Low grade, new standard of care

Redefining the Standard of Care for Low-Grade Serous Ovarian Cancer

https://tinyurl.com/432cxawp

Low grade serous ovarian cancer (LGSC) is rare being about 5% of all ovarian cancer, it has many differences to the common high-grade disease and increasingly it is being treated as a separate disease with targeted therapy appropriate for its distinct molecular features.

Recognition of this has led to a proposed new standard of care which includes complete understanding of the individual tumour with appropriate hormonal suppression for some and use of MEK,  (Mitogen extracellular Kinase) inhibitors, these target protein pathways which increase cancer growth. This treatment may be used alone or in combination with platinum chemo.

Minimally invasive surgical techniques may be used which increases quality of life for the patient. Genetic screening should be included as part of the care with the intent of enabling personalised care.

This new regime should increase survival, especially for the sub-group of younger women who are more prone to develop this form of ovarian cancer.

When to operate

CA-125 elimination rate constant K (KELIM) as a promising predictor of complete cytoreduction after neoadjuvant chemotherapy in advanced ovarian cancer patients: a retrospective study from two Chinese hospitals

https://tinyurl.com/4rusbkw8

For many patients with ovarian cancer complete removal of the cancer at the time of the first surgery is not possible. As with all surgery there are complications and some deaths. If complete resection is not possible a risk/benefit analysis should be performed and discussed with the patient. For older or frail women chemotherapy alone may be appropriate treatment.

This retrospective study looked at the surgical outcomes for 133 women who had chemo prior to surgery. The completeness of the cancer resection was compared to the response to chemo. This response was measured as the elimination rate of the tumour marker CA125, which is expressed as KELIM.

Results from the study suggest that KELIM is a marker of the likelihood of complete removal. The authors suggest a prospective study to prove this would benefit clinicians and patients who have the difficult choice of whether to proceed to surgery.

Ovarian cancer and heart failure, more than a coincidence

Shared and Reciprocal Mechanisms Between Heart Failure and Cancer　― An Emerging Concept of Heart-Cancer Axis ―

https://tinyurl.com/4bsub8j6

The commonest causes of death are heart failure, (30%) and cancer (15%). It has become clear that there is an association between the two. Patients with ovarian cancer have a 60% increased risk of developing heart failure. Patients with heart failure are more likely (20%) to have cancer and have a higher risk (70%) of developing cancer.

This article suggests the reasons for this combination of disease. There are shared lifestyle factors such as age, smoking and obesity. Also, common pathways of disease are present with inflammation, hypertension and blood cell variation called clonal haematopoiesis of indeterminate pathology (CHIP). End stage disease of cancer, with cachexia also has an impact on cardiac muscle, with heart failure frequently being the terminal event.

Because of the high likelihood of both diseases the authors suggest the concept of a Heart-Cancer-Axis. Understanding of likely double disease will assist earlier intervention and improve survival.

Best left alone

Ovarian cancer risk among older patients with stable adnexal masses

https://tinyurl.com/mcndkuna

Conventional management of ovarian masses for women aged 50 years or more has been surveillance with serial ultrasounds. These masses are common, usually benign, may be cystic or solid, and also can be seen with endometriosis or pelvic inflammatory disease.

This retrospective study looked at the incidence of ovarian cancer for 4000 women, who had been noted to have an ovarian mass, which was stable in size and appearance on repeat ultrasound examination after 6 weeks.

Over the follow up period for these women, which was for about 4 years, there was a very low incidence of ovarian cancer with 11 cancers detected, which is about half the number which would be expected for women of this age.

The implication is that active surveillance is unnecessary and scarce resources can be used for other purposes.

More knowledge about metastasis

The role of Piezo1 mechano-transduction in high-grade serous ovarian cancer: Insights from an in vitro model of collective detachment

https://tinyurl.com/mpm7sbve

Sometimes this blog deals with the frontiers of research into ovarian cancer. This article is one such. Why ovarian cancer cells are so prone to metastasis remains a mystery. There are two components; detachment from the primary tumour and subsequent implanting of cancer cells.

Normally the detachment of cells is restricted by the stiffness of the extracellular matrix which is mostly composed of collagen fibres. A gateway for separation of cells is found with a specific protein Piezo-1 which changes the electrical and mechanical resistance.

This in-vitro experimental study, using normal and cancer human omental cells shows the importance of the gateway, with those cell cultures having high Piezo-1 activity being more likely to metastasise. This pathway has the potential to be a target for cancer therapy.