Friday, August 4, 2017

August #gyncsm Chat - "You never heard of Primary Peritoneal Cancer or GTDisease?"

In the past three years we have hosted chats dedicated to a number of the different gynecologic cancers - Cervical, Endometrial/Uterine, Fallopian Tube, Ovarian, Vulvar and Vaginal. This month we are going to discuss two more of the rare gynecologic cancers - primary peritoneal and GTD (Gestational trophoblastic disease).



What are these cancers?

Primary Peritoneal Cancer (PPC) forms in the peritoneum (the tissue that lines the abdominal wall and covers organs in the abdomen), and has not spread there from another part of the body. Primary peritoneal cancer sometimes spreads to the ovary. It is similar to ovarian epithelial cancer and is staged and treated the same way.
-NCI Definition

In data from 1995-2005, Goodman* found that the incidence rate in the U.S. for PPC was 6.78 per million women compared to 119 per million for ovarian cancer. Women with PPC were diagnosed at a later age (mean 67 years) than ovarian cancer (mean 63 years). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706690/)

GTD (Gestational trophoblastic disease) is a rare condition in which abnormal cells grow inside the uterus from tissue that forms after conception (the joining of sperm and egg). This tissue is made of trophoblastic cells, which normally surround the fertilized egg in the uterus and help connect the fertilized egg to the wall of the uterus. These cells also form part of the placenta (the organ that passes nutrients from the mother to the fetus). Most GTDs are benign (not cancer) and do not spread, but some types are malignant (cancer) and spread to nearby tissues or other parts of the body. The two main types of GTDs are hydatidiform mole and choriocarcinoma. Also called gestational trophoblastic disease, gestational trophoblastic tumor, and GTT.
-NCI Definition

GTD occurs in 1 out of 1000 pregnancies in the US. It less than 1% of all gynecologic cancers. GTD is more common in Africa and Asia than in North America. (http://www.cancer.net/cancer-types/gestational-trophoblastic-disease/statistics)

You can learn more about GTD or Primary Peritoneal Cancer by joining our chat and reading these pages on the NCI website.

You can also read a GTD survivor story here on our blog:
http://gyncsm.blogspot.com/2015/04/survivors-story-gtd-and-me-story-of.html

Part of #gyncsm's mission is to support those impacted by all gynecologic cancers. One way we can do this is to offer information on rare gynecologic cancers and support survivors of those cancers. #gyncsm will be participating in the #Dazzle4Rare social media campaign during August 13-19. Check out that tag to learn more about rare disease and share your own story.

We hope you will join us as we raise awareness of the risks of these rare gynecologic cancers, support the women impacted by them, and support the clinicians and researchers who focus on treating these rare cancers.

We look forward to chatting with you on Wednesday, August 9th at 9pm EST (8pm CST/ 6pm PST).

Guiding our discussion will be the following topic questions:
T1: What is Primary Peritoneal Cancer (PPC)? Why is it treated like ovarian cancer?

T2: Are there risk factors and symptoms of Primary Peritoneal Cancer (PPC)? Is there a known genetic mutation that increases risk?

T3: What is Gestational trophoblastic disease (GTDisease)? What types of GTDisease are there? Are they all malignant?

T4: What are the risk factors and other important things to know for GTDisease? Is there a known genetic mutation that raises risk?

T5: Are there any special support services for these two rare cancers? Where can people learn more?


Dee
Co-founder #gyncsm

*Goodman Study

Sunday, July 16, 2017

Sarcoma Awareness Month - Add your support

Guest post by patient advocate Suzie Siegel (@SuzieSiegel)


Many women never hear of sarcoma until they get it.

Sarcoma Awareness Month can teach women about rare gynecological cancers — then give them hope and resources to survive.

The National Cancer Institute, the American Society of Clinical Oncology, the American Association for Cancer Research and the American Cancer Society all recognize July as Sarcoma Awareness Month.

But the White House and Congress have never made it official. Once again, sarcoma nonprofits have a petition going, and we would love to have your help. 

Please add your name to the petition to officially designate July as 
Sarcoma Awareness Month: 

Sarcoma is a cancer of muscle, bone and other connective tissues. It represents 20% of childhood cancer cases but only 1% in adults. It can arise anywhere in the body at any age, from newborns on up.

In women, sarcoma can occur anywhere in the reproductive tract although the uterus is the most common. The different types are:
1.     Carcinosarcoma (formerly known as malignant mixed mullerian tumor or MMMT). Sarcoma specialists often don’t consider this a true sarcoma.
2.     Leiomyosarcoma. The Cancer Genome Atlas is expected to separate gynecologic leiomyosarcoma from LMS found elsewhere in the body.
3.     Endometrial stromal sarcoma. It has been divided into low-grade, high-grade and undifferentiated uterine sarcoma.
4.     Adenosarcoma.
5.     Embryonal botryoides or rhabdomyosarcoma found in infants.
6.     PEComa.

Risk factors include previous pelvic radiation and use of Tamoxifen.

Women often are diagnosed first by an OB/GYN and may then be referred to a gynecologic oncologist. Many also choose to see a medical oncologist who specializes in sarcoma, too.

Sarcoma nonprofits can help women find specialists as well as financial and emotional help. Let us help you!

—————
I’m a 15-year survivor of metastatic leiomyosarcoma that started in my vagina and spread to my right lung. I volunteer for the Sarcoma Alliance, Sarcoma Foundation of America, Imerman Angels and MD Anderson Cancer Center’s MyCancerConnection. You can contact me at suziesiegel@tampabay.rr.com

Suzie Siegel is pictured here at SGO 2017 with Dr. Don Dizon
at her table for the Sarcoma Foundation of America




















Wednesday, July 12, 2017

What's on your Mind? #gyncsm Open Mic Night -July 12, 2017


We didn't have a set series of topic questions for this month's chat but rather allowed our participants to share what was on their minds. We had nineteen participants and over 1.4M impressions. You may find more analytics from Symplur here.

The hour's discussion revolved around these main areas:

Emotional support of women after treatment
  • I'm struggling in post treatment life. Unknowns, grief, plus effects from chemo, rads. :/
  • Post-treatment is really tough for so many people. It's tough to go from the intensity of treatment to the uncertainty of after. 
A petition to make July Sarcoma Awareness Month which led to a discussion of - What is sarcoma? Which are gynecologic?

  • Via @suziesiegel Sarcoma is a cancer of connective tissues. The main types of gyn sarcoma are leiomyosarcoma ,low- & high-grade endometrial stromal sarcoma, & undifferentiated uterine sarcoma. Some include carcinosarcoma
  • Risk factors include exposure to radiation & use of Tamoxifen, plus genetic issues such as Li-Fraumeni Syndrome

Educating the public about the importance of HPV vaccination
  • Caleb's Feet Foundation http://www.calebsfeetfoundation.org/ brings information about cervical cancer and the HPV vaccination to the community. 
  • studies show pediatricians have a huge influence on whether kids get vaccinated - parents do listen to doc rec
  • good to focus on doc's and then community influencers - churches, centers
  • The @GlobalGenes site has some amazing free toolkits for health advocates. Can also check out blogs from @JBBC re: health marketing 
  • HPV vaccination could reduce global deaths from #cervicalcancer by as much as two-thirds
Support for women cancer researchers 
  • I really want to (1 day) discuss the lack of funding 4 female researchers, tasked w/ post BrCa Dx research
  • Issues affecting women's health still does receive equitable share in research dollars. It's time that changes
  • Awarding rates 4 female applicants (14.9%) are systematically lower than those for male applicants (17.7%) 
The science behind the connection between genetic mutations (other than BRCA) and how they may raise the risk of  Breast, Ovarian Color Cancer 
  • I'm in a FB group for CHEK2 and many previvors reporting getting ovaries out though science isn't there yet on that.
  • CHEK2 is the name of a gene...when there is an inherited change (mutation) in CHEK2 = some increased risk for specific cancers
  • Risks to removing ovaries in these young women-->early menopause w/o known cancer risk reduction benefit

You may find the complete chat transcript here.

Please scroll down for Resources mentioned during the chat.

Remember you can always join our discussion on the Smart Patients Platform. (https://www.smartpatients.com/partners/gyncsm )

Be sure to join us next month on Wednesday August 9, 2017 at 9pm ET | 8pmCT | 6pmPT  as we discuss "You never heard of Primary Peritoneal Cancer or GTDisease?".

Remember to tweet things of interest to our community by using the #gyncsm hashtag.

See you in August!

Dee
#gyncsm Co-founder

RESOURCES:

Petition to make July Sarcoma Awareness Month
https://petitions.whitehouse.gov/petition/officially-designate-july-sarcoma-awareness-month

Calebs Feet Foundation
http://www.calebsfeetfoundation.org/

Magenta Study Genetic testing study at MD Anderson
https://magenta.mdanderson.org/magenta_mobile/index.html

Sex Bias in Surgical Research
http://www.physiciansweekly.com/sex-bias-in-surgical-research/

@nccn guidelines for "Hereditary Colorectal Cancer"
https://www.nccn.org/about/news/ebulletin/ebulletindetail.aspx?ebulletinid=294

Friday, July 7, 2017

What's on your Mind? #gyncsm Open Mic Night



This month we are opening the discussion to topics our participants want to discuss.

What is on your mind?

Are you considering a PARP and want to know more? 
Are you interesting in taking part in a clinical trial but have questions? 
Do you want to know if others are experiencing Quality of Life (QOL) issues like you are?
Do you have questions about seeing a Genetic Counselor for genetic testing?  
Do you want to discuss the results of the Our Way Forward Survey
Do you want to discuss how to communicate with your health care team?
Did you see the latest research on obesity and ovarian cancer and wonder if it applies to you? 
If you are a health care provider, do you wonder how much information your patient wants to hear about their condition?

Join us on July 12th at 9pmET | 8pmCT | 6pmPT and bring your thoughts, questions and comments for our third "Open Mic" #gyncsm session.


Dee
Co-Founder #gyncsm Chat

Wednesday, June 14, 2017

Radiation Oncology - What is it? When is it used? June 14, 2017 #gyncsm Chat

We were so pleased to welcome as our guest Dr. Matthew Katz (@subatomicdoc), radiation oncologist. We appreciate the support and guidance Dr. Katz has provided the #gyncsm community over the past three years. Dr. Katz shared information on our topic Radiation Oncology - What is it? When is it used? with our 23 participants. We were also happy to welcome health care providers @temkins, @Sushilberiwal@embosu@shereesepubhlth as well as @Peach_Society and a few new individuals to our discussion.

During our one hour chat we shared 312 tweets and made over 2.5 Million impressions. For a complete transcript of this chat please check here and for more analytics please check here.

Below you may read a sampling of the responses to our topic questions.

T1: What is radiation oncology? How does it work to treat cancer?

  • Radiation oncology is a field of medicine dedicated to the use of ionizing radiation to treat disease, mostly cancer.
  • Ionizing radiation means it’s breaking chemical bonds in cells, which can lead to biologic effects.
  • Radiation treatments are high-energy x-rays (or other particles) designed and focused within the body as cancer treatment
  • The purpose of radiation=damage cancer cells so they (a) stop growing and (b) die to either help cure cancer or relieve symptoms

T2: Which gynecologic cancers are treated with radiation therapy? Under what circumstances is radiation therapy recommended?

  • For ovarian cancer, there is little need for radiation in most cases. Large areas (abdomen and pelvis) too broad to treat 
  • Radiation often can be helpful in endometrial/uterine cancers. It may help lower the chance of recurrences after surgery
  • cervix, endometrial , vagina and vulvar cancer
  • For cervical cancer, radiation can help after surgery in selected cases. However, sometimes it can replace surgery too 
  • Often the 'benefit' of radiation in low grade endometrioid uterine cancers is based local recurrence, not survival, benefit

T3: What professionals are involved on the care team for radiation therapy? Who on your team did you find most helpful?

  • To do our job well, radiation oncologists work closely with nurses, radiation therapists, dosimetrists, physicists
  • Yes, medical dosimetrists plan the treatments in the computer software with guidance from docs and physicists
  • Don't forget your gyn oncology colleagues! We always have opinions and often provide concurrent chemo.
  • Never forget importance of administrative staff, nutritionists and others...
  • other folks can help too... Pelvic physical therapist or sexual health specialist

T4a: What are the differences in radiation therapy types for gyn cancer - external, internal, etc.?

  • External radiation is usually an x-ray (photon) treatment from about a meter away, aimed inside the body
  • brachytherapy means 'close treatment'. Goal = rapid dose drop-off within millimeters 
  • Proton therapy is a highly sophisticated version of external beam radiation. Instead of x-rays (light particles) it's protons 
  • Most gynecological cancers treated with photon. Proton may be for reradiation

T4b: Patients/Survivors/Loved Ones: Were the questions you had about radiation therapy answered for you?


T5: What side-effects and risks are associated w/ pelvic radiation? What tips do you have for controlling side effects? 

  • Gyn and radiation oncologists are probably best trained to manage side effects of pelvic radiation.
  • Radiation's effects are limited to the area treated. Much more focused with brachytherapy than EBRT(external beam radiation therapy

We hope you will join us next month on July 12, 2017 at 9pm for this year's "What's on your mind? #gyncsm Open Mic Night". Bring your questions about gynecologic cancers, treatment options, concerns about sharing your data, concerns about long term side effects, etc.

Please continue to use #gyncsm when tweeting about news of interest to our community.
See you next month.

Dee
#gyncsm Co-founder

RESOURCES:

NIH - Radiation Therapy and You: Support for People With Cancer  https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you

@cancerdotnet radiation therapy resources for patients  

Mayo clinic: http://www.mayoclinic.org/departments-centers/radiation-oncology/sections/overview/ovc-20188591

American Society for Radiation Oncology 
https://www.astro.org/home/

American Society for Radiation Oncology,  @ASTRO_org

Radiation Oncology

Slide share - Understanding Radiation Oncology

Journal articles
Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma  https://www.ncbi.nlm.nih.gov/pubmed/25127122

National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements https://www.ncbi.nlm.nih.gov/pubmed/25216857

Primary radiotherapy for nonsurgically managed Stage I endometrial cancer: Utilization and impact of brachytherapy https://www.ncbi.nlm.nih.gov/pubmed/25600451


MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience https://www.ncbi.nlm.nih.gov/pubmed/25680598