Posts Tagged ‘hospital’

Long-term colorectal-cancer mortality after adenoma removal

BACKGROUND

Although colonoscopic surveillance of patients after removal of adenomas is widely promoted, little is known about colorectal-cancer mortality among these patients.

METHODS

Using the linkage of the Cancer Registry and the Cause of Death Registry of Norway, we estimated colorectal-cancer mortality among patients who had undergone removal of colorectal adenomas during the period from 1993 through 2007. Patients were followed through 2011. We calculated standardized incidence-based mortality ratios (SMRs) using rates for the Norwegian population at large for comparison. Norwegian guidelines recommended colonoscopy after 10 years for patients with high-risk adenomas (adenomas with high-grade dysplasia, a villous component, or a size ≥10 mm) and after 5 years for patients with three or more adenomas; no surveillance was recommended for patients with low-risk adenomas. Polyp size and exact number were not available in the registry. We defined high-risk adenomas as multiple adenomas and adenomas with a villous component or high-grade dysplasia.

RESULTS

We identified 40,826 patients who had had colorectal adenomas removed. During a median follow-up of 7.7 years (maximum, 19.0), 1273 patients were given a diagnosis of colorectal cancer. A total of 398 deaths from colorectal cancer were expected and 383 were observed, for an SMR of 0.96 (95% confidence interval [CI], 0.87 to 1.06) among patients who had had adenomas removed. Colorectal-cancer mortality was increased among patients with high-risk adenomas (expected deaths, 209; observed deaths, 242; SMR, 1.16; 95% CI, 1.02 to 1.31), but it was reduced among patients with low-risk adenomas (expected deaths, 189; observed deaths, 141; SMR, 0.75; 95% CI, 0.63 to 0.88).

CONCLUSIONS

After a median of 7.7 years of follow-up, colorectal-cancer mortality was lower among patients who had had low-risk adenomas removed and moderately higher among those who had had high-risk adenomas removed, as compared with the general population. (Funded by the Norwegian Cancer Society and others.)

source : http://www.sciencedaily.com/releases/2014/08/140828090156.htm

New estrogen-based compound suppresses binge-like eating behavior in female mice

“Previous data has shown that women who have irregular menstrual cycles tend to be more likely to binge eat, suggesting that hormones in women play a significant role in the development or prevention of the behavior,” said Dr. Yong Xu, assistant professor of pediatrics and senior author of the paper. “Previous data has also shown that in humans, there is a strong association between estrogen and binge eating. When estrogen is high, binge eating is inhibited, but when estrogen is low, binge eating becomes more frequent. Using mouse models, we set out to see what the effects of estrogen were on binge behavior in female mice.”

In this study, Xu and colleagues first found that estrogen can strongly inhibit binge eating in mice, which was consistent with data in humans.

“We can speculate that in women who develop binge eating who also happen to have irregular menstrual cycles, it is probably because their estrogen function is somehow damaged, which is what leads to the development of binge eating,” said Xu.

Xu and colleagues went further to determine what receptor was mediating the estrogen effect on binge eating and where this receptor was located. Using genetic mouse models, they found that the estrogen receptor-α, expressed by serotonin neurons in the brain, mediates the effect of estrogen to suppress binge eating.

“The significance is not only understanding the mechanism of how estrogen may modulate this behavior, but from a more therapeutic point of view, this would identify a potential target for estrogen therapy or modified estrogen therapy for treatment of this problem,” said Xu.

However, Xu notes that the current estrogen therapy in practice has been a problem because it produces detrimental effects, such as high risk of breast cancer.

“We thought, if we can understand where and how the estrogen acts to produce some benefits, maybe that will facilitate the development of an estrogen-based therapy that could be more specific and would just produce the benefits and bypass the side effects, such as breast cancer,” he said.

Around this same time, Xu’s collaborators at Indiana University developed a compound called GLP-1-estrogen, which was a conjugate between the peptide GLP-1 and estrogen. The idea was that GLP-1 would be used to carry the estrogen and deliver it to a region where there are GLP-1 receptors as well as estrogen receptors and the estrogen would be released there, producing a biological function. His collaborators at Indiana University published that this compound was good for body weight control and would not increase the risk of breast cancer because the compound did not deliver estrogen to the breast tissue.

Xu and colleagues used this compound to show that when a systemic injection of this compound is given in mice, there is increased activity of estrogen in the serotonin region of the brain, meaning the compound can deliver estrogen in the serotonin region where they believed binge behavior is regulated.

They further showed that the compound actually substantially inhibits binge eating in mice, and their data showed that part of this effect comes from the estrogen and the other part of the effect comes from the GLP-1.

“There are a few studies showing that binge patients tend to have decreased GLP-1 in their blood, but nobody had shown that GLP-1 suppresses binge eating in animals or humans until now,” said Xu. “We showed that these two things, estrogen and GLP-1, work together to decrease binge eating and that GLP-1 can carry estrogen to this specific site to produce a benefit, but bypasses the breast tissue.”

Xu notes that this provides a strong case for an interventional drug that specifically acts on estrogen receptor-α in the serotonin region of the brain to treat binge eating.

The next steps in Xu’s research will be to determine the mechanism by which estrogen regulates serotonin neurons. He and colleagues also hope to go downstream of serotonin to see if increasing serotonin release inhibits binge eating.

source : http://www.sciencedaily.com/releases/2014/08/140826205515.htm

Ovarian Cancer: Know your body, know your risk

“There is no effective surveillance technique for the detection of early stage ovarian cancer, so the only effective way to prevent it and save lives is to identify women at risk,” said David A. Fishman, MD, Director of the Mount Sinai Ovarian Cancer Risk Assessment Program and Professor and Fellowship Director in the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine at the Icahn School of Medicine at Mount Sinai.

He recommends that women with a family history of ovarian and breast cancers get a formal genetic evaluation by a board-certified genetic counselor. For women who have tested positive for a BRCA mutation or are identified to be at a high risk for developing ovarian cancer, preventive surgery should be considered to remove the ovaries and fallopian tubes before ovarian cancer can develop.

Facts About Ovarian Cancer

• About 75 percent of women with ovarian cancer are diagnosed with late-stage disease. Only 15-40 percent of women survive for five years after initial aggressive cytoreductive surgery that is performed to remove cancerous tissue from the abdominal cavity in combination with chemotherapy.

• Almost 90 percent of women who are diagnosed while the disease is still confined to the ovary (stage I) survive for five years. They also require less surgical intervention, may not require chemotherapy and have a better quality of life.

• After removal of the ovaries and fallopian tubes, the risk of developing ovarian cancer is close to zero and the incidence of peritoneal cancer is about 1 percent.

Tips for Ovarian Cancer Prevention

• Family and personal history is important to identify women at increased risk: At least 10 percent of ovarian cancers are attributed to the inheritance of genetic mutations (such as BRCA, HNPCC) that increase the risk of certain cancers (breast, colon, endometrial, thyroid, and melanoma). If you have a history of these cancers in your family (either in men or women), get your risk assessed for ovarian cancer by a board certified genetic counselor.

• Take oral contraceptives: Long term use of oral contraceptives reduces the risk of developing ovarian cancer by approximately 50 percent.

• Pay attention to symptoms: Swollen or bloated abdomen; pressure or pain in abdomen, pelvis, back or legs; difficulty eating or feeling full quickly; nausea, indigestion, gas constipation or diarrhea; feel tired; urinary symptoms; and unusual vaginal bleeding.

New Treatment

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an innovative technique being used by Dr. David Fishman and other oncologists at The Mount Sinai Hospital to treat ovarian cancer in women undergoing cytoreductive surgery. The HIPEC treatment combines cytoreductive surgery with a chemotherapy “bath” that delivers heated chemo directly into the abdomen cavity for two hours. The chemo “bath” then penetrates the diseased tissue, directly killing any remaining cancer cells in the area, destroying undetected cancer cells and preventing them from forming into new tumor while having minimal exposure to the rest of the body.

source : http://www.sciencedaily.com/releases/2014/08/140825185323.htm