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SEPTEMBER 21, 2008

Can palm reading pick up ovarian cancer?
Spotting ovarian cancer, widely known as the "silent killer", is difficult as the symptoms can be vague and go unnoticed.

Author: Emma Wilkinson


But what if doctors could spot the disease simply by reading a woman's palm. Doctors at the Royal Free Hospital in London diagnosed a case of ovarian cancer in a 74-year-old woman after she presented with thickened skin on her palms. Four months before she had noticed lumpy areas on her palms which then progressed to general thickening - but she was otherwise healthy and had no other symptoms.


Palmar fascia lies just below the skin



Palmar fasciitis in ovarian cancer




Writing in the Journal of the Royal Society of Medicine, the team said they suspected the condition, known as palmar fasciitis, could be linked to cancer, found an ovarian mass and successfully treated the patient with chemotherapy.

This phenomenon is known as a paraneoplastic syndrome - where symptoms occur because of a cancer but are not related to cancer cells present in that area of the body.

Other manifestations include types of arthritis or nerve problems.

It is caused by chemicals secreted by the tumour or an immune response to the tumour.


Dr Willie Hamilton of University of Bristol says:

The problem with paraneoplastic syndromes is that they are generally associated with advanced malignancy, so early diagnosis is of marginal - if any - benefit

Rare

Before women all rush to check the skin on their palms it is worth mentioning that this technique is unlikely to pick up a surge of extra cases. In fact it would be quite rare for a case to present this way, says Dr Willie Hamilton, a GP who does research on improving early cancer diagnosis at the University of Bristol.

"I've never seen it in 26 years of medicine," he says.

"The problem with paraneoplastic syndromes is that they are generally associated with advanced malignancy," he added. By this point the cancer is likely to have been picked up by other, more common symptoms, although the occasional case will get picked this way. He added that recent research had given doctors more to go on when trying to pick out ovarian cancer.

A paper published in July concluded that the disease was not actually the silent killer that was commonly believed and the key is to look more seriously at women who have persistent bloating. This symptom was associated with a five times higher risk of ovarian cancer whereas bloating that came and went was not linked with the disease.

GPs should question women who report bloating more carefully to determine whether their symptoms are present all the time, the researchers recommended. But even with this more specific advice for doctors cases are likely to be missed.






Screening

Trials are being done to see if women could be screened for ovarian cancer in order to pick up the disease at an early - and more treatable - stage.

One possibility is a blood test for a protein known as CA125. This can be used to diagnose ovarian cancer in addition to other tests as women with the disease tend to have higher levels of the protein in the bloodstream. Its not ideal for screening all women though as it is not hugely accurate and so would miss some cases and also diagnose women who did not actually have the condition.

Researchers hope to find other markers of the disease they can add to the test to make it more reliable. Another option is transvaginal ultrasound - an imaging test of the ovaries.

A study of 200,000 women is being done in the UK to work out if either of these tests could be incorporated into a national screening programme but the results will not be known for some time.

Professor Hani Gabra, director of research at Ovarian Cancer Action said paraneoplastic syndromes are rare but can lead to detection of a tumour.

"Occasionally you see something like this and it doesn't fit together and the physician thinks it may be cancer but this is unusual.

"Women need to be aware that if they develop new symptoms, which are persistent, and include nausea, vomiting, abdominal pain, bloating, altered bowel habits or bleeding, they need to speak to their GP."


Source: Can palm reading pick up cancer?




THE FOLLOW CONCERNS SOME DETAILS OF THE SCIENTIFIC PUBLICATION:

J R Soc Med 2008;101:473-475 doi:10.1258/jrsm.2008.080060

Authors: Dr Mahinda Yogarajah, Dr Jade Soh, Dr Breck Lord, Mr Nicholas Goddard, and Dr Richard Stratton

Correspondence to: R Stratton r.stratton@medsch.ucl.ac.uk

SUMMARY:

Highlighting the importance and recognition of palmar fasciitis and polyarthritis syndrome, a paraneoplastic syndrome related to ovarian and other malignancies.

Copyright: 2008 Royal Society of Medicine



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