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Gynecologic NETs: Reviewing Treatments

Neuroendocrine tumors (NETs) can be classified as either poorly differentiated, aggressive neuroendocrine carcinomas (NECs) that have a high propensity for distant metastatic spread or well-differentiated, slow growing NETs with good long-term prognoses. NECs of the gynecologic tract comprise 2% of cervical cancers. Well-differentiated NETs of the gynecologic tract, such as primary ovarian carcinoid tumors, comprise less than 0.1% of ovarian neoplasms and 5% of carcinoid tumors overall. In recent years, an increased incidence in the diagnosis of NETs of the gynecologic tract has been observed in clinical investigations. Currently, limited data are available to guide clinicians on the diagnosis and treatment on NETs, making management especially challenging. The Society of Gynecologic Oncology Clinical Practice Committee requested that my colleagues and I develop a clinical document on NETs of the gynecologic tract. Published in the July 2011 issue of Gynecologic Oncology, our study sought to provide a comprehensive review of NETs and a platform from which clinicians can select the most appropriate treatment options. Managing Neuroendocrine Tumors For most cases of NETs of the gynecologic tract, a multimodality, individualized therapeutic approach is recommended. Treatments largely depend upon extent of the disease and the primary organ of involvement. NECs usually arise from the cervix, and a management algorithm has been created that separates NECs on the basis of early- or late-stage tumors. The algorithm presented in our paper stresses that surgical resection with radical hysterectomy and lymphadenectomy for early-stage NECs of the cervix is appropriate and should be followed by adjuvant chemotherapy with etoposide and cisplatin. Surgery may be required to identify a cervical cancer as an NEC cell type. For...
Conference Highlights: ISET 2012

Conference Highlights: ISET 2012

New research was presented at ISET 2012, the annual International Symposium on Endovascular Therapy, on January 15-19 in Miami Beach. The features below highlight just some of the studies that emerged from the meeting. » A New Approach to Managing Unstoppable Nosebleeds  » Cryoablation Deemed Effective in Ovarian Cancer » MS Patients Report Benefits With Angioplasty » Fibromuscular Dysplasia Frequently Undiagnosed Treating DVT in Pregnant Women The Particulars: Studies have shown that DVT is four to six times more common in pregnant women than in non-pregnant women. Research suggests that many pregnant women with DVT often forgo the most effective treatments—surgery or catheter-directed thrombolysis—because they fear that doing so may harm their unborn children. Data Breakdown: In a study of 11 pregnant women with DVT, two underwent surgery to remove the clot, and nine were treated with a bath of thrombolytic medications delivered directly into the clot. Removal of the clot was successful in all cases, and all but one pregnancy resulted in successful birth. One woman who miscarried 1 week after treatment suffered from antiphospholipid antibody syndrome, which the researchers believe likely caused the miscarriage. Take Home Pearl: Aggressive treatment with surgery or catheter-directed thrombolysis for pregnant women with DVT appears to be safe. Aggressive treatment was also shown to prevent serious complications and death.     A New Approach to Managing Unstoppable Nosebleeds [back to top] The Particulars: Unstoppable nosebleeds can cause anemia and may lead to other more serious complications, including heart attack. When packing the nose with gauze, inflating a balloon to stop blood flow, or cauterizing the vessels in the nose fail, surgery or embolization are the...
Physician Referrals for Genetic Counseling/Testing Contradict Guidelines

Physician Referrals for Genetic Counseling/Testing Contradict Guidelines

A survey of 1,878 U.S. family physicians, general internists, and obstetricians/gynecologists suggests that these providers would refer many women at average risk of ovarian cancer for genetic counseling and BRCA 1/2 testing but not many high-risk women. The finding directly opposes current recommendations. The survey included an annual examination vignette posing questions about patients in various age, race, insurance status, and ovarian cancer risk categories. Just over 70% of respondents reported adherence to recommendations against genetic counseling or BRCA 1/2 testing for women at average risk. Predictors of adherence to recommendations against referral/testing included African American versus Caucasian race, Medicaid versus private insurance, and rural versus urban location. Adherence to recommendations to refer high-risk women for genetic counseling or testing was self-reported among 41% physician participants. Younger patient age (35 vs 51), physician sex (female vs male), and OB/GYN versus family medicine specialty were predictors of adherence for referral/testing. Physician-estimated ovarian cancer risk was the most powerful predictor of adherence to recommendations for both average- and high-risk women. The study authors concluded that intervention efforts, “including promotion of accurate risk assessment, are needed.” View Complete Study Results Physician’s Weekly wants to know… • Do you feel rates adherence to recommendations for ovarian cancer-based genetic counseling/testing are low, as the survey findings suggest? • What interventions do you think can be made to improve adherence to genetic counseling and BRCA 1/2...

American Society of Clinical Oncology 2010

The American Society of Clinical Oncology, or ASCO, held its 2010 annual meeting from June 4 to 8 in Chicago. The features below highlight some of the news emerging from the meeting. » A New Screening Strategy for Ovarian Cancer » Yoga Improves Sleep in Cancer Survivors » Genetics, Heart Disease, & Dosing of Chemotherapy » Maintenance Therapy May Cut Risk of Lymphoma Recurrence A New Screening Strategy for Ovarian Cancer [back to top] The Particulars: More than 70% of ovarian cancers are diagnosed when they have already grown to an advanced stage. There are currently no effective screening tools for the early detection of ovarian cancer in women at average risk. A screening strategy that incorporated change of CA-125 levels over time and age of the participant was assessed to estimate the risk of ovarian cancer using the Risk of Ovarian Cancer Algorithm (ROCA), followed by transvaginal sonography (TVS). Data Breakdown: : In an analysis of 3,238 women who participated in the 8-year study, researchers found that the combined specificity of ROCA followed by TVS for referral to surgery was 99.7%. The average annual rate of referral to 3 monthly CA-125 screenings was 6.8%, and the average annual rate of TVS and gynecologic oncology referral was 0.9%. Cumulatively, 85 women received TVS and referral to a gynecologic oncologist. Eight women subsequently underwent surgery based on the TVS and referral, with three invasive ovarian cancers, two borderline ovarian tumors, and three benign ovarian tumors, providing a positive predictive value of 37.5%. Less than 1% of participants annually required a TVS. The invasive high-grade ovarian cancers that were detected were...
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