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Abramson Cancer CenterNCI CANCERLIT® Search: Diagnosis-Histopathology-Pathogenesis of Ovarian Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11248061
AU - Levy-Lahad E; Lahad A; Eisenberg S; Dagan E; Paperna T; Kasinetz L;
TI -
Catane R; Kaufman B; Beller U; Renbaum P; Gershoni-Baruch R
A single nucleotide polymorphism in the RAD51 gene modifies cancer risk
in BRCA2 but not BRCA1 carriers.
SO - Proc Natl Acad Sci U S A 2001 Mar 13;98(6):3232-6
AD - Medical Genetics Unit, Shaare Zedek Medical Center and Hebrew
University/Hadassah Medical School, P.O. Box 3235, Jerusalem 91031,
Israel. lahad@szmc.org.il
BRCA1 and BRCA2 carriers are at increased risk for both breast and
ovarian cancer, but estimates of lifetime risk vary widely, suggesting
their penetrance is modified by other genetic and/or environmental
factors. The BRCA1 and BRCA2 proteins function in DNA repair in
conjunction with RAD51. A preliminary report suggested that a single
nucleotide polymorphism in the 5' untranslated region of RAD51 (135C/G)
increases breast cancer risk in BRCA1 and BRCA2 carriers. To investigate
this effect we studied 257 female Ashkenazi Jewish carriers of one of
the common BRCA1 (185delAG, 5382insC) or BRCA2 (6174delT) mutations. Of
this group, 164 were affected with breast and/or ovarian cancer and 93
were unaffected. RAD51 genotyping was performed on all subjects. Among
BRCA1 carriers, RAD51-135C frequency was similar in healthy and affected
women [6.1% (3 of 49) and 9.9% (12 of 121), respectively], and RAD-135C
did not influence age of cancer diagnosis [Hazard ratio (HR) = 1.18 for
disease in RAD51-135C heterozygotes, not significant]. However, in BRCA2
carriers, RAD51-135C heterozygote frequency in affected women was 17.4%
(8 of 46) compared with 4.9% (2 of 41) in unaffected women (P = 0.07).
Survival analysis in BRCA2 carriers showed RAD51-135C increased risk of
breast and/or ovarian cancer with an HR of 4.0 [95% confidence interval
1.6-9.8, P = 0.003]. This effect was largely due to increased breast
cancer risk with an HR of 3.46 (95% confidence interval 1.3-9.2, P =
0.01) for breast cancer in BRCA2 carriers who were RAD51-135C
heterozygotes. RAD51 status did not affect ovarian cancer risk. These
results show RAD51-135C is a clinically significant modifier of BRCA2
penetrance, specifically in raising breast cancer risk at younger ages.
2
UI - 11292192
AU - Koh SC; Tham KF; Razvi K; Oei PL; Lim FK; Roy AC; Prasad RN
TI -
Hemostatic and fibrinolytic status in patients with ovarian cancer and
benign ovarian cysts: could D-dimer and antithrombin III levels be
included as prognostic markers for survival outcome?
SO - Clin Appl Thromb Hemost 2001 Apr;7(2):141-8
AD - National University of Singapore, Department of Obstetrics and
Gynaecology, National University Hospital, Singapore.
obgkohcl@nus.edu.sg
We determined the hemostatic and fibrinolytic status in 60 patients with
ovarian cancer and benign ovarian cysts. Hypercoagulation, increased
platelets, and enhanced fibrinolysis were seen in patients with
preoperative ovarian cancer compared to patients with benign ovarian
cysts. Enhanced thrombin generation, evidenced by increased F1+2 and
decreased antithrombin III (ATIII) levels with further enhanced
fibrinolysis by elevated D-dimer, was seen in advanced cancer. Ten
ovarian cancer patients died within 13 months after diagnosis and
another died at 24 months, all from advanced stage of cancer, except one
from stage IC cancer who died at 11 months. The survival rates from the
disease at 13 months and 24 months were 66.7% and 45%, respectively.
Most of the patients had gone through the complete course of
chemotherapy, and those patients still alive have been disease free
between 13 and 42 months. No statistical relationships for the
hemostatic parameters studied in ovarian cancer patients could be found
between those who died and those still living 13 and 24 months after
diagnosis, except for ATIII and D-dimer levels. Elevated D-dimer levels
were associated with those who died within 13 and 24 months from the
disease, and the decreased ATIII levels only reached statistical
significance by 24 months. It could be suggested that these two
parameters might be useful as systemic prognostic markers in survival
outcome from the disease for the first 24 months in advanced ovarian
cancer, in addition to the known correlation with the International
Federation of Gynecology and Obstetrics stage.
3
UI - 11419167
AU - Matsuoka Y; Ohtomo K; Araki T; Kojima K; Yoshikawa W; Fuwa S
TI -
MR imaging of clear cell carcinoma of the ovary.
SO - Eur Radiol 2001;11(6):946-51
AD - Department of Radiology, Toshiba General Hospital, 6-3-22, Higashi Ooi,
Shinagawa-ku, Tokyo 140-8522, Japan. matsuokayu@hotmail.com
Magnetic resonance imaging findings are reported for 12 pathologically
proven lesions of clear cell carcinoma (CCC) of the ovary in 11 women
(mean age 50 years). T1- and T2-weighted MR images were obtained in all
patients, and gadolinium-enhanced MR images were obtained in 9. The mean
diameter of the tumors was 13 cm. Seven patients presented with stage-I
tumors. All 12 lesions consisted of cystic masses with solid protrusions
occurring in 10 and solid masses in 2. The cysts were unilocular in 9
lesions and multilocular in 1. In four lesions, the cysts displayed with
high intensity on T1-weighted images. Round solid protrusions were
identified in 8 lesions. In 5 lesions, the number of protrusions was
only a few. The solid portions of 5 masses had slightly high-intensity
regions on T1-weighted images. The number of patients with ascites was
three. Magnetic resonance imaging of CCC usually shows a unilocular
large cyst with solid protrusions, which are often round and few in
number. Such MR imaging findings suggest malignant tumor but are not
specific.
4
UI - 11419910
AU - Zhao X; Wei YQ; Peng ZL
TI -
Induction of T cell responses against autologous ovarian tumors with
whole tumor cell lysate-pulsed dendritic cells.
SO - Immunol Invest 2001 Feb;30(1):33-45
AD - Department of Gynecology and Obstetrics, Second University Hospital,
West China University of Medical Sciences (HuaXi Medical School, Sichuan
University), Chengdu, Sichuan, The People's Republic of China.
The loading of dendritic cells (DCs) with whole tumor cell lysates may
circumvent the facts that few tumor-specific antigens have been
identified in human solid tumors. The present study was designed to
investigate whether ovarian cancer cells lysate-pulsed DCs activate T
cell responses against autologous ovarian tumors. Incubation of T cells
with autologous tumor cell lysate-pulsed DCs stimulated proliferation of
autologous T cells. T cells primed by autologous tumor cell
lysate-pulsed DCs showed significant killing activity against autologous
tumor cells, which could be blocked by anti-MHC-class-I and anti-CD8
mAb. By contrast, T cells primed by autologous unpulsed DCs alone or
tumor lysates alone failed to exhibit significant killing activity. In
addition, T cells primed by DCs pulsed with allogeneic tumor cell
lysates or with autologous normal cell lysate or by these cell lysates
alone did not induce the increase in the autologous tumor killing
activity. As additional controls, T cells stimulated with autologous
tumor lysate-pulsed DCs express no increase in the lysis of autologous
monocytes, allogeneic ovarian tumor cells and other cell lines including
K562, Daudi and Molt-4. Furthermore, T cells stimulated with autologous
tumor lysate-pulsed DCs could produce the considerable amounts of
cytokines such as GM-CSF, TNF-alpha and IFN-gamma. The data in the
present study suggest that whole tumor cell lysates-pulsed DCs could
activate T cell responses against autologous ovarian tumor cells, and
that these pulsed DCs may be used as a new approach for the specific
immunotherapy of ovarian cancer patients.
5
UI - 11434389
AU - Campos B; Diez O; Cortes J; Domenech M; Pericay C; Alonso C; Baiget M
TI -
Conditions for single-strand conformation polymorphism (SSCP) analysis
of BRCA1 gene using an automated electrophoresis unit.
SO - Clin Chem Lab Med 2001 May;39(5):401-4
AD - Servei de Genetica, Hospital de la Santa Creu i Sant Pau, Barcelona,
Spain.
The single-strand conformation polymorphism procedure has been applied
in routine testing for hereditary diseases and cancer. However,
temperature, running time, gel composition, fragment length, etc. can
influence its sensitivity. Mutation detection in the clinical setting
depends on the development of automated technology, especially for large
genes such as the breast cancer gene BRCA1. We analysed DNA samples with
BRCA1 mutations in an automated system (GenePhor System;
Amersham-Pharmacia Biotech, Uppsala, Sweden). The concentrations of DNA
template and PCR primers, the effect of chilling after denaturation, and
the temperature and time of the electrophoresis were investigated. All
band-shifts were detected by electrophoresis at 5 degrees C for 2 h 15
min. Concentrations of DNA and samples used in the PCR did not affect
the SSCP pattern, but chilling the PCR product in ice after denaturation
was required. The type and position of mutation in the fragments did not
influence the probability of a mobility shift, although SSCP analysis
was more sensitive for fragments shorter than 350 bp. This automated
SSCP method meets the requirements of fast turnaround and sensitivity
and can be readily adapted to the screening of large genes such as
BRCA1.
6
UI - 11474658
AU - Mahavni V; Kim SC; Benda TA; Sanders L; Buller RE
TI -
The androgen receptor and DXS15-134 markers show a high rate of
discordance for germline X chromosome inactivation.
SO - J Med Genet 2001 Jul;38(7):474-8
7
UI - 11444200
AU - Garrett AP; Lee KR; Colitti CR; Muto MG; Berkowitz RS; Mok SC
TI -
k-ras mutation may be an early event in mucinous ovarian tumorigenesis.
SO - Int J Gynecol Pathol 2001 Jul;20(3):244-51
AD - Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology,
Department of Obstetrics and Gynecology, Brigham and Women's Hospital
and Harvard Medical School, 75 Francis Street, Boston, Massachusetts,
USA.
We explored the possible pathogenetic pathway for mucinous ovarian
tumorigenesis by examining the k-ras mutational patterns in ovarian
mucinous tumors (OMTs) with benign, borderline, and invasive epithelium
in which the different types of mucinous epithelium are in close
proximity. Sixteen patients with ovarian mucinous borderline tumors
(OMBTs) and 4 patients with grade 1 ovarian mucinous adenocarcinomas
(OMCs) were selected for the presence of a single histologic section
which contained a clear "transition" zone from benign mucinous
epithelium to borderline mucinous epithelium, and in four cases, to
invasive epithelium. A PixCell II Laser Capture Microscope was used to
microdissect and retrieve benign, borderline, and invasive epithelium
separately from the 20 OMTs. Normal ovarian stroma from the same
histologic section in each case was also microdissected and retrieved
for use as a control. k-ras mutations were detected in these samples by
PCR-SSCP analysis followed by direct PCR cycle sequencing. k-ras
mutations were found in 8/16 (50%) of the OMBTs and 2/4 (50%) of the
grade 1 OMCs. In 6 of these 10 cases (4 in OMBTs, 2 in grade 1 OMCs),
the same k-ras mutation was found in both the benign and borderline (and
invasive) regions. In 3 cases in which k-ras mutations were identified,
the mutation was found in either the benign or borderline tissue samples
alone, and in one case, two distinct mutations were found. No k-ras
mutations were identified in the normal ovarian stroma. The presence of
a k-ras mutation in adjacent benign and borderline regions of a single
OMT may suggest a progression in the development of OMTs from benign to
borderline and grade 1 OMCs. k-ras mutations, when they occur, are
likely early genetic changes but may not alone be sufficient for
malignant transformation of ovarian epithelium.
8
UI - 11446472
AU - Karseladze AI
TI -
On the site of origin of epithelial tumors of the ovary.
SO - Eur J Gynaecol Oncol 2001;22(2):110-5
AD - Department of Pathology, Cancer Research Centre of the Russian Academy
of Medical Sciences, Moscow.
Ovaries removed at 1,050 autopsies (accidental deaths) and from 300
patients with various benign gynaecological diseases were studied in
search of the incipient benign epithelial tumors. One percent of the
ovaries contained incipient mucinous tumors, 1.1%--Brenner tumors,
0.5%--endometrioid tumors. The exact percentage of the serous tumors was
difficult to establish because of the absence of morphological criteria
that distinguish these tumors from tumor-like conditions (inclusion
cysts). The mucinous and Brenner tumors, as well as some serous tumors
were located deep in the medullary or hilar regions of the ovary and
were not connected to the covering of the ovary. The theory of incessant
ovulation that links ovulatory damage of the ovarian surface with the
initiation of neoplastic growth does not explain the genesis of all
epithelial tumors. It is more likely that the latter two types arise in
other parts of the female gonad. The process of morphogenesis of
epithelial benign tumors is closely related to stromal alterations,
specific for each histogenetic entity.
9
UI - 11446479
AU - Sawicki W; Spiewankiewicz B; Cendrowski K; Stelmachow J
TI -
Preoperative discrimination between malignant and benign adnexal masses
with transvaginal ultrasonography and colour blood flow imaging.
SO - Eur J Gynaecol Oncol 2001;22(2):137-42
AD - Department of Obstetrics and Gynaecology, Medical University of Warsaw,
Poland.
BACKGROUND: Ovarian cancer is one of the causes of death in women, and
in about 70% of cases is recognized only in advanced stages. This study
was undertaken to evaluate distinctive values of transvaginal and color
Doppler ultrasonography in differentiating malignant and benign adnexal
masses through analysis of ultrasonic morphological features of
malignancy and estimation of location and intensification of
angiogenesis as well as values of resistance of flow in examined masses.
PATIENTS AND METHODS: 329 women with malignant and benign adnexal masses
underwent ultrasonographic and colour Doppler examination 1-5 days
before surgery (laparotomy, laparoscopy) thus allowing histological
verification of diagnosis. The ultrasonographic structure was assessed
using a morphological scoring system devised by Sassone, Jain and
Benacerraf. Regions showing vasculature, especially within septae and
solid parts of tumours were examined by means of transvaginal colour
Doppler. Location and intensification of angiogenesis as well as
resistance index (RI) were investigated. Sensitivity, specificity, PPV
and NPV of both techniques were assessed. Statistical analysis of
obtained data were based on the Student's t test; p < 0.05 level was
considered significant. RESULTS: Postoperatively 255 (77.5%) benign and
74 (22.5%) malignant tumours were seen. In the group of benign masses
the average age of women was 42.6+/-12.3 and in the malignant it was
53.1+/-12.6 (p<0.0001). The transverse dimension of benign lesions was
77.2+/-19, whereas for malignant it was 107.0+/-31 (p<0.0001). Benign
tumours in 63.0% were cystic, in 26.0% mixed cystic-solid and in 11.0%
solid echostructures while in malignant they were respectively, 6.8%,
56.8% and 36.4% (p<0.0001). Doppler flow within the tumour was 74.5% in
benign and 98.6% in malignant masses (p<0.0001). In benign lesions
homogenous superficial or peripheral vasculature was visualized, and in
the majority of cases (82.7%) it was of medium intensification. However
in malignant central, peripheral or mixed vascularisation. in the
majority intensified character was found. Average value of the
resistance index in all benign masses amounted to 0.77+/-0.14, however
in malignant it was 0.39+/-0.07 (p<0.0001). CONCLUSIONS: We contend that
complete ultrasonographic estimation of ovarian neoplasms outside the
qualification of structural details should include Doppler analysis of
vasculature parameters. Most important is the qualification of
resistance of flow, and location and intensification of vascularisation
in examined masses which permit the differentiation of malignant and
benign lesions. Preoperatively recognizing malignant processes with
colour Doppler ultrasonography shows higher accuracy, specificity and
PPV.
10
UI - 11471484
AU - Noujaim AA; Schultes BC; Baum RP; Madiyalakan R
TI -
Induction of CA125-specific B and T cell responses in patients injected
with MAb-B43.13--evidence for antibody-mediated antigen-processing and
presentation of CA125 in vivo.
SO - Cancer Biother Radiopharm 2001 Jun;16(3):187-203
AD - AltaRex Corp., 1123 Dentistry-Pharmacy, University of Alberta, Edmonton,
AB, T6G 2N8, Canada. tnoujaim@altarex.com
The murine monoclonal anti-CA125 antibody MAb-B43.13 has previously been
administered as an immunoscintigraphic agent in order to monitor
recurrence of ovarian cancer in patients, and a long-term follow-up
demonstrated a survival benefit for these patients. The clinical benefit
was initially attributed to the activation of the idiotypic network. The
objective of this study was to investigate the role of CA125-MAb-B43.13
immune complex formation on the induction of CA125-specific immune
responses. Analysis of patient serum samples from pharmacokinetic
studies demonstrated that the antibody forms immune complexes with CA125
in circulation within 30 minutes of injection. Induction of humoral and
cellular anti-CA125 responses correlated with the amount of circulating
CA125 antigen present at time of antibody injection. Subsequent to the
injection of MAb-B43.13, the patients generated anti-CA125 antibodies
that were directed against various epitopes on the antigen and were not
restricted to the specific epitope recognized by MAb-B43.13. The
generation of CA125-specific B and T cell responses after MAb-B43.13
injection correlated with improved survival. The influence of
circulating CA125 for the induction of CA125-specific immune responses
and the multi-epitopic nature of the human anti-CA125 antibodies suggest
that the majority of these antibodies were not induced via the idiotypic
network but by the autologous antigen itself. Since antibody and T cell
responses to CA125 were not present before injection of MAb-B43.13, it
is hypothesized that complex formation of MAb-B43.13 with circulating
antigen triggers the induction of CA125-specific immune responses.
11
UI - 11462239
AU - Jakubowska A; Gorski B; Byrski T; Huzarski T; Gronwald J; Menkiszak J;
TI -
Cybulski C; Debniak T; Hadaczek P; Scott RJ; Lubinski J
Detection of germline mutations in the BRCA1 gene by RNA-based
sequencing.
SO - Hum Mutat 2001 Aug;18(2):149-56
AD - Department of Genetics and Pathology, Pomeranian Academy of Medicine,
Polabska, Poland. aniaj@r1.pam.szczecin.pl
BRCA1 mutation detection is expensive and has sensitivity limitations,
which might at least partially be overcome by RNA-based sequencing.
There are claims that RNA tests are unreliable due to differential
splicing, exon skipping, or nonsense-mediated mRNA decay that results in
either the absence or low expression of mRNA harboring mutations. The
major aim of this study was to determine if the application of specific
high temperature annealing primers can assure high sensitivity of
detection of BRCA1 sequence alterations by cDNA sequencing. The study
group comprised 21 Polish cancer families with aggregations of breast
and/or ovarian cancer. We detected mutations in 10 out of 21 unrelated
patients. These were: nucleotide substitutions (c.309T>C; c.300T>G);
nucleotide insertions (c.5382insC) three cases; nucleotide deletions
(c.4154delA) one case, (c. 185delAG) one case, (c.3819delGTAAA) two
cases; and the deletion of the entire sequence of exon 22, one case. In
addition, we identified three transcript variants resulting from
alternative splice sites affecting the last six nucleotides of exon 1a
(GTAAAG), and the first three nucleotides (CAG) of exon 8 and exon 14.
In all cases these were cDNA heterozygous changes. Two of these splice
site changes have not been previously described. Sequencing of genomic
DNA "exon by exon" did not result in the detection of any additional
abnormalities. The sensitivity of our analyses was sufficient to
reliably detect mutations without the necessity of tissue culturing to
obtain enough template cDNA for analysis. Copyright 2001 Wiley-Liss,
Inc.
12
UI - 11462242
AU - Baudi F; Quaresima B; Grandinetti C; Cuda G; Faniello C; Tassone P;
TI -
Barbieri V; Bisegna R; Ricevuto E; Conforti S; Viel A; Marchetti P;
Ficorella C; Radice P; Costanzo F; Venuta S
Evidence of a founder mutation of BRCA1 in a highly homogeneous
population from southern Italy with breast/ovarian cancer.
SO - Hum Mutat 2001 Aug;18(2):163-4
AD - Dipartimento di Medicina Sperimentale e Clinica "G. Salvatore",
Universita degli Studi di Catanzaro "Magna Graecia", Italy.
Several genes have been involved in the pathogenesis of hereditary
breast/ovarian cancer (BOC), but mutations in the BRCA1 gene are by far
the most recurrent. In this study, we report the identification of a
founder mutation in a geographically and historically homogeneous
population from Calabria, a south Italian region. A screening performed
on 24 patients from unrelated families highlighted the high prevalence
of a 5083del19 alteration in the BRCA1 gene, which accounts for 33% of
the overall gene mutations. The same mutation was also detected in 4
patients, all of Calabrian origin, referred to us by research centres
from the north of Italy. Allelotype analysis, performed on probands and
unaffected family members revealed the presence a common allele,
therefore suggesting a founder effect due to a common ancestor. Our
findings underscore the importance of ethnic background homogeneity in
patients' selection and highlight the usefulness of founder mutations as
a potential tool for optimisation of preclinical diagnosis in gene
carriers and therapeutic approaches in affected individuals. Copyright
2001 Wiley-Liss, Inc.
13
UI - 11451584
AU - Burger HG; Fuller PJ; Chu S; Mamers P; Drummond A; Susil B; Neva P;
TI -
Robertson DM
The inhibins and ovarian cancer.
SO - Mol Cell Endocrinol 2001 Jun 30;180(1-2):145-8
AD - Prince Henry's Institute of Medical Research, PO Box 5152, Vic. 3168,
Clayton, Australia. henry.burger@med.monash.edu.au
Interest in inhibin as a marker of ovarian malignancy was stimulated by
the description of elevated immunoreactive inhibin levels in the sera of
patients with granulosa cell tumours. Several groups have confirmed the
value of serum inhibin in the diagnosis and follow-up of patients with
this uncommon malignancy. Immunoreactive inhibin levels are also
frequently elevated in patients with mucinous cystadenocarcinoma and
less frequently in other forms of ovarian tumour. Assay of sera using
the specific dimeric inhibin assays has shown that ovarian tumours are
able to secrete dimeric inhibin particularly inhibin B. The less
specific alpha-subunit directed assays, however, most frequently show
elevated concentrations. Used in combination with CA125 as a dual tumour
marker, it appears in principle that inhibin can be a useful diagnostic
agent. Immunohistochemistry for the inhibin subunits has been reported
with increasing frequency as a helpful method to assess suspected
ovarian stromal cell tumours. Its diagnostic accuracy for other types of
ovarian adenocarcinoma appears less reliable. Expression of the inhibin
subunit mRNAs has been demonstrated in a variety of ovarian
malignancies. The observation that inhibin levels are elevated in
ovarian cancer has stimulated studies of their relevance to the
molecular pathogenesis of these malignancies. Findings to date have been
largely negative with no evidence for activating mutations of the FSH
receptor or of the post-receptor signalling pathway proteins.
14
UI - 11499690
AU - Srivastava A; McKinnon W; Wood ME
TI -
Risk of breast and ovarian cancer in women with strong family histories.
SO - Oncology (Huntingt) 2001 Jul;15(7):889-902; discussion 902, 905-7,
911-13
AD - Division of Hematology and Oncology, University of Vermont College of
Medicine, Burlington 05401, USA.
Assessing the risk of breast and ovarian cancer starts with obtaining a
complete and accurate family history. This can reveal evidence of
inherited cancer risk. The highest risk of cancer is associated with
germ-line abnormalities in several genes, including BRCA1, BRCA2, and
TP53. Moderate-risk genes associated with syndromes that are inherited
in an autosomal dominant pattern (such as Cowden's disease, hereditary
non-polyposis colorectal cancer, Muir-Torre syndrome, and Peutz-Jeghers
syndrome) exhibit lower penetrance and thus less risk of breast and/or
ovarian cancer. Low-risk genes likely require significant environmental
exposure, and although they are associated with the lowest risk of
cancer, they account for more cancer than high- and moderate-risk genes.
Lifetime risks for breast or ovarian cancer can be estimated. The Gail
and Claus models, the more widely utilized models for calculation of
lifetime breast cancer risk, are discussed. Models are also available
for determining the likelihood of finding a BRCA1/2 mutation (the
BRCAPRO and Myriad models). Appropriate candidates for testing include
affected individuals who are most likely to have a hereditary form of
cancer. Testing should proceed only after a thorough discussion of the
risks, benefits, and limitations of testing. Risk-reducing options are
available to women with a strong family history of breast and ovarian
cancer. These options include high-risk screening, chemoprevention, and
prophylactic surgery.
15
UI - 11503919
AU - Kurjak A; Kupesic S; Sparac V; Bekavac I
TI -
Preoperative evaluation of pelvic tumors by Doppler and
three-dimensional sonography.
SO - J Ultrasound Med 2001 Aug;20(8):829-40
AD - Department of Obstetrics and Gynecology, Medical School, University of
Zagreb, Sveti Duh Hospital, Croatia.
OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal,
transvaginal color Doppler, three-dimensional, three-dimensional power
Doppler, and contrast-enhanced three-dimensional power Doppler
sonography) for preoperative evaluation of pelvic tumors. METHODS: Two
hundred ninety-two patients were evaluated by the 5 complementary
methods in preoperative sonographic assessments. We examined adnexal and
endometrial morphology, thickness, and volume by two- and
three-dimensional sonography and analyzed blood flow by transvaginal
color, pulsed Doppler, and three-dimensional power Doppler sonography in
all examined patients. In 89 patients with complex adnexal lesions of
uncertain malignancy, contrast-enhanced three-dimensional power Doppler
sonography was performed. RESULTS: Morphologic assessment by
three-dimensional sonography yielded additional information in 58% of
cases compared with two-dimensional sonography. Furthermore, this
modality was superior to two-dimensional sonography in accurate
depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined
morphology and vascular indexing reached sensitivity of 97% and
specificity of 99%. Endometrial volume in patients with malignant
disease was significantly different (28.2 +/- 0.02 cm3) from that in
those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02
cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic
and three-dimensional power Doppler examination of endometrial lesions,
sensitivity and specificity reached 89% and 97%, respectively.
CONCLUSIONS: Combined morphologic and vascular imaging improves
preoperative assessment of gynecologic tumors.
16
UI - 11503920
AU - Alcazar JL; Errasti T; Laparte C; Jurado M; Lopez-Garcia G
TI -
Assessment of a new logistic model in the preoperative evaluation of
adnexal masses.
SO - J Ultrasound Med 2001 Aug;20(8):841-8
AD - Department of Obstetrics and Gynecology, Clinica Universitaria de
Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
OBJECTIVE: To assess a new logistic regression model developed to
predict malignancy in adnexal masses. METHODS: In the first part of this
study, we developed a logistic model by applying logistic regression
analysis in a series of 268 adnexal masses (203 benign and 65 malignant
lesions) in 248 patients (mean age, 43.6 years; SD, 14.2 years)
evaluated and treated at our institution. Eleven parameters were entered
in the logistic regression analysis in a forward stepwise way. In the
second part of the study, we evaluated the model's diagnostic
performance in a further set of 135 adnexal masses (103 benign and 32
malignant tumors) in 129 patients (mean age, 44.4 years; SD, 14.6
years). This diagnostic performance was compared with that of age, tumor
volume, Sassone's and Ferrazzi's B-mode ultrasonographic morphologic
scoring systems, serum cancer antigen 125 level, and the tumor's lowest
resistive index. Comparison was done by calculating the area under the
receiver operating characteristic curve. RESULTS: In logistic analysis,
only menopausal status, the presence of papillary projections, the
logarithm of the cancer antigen 125 value, tumor blood flow location,
and the lowest resistive index were retained in the model. The model had
the best area under the curve (0.97), significantly higher than patient
age (area under the curve, 0.78; P = .001), tumor volume (area under the
curve, 0.68; P < .0001), cancer antigen 125 (area under the curve, 0.88;
P = .008), lowest resistive index (area under the curve, 0.85; P =
.011), Ferrazzi's scoring system (area under the curve, 0.89; P = .01),
and maximal peak systolic velocity (area under the curve, 0.71; P<
.0001). Comparison with Sassone's scoring system (area under the curve,
0.91) did not reach statistical significance, but a clear trend was
found (P = .116). CONCLUSIONS: The model had the best diagnostic
performance for discriminating between benign and malignant adnexal
masses. A clinical prospective evaluation is needed to confirm its
actual value.
17
UI - 11503922
AU - Mlikotic A; McPhaul L; Hansen GC; Sinow RM
TI -
Significance of the solid component in predicting malignancy in ovarian
cystic teratomas: diagnostic considerations.
SO - J Ultrasound Med 2001 Aug;20(8):859-66; quiz 867
AD - Department of Radiology, Harbor-UCLA Medical Center, Torrance,
California, USA.
OBJECTIVE: To determine whether gray scale characteristics of the solid
components of cystic ovarian teratomas exist that could differentiate
more common benign forms from malignant variants. METHODS: We
retrospectively reviewed the sonographic images of 188 ovarian teratomas
that contain at least a 25% cystic component and correlated the images
with the final diagnosis. Features of the solid component assessed
included its echo texture, overall appearance, shape, size, and internal
homogeneity. RESULTS: One-hundred seventy-seven teratomas were benign,
and 11 were malignant; among the malignant masses, 7 were high grade. Of
the benign forms, 155 solid components (88%) were hyperechoic, 168 (95%)
were focal in appearance, 105 (59%) were nodular in shape, and 123 (69%)
were uniformly solid. Of the malignant types, 9 solid components (82%)
were isoechoic, 6 (55%) had branching, 6 (55%) were irregular in shape,
and 8 (73%) were uniformly solid. Five malignant teratomas (45% overall
and 71% of high-grade subtypes) had branching isoechoic components. Only
2 benign teratomas (1%) had isoechoic components that branched.
CONCLUSIONS: The presence of a branching isoechoic component in a cystic
ovarian teratoma may suggest malignancy.
18
UI - 11503928
AU - Alcazar JL; Errasti T; Minguez JA; Galan MJ; Garcia-Manero M; Ceamanos C
TI -
Sonographic features of ovarian cystadenofibromas: spectrum of findings.
SO - J Ultrasound Med 2001 Aug;20(8):915-9
AD - Department of Obstetrics and Gynecology, Clinica Universitaria de
Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
OBJECTIVE: To describe the sonographic characteristics of ovarian
cystadenofibromas. METHODS: We conducted a retrospective study of 23
ovarian tumors histopathologically confirmed as ovarian
cystadenofi
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