Malignancies of the appendix: beyond case series reports

PURPOSE

A comprehensive analysis was performed for five histologic types of appendiceal tumors to compare incidence, clinicopathologic features, survival, and appropriateness of surgery.

METHODS

All patients diagnosed with mucinous adenocarcinoma (n = 951), adenocarcinoma (n = 646), carcinoid (n = 435), goblet (n = 369), and signet-ring cell (n = 113) in the Surveillance, Epidemiology, and End Results database (1973-2001) were analyzed. Evaluation of incidence, stage, and five-year relative survival were determined for each histology. The appropriateness of the operative procedure (i.e. , appendectomy vs. colectomy) was examined by tumor type and size.

RESULTS

Tumor incidence, patient demographics, survival outcomes, and appropriateness of surgery varied significantly among the different appendiceal tumor histologies. The most common appendiceal tumors were mucinous. With regard to patient demographics, carcinoids presented at an earlier mean age of 41 years and 71 percent were female (P < 0.001 for both). Overall five-year survival was highest for carcinoid (83 percent) and lowest for signet ring (18 percent). Although current guidelines specify that a right hemicolectomy (rather than an appendectomy) be performed for all noncarcinoid tumors and carcinoid tumors >2 cm, we found that 30 percent of noncarcinoids underwent appendectomy. Similarly, 28 percent of carcinoids >2 cm under-went appendectomy, which is a lesser resection than is indicated.

CONCLUSIONS

This study provides a population-based analysis of epidemiology, tumor characteristics, survival, and quality of care for appendiceal carcinomas. This characterization provides a novel description of the presentation and outcomes for malignancies of the appendix and highlights that a substantial number of patients with appendiceal tumors may not be receiving appropriate surgical resection.

Lactase persistence and ovarian carcinoma risk in Finland, Poland and Sweden

Ovarian carcinoma is the fourth most common cause of cancer death in women. The cause and pathogenesis of this disease has remained obscure. Galactose, the hydrolyzing product of the milk sugar lactose, has been hypothesized to be toxic to ovarian epithelial cells and consumption of dairy products and lactase persistence has been suggested to be a risk factor for ovarian carcinoma. In adults, downregulation of lactase depends on a variant C/T-13910 at the 5' end of the lactase gene. To explore whether lactase persistence is related to the risk of ovarian carcinoma we determined the C/T-13910 genotype in a cohort of 782 women with ovarian carcinoma. The C/T-13910 genotype was defined by solid phase minisequencing from 327 Finnish, 303 Polish, 152 Swedish patients and 938 Finnish, 296 Polish and 97 Swedish healthy individuals served as controls. Lactase persistence did not associate significantly with increased risk for ovarian carcinoma in the Finnish (odds ratio [OR]=0.77, 95% confidence interval [CI]=0.57-1.05, p=0.097), in the Polish (OR=0.95, 95% CI=0.68-1.33, p=0.75), or in the Swedish populations (OR=1.63, 95% CI=0.65-4.08, p=0.29). Our results do not support the hypothesis that lactase persistence increases the ovarian carcinoma risk. On the contrary, lactase persistence may decrease the ovarian carcinoma risk at least in the Finnish population.

A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum

PURPOSE

Most studies examining mucinous or signet-ring cell colorectal cancers are single institution reports. This study used a national cancer registry to analyze the epidemiology and survival outcomes of these two subtypes of colorectal cancer compared with adenocarcinoma tumors.

METHODS

All patients diagnosed with mucinous (n = 16,991), signet-ring cell (n = 1,522), or adenocarcinoma (n = 146,115) colorectal cancer in the Surveillance, Epidemiology, and End Results database (1991-2000) were evaluated. Analyses were performed to obtain age-adjusted incidence rates, stage at presentation, tumor grade, and five-year relative survival for each subtype.

RESULTS

Mucinous were slightly more common in females (53.4 percent). Incidence rates per 100,000 persons were: mucinous, 5.5; signet-ring cell, 0.6; and adenocarcinoma 46.6. The annual percent change during ten years was stable for mucinous, increased for signet-ring cell (4.8 percent; P < 0.05), and decreased for adenocarcinoma (-1.1 percent; P < 0.05). Fewer mucinous (18 percent) and signet-ring cell (21 percent) tumors were located in the rectum compared with adenocarcinoma (29 percent). Signet-ring cell presented at later stage (III/IV, 80.9 percent) more often than mucinous (52.8 percent) and adenocarcinoma (49.5 percent), and also had worse tumor grade (high grade: signet-ring cell, 73.5 percent; mucinous, 20.9 percent; adenocarcinoma, 17.5 percent). Relative five-year survival was worse for signet-ring cell than mucinous or adenocarcinoma.

CONCLUSIONS

We present a large population-based review of colorectal cancer subtypes by analyzing national data from the past decade. Although the incidence of colorectal adenocarcinoma is decreasing in the United States, mucinous and signet-ring cell subtypes are stable and increasing, respectively. Importantly, it seems that the signet-ring cell subtype has worse outcomes, whereas survival rates for mucinous tumors are similar to adenocarcinomas.

Prognostic significance of p53, Her-2, and EGFR overexpression in borderline and epithelial ovarian cancer

The objective of the study was to evaluate the prognostic effect of p53, Her-2, and EGFR in borderline and epithelial ovarian cancer. Tumor tissue from 85 patients with borderline and 783 patients with epithelial ovarian cancer stage I-IV were analyzed immunohistochemically for p53 positivity and over-expression of Her-2 and EGFR. In the ovarian cancer (OC) group 415 patients (53%) had p53-positive tumors, 272 (35%) had tumors with Her-2 over-expression, and 483 (62%) had over-expression of EGFR. In the OC group the classical prognostic factors (older age, higher FIGO stage, and poorer differentiated stage) had significant prognostic value in both uni- and multivariate analyses. Multivariate analyses in the OC group proved p53 positivity to increase mortality significantly depending on the grade of the tumor. Her-2 likewise increased the risk of mortality significantly in this group depending on the grade of the tumor. EGFR on the other hand did not have any additional prognostic effect in the OC group after adjustment for the classical prognostic and molecular factors was made. In the borderline group Her-2 and EGFR over-expression in combination, adjusted for age and p53, significantly improved the prognosis.

Fertility after conservative treatment for borderline ovarian tumors: A French multicenter study

OBJECTIVE

To examine fertility outcomes and determinants of fertility after conservative surgery for women with borderline ovarian tumors.

DESIGN

Retrospective multicenter study.

SETTING

Thirteen specialized gynecologic units and one cancer center.

PATIENT(S)

In a study of women with borderline ovarian tumors, 162 of 360 women underwent conservative surgery; from these 162, we compared epidemiologic, surgical, and histological parameters between 21 women who conceived and 44 women who failed to conceive.

INTERVENTION(S)

Conservative surgery for borderline ovarian tumors.

MAIN OUTCOME MEASURE(S)

Fertility results and outcome.

RESULT(S)

Women undergoing conservative treatment were significantly younger and more likely to be nulliparous. Tumor size was significantly smaller in the conservative treatment group. Thirty pregnancies occurred in 21 (32.3%) of the 65 women who wished to conceive after conservative treatment. Twenty-seven pregnancies were spontaneous, whereas three occurred after ovarian stimulation and IUI (one case) or IVF (2 cases). Women who conceived did not differ from women who did not conceive in terms of the tumor recurrence rate or the mean time to recurrence (39.6 +/- 28.2 and 22.9 +/- 14.9 months, respectively). Age at initial treatment was the only determinant of fertility.

CONCLUSION(S)

Despite a high recurrence rate, our results confirm that conservative surgery for women with borderline ovarian tumors is an acceptable option and that fertility is preserved in nearly one third of cases.

Mucocele-like Lesions of the Breast: A Benign Cause for Indeterminate or Suspicious Mammographic Microcalcifications

Most earlier reports of mucocele-like lesions (MLL) of the breast have dealt with symptomatic cases in premenopausal women or lesions found incidentally in breast biopsies performed for other reasons. The diagnosis of this lesion has special challenges in the setting of mammographic screening for breast cancer because the imaging characteristics of MLL may mimic those of ductal carcinoma in situ (DCIS), while mucinous carcinoma enters the differential diagnosis on cytologic grounds. This report focuses on our experience with MLLs detected during screening mammography. Cases with MLL as the final histologic diagnosis in our database during January 1992-June 2000 are included. The results of clinical, imaging, cytologic, core biopsy, and histologic examination of these lesions are recorded. The relevant literature is reviewed. Twenty-six cases were found, with a mean patient age of 57.5 years. Microcalcifications were the dominant radiologic abnormality in 22 cases (84.6%). Imaging was considered suspicious or almost certainly malignant in 17 cases (65.4%). Cytology was classified as atypical or suspicious in 17 cases (70.9%). However, open biopsy showed mostly benign changes, including atypical ductal hyperplasia (ADH) in five cases (19.2%). In one case, ADH merged with a 3-4 mm focus of low-grade DCIS. This, the largest series focusing purely on screen-detected MLL, suggests that the combination of clinical, imaging, and cytologic features of screen-detected MLL are different from those of mucinous carcinoma, symptomatic MLL, or incidental MLL. Correlating the cytomorphology of mucinous lesions of the breast with their mammographic appearance may permit more precise preoperative diagnosis.

Epidemiological aspects of ovarian malignancies in North Sardinia in the period 1992-2001

Malignant ovarian tumors have been continuously increasing in Western countries and represent the leading cause of death for gynecological cancer. In fact, the mortality for malignant ovarian tumors remains very high with a low percentage of 5-year survival in the advanced stage of disease. The aim of this study was to evaluate the incidence trend and epidemiological characteristics of malignant ovarian tumors in the Province of Sassari, Sardinia (Italy) in the period 1992-2001 and to report the variations in comparison to the 1974-1985 period. The analysis of our data regarding the period 1992-2001, if compared with those of the period 1974-85, showed an increase of malignant ovarian tumors which triplicated achieving an incidence of 11.99/100,000 vs 4.27/100,000. The analysis of our epidemiologic data showed an increase of the age of first diagnosis (mean 60.9 years for epithelial ovarian tumors), the occurrence of the cancer in women at low socio-economic levels and a family history of cancer among the patients with malignant ovarian tumors. These data suggest that both local environmental factors combined with genetic characteristics play a role in the pathogenesis of ovarian tumors. The genetic characteristics could be of particular interest because Sardinia has been through the centuries a geographical area with little population migration. The marked increase in the incidence of ovarian tumors in the last several years points out the need to organize systematic screening by ultrasonography in our population.

Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California

Perineal talc use has been suggested as a possible risk factor for ovarian cancer based on its structural similarity to asbestos, a known human carcinogen. A population-based epidemiologic case-control study of epithelial ovarian cancer (EOC) was conducted in 22 counties of Central California that comprise the reporting area for 2 regional cancer registries. Telephone interviews were conducted with 256 cases diagnosed in the years 2000-2001 and 1,122 controls frequency-matched on age and ethnicity. The interview obtained information on demographic factors, menstrual and reproductive experience, exogenous hormone use, surgical history and family history of cancer. Questions on perineal talc use included frequency of use, duration of use and specific years when talc was used. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of talc was 1.37 (CI = 1.02-1.85) compared to never users. However, no dose response association was found. Tubal ligation (TL) modified the effect of talc on EOC such that women with TL had an OR of 0.88 (CI = 0.46-1.68) associated with perineal talc use, whereas women with no TL had an OR of 1.54 (CI = 1.10-2.16). Talc use and EOC risk was highest in women with serous invasive tumors (OR = 1.77; CI = 1.12-2.81). This study provides some support for the hypothesis that perineal talc use is associated with an increased risk of EOC.

Well-differentiated adenocarcinoma of the gallbladder with intratumoral cystic components due to abundant mucin production: a mimicker of adenomyomatosis

The prevalence and etiology of the cystic components within gallbladder carcinomas as seen on MR images were evaluated. A retrospective review of MR images was performed for 35 proven gallbladder carcinomas in search of radiologically detectable intratumoral cystic components. The pathologic specimens were meticulously reviewed to determine the etiology. MR images of 31 adenomyomatoses were also reviewed for comparison to clarify the difference in MR features between these two entities. Three cases out of 35 proven gallbladder carcinomas were found to have intratumoral cystic components. They were all well-differentiated adenocarcinomas, and the cystic components consisted of dilated neoplastic glands filled with abundant mucin pool. Adenomyomatosis tended to have more and rounded cystic components (Rokitansky-Aschoff sinuses) lined in a linear fashion and were flat-elevated in shape, smaller in size and had a regular surface, as compared to the three carcinomas. Although rare, radiologists need to be aware that well-differentiated gallbladder carcinoma with mucin production can have cystic components, which may mimic adenomyomatosis. Careful interpretation of MR images may provide useful information in the differentiation of these two entities.

Prediction of Additional Axillary Metastasis of Breast Cancer Following Sentinel Lymph Node Surgery

Sentinel lymphadenectomy is a sensitive and specific procedure that has reduced the need for complete axillary lymph node dissections in patients with negative sentinel lymph nodes (SLNs). However, numerous studies have shown that SLN may be the only positive lymph node in 40 to 70% of cases. This study was therefore undertaken to determine if the characteristics of primary breast tumor or its metastasis in the SLN could predict the presence of residual disease in the nonsentinel lymph nodes (NSLNs) and thus allow for further reduction in axillary lymph node surgery. The SLN procedure was performed on 329 patients at our institution, of which 131 had positive SLNs and underwent further axillary surgery. Fifty-four patients had additional disease in the NSLNs, while in the remaining 77 cases, no residual disease was detected. The clinical and pathologic features of these cases were reviewed and statistical analysis was performed. Multivariate analysis determined two significant independent variables for prediction of residual disease in the axilla: the size of the metastatic tumor in SLNs and the presence of its extranodal extension. The mean tumor size in SLNs without residual disease in NSLNs was 0.4 cm. It was 1.1 cm in patients with additional NSLN metastasis. The positive predictive value in both instances is about 80%. The risk of NSLN involvement in patients with SLN tumors of < or = 0.4 cm was 21%. The risk was the same (21%) for patients with micrometastatic disease (< or = 0.2 cm) in SLNs. In these cases the residual disease in the NSLNs was also small. SLNs with metastatic deposits larger than 1.0 cm were likely to contain additional metastases in the NSLNs in 81% of cases. This increased to 100% if the primary carcinoma was larger than 5 cm, if it was poorly differentiated, or if it showed HER-2/neu gene amplification. The presence of an extranodal extension of SLN metastasis was an independent predictor of residual axillary disease and was associated with NSLN metastasis in 76% of cases. Primary tumor characteristics did not correlate with the incidence of NSLN metastasis in our series.

Risk factors for an adverse outcome in early invasive colorectal carcinoma

BACKGROUND & AIMS

Various histologic findings exist for managing patients with malignant polyps. Our goal was to determine the criteria for a conservative approach to patients with locally excised early invasive carcinoma.

METHODS

In 292 early invasive tumors (local resection followed by laparotomy [80 tumors, group A], local resection only [41 tumors, group B], and primarily laparotomy [171 tumors, group C], potential parameters for nodal involvement were analyzed. The status of the endoscopic resection margin also was examined for the risk for intramural residual tumor.

RESULTS

Unfavorable tumor grade, definite vascular invasion, and tumor budding were the combination of qualitative factors that most effectively discriminated the risk for nodal involvement in patients in groups A-C. The nodal involvement rate was 0.7%, 20.7%, and 36.4% in the no-risk, single-risk, and multiple-risks group, respectively. Thirty-two and 9 patients from group B were assigned to the no-risk and one-risk group, respectively; extramural recurrence occurred in 2 patients with risk factors. Considering quantitative risk parameters for submucosal invasion (i.e., width > or =4000 microm or depth > or =2000 microm), nodal involvement (including micrometastases) was not observed in the redefined no-risk group that accounted for about 25% of the patients from groups A and C. An insufficiency of endoscopic resection could be evaluated most precisely based on the coagulation-involving tumor, rather than the 1-mm rule for the resection margin.

CONCLUSIONS

Provided that the criterion of sufficient excision is satisfied, the absence of an unfavorable tumor grade, vascular invasion, tumor budding, and extensive submucosal invasion would be the strict criteria for a wait-and-see policy.

Appendix tumors in the era of laparoscopic appendectomy

BACKGROUND

The safety of laparoscopic appendectomy for the management of incidentally discovered appendiceal tumors has not yet been established.

METHODS

Appendiceal tumor cases managed by laparoscopy or laparotomy over a 10-year period were reviewed.

RESULTS

The pathological diagnoses were 23 carcinoid and 20 cancerous lesions. The median patient ages were 36 and 69 years, respectively, for carcinoid and other tumors (p < 0.05). Acute appendicitis was present in 70% of carcinoid cases and 35% of other tumors (p < 0.05). Eight patients with carcinoid tumors were operated on by laparoscopy, whereas 15 underwent laparotomy. Laparoscopic and open procedures were performed in three and 17 patients with cancerous lesions, respectively. Invaded surgical margins were seen after laparoscopy in 20% of patients and open surgery in 6%. Synchronous colon carcinoma was detected in 14% of the patients with an appendix neoplasm. The 5-year survival rates were similar after both laparoscopic and open appendectomy for either carcinoid or other tumors.

CONCLUSION

Laparoscopic appendectomy for appendiceal tumors seems to have a slightly higher rate of inadequate resection. However, it is not associated with a significantly worse patient prognosis than open appendectomy.

Do Young Colon Cancer Patients Have Worse Outcomes?

Previous studies on colon cancer have noted rising incidence rates among young individuals and suggest that they may have more aggressive disease and worse 5-year survivals than their older counterparts. Our study uses a nationwide population-based cancer registry to analyze colon cancer presentations and outcomes in a young versus an older population. The records of patients with colon carcinoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) national cancer database (1991-1999). Two cohorts based on age at diagnosis (20-40 years, n = 1334 vs. 60-80 years, n = 46,457) were compared for patient and tumor characteristics, treatment, and 5-year cancer-specific survival. A multivariate Cox regression was performed to identify predictors of survival. The young group had a higher proportion of black and Hispanic patients than did the older group (p < 0.001). Young patients had less stage I or II disease, more stage III or IV disease (p < 0.001), and worse-grade (poorly differentiated or anaplastic) tumors (p < 0.001). The 5-year stage-specific survival was similar for stage I and III disease (p = NS) but was significantly better for young patients with stage II and IV disease (p < 0.01). Using a nationally representative cancer registry, we found that young colon cancer patients tend to have later-stage and higher-grade tumors. However, they have equivalent or better 5-year cancer-specific survival compared to older patients. This population-based finding contradicts prior single-institution reports.

Risk factors for different histological types of ovarian cancer

Various histological types of ovarian cancer may develop from different etiological aspects. Data separated by histological subtypes collected in the framework of a large case-control study on ovarian cancer conducted in Italy were analyzed. The cases were women below the age of 75 years, admitted to a network of hospitals in Milan. Cases were grouped into four categories by histological type: mucinous tumor (n = 52), serous tumor (n = 680), endometrioid tumor (n = 41), and other histologies including clear-cell and undifferentiated epithelial tumors (n = 50). Controls were 2758 patients admitted to the same network of hospitals for a wide spectrum of acute, nongynecological, non-hormone-related, non-neoplastic conditions. In comparison with nulliparae, the risk of serous, endometrioid, and other histologies of ovarian cancer tended to be lower in parous women, but the odds ratios (OR) were above unity for mucinous ovarian cancer. Oral contraceptive use was associated with OR lower than unity for serous (OR = 0.7) and endometrioid (OR = 0.8) ovarian cancers but not for mucinous (OR = 1.4) and other histologies (OR = 1.6). Finally, our results on dietary fat intake did not show substantial differences in all histological types of ovarian cancer.

Cigarette smoking and increased risk of mucinous epithelial ovarian cancer

Several studies have reported that cigarette smoking is associated with an increased risk of mucinous ovarian cancer, but other studies have failed to find such a relation. Using data from the Case-Control Surveillance Study, begun in four US cities in 1976, the authors conducted a case-control study (1976-2001) to examine the association between cigarette smoking and the risk of ovarian cancer of different cell types. Among 709 incident cases of epithelial ovarian cancer, 402 were serous, 74 were mucinous, 106 were endometrioid, and 127 were of other cell types. For mucinous ovarian cancer, the odds ratios were 1.5 (95% confidence interval (CI): 0.7, 3.4) among women who smoked less than one pack of cigarettes per day, 1.4 (95% CI: 0.6, 3.5) among women who smoked one pack per day, and 2.9 (95% CI: 1.2, 7.5) among women who smoked more than one pack per day, relative to never smokers. The odds ratios were 2.5 (95% CI: 1.1, 5.4) for ex-smokers and 1.4 (95% CI: 0.7, 2.9) for current smokers. While women with up to 15 pack-years of smoking had an almost 2.5 times' increased risk of mucinous ovarian cancer, such an increased risk was not found among those with more than 15 pack-years of smoking. There was no association between cigarette smoking and epithelial ovarian cancer of other cell types. Despite inconsistencies in the data, these results strengthen the evidence that cigarette smoking may play a role in the development of mucinous ovarian cancer but not ovarian cancer of other cell types.

Alcohol consumption and the risk of mucinous and nonmucinous epithelial ovarian cancer

OBJECTIVE

To examine alcohol consumption as a risk factor for epithelial ovarian cancer according to tumor histology.

METHODS

We examined total alcohol consumption and consumption of beer, wine, and spirits as risk factors for mucinous and nonmucinous tumors in a population-based, case-control study comparing 761 incident cases of epithelial ovarian cancer with 1352 community controls frequency-matched to cases by age and three-digit telephone exchange. Multivariable, unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for mucinous and nonmucinous tumors associated with alcohol consumption. Adjustments were made for age, parity, oral contraceptive use, education, tubal ligation, smoking, and family history of ovarian cancer.

RESULTS

Overall, no association between total alcohol consumption and ovarian cancer was found. However, current heavy alcohol consumption (24 g or more per day) was associated with mucinous (OR 1.93; 95% CI 1.02, 3.65) but not nonmucinous tumors (OR 0.88; 95% CI 0.57, 1.37). The association between heavy current consumption and mucinous tumors was strongest for spirits (OR 8.83; 95% CI 2.89, 27.01) and apparent for beer (OR 2.53; 95% CI 0.86, 7.42). For nonmucinous tumors, no such associations were found for either spirits (OR 1.53; 95% CI 0.58, 4.00) or beer (OR 0.92; 95% CI 0.39, 2.14).

CONCLUSION

Current heavy consumption of alcohol might be a risk factor for mucinous but not nonmucinous epithelial ovarian cancer. This supports the hypothesis of a distinct etiology for mucinous tumors.

Expression of epidermal growth factor receptor in gastric carcinomas

BACKGROUND & AIMS

Epidermal growth factor receptor belongs to the family of type I receptor tyrosine kinases. Overexpression of epidermal growth factor receptor has been observed in a variety of cancers with or without amplification of the gene. Novel chemotherapies targeting receptor tyrosine kinases might be effective for the treatment of cancers in which overexpression of this protein is a feature. The aim of this study was to assess the potential efficacy of epidermal growth factor receptor-targeted therapy in gastric cancer. This was achieved by determining the frequency of increased epidermal growth factor receptor expression in gastric cancers and investigating the relationship between protein overexpression and gene amplification.

METHODS

Immunohistochemical evaluation of 413 gastric cancers was carried out by using a monoclonal antibody to the epidermal growth factor receptor. The intensity of reactivity was scored by using a 4-tier system (negative, 1+, 2+, and 3+). All positive staining (>1+) tumors overexpressing the protein were then analyzed for gene amplification by fluorescence in situ hybridization by using a gene-specific probe.

RESULTS

High levels of overexpression (2+ or 3+ staining) were found in 9 of 413 (2.2%) patients, whereas low levels of overexpression (1+) were found in 34 (8.2%) of the study cohort. Fluorescence in situ hybridization analysis showed that more than 10 copies of the gene were recognized in all 5 cancers with 3+ staining and in 2 of the 4 tumors with 2+ staining.

CONCLUSIONS

Although a high level of overexpression of epidermal growth factor receptor is uncommon in gastric carcinomas, it almost exclusively occurs by gene amplification.

Polymorphisms in BRCA1 and BRCA2 and risk of epithelial ovarian cancer

PURPOSE

Because inherited BRCA1 or BRCA2 mutations strikingly increase ovarian cancer risk, polymorphisms in these genes could represent low penetrance susceptibility alleles. Previous studies of the BRCA2 N372H polymorphism suggested that HH homozygotes have a modestly increased risk of both breast and ovarian cancer. We have examined whether BRCA2 N372H or common amino acid-changing polymorphisms in BRCA1 predispose to ovarian cancer.

EXPERIMENTAL DESIGN

A population-based, case control study of ovarian cancer was performed in North Carolina. Cases included 312 women with ovarian cancer (76% invasive and 24% borderline) and 401 age- and race-matched controls. Blood DNA from subjects was genotyped for BRCA2 N372H and BRCA1 Q356R and P871L.

RESULTS

There was no association between BRCA2 N372H and risk of borderline or invasive epithelial ovarian cancer. The overall odds ratio (OR) for HH homozygotes was 0.8 [95% confidence interval (CI) = 0.4-1.5] and was similar in all subsets, including invasive serous cases. In addition, neither the BRCA1 Q356R (OR = 0.9, 95% CI 0.5-1.4) nor P871L (OR = 0.9, 95% CI 0.6-1.9) polymorphisms were associated with ovarian cancer risk. There was a significant racial difference in allele frequencies of the P871L polymorphism (P = 0.64 in Caucasians, L = 0.76 in African-Americans, P < 0.0001).

CONCLUSIONS

In this population-based, case control study, common amino acid changing BRCA1 and 2 polymorphisms were not found to affect the risk of developing ovarian cancer.

Socioeconomic variation in colon cancer tumour factors associated with poorer prognosis

Analysis of population-based registry data (n=7393) showed that more deprived colon cancer patients had lower risk of the mucin-producing adenocarcinoma subtype, proximal subsite (to the descending colon), and no greater risk of high-grade tumours. Tumour factors therefore appear unlikely to account for socioeconomic gradients in survival.

Active and passive tobacco smoking and the risk of borderline and invasive ovarian cancer (United States)

OBJECTIVE

A population-based case-control study was conducted to examine the hypothesis that active and passive tobacco smoking were associated with the risk of epithelial ovarian cancer.

METHODS

In-person interviews were obtained from 558 women with epithelial ovarian cancer (431 invasive, 127 borderline) and 607 population controls regarding active lifetime tobacco smoking, environmental tobacco smoke exposure in utero and during childhood, and other factors that may be related to the development of ovarian cancer.

RESULTS

No significant associations of ever or former tobacco smoking with the risk of invasive or borderline ovarian cancer were found, although long-term ex-smokers of 20 years or more were at significantly reduced risk of invasive cancer. Significant, positive dose-response relations of the number of cigarettes smoked per day and pack-years with the odds ratios for borderline cancer were evident. No association of active tobacco smoking with risk was found by histologic subtype of invasive ovarian cancer. Smokers were at significantly increased risk for borderline serous cystadenoma (OR: 1.91; 95% confidence intervals, CI: 1.09-3.34), but not for borderline mucinous cystadenoma. When we limited the analyses to current smokers, age-started smoking was significantly inversely related to the risk of invasive, but not borderline ovarian cancer. We found no association of gestational or childhood environmental tobacco smoke exposure with the risk of invasive or borderline ovarian cancer among never smokers.

CONCLUSIONS

These findings do not support an association of active tobacco smoking with the risk of invasive ovarian cancer. An increased risk of borderline serous cystadenoma among smokers must be viewed with caution.

Rectal carcinoma in Egyptian patients less than 40 years of age

In Egypt, there is an increasing incidence of colorectal cancer, especially among patients < or = 40 years of age. The aim of this work was to study the characteristics of rectal cancer in a group of young Egyptian patients treated at Alexandria Main University hospital, Alexandria, Egypt, from June 1998 to June 2001. This study included 50 rectal cancer patients. They were divided into two groups. Group I was patients < 40 years of age (26 patients), and group II was patients > 40 years of age (24 patients). Both groups were evaluated regarding history taking and physical examination, the gross tumor characteristics, the presence or absence of metastases, the histopathological characteristics of the tumor, and the treatment failure within the 3-year period of this study. Group I patients had a significantly longer duration of complaint. A total of 15.4% of patients in this group presented with intestinal obstruction compared with 8.3% in group II. A total of 30.8% of patients in group I presented with metastatic disease compared with 20.8% in group II. More patients in group I had fixed and/or circumferential lesions than did those of group II (38.5% and 53.8% versus 20.8% and 8.3%, respectively). More patients in group I had nonresectable tumors. A total of 62.5% of group II patients underwent curative resection compared with 53.8% of the patients in group I. A total of 38.5% of patients in group I had mucoid carcinoma compared with 8.3% in group II. At the end of the 3-year period of this study, only 38.5% of group I patients were alive and free of disease compared with 45.8% in group II. In Egypt, rectal cancer patients <40 years of age have more advanced disease at presentation and a higher incidence of treatment failure caused by both a delay in the diagnosis and a more aggressive pattern of the disease.

Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis

Mucinous carcinomas are reported to comprise 6-25% of ovarian carcinomas (mean 12%), but recent refinements in the interpretation of histologic features of noninvasive and metastatic mucinous carcinomas suggest that this may be an overestimate. Mucinous carcinomas in the ovaries are commonly metastatic, but the proportion of primary versus metastatic mucinous carcinomas in unselected patients is unknown. To evaluate the histologic-type distribution of ovarian surface epithelial carcinomas, a consecutive series of 124 ovarian carcinomas was reviewed using uniform current criteria. Microinvasive and intraepithelial carcinomas and carcinomas arising in germ cell and stromal tumors were excluded. To evaluate the proportions of primary and metastatic tumors among the mucinous carcinomas, 52 consecutive mucinous carcinomas from nonreferral patients were reviewed. Three of 124 primary ovarian carcinomas were pure mucinous carcinomas (2.4%). Among 52 cases of mucinous carcinomas in the ovaries, 40 (77%) were metastatic and 12 (23%) were primary. Among the 12 primary mucinous tumors, three were atypical proliferative mucinous tumors with microinvasion and nine were invasive mucinous carcinomas. Among the 40 metastatic mucinous tumors, 18 (45%) were from the gastrointestinal tract, 8 (20%) were pancreatic, 7 (18%) were gynecologic malignancies (5 cervical, 2 endometrial), 3 (8%) were from the breast, and 4 (10%) were of unknown primary site. A simple rule that classifies all bilateral mucinous carcinomas as metastatic, unilateral mucinous carcinomas <10 cm as metastatic, and unilateral mucinous carcinomas >or=10 cm as primary correctly classified 90% of the neoplasms. This algorithm for distinguishing primary and metastatic mucinous carcinomas in the ovary can be used at the time of intraoperative consultation to guide surgical management. After careful exclusion of noninvasive, microinvasive, and metastatic tumors, pure mucinous adenocarcinoma primary in the ovary appears to be substantially less common than previously reported.