7% [1].TreatmentSurgery is the standard initial management of ovarian cancer [6]. Because of transperitoneal spread and the frequent appearance of upper abdominal disease, pre-treatment surgical staging is performed. Surgical staging involves partial omentectomy, visualization or the entire peritoneum, biopsy of any suspicious or palpable lesions, and cytologic examination of ascites or peritoneal washings from pelvis, paracolic gutters, and diaphragm [6].Studies have revealed that the amount of residual tumor volume after surgery may impact survival. As residual tumor volume increases, median survival decreases [6]. Cytoreductive surgery is thus recommended for maximum tumor removal [6]. For stage I, grade 1 disease, surgery alone has a 5% relapse rate and is often the only treatment modality used [6]. Patients with stage I disease with unfavorable prognostic factors, such as grade 2 or 3, and patients with stage II and III disease are often recommended to have surgery followed by intravenous (IV) carboplatin and paclitaxel chemotherapy, since there is often at least a 30% risk of recurrence [2]. Recent trials have shown that platinum-based adjuvant chemotherapy improved survival and recurrence-free survival in early-stage ovarian cancer [7]. Alternatively, intraperitoneal (IP) chemotherapy, which involves injecting chemotherapy directly into the abdomen, has gained recent attention and may be considered an alternative to IV chemotherapy in certain clinical situations [8]. Adjuvant abdominopelvic radiotherapy can also be used in selected patients [9].Rationale for Radiation TherapyEvidence that radiation therapy is an effective adjuvant therapy in certain stages and extents of ovarian cancer has been proven in several trials [6]. For early and intermediate stage disease, trials have shown that radiotherapy to the whole abdomen following surgery to be more effective than certain chemotherapy and pelvic radiation. Although there have been no randomized trials comparing platinum based chemotherapy to whole abdominal therapy, platinum based chemotherapy has largely supplanted the use of radiotherapy in the United States. However, radiotherapy does have a role in both cure and symptom control in patients with ovarian cancer.A Princess Margaret Hospital randomized trial of 147 patients compared pelvic radiotherapy alone or with chlorambucil chemotherapy to whole abdomen radiotherapy, in patients with stages I-III disease. After a 7 year follow-up, the 10-year difference in survival was significantly higher in the 76 patients treated with pelvis plus whole abdomen radiotherapy compared to the 71 patients treated with pelvic irradiation and chlorambucil (46% vs 31%, p=0.05) [10]. The survival benefit was only seen in patients with small macroscopic residual tumor

Researchers identify ovarian cancer biomarkersFinding could be first step toward new screening tool, treatmenttargetAnn Arbor - Researchers have identified markers unique to the cells of blood vessels running through ovarian tumors. The finding, while preliminary, could one day improve screening, diagnosis and treatment for this disease. The team of researchers from the University of Michigan, University of Pennsylvania, and universities in Greece and Italy used a laser technique to isolate blood vessel cells from 21 ovarian tumors and four normal ovarian tissue samples. From there, they were able to determine which genes the vascular cells expressed.The results identified more than 70 markers that were present in large amounts in the blood vessels of cancer tissue but not in the vessels of normal tissues. The researchers went on to study in detail 12 markers that had not previously been linked to tumor blood vessels. The study appears in the March 1 issue of the Journal of Clinical Oncology."Some of these genes, depending on how highly expressed they were in the tumor vasculature, were also prognostic of a patient's survival. We suspect when these genes are highly expressed it may be a sign of a tumor that's able to grow blood vessels more efficiently, and therefore is more aggressive. This may help us down the road in treatment decisions," says lead study author Ronald Buckanovich, M.D., Ph.D., assistant professor of internal medicine and obstetrics and gynecology at the University of Michigan Medical School. Buckanovich was at the University of Pennsylvania when he conducted this research.The study analyzed the largest number of samples to date in tumor vasculature, or blood vessel, profiling. While many of the genes identified in this analysis have been shown previously to be involved in tumor vasculatures for other cancer types, several of the markers appear to be new.In addition, the researchers were able to determine that some of the markers present in large amounts in ovarian tumors were not expressed by normal ovaries or other healthy organs. The researchers also found these markers were not present in normal reproductive tissues that experience blood vessel growth, such as the placenta or endometrium. This suggests that the markers are specific to tumors and would not be mistaken for normal blood vessel growth in women of reproductive age.If the markers do prove to be specific to ovarian tumors, researchers believe that could be a new avenue to develop drugs that would target the blood vessels and strangle the tumor.Biomarkers are also seen in other cancer types as a potential screening tool. A new way of detecting ovarian cancer could make a significant dent in this disease, where 70 percent of patients are diagnosed after the tumor has grown large or spread. There are few or no symptoms early in the disease and no effective screening tests. Early diagnosis is crucial, marking the difference between a 95 percent survival rate for cancers found at the earliest stage and 20 percent survival among patients diagnosed with advanced disease."All the things we could hope for are present with this approach: It has potential for diagnosis, imaging, treatment and prognosis. It needs more work and much more confirmation, but our early results are promising," Buckanovich says.Continued research will look at developing antibodies and methods to detect these novel proteins. "In some cases, these are genes that many people have never worked on before," Buckanovich says.The American Cancer Society estimates 22,430 women will be diagnosed with ovarian cancer this year and 15,280 women will die from it.The research is very preliminary at this point. Any potential screening or treatment benefit would be many years in the future. For information about currently available therapies, call the Cancer AnswerLine at 800-865-1125 or visit their web page.In addition to Buckanovich, study authors were Dimitra Sasaroli, Anne O'Brien-Jenkins, Jeffrey Botbyl, Rachel Hammond, Lance A. Liotta, Phyllis A. Gimotty and George Coukos, all from the University of Pennsylvania; Dionysios Katsaros of the University of Turin in Italy; and Raphael Sandaltzopoulos of the Democritus University of Thrace in Greece.Funding for the study was from the National Institutes of Health, a National Cancer Institute Specialized Program of Research Excellence (SPORE) grant, the U.S. Army Medical Research and Materiel Command Grant, the Marcia and Philip Rothblum Foundation and the Ovarian Cancer Research Fund. The laser-capture microdissection facility was supported by the Fannie Rippel Foundation.

Source: Memorial Sloan Kettering Cancer CenterUnderutilized Treatment for Advanced Ovarian Cancer Found to Significantly Improve SurvivalNEW YORK, January 4, 2006 - According to a study published in the January 5 issue of the New England Journal of Medicine, women with Stage III ovarian cancer given a combination of intravenous (IV) and intra-abdominal chemotherapy, following the successful surgical removal of tumors, experienced a median survival time 16 months longer than women who received IV chemotherapy alone. Intra-abdominal chemotherapy, also known as intraperitoneal (IP) chemotherapy, involves the delivery of anticancer drugs directly into the abdomen. This type of chemotherapy administration is underutilized, but significant evidence from this new study confirms the survival benefit of IP chemotherapy for most women with advanced ovarian cancer.The study, conducted by Deborah K. Armstrong, MD, an assistant professor at the Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland, and her colleagues, builds upon evidence from eight other clinical trials -- including those conducted at Memorial Sloan-Kettering Cancer Center (MSKCC) -- showing an overall survival period of approximately one year for women treated with IP chemotherapy after "optimal debulking" -- surgery to remove most, if not all, of the cancer in the abdomen. Based on this overwhelming evidence, the National Cancer Institute (NCI) will issue a clinical announcement on January 5 encouraging the administration of a combination of IV and IP chemotherapy to treat women with advanced ovarian cancer, who have undergone optimal surgical debulking. After pioneering the first clinical trials of IP chemotherapy in the late 1980s, MSKCC is one of the most experienced centers with the largest volume of patients who have undergone the procedure. The Center has been using IP chemotherapy as a standard of care based on Dr. Armstrong's presentation at the American Society of Clinical Oncology's annual meeting in May 2005 and research conducted at MSKCC.

The Shape of Health to Come M. D. Anderson to help endometrial cancer survivors take "Steps to Health"While millions of Americans place fitness as one of their top New Year's resolutions to improve shape, muscle tone and overall appearance, cancer survivors have another priority - life.Researchers at The University of Texas M. D. Anderson Cancer Center have developed a customized fitness program to help survivors of endometrial cancer - or cancer of the uterus - shed pounds and keep cancer at bay. Karen Basen-Engquist, Ph.D., principal investigator of the five-year "Steps to Health" study and associate professor in the Department of Behavioral Science, aims to determine how well participants adhere to a personalized fitness plan, motivation both for beginning and sustaining regular workouts and the role of a support system in encouraging determination.All endometrial cancer survivors who are six months post treatment - from M. D. Anderson or elsewhere - are eligible to participate in the Steps to Health study, funded by the National Cancer Institute.Following an initial 30-minute orientation, including an electrocardiogram, researchers will assess participants at baseline and again every two months using a series of health and quality-of-life questionnaires, as well as fitness tests on an exercise bike. Depending on a participant's current physical ability, exercise physiologists and fitness specialists then will create a customized plan for each survivor.According to Basen-Engquist, cancer survivors' confidence following a stressful course of treatment often can be diminished."I'm most interested in learning which factors encourage survivors to persist with exercise and take charge of their cancer prevention for the future," said Basen-Engquist. "As the risk for endometrial cancer is two-to four-fold greater in obese women than the general population, we hope that providing a personalized exercise plan for this population will be an incentive to achieve improved physical and psychological well-being.Basen-Engquist and her team intend to enroll 270 participants into the study, each of whom will personally record her physical activity for six months using a portable personal computer. Researchers will build on the body of evidence gleaned from a five-week pilot study conducted before the official launch of the Steps to Health study."Our team is interested in assisting participants with the actual process of initiating and incorporating physical activity into daily life," said Basen-Engquist. "We hope to discover individual traits and tools that enable certain people to stay with an exercise plan better than others."In addition to bimonthly assessments, M. D. Anderson researchers will mail information regarding goal setting and fitness tools to all participants and provide weekly telephone counseling. Study leaders will use social cognitive theory, which measures how individuals adopt and maintain behavioral patterns, in developing intervention strategies for participants."By participating in the Steps to Health pilot study, I developed an increased awareness of how essential exercise really is to maintain health," said Maureen Hughes, endometrial cancer survivor. "It is easy to keep putting exercise off, but when I was presented with all the information, I couldn't deny its importance for my well-being."While researchers will measure physical and biological changes in participants, they also will evaluate self-efficacy, or survivors' confidence that they can succeed. Researchers also plan to determine the level of support participants need to exercise and feel successful.According to the American Cancer Society, approximately 41,200 women in the United States will be diagnosed with endometrial cancer in 2006 and approximately 7,350 of these women will die from the disease, making it the most commonly diagnosed cancer of the female reproductive organs.

Source: University of Michigan Comprehensive Cancer Center (January 10, 2007) 15 common myths about cervical cancerU-M experts explain common misconceptions, fears about this largely preventable diseaseAnn Arbor - About 9,700 women in the United States will be diagnosed with cervical cancer this year. It may seem like a small number, until you consider that another 1.2 million women will develop a pre-cancerous condition called dysplasia. And if left untreated, dysplasia will become cervical cancer.Because of Pap smears, a huge number of women are no longer dying of cervical cancer in this country, but this is a disease that can be almost entirely prevented," says Carolyn Johnston, M.D., clinical associate professor of obstetrics and gynecology at the University of Michigan Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center.In addition to early detection through screening, a new vaccine now available could help prevent cervical cancer. In honor of Cervical Cancer Awareness Month, which is January, U-M experts respond to common myths and misconceptions about this disease.Myth 1: Cervical cancer cannot be prevented.Truth: Infection with the human papillomavirus, or HPV, is an absolute requirement for cervical cancer to develop. This virus is transmitted sexually, but the majority of the most worrisome types of infection can be prevented with a newly available vaccine. Preventing HPV infection dramatically reduces a woman's risk of cervical cancer. In addition, cervical cancer usually develops slowly after persistent infection with HPV and will first appear as a precancerous condition called dysplasia. If detected at this stage, it can be effectively treated to prevent cervical cancer from developing. Screening with Pap smears and tests for HPV detect these pre-cancerous conditions so patients are treated early.Behavioral issues can also influence cervical cancer. "A woman can reduce her risk of these problems by limiting the number of sexual partners over a lifetime, by not smoking cigarettes and by following accepted screening guidelines. Each of these behaviors relates to known risk factors for this disease," says Anthony Opipari, M.D., Ph.D., associate professor of obstetrics and gynecology at the U-M Medical School. Myth 2: I'm too young to worry about cervical cancer.Truth: The average age of cervical cancer patients is 48. While it's not common, women can be diagnosed in their 20s. HPV infection and the precancerous condition dysplasia are common in younger women.Myth 3: I don't have intercourse, so I don't need the HPV vaccine.Truth: HPV can be passed from one partner to another through intercourse, as well as orally and through touching. In 2006, the Food and Drug Administration approved a vaccine, Gardasil, to protect against four types of HPV, two of which are commonly linked to cervical cancer and two linked to genital warts. A CDC advisory committee recommended that Gardasil be given routinely to girls age 11-13. Until everyone is vaccinated, girls and women ages 13-26 are also candidates for the vaccine. Experts believe the vaccine should be given at a young age before a woman becomes sexually active. Myth 4: I had the HPV vaccine, so I don't need to use condoms during sex.Truth: The HPV vaccine will protect you from infection with four types of HPV - but there are other strains of this virus and many other sexually transmitted diseases that it does not protect against. Continue using condoms to protect against STDs.Myth 5: I don't need a Pap test.Truth: A woman's first Pap test should be given when she turns 21 or three years after she begins having intercourse, whichever comes first. Recommendations differ for how often a woman should receive a Pap test. Ask your doctor how often you should be screened. Even if you have the HPV vaccine, you still need a regular Pap test. The vaccine targets four types of HPV but it will not protect against all the types of HPV that can cause cervical cancer, so it's still important to continue regular screenings.Myth 6: I'm too old to need a Pap test any longer.Truth: "We have seen an increase in cervical cancer and HIV in older populations," says Lauren Zoschnick, M.D., clinical assistant professor of obstetrics and gynecology at the U-M Medical School. "Women can have new sexual partners, which puts them at risk of cervical cancer and other STDs." Talk to your health care provider about the need to have Pap smears even if you have gone through menopause, have had a hysterectomy, or are over the age of 65.Myth 7: My doctor gave me a pelvic exam, which is the same as a Pap test.Truth: The Pap test collects cells from the cervix, which are sent to a lab to be evaluated. In a pelvic exam, your doctor physically examines the cervix and other parts of a woman's anatomy. Both are important to detect problems early.Myth 8: My Pap test was abnormal, which means I must have cancer.Truth: Not necessarily. You'll likely need follow-up tests, possibly a test for HPV, colposcopy or a biopsy to test for cancerous cells. An abnormal Pap test could indicate a precancerous condition that can be treated. Conversely, a negative Pap test does not always mean a woman is cancer-free. About 10 percent of all Pap tests return a false negative result, meaning the test did not identify a problem that is there. If you have problems such as bleeding or pain, seek further care even if your last Pap test was normal.Myth 9: Cervical cancer has no symptoms.Truth: Bleeding after intercourse, bleeding between menstrual periods or bleeding after menopause may indicate cervical cancer. Other symptoms include an abnormal discharge or pain in the pelvic region.Myth 10: If I am diagnosed with cervical cancer, I am going to die.Truth: Survival after cervical cancer caught in its earliest stage is 92 percent. The later it is diagnosed, the lower the chance of survival. Survival is lower in developing countries because of inadequate screening. Regular screening will help ensure cervical cancer is caught at an early, treatable stage.Myth 11: After I finish treatment, I will live the rest of my life worried about cancer returning.Truth: If cervical cancer is going to recur, it is most likely to happen in the first two years after treatment. Most patients are followed for five years, after which the risk of recurrence is extremely low.Myth 12: I must have a hysterectomy to treat cervical cancer.Truth: Early cervical cancer is typically treated with a hysterectomy, surgery that removes the cervix and uterus. But it's not the only option. Radiation and chemotherapy are used to treat more advanced disease and may also be options for women with early stage disease who cannot have surgery. Some women with early cervical cancer can also avoid hysterectomy with procedures such as a cone biopsy that removes only the cancerous tissue and a small margin of surrounding healthy tissue, or a procedure called radical trachelectomy, which removes the cervix but not the uterus.Myth 13: I won't be able to conceive a child after cervical cancer treatment.Truth: If you have a hysterectomy or radiation to treat cervical cancer, you will not be able to conceive. But newer surgical procedures help preserve a woman's fertility without compromising survival. A radical trachelectomy removes the cervix but not the uterus so that a woman can still conceive. For small, early cancers, a cone biopsy may be appropriate and will also preserve fertility.Myth 14: A hysterectomy to treat cervical cancer will put me in menopause afterward.Truth: Hysterectomy to treat cervical cancer does not remove the ovaries, which are what determines whether a person is menopausal. Cervical cancer very rarely spreads to the ovaries. Women who receive pelvic radiation to treat cervical cancer will likely experience menopause because the radiation will affect the ovaries.Myth 15: Taking hormone replacement therapy will increase my risk of cervical cancer.Truth: Cervical cancer does not respond to hormones like breast or ovarian cancers. Low doses of hormone replacement therapy can treat menopausal symptoms without increasing the risk of cervical cancer.For more information about cervical cancer and the HPV vaccine, visit the following resources: U-M Cancer Center Cervical Cancer information page U-M Cancer AnswerLine: 800-865-1125