Low-grade serous ovarian cancer; conundrum

Diagnosis-shift between low-grade serous ovarian cancer and serous borderline ovarian tumor: A population-based study

https://tinyurl.com/wha6lm2

In 1971 the World Health Organisation introduced the new pathological classification of borderline ovarian tumours. The gradual acceptance of this term has led to fewer early low-grade serous ovarian cancer diagnoses.  Borderline tumours have low mortality, whether progression to cancer occurs is uncertain.

            This study is a retrospective analysis of registry data in the period 1988-2000. The number of low-grade cancers diagnosed decreased by a quarter, with worse survival. Most patients were older women. The previous misdiagnosis of borderline tumours as low-grade cancer gave an impression of better survival, the outcomes being skewed by the number of benign tumours included in the reference group. 

            The correct diagnosis at presentation is critical for management. Low-grade serous ovarian cancer is relatively chemo resistant, surgical clearance is the most important predictor of survival.  Personalised medical care is required.

Epithelial Ovarian Cancer
LGSC = Low-grade serous cancer

Ovarian cancer, why some live longer

Tumour immune cell infiltration and survival after platinum-based chemotherapy in high-grade serous ovarian cancer subtypes: A gene expression-based computational study

https://tinyurl.com/wqqzfm3

Ovarian Cancer has a variable prognosis, with some patients surviving longer than would be expected from the stage and type at presentation. The extent and type of immune cell infiltration of the tumour, after treatment,  is known to affect the prognosis. This study, a Meta-analysis, looks at all available large series to try to understand the nature and diversity of the immune reaction following platinum chemotherapy.

Better survival is associated with an immune reaction and the presence of large white cells from the blood (macrophages).  Worse survival occurs when there is no immune reaction or in the presence of different white cells called neutrophils.

The different immune reactions were also associated with genetic variations making the cancer more or less responsive to immunotherapy. Those patients who have a macrophage infiltration are more likely to have a good response to checkpoint inhibition with an agent such as Keytruda. The study advances the prospects of personalized medical care for ovarian cancer patients.

Talc does not cause ovarian cancer

Association of Powder Use in the Genital Area With Risk of Ovarian Cancer

https://tinyurl.com/ye96737v

The possible association of the use of talcum powder on the perineum and the development of ovarian cancer has been debunked by this recent analysis.

Multiple contingent lawsuits in the US against the defendant Johnson and Johnson, the major producers of baby powder, are now put in jeopardy. There is however some alleged contamination of the talc powder, with asbestos, which will no doubt prolong any settlements.

250,000 women were recruited from the Nurses’ Health Study (another great achievement by this group) and the Women’s Health Initiative. 38% of the group reported use of talc. The follow up was for 11 years. This extensive and incontrovertible analysis shows no association and probably no increased risk.

Information is power for BRCA+

BRACAVENIR: an observational study of expectations and coping in young women with high hereditary risk of breast and ovarian cancer

https://tinyurl.com/txykwuu

         Genetic screening with BRCA positive results puts pressure on young women, with difficult decisions about whether to undergo risk reduction surgery causing fertility and body image concerns.

         This study from France looked at the value of an educational and psychological support program. Psychometric testing showed increased optimism, self-esteem and quality of life on completion of the program.

         Most described the communication of genetic test results as brutal and traumatic,. Relationship issues after surgery were important, body image less so. There was no sense of injustice about BRCA positive status.