Podcasts about ca125

In this episode of Bench to Bedside, Dr. Roy Jensen, vice chancellor and director of The University of Kansas Cancer Center, sits down with Dr. Rebecca Whelan, an associate professor of chemistry at the University of Kansas and member of KU Cancer Center's Cancer Biology research program. The discussion focuses on the limitations of the CA125 blood test for ovarian cancer detection and Dr. Whelan's groundbreaking research, which reveals new insights into the structure of the CA125 protein. Dr. Whelan explains how new DNA sequencing technologies and artificial intelligence, specifically the Alpha Fold program, have helped her team improve the understanding and detection of ovarian cancer. Additionally, Dr. Whelan talks about collaborative efforts to identify new biomarkers for early diagnosis of ovarian cancer and shares advice for young scientists interested in making a difference in medicine through chemistry. Do you have questions about cancer? Call our Bench to Bedside Hotline at (913) 588-3880 or email us at benchtobedside@kumc.edu, and your comment or question may be shared on an upcoming episode! If you appreciated this episode, please share, rate, subscribe and leave a review. To ensure you get our latest updates, For the latest updates, follow us on the social media channel of your choice by searching for KU Cancer Center. Links from this Episode: Learn more about Dr. Whelan's research into CA125 Learn more about ovarian cancer  Read about ovarian cancer screening and diagnosis at KU Cancer Center Learn more about Dr. Rebecca Whelan

40% CHANCE OF DEATH - What would you do if you heard this from your doctor? In this week's podcast episode, we are joined by the force behind The Good Property Company, which has sourced more than 200+ properties, all in Bristol, with a value of over £45 million, at a purchase price of £30 million(before refurb) - SUSANNAH COLE.  And while all her achievements in property are amazing, you'll find Susannah to be even more so as she shares with us her story of how she's beaten not one, not two, but THREE cancers in a span of one year and the lessons she's learned along the way. Productivity hacks & important health lessons whilst building a property business - all this and more in Episode 31. All this and more in Episode 31!! Want to be more proactive about your health but stuck where to start? Here's a list that Susannah has compiled to make your journey a bit easier: Low cost easy to do, easy to organise and available privately UK wide and often on post.  Poo test (fit test) - testing for colon cancer, do 2 in 2 weeks for greater accordance Mammogram for women Blood tests for common cancer markers. CA125, CEA, PSA the most common. Do at least these 3 (PSA is only for men) Full body MRI For smokers, highly suggest doing a CT chest scan   Scientists are still learning about known tumor markers and discovering new tumor markers. Some tumor markers currently used include:   Alpha-fetoprotein (AFP) for liver cancer Beta 2-microglobulin (B2M) and lactate dehydrogenase (LDH) for blood cancers Calcitonin for thyroid cancer Cancer antigen 125 (CA 125) for ovarian cancer Cancer antigens 15-3 and 27-29 for breast cancer Carcinoembryonic antigen (CEA) for colorectal cancer, lung cancer, stomach cancer, pancreatic cancer and others Human chorionic gonadotropin (HCG) for testicular cancer and ovarian cancer Prostate-specific antigen (PSA) for prostate cancer   If you find all of this interesting and want to know more, connect with Susannah Cole and The Good Property Company using the links below: Website: https://thegoodpropertycompany.co.uk/ YouTube: https://www.youtube.com/c/TheGoodPropertyCompanySusannahCole Instagram: https://www.instagram.com/susannahcoleuk Facebook: https://www.facebook.com/SusannahColeTGPC If you're interested in taking the Wealth Dynamics test but don't know where to start, email us at hi@property-strategy.com Subscribe to our newsletter www.property-strategy.com/insights Visit our website at www.property-strategy.com Connect with Jackie at www.facebook.com/jackietomes1 www.instragram.com/tomesjackie www.linkedin.com/in/jackietomes/

In the beginning, God created the heavens and the earth. And morality. The standard moral argument popularized by William Lane Craig and others goes as follows: (1) If God does not exist, objective moral values do not exist.  (2) Objective moral values do exist.  (3) Therefore, God exists.  Today, we cast some doubt on the … Continue reading CA125 The Moral Argument for God (pt.1) →

El Dr. Luis Alfonso Romero, oncólogo médico de León, Guanajuato, México, en este episodio de “Pase de visita” abordará un caso clínico de una paciente con cáncer de ovario seroso de alto grado. Como invitados al programa se encuentran tres médicos mexicanos, el Dr. Eduardo Cisneros, oncólogo quirúrgico residente en el Hospital Juárez de México; la Dra. Gabriela Castro, ginecooncóloga residente en el Hospital Militar de Especialidades de la Mujer, SEDENA y el Dr. Alfonso Torres Rojo, cirujano oncólogo adscrito al Hospital Ángeles México, los tres de la Ciudad de México. Ellos, con base en evidencia científica y en su experiencia, responderán a varias interrogantes. El caso describe a una mujer de 58 años que recibió el diagnóstico de cáncer de ovario seroso de alto grado en etapa III hace tres años. En ese momento, se le administró un tratamiento que incluyó citorreducción primaria R0, seguida de seis ciclos de quimioterapia con carboplatino y paclitaxel. Después de tres años sin evidencia de enfermedad, la paciente experimenta una recurrencia, evidenciada por un aumento en los niveles de Ca125 hasta 200 y por tomografía se revela una actividad tumoral de 4 cm a nivel pélvico que parece afectar el sigmoides. Las preguntas para los médicos respecto a este caso son las siguientes: ¿Cuál es el beneficio de realizar la citorreducción antes de iniciar la quimioterapia sistémica en casos de recurrencias locales? ¿Se ha evidenciado algún beneficio al combinar la cirugía con quimioterapia hipertérmica intrabdominal (Hipec) en este contexto? ¿Qué seguridad se le ofrece a la paciente con la resección multiorgánica en términos de control de la enfermedad? Fecha de grabación: 6, 12 y 17 de octubre de 2023.     Todos los comentarios emitidos por los participantes son a título personal y no reflejan la opinión de ScienceLink u otros. Se deberá revisar las indicaciones aprobadas en el país para cada uno de los tratamientos y medicamentos comentados. Las opiniones vertidas en este programa son responsabilidad de los participantes o entrevistados, ScienceLink las ha incluido con fines educativos. Este material está dirigido a profesionales de la salud exclusivamente.

When someone is diagnosed with uterine cancer, in most cases, their uterus announces there is a problem by bleeding when it is not supposed to, or bleeding too heavily. Breast cancer, in most cases makes itself known by a lump, a nipple discharge or an abnormality on a mammogram. But ovarian cancer is not so accommodating and, in many cases, does not make its presence known until it has already moved well beyond the ovaries. My guest today is Dr. Shieva Ghofrany a practicing Ob-Gyn who was diagnosed with stage 2 ovarian cancer at age 46. She is going to share her story and talk about early signs, symptoms, and detection of ovarian cancer in women who are at average risk. And how to advocate for yourself when something is not quite right… Dr. Ghofrany's own journey with ovarian cancer Why women often ignore symptoms Why screening tests such as CA125 and ultrasound can be falsely reassuring  How bad news is delivered to patients matters The role of integrative medicine in enhancing recovery Symptoms of ovarian cancer Appropriate testing if ovarian cancer is suspected How women can advocate for themselves if symptoms are disregarded Importance and timing of follow-up ultrasounds of ovarian cysts Living with a cancer diagnosis (any cancer)  Wrap up including Risk factors of ovarian cancer  Reducing the risk of ovarian cancer  Symptoms that may indicate ovarian cancer Shieva Ghofrany MD Website: www.tribecalledv.com Instagram: @Biglovefiercejuju Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society.                 Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.  Subscribe and Follow Dr. Streicher on  DrStreicher.com Instagram @DrStreich Twitter @DrStreicher Facebook  @DrStreicher YouTube  DrStreicherTV Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

Doctors Lisa and Sara talk to GP Dr Charlotte Bădescu about Ovarian Cancer. We focus on the important learning points about cardinal and other features of presentations to better understand this cancer as an abdominal cancer with symptoms that can and do often present much earlier than the diagnosis is often picked up. She talks us through the value of CA125 tests and the reasons not to be overly reliant on them, though they can be a useful tool in the tool box. The usefulness of ultrasound scans, both pelvic and transvaginal, as well as clinician continuity is discussed.  We go through 2 hypothetical cases based on real examples as well as Charlotte's own diagnosis. An excellent episode for picking up great learning points to avoid missing this diagnosis in your own patients.  You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  NICE Guidelines: Suspected Cancer, Recognition and Referral (Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers NICE guidelines on Ovarian Cancer (Published April 2011): https://www.nice.org.uk/guidance/cg122 GP network & resources: https://targetovariancancer.org.uk/health-professionals/GPs Nurses network & resources: https://targetovariancancer.org.uk/health-professionals/nurses Patient resources: https://targetovariancancer.org.uk/support-for-you Shine Cancer Support: https://shinecancersupport.org/ ForteenFish Free Ovarian Cancer Webinar (you will need to log-on and search Ovarian Cancer): https://www.fourteenfish.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this episode, our GP hosts cover ovarian cancer and share their clinical experiences to support better, faster, and more confident cancer diagnosis in primary care. Hosts Dr Rebecca Leon and Dr Sarah Taylor are both practicing GPs and GP Leads for GatewayC. Dr Ellen Macpherson, a junior doctor, also joins our hosts. This episode covers: Statistics Patient cases Investigating bloating and abdominal pain, CA125 and other investigationsFamily historyNICE guidelinesSafety nettingReferral If you loved it, you know what to do – leave us a review, a rating (hopefully 5 stars) and share. GPs Talk Cancer is the podcast series from GatewayC. GatewayC is the free early cancer diagnosis resource funded by the NHS and is part of The Christie NHS Foundation Trust. Visit https://www.gatewayc.org.uk/ to learn more. View the full show notes for this episode at https://www.gatewayc.org.uk/podcast/ DISCLAIMER: We know this podcast might be of interest to anybody, however it is aimed at primary care health professionals. All patient cases are based on real stories from our clinical practice as GPs. They are fully anonymised with no identifiable patient data. Hosted on Acast. See acast.com/privacy for more information.

Diagnosing cancer in primary care is difficult. Many patients present with non-specific symptoms and the positive predictive value of even the ‘red flag' symptoms is low. In this podcast, Dr Thomas Round and Professor Willie Hamilton discuss the issues around cancer diagnosis in primary care, including the positive predictive value of symptoms, the increasing number of two-week wait referrals and the usefulness of tests such as Ca125.  Financial support for the project was provided as an Independent Medical Education Grant from Pfizer Limited. Editorial and content decisions were made solely by the RCGP.

In this episode, Ayesha discussed Bristol Myers Squibb's new heart drug Camzyos (mavacamten), which has received approval from the US Food and Drug Administration (FDA) for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). The drug is the first to target the pathophysiology of obstructive HCM and may be Bristol Myers' next blockbuster cardiac drug. Hear more about the company's looming patent cliff for some of its drugs as well as the company's risk evaluation program for Camzyos given some of its safety concerns.Ayesha also talked about a new ovarian cancer blood test developed by researchers at the University of Manchester that may help diagnose the disease quicker and more accurately, especially in younger women. The test includes a newer ovarian cancer biomarker that when used in combination with CA-125, the biomarker currently used to monitor and screen for ovarian cancer in some cases, could improve its diagnostic value. Learn more about the test and about the importance of women's health advocacy in the early detection of diseases like ovarian cancer.Read the full articles here: Researchers Use Emerging Ovarian Cancer Biomarker to Develop New Blood Test for Ovarian CancerCamzyos Secures FDA Approval for Obstructive HCM, Bristol Myers Eyes it as its Next Big Cardiac DrugFor more life science and medical device content, visit the Xtalks Vitals homepage.Follow Us on Social MediaTwitter: @Xtalks Instagram: @Xtalks Facebook: https://www.facebook.com/Xtalks.Webinars/ LinkedIn: https://www.linkedin.com/company/xtalks-webconferences YouTube: https://www.youtube.com/c/XtalksWebinars/featured

Neste episódio vou comentar sobre o POEM publicado na área da página da BVS APS chamada “Revisões Comentadas - POEMS”, falando sobre um estudo de coorte retrospectivo usando bancos de dados clínicos representativos da população do Reino Unido, para avaliar o desempenho do exame CA-125 em mulheres com suspeita de câncer de ovário atendidas na APS. Aproveito para falar um pouco sobre sensibilidade, especificidade e valor preditivo positivo e negativo nas avaliações de performance dos testes diagnósticos. Funston G, Hamilton W, Abel G, Crosbie EJ, Rous B, Walter FM. The diagnostic performance of CA125 for the detection of ovarian and non-ovarian cancer in primary care: A population-based cohort study. PLoS Med 2020;17(10):e1003295. Disponível em: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003295

An interview with Dr. Zeba Aziz from Hameed Latif Hospital in Lahore, Pakistan, Dr. William Burke from Stony Brook University Hospital in Stony Brook, NY, and Dr. Keiichi Fujiwara from Saitama Medical University International Medical Center in Saitama, Japan, authors on "Assessment of Adult Women with Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource Stratified Guideline." This guideline provides recommendations in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. Read the full guideline at www.asco.org/resource-stratified-guideline.   TRANSCRIPT ASCO: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at podcast.asco.org. My name is Brittany Harvey, and today, I'm interviewing Dr. Zeba Aziz from Hameed Latif Hospital in Lahore, Pakistan, Dr. William Burke from Stony Brook University Hospital in Stony Brook, New York, and Dr. Keiichi Fujiwara from Saitama Medical University International Medical Center in Saitama, Japan, authors on Assessment of Adult Women with Ovarian Masses in Treatment of Epithelial Ovarian Cancer: ASCO Resource Stratified Guideline. Thank you for being here, Doctors Aziz, Burke, and Fujiwara. First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline and the Journal of Clinical Oncology, Global Oncology. Dr. Burke, do you have any relevant disclosures that are directly related to this guideline topic? DR. WILLIAM BURKE: I do not. BRITTANY HARVEY: And Dr. Fujiwara, do you have any relevant disclosures that are related to this guideline topic? DR. KEIICHI FUJIWARA: Yes. I have the consultancy for the PARP inhibitors development. BRITTANY HARVEY: Thank you. And then Dr. Aziz, do you have any relevant disclosures that are related to this guideline? DR. ZEBA AZIZ: No, I don't. BRITTANY HARVEY: Thank you. OK, so first, Dr. Burke, can you give us a general overview of what this guideline covers? DR. WILLIAM BURKE: Sure, Brittany. The purpose of this guideline is to provide expert guidance in treatment of adult women 18 years and older with epithelial ovarian cancer, including fallopian tube and primary peritoneal cancer, to clinicians, public health leaders, patients, and policymakers in a resource-constrained setting. To do this, ASCO has established a process for development of resource stratified guidelines, which includes a mixed methods of evidence-based guideline development, adaptation of the clinical practice guidelines to other organizations, and formal expert consensus. This guideline summarizes the results of this process and presents resource-stratified recommendations. The recommendation of this guideline centers around the four key clinical questions pertaining to the care of women with ovarian cancer. BRITTANY HARVEY: Great. And then, as you just mentioned, this is a resource-stratified guideline. So Dr. Fujiwara, can you tell our listeners about the four-tier resource stratification used for the development of this guideline? DR. KEIICHI FUJIWARA: Oh, yes. So we have the four tiers resource stratification, which were basic, limited, enhanced, and maximum. So for the basic, it's the core resources or fundamental services that are absolutely necessary for any public health or primary health care systems to function. So the basic levels of this typically are applied in our single clinical interactions. For the limited, so this is the second tier resources or services that are intended to produce major improvements in outcomes such as, for instance, cost-effectiveness, and are attainable with a limited financial means and modest infrastructures. So the limited level of service may involve single or multiple interactions. And the third  tier is enhanced. The third tier resources or services that are optional, that are important, enhance the level of resources should produce further improvements in the outcome and to increase the number of the quality of options in the individual choices. Lastly, the fourth tier is a maximal, so high-level or state of the art resources, or services that may be used or are available in some high-resource countries, and/or may be recommended for the high resource setting guidelines that do not adapt to resource constraints, but that nonetheless should be considered for a lower priority than those resources or services listed in the other categories on the basis of extreme cost and/or impracticality for the broad use of the resource-limited environment. BRITTANY HARVEY: Great. Thank you for going over those. So next, I'd like to review the key recommendations of this guideline. This guideline addresses four overarching clinical questions. So first, Dr. Aziz, what are the key diagnostic and staging recommendations for patients with symptoms of epithelial ovarian cancer? DR. ZEBA AZIZ: Thanks, Brittany. Basically, as pointed out, we have three levels. The basic level usually involves one or two encounters, and at the basic level, the doctor makes a clinical assessment of a suspected ovarian mass, takes a good history and physical, and the family history is also important at the same time. At the basic level, one can do a chest X-ray and an ultrasound to confirm the suspicion, and then the doctor should ideally send the patient to a limited or an enhanced level-- wherever the patient can go. At the limited and enhanced level, again, you have to do diagnostics, which include a CT scan and an MRI if it's available and feasible. You can do the biomarker studies for CA125 and CEA level, and to make a diagnosis, you can do a CT-guided biopsy. You can also do a cell cytology and if a cell block preparation can be made through cell block. Very rarely, if need be, and if you think that you need to make a diagnosis and you can't do anything else, laparoscopy can be done. Once the diagnosis is made, you then go for staging. And the staging is usually done when you're doing a CT scan and you do an abdominal and pelvic CT scan. You do a CT scan of the chest if you think it's needed. Otherwise, a chest ray will suffice. And then you go forward and get a diagnostic workup done and send it to the surgeon for either and decide on a multidisciplinary with a neoadjuvant or surgical assessment testing. BRITTANY HARVEY: Great. Then so next, Dr. Fujiwara, what are the overarching recommendations for surgery with women with stage one to four epithelial ovarian cancer? DR. KEIICHI FUJIWARA: Yes. So the purpose of the surgery is to diagnose, stage, and/or for treatment. So we strongly recommended the ovarian cancer surgery should be performed by trained gynecological oncologists or surgeons with oncologists' surgical expertise. If it is not suitable, we strongly recommend to refer those patients to the highest-resourced level center with an oncology surgical care capacity. For the staging purpose, where the feasible patients with a presumed early stage ovarian cancer should undergo surgical staging by train surgeons. In basic setting, surgical staging is not feasible. Thus, it is not recommended. For the treatment purpose of the women with advanced ovarian cancer, which is a stage three or four, should receive optimal surgical debulking to remove all visible disease to improve overall survival by trained surgeons. BRITTANY HARVEY: Great. And then Dr. Burke, what are the key recommendations for optimal adjuvant and systemic therapy for patients with stage one to four epithelial ovarian cancer? DR. WILLIAM BURKE: Sure. Well, one of the most important things is that access to appropriate evidence-based chemotherapy agents, contraindications to chemotherapy, and potential side effects of chemotherapy should be evaluated and managed in every patient. Basic resource settings that most likely lack the capacity to provide safe administration of chemotherapy should refer patients to a higher level center for evaluation. Limited settings without skilled capacity should refer patients to settings with access to specialized care. Some other notes include that clinicians should be able to document pathology and stage to determine eligibility for adjuvant chemotherapy. If pathology confirmation is not possible due to patient or resource limitation, alternatives can be discussed. Clinicians should not administer systemic treatment, adjuvant chemotherapy, to patients with ovarian low malignant potential tumors or early stage, microinvasive borderline tumors, independent of stage. Combination chemotherapy with paclitaxel and carboplatin is the standard of care for adjuvant therapy in ovarian cancer. However, single agent carboplatin may be utilized due to resource limitation or patient characteristics. Only in enhanced settings, highly selected cases can be assessed for appropriate evidence based intraperitoneal chemotherapy following optimal debulking, where there are resources and expertise to manage the toxicities. BRITTANY HARVEY: Great. And then the last overarching clinical question-- Dr. Aziz, what is recommended for patients with recurrent epithelial ovarian cancer? DR. ZEBA AZIZ: You know, with recurrent ovarian epithelial cancer is a tough option, especially in patients residing in the low-middle income countries. Supportive care treatment should be started together with whatever we have to do. So there are three options. There's one patient who presents with a rising CA125 with no evidence of disease and asymptomatic. We can elect to follow these patients, and it's easier to follow them until they become symptomatic or they have evidence of disease. If you have small volume disease which is resectable, you send them to an enhanced level setting, ideally where surgery can be done. Then you also look at patients and divide them into platinum resistant or platinum sensitive. If they're platinum sensitive, you can give a platinum-containing regimen, but if they're platinum resistant, you can put them on a non-platinum chemotherapy-- a single agent or whatever-- but these patients are tough to manage in that part of the world. BRITTANY HARVEY: Definitely. Well, thank you all for reviewing each of those key recommendations. The full recommendations are available in the guideline, but those are some important highlights. Thank you very much. So Dr. Burke, in your view, what is the importance of this guideline, and how will it change practice? DR. WILLIAM BURKE: Sure. Well, I think the importance of this guideline is that it globally targets health care providers, including gynecologic oncologists, surgeons, nurses, and palliative care clinicians, as well as non-medical community members, including patients, caregivers, and members of advocacy groups, providing them with resource-stratified clinical guidelines, recommendations that can be implemented across many health settings. The guideline will hopefully raise awareness among frontline practitioners, and provide guidance to provide adequate services in the face of varied and sometimes limited resources we see throughout the world. BRITTANY HARVEY: Great. And Dr. Aziz, how do you envision that these guidelines can be applied in low and middle income regions? DR. ZEBA AZIZ: These are extremely important guidelines for our part of the world. Remember that there are about 70 low-middle income countries, and all these countries-- and within each country-- there's marked variability in training of physicians who encounter cancer patients. There's also difficulty by the patients in accessing a few tertiary care centers, cancer care centers which are present, and most of all, financial implications, because you have to go there, you have to stay there, you have to get your chemotherapy, and this is true for the marginalized population. You also have to remember that more than 50% of our patients are treated in a limited resource setting, and the availability of enhanced resources are very difficult for them. And these limited settings are in public sector hospitals, where the doctors-- some of the doctors are very good, but the physicians or surgeons are overworked. They have resources ranging from minimal to moderate, depending on the funds available. And because they're overworked and there are few working hours, detailed counseling of the patient is infrequent because there are a large number of patients there. And the majority of surgeries, which is the cornerstone of ovarian cancer, is done by the postgraduate fellows who are there. Sometimes the senior consultants do surgeries, but most of the time, it is done by them. First time chemotherapy is easier to deliver because it does not have any expensive medicines. There are a lot of generics for carboplatin and taxanes regimen available, so it's not a major problem. But treating the side effects, again, becomes very expensive, and the patients have to come back and forth. The relapsed disease is very difficult to treat because we don't have too many options there and it is expensive. We've also seen that patients who are treated at an enhanced level do much better. Their survival outcomes are better, the supportive care treatment is better, and the progression-free survival is also better. BRITTANY HARVEY: Great. Thank you for reviewing that information. And then finally, Dr. Fujiwara, Dr. Aziz touched on this a bit on how it impacts patients, but how else do you view that these guideline recommendations will affect patients? DR. KEIICHI FUJIWARA: Yes. As Dr. Aziz said and Dr. Burke said, this guideline is written for the patients around the world in a different medical environment. So I think that it is very useful resource of information for patients to receive the best ovarian cancer treatment that suits the actual situation of each country or regions. BRITTANY HARVEY: Great. Well, thank you all for your work on these important guidelines. It sounds like they're going to have a real impact globally, and so I really appreciate both all of your work on these guidelines, and also for taking the time to speak with me today, Dr. Aziz, Dr. Burke, and Dr. Fujiwara. DR. ZEBA AZIZ: Thank you, Brittany. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast Series. To read the full guideline, go to www.asco.org/resource-stratified-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines available on iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.

CA125是卵巢癌常见的肿瘤标志物，随着数值的升高程度可以辅助医生进行炎症甚至是癌症的诊断。然而通过物理手段的体触竟然也能进行辅助诊断。本期《非要你健康》为您请到北京协和医院妇产科主任医师——吴鸣教授，讲述如何通过肿瘤标志物及体触的方式进行卵巢癌的诊疗。

CA125是卵巢癌常见的肿瘤标志物，随着数值的升高程度可以辅助医生进行炎症甚至是癌症的诊断。然而通过物理手段的体触竟然也能进行辅助诊断。本期《非要你健康》为您请到北京协和医院妇产科主任医师——吴鸣教授，讲述如何通过肿瘤标志物及体触的方式进行卵巢癌的诊疗。

CA125是卵巢癌常见的肿瘤标志物，随着数值的升高程度可以辅助医生进行炎症甚至是癌症的诊断。然而通过物理手段的体触竟然也能进行辅助诊断。本期《非要你健康》为您请到北京协和医院妇产科主任医师——吴鸣教授，讲述如何通过肿瘤标志物及体触的方式进行卵巢癌的诊疗。

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Positive CA125 test results for "symptomatic" women are wrong most of the time '

So, my CA125 (blood tumor marker) came back with it being a bit higher then 3 months ago. But this gal ain't gonna worry about it. Gonna instead trust that it will go back down and leave it at that. Now, feel free to fast forward but I'm bringing up facemasks again as today I was told my attitude was not good for doing my job. Ugh! Lastly, talking about the craziness of TTT, AKA Talk To Text. It's horrible on my new Galaxy S10. Like HORRIBLE!

TRANSCRIPT: Welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll. Joining me today to discuss key takeaways from the ASCO-SITC Immuno-Oncology Symposium in Orlando is the meeting's co-chair, Dr. James Gulley. Dr. Gulley is chief of the Genitourinary Malignancies Branch at the National Cancer Institute at NIH where he also leads the immunotherapy group. Dr. Gulley, welcome to the Daily News Podcast. Dr. James Gulley: Thank you so much, Geraldine. I'm delighted to be on here with you. ASCO Daily News: Dr. Gulley, do you have any conflicts of interest that you'd like to disclose that are relevant to our conversation? Dr. James Gulley: The National Cancer Institute does have some cooperative research and development agreements with several companies, including Bavarian Nordic and EMD Serono that supply institutional funding for some of the projects that I work with. ASCO Daily News: OK. Well, the 5th and final Immuno-Oncology Symposium, co-sponsored by ASCO, that is dedicated to immunotherapy revealed some significant advances in the field. What are the key scientific takeaways from the meeting? Dr. James Gulley: So Geraldine, this is an amazing meeting. There were 18 oral sessions, and there's so much going on here. I just want to share a few highlights that were my key takeaways. Dr. James Gulley: First story comes about earlier use of immunotherapy may be better. Jen Wargo from MD Anderson gave a really nice talk on neoadjuvant studies in melanoma, really highlighting the fact that this can be a correlative goldmine for addressing the impact of immunotherapy on the tumor microenvironment. In addition, Dr. Sara Tolaney talked about breast cancer and the consistent improvement in pathologic complete response rates with immunotherapy in combination with chemotherapy versus chemotherapy alone of about 15%. As you know, pathologic complete response rate are a registration pathway for agents. Dr. James Gulley: What was interesting is that this is seen both in PD-L1 positive and PD-L1 negative patients. In addition, both Dr. Jamie Chaft as well as Dr. Ford talked about lung cancer and the use of neoadjuvant immunotherapy studies in lung cancer, showing major pathologic response rates of about 50%-- up to 50%. In a study that was published in the New England Journal of Medicine, the first studies showed nine out of 20 patients having this major pathologic response rate. And this has led to four ongoing phase II slash phase III studies with PD-1 or PD-L1 inhibitors in the neoadjuvant setting. Dr. James Gulley: Now, in addition to the earlier is better story that we heard, we also heard about that it's not just about T cells. So there was a couple of abstracts of clinical trial data. One of them was by Dr. Christopher Cole from Dr. Annunziata's group at the National Cancer Institute, talking about autologous monocytes with interferon given to patients with ovarian cancer. And they saw some nice, interesting responses in this relatively small phase II study of 18 patients. With two out of 11 patients with a valuable disease having a partial response, and an additional patient that didn't have a valuable disease having a response by CA125 markers. In addition, six out of 11 patients had stable disease. Dr. James Gulley: There was another interesting study or a small randomized phase II study of 88 patients that was presented by Dr. Lindskog talking about monocytic dendritic cell approach with sunitinib versus sunitinib alone in patients with renal cell carcinoma. Now this is still relatively early on in this study to look at overall survival and progression free survival. Survival curves looked similar, although there was a late separation in the curves. Dr. James Gulley: However, the objective response rate in those patients receiving the dendritic cell approach was 42% versus 24%. The complete response rate was 6.7% versus 0%, and the duration of responses was 7.1 months versus 2.9 months, suggesting there may be some activity there. So it's an interesting story to continue to follow up on down the road. Dr. James Gulley: The final take away point is that biomarkers are becoming more sophisticated. There was a great biomarker session, and I just want to highlight some of the contributions from Dr. Larry Fong. He really put it nicely when he said that we started out with simple T cell enumeration, looking in the peripheral blood at things like neutrophil, the lymphocyte ratio. That does make a difference, and you can divide patients up into a higher versus lower and look at the outcomes as well as looking at T cell enumeration within the tumor. Dr. James Gulley: More recently, we've looked at T cell specificity by TCR sequencing. But what we're now able to do is to look at-- not only at T cell specificity, but to couple that with a functional state looking at single cell RNA seq. And this may provide new insights that can really help propel the field forward. ASCO Daily News: Well, you've described some amazing new insights. What were the advances reported at the meeting that are likely to support new standards of care moving forward? Dr. James Gulley: That's a really good question. And I think that what I take away from the meeting is there are a couple of very interesting emerging stories that I'd like to share with you. So first of all, we have the alveolar small part sarcoma story, and this is a very rare malignancy. Less than 1% of all soft tissue sarcomas are alveolar soft part sarcomas. Dr. James Gulley: This is a relatively indolent slow growing disease, but 80% of the patients develop metastasis and it's unresponsive to traditional treatment. Like most sarcomas, this has low tumor mutation burden and it's driven by effusion. So what we are seeing now from emerging data is that it actually has a good response rate to immune checkpoint inhibitor therapy. Dr. James Gulley: There's a study looking at atezolizumab where the response rate is 37.5%. Another study with pembrolizumab and axitinib where six out of 11 patients have had partial response. So these studies that were presented by Dr. Miriam from Dana Farber, I think, really provide an interesting story in what might be emerging. I think with a very rare tumor like this, it is likely that only single arm studies will need to be done to get approval or compendium listening. Dr. James Gulley: There's another interesting emerging story with adoptive cellular therapy and multiple myeloma. And Dr. Garfold had a really nice presentation about B Cell maturation antigen, or BCMA CAR T Cells. So these chimeric antigen receptor T cells are associated with the response rates in multiple myeloma of between 65% and 90%, depending on the studies, and a very good PR or CR rate of 35% to 80%. Dr. James Gulley: There were four studies that were looked at. The one thing that I would point out is that these responses were not as durable as hoped. And so new strategies are emerging to use this earlier on in the disease course in multiple myeloma, and perhaps co-target CD19. Another very interesting target for adaptive cellular therapy CAR T's is mesothelin. And Dr. Adusumilli talked about the use of these mesothelin targeted CAR T's in mesothelioma. Dr. James Gulley: One interesting thing about this is with mesothelioma, for instance, plural mesothelioma, you can just give these CAR T's directly into the pleura and therefore get a higher amount of these cells directly to the tumor than you could if you gave this intravenously. In addition, he showed data that suggested an improved outcome with PD-1 inhibition. And these studies are ongoing. Dr. James Gulley: The final study that I think is very interesting and could change standard of care is a story that is emerging about the ability of doctors to use immunotherapy in patients with solid organ transplants. It turns out that there's been a threefold increase in solid organ transplants since 1988, and cancer is the third most common cause of death in organ transplant recipients. Unfortunately, because of the requirement of the patients to use immune suppression to prevent the rejection of the organ graft, and because the anti PD-1 or anti PD-L1 agents could promote the rejection of the organ transplants, these have been traditionally excluded from clinical trials. Dr. James Gulley: There's now an effort going on combining nivolumab with tacrolimus and prednisone for patients with kidney transplant. The nice thing about this study is that there is a backup of dialysis if there are problems with the organ transplants. So this should allow us to get substantial data in the solid organ transplant setting. This trial is open now and is enrolling patients with melanoma, merkel cell carcinoma, basal cell carcinoma, cutaneous squamous cell carcinoma, and MSI high colorectal cancer. ASCO Daily News: Dr. Gulley, are there new treatment approaches emerging or agents in development that seem really promising? Dr. James Gulley: So Geraldine, there are some fantastic new approaches and some new agents that I think are worth keeping an eye on. First of all, I want to highlight the really excellent talk given by Dr. McQuaid on the microbiome. There were multiple excellent talks, but I just want to highlight this one talk because it really hit home for me how important the diversity of the microbiome is. Dr. James Gulley: So it turns out that when we have a diverse gut microbiome, we have better outcomes. And actually things that we might think that could improve that, such as taking probiotics, actually narrow the repertoire of the diversity in the microbiome and are associated with worse outcomes. Antibiotics obviously can also decrease that. In another talk, Brian Chu from UPenn showed that the use of antibiotics was associated with decreased overall survival and increased colitis in patients with melanoma that was required steroid. But in Dr. McQuaid's talk, she talked about how we could potentially improve the good microbiome. So it's not just enough for us to have the right bacteria. You really need to also be able to feed them. Dr. James Gulley: And what she showed was that if you had a high fiber diet, you could get fermentation by the bacteria, which would lead to increased short chain fatty acids, which would lead to increased immunity. And the fiber should be from multiple sources. And then also you need to not kill those bacteria with antibiotics if at all possible. Dr. James Gulley: In addition, there was some really interesting data on anti-semapohrin 4D. So semaphorin 4D is associated with myeloid derived suppressor cells with M2 polarized tumor-associated macrophages and with T regulatory cells. An agent, ipnimab targets semaphorin 4D. This allows for increased infiltration of effector cells within the tumor. In addition, there was a clinical trial showing that there was activity in non-small cell lung cancer in combination with avelumab. Dr. James Gulley: Another interesting story was the fact that real world evidence and real world data are going to be playing an increasingly important role in helping us understand issues in medicine in general, but also may be important in immunotherapy. This was highlighted in a session that was looking at real world evidence, not just from big data sets like electronic medical records, but also in a very interesting talk by Dr. Heather Jim from the Moffitt. Wearables or devices like cell phones or smart watches have accelerometers in them, and they can be used to help gather data on the activity of patients and whether they're up and about more. I think we're going to see a lot more of this type of approach in understanding what's going on in between clinic visits for patients, so stay tuned for this approach in the near future. Dr. James Gulley: Finally, we had three excellent keynote speakers. I just want to highlight one of them from-- one aspect of one of them from Dr. Dario Vignali from the University of Pittsburgh. And he talked about several things, including neuropilin-1 and how this may be targeted to help destabilize T regulatory cells within the tumor microenvironment. I would stay tuned for that emerging story from Dr. Vignali's lab. ASCO Daily News: Well, I want to thank you, Dr. Gulley, for sharing these amazing developments in immunotherapy. I look forward to continuing this conversation with you in our next episode, to reflect on the enormous impact that the IO Symposium has had on cancer research, education, and patient care over the past five years. Dr. James Gulley: Thank you so much. ASCO Daily News: Thank you to our listeners for tuning in to the ASCO Daily News Podcast. If you're enjoying the content, please rate and review us on Apple Podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. The following represents disclosure information provided by the guest(s) of this podcast. Dr. James Gulley The National Cancer Institute has cooperative research and development agreements with several companies, including Bavarian Nordic and EMD Serono that supply institutional funding for some of Dr. James Gulley's projects. 

In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.

 "The Gift of Cancer" - these are the words of Kelly Anne Branco - and in this interview she shares how the medical error and cancer diagnosis have lead her on a journey to take those tragedies and make a greater meaning personally and through patient advocacy.   The medical error impacts every aspect of Kelly Anne’s life, but she has adopted an attitude that forgiveness is a gift you give yourself.   KELLY ANNE BRANCO - SHOW NOTES: A sickly child 0:04:50 Kelly Anne was born in Toronto, St Michael's hospital - grew up in Toroto - mother came from Azores - Dad came after his military service - a lot of family on her childhood street - working class neighbourhood - an awesome place to grow up - late 80s moved to Mississauga at age 10 0:06:30 Mississauga is a suburb just west of Toronto - nearly 1 million population now, but like small town back then - Mom did office work, Dad a construction foreman until his traumatic brain injury (TBI) - this made him more difficult to live with - and he couldn't work 0:08:30 Kelly Anne was a sickly child, always problems with her instestines - but her symptoms dismissed and minimized - but in her 20s, Kelly Anne started to have anxiety and panic attacks associated with stomack pain - terrified to leave the house for fear of being sick 0:09:50 Took a while to get her GP on board - who dismissed her symptoms as psychiatric - and sent Kelly Anne to a gastroenterologist - but had to fight to get referral - took 6 months to get appointment with gastro, but within 5 minutes had diagnosed Kelly Anne with celiac disease - probably since a child 0:11:15 Kelly Anne goes back to her GP and says I told you so - the GP apologizes - is willing to learn is what Kelly Anne likes about her - this is just a few years before her ovarian cancer symptoms emerged           Medical errors start in early life 0:13:15 Kelly Anne describes celiac diagnosis and treatment - gastroscopy found very poor absorption of vitamins and minerals - within a year intestines started to heal 0:14:45 January 2012 Kelly Anne stopped getting her period, it was odd - thought maybe it just stress or her birth control pills, so didn't worry about it - but after months passed she started to worry so went to see her GP - sent for ultrasound and they found a mass on right ovary - referred to gynecologist in August 2012 0:17:10 Stressful waiting for appointments, not knowing what's going on with her body - unknown is the worse part - wondering about having kids 0:18:45 Gynecologist asks Kelly Anne about other symptoms, but she has none - doctor asks why she's worried and to stop complaining, lots of women would like not to have their period - doctor is ending meeting and Kelly Anne asks if the doctor is going to examine her - huffily the doctor acquiesces and Kelly Anne has a 'quite rough' examination - dismisses ovarian mass as probably just a cyst 0:20:15 Doctor did not so usual cancer checks (CA125 test, biopsy) - just sent Kelly Anne away with new birth control perscription - she felt foolish, an idiot, scared, questioning self - the new birth control pill re-started her period and that reinforced the self-doubt and everything is fine with her body - but later, found out her body was not fine 0:23:15 January 2013 her period stopped again - had surgery to have her gall bladder out, so blamed the stress of surgery - had put on a lot of weight, became pre-diabetic, had seen what diabetes had done to relatives, went on strict diet, causing gall stones - pain in hte middle of the night brought Kelly Anne to ER - gets ultrasound, we'll call you with results, but they didn't call her with the results - she has another gall bladder attack     Gallstone surgery 0:25:30 Kelly Anne passes gall bladder stone - 'most horrendous' experience - finds out that she has lots of gall stones and needs surgery - took 2 months to get surgery - living off baby food oatmeal for 2 months 0:26:00 What they didn't know was that Kelly Anne had a tumour and a weakened immune system heading into the gall bladder surgery - infection post surgery 0:28:05 Back to family doctor - another ultrasound and MRI showed the 'mass' had doubled in size - Kelly Anne said she did not want to go back to that same gynecologist - Sept 2013 sees new gynecologist - but got her period again in July, but it didn't stop, getting increasingly heavy flow - pain shooting down her leg, anxiety, bloated - started carrying her 'diaper bag' for such heavy bleeding - new gyno runs fertility clinic - did ultrasounds in her office and reviewed by gyno - great bedside manner 0:32:00 Gyno says could be cyst or fibroid - recommends laproscopy surgery to remove cyst or fibroid - no discussion of running blood work to rule out cancer - for the next months, symptoms worsen - by January 2014 Kelly Anne has surgery with gyno - finds out that the mass had gotten so big, it had consumed her ovary 0:34:10 gyno couldn't remove the mass via laproscopy - so tries to 'schuck' the mass to seperate the mass from the ovary, but couldn't so decided to remove the whole ovary - she morcellated (minced) the mass and ovary - chopped it up and pulled it out - the worse thing you can do with cancer because the cancer cells go everywhere 0:36:50 After surgery, gyno says Kelly Anne will recover in a few days, they'll send the mass to pathology, and she'll see her in 6 weeks - Kelly Anne describes the surgery prep and the gyno's empathy and support and great bedside manner - had a great recovery, felt good       Granulosa Cell Tumor 0:39:30 Back to the gyno for 6 week follow up and Kelly Anne knew that the pathology report would be back - gyno gave a summary of the report, but did not give the pathologists comments or recommendations - gyno says Kelly Anne has granulosa cell tumor but its benign, don't worry, but come back in 6 months 0:41:30 "I trusted her" - periods normalized, feeling good - felt like normal healthy human being - returned twice to gyno for ultrasounds - gyno says come back in 8 months, June 2015 - but spring 2015 new mild symptoms emerge 0:44:15 Heartburn, bloating but just chocked it up to stress - but still getting period so thought 'its nothing' - but in March called to book June appointment, but got appointment beginning of May - symptoms continued0:46:20Has appointment in mid May for pelvic ultrasound in gyno's office - gyno says there is something big on your ovary and need to get it out - also books Kelly Anne for MRI in mid July 0:47:25 Kelly Anne goes for pelvic MRI - but after, the MRI technician wouldn't look her in the eye - but says, robotically 'you're perfectly fine' - Kelly Anne could tell she was lying - there's something wrong - she actually got the MRI in late May, so had been prioritized - gyno calls Kelly Anne and askd her to come into the office the same day. 0:50:10 Kelly Anne goes to gyno Monday June 1st who says there is a lot of stuff there (ovary) and going to send you to cancer pre-op consult - gyno says just a precaution as her tumour is benign and denies Kelly Anne has cancer and dismisses her concern - Kelly Anne tries to down play her fears, but couldn't imagine it was as bad as it was 0:52:30 On Friday morning, while at work, Kelly Anne gets a call from the cancer centre saying she has to come in that day - Kelly Anne realizes something is very wrong - but is told she has to go to another hospital to pick up her MRI results for the cancer centre     Its not benign, you've got cancer 0:54:20 Borrows Mom's car to drive to get MRI results at one hospital before driving across city to cancer centre - the admin behaviour and facial expressions showed concern, made Kelly Anne feel weird - sitting in waiting room with chemo patients, feeling out of place, didn't click what was going to happen 0:57:30 Onclogist says 'it looks like you have a recurrence of your cancer that you had last year' - this is the first time any one said she had cancer - shocked, all Kelly Anne could say was 'I have cancer?' - the oncologist says 'yes, you have cancer, you had cancer before' - Kelly Anne tells him she's not been told she had concer before, that the tumour was benigh - the oncologist gets frustrated, 'its not benign, you've got cancer' 0:58:45 Kelly Anne asks how bad the cancer is - the oncologist says it is everywhere on her uterus and left ovary that she'll have to have CT, biopsy, surgery, hysterectomy, chemotherapy, blood work, urine example - left with more appointments and to return on June 19th 1:00:00 At that appointment Kelly Anne had Mom and her boyfriend with her - oncologist says cancer is everywhere in her uterus, tubes, ovaries, colon, bowel - we need take out uterus and cervix and appendix - will be a rough surgery, then chemo 1:01:00 The oncologist suggests Kelly Anne see a fertility doctor to harvest eggs before surgery - Kelly Anne is offended and gets angry - she's already decided that if the choice is to delay surgery for a fertility appointment, her life is more important, so not delaying surgery - but oncologist is insistent and gets Kelly Anne into fertility clinic next day 1:03:10 Fertility clinic examines and says there is nothing they can do because of so much cancer around her ovary 1:04:00 Kelly Anne has surgery end of June - hysterecotomy, but save bowel - also removed appendix and other abdominal cancerous tissues - surgery a success, but big scar on her belly - 2 months to recover before starting chemotherapy in late August     Chemotherapy 1:05:50 Because Kelly Anne was stage 3C, fairly advanced, the oncologist wanted to try something different, very aggressive - treated with BEP, that has 3 drugs, including a platinum drug reserved for advanced cases as it is so hard on the body 1:07:00 They wanted 3 cycles of chemo - but also had an infection and open wound - still feeling weak, not sure if healthy enough for chemo, but doctors insist to start - after first cycle of 3 weeks whipped out her white blood cells - developed fever, infection and hospitalized for 5 days with IV antibiotics - realizes they may kill me trying to cure me 1:09:20 Chemo trying to kill cancer cells, but affects other cells - Kelly Anne realizes it is going to get worse before it gets better - Kelly Anne tells her Mom she's not going for second cycle of chemo - but went for her Mother - the worst 3 months of life, felt like she was dying 1:11:40 At the end of a chemo cycle she would have lymphedema, swelling legs, face, nueropathy in hands and feet, losing feeling in arms and legs, intense heart beats, resting on stair case to make it up, vertigo, tinnitus, lots of sleep, loss of hair, pixelated vision - couild only keep oatmeal down due to nausea - it was absolute hell 1:13:20 November 2015 to see oncologist - he says all clear, no evidence of disease - but during chemo, asking herself how this happened - so called gyno office and asked for copies of all her records and went to pick up her records but receptionist pretends she doesn't know Kelly Anne 1:15:00 Kelly Anne subsequenlty learns that when it is cancer, the doctor has to get a second pathology at cancer centre, so she wanted records from the cancer centre too - in reading gyno's notes, the pathologist had said that patient should be referred to onclology for staging and assessment - this is not what gyno told Kelly Anne - but pathologist's January 2014 report said nothing about it being benign.     Facing mortality 1:16:45 But Kelly Anne discovers that 1.5 years of gyno's notes are missing - and when Kelly Anne gets hospital records, they had no notes from prior to her surgery, no 2nd pathology from gyno doctor - Kelly Anne livid, this is not right - but puts it aside as she is so sick from chemo - lots of support for cancer patients, but when done chemo done and given NED label - 'no evidence of disease' - support ends 1:19:45 That's when the weight of diagnosis and loss of health and grieving hit Kelly Anne - a real eye-opener to address your own mortality - wanted desperately for normalcy - took 6 months to focus on recovery and return to work 1:21:00 But in March 2016 at follow up scan, they found more disease - that's when she started to mobilize to learn and connect with people online with granulousis cell tumours to share - met people who had lived with it for 15 - 20 years - learned that if she had treatment when initially diagnosed, she could have a better potential outcome 1:24:00 Learned of hormone therapy to maintain stability - was a sponge aborbing all the research - tranferred to a medical oncologist (vs earlier gyno oncologist) - wanted to try hormone therapy 1:25:30 Kelly Anne discovers 3 types of doctors: those that want to heal people, have empathy, compassion and listen - also science geeks want to heal people, but only want to deal with the person from neck down - the 3rd type is all ego, love the prestige and misdiagnose - but she had a great doctor who was open to try 1:27:00 Did a couple of months of a medication, hormone therapy - ovarian cancer they now know, is driven by hormones - hormone therapy suppresses hormones - may keep patient stable, and live a long time with cancer, or shrink the cancer - may be able to lead a normal life - whereas chemotherapy is much harder on the body 1:30:20 But the hormone therapy didn't work for Kelly Anne and cancer progressed and they found it on her liver too - so advised to try a different chemo drug and Kelly Anne agreed and started it March 2017     "Forgiveness is a gift you give to yourself" 1:32:00 Different side effect experience on the new chemo drug, but sill lots of nausea and fatigue - from her previous chemo, Kelly Anne became pre-diabetic due to the steroids - this time for chemo, she only did steroids with the infusion - took CBD oil instead and was not pre-diabetic by end of chemo - also took other supplements to help with side effects 1:34:15 But her cancer started to grow exponentially be the end of chemo - felt like she did all this for nothing - during this time Kelly Anne also sought legal advice about her mised diagnosis - the lawyer said that she did have a case, but the reality was that in Canada doctor's are protected by the Canadian Medical Professionals Association 1:35:00 The lawyer says - Tax payers pay the premium that pay the physician's lawyers - will be at least 4 or 5 years before a trial because they always fight and take it to trial - they will put you on the stand and blame you for not following up - it is very difficult to litigate these cases in Canada - it will cost you money and the most you can sue for under the law is your lost wages - and then your employer can sue you to recover the disability payments they paid to you - lot of work for minimal return 1:37:00 In Ontario, part of the physicians agreement with the provincial govt, is that the Ministry pays the CMPA premium - and the Ministry is funded by tax payer dollars - in the news the College of Physiciand and Surgeons of Ontario (CPSO) has had problems with disciplining their doctors 1:39:00 "Forgiveness is a gift you give to yourself" is one of Kelly Anne's values - willing to say the gyno doctor made a mistake, they are human - need to move away from mode of thinking of doctor's know everything - but I needed to know the gyno had learned her lesson so no other woman would go through what Kelly Anne did - so did not move forward with a law suit - instead filed a complaint with the CPSO that the gyno had practiced outside of her area of expertise - she's not an oncologist, just a gynecologist     Stopping the medical harm 1:41:10 Complaint process includes a rebuttal from the phsycian - Kelly Anne was gobsmacked that the doctor would still profess that Kelly Anne never had cancer, she was lying, she was wrong 1:42:29 Kelly Anne replies that the gyno failed to proved Kelly Anne with a year of her file - that Kelly Anne did have cancer and here's the report - but Kelly Anne got great support from the cancer community in preparing her reply 1:44:30 Gyno claims to have called the cancer centre, but no records exist - and not proper protocol by gyno 1:45:45 With ovarian cancer, it is not uncommon for doctors to ignore or mis-attribute symptoms - that's why mortality rate so high for ovarian cancer - 50-60% diagnosed pass away in 5 years 1:47:10 Complaint went to CPSO committee, 6 months later Kelly Anne got the decision - they said they sent gyno to remediation - made her change her practice so no longer allowed to do ultrasounds in her office without a radiologist reviewing the scans 1:49:00 CPSO not looking to see if other of gyno's patients also harmed - Kelly Anne's doctor is 'type # 3", it is all about her ego 1:50:30 Kelly Anne hopes gyno has learned her lesson and that other women aren't harmed - making her change her practice is a huge win because a radiologist will review scans - hopefully remediation and the slap on the wrist will help people get right diagnosis - prevention and early diagnosis is key 1:51:45 Has been a spiritual journy - 'forgiveness is a gift you give yourself' - when facing your mortality, start to ask what is my purpose, what do I want out of this live, what do I regret - wants to leave place better then I found it - went to CPSO and made complaint 1:53:00 Kelly Anne has come to a place where she accepts this is her journey and this is how it unfolded 1:54:00 Finished chemo July 2017, disease really accelerated - fluid in lung, abdomen, couln't eat, couldn't breathe, constant pain - made decsion to do surgery again - drain lung first by going in through rib cage with a tube and pump out fluid, 2 litres - could breathe when she woke up, felt marvellous - then being able to walk and eat, had regular bowel movements     Dying 1:57:00 Was dying before surgery - but they were able to resect her liver, removed spleen, resected bowel and reattach - cleaned as much disease / cancer they could see, but some left behind - removed 5 litres of fluid - 170 staples and tension sutures - lost a lot of blood - woke up without pain meds - lots of pain, had to wear binders to hold stitches - under for 9 hours of surgery 1:59:30 Heart took a hit - took 8 months for resting heart rate to get back to normal - but within 2 months more cancer - at this point it is chronic, not hoping for a cure - stability is realistic goal - have met women that have lived 20 30 years - just matter of finding right combo of meds - ongoing discussions with oncology doc about meds to try 2:03:07 In 2017 sought 2nd opinion from US hospital - and oncology doc was open to their opinion2:04:30Canada behind updated cancer monitoring - the last year has been trying to find right meds combo - including $10k a dose med 4 times, but it didn't work - new med means small tumours have stopped growing, medium sized tumours are slowing down their growth, but large tumours are being stubborn - added another med suppresses hormones and seems to be helping 2:07:30 Some meds tolerated better than others - side effect caused blood clots and trips to emergency room - pain and fatigue - can sleep 12 hour and nap 4 hours and feel like need more - losing hope will be able to return to work      Making meaning out of life 2:09:00 Gifts from this experience is advocating with Ovarian Cancer Canada and a program called Survivors Teaching Students for medical schools and nurses and share their stories - worked with pharma companies, share her experience at conferences - also Patient and Family Advisor for psychosocial care - when you're ill it affects physical, emotional and spiritual 2:12:30 Whole life trajectory changed, want something different - healing journey - meet, connect, bond with other patients - a lot of good has come out of this tragedy - there is old Abroriginal saying that when you heal yourself, you heal 7 generations behind and forward - healing family relationships because of cancer experience 2:15:15 Wouldn't trade cancer because all of these great things have happened - perspective shift is the gift of cancer - connecting deeply with others is meaningful is liberating - feels freer, happier, more joyous having gone through all this - I like the person I am now then I was before 2:18:10 When you're sick you realize you can't take anything with you, and what you really want is to have the people that love you, around you - I've accepted and embraced that this is how my life is unfolding   The Gift of Cancer Connect with Kelly Anne Branco on Instagram: @BrancoBookNerd   Learn more: The Granulosa Cell Tumor Research Foundation     SUPPORT THE PODCAST   Be a Patron: https://www.patreon.com/MedicalErrorInterviews         Host Scott Simpson    

In our third and final Research Roundup recorded on location at the 2019 Cancer and Primary Care Research International Network (Ca-PRI) Conference held in Toronto in May, Dr Kristi Milley chats to Dr. Garth Funston. Garth is a General Practitioner, and Clinical Research Fellow with the CanTest Collaborative. In this episode, Garth discusses his current PhD research on the topic of evaluating tests and tools to diagnose ovarian cancer, with a specific focus on biomarker CA125. During the Ca-PRI Conference, Garth delivered a presentation titled ‘The association between CA125 level, diagnostic interval and stage at diagnosis in ovarian cancer: an analysis of CPRD and NCRAS data’. Garth discusses his use of big data to evaluate and improve the performance of cancer antigen 125 (CA125) biomarker as a test for the diagnosis of ovarian cancer in primary care. Show notes are available here http://pc4tg.com.au/research-round-up-research-round-up-july-2019-ca-pri-special-dr-garth-funston/

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about Irritable Bowel Syndrome.  ***THIS EPISODE HAS BEEN RE-UPLOADED WITH ADDITIONAL INFORMATION ABOUT CA125 BLOOD TESTS*** Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ------------------------- This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Dr. Nasha Winters, ND, L.Ac., FABNO, is the founder, CEO, and visionary of Optimal Terrain Consulting. She is a nationally board certified naturopathic doctor, licensed acupuncturist, and a fellow of the American Board of Naturopathic Oncology. She lectures all over the world training physicians in the application of mistletoe therapy and consulting with researchers on projects involving immune modulation via mistletoe, hyperthermia, and the ketogenic diet. In this episode Dr. Nasha Winters, who is also a cancer thriver, shares the story of her own healing as well as her program called The Optimal Terrain Ten Protocol™.  With this protocol she identifies the ten key elements of a person’s terrain—including the microbiome, the immune system, and blood sugar balance—as they relate to the cancer process.  As a gift to our listeners she offers a PDF of the Foreword, Introduction, and 1st Chapter of her book The Metabolic Approach to Cancer.

The meta-analysis discussed in this podcast studied the outcomes of Carbohydrate antigen-125 (CA125), an ovarian cancer marker, in acute heart failure. Heart Asia social media editor Dr Robin Chung discusses the clinical practice implications of this paper with Dr Christien Li Ka Hou, Associate-medical student at Newcastle University, UK, and clinical researcher of the Chinese University of Hong Kong, China. He is the leading author of “Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis”, published by Heart Asia (https://heartasia.bmj.com/content/10/2/e011044).

Measurement of serum cancer antigen 125 (CA125) is the standard approach for epithelial ovarian cancer (EOC) diagnostics and follow-up. However, the clinical specificity is not optimal because increased values are also detected in healthy controls and in benign diseases.

The discovery phase of proteomics is critical in the identification of suitable markers for exploration and validation of promising new clinical tests. But can laboratories be certain if what they believe they are measuring is, in fact, what they actually measuring?

ASHTB11 - A 76-year-old woman with altered mentation, hypercalcemia, anemia and abdominal bloating with ascites, omental caking and elevated CA125 is diagnosed with DLBCL and achieves a complete response after three courses of R-CHOP but has a decreased cardiac ejection fraction. Case discussion moderated by Neil Love, MD. Produced by Research To Practice.

Background: Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. Methods: We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n = 78, leimyoma: n = 66, endometriosis: n = 52, functional ovarian cysts: n = 79, other: n = 10), 16 low malignant potential (LMP) ovarian tumors and 125 OC (stage 1: 22, II: 15, III: 78, IV: 10). CA 125 was analyzed using the ARCHITECT system, HE4 using the ARCHITECT(a) system and EIA(e) technology additionally. Results: The lowest concentrations of CA125 and HE4 were observed in healthy individuals, followed by patients with benign adnexal masses and patients with LMP tumors and OC. The area under the curve (AUC) for the differential diagnosis of adnexal masses of CA 125 alone was not significantly different to HE4 alone in premenopausal (CA 125: 86.7, HE4(a): 82.6, HE4(e): 81.6% p > 0.05) but significantly different in postmenopausal {[}CA125: 93.4 vs. HE4(a): 88.3 p = 0.023 and vs. HE4(e): 87.8% p=0.012] patients. For stage I OC, HE4 as a single marker was superior to CA 125, which was the best single marker in stage H-IV. The combination of CA 125 and HE4 using risk of malignancy algorithm (ROMA) gained the highest sensitivity at 95% specificity for the differential diagnosis of adnexal masses {[}CA 125: 70.9, HE4(a): 67.4, HE4(e): 66.0, ROMA(a): 76.6 and ROMA(e): 74.5%], especially in stage I OC {[}CA 125: 27.3, HE4(a): 40.9, HE4(e): 40.9, ROMA(a): 45.5 and ROMA(e): 45.5%]. Conclusions: CA 125 is still the best single marker in the diagnosis of OC. HE4 alone and even more the combined analysis of CA 125 and HE4 using ROMA improve the diagnostic accuracy of adnexal masses, especially in early OC.

Background: MUC16 is a cell surface mucin expressed at high levels by epithelial ovarian tumors. Following proteolytic cleavage, cell surface MUC16 (csMUC16) is shed in the extracellular milieu and is detected in the serum of cancer patients as the tumor marker CA125. csMUC16 acts as an adhesion molecule and facilitates peritoneal metastasis of ovarian tumors. Both sMUC16 and csMUC16 also protect cancer cells from cytotoxic responses of natural killer (NK) cells. In a previous study we demonstrated that sMUC16 binds to specific subset of NK cells. Here, we identify the csMUC16/sMUC16 binding partner expressed on immune cells. Results: Analysis of immune cells from the peripheral blood and peritoneal fluid of ovarian cancer patients indicates that in addition to NK cells, sMUC16 also binds to B cells and monocytes isolated from the peripheral blood and peritoneal fluid. I-type lectin, Siglec-9, is identified as the sMUC16 receptor on these immune cells. Siglec-9 is expressed on approximately 30-40% of CD16(pos)/CD56(dim) NK cells, 20-30% of B cells and > 95% of monocytes. sMUC16 binds to the majority of the Siglec-9(pos) NK cells, B cells and monocytes. sMUC16 is released from the immune cells following neuraminidase treatment. Siglec-9 transfected Jurkat cells and monocytes isolated from healthy donors bind to ovarian tumor cells via Siglec-9-csMUC16 interaction. Conclusions: Recent studies indicate that csMUC16 can act as an anti-adhesive agent that blocks tumor-immune cell interactions. Our results demonstrate that similar to other mucins, csMUC16 can also facilitate cell adhesion by interacting with a suitable binding partner such as mesothelin or Siglec-9. Siglec-9 is an inhibitory receptor that attenuates T cell and NK cell function. sMUC16/csMUC16-Siglec-9 binding likely mediates inhibition of anti-tumor immune responses.

Host Dr Nicholas Fogelson discusses articles from the October and November 2009 issues of the Grey Journal.  On tap are discussions of the effects of second stage length and pushing times on outcomes, ST segment automated analysis of fetal heart rate tracings, a listener question on CA125 screening, and a few other short reviews. Academic […]

Women's reports of persistent, recent-onset symptoms linked to ovarian cancer (abdominal or pelvic pain, difficulty eating or feeling full quickly, abdominal bloating) when combined with the CA125 blood test may improve early detection of ovarian cancer. Individuals participating in a clinical trial hope to benefit personally from the research but also understand they are contributing to society.

Background: Cancer antigen CA125 is known as a valuable marker for the management of ovarian cancer. Methods: The analytical and clinical performance of the Access OV Monitor Immunoassay System (Beckman Coulter) was evaluated at five different European sites and compared with a reference system, defined as CA125 on the Elecsys System (Roche Diagnostics). Results: Total imprecision (%CV) of the OV Monitor ranged between 3.1% and 8.8%, and inter-laboratory reproducibility between 4.7% and 5.0%. Linearity upon dilution showed a mean recovery of 100% (SD+8.1%). Endogenous interferents had no influence on OV Monitor levels (mean recoveries: hemoglobin 107%, bilirubin 103%, triglycericles 103%). There was no high-dose hook effect up to 27,193 kU/L. Clinical performance investigated in sera from 1811 individuals showed a good correlation between the Access OV Monitor and Elecsys CA125 (R = 0.982, slope = 0.921, intercept = + 1.951). OV Monitor serum levels were low in healthy individuals (n = 267, median = 9.7 kU/L, 95th percentile = 30.8 kU/L), higher in individuals with various benign diseases (n = 549, medians = 10.9-16.4 kU/L, 95th percentiles = 44.2-355 kU/L) and even higher in individuals suffering from various cancers (n = 995, medians= 12.4-445 kU/L; 95th percentiles = 53.4-4664 kU/L). Optimal diagnostic accuracy for cancer detection against the relevant benign control group by the OV Monitor was found for ovarian cancer {[}area under the curve (AUC) 0.898]. Results for the reference CA125 assay were comparable (AUC 0.899). Conclusions: The Access OV Monitor provides very good methodological characteristics and demonstrates an excellent analytical and clinical correlation with Elecsys CA125. The best diagnostic accuracy for the OV Monitor was found in ovarian cancer. Our results also suggest a clinical value of the OV Monitor in other cancers.