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Lymphatic anatomy: lymphatics of the ovary
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
More than 20% of patients with epithelial ovarian cancer will be diagnosed at an apparent early stage (I–II), with the disease macroscopically confined to the pelvis.16 Attributed to the extrapelvic vascular supply of the adnexa, approximately 30% of patients with presumed early-stage cancer will experience an upstaging of the disease after comprehensive lymphatic and peritoneal staging.17 Pelvic and paraaortic lymph node dissection is therefore part of a comprehensive surgical staging in early disease to define the accurate stage that will have significant implications on the choice and indication of the adequate adjuvant systemic treatments. The incidence of lymph node metastasis in apparent early-stage epithelial ovarian cancer (EOC) (all histologic grades) is estimated to be around 14%–15%;18–19 approximately 35% of patients have only pelvic-positive nodes, 37% have only paraaortic-positive nodes, and the remaining 28% have both pelvic and paraaortic involvement.20 In particular, patients with apparent early-stage cancer might be candidates for sentinel node detection in order to obviate the side effects associated with full pelvic and paraaortic lymphadenectomy in patients with, in principle, a low likelihood of metastatic lymph nodes. A recent review indicates a frequency of approximately 3% metastatic nodes in these patients, which stresses the need for alternative staging techniques, i.e., sentinel node detection rather than full lymph-adenectomy in these patients.21
Estrogen replacement therapy use and risk of ovarian cancer: results from two Italian studies and review of the literature
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
F. Parazzini, G. Polverino, S. Cipriani, E. Ricci, F. Chiaffarino, C. Vecchia
Some points are, however, still open to debate. It is unclear whether such a moderate increase in risk is present for all histologic subtypes of epithelial ovarian cancer, or whether it is limited to specific subgroups. In fact, with regard to the potential association between HRT use and selective histologic subtypes, a possible relation with endometroid types has been suggested. A Canadian study7 reported RR values of 1.4 for serous, 1.9 for endometrioid and 0.7 for mucinous tumors, with significant increases in risk with duration of use for serous and endometrioid tumors. Purdie and colleagues16 also found an elevated risk of endometrioid and clear cell ovarian cancers associated with unopposed estrogen use (RR 2.6, 95% CI 1.3–4.9). It is possible, however, that ovarian cancers in women who have used HRT are more often classified as endometrioid tumors.
Diagnostic evaluation
Published in Seema Chopra, Endometriosis, 2020
Neha Agarwal, Seema Chopra, Arshi Syal
CA-125 is a transmembrane glycoprotein and is synthesized and secreted by the coelomic epithelium derivatives. Its utility in monitoring the disease remission and recurrence has been well established in epithelial ovarian cancer. Chronic inflammation in endometriosis can cause irritation of the peritoneum, leading to increased production of CA-125 [27]. A study was done by Mol et al. to assess the utility of CA-125 as a noninvasive diagnostic marker for endometriosis. The assay seems to be a poor marker for stage I/II endometriosis but has a better sensitivity in diagnosing stage III/IV disease. Despite having limited utility in diagnosing endometriosis, Mol continued to advocate for the routine measurements of CA-125 in patients who present with infertility, as this could identify the subgroup of patients who will benefit from early laparoscopy [28].
Clinical significance of the CD98hc-CD147 complex in ovarian cancer: a bioinformatics analysis
Published in Journal of Obstetrics and Gynaecology, 2023
Xin-Yue Zhou, Jin-Yao Li, Jing-Tong Tan, Yi-Li HuangLi, Xiao-Cui Nie, Pu Xia
Ovarian cancer is one of the most common malignant tumours affecting the female reproductive organs, and its incidence rate is second only to cervical and uterine body cancer (Sung et al.2021, Li et al.2022). Epithelial ovarian cancer is the most common type of gynaecological tumour and poses a serious threat to women’s lives (Siegel et al.2021). The recurrence rate of advanced epithelial ovarian cancer is very high, and the five-year survival rate is approximately 30% (Siegel et al.2021, Upadhyay et al.2022). Moreover, the treatment effect of patients with recurrent ovarian cancer often fails to reach the initial treatment, and the time to remission after treatment will decrease with the increasing number of times of recurrence (Marchetti et al. 2012, Musella et al. 2017, Cybula and Bieniasz 2022). Therefore, revealing the molecular mechanism of ovarian cancer cell proliferation and invasion is of great significance for the development of targeted drugs for the treatment of ovarian cancer.
Antibody therapeutics for epithelial ovarian cancer
Published in Expert Opinion on Biological Therapy, 2022
Mason Ruiz, Ningyan Zhang, Anil K Sood, Zhiqiang An
Patients with epithelial ovarian cancer are typically treated with surgery and chemotherapy [95]. While HGSC initially responds well to chemotherapy, other histological subtypes such as mucinous carcinoma are known to be more resistant to chemotherapy [96,97]. While platinum-taxane doublet therapy in addition to cytoreductive surgery has been the gold standard treatment for patients with ovarian cancer, >70% will develop relapsed disease [98]. Patients with epithelial ovarian cancer who develop disease resistant to platinum therapy are now burdened with a terminal condition, meaning almost every patient succumbs to the disease [99]. Poly ADP-ribose polymerase inhibitors (PARPi) have recently become established as maintenance therapies in the front-line and recurrent setting for patients with ovarian cancer [100,101], and they substantially delay the length of time of recurrence, although primary and adaptive resistance are a major issue [102].
Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Apichaya Techata, Tanarat Muangmool, Nahathai Wongpakaran, Kittipat Charoenkwan
The mainstay of epithelial ovarian cancer treatment has been primary debulking surgery followed by combination chemotherapy. The goals of surgery include acquiring tissue for diagnostic confirmation, evaluating disease extent (staging), and eradicating visible tumours (debulking) (Fader and Rose 2007; Winter et al. 2007; Winter et al. 2008). The surgical procedures are performed through a long open vertical abdominal incision and usually extensive including total removal of the ovarian tumours, uterus, and all visible intraabdominal tumours along with omental resection, peritoneal/mesenteric surfaces biopsy, and lymph node sampling. Therefore, intra/postoperative complications are frequently difficult to avoid and could have long-term effects on quality of life (QoL). Systemic chemotherapy is universally indicated in patients with stage II–IV diseases either before or after surgery. In those cases, regimens containing two or more chemotherapeutic agents are generally offered (Bookman et al. 2009; Vergote et al. 2018). The adverse effects of chemotherapy are well-known, systematic, and frequently severe. This could further negatively impact long-term QoL. While survival outcome for women with epithelial ovarian cancer varies depending mainly on stage, those who survive the disease could expect long-term disease and treatment-related morbidities that significantly affected QoL.