The functional trajectories of older women having surgery for  gynae-oncology  cancer: A single site prospective observational study http://tinyurl.com/49sebad9 Whether to put elderly women through the challenge of clearance surgery for ovarian cancer  is a difficult choice. There has previously been a reluctance to treat older women with the same  extensive surgical resection  which is the standard of care for younger fitter women. This  p rospective review looked at about 100  previously self-reliant  women  with cancer ,   who were 65   years old or older  and  measured their postoperative fun ctional recovery ,  with correlation to their  independence before diagnosis. Results from the survey showed that 70% of the women were able to function normally with full independence at 12 mo nths  post-surgery . Some of the women  had impairment of function at six months with  subsequent  recovery....

Unveiling the Immunogenicity of Ovarian  Tumo u rs  as the Crucial Catalyst for Therapeutic Success https://tinyurl.com/bd4ke3sx Ovarian cancer is resistant to immune therapy.  Because of this less than 15% will respond to treatments such as checkpoint  inhibition or T Cell infusion which are effective as treatment for many other cancers . Immune resistance occurs in ovarian cancer  by various processes which include ,  downwards regulation of otherwise protective genes ,  and change of  surface proteins on cancer  cells that act as   targets for immune response.  This leads to platinum resistance and  early recurrence. Understanding of this altered immune status  results in  new  classifications of cancer types , with separation of ovarian cancer into  homologous recombination deficiency,  (about 40%) , and epithelial mesenchymal transition,  (the rest). The latter group are th e most immune resis...

Prevalence of viral DNA in high-grade serous epithelial ovarian cancer and correlation with clinical outcomes https://tinyurl.com/e6e9vaer It becomes clear with new understanding that many cancers including ovarian cancer show evidence of viral infection. This retro spective study looks at tissue samples from 98 patients with ovarian cancer . Using  a  polymerase chain reaction ,  the presence or absence of viral DNA in these samples were  measured  and compared to the survival outcomes. 46 of the patients showed evidence of viral infection  with one or more virus signatures detected. The viruses found included  known carcinogens such as the human papilloma virus and Epstein - Barr  virus. Cancers  containing  viral DNA were more likely to be platinum resistant and had worse survival . This was especially true for younger women, (<70). It is not clear whether the  virus infection is  a   cause of the cancer or an effect...

Early-Onset Ovarian Cancer <30 Years: What Do We Know about Its Genetic Predisposition? https://tinyurl.com/2x6p5jhj Ovarian cancer in young women (age 18-30) is rare being about 5% of the total. I t was assumed that most ovarian cancer in women of this age was due to inherited genetic mutatio ns. Usually, ovarian cancer is a disease of the elderly . Of whom about 20% have a genetic mutation ,  which causes the disease. This  retrospective survey of  more than 300 young women from four different data sets found much less  genetic mutation; about 3%. A different spectrum of disease is seen in the young ,  w ith about half of ovarian cancer arising from embryonal germ cells. Ser ous Ovarian Cancer is much less common in young women,  being about 40% of all cases compared to  9 0% overall. Low Grade  disease is more likely in the young . However, survival is almost 50% worse for the young, (HR0.53)  despite these  seemingly favourable...

Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis  https://tinyurl.com/3drtt9jb Use of  intra peritoneal chemotherapy  (IPEC)  is low in  A ustralia. The reasons for this include adverse effect with pain and  toxicity. Logistic issues such as access and  expertise  also limit its use. There has previously been little evidence of the potential benefit. This study, a retrospective analysis of all available  data looked at the survival benefits of  IPEC. Six studies ,  with results for more than 4500 patients were shown to fit the selection criteria. Both overall survival and progress free survival  were improved with IPEC ,  by  almost 20% , (HR 0.81). The implication of the study is that the IPEC therapy should be  re-evaluated,  and greater use would be benefi cial.

A retrospective study of  Pipelle  endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers https://tinyurl.com/3jc3my57 Although well  established  in the diagnosis of endometrial cancer, the  value  of endometrial biopsy for ovarian and fallopian  tube cancer  is not well understood. Much ovarian cancer starts in the fallopian tube, it has been su ggeste d that end ometrial biopsy could be a low-invasive means to obtain a tissue diagnosis. This retrospective study reviewed  biopsies  obtained from   99  women who had endometrial bi o psy as part of their workup for ovarian cancer.  Findings from the review showed that the biopsy had a low s pecificity , with high false negative results  for early-stage ovarian cancer but  the sensitivity for a positive test was  acceptable at   44%  for  late-stage disease. T he tissue type found at biopsy  was confirmed in the resected ov...

Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden https://tinyurl.com/2mk66bpe On ce again, the large data base of clinical information in Sweden gives further insight into the epidemiology of ovarian  cancer. This study compares the risk of developing ovarian cancer after  previous  pelvic inflammatory disease .  (PID)  It is becoming increasingly obvious that infection is  an important  cause  for much cancer. The retrospective  review  compared the incidence of  PID  in 1000 women who developed ovarian cancer with   10000  women who did not  have cancer . P ID  may occur as salpingitis  possibly sexually transmitted , be associated with  endometriosis, urinary tract infection or inflammatory bowel disease. Results from the study showed that wo m en with  a past history  of  PID were 39% more likely to develo...

Prevalence of active cytomegalovirus infection at diagnosis of ovarian cancer and during chemotherapy and  subsequent  changes in cognitive functioning https://tinyurl.com/yc5mfuf9 Cytomegalovirus (CMV) is a herpes type virus found in 50% of the  population.  It lies dormant after  initial  infection and can recur causing various symptoms which include fatigue and decreased cognitive function. This prospective study looked at the CMV status of 89 women with ovarian cancer and reviewed their cognitive function before and following chemotherapy. At the time of  initial  presentation 30% of the women had blood levels of antibodies suggested active CMV infection. This increased to 60% following chemo. The infection rate reverted to 30% once chemo was ceased.  Those women with active CMV disease at the onset had significantly worse cognitive function than the uninfected. The authors suggest that “brain fog”, which is a complication of chemo for ov...

Causality and functional relevance of BRCA1 and BRCA2 pathogenic variants in non-high-grade serous ovarian carcinomas https://tinyurl.com/e5859f7b With increased availability  more and more  patients with ovarian cancer have genetic screening with the BRCA variants being the primary target. Is this a suitable use of resources? This paper; a prospective review of almost 1000 ovarian cancer cases looked at the incidence of BRCA variants for patients who had the commonest type being high-grade serous ovarian cancer versus the less common non- high-grade  types. BRCA variants were found in 13% of the high-grade cancers and 3% of the non-high-grade cancers. Further review showed that some of the less common cancers had incorrect pathology, the others had faulty BRCA genotyping or that the variation was only partial with incomplete penetration. The authors suggest that BRCA genotyping for non-high-grade serousovarian cancer has no value

Association between wine consumption and cancer: a systematic review and meta-analysis https://tinyurl.com/2jaz8hu6      High alcohol consumption has been shown to be associated with an increased risk for many cancers including breast and ovarian cancer. However, it has been suggested that low to moderate wine consumption (less than 2 glasses of wine daily for women) may be protective.      This review; a meta-analysis of all the available data looked at 454 reports which conformed with the criteria for inclusion. The relative risk of developing breast or ovarian cancer for moderate drinkers was the same as the normal population (RR 1.03).     Moderate drinking is protective against gastric cancer. The authors suggest this may be due to antibacterial activity of alcohol against H. Pylori. Low to moderate consumption of alcohol does not increase ovarian cancer risk.

Proteogenomic analysis of chemo-refractory high-grade serous ovarian cancer https://tinyurl.com/2p9bdrwk One of the many problems with ovarian cancer is that many women (about 15%) do not respond to standard therapy. These women are termed as platinum resistant, have a recurrence before six months after  initial  treatment, with  very poor  outcomes. This study looks at  identifying  those women so that alternative personalised treatment might be considered. It is a retrospective review of pretreatment biopsy obtained from 242 women with high grade ovarian cancer. Of them, 97 were platinum resistant. Using proteogenomic analysis, which combines information from whole of genome sequencing and spectroscopic data about protein and RNA transcription, different subgroups were  identified .  In particular a  protein signature common to all the platinum resistant cancers may  assist  in early diagnosis. As of now there is no alternative ef...

Risks of non-ovarian cancers in women with borderline ovarian  tumour : a national cohort study in Sweden https://tinyurl.com/uchdbbnk One of the great advantages of medical research from Scandinavia is the quality of the epidemiology data. This paper is an example of the large numbers of the sample group which can be obtained from the Swedish Cancer Registry. Almost 5000 women were diagnosed to have a borderline ovarian tumour during the period 1995-2018. Follow up of those women showed an increased risk of non-ovarian cancer when compared to the general population. The types of cancer included bowel, uterine, renal, lung,  thyroid  and pancreas. There was no association shown with breast cancer or leukaemia. The authors  speculate  that the presence of a borderline tumour may be a marker for increased cancer risk  possibly due  to a shared cause or predisposition.

IDEAYA Receives Fast Track Designation for Potential First-in-Class PARG Inhibitor, IDE161, for Treatment of Pretreated, Platinum-Resistant Advanced or Metastatic Ovarian Cancer Patients having  tumours  with BRCA1/2 Mutations https://tinyurl.com/bdhy2uuj Defective DNA repair is important as a cause for ovarian cancer and the prevention of cancer elimination once  established . Personalised treatment using PARP inhibitors acts by blocking alternative repair pathways through a process called synthetic lethality.  Unfortunately resistance to  PARPi  is inevitable. Often this occurs because another repair process becomes active. One such process is Poly (ADP-ribose)  Glycohydralase  (PARG). A new Drug IDE161 has been developed to inhibit this repair process in  a similar manner  to PARPi. The FDA has given Fast Track approval for this drug as a preliminary to full access. Usually this implies the FDA has confidence that the new treatment fo...

Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients with Less Common Epithelial Ovarian Carcinomas https://tinyurl.com/5xvnykwb Sometimes there is a temptation to use a treatment protocol, which has shown to be successful for one type of cancer more widely. An example of this is the application of Neoadjuvant chemo (Neo) prior to surgery for rarer types of ovarian cancer. Although Neo is  beneficial for High Grade Serous Ovarian Cancer, it seems to be ineffective for other types. This retrospective review looked at about 1000 cases of Low Grade Serous Ovarian Cancer in women who presented with advanced disease (stage III-IV), during the period 2006-2019. There was a gradual increase in the number receiving Neo, with 15% having delayed surgery with Neo beforehand. When the data was reviewed in 2022, no benefit was shown with survival worse for those who had Neo, and larger residual volumes after  initial  surgery. Similar failed Neo, with worse outcomes, were...

Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer (OVHIPEC-1): final survival analysis of a randomised, controlled, phase 3 trial   https://tinyurl.com/3kparpnm      For cancer research it is important to consider the longer term. It is often many years before a conclusion about the merit of a new procedure can be reached.        This study looked at the long-term benefits of hyperthermic intraperitoneal chemo (HIPEC) by revisiting the subjects of the OVHIPEC-1 trial 7 years after the trial ceased. The initial trial showed improved progression free survival and overall survival for those women who received HIPEC as part of their therapy in addition to normal chemo for ovarian cancer.        Review of the data has enabled the determination of 10-year survival for the first time, which shows that HIPEC benefit is prolonged. More patients survive with better q...

Tumour stage, treatment, and survival of women with high-grade serous Tubo -ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial   https://tinyurl.com/dr7z7sr9        Screening of ovarian cancer has been shown to be ineffectual. The UKCTOCS trial over 15 years, which had more than 200,000 participants proved that there was no benefit in terms of long-term survival for women who received comprehensive ovarian cancer screening when compared to women who did not.        This review of the data looked at the staging for those women who developed ovarian cancer either during the trial or in the 9 years since the trial finished. Of the participants 0.5% had ovarian cancer, the incidence is the same in the screened and non-screened group.        A significant difference is noted in the staging of the cancers detected, with fewer women from the screened group presenting with advanced (III-IV stage) o...