Ovarian Cancer Blog

A few weeks ago I posted on Star-Trek Borg-like technology (the "Borg" were aliens in that SciFi series from the 24th Century) being used for cancer therapy TODAY. This is another interesting tidbit which suggests we are really moving into a different era of treatment. Indeed it won't be long before we are out of the "cut,poison,burn" limited treatment set that mainstream medicine is always criticized for.

In a recent study, albeit in mice, scientists injected some nanoparticles made from a particular type of metal into the abdominal area where ovarian cancer cells were previously injected and growing. Then using powerful magnets they were able to move these ovarian cancer cell growths to one small area for extraction by minimal surgery (small incision). Using their methods, only cancer cells absorbed these nanoparticles, so only cancer cells were moved this way.

Truly amazing stuff. Here's the link for those who want to read more: J. Am. Chem. Soc., 2008.

As always, leave a comment if you have a moment. Please no animal rights stuff. I am all for limiting animal research, but in this case it would be literally impossible to do this in humans or any other model before testing in animals....

A recently published study out of the Dana-Farber Institute showed that patients with higher Vitamin D levels survived markedly longer after diagnosis. In the group of 300 patients they reviewed, the chances of dying from ANY cause was cut in half if Vitamin D levels were in the upper 25% of normal.

It's not clear whether supplementing Vitamin D in your diet will produce the same result, but a trial is planned. Also of note, this was not a study to determine if SUPER high levels help or not. This is all information from people who had Vitamin D levels within the currently defined "normal range". Vitamin D consumption in high doses can lead to significant complications, so no one is recommending that at this point.

These results, along with others in various diseases, including those published for ovarian cancer, are all pointing at the importance of Vitamin D. Standard recommended daily vitamin D supplementation ranges from 200 International Units (IU) per day for people under age 50 to 400 IU for folks between 50 and 70. That goes up to 600 IU for those over 70. But remember, it is very important to consult your physician(s) before taking anything beyond your routine diet and daily multivitamin.

UCLA researchers have created a potentially new use for the PET scanner by using a modified chemotherapy drug (Gemcitabine) to create a new molecular probe which can monitor the immune system in action in a very new way.

The system is not a treatment but it may be able to help evaluate immune system response to therapy. Today's standard scans, including CT and the regular version of the PET can usually tell whether a cancerous tumor is responding or not over several months. But that means several months of chemotherapy which may or may not be effective. If the new PET scan probe fulfills its potential, it may be able to evaluate response to treatment much more quickly. Potentially this could be as short as a week or two. Patients could avoid getting toxic treatment that is not working.

Almost 10 years ago I became aware of a growing scientific interest in the mind-body aspects of cancer care and research. What had been suggested by alternative practitioners for eons was finally coming into the light of Western medicine under the name of PsychoNeuroImmunology(PNI). At that time we already had quite a bit of evidence from research in the 90's that stress seriously affects the immune system, which in turn should influence cancer progression.

Since that time there has been no PNI intervention that has become a standard in mainstream cancer care. Fortunately, at least basic and animal research has been ongoing that suggests neuroendocrine and immunological mediators of stress affect cancer progression, especially with respect to the role of NK cell immune activity. Furthermore, we have known for a while that distress or depression is also associated with two important factors in the development of cancer. These are poorer repair of damaged DNA, and alterations in programmed cells death known as apoptosis.

I guess this post is sort of a controlled rant that we have not been able to progress much over the past 10 years judging by the limited number of scientific publications in this area of research. We must test these theories in patients to support or refute the whole idea.

As always, I'd love to hear your thoughts. Leave a comment!

Thalidomide, which was blamed for birth defects in the 50's, has been making a "reputation comeback". About six years ago it was shown to be effective and safe for multiple myeloma (a bone marrow cancer). Now, a University of Minnesota research unit, headed by Dr.Levi Downs, has shown it may be effective and safe for recurrent ovarian cancer.

In their study 75 women received either topotecan alone or topotecan plus thalidomide. They found that those who received the combination therapy had an overall response rate of 47% compared to 21% with topotecan alone. In fact 30% in the thalidomide group achieved a complete response (cancer undetectable at the end of treatment) compared to 18% with topotecan alone.

Although it did not lead to any cures, those who received thalidomide with topotecan had a longer cancer-free period of time. These encouraging results led the team to develop a new thalidomide-like drug which is predicted to work even better. Only further clinical trials will tell. This isn't the first time a drug which was literally cast aside for one reason, made a comeback as a promising drug in another area of need.

In a different kind of early detection screening program, our furry friends apparently have the capacity to detect the scent of ovarian cancer, and can even distinguish it from other cancers. This latest information comes from both Sweden and Hungary.

"While we do not believe that dogs should be used in clinical practice, because they may be influenced during their work, leading to changes in the accuracy rates, still, under controlled circumstances, they may be used in experiments to further explore this very interesting new property of malignancies," the researchers were quoted to say.

Well, perhaps not the same as a high tech multi-marker assay we're all waiting for. But if bowser starts acting funny, it might mean he's worried about you.

You've seen me blog about "eat your veggies", but are they all the same in preventative strength? Some newer studies are shedding more light on which vegetables might be better and why. We have a good source of data from the Nurse's Health Study which enrolled 66,940 women. The researchers looked at the flavonoids myricetin, kaempferol, quercetin, luteolin, and apigenin specifically.

It looks like veggies that are highest in kaempferol, which is found in broccoli, reduce the risk of ovarian cancer the most. Another flavonoid, luteolin, found in carrots, peppers, and cabbage is also a leading preventative. The others are also likely to be preventative but the results were best with these two, reducing the risk of ovarian cancer by up to 40%.

Want a beverage with that? Many non-herbal teas also contain kaempferol.

By the way, all of this data is for primary prevention. However, even though we do not know if this might help in prevention of recurrence, the risk is small in consuming lots of veggies. At the least, it probably can't hurt and may benefit. So, this is food for thought and consumption for everyone.

Please leave me a comment and let me know what you think...

If you have an ovarian cancer removed, the usual additional procedure includes at least lymph node sampling or a more extensive removal of nodes called a lymphadenectomy. This, in addition to biopsies throughout the abdomen, provides pretty accurate information to determine the stage of your cancer. Treatment is, of course, dependent upon what the stage is. So, the question is whether or not the risk of node removal near large blood vessels is worth the risk.

The traditional viewpoint is that removal of nodes is crucial. However, sometimes a surgeon (usually a gynecologic oncologist) who is able to remove nodes safely is not available. What then? Well, it means another surgery. Or does it?

At the recent 55th meeting of the Society of Nuclear Medicine, Dr.Guerra and his colleagues from Italy reported on an alternative that seems to hold promise. In their small series of 30 women, a combined PET and CT scan was done before staging surgery. They found that it was accurate in predicting lymph node positivity in 98% of patients. Surgical staging itself is about as accurate, or perhaps a little less so.

This has some interesting implications. First of all, if this is proven to be true in larger studies, taking someone BACK to perform a second surgery for surgery may become unnecessary. Beyond that, even though lymph node removal is pretty safe in the hands of a surgeon who is trained to do this, it is still arguably the riskiest part of an early cancer surgery staging procedure. So, it may eliminate the need for lymph node dissection in all patients in the future. It certainly may prove to be better than an inadequate surgery with just a few lymph nodes removed for the pathologist to review.

The standard formula for calculating ovarian cancer chemotherapy dose (Calvert) ignores weight as a factor. This has always been controversial, with some oncologists taking that position that some women may get too low of a dose if they are overweight.

A recent study from the national Gynecologic Oncology Group has shown that women who are technically classified as obese (Body Mass Index, or BMI, over 30) had less chemotherapy side effects, and this difference was statistically significant. There was also a trend towards a higher risk of having the ovarian cancer progress in obese women. This suggests, but does not prove, that if you have a high BMI and are getting chemotherapy for ovarian cancer you may be getting a dose lower than you should be getting.

Chemotherapy, like any drug therapy, is based on determining the dose which provides the best effect but also limits the side effect risk. The formulas used are quite complex and depend upon good kidney function. Other complex relationships exist including the total body distribution that the drug can go to and stay in your body longer. Without getting too deep into science that can't be explained in a short blog post, there are several formulas, but some think that the most commonly used one for ovarian cancer may be flawed. Talk with your oncologist about the best options for you. Here is the reference to the recent publication: Gynecol Oncol. 2008 Jun;109(3):353-8

So far there is no accepted method for accurately screening ovarian cancer. You have heard this before and there is a lot of emotion that spills into the argument, but the reason for the statement is based on simple statistics. The sensitivity of CA125 has been reported in multiple studies and ranges 50-95%, which means it can miss as many as 50% of ovarian cancers. The specificity has been much better, ranging from 88-99%, but this still means that if the test is positive in up to 12% of women there may be no cancer present. There are other statistics, but you get the point. There is very big chance of missing ovarian cancer or putting a lot of people through unnecessary tests and/or surgeries. But let's move on to the good news....

There is a lot of interest in combining CA125 with other tests and getting a much better "combined test" result. It also goes well beyond CA125 because there have been a lot of proteins identified that may be good markers for early ovarian cancer screening.

A multi-institution research group headed by Yale's Dr. Gil Mor, have come up with a combined test which includes leptin, prolactin, osteopontin, and insulin-like growth factor-II. Using these four proteins, they were able to boost BOTH the sensitivity and specificity to 95%. In a related study, when Macrophage Inhibitory Factor (MIF) and CA-125 were added, the numbers went up to 99% on both counts. This means the test combo is much more "accurate" for finding cancer and avoiding false positive results. There are other examples in the medical literature that are very encouraging, like this one. Of course this is still research data, but we are headed in the right direction, and in my opinion are really very close to some breakthroughs in ovarian cancer screening.