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Diamandis EP, Bast RC, Gold P, Chu TM, Magnani JL. Reflection on the discovery of carcinoembryonic antigen, prostate-specific antigen, and cancer antigens CA125 and CA19-9. Clin Chem 2013; 59:22-31. [PMID: 23204222 PMCID: PMC3983776 DOI: 10.1373/clinchem.2012.187047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Eleftherios P Diamandis
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Abstract
Ultimately, the timely diagnosis of ovarian cancer will rely on clinical judgment and careful analysis of presenting symptoms within the context of a thoughtful dialogue between the patient and her physician. Symptoms most typical of ovarian cancer include bloating, abdominal or pelvic pain, and difficulty eating. In some studies, urinary symptoms are also a common presenting symptom. When these symptoms occur more than 12 times per month and are of recent onset, then ovarian cancer should be considered as a possibility. Although most women who have these symptoms do not have ovarian cancer, it is important that providers include ovarian cancer in their differential diagnosis. Through research from the past decade, we now understand that there are patterns of symptoms associated with ovarian cancer. Importantly, we now know that ovarian cancer is not a “silent disease.” Finally, clinicians must always listen carefully to their patients avoid potentially harmful delays in diagnosis. Until there is a screening test, awareness is best.
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Affiliation(s)
- Barbara A Goff
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98195-6460, USA.
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Romero I, Bast RC. Minireview: human ovarian cancer: biology, current management, and paths to personalizing therapy. Endocrinology 2012; 153:1593-602. [PMID: 22416079 PMCID: PMC3320264 DOI: 10.1210/en.2011-2123] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
More than 90% of ovarian cancers have been thought to arise from epithelial cells that cover the ovarian surface or, more frequently, line subserosal cysts. Recent studies suggest that histologically similar cancers can arise from the fimbriae of Fallopian tubes and from deposits of endometriosis. Different histotypes are observed that resemble epithelial cells from the normal Fallopian tube (serous), endometrium (endometrioid), cervical glands (mucinous), and vaginal rests (clear cell) and that share expression of relevant HOX genes which drive normal gynecological differentiation. Two groups of epithelial ovarian cancers have been distinguished: type I low-grade cancers that present in early stage, grow slowly, and resist conventional chemotherapy but may respond to hormonal manipulation; and type II high-grade cancers that are generally diagnosed in advanced stage and grow aggressively but respond to chemotherapy. Type I cancers have wild-type p53 and BRCA1/2, but have frequent mutations of Ras and Raf as well as expression of IGFR and activation of the phosphatidylinositol-3-kinase (PI3K) pathway. Virtually all type II cancers have mutations of p53, and almost half have mutation or dysfunction of BRCA1/2, but other mutations are rare, and oncogenesis appears to be driven by amplification of several growth-regulatory genes that activate the Ras/MAPK and PI3K pathways. Cytoreductive surgery and combination chemotherapy with platinum compounds and taxanes have improved 5-yr survival, but less than 40% of all stages can be cured. Novel therapies are being developed that target high-grade serous cancer cells with PI3Kness or BRCAness as well as the tumor vasculature. Both in silico and animal models are needed that more closely resemble type I and type II cancers to facilitate the identification of novel targets and to predict response to combinations of new agents.
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Affiliation(s)
- Ignacio Romero
- M.D. Anderson Cancer Center, Translational Research, Houston, Texas 77030, USA
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George R, Michaelides M, Brewer MA, Utzinger U. Parallel factor analysis of ovarian autofluorescence as a cancer diagnostic. Lasers Surg Med 2012; 44:282-95. [PMID: 22407572 DOI: 10.1002/lsm.22014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Endogenous fluorescence from certain amino acids, structural proteins, and enzymatic co-factors in tissue is altered by carcinogenesis. We evaluate the potential of these changes in fluorescence to predict a diagnosis of malignancy and to estimate the risk of developing ovarian cancer. STUDY DESIGN/MATERIALS AND METHODS Ovarian biopsies were interrogated over 270-550 nm excitation and fluorescence was collected from 290 to 700 nm. Two hundred forty-nine measurements were performed on 49 IRB-consented patients undergoing oophorectomy. Data are analyzed using parallel factor analysis to determine excitation and emission spectra of the underlying fluorophores that contribute to the total detected fluorescence intensity. RESULTS Using multivariate normal distribution fits and cross-validation techniques, sensitivity and specificity of 88% and 93%, respectively, are achieved when classifying malignant samples versus others, while 88% and 80%, respectively, are achieved when classifying normal post-menopausal patients as being either at high- or low-risk of developing ovarian cancer based on their personal and family history of cancer. Performance of classifying cancer increases when the normal group does not include benign neoplasm and endometriosis samples. Performance of high- versus low-risk classification decreases when normal samples include both pre- and post-menopausal women. Excitation over 270-400 and 380-560 nm, respectively, have the best diagnostic performance for cancer detection and risk-status assessment. CONCLUSIONS Assessing the endogenous fluorescence could be useful in screening women at increased risk of developing ovarian cancer.
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Affiliation(s)
- Ronie George
- College of Optical Sciences, University of Arizona, Tucson, Arizona 85721, USA
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Screening for ovarian cancer in the general population. Best Pract Res Clin Obstet Gynaecol 2011; 26:243-56. [PMID: 22182415 DOI: 10.1016/j.bpobgyn.2011.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 11/07/2011] [Indexed: 12/13/2022]
Abstract
Advances in screening and early detection of ovarian cancer over the past decade have included novel interpretation of serum CA125, discovery of human epididymis protein 4, which has the potential to add to CA125, and the growing understanding of the flaws of previous biomarker studies. No mortality effect was found in the ovarian screening arm of the Prostate Lung Colorectal and Ovarian Cancer Screening Trial.(87) Concerns, however, have been raised about trial design, and the results from the UK Collaborative Trial of Ovarian Cancer Screening in the general population(38) and other ongoing studies in the high-risk population are awaited for a definitive conclusion. Future work needs to take into account the new insights into ovarian cancer subtypes and the growing evidence that a significant proportion of ovarian cancers might originate in premalignant lesions in the distal fallopian tube.
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Abstract
Adnexal masses are commonly encountered in gynecologic practice and often present both diagnostic and management challenges. This is partly because of the fact that the majority of adnexal masses that are identified represent benign entities that do not necessarily require active intervention, yet a small subset will represent malignant processes that require both timely and appropriate surgical intervention for optimal outcome. To determine the best diagnostic and management strategies in this setting, physicians must effectively triage risk for malignancy by having a thorough understanding of the entities on the differential diagnosis and carefully considering the clinical context for each individual patient. Optimal selection and interpretation of diagnostic tests are enhanced by both an accurate clinical risk assessment and an understanding of the inherent accuracy of diagnostic tests considered in this setting. The purpose of this document is to provide clinicians with a practical strategy for distinguishing benign and malignant masses in the nonpregnant woman. Our approach addresses the critical elements of accurate risk stratification, reviews the performance of diagnostic tests for identifying malignancy, and offers evidence-based management algorithms to optimize outcomes for women with adnexal masses.
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Clarke CH, Yip C, Badgwell D, Fung ET, Coombes KR, Zhang Z, Lu KH, Bast RC. Proteomic biomarkers apolipoprotein A1, truncated transthyretin and connective tissue activating protein III enhance the sensitivity of CA125 for detecting early stage epithelial ovarian cancer. Gynecol Oncol 2011; 122:548-53. [PMID: 21708402 DOI: 10.1016/j.ygyno.2011.06.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/02/2011] [Accepted: 06/06/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The low prevalence of ovarian cancer demands both high sensitivity (>75%) and specificity (99.6%) to achieve a positive predictive value of 10% for successful early detection. Utilizing a two stage strategy where serum marker(s) prompt the performance of transvaginal sonography (TVS) in a limited number (2%) of women could reduce the requisite specificity for serum markers to 98%. We have attempted to improve sensitivity by combining CA125 with proteomic markers. METHODS Sera from 41 patients with early stage (I/II) and 51 with late stage (III/IV) epithelial ovarian cancer, 40 with benign disease and 99 healthy individuals, were analyzed to measure 7 proteins [Apolipoprotein A1 (Apo-A1), truncated transthyretin (TT), transferrin, hepcidin, ß-2-microglobulin (ß2M), Connective Tissue Activating Protein III (CTAPIII), and Inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4)]. Statistical models were fit by logistic regression, followed by optimization of factors retained in the models determined by optimizing the Akaike Information Criterion. A validation set included 136 stage I ovarian cancers, 140 benign pelvic masses and 174 healthy controls. RESULTS In a training set analysis, the 3 most effective biomarkers (Apo-A1, TT and CTAPIII) exhibited 54% sensitivity at 98% specificity, CA125 alone produced 68% sensitivity and the combination increased sensitivity to 88%. In a validation set, the marker panel plus CA125 produced a sensitivity of 84% at 98% specificity (P=0.015, McNemar's test). CONCLUSION Combining a panel of proteomic markers with CA125 could provide a first step in a sequential two-stage strategy with TVS for early detection of ovarian cancer.
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Suh DH, Kim JW, Kim K, Kang SB. Major clinical research advances in gynecologic cancer in 2010. J Gynecol Oncol 2010; 21:209-18. [PMID: 21278881 PMCID: PMC3026298 DOI: 10.3802/jgo.2010.21.4.209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/07/2010] [Indexed: 01/06/2023] Open
Abstract
This review summarizes 11 major clinical research advances in gynecologic oncology in 2010. For ovarian cancer, bevacizumab as a leading molecular targeted agent, pegylated liposomal doxorubicin in recurrent disease, the role of neoadjuvant chemotherapy in an advanced setting, an effective screening method, and ARID1A mutations as a clue to the origin of clear cell carcinoma are mentioned. For cervical cancer, confirmation of the efficacy and the introduction of a self collection method of the human papillomavirus (HPV) test, and the association between the HPV vaccine and miscarriage are examined. For endometrial cancer, the superiority of laparoscopy in staging operation, the role of vaginal brachytherapy in an adjuvant setting, and the effect of para-aortic lymph node dissection are reviewed. In addition, the trend of geriatric oncology and chemotherapy in carcinosarcomas is also assessed.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Soon-Beom Kang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Kris MG, Benowitz SI, Adams S, Diller L, Ganz P, Kahlenberg MS, Le QT, Markman M, Masters GA, Newman L, Obel JC, Seidman AD, Smith SM, Vogelzang N, Petrelli NJ. Clinical cancer advances 2010: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 2010; 28:5327-47. [PMID: 21060039 DOI: 10.1200/jco.2010.33.2742] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A MESSAGE FROM ASCO'S PRESIDENT Like many health professionals who care for people with cancer, I entered the field because of specific patients who touched my heart. They still do. In an effort to weave together my personal view of what the American Society of Clinical Oncology (ASCO) stands for and the purpose the organization serves, my presidential theme this year is “Patients. Pathways. Progress.” Patients come first. Caring for patients is the most important, rewarding aspect of being an oncology professional. At its best, the relationship between doctor and patient is compassionate and honest—and a relationship of mutual respect. Many professional organizations have an interest in cancer, but no other society is so focused on the entire spectrum of cancer care, education, and research. Nor is any other society as particularly interested in bringing new treatments to our patients through clinical trials as ASCO is. Clinical trials are the crux for improving treatments for people with cancer and are critical for continued progress against the disease. “Pathways” has several meanings. Some pathways are molecular—like the cancer cell's machinery of destruction, which we have only begun to understand in recent years. But there are other equally important pathways, including the pathways new therapies follow as they move from bench to bedside and the pathways patients follow during the course of their diseases. Improved understanding of these pathways will lead to new approaches in cancer care, allowing doctors to provide targeted therapies that deliver improved, personalized treatment. The best pathway for patients to gain access to new therapies is through clinical trials. Trials conducted by the National Cancer Institute's Cooperative Group Program, a nationwide network of cancer centers and physicians, represent the United States' most important pathway for accelerating progress against cancer. This year, the Institute of Medicine released a report on major challenges facing the Cooperative Group Program. Chief among them is the fact that funding for the program has been nearly flat since 2002. ASCO has called for a doubling of funding for cooperative group research within five years and supports the full implementation of the Institute of Medicine recommendations to revitalize the program. ASCO harnesses the expertise and resources of its 28,000 members to bring all of these pathways together for the greater good of patients. Progress against cancer is being made every day—measurable both in our improved understanding of the disease and in our ability to treat it. A report issued in December 2009 by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries found that rates of new diagnoses and rates of death resulting from all cancers combined have declined significantly in recent years for men and women overall and for most racial and ethnic populations in the United States. The pace of progress can be and needs to be hastened. Much remains to be done. Sustained national investment in cancer research is needed to bring better, more effective, less toxic treatments to people living with cancer. Pathways to progress continue in the clinic as doctors strive to find the right treatments for the right patients, to understand what represents the right treatments, and to partner with patients and caregivers for access to those treatments. This report demonstrates that significant progress is being made on the front lines of clinical cancer research. But although our nation's investment in this research is paying off, we must never forget the magnitude of what lies ahead. Cancer remains the number two killer of Americans. Future progress depends on continued commitment, from both ASCO and the larger medical community. George W. Sledge Jr, MD President American Society of Clinical Oncology
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Affiliation(s)
- Mark G Kris
- American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA 22314, USA
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