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Blaquiere RM, Husband JE. Conventional Radiology and Computed Tomography in Ovarian Cancer: Discussion Paper. J R Soc Med 2018; 76:574-9. [PMID: 6876049 PMCID: PMC1439109 DOI: 10.1177/014107688307600710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Ovarian cancer is relatively common, and often presents at an advanced stage with widespread intraperitoneal metastases. The constellation of complex pelvic masses, ascites, omental cake, and other peritoneal implants is virtually diagnostic. All patients are potential surgical candidates, since suspected early stage disease is treated by a comprehensive staging laparotomy including total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Operable advanced disease is treated by surgical debulking and adjuvant combination chemotherapy. The role of imaging is to detect and characterize adnexal masses as likely malignant, recognize unusual findings that may suggest atypical pathology, demonstrate metastases in order to prevent under-staging, and detect specific sites of disease that may be unresectable. These aims are directly related to clinical management; characterization of an adnexal mass as malignant guides appropriate surgical referral, recognition of atypical pathology such as malignant granulosa cell tumor in a young woman may be an indication for fertility-preserving surgery. Demonstration of metastatic site-assists surgical planning, and detection of unresectable disease may be an indication for neoadjuvant (ie, preoperative) chemotherapy with interval debulking rather than primary debulking with adjuvan (postoperative) chemotherapy.
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Affiliation(s)
- Fergus V Coakley
- Department of Radiology, University of California San Francisco, 94143, USA.
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Abstract
Ovarian cancer affects over 25,000 women each year in the United States. The performance of appropriate surgery for ovarian cancer is critical in directing further therapies and improving survival. Systematic surgical staging must be performed in patients who appear to have early stage ovarian cancer because a significant proportion of these women have occult metastases. A marked improvement in survival has been demonstrated in patients with bulky disease if all masses larger than 2 cm can be surgically removed. Despite the dramatic effect of surgery on the subsequent course of the disease, recent studies show that only a minority of women with ovarian cancer receive appropriate initial surgery. We review the evidence and rationale for systematic surgical treatment of ovarian cancer.
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Affiliation(s)
- T C Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
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Zanetta G, Chiari S, Rota S, Bratina G, Maneo A, Torri V, Mangioni C. Conservative surgery for stage I ovarian carcinoma in women of childbearing age. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:1030-5. [PMID: 9307530 DOI: 10.1111/j.1471-0528.1997.tb12062.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the results of a policy of tailored conservative surgical management for young women with stage I ovarian carcinomas. DESIGN Retrospective study. PARTICIPANTS Ninety-nine women aged 40 years or younger who underwent either primary surgery in our department or were referred after primary surgery performed elsewhere. METHODS Of the 99 women in our study, 56 underwent fertility-sparing surgery and 43 more radical surgery. Minimal requirements for conservative management were adequate staging and complete information about the therapeutic options. Factors important in the choice of the treatment were, age, wish to preserve fertility, histologic type and grade, and the stage of the tumour. RESULTS Conservative treatment was conducted in 84% of nulliparous and in 33% of parous women; 62% of grade 1 tumours, 48% of grade 2, and 50% of grade 3 were treated conservatively. With a median follow up of seven years, we observed five recurrences (9%) of carcinoma in women treated conservatively and five (12%) in those treated more radically. Two women (one in each treatment arm) were saved after recurrence. Two recurrences after conservative surgery involved the residual ovary (3.6%). Two women developed borderline tumour in the contralateral ovary and both were treated by surgery. CONCLUSION After adequate staging and accurate information is given to the patient, conservative treatment may be safe in some women with early ovarian cancer. The risk of recurrence in the contralateral ovary is low. Conservative surgery may be also considered in some Stage I grade 3 tumours and in some women with stage JC tumours.
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Affiliation(s)
- G Zanetta
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan, Italy
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Zanetta G, Chiari S, Barigozzi P, Rota S, Losa G, Mangioni C. Limited invasiveness to assess retroperitoneal spread in stage I-II ovarian carcinoma. Int J Gynaecol Obstet 1995; 51:133-40. [PMID: 8635634 DOI: 10.1016/0020-7292(95)02455-l] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the incidence of retroperitoneal metastases, survival rate and site of recurrence in early ovarian tumors undergoing limited retroperitoneal surgery. METHOD Three hundred seventy-three consecutive patients underwent assessment of the retroperitoneum consisting of intraoperative palpation with or without biopsies. RESULTS Retroperitoneal metastases were detected in 10 stage-I tumors (3.2%) and in 10 stage-II tumors (16%). The risk was inversely related to tumor differentiation. Palpation revealed metastases in 10 cases. During follow-up, none of the borderline tumors (1.9% of stage-I grade-1 node-negative, 2.7% of grade-2 and 7.0% of grade-3 tumors) recurred in the retroperitoneum. In stage II, two recurrences were observed in grade-2 tumors (11%) and one in grade 3 (4.5%). CONCLUSION Limited retroperitoneal surgery enables satisfactory outcome in early ovarian cancers. Risk of retroperitoneal recurrence is minimal in grade 1 and non-existent in borderline tumors. Less differentiated tumors have low risk but further investigation of the therapeutic role of lymphadenectomy is justified.
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Affiliation(s)
- G Zanetta
- Department of Obstetrics and Gynecology, S. Gerardo Hospital, University of Milan, Monza, Italy
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Nguyen HN, Averette HE, Hoskins W, Penalver M, Sevin BU, Steren A. National survey of ovarian carcinoma. Part V. The impact of physician's specialty on patients' survival. Cancer 1993; 72:3663-70. [PMID: 8252483 DOI: 10.1002/1097-0142(19931215)72:12<3663::aid-cncr2820721218>3.0.co;2-s] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Data analysis of the recent National Survey of Ovarian Carcinoma revealed significant differences in patterns of care among various physician specialists. The goal of this study was to determine if different care patterns led to differences in patient survival. METHODS Data were collected from 25 consecutive patients with ovarian cancer diagnosed in 1983 and 1988 from 1230 hospitals with cancer programs across the United States. RESULTS A total of 12,316 patients from 904 hospitals were registered, of whom 20.8% were cared for by gynecologic oncologists (GYO), 45.0% by obstetrician-gynecologists (OBG), and 21.1% by general surgeons (GS). GYO preferred the upper-lower midline incision in 44.1% of patients, whereas both OBG and GS chose the low midline approach in 44-45%. GYO performed more hysterectomies, oophorectomies, omentectomies, and lymph node and peritoneal biopsies than did other specialists. Although the rates of surgery of the small intestine were comparable between GYO and GS, the latter performed significantly more colostomies and resections of the large intestine. The optimal debulking rates were: GYO, 42-45%; OBG, 40-44%; and GS 25%. There was no significant survival difference between patients cared for by GYO and those cared for by OBG for all stage divisions. However, with the exception of patients with Stage I disease, patients cared for by GS had significantly reduced survival than did those cared for by GYO and OBG (P < 0.004). CONCLUSION Efforts must be made to ensure that more patients with ovarian cancer are cared for by physicians in the appropriate specialties.
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Affiliation(s)
- H N Nguyen
- Division of Gynecologic Oncology, University of Miami School of Medicine, FL 33101
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Abstract
The staging and treatment of ovarian cancer is reviewed with special attention to developments during the last decade. Pathways of spread, presurgical and surgical staging are described and discussed, as are the biologic characters of the different histologic subtypes. Principles of surgery, endoperitoneal and external radiotherapy, single-drug and multiple-drug systemic chemotherapy (therapeutic and adjuvant), intraperitoneal chemotherapy, second-line chemotherapy, hormone therapy and the use of biologic response modifiers are reported and discussed with background of recent clinical trials. It is concluded that considerable progress has been made concerning diagnosis, staging and treatment of ovarian cancer. The proportion of cases in advanced stages has thus decreased and the survival rate increased. However, it is also obvious that the long-term prognosis for patients with advanced disease has not significantly improved over the last 10 years, despite introduction of multiple-drug regimens with high initial response rates. Ovarian cancer remains the most important gynecologic cause of death in the Western countries.
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Affiliation(s)
- G De Palo
- Division of Diagnostic Oncology, Istituto Nazionale Tumori, Milan, Italy
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Adcock LL, Dehner LP. Surgical staging of ovarian tumours: the individual and integrative roles of the oncologist and pathologist. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1989; 78:41-68. [PMID: 2651024 DOI: 10.1007/978-3-642-74011-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Buskirk SJ, Schray MF, Podratz KC, Lee RA, Stanhope CR, Gaffey TA, Weber FC, Earle JD, Naessens JM, Malkasian GD. Ovarian dysgerminoma: a retrospective analysis of results of treatment, sites of treatment failure, and radiosensitivity. Mayo Clin Proc 1987; 62:1149-57. [PMID: 3682960 DOI: 10.1016/s0025-6196(12)62512-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thirty-five patients with a diagnosis of pure ovarian dysgerminoma underwent assessment at our institution between 1950 and 1984. The median age of these patients was 21 years (range, 8 to 41 years). The surgical pathologic stages of the tumors were as follows: stage IA1 in 18 patients, stage IA2 in 2, stage IB1 in 2, stage IC in 1, stage IIB in 2, stage III in 9, and stage IV in 1. The overall survival at 5, 10, and 20 years was 94.3%, 82.9%, and 82.9%, respectively, for all 35 patients and 100%, 83.9%, and 83.9%, respectively, for the 18 patients with stage IA1 lesions. The maximum interval from diagnosis to relapse was 3.7 years. All patients were under surveillance for a minimum of 2 years (median follow-up, 15.9 years). Of the 18 patients with stage IA1 disease, 16 did not receive prophylactic radiation therapy to the para-aortic lymph nodes, and in 6 of the 16 (38%) recurrent disease developed in this region. Five of these patients were salvaged with radiation therapy and one with radiation therapy and subsequent chemotherapy. No definite correlation was noted between the size or mass of the resected unilateral encapsulated tumor and the risk of development of recurrent disease. For patients with stage IA1 dysgerminoma who have undergone unilateral oophorectomy, two treatment options seem reasonable: (1) observation, with radiation therapy reserved for subsequent recurrence, or (2) prophylactic radiation therapy (2,000 cGy) to para-aortic and ipsilateral common iliac lymph nodes, which would preserve fertility.
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Affiliation(s)
- S J Buskirk
- Division of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224
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Abstract
The diagnostic process in ovarian carcinoma is divided into the pre- and intraoperative procedures, examinations of tumor tissue, and follow-up. For preoperative diagnosis, the probability of a palpable adnexal mass being a malignant tumor should first be ascertained by sonography. This should be followed by an appropriate general examination, a search for tumor outside the abdominal cavity and in the liver parenchyma as well as by determination of markers. Intraoperative diagnosis determines the tumor stage and must be carried out all the more comprehensively when the ovarian carcinoma is more limited. Histologic subtype and degree of differentiation are in direct relation to the tumor stage, whereas the size of the primary tumor is often indirectly proportional to its extent. Besides the morphological analysis, the determination of possible chemoresistance and chemosensitivity, as well as further investigations on fresh tumor tissue are included in the tissue examination. Follow-up after a curative operation consists of gynecologic examination and Douglas lavages if tumor is still present in CT Scans and sonographs. To verify a relapse, laparoscopy can be used, but to ascertain a complete remission, a laparotomy is necessary.
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Abstract
Optimal management of patients with gynecologic malignancies requires a multidisciplinary approach with close cooperation between the primary care physician, the gynecologic oncologist and the radiation therapist. In order to obtain maximum survival rates with minimal morbidity, treatment should be based on a detailed knowledge of tumor localization, potential sites of occult spread, and tumor-host interactions. A careful delineation of patterns of recurrence will permit the identification of patients at increased risk for treatment failure and will aid in the design of alternative treatment protocols tailor-made to control potential site(s) of tumor spread. The technological advances in radiation oncology and their influence on survival rates are presented, with illustrations taken from the literature and from the recent results of the Patterns of Care Study for treatment of carcinoma of the cervix. The role of radiation therapy in the treatment of carcinomas of the cervix, uterus, and the epithelial tumors of the ovary are reviewed, emphasizing treatment protocols based on consideration of technical, tumor, and host factors. Ongoing clinical research trials and potential areas for further improvement in the management of gynecologic malignancies are discussed.
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Solomon A, Brenner HJ, Rubinstein Z, Chaitchik S, Morag B. Computerized tomography in ovarian cancer. Gynecol Oncol 1983; 15:48-55. [PMID: 6822367 DOI: 10.1016/0090-8258(83)90116-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sixteen women suffering from ovarian cancer were staged by clinical and pathological means and concomitantly scanned by computed tomographic means. Computed tomography (CT) was found accurate in nine patients. The staging of the disease was upgraded in three patients following the CT examination. CT examination in four patients was equivocal or failed to detect the true extent of the disease. It was not possible to accurately assess the true nature of the pelvic mass on CT following a partial debulking pelvic procedure, as the remnant pelvic bed tissue could be misinterpreted as recurrent cancer. Small peritoneal cancer seedings were not detected on CT. CT scanning despite certain limitations is a valuable noninvasive adjunct in the assessment of carcinoma of the ovary and its response to treatment.
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De Palo G, Pilotti S, Kenda R, Ratti E, Musumeci R, Mangioni C, Di Re F, Lattuada A, Conti U, Cefis F, Recanatini L, Carinelli S, Rossi G. Natural history of dysgerminoma. Am J Obstet Gynecol 1982; 143:799-807. [PMID: 6213157 DOI: 10.1016/0002-9378(82)90013-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Data on 56 patients with pure dysgerminoma are discussed. Forty-nine patients were classified as having new disease or were to have reassessment of disease, and seven cases were to be restaged (one with and six without clinical evidence of disease). Of new and reassessment cases, 44 patients underwent lymphography, 16 underwent peritoneoscopy with diaphragmatic inspection and 30 had peritoneal cytologic testing performed. Positive lymphography resulted in restaging in 31.6% of patients. Diaphragmatic inspection was always negative. Peritoneal cytologic testing was positive for malignant cells in three patients and worsened the stage in one. Pathologic staging of disease was as follows: Stage IA, 24; Stage IB, one Stage IC, one; Stage III peritoneal disease, two. Stage III retroperitoneal disease, 12; Stage III peritoneal and retroperitoneal disease; four. The 5-year relapse-free survival rates were 91% in patients with pathologic Stages IA, IB, and IC; 74% in those with Stage III retroperitoneal disease, and 24% in patients with Stage III peritoneal disease or peritoneal plus retroperitoneal disease. The results indicate that the prognosis is excellent for patients with Stage I and Stage III retroperitoneal disease whereas peritoneal involvement is associated with a poor prognosis.
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Knipscheer RJ. Para-aortal lymph nodes dissection in 20 cases of primary epithelial ovary carcinoma stage I (Figo): influence on staging. Eur J Obstet Gynecol Reprod Biol 1982; 13:303-7. [PMID: 7117662 DOI: 10.1016/0028-2243(82)90053-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study 20 cases of primary epithelial ovary carcinoma stage I (Figo) were presented. In 5 cases (25%) para-aortic lymph nodes were positive, because of which their stage changed into Stage III. This shows that for correct staging of ovary carcinoma stage I, extirpation of the para-aortal glands is obligatory. It was observed that tumors on the external surface of the ovary and tumor cells in the peritoneum fluid were not related to positive para-aortal glands. The para-aortic metastases were found in the tumors with a histologic grading according to Broders' classification III and IV.
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Mamtora H, Isherwood I. Computed tomography in ovarian carcinoma: patterns of disease and limitations. Clin Radiol 1982; 33:165-71. [PMID: 7067349 DOI: 10.1016/s0009-9260(82)80051-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Between June 1977 and July 1980, a mixed group of 46 patients with ovarian carcinoma was examined by computed tomography (CT). CT was useful for demonstration of extent of disease within the abdomen and pelvis and may be used to provide an objective means for assessing response to treatment. The limitations of CT include failure to detect peritoneal deposits less than 2-3 cm in diameter, bowel infiltration and minor residual or recurrent disease. The patterns of disease as seen on CT are illustrated and its potential role is discussed.
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de Palo G, Musumeci R, Kenda R, Spinelli P, Pilotti S. The reassessment of patients with ovarian carcinoma. Eur J Cancer 1980; 16:1469-74. [PMID: 6453013 DOI: 10.1016/0014-2964(80)90057-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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