Showing posts with label cancer. Show all posts
Showing posts with label cancer. Show all posts

Tuesday, November 6, 2012

Identifying women with undetected ovarian cancer: independent and external validation of QCancer(®) (Ovarian) prediction model.


Identifying women with undetected ovarian cancer: independent and external validation of QCancer(®) (Ovarian) prediction model.


 Nov 2012

Source

Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford, UK.

Abstract


Early identification of ovarian cancer is an unresolved challenge and the predictive value of single symptoms is limited. We evaluated the performance of QCancer(®) (Ovarian) prediction model for predicting the risk of ovarian cancer in a UK cohort of general practice patients. A total of 1.1 million patients registered with a general practice surgery between 1 January 2000 and 30 June 2008, aged 30-84 years with 735 ovarian cancer cases, were included in the analysis. Ovarian cancer was defined as incident diagnosis of ovarian cancer during the 2 years after study entry. The results from this independent and external validation of QCancer(®) (Ovarian) prediction model demonstrated good performance on a large cohort of general practice patients. QCancer(®) (Ovarian) had very good discrimination with an area under the receiver operating characteristic curve of 0.86 and explained 59.9% of the variation. QCancer(®) (Ovarian) was well calibrated across all tenths of risk and over all age. The 10% of women with the highest predicted risks included 64% of all ovarian cancer diagnoses over the next 2 years. QCancer(®) (Ovarian) appears to be a useful tool for identifying undetected cases of ovarian cancer in primary care in the UK for early referral and investigation.

Saturday, November 3, 2012

Azaya ramps up effort to produce generic cancer drug


Azaya ramps up effort to produce generic cancer drug


Nov 2012

Azaya Therapeutics is conducting a study of a generic version of a popular drug used to treat ovarian cancer. The company hopes that drug will fill a gap in the market next year.
Azaya’s drug is currently known as ATI-0918, but it is essentially a generic copy of the drug Doxil. The company that was producing Doxil recently shut down its manufacturing operation and this has led to a worldwide shortage of the drug for ovarian and breast cancer patients.
In response, San Antonio-based Azaya has accelerated efforts to produce a generic version in hopes of having the product on the market by 2014. The U.S. Food and Drug Administration has approved the new study and Azaya expects to file for full approval to market the drug later next year.
“We have been working on this development program of ATI-0918 since 2009 and it is gratifying to finally get the product into the clinic for final testing,” says Mike Dwyer, president and CEO of Azaya. “We expect to have the results of this study by mid-year 2013 and file all of the required information and the clinical data for regulatory approval shortly thereafter.”
see also: 

Sunday, September 2, 2012

Leg Swelling and Ovarian Cancer

Arm and Leg Swelling After Cancer 

With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically. With this progress, a new and often misunderstood and misdiagnosed complication has arisen. 

Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs. 

This swelling occurs because of one of several factors. 

First, the swelling begins after lymph nodes have been removed for cancer biopsies.

Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system. 

Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids. The fluids collect in the limbs effected and swelling beings. 

This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable. 

Permanent Leg Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses oflymphedema must be considered**** 

There are several groups of people who experience leg swelling from known causes, but it doesn’t go away or unknown causes where the swelling can actually get worse as time goes by. 

Group One 

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema. 

Group Two 

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body’s waste fluid. In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries. This is also referred to as secondary lymphedema. 

Group Three 

Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time. 

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later. This type of leg swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system. This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics. 

What is Lymphedema? 

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system. 

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema. 

What are the symptoms of Lymphedema?

If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them. 

1.) Unexplained aching, hurting or pain in the leg. 

2.) Experiencing “fleeting lymphedema.” This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction. 

4.) Any arm inflammation, redness or infection. 

5.) You may experience a feeling of tightness, heaviness or weakness of the leg. 

How is Lymphedema Treated? 

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment. It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally. With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size. 

What are some of the complications of lymphedema? 

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids. 

4. Loss of Function due to the swelling and limb changes. 

5. Depression – Psychological coping as a result of the disfigurement and debilitating effect of lymphedema. 

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections. 

7. Sepsis, Gangrene are possibilities as a result of the infections. 

8. Possible amputation of the limb. 

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids. 

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured? 

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

Lymph Nodes Female

Lymph Nodes Female


The abdominal/pelvic region is rich in lymph nodes and a very complex lymphatic system. This shows the lymph nodes that are likely to be effected by ovarian cancer treaments, biopsies and radiation.
lymph_nodes_female

female-genitalia-nodes

pelvic-and-abdominal-nodes

pelvic-lymph-nodes

intestinal-lymph

lymphatis_system

When Silent Cancer Speaks Loudly

When Silent Cancer Speaks Loudly


Part 1: How Ovarian Cancer Beat My Mother
By Suja S. Amir
Freelance Wirter – United States
The word cancer strikes a chilling chord with most people. It sends out the message of fear and death. It creates mental images of the physical side effects of chemotherapy and the flashing symbol of “radiation”.
Cancer, although extremely prevalent in Western society, is unfortunately a condition that educates most only after direct experience through friends, family or other loved ones. My education about cancer was no different. My mother was diagnosed with ovarian cancer on the 29th of August 2008. From that point on, everything was different.
Prior to the 29th, my mind was on other things. Ramadan was on its way and I was excited. I have a habit of “practicing” fasts to prepare my mind and body for Ramadan and this year, it was more important for me since the days were longer. I started my practice fast mid-August and shortly after my first few, I got a call from my mother saying she was admitted to the hospital for abdominal pain. She was admitted by her gastroenterologist, a physician who is specialized in treating disorders related to the digestive system.
The normal worries ran through my mind about the possibilities of my mother’s condition. At 68, she was in pretty good health. My mother’s occupation as a registered nurse meant she was extremely vigilant about her health and check ups. Recently, my mom was even more conscientious about her health as my father had passed at age 70 (of natural causes) in February 2007. She had high blood pressure and had her thyroid removed six months prior, but nothing that stood out.
There wasn’t a family history of any other condition that crossed my mind. She had mentioned some earlier symptoms to me, but they were vague. Abdominal distention, early satiety (feeling full early), and bloating all seemed to point towards a gastrointestinal problem. She had gotten every test known prior to her admission and everything was normal before August.
A Harsh Reality
When the final diagnosis came on the 29th of August, it felt like I was hearing something about someone else, someone else’s family. This couldn’t possibly be happening to my mother. It was a harsh reality to face. Listening to the doctor explain the diagnosis, the treatment plans and the outlook felt extremely unreal. She was diagnosed with ovarian cancer, stage IIIc (the cancer metastases are larger than 2 centimeters). For all intents and purposes, that didn’t make much sense to me. Although the doctor took his time and explained everything very eloquently, I was still a bit “shell shocked”.
After I put down the phone, I did what most of us do. I went to the “Google Dr.” and searched for some answers. I had a ton of questions. Questions like, why wasn’t this caught earlier? What tests could she have gotten to find out about this earlier? Weren’t there some signs to tell her that this was going on? Why did they only find out so late in the stage of ovarian cancer? What is chemotherapy? Will chemotherapy cure her? Is there a genetic component?
The list of questions just went on and on through my mind. As I did my internet research, I kept seeing a phrase that just sent chills every time I saw it. Ovarian cancer is sometimes called the “silent cancer”. I thought, silent? Silent??? That’s the LAST thing you want to hear about any medical diagnosis. And given the severity of any cancer, silent is not what comes to mind. You want to know that there are identifiable symptoms and tests. You want to know that there are tests that can accurately diagnose in order to optimize the treatment plans. But everything I was reading or hearing from the doctors as the days went on did not give me much more to go on. I was left with the idea that my mom was in agonizing pain from a “silent” cancer, a cancer that essentially crept up on her over a matter of weeks.
Chemotherapy was ordered because the doctors felt the tumor was too large for operation and felt chemotherapy would help shrink the tumor. My mother’s abdomen was extremely distended and looked as if she was about seven months pregnant. Oddly, her abdomen had looked normal only a few weeks prior. My brother and I sat with her, watching how she was grappling with the idea of cancer. My mother was now dealing with a situation she could not understand herself. My mother’s thirty years as a registered nurse, who took care of patients with worse conditions, did not know how to be on the other side.
Blessing
As Ramadan started, my anxiety went up about how I was going to manage being able to help my mom and fast. The only thing that kept me going was the thought that Allah doesn’t place a burden on a person greater than he/she can bear. I knew that fasting would drain me, but looking back, I doubt that I would have been able to focus if I was not fasting. Fasting sharpened my goals and sharpened my mind towards Allah. Fasting allowed me to ignore the worldly distractions that kept arising daily.
One night, as I sat next to my mother holding her hand a few days after her chemotherapy, I was gazing at the TV above her bed and just sat there, dumbfounded at the TV program. It was a telethon for cancer. “Stand Up To Cancer.” What? Ironically, the month of September is Cancer Awareness month. I was sitting there, by her bedside, just watching these people talk about all types of cancers, the need for awareness, the need for research and it just felt unreal.
It was only a few days after the chemotherapy treatments that my mother’s condition worsened. The outlook was grim. She was not improving and the pain of this tumor pressing on her internal organs was making it more difficult to breath. My brother, a cardiologist, who had taken time off to help with my mom had started looking more and more worried. I saw his frustration and helplessness. It must have been torturous for him to be a trained medical professional, but not have any idea or ability to help rid my mom of the pain she was experiencing. We sat next to her as the days passed, with nothing more than hugs, kisses and prayers to offer. No amount of medicine, visits from nurses or doctors were helping her condition.
Her oncologist came in one day to meet with us and said, “I was really hoping that the chemotherapy would have shrunk this tumor by now. But this is the most aggressive case of ovarian cancer I have ever seen. It is probably best to just make her comfortable now.” With that, my brother’s face just went pale. None of us wanted to give up on her ability to fight this disease, least of all my brother. He had been trying so hard to be there for my mom the way he felt my father would have wanted him to be. I know he took this as some sort of failure on his part, but it really was God’s will.
We moved her to hospice care and she was moved to our house. My kids decided they needed to be close to her and used her room as a play room. She died on September 14th, 2008. I was blessed with three weeks with my mother from the time of diagnosis to the time she left this world. I was blessed because I was given time to spend with her before she left us. I had time to talk to her, express my feelings to her and tell her exactly how much she meant to me. After all that has happened, I am left with the cloud of cancer, which is now “in the family”.
Education about ovarian cancer is important and any woman should educate herself as much as she can about it. Next week I will tell you what I’ve learnt in the second part of this series.
Suja S. Amir has a B.S. in Psychology from Virginia Commonwealth University. She has ten years of experience in nonprofit management in the US. She can be reached by sending an e-mail to sciencetech@iolteam.com.