Chemo makes you deaf

Common Chemotherapy Drugs Seem to Increase Hearing Loss in Adults

https://tinyurl.com/mr48a9jd

 

         One of the more significant side effects of chemo is neuropathy. Peripheral neuropathy with loss of function and pain is well recognised and may be an inevitable consequence of chemotherapy as part of the initial treatment of ovarian cancer.

         Less well recognised and often not considered is cranial neuropathy, where the cranial nerves are damaged. For the auditory nerve this damage presents as hearing loss and often tinnitus. 

         Data from a study looking at survivors of cancer who had chemo found that 70% had significant hearing loss, with hearing below the 50^th percentile for any frequency. Similarly 40% reported tinnitus with ringing in the ears for longer than 10 minutes. Despite the high incidence of hearing loss only 17% of those affected had hearing aids.

         It may well be that hearing loss is also an inevitable consequence of effective chemo. However, it can and should be managed by early diagnosis and appropriate assistance with hearing.

Drug resistance

Genomic and epigenomic BRCA alterations predict adaptive resistance and response to platinum-based therapy in patients with triple-negative breast and ovarian carcinomas

https://tinyurl.com/5xw4248z

 

         One of the unsolved issues in ovarian cancer is why some patients are resistant to the normal chemotherapy regime. This article suggests that epigenetic alteration may be a cause.

         Epigenetic change occurs when chemical effects such as methylation cause structural deformity to DNA. The effects of this change to the BRCA gene are similar to mutation. Both groups with BRCA alteration, either due to mutation or epigenetics, have a good response to chemo.

         Exposure of the epigenetically changed BRCA gene to platinum chemo may cause reversal to normal BRCA status. It is suggested that adaption to the effects of chemo in this way can account for unexpected resistance to platinum chemo. This fundamental research may lead to better selection of initial treatment for ovarian cancer.

Does side matter?

Exploring the prognostic impact of tumor sidedness in ovarian cancer: A population-based survival analysis of over 10,000 patients

 

https://tinyurl.com/247uyffd

 

         For some cancers the side of origin makes a difference in survival. The side of presentation for instance, affects Colon cancer, with left sided tumours having better survival. Differences in genetic and physical factors account for the side variation in colon cancer.

         This study looks at a large number of women who have ovarian cancer and explores the impact of which side of the abdomen is affected. Data from the SEER public database provided information about more than 10,000 women who had ovarian cancer during the period, 2004 through to 2017.

         Of these women about 26% had bilateral cancer at presentation, the remainder had an equal distribution between right and left side. Results showed no survival advantage for either side, Women with bilateral disease at presentation do slightly worse.

Leak prediction

OVA-LEAK: Prognostic score for colo-rectal anastomotic leakage in patients undergoing ovarian cancer surgery

 

https://tinyurl.com/2apaxd4t

 

         One of the more devastating consequences of surgery for ovarian cancer is post-operative leakage of bowel content from an anastomotic site. This complication has a mortality of about 3%.

         A strategy for avoiding this complication of difficult surgery is to perform a bowel diversion in the form of an ileostomy as part of the initial surgery. It is however difficult to predict which patients will be liable to post-operative leak. An application; OVA-LEAK, accessible via the web has been developed to predict which patients should be managed in this way*.

         This study looked at the value of the OVA-LEAK score with a comparison to the standard clinical assessment of those patients requiring bowel diversion during initial surgery. The OVA-LEAK score had a negative predictive value of 97% meaning it is likely that those women who score well will not have a leak. For those women who qualified for bowel diversion it was almost four times more likely to be beneficial than for those women who were chosen by clinical assessment only.

*  https://tinyurl.com/3k4ancdj

Could COVID increase ovarian cancer risk?

Are female-specific cancers long-term sequelae of COVID-19? Evidence from a large-scale genome-wide cross-trait analysis

https://tinyurl.com/mvdfnx9r

 

         Could the pandemic result in more ovarian cancer in the future?  Previously an association of cancer with viral infections has been noted especially involving the liver cervix and lymphomas. It is suspected that up to 10% of all cancer is associated with a previous viral infection.

         This begs the question, “Will COVID-19 infection do the same”? Obviously the pandemic is too recent for long-term effects to be apparent. However, it is possible to look at the genetic variants resulting from the infection and speculate about the consequences.

         One of the commonest genetic variations is a Single Nucleotide Polymorphism (SNP), where a single change in the DNA code has occurred. This study looked at the large amount of genetic information available about ovarian cancer genotypes and COVID-19 affected individuals. There are correlations, with 15 SNP variants being common to both groups. This is a preliminary study and does not indicate any known increased risk but does raise concern.