Archive for the Ovarian Cancer category.
The fallopian tube is the least common site of gynecologic cancer in females, accounting for fewer than 1,000 new cases each year. Histologically, these tumors resemble papillary serous carcinoma of the ovary in more than 90% of cases. Diagnostic criteria for primary fallopian tube carcinoma include the following:
• The main tumor is in the tube and arises from the endosalpinx.
• The pattern histologically reproduces the epithelium of the mucosa and usually shows a papillary pattern.
• If the wall is involved, the transition between benign and malignant tubal epithelium should be demonstrable.
• The ovaries and endometrium are either normal or contain less tumor than the tubes.
The major concern is to distinguish these cancers from primary ovarian cancers. The staging system used for fallopian tube cancer is modified from the staging system for ovarian cancer because there is no FIGO-established official staging system for fallopian tube cancer.
Fallopian tube cancer and ovarian cancer spread in a similar manner. The classic triad of colicky pain, abnormal bleeding, and leukorrhea is rarely seen in its entirety; the most common symptom is abnormal vaginal bleeding. Pain, however, is reported frequently as an early symptom.
Cheap pharmacy Canada
The therapy of fallopian tube cancer is similar to the therapy of ovarian cancer; the most important initial therapy is effective cytoreductive surgery. As in ovarian cancer, residual disease is a good predictor of survival rates. The adjuvant therapy of choice is chemotherapy with platinum-based multidrug therapy, followed by a second-look laparotomy and second-line therapy as necessary. There are no reports of the use of paclitaxel in fallopian tube cancer, but one would surmise that this drug will have a significant role in the therapy of the disease.
Sex cord-stromal or sex cord-mesenchymal tumors include tumors of the female type (granulosa cell tumors and granulosa-theca cell tumors), the male type (Sertoli-Leydig tumors), and very rare types such as lipid cell tumors and gynandroblastoma. The majority of these rare tumors will never be seen by the practicing gynecologist.
Ovarian cancer
The granulosa cell tumor is the most common malignant tumor of this group of neoplasms. As shown in Figure 4, these tumors occur throughout a woman’s lifetime but are more common in the first four decades. They are bilateral in only about 5% of cases. All granulosa cell tumors should be considered potentially malignant, and late recurrences are common. There are two major histologic types: the adult variety and the juvenile form. The juvenile form is much more likely to result in a malignancy.
Cialis soft tabs online
The therapy of granulosa cell tumors is surgical removal; there is no proven benefit for adjunctive therapy. In younger patients who desire to retain their childbearing capability, unilateral salpingo-oophorectomy and full surgical staging are the treatment of choice. Patients with residual or recurrent disease should receive chemotherapy. The usual choice of chemotherapy is bleomycin, etoposide, and platinum, as it is in germ cell tumors. There are too few reported series of granulosa cell tumors treated with chemotherapy to provide accurate figures on response rates to chemotherapy.
Cancer treatment
Young patients with granulosa cell tumors may show precocious puberty because these tumors may produce estrogen. In older women, menstrual irregularity or post-menopausal bleeding due to estrogen production may be the presenting symptom.
Sertoli-Leydig tumors occur less frequently than granulosa cell tumors and are rarely bilateral. These tumors may produce androgens and can present clinically with defeminization or masculinization. The malignant potential of these tumors is directly related to the degree of differentiation, and they are usually classified as well differentiated, moderately differentiated, or poorly differentiated. A fourth classification is Sertoli-Leydig tumors with heterologous elements.
The treatment for these tumors is surgical removal, and unilateral salpingo-oophorectomy is indicated for patients with properly staged disease and tumors confined to one ovary. Little is known about the responsiveness of these tumors to chemotherapy, but most authors recommend bleomycin, etoposide, and platinum chemotherapy for persistent or recurrent disease.
Other stromal tumors are very rare. In general, the therapy is total abdominal hysterectomy and bilateral salpingo-oophorectomy, with full surgical staging for patients who do not desire further childbearing. For younger patients, unilateral salpingo-oophorectomy and full surgical staging are indicated.
TABLE 14. Adjuvant Chemotherapy for Stage I and Completely Resected Stage II and III Malignant Germ
Cell Tumors*
Institution Regimen No. Progression Free % of Total
GOG BEP 50 of 52 96
Stanford PVB 5 of 5 100
Cross Cancer Institute PVB 4 of 4 100
MD Anderson Cancer Center PVB 4 of 4 100
MD Anderson Cancer Center BEP 20 of 20 100
Total 83 of 85 98
*GOG indicates Gynecologic Oncology Group; BEP, cisplatin-etoposide-bleomycin combination; PVB, cisplatin-vinblastine-bleomycin combination.
Modified from Williams SD, Gershenson DM. Management of germ cell tumors of the ovary. In: Markman M, Hoskins WJ, eds. Cancer of the ovary. New York: Raven Press, 1993
TABLE 15. Chemotherapy of Patients with Incompletely Resected, Persistent, or Recurrent Malignant Germ
Cell Tumors*
Institution Regimen No. Prognosis Free % of Total
GOG PVB 47 of 89 53
Stanford PVB 4 of 4 100
Cross Cancer Institute PVB 8 of 10 80
MD Anderson Cancer Center PVB 7 of 11 64
MD Anderson Cancer Center BEP 5 of 6 83
Total 71 of 120 59
*GOG indicates Gynecologic Oncology Group; PVB, cisplatin-vinblastine-bleomycin combination; BEP, cisplatin-etoposide-bleomycin combination.
Modified from Williams SD, Gershenson DM. Management of germ cell tumors of the ovary. In: Markman M, Hoskins WJ, eds. Cancer of the ovary. New York: Raven Press, 1993
Survival is enhanced by complete cytoreduction of malignant germ cell tumors. Every effort should be made to resect the disease completely, but there is no need to remove reproductive organs not involved with the cancer. These tumors are virtually never bilateral. Thus, even patients with advanced disease who do not have involvement of the other ovary and the uterus should have those organs conserved. Because high cure rates are achieved with the use of multidrug chemotherapy, many patients will retain their reproductive capability.
Patients with malignant germ cell tumors of the ovary should undergo surgical staging similar to that for epithelial ovarian cancer. However, because most patients will require chemotherapy, reexploration for staging is not indicated unless the goal is to resect residual cancer completely. It is best to begin chemotherapy as soon as possible because tumors recur and grow rapidly.
The potential benefit of second-look laparotomy has been debated for several years. Recently, no benefit was found for second-look laparotomy except in incompletely resected immature teratomas, and its routine use in other malignant germ cell tumors cannot be justified.
Cheap canadian pharmacy
Malignant germ cell tumors of the ovary occur primarily in the second and third decades of life, although they are occasionally found in young girls and older women. The tumors are usually accompanied by abdominal pain, and almost 10% of patients will present with an acute episode of torsion, hemorrhage, or rupture of the tumor.
Herbal Phentermine
Germ cell tumors may be associated with elevated serum levels of the beta subunit of human chorionic gonadotropin (b-hCG), alpha-fetoprotein, or lactic dehydrogenase. Measurement of these markers may aid in the diagnosis of germ cell tumors and may be useful in management and follow-up care. Serum markers are shown in Table 13. There is considerable variation in markers, although most endodermal sinus tumors produce alpha-fetoprotein, and most choriocarcinomas and dysgerminomas produce b-hCG and lactic dehydrogenase, respectively.
TABLE 13. Serum Markers in Malignant Germ Cell Tumors of the Ovary*
Serum Marker
Malignant Germ Cell Tumor AFP b-hCG LDH CA 125
Endodermal sinus tumor + - + +
Embryonal carcinoma + + + +
Choriocarcinoma - + + +
Xanax Canadian
Immature teratoma + - + +
Dysgerminoma - + ± ±
Mixed germ cell tumor ± ± ± ±
*AFP indicates alpha-fetoprotein; b-hCG, beta subunit of human chorionic gonadotropin; LDH, lactic dehydrogenase. t Marker depends on the type of germ cell tumors present.
Cancer treatment
Prognosis is good for most patients treated with platinum-based multidrug chemotherapy. Table 14 displays the results of adjuvant chemotherapy in stage I and completely resected stage II and stage III patients with malignant germ cell tumors. Of 85 patients given adjunctive therapy of either bleomycin, etoposide, and platinum or platinum, vinblastine, and bleomycin, 83 (98%) were progression free. In comparison, patients who had residual disease, had persistent disease, or developed recurrences had a progression-free survival rate of only 59% (71/120 patients) when treated with similar regimens (Table 15).
Patients with early-stage ovarian cancer usually have a low recurrence rate, providing they had full surgical staging and received appropriate therapy. Exceptions include patients with clear-cell cancers of the ovary. Because of the low recurrence rate, patients should be followed with a gynecologic examination and a serum CA 125 test every 3 months for the first year, every 4 months for the second year, and every 6 months for the next 3 years. After 5 years, annual examinations are recommended. Annual Pap tests are recommended. There is no proven benefit of diagnostic radiography and computed tomography in asymptomatic patients with a normal serum CA 125 level.
Discount Canadian pharmacy
Patients with advanced ovarian cancer have a very high recurrence rate, approaching 75% after a complete clinical response and 50% after a complete pathologic response (negative second-look laparotomy). For these patients, follow-up should be more intensive. They should have a gynecologic examination and a serum CA 125 test every 3 months for the first 2 years. Follow-up at 6-month intervals is recommended for the next 3 years. The use of routine computed tomographic scans is debatable, although many experts recommend scans for follow-up of patients who did not have a second-look laparotomy. The optimum frequency for such scans has not been established.
The value of the serum CA 125 test in the follow-up of patients depends in large part on whether the patient had an elevated serum level before therapy, even though CA 125 levels do not always correlate with tumor volume. The serum test does, however, appear to be the best follow-up test available.
For patients with small-volume persistent or recurrent disease confined to the peritoneal cavity, intraperitoneal chemotherapy may be a reasonable regimen. With large tumors (> 1 cm) or with disease located outside the peritoneal cavity, systemic chemotherapy should be considered. Patients who respond to platinum often can be retreated with one of the platinum compounds alone or in combination with other agents. The longer the disease-free interval from their primary chemotherapy, the better their chances of response; patients who have a disease-free interval of 2 years or more respond at a rate similar to that of newly diagnosed patients.
Patients who are platinum resistant and have not received paclitaxel should be treated with systemic paclitaxel. Administration of paclitaxel has resulted in a 30-35% response rate as salvage therapy and a 25-30% response rate as salvage therapy in patients resistant to platinum therapy. Other drugs for which modest response rates have been reported are topotecan, ifosfamide, hexamethylmelamine, and low-dose oral etoposide (VP-16). All patients who require salvage therapy for epithelial ovarian cancer should be considered for clinical trials.
Cheap Canadian pharmacy levitra
Radiation Therapy. The role of irradiation in the management of ovarian cancer remains controversial. There is little doubt that patients with early-stage ovarian cancer or microscopic residual advanced epithelial ovarian cancer can be cured with whole-abdominal radiation therapy. A review of the literature demonstrates survival rates that are not substantially different from those obtained with modern multidrug chemotherapy (Table 12). Although there has never been a randomized trial of modem multidrug chemotherapy and whole abdominal radiotherapy, few centers use radiotherapy as primary treatment for epithelial ovarian cancer. Most specialists believe that the complication rates are higher with irradiation; however, the lack of a randomized trial does not allow that conclusion to be established.
Levitra
Radiation therapy may be used as palliative therapy for selected patients who are symptomatic from localized disease and for whom conventional chemotherapy has failed. Examples of such palliative therapy are the control of vaginal bleeding for cancer metastatic to the vagina and temporary control of persistent pelvic disease in an attempt to avoid a colostomy. Such therapy is palliative, however, because the spread pattern of the disease makes it unlikely that there are no metastases outside of the pelvis.
Order cheap levitra
TABLE 12. Long-Term (5-10-Year) Survival in Ovarian Carcinoma Patients Treated with Whole Abdominal
Irradiation: Correlation of Survival with the Size of Tumor After Initial Surgery
No. with No. with Minimal No. with Large
Residual Tumor Residual Tumor Residual Tumor
Author Year (% Surviving) (% Surviving) (% Surviving)
Dembo 1985 46 (48) 55 (43) 71 (18)
Martinez et al 1985 30 (68) 42 (54) 54 (20)
Fuller et al 1987 20 (77) 12 (62) 10 (0)
Macbeth et al 1988 57 (57) - -
Goldberg and Peschel 1988 60 (77) 14 (7) -
van Bunningen et al 1988 85 (75) - -
Weiser 1988 37 (59) 24 (42) 23 (10)
Lindner et al 1990 63 (65) 10 (40) -
Mean survival 65% 41% 12%