The current standard regimen for advanced ovarian cancer is paclitaxel (Taxol) and the platinum compound carboplatin. Alternatives are docetaxel (Taxotere) with carboplatin or paclitaxel with cisplatin, another platinum compound. Recent clinical trials found no difference in survival between patients receiving carboplatin with either docetaxel or paclitaxel, but the docetaxel/ carboplatin group had a greater incidence of myelosuppression. Those receiving paclitaxel/carboplatin had more neuropathy. Newer drugs being combined with carboplatin and paclitaxel are topotecan, liposomal doxorubicin, and gemcitabine.
The Gynecologic Oncology Group (GOG), a research group funded by the National Cancer Institute, is currently conducting a clinical trial for high-risk early-stage disease comparing three cycles of paclitaxel/carboplatin followed by surveillance versus paclitaxel alone weekly for 24 weeks. The GOG is also proposing a clinical trial on the use of carboplatin and paclitaxel combined
with bevacizumab to treat advanced ovarian cancer.
Friday, November 24, 2006
Categories of Ovarian Cancer
Three major categories of ovarian cancer have been identified: Epithelial cancers, arising from the cells lining or covering the ovaries, account for 90% of ovarian malignancies. Epithelial cancers are further classified as serous (most common), endometrioid, clear cell, mucinous, and poorly differentiated. Germ cell cancers start in cells destined to become ova. Stromal cell cancers start in the connective tissue cells that hold the ovaries together and produce female hormones.
Symptoms of Ovarian Cancer
Contrary to what you may have heard, ovarian cancer does present with signs and symptoms. Unfortunately, they can be so general—lower abdomen discomfort, dyspepsia, and early satiety, for example—that you dismiss them. The most important message I can convey is: Don't ignore any persistent symptoms. The classic pelvic examination—during which the clinician searches for palpable ovarian masses—is the starting point for a diagnosis of ovarian cancer. In premenopausal women, enlarged ovaries are common and usually are caused by ovarian cysts. The clinician usually follows the mass through several menstrual cycles.
In premenarchal children and adolescents and postmenopausal women, a palpable ovarian mass isn't normal and must be investigated with a CA-125 tumor antigen blood test and a transvaginal ultrasound. Color Doppler imaging studies also may be used to measure blood flow patterns to ovarian vessels. Increased blood flow resistance signals a mahgnancy. If these studies document an abnormality, the next step is a computed tomography scan of the abdomen and pelvis, possibly followed by a barium enema or a colonoscopy.
The CA-125 tumor antigen is associated with ovarian cancer. In fact, 80% or more of women with ovarian cancer have an elevated CA-125 level. The problem is that it's also elevated in some benign diseases and other malignancies as well, so it's not specific enough to detect the disease. The CA-125 tumor antigen has a role in indicating early treatment failure, confirmation of relapse, and in decision making during relapse therapy in ovarian cancer.
In premenarchal children and adolescents and postmenopausal women, a palpable ovarian mass isn't normal and must be investigated with a CA-125 tumor antigen blood test and a transvaginal ultrasound. Color Doppler imaging studies also may be used to measure blood flow patterns to ovarian vessels. Increased blood flow resistance signals a mahgnancy. If these studies document an abnormality, the next step is a computed tomography scan of the abdomen and pelvis, possibly followed by a barium enema or a colonoscopy.
The CA-125 tumor antigen is associated with ovarian cancer. In fact, 80% or more of women with ovarian cancer have an elevated CA-125 level. The problem is that it's also elevated in some benign diseases and other malignancies as well, so it's not specific enough to detect the disease. The CA-125 tumor antigen has a role in indicating early treatment failure, confirmation of relapse, and in decision making during relapse therapy in ovarian cancer.
Ovarian Cancer and Tea
If you need one more reason to begin a habit of drinking tea, the results of a new Swedish study might just push you over the edge and into the tea aisle of your grocery or health food store. Susanna C. Larsson, MSc, and colleagues reported in the Archives of Internal Medicine that middle-aged women who drink two or more cups of green or black tea every day may reduce their risk for invasive epithelial ovarian cancer by almost half.
The Karolinska Institute researchers studied 61,057 women ages 40 to 76 who completed a diet questionnaire and were then tracked for an average of 15.1 years. Women who consumed two or more cups of tea per day lowered their risk for ovarian cancer by 46%, with each additional cup lowering the risk by another 18%. The study found that even enjoying a spot of tea only occasionally offered some benefit: Those who drank less than one cup daily still reduced their risk somewhat when compared with women who rarely or never drank tea.
Tea contains antioxidant polyphenols, substances thought to block cell damage that can lead to cancer. Jeffrey Blumberg, PhD, a professor in Tufts' Friedman School of Nutrition Science and Policy, notes that the antioxidant capacity per cup is similar between green and black tea. You can think of tea as another serving of plant food, providing phytochemicals similar to those in fruits and vegetables, Blumberg says.
The results in the Swedish study may not be entirely due to tea, however, Julie Buring, DSc, of Harvard's Brigham and Women's Hospital cautioned in an Associated Press report. She noted the study also found that women who drank tea tended to be in better health, thanks to lifestyle habits. Indeed, the study's authors acknowledged that "the women who were regular tea drinkers were also those who ate more fruits and vegetables, were slimmer, and generally more health-conscious."
Still, Larsson and her team concluded that the dose-response relationship for tea consumption with ovarian cancer risk makes a strong case for the preventive properties of tea.
The Karolinska Institute researchers studied 61,057 women ages 40 to 76 who completed a diet questionnaire and were then tracked for an average of 15.1 years. Women who consumed two or more cups of tea per day lowered their risk for ovarian cancer by 46%, with each additional cup lowering the risk by another 18%. The study found that even enjoying a spot of tea only occasionally offered some benefit: Those who drank less than one cup daily still reduced their risk somewhat when compared with women who rarely or never drank tea.
Tea contains antioxidant polyphenols, substances thought to block cell damage that can lead to cancer. Jeffrey Blumberg, PhD, a professor in Tufts' Friedman School of Nutrition Science and Policy, notes that the antioxidant capacity per cup is similar between green and black tea. You can think of tea as another serving of plant food, providing phytochemicals similar to those in fruits and vegetables, Blumberg says.
The results in the Swedish study may not be entirely due to tea, however, Julie Buring, DSc, of Harvard's Brigham and Women's Hospital cautioned in an Associated Press report. She noted the study also found that women who drank tea tended to be in better health, thanks to lifestyle habits. Indeed, the study's authors acknowledged that "the women who were regular tea drinkers were also those who ate more fruits and vegetables, were slimmer, and generally more health-conscious."
Still, Larsson and her team concluded that the dose-response relationship for tea consumption with ovarian cancer risk makes a strong case for the preventive properties of tea.
Thursday, November 23, 2006
Treating Ovarian Cancer With Ginger
Researchers at the University of Michigan Comprehensive Cancer Center,
Using a standardized research grade ginger powder dissolved in solution, the researchers applied ginger to ovarian cancer cell cultures. The ginger caused two types of cell death—apoptosis and autophagy, in which cells digest themselves— in all the ovarian cancer cell lines tested. "In multiple ovarian cancer cell lines, we found that ginger induced cell death at a similar or better rate than the platinum based chemotherapy drugs typically used to treat ovarian cancer," says Jennifer Rhode, MD, a gynecologic oncology fellow at the University of Michigan Medical School. While the study results are still very preliminary, the researchers, who presented their finding at the poster session at the American Association for Cancer Research annual meeting, plan to test whether they can obtain similar results in animal studies. The advantage of using ginger to treat ovarian cancer is that it could be administered in capsule form with virtually no side effects.
Stages of Ovarian Cancer
Stage 1: Tumor limited to the ovaries
IA , limited to one ovary, no tumor on the ovarian surface, no malignant cells in ascites or peritoneal washings, capsule intact
IB , limited to both ovaries, no tumor on the ovarian surface, no malignant cells in ascites or peritoneal washings, capsules intact
IC , limited to one or both ovaries, tumor on ovarian surface, capsule ruptured, ascites or peritoneal washings containing malignant cells
Stage 2: Tumor involving one or both ovaries with pelvic extension
IIA , extension or metastasis to the uterus or tubes, no malignant cells in ascites or peritoneal washings
IIB , extension to other pelvic tissues, no malignant cells in ascites or peritoneal washings
IIC , pelvic extension, ascites fluid or peritoneal washings containing malignant cells
Stage 3: Tumor involving one or both ovaries, peritoneal implants outside the pelvis or regional lymph node metastasis
IIIA , gross tumor limited to the true pelvis, negative nodes, microscopic peritoneal metastasis beyond the pelvis
IIIB , macroscopic peritoneal metastasis 2 cm or less in greatest dimension beyond the pelvis
IIIC , abdominal implants greater than 2 cm in greatest dimension or positive regional nodes
Stage 4: Tumor involving one or both ovaries, metastasis greater than 2 cm in greatest dimension beyond the pelvis. If pleural effusion is present, cytologic test results must be positive.
Parenchymal liver metastases equals stage 5.
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