Avoid biopsy; save time and money

How Could Machine Learning and Radiomics Improve Ovarian Cancer Care?

https://www.cancernetwork.com/news/how-could-machine-learning-and-radiomics-improve-ovarian-cancer-care

Usually preoperative tumour biopsy is needed to determine ovarian cancer type. This is invasive with high cost and takes time. The same assessment is now available from a patient’s routine preoperative CT scan at presentation.

A score, calculated from CT data, termed the Radiomic Prognostic Vector (RPV) reliably identifies the 5% of patients with median overall survival expectation of less than 2 years.

Patients with high RPV are likely not to benefit from standard surgery and chemotherapy and may need alternative care.

Positive BRCA1/2 status is a survival advantage

Fifteen-year survival of invasive epithelial ovarian cancer in women with BRCA1/2 mutations – the National Israeli Study of Ovarian Cancer

https://doi.org/10.1016/j.ygyno.2019.02.022

Women with invasive epithelial ovarian cancer who are carriers of BRCA1/2 mutation have lower 5, 10, and 15 years all-cause mortality than non-carriers.

In the first 5  years, being a carrier was associated with a 26% reduction in mortality compared to non-carriers.

For women who survived 5  years and more, being a BRCA carrier was not associated with better survival in the subsequent years.

Is miRNA the holy grail?

Functions of miRNAs in the Development, Diagnosis, and Treatment of Ovarian Carcinoma

http://tinyurl.com/y6tqavwb

Micro RNAs (miRNAs ) are small RNA molecules, which are released into plasma by normal and tumor tissues during cell metabolism and may be highly significant biological markers and therapeutic targets for ovarian cancer.

Currently, there is no biomarker in clinical use for detecting ovarian cancer in the early stage. Circulating miRNAs in ovarian cancer have been identified in blood plasma, serum, ascites, and urine.

 miRNAs will contribute to diagnosis, prognosis, and development of new chemotherapeutic drugs leading to improved management of ovarian cancer

Ovarian cancer: - Not always a death sentence

Characteristics of Long-Term Survivors of Epithelial Ovarian Cancer

https://tinyurl.com/y3wwrrcc

Patients and physicians commonly perceive ovarian cancer as a highly fatal disease. Although most women diagnosed with advanced-stage ovarian cancer will die of the disease, one third of all patients with ovarian cancer survive 10 years or more.

Of the long-term survivors, 32% have stages III and IV epithelial cancer. The explanation for this is unclear, advanced cancer usually means a poor outcome.

Long-term survivors are most likely to be women younger than age 50 years, who more often have low-stage and low-grade epithelial cancers and are able to tolerate aggressive surgery and chemotherapy.

Routine lymph node removal is not justified

A Randomised Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms

https://www.nejm.org/doi/full/10.1056/NEJMoa1808424

For decades, patients with advanced ovarian cancer have routinely had regional lymph nodes removed; supporting evidence from randomised clinical trials has been limited.

647 patients with ovarian cancer stage IIB through IV and with normal lymph nodes either did or did not undergo lymphadenectomy as a randomised trial.

Lymphadenectomy in patients with advanced ovarian cancer and normal lymph nodes  was not associated with longer overall or progression free survival but was associated with a higher surgical mortality and postoperative complications.