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Dietary flavonoid for preventing colorectal neoplasms

Eight studies with 390,769 participants, mainly observational, were included in this systematic review. The aim of the studies reviewed was to determine an association of the intake of total flavonoids, and eight main flavonoid subclasses, with colorectal neoplasms including CRC and adenomas. The majority of the studies were of medium to high methodological quality. The evidence that intake of dietary flavonoids reduces the risk of colorectal neoplasms was conflicting, and could partly be explained due to difficulties in quantifying the intake of flavonoids. Therefore, the association of dietary flavonoids and prevention of colorectal neoplasms remains unproven.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Colorectal (bowel) cancer is common worldwide but is especially prevalent in industrialised countries. Genes, diet and lifestyle all seem to be important in the development of bowel cancer.

Experimental animals studies and observational studies have suggested that nonsteroidal anti‐inflammatory drugs and aspirin may reduce the development of colorectal cancer and recurrence of adenomas in patients with familial adenomatous polyposis (FAP).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with a gynaecological cancer

Patients with advanced ovarian cancer and some patients with advanced endometrial cancer often need repeated drainage for malignant ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence‐based but mainly based on clinicians' anecdotal evidence and experience.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Local treatment with Bacillus Calmette‐Guérin following surgery for superficial bladder cancer reduces the risk of the cancer returning.

Worldwide, bladder cancer is common in both men and women. In most cases, the cancer occurs in the superficial layers of the bladder and can be surgically removed. However, in many people the cancer returns. Drugs placed directly into the bladder tissue following surgery are therefore often used to try to prevent the cancer recurring. Bacillus Calmette‐Guérin (BCG) is a live attenuated bacterium used for immunization against tuberculosis, and is safe and effective for that purpose; it has also been licensed by the US FDA and other national regulatory agencies for use in superficial bladder‐cancer treatment. The review found that BCG treatment was effective in preventing cancer recurrence following surgery. Further studies into making treatment more effective are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Radioactive beads given in addition to chemotherapy does not improve control of cancer nor survival in patients with colorectal cancer and metastasis in the liver.

Bowel cancer commonly spreads to the liver. In most patients this cannot be removed by an operation and cure is not possible. Chemotherapy treatment can help control the growth of the cancer and improve survival. Radioactive beads can be injected into the blood vessels of the liver to try and control the cancer in the liver. In one study that had 21 participants, radioactive beads (injected into the blood vessels of the liver) given with chemotherapy (into the veins of the arm) was more effective at controlling the cancer and improving how long people lived than chemotherapy given on it's own. However, in this study more people who received the radioactive beads suffered from side effects and this study used an older type of chemotherapy that is less effective than the newer treatments that are now available. In a second study with 63 participants, radioactive beads were given with chemotherapy that was injected directly into the blood vessels of the liver. In this study there was no extra benefit in the control of cancer growth or survival for those participants who received radioactive beads in addition to the chemotherapy. More studies are needed with a particular focus on whether radioactive beads provides extra benefit when given with newer chemotherapy treatments, and if radioactive beads provide benefit when given on their own.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

It is not yet clear whether adding chemotherapy (anti‐cancer drugs) to another treatment for a recurrence of breast cancer in the same area improves survival

Early breast cancer can be removed by surgery, and for most women the chance of the cancer returning (recurrence) is small. In some women however, the cancer returns in the same area. Chemotherapy (anti‐cancer drugs) can be used together with other treatments, such as surgery or radiation therapy, to try to treat recurring cancer and improve survival. The review found that few trials have been performed to investigate its effectiveness. There is currently not enough evidence that adding chemotherapy to other treatments helps to treat the recurring cancer or to improve survival. However, chemotherapy may be an option, and further trials are underway.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Should the primary cancer be surgically removed in asymptomatic patients with unresectable stage IV colorectal cancer

A majority of patients with advanced colorectal cancer cannot be cured of their disease. This is because it has spread widely throughout the body and is therefore not resectable. In many of these patients, the original cancer that caused the problem is relatively asymptomatic and the patient is not aware of it. Most of these patients will be treated with a combination of chemotherapy and possibly radiotherapy. From a clinical perspective, a major problem in dealing with these patients is what to do with the primary cancer. Some studies have suggested that resecting the primary cancer can prolong survival and prevent complication arising from the cancer, such as obstruction or bleeding. This review addresses the question of whether surgically removing the primary cancer is beneficial to patients with advanced and unresectable colorectal cancer. No randomised controlled trials were identified.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This systematic review focuses on long‐term outcome of laparoscopic versus open surgery for colorectal cancer, including long‐term complications and cancer outcome.

Laparoscopic resection of carcinoma of the colon is associated with a long term outcome no different from that of open colectomy. In the case of rectal cancer, data on long term outcome are scarce and the results of large randomised trails have to be awaited.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Five‐alpha‐reductase inhibitor drugs, such as finasteride or dutasteride, reduce the risk prostate cancer in men who have routine prostate cancer screening

Five‐alpha‐reductase inhibitor drugs have potential as chemopreventive agents. Reduction of prostate cancer was similar between racial groups, age groups (aged 65 years or older compared to younger age groups) and those with or without a family history of prostate cancer. Reduction of prostate cancer was limited to men who had a baseline prostate specific antigen (PSA) values less than 4.0 ng/mL. However, use of five‐alpha‐reductase inhibitors may also increase the risk of high‐grade prostate cancer in men undergoing prostate cancer screening. Future research is needed to determine if the use of five‐alpha‐reductase inhibitors can reduce prostate cancer in men who are not being regularly screened for prostate cancer. Future studies should also determine whether five‐alpha‐reductase inhibitors can reduce death and prostate cancer death and further evaluate the risk of developing high‐grade prostate cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chemotherapy for adult women diagnosed with a rare type of ovarian cancer of all stages (malignant germ cell cancer of the ovary)

Malignant germ cell cancer of the ovary (type of ovarian cancer) is a very rare type of cancer. Malignant ovarian germ cell cancer is a term used to describe a group of heterogeneous rare tumours affecting the ovaries. These tumours start in the egg (ovum) producing cells of the ovary, whereas the more common epithelial ovarian cancers start in the cells that cover the surface of the ovary. Unlike epithelial ovarian cancers, these tumours are often diagnosed early and a combination of surgery and chemotherapy usually results in favourable long term overall survival. Due to its rarity, this review is based on only one very small RCT and one small retrospective study. The data from these studies were too sparse to adequately assess the effectiveness and safety of chemotherapy after surgery (adjuvant chemotherapy) in the treatment of malignant germ cell ovarian cancer. All comparisons were restricted to single study analyses and this review was only based on 32 women, so it was not adequately powered to detect differences in survival. Adverse effects of treatment and recurrence‐free survival were incompletely documented and QoL was not reported in any of the studies. We did not find any studies that reported specifically on adults as this disease usually afflicts younger people as opposed to the older population, so there were problems in separating data on adults and children in many of the studies. Many of the treatments used were taken from experiences of treating patients with testicular cancer, as they look similar under the microscope and behave similar clinically. Due to the small number of patients with malignant germ cell cancer in the two studies, our review shows that there were no good quality studies assessing the role of chemotherapy in this disease, be it in early or late stages. There was insufficient evidence to conclude that any form of chemotherapy or best supportive care is superior over the other. This review highlights the need for future good quality, well designed studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

There is no evidence to recommend that patients with non‐small cell lung cancer receive prophylactic radiotherapy to the brain following potentially curative treatment with surgery or radiotherapy

Patients with non‐small cell lung cancer have a significant risk of developing tumour spread (metastases) to the brain after potentially curative treatment. To date, four research trials have been published in full; they included different groups of patients who had different doses of radiotherapy, and different outcomes were measured. None of the trials showed that patients who had received prophylactic radiotherapy to the brain lived longer than those who had not, although fewer of them developed brain metastases. A fifth trial (RTOG 0214) has not yet been published in full and is discussed in the results section.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Angiogenesis‐inhibitors for metastatic thyroid cancer

There is currently no reliable evidence from randomized controlled trials demonstrating that the benefits of angiogenesis‐inhibitors outweigh their risks in treating advanced thyroid cancer. Angiogenesis (that is blood supply of tumors and new blood vessel formation in tumors) plays an important role in tumor growth and metastasis. Currently, four randomized controlled trials are ongoing. Despite the potential benefits of angiogenesis‐inhibitors, various undesirable side effects have been reported. These include rash, diarrhea, fatigue, nausea, proteinuria, stomatitis or mucositis, and hypertension. We will update this review as data from the ongoing trial become available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Treatments for melanoma (an aggressive type of skin cancer) that has spread to other tissues.

There are no randomised trials comparing the effects of systemic therapies for metastatic cutaneous melanoma with best supportive care or placebo. Cutaneous melanoma is the most aggressive form of skin cancer. When it has spread (metastatic cutaneous melanoma), the prognosis is very poor. Current practice, based upon the results of non comparative studies, is to use different forms of chemotherapy (anti cancer drugs) as well as drugs that try to affect the immune system's response to the cancer. Combinations of these two types of therapy have improved the outcome in some forms of cancers, and are used for melanoma. However the review found no trials which compared the outcome of treatments, used alone or in combination, with the outcome of best supportive care or placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Chemotherapy improves the survival of people with advanced colorectal cancer, but the adverse effects and impact on quality of life are not yet known.

Colorectal (bowel) cancer is common worldwide, but can often be treated effectively with surgery. In some people, however, the cancer returns and sometimes also spread to other parts of the body. When this happens, chemotherapy (anti‐cancer drugs) can be used to try to slow the progression of the cancer. However, chemotherapy also have adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

No evidence to suggest tamoxifen benefits patients with relapsed ovarian cancer

Ovarian cancer often spreads before symptoms show. Cytotoxic drugs are often only partly effective and cause severe side‐effects. The main aims of treatment for relapsed disease are symptom control and prolongation of life. No data from RCTs or non‐RCTs were found, so there was no evidence that tamoxifen was effective and safe as a treatment for relapsed ovarian cancer. Laboratory studies suggest tamoxifen may be effective as a treatment for women with ovarian cancer. Although, uncontrolled non‐comparative trials on patients with relapsed ovarian cancer showed tamoxifen may shrink or stabilise tumours in a small number, there is a strong need for an RCT or good quality non‐randomised comparative studies to determine the effectiveness and safety of tamoxifen in terms of overall survival, tumour response, symptom control, quality of life and adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Screening for testicular cancer

Testicular cancer commonly affects men aged between 20 and 35 years. It accounts up to 2% of cancers diagnosed in men, although the lifetime risk of mortality is less than 1%. Screening for testicular cancer is commonly performed by physician, who performs a physical examination, or self‐examination by the patient. However, there is little evidence that documents the accuracy of such examinations. This review identified that no randomised controlled trials have been performed to evaluate the effectiveness of screening for testicular cancer. In the absence of high quality evidence, male patients with an increased risk of developing testicular cancer should be informed of the potential benefits and harms associated with screening.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Thalidomide for managing wasting syndrome (cachexia) in advanced cancer

This review aims to assess if thalidomide is an effective treatment for the wasting syndrome (know as cachexia) seen in patients with advanced cancer. However, there was not enough evidence to make an informed decision about the use of thalidomide for patients with advanced cancer who have this wasting syndrome. This means that thalidomide as a treatment for this wasting syndrome remains unproven and its use needs more testing. Additionally, this review highlighted that there may be undesirable side effects of thalidomide when used for this syndrome, which need to be looked at closely to ensure it is suitable for this group of patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Endoscopic mucosal resection for early stomach cancer

There is a lack of randomised controlled trials (RCTs) in which endoscopic mucosal resection (EMR) is compared with surgery for early stomach cancer. There is a need for well‐designed randomised controlled trials to determine the effects of EMR compared to gastrectomy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Audio recordings or written summaries of key consultations for adults with cancer

Many people find it hard to remember medical consultations. Providing a record of the conversation may help. The review of trials examined the effects of giving people with cancer audio recordings or written summaries of consultations. Most people found them useful as a personal reminder, to inform their families or friends, or to play to their general practitioners. People tended to remember more of the information they were given, and some were more satisfied with the information they received. Recordings or summaries did not make people more anxious or depressed. The recordings had no effects on quality of life, and no studies measured survival.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Not enough evidence to give a second round of chemotherapy to patients with lung cancer in a poor state

Patients with lung cancer and a good physical condition who have not been cured by a first round of chemotherapy often receive a second round of chemotherapy (second‐line). A second round of chemotherapy may not increase the survival chances of these patients and may make them feel worse because of bad side effects. This review has found only one study that compared the effects of a second round of chemotherapy with treatment showing no benefits for the patients, apart from keeping them comfortable. This study does not provide enough evidence to judge whether such treatment causes more benefits than harms and further larger studies are needed before firm conclusions can be drawn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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