Researchers at the University of Hawaii have been tracking the incidence of papillary serous Primary Peritoneal cancer. We have known about this “uncommon” malignancy for about 5 decades, and now it may be on the rise.

In the USA, this is generally a disease of older white women, usually not seen under the age of 40. However, it is also diagnosed in other ethnic groups. The majority (68%) is diagnosed at an advanced stage.

This research group tracked the incidence of primary peritoneal cancer in the US from 1995-2004. Unfortunately, they found that there is a dramatic increase with the greatest rise (>13% per year) among non-Hispanic and white women. Reasons are unknown at this time, and some of this may be due to how ovarian cancer was classified in this set of databases.

So what does this mean? Well, hopefully some of it is related to the last reason, which is essentially how things are recorded rather than real increases. However, it may also be a disturbing trend, adding to our already poor sensitivity for ovarian cancer screening. Over the next few years, the blood tests that are being developed for ovarian cancer screening will help find this disease. On the other hand, primary peritoneal cancer usually means that many areas of the peritoneum have gone bad. Because of this, an “early diagnosis” is uncommon.

Just released information from Dr. Michael F. Leitzmann of the National Cancer Institute strongly ties obesity to development of ovarian cancer. This study looked at 94,525 U.S. women aged 50 to 71 years over a period of seven years. 303 ovarian cancer cases were found during this time. Among women who had never taken hormones after menopause, obesity was associated with an almost 80 percent higher risk of ovarian cancer.

What this means is that obesity may increase the risk of ovarian cancer through hormonal effects. Body fat cells produce estrogen, so the more you have, the more estrogen gets produced. Even though this type of estrogen is weaker than that produced by ovaries, it can apparently still cause adverse events....like ovarian cancer.

So, this might be an excellent time to re-double efforts on the weight loss program that your New Year's resolutions included.

The PET scan for ovarian cancer, in my opinion, is a misunderstood test. Because of it's expense and "lack of data" and lack of approval leads payers to deny coverage often. Why is that? It's just a test. It will not lead to someone living longer by itself, just like CT or MRI scans and CA125 or other tumor markers. But if you take that position, may as well not pay for anything. Any test or procedure in the care of ovarian cancer, or any medical condition, can be misapplied.

With regard to the role of PET scanning in ovarian carcinoma, it appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Is this always helpful additional information? No! If the plan is not going to change much, for example chemo vs. no chemo, then finding the details of where the cancer might be located is not too helpful. That may only shift the date of chemo by weeks or months, without helping you live any longer. On the other hand, if the location of disease and number of areas involved will help make the decision of surgery vs. no surgery, then it can be crucial. There is no point in operating with suboptimal information only to find out during surgery that the surgical plan was a bad idea (e.g. "cancer all over the place and not removable"). The point is that deciding whether or not to perform a test, including the PET, is a multifactorial rather than a knee-jerk decision. In the right decision-making "hands", proper selection of testing can make the difference between avoiding unnecessary surgery (or not) and sometimes the difference between life and death.

From a purely technical standpoint the data is growing and the role of fluoro-D-deoxyglucose (FDG)-PET along with CT for the detection of recurrent ovarian cancer appears very promising. This a test which melds detection of abnormal anatomy and physiology very well. The devil is in the decision details as to when to use what and, more importantly, what difference it can make. If denied, go over these details with your trusted physician.

Perusing the latest from several sources.... I thought I'd post a list of biotech meds in development at various stages of clinical trials as of December 2008. Some are specific to ovarian cancer, others are being tested in several areas, and some include Fallopian tube and primary peritoneal cancers which are certainly treated in a very similar way. After the listing are phone numbers you can call for more info, where available.

AMG386 from Amgen is a recombinant fusion protein in Phase II (805)447-1000

Avastin from Genetech is a monoclonal Ab in Phase III (650)225-1000

DCVax-L from Northwest Bio is a dendritic cell vaccine in Phase I/II (240)497-9024

EGEN-001 from Expression Genetics is an interleukin in Phase I (256)512-0077

Herceptin from Genentech is a monclonal antibody in Phase II (650)225-1000

IL-21 from Zymogenetics is an interleukin in Phase I/II (206)442-6600

IMT-1012 from Immunotrope is an immunotherapeutic vaccine in Phase I (215)253-4180

Advexin from Introgen Therapeutics is in the gene therapy arena Phase I (512)708-9310

Neuvenge from Dendreon is a dendritic cell vaccine in Phase I (206) 256-4545

OmniTarg from Genentech is a monoclonal antibody going to Phase III (650) 225-1000

OvaRex from ViRexx is a monoclonal antibody in Phase III (780) 433-4411

Ovax from AVAX is a vaccine in Phase I/II (215) 241-9760

Tucotuzumab celmoleukin from EMD Lexigen is a fusion protein in Phase II (978) 294-1100

volociximab from PDL BioPharma is a monoclonal antibody in Phase II (510) 574-1400

There are others and I will post on those from time to time as they come across my research desk.