WEDNESDAY, Nov. 28 (HealthDay News) - A gene long linked to suppressing the growth of cancer may also play a vital role in human reproduction, researchers report.

In experiments with mice, researchers found that females lacking the p53 gene had fewer embryos implanted in the uterus, less chance of becoming pregnant, and when they did conceive, they had fewer offspring. A lack of p53 did not affect the fertility of male mice, however.

"This is an amazing new function for a gene that everybody thought they knew what it did," said lead researcher Arnold J. Levine, a professor at the Institute for Advanced Study, in Princeton, N.J. "This is a gene that is not only watching over us so that we cannot get cancer, but it watches over our genome so that we can develop normally," he added.

The report appears in the Nov. 29 issue of Nature.

The p53 gene responds to a variety of stresses, such as radiation damage, in ways that allow it to protect cells against cancer, Levine explained. However, he added, "We found, quite by surprise, the normal function of p53 in the uterus of mice."

In order for embryos to implant in the uterus, a cytokine called LIF (leukemia inhibitory factor) is essential, and "p53 turns on the gene that makes LIF," Levine explained. "It's estrogen plus p53 making LIF that allows implantation."

In mice without the p53 gene, males are fine, but females only infrequently implant eggs and "the litter sizes go way down," Levine said. However, when these mice were given an injection of LIF, they reproduced normally.

Whether this finding has implications for humans isn't clear, Levine said. "We do know that humans require LIF in the uterus, but whether p53 has the same function in humans is something we are working on," he said.

Levine believes that p53 could play a part in human reproduction and infertility, but "there must be other factors as well," he said.

Defects in p53 are extremely rare in humans. "There are about 250 families in the United States that have defects in the p53 gene, a condition called Li-Fraumeni syndrome. This syndrome predisposes patients to cancer at an early age," Levine said.

One expert believes the finding could have clinical implications.

"Some humans show genetic variation in the amount of p53 they can produce and how well some of these variants of p53 function," said Colin Stewart, a principal investigator at the Institute of Medical Biology in Singapore and author of an accompanying editorial in the journal.

One study suggested that some women who have difficulty in getting pregnant tend to have the less efficient form of p53, Stewart noted.

"This may be why they have problems becoming pregnant, because the less efficient form of p53 does not make sufficient amounts of LIF that are necessary to get the embryo to attach to the wall of the uterus," Stewart said.

Drugs are currently being developed that would either improve the way p53 works or block the action of defective forms of p53, Stewart said.

"Some of these drugs may turn out to be useful in helping women conceive by improving the function of p53 in the uterus. Others may turn out to be possible contraceptives by blocking p53's function in the uterus," he added.

More information

For more information on p53, visit the National Center for Biotechnology Information.

MONDAY, Nov. 26 (HealthDay News) -- More than a third of prostate cancer patients may receive treatments that are inappropriate because of problems they are already having with urinary, bowel or sexual function, a new study suggests.

These mismatches might occur, because patients don't give enough information to their doctor or because their doctor favors a particular type of treatment, according to the report in the Nov. 26 online edition of Cancer.

"We found an awful lot of patients whose treatment seemed to be contraindicated by urinary, bowel or sexual problems they had before they got treated," said lead researcher Dr. James Talcott, from the Center for Outcomes Research at Massachusetts General Hospital Cancer Center in Boston. "That's pretty good evidence that information wasn't transmitted or didn't factor in with the treatment decision."

Unlike other cancers, there are several treatment options for prostate cancer. The treatment that is best for an individual patient is based on several factors, including stage at which the cancer is diagnosed, age of the patient, and existing problems with urinary, bowel or sexual function that the patient has.

Treatments include external radiation therapy; brachytherapy, in which tiny radioactive particles are implanted into the prostate gland, and the surgical removal of the prostate gland.

Although these treatments are effective, each has a different set of side effects. External radiation can lead to bowel dysfunction, brachytherapy can cause urinary problems, and surgery can damage nerves involved in sexual function.

Treating patients who already have problems in these areas with a procedure that could exacerbate their problem is usually not recommended.

For example, treatment designed to preserve normal functions, such as nerve-sparing, prostate-removal surgery, is not appropriate for patients who have already lost sexual function, Talcott said.

To find the extent of treatment mismatches, Talcott's team collected data on 438 prostate cancer patients. Patients were asked to complete questionnaires that included questions about urinary incontinence and other urinary problems, and bowel and sexual dysfunction.

The researchers found that 89 percent of the patients had some level of urinary, bowel or sexual problem before starting treatment. Among these patients, 34 percent of those with one serious symptom had a mismatched treatment, as did 37 percent who had a less serious symptom. Moreover, 40 percent of those who had several symptoms also received contraindicated therapy.

In addition, among patients with significant dysfunction in all three areas for whom no treatment would be recommended, only 5 percent chose watchful waiting. In this strategy, patients are not treated but are followed closely.

These mismatches appear to occur because doctors and patients don't communicate well. Patients are often reluctant to talk about urinary, bowel and sexual problems, Talcott said. "And, sometimes patients override their doctor's recommendation," he added.

Talcott also thinks that physicians can be wedded to a particular treatment at the exclusion of others. "Surgeons believe in surgery, and radiation oncologists believe in radiation," he said. "That may be part of the problem."

To counterbalance physician bias, patients should get another opinion, Talcott said. "Patients should always get a second consult," he said. "It's a good idea to talk with a surgeon, a radiation oncologist and possible a medical oncologist."

One expert thinks that patients need to make an informed decision about which treatment is best.

"The kind of doctor that you see often predetermines the treatment you receive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society. "Urologists are much more likely to have a surgical solution, and those who see a radiation oncologist are more likely to have radiation."

Patients need to be well-informed about their condition and the possible treatments and their side effects, Brooks said. "Patients need to arm themselves with as much information as possible about what their treatment options are, and what some of the contraindications of particular treatments are," he said.

Men also need to know what all the treatment options are, Brooks said. "Men need to be aware that, in some cases, depending on their overall medical condition and the stage of their cancer, that it is, at times, appropriate not to have any active treatment," he said. "Watchful waiting is a legitimate option in a significant proportion of men."

"In addition, doctors need to work with their patient to choose the best treatment option, Brooks said.

"If one takes the time to have a discussion, educate the patient and not rush them into a decision, then you may be able to allow them to get past their emotional response and make a more educated, logic-based response," Brooks said.

Brooks noted that because there are so many treatment options in prostate cancer, patients may insist on a particular treatment even though it's not the best choice for them.

"Where treatments are contraindicated in other places in medicine, doctors don't provide a treatment for a patient just because that's what they say they want," Brooks said. "You explain that that treatment is simply the wrong treatment for you, and therefore, we are not going to take that approach."

More information

For more on prostate cancer, visit the American Cancer Society  .

SUNDAY, Oct. 28 (HealthDay News) -- Ovarian cancer has long had a reputation as a silent killer, because many people believed it gave no warning signs until far advanced.

But women suffering from the disease knew differently. They knew they had certain symptoms that were common from patient to patient.

"Survivors for years have said there are symptoms for the disease, but no one listened to them," said Jane Langridge, chief executive officer for the National Ovarian Cancer Coalition.

Now, doctors have agreed with them.

A screening test has been developed that, in one study, accurately detected early stage ovarian cancer 57 percent of the time.

Based on that and similar studies, experts from the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.

"We want people to know it's not the silent killer. There are symptoms women can bring to their doctors that are important to pay attention to," said Dr. Linda Duska, a member of the National Ovarian Cancer Coalition's medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center, in Boston.

"This agreement is significant in the fact that, maybe if we pay more attention to symptoms, we can catch them sooner and have more success in treating them," she continued.

Early detection of ovarian cancer is crucial.

More than 22,000 U.S. women will be diagnosed with the disease this year, and three-fourths of them -- more than 15,000 -- will die from it, according to the National Cancer Institute.

If caught in the early stages, the five-year survival rate for ovarian cancer is 90 percent. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.

Ovarian cancer is the eighth most common cancer among American women, not including skin cancer, according to the American Cancer Society. An estimated two-thirds of women with ovarian cancer are 55 or older.

"It is a disease that is detected in stage 3 and above, and that is unacceptable," said Sherry Salway Black, executive director of the Ovarian Cancer National Alliance and a survivor of the disease. "Our mortality figures are unacceptable."

The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders. They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate.

Because these symptoms are so common, women should be careful not to assume the worst, Duska said.

"The goal of this is not to make everyone think they have ovarian cancer," she said. "If women have these symptoms, and they persist over time, they should have them investigated. Everyone with bloating does not have ovarian cancer."

Typically, two or more symptoms occur simultaneously and increase in severity over time, according to the National Ovarian Cancer Coalition.

The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time. The test also produced "false-positive" findings 10 percent to 13 percent of the time.

The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.

"When women go to their doctors and have had some of these symptoms, and they are new and have persisted for two or more weeks, perhaps a doctor now would be willing to perform some pretty simple tests to rule out ovarian cancer," Langridge said.

Women who have a family history of breast or ovarian cancer are at increased risk and should pay particular attention to the symptoms, Duska said.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Advances in chemotherapy have made the late-stage disease more survivable, Duska said.

In a more intensive regimen recently shown to improve survival, standard intravenous chemotherapy is combined with chemotherapy injected directly into the abdominal cavity. The abdominal injection exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.

"That was a breakthrough, I think," Duska said.

Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the body's own immune system to help combat cancer, according to the Mayo Clinic.

More information

To learn more about ovarian cancer, visit the U.S. National Library of Medicine.

WEDNESDAY, Oct. 24 (HealthDay News) -- The addition of the chemotherapy drug, docetaxel, to the standard two-drug regimen used for head and neck cancers improved the efficacy of the treatment while reducing the toxicity, two new studies report.

The triple drug chemotherapy regimen was so effective that it increased survival in both studies and more than doubled the average overall survival in one of the studies.

"This is a study that demonstrates that a three-drug regimen is better by a substantial amount in terms of survival for head and neck cancer. There was a 30 percent reduction in mortality with less toxicity," said Dr. Marshall R. Posner, lead author of the first study and medical director of the head and neck oncology program at the Dana-Farber Cancer Institute in Boston. "This is a wonderful step forward for patients."

Results from both clinical trials are published in the Oct. 25 issue of the New England Journal of Medicine. Both studies were funded, at least partially, by Sanofi-Aventis, the manufacturer of docetaxel.

About 3 percent to 5 percent of all cancers in the United States are head and neck cancers, according to the National Cancer Institute. That means almost 40,000 Americans are diagnosed with these cancers each year. They most commonly occur in people over 50, and the biggest risk factor for head and neck cancers is tobacco use.

Treatment for these cancers can be difficult, because surgical removal of tumors can affect the way a person chews, talks and swallows. In some cases, it's impossible to surgically remove some of these cancers, because the risk of harm outweighs the potential benefit. The cancer is then referred to as unresectable.

The study done by Posner and his colleagues included 501 people with advanced -- stage III or IV -- head and neck cancers. None of the volunteers had any signs of cancer in areas far from the original tumor site. Posner said his study included people who had both unresectable and resectable tumors.

The study participants were randomly assigned to receive the standard two-drug regimen (cisplatin and fluorouracil) or the new three-drug treatment which included cisplatin, fluorouracil and docetaxel. People in both groups then received seven weeks of weekly chemoradiotherapy (chemotherapy and radiation combined) with carboplatin, and radiotherapy (radiation treatment) for five days a week. Those who became eligible for surgery were able to have surgery six to 12 weeks after completing chemoradiotherapy.

Overall survival after three years was estimated to be 62 percent for the three-drug group compared to 48 percent for the two-drug group. Median overall survival was 71 months for the newer treatment versus just 30 months for the older regimen, according to the study.

The second study, conducted by European researchers, randomly assigned 358 people with unresectable stage III or IV head and neck cancer to receive either the two-drug regimen or the newer three-drug treatment. If there was no progression of disease after the study participants completed chemotherapy, they were given radiotherapy.

Overall survival increased from 14.5 months for the two-drug group to 18.8 months for the three-drug group in this study.

In both studies, the three-drug regimen had a similar, though slightly reduced, side-effect profile than the two-drug therapy. Posner said that's because they were able to use less fluorouracil in the three-drug regimen.

"We maximized efficacy and reduced toxicity. With the inclusion of the [three-drug induction chemotherapy] followed by chemoradiotherapy, we saw unprecedented survival," said Posner.

Of the new research, Dr. David Pfister, chief of the head and neck medical oncology service at Memorial Sloan-Kettering Cancer Center in New York City, said that the "triple-drug regimen is more effective than the standard regimen alone when given prior to radiation-based treatment and not at a cost of side effects. There was no increase in overall toxicity."

But, what he said oncologists want to know is whether induction chemotherapy (as was done in these studies) plus chemoradiotherapy is more effective than chemoradiotherapy alone. The addition of induction therapy, said Pfister, adds about three months to the treatment process.

He said studies are currently under way to determine which treatment is best, and, in the meantime, said that chemoradiotherapy alone is the current standard of care.

More information

To learn more about head and neck cancers, visit the National Cancer Institute.