Seed and Soil Cells Are Sought

In her essay in the May 2011 issue of Obstetrics and Gynecology Paola Gehrig discussed the 1889 theory of the great British physician Sir James Paget who proposed that certain cancers could shed cells and then those cells could travel to other organs and grow as metastasis and it became known as his "seed and soil" theory. Although it seems as obvious to us as how dandelions take over the lawn it wasn't a well accepted theory in his day. Now we not only know the presence of circulating tumor cells can produce distant growth, but their presence can predict response to treatment. Thus Dr. Gehrig said the "liquid biopsy" was born, essentially looking for those tumor cells in the blood stream. In breast cancer treatment, if you have less than 5 cells in a cc of blood you do much better, colon cancer the cut off is 3 cells. But straight forward answers have not been the case in all tumors and the amount of circulating cells found in ovarian cancer has not predicted success of treatment. A new company is trying to use their techniques of finding cells, with their Magnetic Nest Cell Presentation Device that magnetically aligns cells so their CellTracks Analyzzer can check them out. Researchers at Mass General are looking at this as a new way to treat cancer, and the media, like me, has pricked up their ears and are wondering if it could become that, to quote Dr. Gehrig again, golden chalis of ovarian cancer: a screening test! Since OvaSure let us down in 2008 and was found not to be an accurate test and had to be withdrawn as a screening test, and we don't know yet if Ova1 will even preform like CA125 on at risk women, we have to be a bit patient and see if we really will have the next new ovarian cancer screening test!

Comments

  1. What is the usefulness of CA125 in screening at risk women? It's like flipping a coin...and OVA1 clearly outperformed CA125 presurgically. It's not FDA approved for screening (neither is CA125) so not really a comparison at all.

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  2. Ovarian cancer is very hard to diagnose. Women have a lifetime risk of about 1/70 of getting ovarian cancer. CA215 is elevated in about 50% of women with early stage ovarian cancers, about 80% of women with advanced ovarian cancers, and about 1% of healthy women. CA125 can vary with the menstrual cycle. Various screening programs have been looked that that would include pelvic examinations, CA125, pelvic ultrasounds with or without CT scans. CT scans have radiation exposure and thus cause more risk without yet out performing ultrasound. No combination of these tests have been shown to be helpful in low risk women. In women with hereditary ovarian cancer syndromes where lifetime risk is about 25-50% screening programs have been found to be useful. Other studies looking at women at risk from other factors have found some use to combination protocols as well. the consequences of screening for ovarian cancer are important as well as the "treatment" of an abnormal test may be surgery. And the finding of a screening ultrasound may be a cyst...at which point OVA1 can help in decision making. Other trials using various markers and looking at other ways to approach the problem are on going. One NIH sponsored study will be finished in 2013. However the early reports are very interesting. Although CA215 itself not as helpful: the trend in the CA125 value looks like it is very important, with that trend being able to have a positive predictive value of over 98%! Early data, and there are positive things women can do to reduce their ovarian cancer risk, so a lot more to talk about, keep in touch! Thanks.

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