Is Early Detection of Ovarian Cancer Possible?

Advances in medical technology have led to potentially useful techniques for the early detection of epithelial ovarian cancer. Early detection of ovarian cancer is crucial for survival as women found to have Stage I or II disease have a 5-year survival of 90% and 70%, respectively, whereas those with advanced disease (Stage III and IV) have a survival of approximately 20%. The circulating tumour marker CA-125 has been extremely useful in following women known to have epithelial ovarian cancers. It has been employed in differentiating benign tumours from malignancies, and is now being tested in a variety of programmes for its role in the early detection of ovarian cancer. The application of endovaginal ultrasound and colour Doppler flow techniques to early detection of ovarian cancer have resulted in several large series identifying ovarian cancer in 1: 1000 to 1: 2000 postmenopausal women screened. However, a high false positivity rate persists using CA-125 and ultrasound techniques alone or in sequence. Developments in molecular genetics may be extremely useful in evaluating women with inherited susceptibilities for this disease, but this probably represents only about 3% of the population of the women who develop epithelial ovarian cancer. The cost-benefit analysis of isolated screening for epithelial ovarian cancer using CA-125 and ultrasound techniques, even in women at high risk for the disease, would suggest that such screening is not cost-effective at this time.     

Oligometastatic Non-Small Cell Lung Cancer: A Significant Entity outside of Specialized Cancer Centers?

Objective

To report the incidence, patterns of care, and outcomes of oligometastatic non-small cell lung cancer (NSCLC) in a rural practice setting in Norway.

Materials and Methods

A retrospective analysis was conducted of all patients with stage IV NSCLC at the initial diagnosis who received active treatment in the central part of Nordland, a rural county in northern Norway, during the period of 2006–2012. We analyzed overall survival and prognostic factors.

Results

The initial study population included 113 patients with stage IV disease who received active therapy; of these, 23 (20%) had oligometastatic spread (a maximum of 3 metastases to 1 organ). The median age was 71 years. Of the 23 patients, 16 (70%) did not receive radical or at least moderately aggressive local treatment for their thoracic disease. Of the remaining 7 patients, 4 (17.4%) did not receive systemic therapy. The median actuarial survival was 5.6 months in patients with more advanced metastases and 11.7 months in those with oligometastases (p = 0.03). Significant differences were also seen between the 2 oligometastatic patient groups with and without more intense thoracic treatment (median 19.7 vs. 7.6 months, p = 0.004). Further significant predictors of survival in patients with oligometastases were nodal stage (p = 0.028) and weight loss (p = 0.045). Trends were seen for T stage (p = 0.058) and performance status (p = 0.07).

Conclusion

Oligometastatic NSCLC was diagnosed in a relevant proportion of patients; therefore, warranting prospective studies are recommended. Such studies are also needed to confirm the treatment-dependent survival differences observed in our patient population.Key Words: Non-small cell lung cancer, Disease stage, Staging, Metastases, Oligometastases     

Early Assessment for Prevention of Breast Cancer–Related Lymphedema

Breast cancer–related lymphedema (BCRL) is an incurable, disfiguring, progressive complication occurring after breast cancer treatment. BCRL is difficult to treat and is characterized by significant and persistent swelling. Lymphedema is the most common morbidity resulting from breast cancer treatment. Therefore, BCRL should be assessed during clinic visits in oncology and primary care settings. An evidence-based algorithm for early detection of BCRL in primary care settings is presented with explanations of the protocol elements.     

Cancer caregivers’ perceptions of an exercise and nutrition program

Purpose

Little research has addressed exercise and nutrition-based interventions for cancer caregivers. This study explored cancer caregivers’ perceptions of participating in a structured exercise and nutrition program alongside cancer survivors for whom they provided care.

Methods

In-depth, semi-structured interviews were conducted by one interviewer with 12 cancer caregivers about their experiences participating in a structured, 12-week exercise and nutrition program designed for cancer survivors and caregivers to complete concurrently. Interviews were conducted until data saturation was reached.

Results

Inductive content analysis from individual interviews indicated three separate, but interrelated, themes: (1) the program was a positive mechanism through which caregivers shared and supported the cancer journey concurrently with survivors, (2) the program led to perceived physical and psychological benefits for both caregivers and survivors, and (3) participants perceived that participation in the program led to feeling increased social support in their caregiving duties.

Conclusions

Findings from this study suggest that participating in an exercise- and nutrition-based intervention is viewed positively by caregivers and that the outcomes are seen as beneficial to both caregivers and survivors. Interventions that address the health needs of both members of the caregiver–survivor dyad should continue to be encouraged by allied health professionals.     

Effect of Endostar Combined with Gemcitabine on the Mouse Model of Human Pancreatic Cancer

Objective To investigate the effects of recombinant human endostatin, that is, endostar combined with gemcitabine on the mouse model of human pancreatic cancer. Methods We use the cell line PANC-1 and the severe combined immune deficient mice to set up the mouse model of human pancreatic cancer, then devide them into three groups, treat them with gemcitabine, gemcitabine combined with endostar, and 0.9 % saline water respectively. We observe the change of the tumor volumn, use ELISA method to detect the serum VEGF level, stain the micro vessel in the tumor tissue with immunohistochemistry method, and compare the data among the different groups respectively. Results On the twenty-eighth day, the tumor volume of the control group, the monotherapy group and the combination group, averaged 1 700 mm^3, 19. 2 mm^3, 10.4 mm^3, serum VEGF level 88.6 L, 35.5, 26.3 pg/mL and MVD 43.9, 30.3, 19. 2 respectively, which had significant difference. Conclusion Endostar can strengthen the lethal effect of gemcitabine on the mouse model of human pancreatic cancer.     

Cancer: disease and nutrition are key determinants of patients’ quality of life

Goals of work The aims of this study were (1) to evaluate quality of life (QoL), nutritional status and dietary intake taking into account the stage of disease and therapeutic interventions, (2) to determine potential interrelationships, and (3) to quantify the relative contributions of the cancer, nutrition and treatments on QoL.Patients and methods In this prospective cross-sectional study conducted in 271 head and neck, oesophagus, stomach and colorectal cancer patients, the following aspects were evaluated: QoL (EORTC-QLQ C30), nutritional status (percent weight loss over the previous 6 months), usual diet (comprehensive diet history), current diet (24-h recall) and a range of clinical variables.Main results Usual and current intakes differed according to the site of the tumour (P=0.02). Patients with stage III/IV disease showed a significant reduction from their usual energy/protein intake (P=0.001), while their current intakes were lower than in patients with stage I/II disease (P=0.0002). Weight loss was greater in patients with stage III/IV disease than in those with stage I/II disease (P=0.001). Estimates of effect size revealed that QoL function scores were determined in 30% by cancer location, in 20% by nutritional intake, in 30% by weight loss, in 10% by chemotherapy, in 6% by surgery, in 3% by disease duration and in 1% by stage of disease. Likewise in the case of symptom scales, 41% were attributed to cancer location, 22% to stage, 7% to nutritional intake, 7% to disease duration, 4% to surgery, 1% to weight loss and 0.01% to chemotherapy. Finally for single items, 30% were determined by stage, 20% by cancer location, 9% by intake, 4% by surgery, 3% by weight loss, 3% by disease duration and 1% by chemotherapy.Conclusions Although cancer stage was the major determinant of patients QoL globally, there were some diagnoses for which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be more important than the stage of the disease process.Conflict of interest statement: The authors assert that they have no financial or personal relationships with other people or organizations that could inappropriately influence their work.     

Effect of Endostar Combined with Gemcitabine on the Mouse Model of Human Pancreatic Cancer

IntroductionPancreatic canceris an unsolved health problem.The 5-year survival rateis only 3%and median over-all survival is<6 months,a situationthat has remained unchangedfor the past three decades.Surgical re-sectionis the only potentially curative ther…     

Can Routine Laparoscopy Help to Reduce the Rate of Explorative Laparotomies for Gastric Cancer? Laparoscopy in Gastric Cancer

1. Background We developed this surgical protocol about performing intraoperative laparoscopy for staging in every patient affected by stomach cancer. Sensitivity and specificity of intraoperative laparoscopy are compared with conventional preoperative staging techniques.2. Methods From January 1994 to June 1999, 83 patients affected by stomach cancer were accepted in our department: 12 patients (14.5%) were excluded from our study after the preoperative staging; in 71 patients (85.5%) an explorative laparoscopy as the first step of the operation was performed.3. Results Laparoscopy confirmed preoperative staging in 53 cases (74.6%), in 12 patients demonstrated an overstaging. Laparoscopy demonstrated in 6 patients unsuspected causes of unresectability.4. Conclusions When performed in patients affected by malignant neoplasm and declared resectable, intraoperative laparoscopy can demonstrate conditions not detectable by traditional preoperative investigations, consequently reducing to zero explorative laparotomies.     

Which quality of life instruments are preferred by cancer patients in Japan? Comparison of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and the Functional Assessment of Cancer Therapy-General

Purpose

We compared two health-related quality of life (HRQOL) instruments used for cancer patients [the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy-General (FACT-G)] to identify which instrument cancer patients most preferred.

Methods

Adult cancer patients who had received cancer treatments within the previous 2 years (n?=?395) completed both surveys; participants assessed the importance, necessity, and appropriateness of each as an indicator of their quality of life.

Results

The patients significantly preferred the FACT-G over the EORTC QLQ-C30 as a more important (effect size (ES)?=?0.37, P?P?P?=?0.005). The subgroups of patients with good performance status, and those who reported low levels of work disruption, significantly preferred the FACT-G more than the other. The corresponding correlation coefficients were the following: physical functioning and well-being subscale, r?=?0.65; emotional functioning and well-being subscale, r?=?0.60; social functioning and social/family well-being subscale, r?=?0.00; and role functioning and functional well-being subscale, r?=?0.41.

Conclusions

We recommend using the FACT-G if the performance status of the subject is good, e.g., in outpatient or cancer survivor surveys, based on the observed patient preferences. When performance status is not good, an instrument should be chosen after considering the differences between their scale structures and social domains and based on the availability of disease-specific modules.     

MR Imaging Evaluation of Cancer Extent: Is There Clinical Relevance?

The traditional methods for selecting women for breast conservation therapy (BCT), coupled with adjuvant radiation therapy, have reduced recurrence rates of BCT to acceptable levels. These recurrence rates are still significant, however. They may be further affected by the application of more anatomically targeted radiation therapy. Preoperative MR imaging should theoretically reduce the local failure rate of BCT by at least 5%, with only a modest increase in the mastectomy rate. The evolution of BCT to include more targeted radiation therapy and ablation should place an even larger emphasis on accurate tumor localization and has the potential to allow BCT to become more prevalent and effective.     

Cancer patients�� evaluation of communication: a report from the population-based study ��The Cancer Patient��s World��

Purpose

The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.

Methods

In a cross-sectional survey, a nationally representative sample of 2,202 cancer patients who had been in contact with a hospital department during the past year was invited to respond to a questionnaire. Communication with doctors and nurses was assessed separately as were their abilities as listeners, doctors?? use of an understandable language, timing of the information, duration of consultations, and whether doctors criticised other doctors.

Results

A total of 1,490 cancer patients responded to the questionnaire. Of these, 24?% reported one or more problems with the areas of communication measured. The problem most frequently reported (by 12?%) was not having sufficient time for consultations. More patients reported problems with doctors?? communication and abilities as listeners than with nurses?? skills in these areas. There was a general pattern that younger patients and those sampled in Copenhagen reported the highest degree of dissatisfaction with the communication. Those exposed to a high number of different treatment modalities were at especially high risk of experiencing problems.

Conclusions

A high proportion of patients reported one or more problems in the communication. However, the number reporting each of the specific problems was remarkably low. Special focus should be given to patients exposed to several treatment modalities and their communicative needs.     

All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types

ContextLittle is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type.ObjectivesThis research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors.MethodsA population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms.ResultsLong-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean = 79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean = 77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α = 0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types.ConclusionContrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong “good news” message, providing health professionals with a sound foundation for making encouraging predictions about their patients’ long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.     

Cancer is only skin-deep

从本期起《医学英语》栏开辟“笔译征文”,2～3期刊登一次。下面刊出的“Cancer is only skin-deep,一文。译文欢迎寄来我刊《医学英语》栏(请自贴邮票),我们将选译得较好的数篇在第10期本栏发表,并对寄来的译文中较普遍的误译和不妥之处,作一综合分析,以提高大家的笔译水平。译文较好而未能采用的,选50名公布名单并酌发学习资料。来稿不论采用与否,均不退稿。读者所提的问题,如有普遍意义则公开解答,对其他问题,因人力所限,恕不一一作复。     

Potential of Cancer Cell–Derived Exosomes in Clinical Application: A Review of Recent Research Advances

Background

Exosomes are 30- to 100-nm, membrane-bound vesicles that are released by most types of cells, including tumor cells. Exosomes contain a great variety of bioactive molecules, including signal peptides, microRNA, lipids, and DNA. In cancer, tumor cells aberrantly secrete large quantities of exosomes to transport paracrine signals or to contribute to tumor–environment interaction at a distance.

Objective

The goal of this review was to discuss the recent advances on the mechanism of cancer-derived exosomes in tumor regulation.

Methods

Pertinent articles and abstracts were identified through searches of PubMed for literature published from 1983 to December 2013. Search terms included exosome, tumor, cancer, diagnosis, and therapy.

Results

All of the exposed evidence points to communication between cancer cells and their surroundings, either mediated by cancer cell–derived exosomes or by stromal cell–derived exosomes. This communication probably supports tumor proliferation, motility, invasion, angiogenesis, and premetastatic niche preparation. In addition, recent research implies that cancer cell–derived exosomes play a suppressive role in cancer-directed immune response.

Conclusions

The biomarkers detected in bodily fluid–derived exosomes imply a potential for exosomes in cancer diagnosis. Also, exosomes could be used as a vehicle to selectively deliver therapeutic nucleic-acid drugs or conventional drugs for tumor therapy. The tolerability and feasibility of cancer exosomes in diagnosis and therapy need to be further evaluated.