Transcript BMED 1300 - Project 1 - BMED1300SectionBGroup2Problem1

BMED 1300 - Project 1
Group:
Eric Sood
Hamza Darb
Jean Wall
Matt Richner
Regina Chang
Mickael Gueye
 OVARIAN CANCER
SCREENING PROBLEM

www.cs.nsw.gov.au/cancer/sgog/ImageLibrary.html.
Ovarian cancer
 Survival improved when cancer detected in early stage
 Survival rate for stage I disease is about 90% and for
stage II about 70%.
Who should be concerned?
 Women with OC+BC Hereditary background
 Women over age 50 account for ~80% of all cases
 (avg. age at diagnosis is 61)
 early menarche, nulliparity or age >30 at first child-
bearing, and late menopause
 Prolonged use of Clomid, especially without achieving
pregnancy
Paul D. DePriest & Christopher P. DeSimone , Journal of Clinical Oncology,2004
Signs & Symptoms Ovarian Cancer (Ovaraian Cancer)
 -Vague and non-specific
 – Abdominal bloating
 – Indigestion
 – Uterine bleeding
 – Pelvic fullness
 – Pain
www.cs.nsw.gov.au/cancer/sgog/ImageLibrary.html.
Stages
1
2
4

www.medscape.com
5A
3
5B
Symptoms Index & Family History
● 1.4% lifetime risk with no history
● Women are considered high risk have:
●
●
first degree relative with ovarian cancer and/or early breast cancer (risk
increases with quantity)
family with both cancers or male breast cancer
Sensitivity
● 79.5% for advanced-stage disease.
Specificity
● 86.7% (same sen.) for women age <50 years.
Not the most sensitive and specific test, but the easiest to perform on general
population and low risk
Diagnostic tools & Screening methods
 History (BRCA)
 Pelvic Exam (including rectal)
 Transvaginal Ultrasound – detection of masses
and mass characteristics
 Tumor markers – CA-125, HE4
 CT – assess spread to LN, pelvic and abdominal
structures
 MRI – best for distinguishing malignant from
benign tumors

www.cs.nsw.gov.au/cancer/.html
CA-125
Definition
A cancer marker, a protein normally made
by certain cells in the body including those
of the uterine tubes, uterus, cervix, and the
lining of the chest and abdominal cavities CA125
stands for cancer antigen 125.
Accuracy
83% sensitivity, 99.7% specificity 16% PPV depending on
if your body secretes the protein1
1Ovarian Cancer screening UCLA School of Medicine
Cost
Between $60-$100
HE4
 The gene was initially identified in epithelialcells of
human epididymis is fertility-related protein.
 A laboratory test to detect a protein called HE4, which
is released into the blood by ovarian tumors.1

Fred Hutchinson Cancer Research Center; Seattle, WA
Combination Test
81%
 When HE4 and CA-125 are combined the effectiveness
of screening is higher.
 The sensitivity is 76.7% and the specificity is 95%1.
 The cost is about $60- $200.
 The best thing about HE4 and CA-125 was that it
detects 45.9% of Stage I ovarian cancer.

University of Madison
Ultrasound
 TVUS underway has reported
sensivity 81% & specificity 98.9%
 Major limitations are poor
PPV 20% in asymptomatic
women and inability to detect
malignances when ovaries are
normal size
 improved by used Color Doppler
Cost $75- $200
D. DePriest &DeSimone, Clinical Oncology,2004
www.medicineworld.org
Blood Tests BRCA 1 & 2
•General Info
•BRCA: short for breast cancer 1 and 2.
•5-10% of population has this genetic deformity
•Statistics
•Sensitivity: 93%
•Specificity: 17%
•PPV: 75%
•How it Works
•A blood sample is to analyze the DNA in white blood
•A doctor can determine whether or not any mutations are present in the gene
•This is a very time consuming and labor intensive procedure
•Total Cost of BRCA 1 & 2 tests: $3280-$3480
•Interpretation of Results
•Takes on average 3-4 weeks for BRCA 1 & 2 results to be received.
•Takes on average 1-4 weeks for BRCA (Ashkenazi Mutations) results to be received.
Ways to improved…?
Current Plan Hirosaki & University of Kentucky screening algorithm
Proposed Plan
After math
Sensitivity: 95.24%
Specificity: 99.99%
Positive Predicted Value: 76.92%
Additional Citations
 David E. Cohn, N. C. H., Stephen P. Povoski, Leigh G. Seamon, William B. Farrar, Edward
W. Martin Jr. (2008). "Novel perioperative imaging with 18F-FDG PET/CT and
intraoperative 18F-FDG detection using a handheld gamma probe in recurrent
ovarian cancer." Gynecologic Oncology(110): 152-157.
 David H Geho, C. D. J., Emanuel F Petricoin and Lance A Liotta (2006). "Nanoparticles:
potential biomarker harvesters." Current Opinion in Chemical Biology(10): 56–61.
 Irene Visintin, Z. F., Gary Longton, David C. Ward, Ayesha B. Alvero, Yinglei Lai,
Jeannette Tenthorey, Aliza Leiser, Ruben Flores-Saaib, Herbert Yu, Masoud Azori,
Thomas Rutherford, Peter E. Schwartz and Gil Mor (2008). "Diagnostic Markers
for Early Detection of Ovarian Cancer." Clinical Cancer Research 14(4): 1065-1072.
 K. Maheedhar, M. S., Rani A, Bhat M.D., R. Malini, M. Sc, N.B. Prathima, M. Sc, Patil
Keerthi, B. Sc and C. Murali Krishna, Ph.D. (2008). "Diagnosis of Ovarian Cancer
by Raman Spectroscopy; A Pilot Study." Photomedicine and Laser Surgery 26(2):
83-90.