17 May 2013

Ovarian Cancer Signs and Symptoms

In September 2011, Jo blogged about the signs and symptoms of Ovarian Cancer. As Jo's sister/webmaster, I thought this would be a good time for a refresher.

Please share this information with all of your female family members and friends.

What are the some of the possible signs of ovarian cancer?
  1. abdominal pressure, fullness, bloating
  2. pelvic discomfort or pain
  3. persistent indigestion, gas or nausea
  4. changes in bowel habits such as constipation
  5. changes in bladder habits such as frequent need to urinate
  6. loss of appetite or quickly feeling full
  7. increased abdominal girth - clothes fitting tightly around the waist
  8. a persistent lack of energy
  9. low back pain
  10. some of the above...none of the above.
As you can read, most premenopausal women experience all or some of these symptoms on a monthly basis.  They are commonly attributed to PMS and not typically alarming to any of us.  The difference between one's monthly experience and cancer is usually persistence and worsening .  OR NOT...which is why the disease has been labelled "the silent killer".

There is no screening test for ovarian cancer.  A Pap smear cannot diagnose this disease.  There is no reliable blood test.  Ovarian cancer, gone undetected, spreads throughout the abdomen where it is very difficult to treat. Right now, the key to early detection is to know the signs, know yourself and know what is normal for you.

The following website has some interesting facts about Ovarian Cancer:

Ovarian Cancer INFOGRAPHIC Know The Facts

Jo's original post can be read here:
SunflowerSisters Ovarian Cancer Blog: September is Ovarian Cancer Awareness Month:

7 May 2013

Joanne M. Meyer (1953 - 2013)

It is with deep sadness that I, Jo's webmaster and sister, must report that after 5 and a half years of LIVING with Ovarian Cancer, Jo has earned her wings. She passed peacefully last Thursday morning surrounded with the love of her family.

Throughout Jo's journey, she always maintained a positive attitude and a driving determination to help herself and others with this disease. No "bump in the road" could break her fighting spirit as she always asked, "What's next? What else can we try?".

Jo leaves behind a legacy - her website SunflowerSisters.ca - her gift to all teal sisters everywhere. It is my hope that her work on this site brings some help and/or comfort to other women living with Ovarian Cancer, and for their families and friends.

"If there ever comes a day when we can't be together, keep me in your heart, I'll stay there forever." ~ Winnie the Pooh

MEYER, Joanne Marie - (Dec. 6, 1953 - May 2, 2013) Jo passed away peacefully with her sisters by her side, on May 2, 2013, at Parkwood Hospital, London, Ontario.
She was the loving wife of Stuart Raven-Hill; daughter of Ralph Meyer of Goderich and of the late Ruth Meyer (nee Freiburger); step-daughter of Margaret Meyer; sister to Anthony Meyer, Florida (Gloria); Maryann Gavin, Kitchener (Marshall); Rose Blake, London (Peter); Carol Wahl, Georgia (Philip); Greg Meyer, Newmarket; Lisa Debeljak, Cambridge (John); Chris Meyer, Brampton (Karen); and John Meyer, Idaho (Jennifer); daughter-in-law to Patrick and Alice Raven-Hill of Queensferry, Scotland; sister-in-law to Sheila Meyer, Newmarket and Valerie Raven-Hill, Nassington, England; loving Auntie Jo to Andrew (Holly), Lesley, Michael, Tara (Craig), James, Matthew, Andrew, Brendan, Kirsten, Natalie, Zachary, Sarah (Jason), Julianna, Alexandra, Sophia and Chloe; Great-Auntie Jo to Kayla, Violette, Maeva, Aubrey, Mateo and Lailah.
Jo's career spanned many years and activities: Comptroller at Mitel Corporation, Partner in MacDougall Meyer Inc., and various entrepreneurial ventures. She was an accomplished musician, a gourmet cook, loved nature, gardening and her doggies. People were drawn to her charismatic personality and "joie de vivre".
Always the eternal optimist, when diagnosed with Ovarian Cancer in 2007, Jo sought out ways to help herself. Through the creation of her website: SunflowerSisters.ca, she leaves behind a legacy that provides hope and inspiration to "teal sisters" and their families worldwide.
Special thanks to Dr. Dominique Lanvin, Dr. Stephen Welch and Bonnie Martin at the London Regional Cancer Centre, and to the entire Palliative Care team at Parkwood Hospital.
A celebration of life was held on Sunday, May 5 from 1:30 to 4:00pm at the Elsie Perrin Williams Estate, 101 Windermere Road West, London, ON. In lieu of flowers, donations would be appreciated to Wellspring London and Region.
Online obit link: Joanne Marie Meyer

"Keep your face to the sunshine and you cannot see the shadow. It's what sunflowers do." - Helen Keller


9 Apr 2013

Run for Ovarian Cancer - 2013

Once again, this year on Mother's Day, May 12, 2013, family and friends of Sunflower Sisters will be participating in the London Health Sciences Centre's Run for Ovarian Cancer.

Since 2006, all funds raised through this event go directly toward the Translational Ovarian Cancer Research Program, led by Dr. Trevor Shepherd and Dr. Gabriel DiMattia. These scientists and their team members perform laboratory research with ovarian cancer patient cells obtained here in London in collaboration with local cancer surgeons. Funds from the London Run for Ovarian Cancer help pay for this program, which is dedicated to making discoveries that will impact the health of ovarian cancer patients.

In the past 10 years, this grass-roots event has raised over 1 million dollars for Ovarian Cancer research to uncover the mystery of this silent killer.

Why not dust off your sneakers and join Team Sunflower Sisters in this fun, 5K run or 1K walk? If you are unable to participate, won't you please consider sponsoring our team or one of our runners/walkers?

Your generosity and support is greatly appreciated. We hope to see you there!

7 Feb 2013


The following was published yesterday on Gregory Pawelski's website CancerFocus.org :
What is chemoprevention and when is it used to prevent cancer?

Yuesheng Zhang, M.D., Ph.D.
Professor of Oncology
Roswell Park Cancer Institute

Cancer chemoprevention is defined as interventions with pharmaceuticals, vitamins, minerals, biologics, or other substances to retard, block or reverse the carcinogenic process. I would add that cancer chemoprevention is also important for inhibition of cancer recurrence. Hence, cancer chemoprevention is about preemptive strike against cancer. Before I go further, however, let me say a few words about carcinogenesis. Carcinogenesis is the developmental and also the silent process from normal cells to cancer cells, caused by chemicals, radiation or biological agents, and driven by genetic changes including activation of oncogenes (e.g. Ras) and inactivation of tumor suppressor genes (e.g. p53) as well as epigenetic changes. So, chemoprevention may be viewed as chemotherapy of carcinogenesis or chemotherapy of cancer recurrence.

Chemopreventive agents may be used in people at high risk of developing cancer and cancer recurrence. To date, the US Food and Drug Administration (FDA) has approved the following agents for cancer prevention: tamoxifen and rolaxifene against breast cancer, celecoxib against adenomatous colorectal polyps, fluorouracil against actinic keratosis, BCG (Bacillus Calmette-Guerin) against bladder cancer recurrence, HPV (human papilloma virus) vaccine against cervical cancer, and PDT (photodynamic therapy) with photofrin against Barrett Esophagus.

Is chemoprevention common? The answer is yes or no. If one looks at the drugs listed above, it is not that many. But if one includes dietary modification (e.g. eating more vegetables and less oily foods), which certainly modifies cancer risk, then chemoprevention is very common. Everyone should be doing it. In fact, dietary modification may have the greatest impact on reducing cancer risk among all chemopreventive approaches.

When we talk about cancer chemoprevention or cancer prevention, it is important to recognize the concept of cancer prevention by delay. Whatever we may be doing, we may not totally stop cancer, but if prevention can delay cancer occurrence/diagnosis by 10 years or so, cancer incidence will be dramatically reduced, because many people will die with cancer but not of cancer.

The list of cancer chemopreventive targets is long; basically, any genes, proteins or biological agents that play important roles in carcinogenesis and cancer progression may be potential chemopreventive targets, as long as they are druggable. Indeed, numerous genes and proteins have been studied as chemopreventive targets. Targets of chemopreventive agents approved by the FDA include: Estrogen receptor, targeted by tamoxifen and raloxifene for breast cancer prevention; cyclooxegenase-2, targeted by celecoxib for prevention of colon cancer; human papilloma virus, targeted by HPV vaccine for prevention of cervical cancer; thymidylate synthase, targeted by fluorouracil for skin cancer prevention. Finasteride, which targets 5-alpha reductase, has shown clinical efficacy in prostate cancer prevention, but has not been approved by the FDA.

I should also mention that some of the FDA-approved cancer chemopreventive agents do not have clear targets, e.g. BCG for prevention of bladder cancer recurrence, and PDT with phtofrin for prevention of esophageal cancer.

It is not possible to name a single best cancer prevention diet as far as specific foods are concerned. But it has been widely recognized that a diet with an emphasis on plant foods (fresh vegetables and fruits) which also maintains a healthy body weight prevents cancer and other diseases. This is supported by numerous scientific studies; just to mention a few below. We know that vegetables and fruits contain chemicals that fight cancer (e.g. sulforaphane in broccoli, resveratrol in grape), whereas carcinogens (e.g. heterocyclic amines and polycyclic aromatic hydrocarbons) are formed in meat cooked in high heat (e.g. grill). Alcohol is also potentially carcinogenic, so drinking in moderation or no drinking is recommended. We also know that overweight and obese are causatively linked to many forms of cancer.

There is very strong and ever accumulating evidence about cruciferous vegetables reducing risk of most if not all cancers. The International Agency for Research on Cancer, World Health Organization, devoted one volume of the IARC handbooks of cancer prevention to this subject: Volume 8, entitled “Fruit and Vegetable” (IARC Press, Lyon, 2003, ISBN 92 832 3008 6), which provided a comprehensive account of the cancer protective activities of fruits and vegetables. Cruciferous vegetables are full of phytochemicals that have been repeatedly shown to fight cancer in preclinical studies and epidemiological studies. We have certainly seen the cancer preventive activities of cruciferous vegetables in our own studies of bladder cancer.We showed that mustard seed powder and its active ingredient allylisothiocyanate, when fed to rats, both inhibited bladder cancer growth and muscle invasion (see papers mentioned in Answer 2), that sulforaphane, which is abundant in broccoli, inhibited tobacco carcinogen-induced DNA damage in the bladder in mice (Ding et al., Carcinogenesis 31, 1999-2003, 2010), that broccoli sprout extracts inhibited bladder cancer development in rats (Munday et al., Cancer Research, 68, 1593-1600, 2008), and that cruciferous vegetables intake, especially broccoli, was inversely associated with bladder cancer risk and positively associated with bladder cancer survival in human (Tang et al., Cancer Epidemiology, Biomarkers & Prevention, 17, 948-944, 2008; 19, 1806-1811, 2010).

A very large number of phytochemicals from cruciferous vegetables have been shown to modulate various steps and processes involved in cancer development and progression. This includes but not limited to scavenging of reactive oxygen species, inhibition of cellular enzymes that activate carcinogens, induction of carcinogen-detoxifying enzymes, induction of antioxidant enzymes, modulation of cell cycle progression, activation of programed cell death and inhibition of angiogenesis. Two review articles I published a few years back on two cruciferous vegetable phytochemicals provide additional useful information: Zhang and Tang, Discovery and development of sulforaphane as a cancer chemopreventive phytochemical, Act Pharmacol Sin 28, 1343-1354, 2007; Zhang, Allylisothiocyanate as a cancer chemopreventive phytochemical, MolNutr Food Res 54, 127-135, 2010. Cruciferous vegetables also contain vitamins, minerals and other nutrients. There are also studies showing inverse association between dietary fiber intake and cancer risk in the colon, breast and prostate.

While many Chinese herbs and their active ingredients have been shown to possess cancer preventive activities, lack of standardization and quality control have slowed the progress. My own research experience tells me that the level of an active ingredient in a given plant can vary dramatically depending where and when the plant is grown, how the plant is harvested, processed and stored, how long the plant has been stored, and things of that nature. Just to give you an example about what I am talking about, at one point we were interested in horseradish powder for cancer prevention, and bought the powder from a company on two occasions. It was the same catalog number and the same name, and the company swore that the two powders were exactly the same, but upon lab analysis we found that the level of the active ingredient (allylisothiocyanate) in the two powders differed by more than 50 fold.
By David S. Alberts, M.D.
Director, Arizona Cancer Center
University of Arizona

There may be a role for chemoprevention in lowering the risk of ovarian cancer and ovarian cancer recurrence. Dr. Alberts points out that there is an especially strong rationale for chemoprevention in ovarian cancer.

The overall five-year survival rate for ovarian cancer is about 31% (according to National Cancer Institute figures), and more than 70% of women in remission on primary chemotherapy will experience disease recurrence and ultimately die.

Diet and physical activity remain potential modifiable risk factors for this disease. Alberts points out that data from the large Women's Health Initiative study suggested that a low-fat eating plan is associated with a reduced risk for ovarian cancer.

In addition, data show that a high milk intake may be a possible harmful prognostic factor for ovarian cancer, while data from the Iowa Women's Health Study indicated that a high intake of vegetables improved ovarian cancer survival.

Additionally, data from the Women's Healthy Eating and Living (WHEL) Study showed that women who followed both diet and exercise recommendations had lower recurrence rates and better survival rates.

There are specific mechanisms by which physical activity may serve to lower the risk of ovarian cancer. Physical activity can:

* improve immune functioning

* reduce ovarian oestrogen production

* reduce body fat (thereby reducing fat-produced oestrogens and the potential for storage of fat-soluble carcinogens)

* increase sex-hormone binding globulins

* reduce circulating insulin and glucose

* reduce the activity of COX-2 and levels of prostaglandins in ovarian epithelium.

Dr. Alberts will serve as the study chair for the GOG-225 Diet and Exercise Trial: "Can diet and physical activity modulate ovarian cancer progression-free survival?"

The enrollment target is 1,070 women, and the primary objective is to determine if disease-free women who have completed therapy for Stage II-IV ovarian, fallopian tube, or primary peritoneal cancer randomized to a healthy lifestyle intervention have increased progression-free survival compared with those randomized to usual care.

Secondary objectives are to determine whether women in the intervention group have improved general quality of life and improved physical functioning. The protocol revisions are under review for GOG-225, funding is in place for start-up, and activation is planned for January 2012.

Source: Oncology Times
Gregory D. Pawelski

3 Feb 2013

Bulletproof Your Teeth

There was an extremely interesting article published today on Dr. Mercola's website entitled "The Benefits of Minimally Invasive Dentistry".   Dr. Mercola's interview with Dr. Tim Rainey - a pioneer of biologic dentistry - offers alternatives to the "drill and fill" stereotypical methods.  Early intervention, using Dr. Rainey's techniques, is said to prevent up to 80% of future decay.

Many ovarian cancer patients, especially those who have undergone multiple rounds of chemotherapy, experience problems with their teeth.   Whether it is accelerated decay, gum erosion or tooth loss, most issues stem from the drugs' seepage (up to 30%) into your mouth via the saliva glands.  Dr. Rainey suggests the nightly use of baking soda - both as a toothpaste and a rinse - to neutralise the acidity in your mouth.

Cancer patients can also be victims of early onset osteoporosis - calcium deficiency being a common side effect of chemo.  Dr. Rainey recommends toothpastes which contain calcium phosphate to help rebuild the surface enamel.  He states that the most fundamental way to correct the Ph in your mouth is to change your diet.  Promoting beneficial flora can be achieved by eating fermented vegetables, cultured yogurts from raw organic milk and using oral probiotic tablets.  And who ever heard of "oil pulling"?  No, not tooth extraction!

Here is the complete video and article full of interesting and modern approaches to "bulletproofing your teeth":


21 Jan 2013

Cancer Focus: Surgery for Ovarian Cancer

Gynecologic Oncologists Have Better Outcomes Than Surgeons Treating Ovarian Cancer
(reprinted with permission from Gregory Pawelski)

Elderly women with ovarian cancer tend to survive longer when treated by gynecologic oncologists than by general surgeons, according to results of a meta-analysis published in the Journal of the National Cancer Institute for February 1.

Dr. Craig C. Earle, from Dana-Farber Cancer Center in Boston, and his colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) program for 3067 women aged 65 or older who underwent surgery for pathologically confirmed invasive epithelial ovarian cancer between 1992 and 1999.

These data were linked to Medicare data and American Medical Association files to obtain information about medical care they received and specialty type of the surgeon who performed cancer-related procedures. Records showed that 33% were operated on by a gynecologic oncologist, 45% by a general gynecologist, and 22% by a general surgeon.

Patients with stage I or stage II disease treated by gynecologic oncologists were more likely to undergo lymph node dissection (60% versus 36% by general gynecologists and 16% by general surgeons).

Those treated by gynecologic oncologists and general gynecologists were more likely to undergo a debulking procedure at the time of their first surgery than those operated on by general surgeons (58%, 51% and 40%, respectively) and to receive postoperative chemotherapy (79%, 76%, 62%).

Even though patients operated on by gynecologic oncologists tended to have more advanced disease at diagnosis, their survival rates were similar to those operated on by general gynecologists and better than those operated on by general surgeons (median survival 32.5 months, 35.6 months, and 24.3 months, respectively).

"Our data support professional societies' recommendations that it is preferable for ovarian cancer patients to be operated on by gynecologic oncologists when possible," Dr. Earle's group concludes.

SOURCE: J Natl Cancer Inst 2006;98:163-180.

Gregory D. Pawelski

17 Jan 2013

Cancer Focus: Pap Test for OVCA by G. Pawelski

'Pap' test possible for Ovarian Cancer?
(reprinted with permission from Gregory Pawelski)

Using cervical fluid obtained during routine Pap tests, scientists at the Johns Hopkins Kimmel Cancer Center have developed a test to detect ovarian and endometrial cancers. In a pilot study, the "PapGene" test, which relies on genomic sequencing of cancer-specific mutations, accurately detected all 24 (100 percent) endometrial cancers and nine of 22 (41 percent) ovarian cancers. Results of the experiments are published in the journal, Science Translational Medicine.

The investigators note that larger scale studies are needed before clinical implementation can begin, but they believe the test has the potential to pioneer genomic-based cancer screening tests.

The Papanicolaou (Pap) test, during which cells collected from the cervix are examined for microscopic signs of cancer, is widely and successfully used to screen for cervical cancers. However, no routine screening method is available for ovarian or endometrial cancers.

Since the Pap test occasionally contains cells shed from the ovaries or endometrium, cancer cells arising from these organs could be present in the fluid as well, says Luis Diaz, M.D., associate professor of oncology at Johns Hopkins and director of the Swim Across America Laboratory. The Laboratory is sponsored by a volunteer organization that raises funds for cancer research. "Our genomic sequencing approach may offer the potential to detect these cancer cells in a scalable and cost effective way," adds Diaz.

Cervical fluid of patients with gynecologic cancer carries normal cellular DNA mixed together with DNA from cancer cells, according to the investigators. Their task was to use genomic sequencing to distinguish cancerous from normal DNA.

The scientists had to determine the most common genetic changes in ovarian and endometrial cancers in order to prioritize which genomic regions to include in their test. They searched publically-available genome-wide studies of ovarian cancer, including those done by other Johns Hopkins investigators, to find ovarian-cancer specific mutations. Such genome-wide studies were not available for the most common type of endometrial cancer, so they conducted genome-wide sequencing studies on 22 of these endometrial cancers.

From the ovarian and endometrial cancer genome data, the Johns Hopkins-led team identified 12 of the most frequently mutated genes in both cancers and developed the PapGene test with this insight in mind.

The investigators then applied PapGene on Pap test samples from ovarian and endometrial cancer patients at The Johns Hopkins Hospital, Memorial Sloan-Kettering Cancer Center, the University of Sao Paulo in Brazil and ILSBio, a tissue bank. The new test detected both early and late stage disease in the endometrial and ovarian cancers tested. No healthy women in the control group were misclassified as having cancer.

The investigators' next steps include applying PapGene on more samples and working to increase the test's sensitivity in detecting ovarian cancer. "Performing the test at different times during the menstrual cycle, inserting the cervical brush deeper into the cervical canal, and assessing more regions of the genome may boost the sensitivity," says Chetan Bettegowda, M.D., Ph.D., assistant professor of neurosurgery at Johns Hopkins.

Together, ovarian and endometrial cancers are diagnosed in nearly 70,000 women in the United States each year, and about one-third of them will die from it.

"Genomic-based tests could help detect ovarian and endometrial cancers early enough to cure more of them," says graduate student Yuxuan Wang, who notes that the cost of the test could be similar to current cervical fluid HPV testing, which is less than $100.

PapGene is a high-sensitivity approach for the detection of cancer-specific DNA mutations, according to the investigators; however, false mutations can be erroneously created during the many steps - including amplification, sequencing, and analysis - required to prepare the DNA collected from a Pap test specimen for sequencing. The investigators needed to build a safeguard into PapGene's sequencing method, designed to weed out artifacts that could lead to misleading test results.

"If unaccounted for, artifacts could lead to a false positive test result and incorrectly indicate that a healthy person has cancer," says graduate student Isaac Kinde.

Kinde added a unique genetic barcode - a random set of 14 DNA base pairs - to each DNA fragment at an initial stage of the sample preparation process. Although each DNA fragment is copied many times before eventually being sequenced, all of the newly-copied DNA can be traced back to one original DNA molecule through their genetic barcodes. If the copies originating from the same DNA molecule do not all contain the same mutation, then an artifact is suspected and the mutation is disregarded. However, bonafide mutations, which exist in the sample before the initial barcoding step, will be present in all of the copies originating from the original DNA molecule.


Funding for the research was provided by Swim Across America, the Commonwealth Fund, the Hilton-Ludwig Cancer Prevention Initiative, the Virgina and D.K. Ludwig Fund for Cancer Research, the Experimental Therapeutics Center of Memorial Sloan-Kettering Cancer Center, the Chia Family Foundation, The Honorable Tina Brozman Foundation, The United Negro College Fund-Merck Graduate Science Dissertation Fellowship, the Burroughs Wellcome Career Award for Medical Scientists, the National Colorectal Cancer Research Alliance and the National Institutes of Health's National Cancer Center (N01-CN-43309, CA129825, CA43460).

In addition to Kinde, Bettegowda, Wang and Diaz, investigators participating in the research include Jian Wu, Nishant Agrawal, Ie-Ming Shih, Robert Kurman, Robert Giuntoli, Richard Roden, James R. Eshleman from Johns Hopkins; Nickolas Papadopoulos, Kenneth Kinzler and Bert Vogelstein from the Ludwig Center at Johns Hopkins; Fanny Dao and Douglas A. Levine from Memorial Sloan-Kettering Cancer Center; Jesus Paula Carvalho and Suely Kazue Nagahashi Marie from the University of Sao Paulo. Papadopoulos, Kinzler, Vogelstein and Diaz are co-founders of Inostics and Personal Genome Diagnostics. They own stocks in the companies and are members of their Scientific Advisory Boards. Inostics and Personal Genome Diagnostics have licensed several patent applications from Johns Hopkins. These relationships are subject to certain restrictions under The Johns Hopkins University policy, and the terms of these arrangements are managed by the University in accordance with its conflict-of-interest policies.

Citation: Johns Hopkins Medicine. "Detecting Ovarian, Endometrial Cancers Using "PapGene" Test." Medical News Today. MediLexicon, Intl., 11 Jan. 2013

Gregory D. Pawelski