ERKEN EVRE OVER KANSERLERİNDE PROGNOZ VE STANDART TEDAVİ UYGULAMALARI

Abstract

Over kanseri jinekolojik maligniteler içerisinde üçüncü sıklıkta olmasına karşın mortalite oranı en yüksek olan jinekolojik malignitedir. Premenopozal dönemde saptanan overe ait kistlerin ya da adneksial kitlelerin benign ya da malign ayrımında sonografik bulgular, kitle boyutu ve biyokimyasal belirteçler büyük önem taşımaktadır. Postmenopozal over kistlerine yaklaşımda ise malignite riski indeksi hesaplanması kullanılmaktadır. Tümörün evresi, kalıntı hastalık hacmi, histolojik alt tip ve derece, CA 125 düzeyi, cerrahi açıdan tümör dökülmesi, kapsül penetrasyonu ve sitolojik malign asit prognostik faktörlerdir. Tüm epitelyal over kanserleri için optimal tedavi uterusun adneksler ile birlikte çıkarılmasıdır. Fertilite koruyucu cerrahide yenileme riski nedeniyle, uygun hastaların seçimi çok kritik bir önem taşı- maktadır. Kapsamlı cerrahi evreleme yapılan evre IA ya da IB derece 1 epitelyal over kanserlerinde cerrahi sonrası kemoterapiye gerek yoktur ve izlem önerilir. Suboptimal cerrahi evreleme yapılan ve evre I hastalık olarak görünen olgularda ise adjuvan kemoterapinin yarar ve yan etkileri tartışılmalıdır

Keywords

• Erken Evre Over Kanseri, Prognoz, Tedavi.

Abstract

Ovarian cancer is the third common gynecologic malignancy and moreover it is the leading cause of death related with gynecologic malignancies. Evaluation of ovarian cysts during the postmenopausal period to differentiate benign and malignant tumors by using physical examination, laboratory testing and sonography has a crucial role in diagnosis and the treatment. MRI (Malignancy Risk Index) can be used for evaluation of the postmenopausal ovarian cysts. Tumor stage, histological type and grade, CA-125 level, rupture of tumor capsule, malignant ascites or positive peritoneal washing are the important prognostic factors. Total abdominal hysterectomy and bilaterally salpingo-ophorectomy is the best surgical approach to all types of epithelial ovarian cancers. Fertility sparing management is very critical because of the risk for recurrence; therefore patients must be carefully selected. Adjuvant chemotherapy is not necessary for the patients accurately surgical staged with early stage ovarian cancers (stage 1 and 2) and following is recommended. However, adjuvant chemotherapy for patients who had stage 1 disease with suboptimal surgical staging is still remains debated.

Keywords

• Early-stage Ovarian Cancer, Prognosis, Treatment

References

1. 1. Sankaranarayanan R, Ferlay J: Worldwide burden of gynecological cancer: the size of the problem.Best Pract Res Clin Obstet Gynecol 2006;20:207
2. 2. Gallagher DJ, Konner JA, Bell-McGuinn KM et al. Survival in epitelial ovarian cancer: a multivariate analysis incorporating BRCA mutation status and platinum sensitivity. Ann Oncol 2011;22:1127-1132
3. 3. Heintz APM, Odicino F, Maisonneuve P, et al: Carcinoma of the ovary. In FIGO annual report on the results of treatment in gynecological cancer. Int J Obstet Gynecol 2006;95:S161
4. 4. RCOG-BSGO Joint Guideline No.62, November 2011.
5. 5. Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol 2005;23:8794–801.
6. 6. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000;16:500–5. 7. Steffensen KD, Waldstrom M, Grove A et al. Improved classification of epithelial ovarian cancer: results of three Danish cohorts. Int J Gynecol Cancer 2011:21:1592-1600.
7. 8. Liu N, Wang X & Sheng X. “Triple negative” epithelial ovarian cancer and pathologic markers for prognosis. Curr Opin Obstet Gynecol 2011:23:19-23
8. 9. Maiman M, Seltzer V, Boyce J. Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. Obstet Gynecol 1991;77:563-65

9. 10. Maggioni A, Benedetti Panici P, Dell’Anna T, Landoni F, Lissoni A, Pellegrino A, Rossi RS, Chiari S, Campagnutta E, Greggi S, Angioli R, Manci N, Calcagno M, Scambia G, Fossati R, Floriani I, Torri V, Grassi R, Mangioni C. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer. 2006;18:699-704.
10. 11. Yokoyama Y, Sakamoto T, Sato S, Saito Y. Evaluation of cytoreductive surgery with pelvic and paraaortic lymphadenectomy and intermittent cisplatin-based combination chemotherapy for improvement of longterm survival in ovarian cancer. Eur J Gynaecol Oncol 1999;20(5-6):361-6 12. Young RC, Decker DG, Wharton JT. Staging laparatomy in early ovarian cancer JAMA 1983;250:3072-3076
11. 13. Munoz KA, Harlan LC, Trimble EL. Patterns of care for women with ovarian cancer in the United States J Clin Oncol 1997;15:408-415
12. 14. Heintz AP, Odicino F. Carcinoma of the ovary In J Gynecol Oncol 2000;83:135-166
13. 15. Hacker NF, Berek JS, Lagasse LD. Primary cytoreductive surgery for epithelial ovarian cancer Obstet Gynecol 1983;61:413-420
14. 16. Young RC, Walton LA, Ellenberg SS. Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials N Engl J Med 1990;322:1021-1027
15. 17. Sevelda P, Vavra N, Schemper M. Prognostic factors for survival in stage I epithelial ovarian carcinoma Cancer 1990;65:2349-2352
16. 18. Mogensen O. Prognostic value of CA 125 in advanced ovarian cancer Gynecol Oncol 1992;44:207-212
17. 19. Vergote I, De Brabanter J, Flyes A. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial carcinoma Lancet 2001;357:176-182
18. 20. Zwart J, Geisler JP, Geisler HE. Five-year survial in patients with endometrioid carcinoma of the ovary versus those with serous carcinoma Eur j Gynaecol Oncol 1998;19:225-228
19. 21. Obermair A, Fuller A. A new prognostic model for FIGO stage I epithelial ovarian cancer Gynecol Oncol 2007;104:607-611
20. 22. Ahmed FY, Wiltshaw E, A’Hern RP. Natural history and prognosis of untreated satge I epithelial ovarian carcinoma J Clin Oncol 1996;14:2968-2975
21. 23. Monga M, Carmichael JA, Shelley WE. Surgery without adjuvant chemotherapy for early epithelial ovarian carcinoma after comprehensive surgical staging Gynecol Oncol 1991;43:195-197
22. 24. Trimbos JB, Schueler JA. Watch and wait after careful surgical treatment and staging in well-differentiated early ovarian cancer 1991;67:597-602
23. 25. Scully RE, Young RH, Clement RB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. In: Atlas of Tumor Pathology Washington DC. Armed Forces Institute of Pathology 1998;23
24. 26. Colombo N, Gutrie D. Internation Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer J Natl Cancer Inst 2003;95:125-132
25. 27. Trimbos JB, Vergote I. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organization for Research and Treatment of Cancer-Adjuvant Chemotherapy in Ovarian Neoplasm Trial J Natl Cancer Inst 2003;95:113-125
26. 28. Winter-Roach BA. Adjuvant (post-surgery) chemotherapy for early Stage epithelial ovarian cancer (Review). Cochrane Database Syst Rev. 2012 Mar 14;3:CD004706
27. 29. Bell J, Brady MF, Young RC. Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic Oncology Group study Gynecol Oncol 2006;102:432-439
28. 30. Chan JK, Tian C, Fleming GF, Monk BJ, Herzog TJ, Kapp DS, Bell J.The potential benefit of 6 vs. 3 cycles of chemotherapy in subsets of women with early-stage high-risk epithelial ovarian cancer: an exploratory analysis of a Gynecologic Oncology Group study. Gynecol Oncol. 2010;116(3):301-6
29. 31. Mannell RS, Brady MF. A randomized phase III trial of carboplatin and paclitaxel x3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study Gynecol Oncol 2011;122:89-94
30. 32. Chan JK, Tian C, Monk BJ, et al. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer. 2008; 2202–2210.
31. 33. Plaxe SC, Braly PS, Freddo JL. Profiles of women age 30–39 and age less than 30 with epithelial ovarian cancer. Obstet Gynecol 1993; 81: 651–654.
32. 34. Rodriguez M, Nguyen HN, Averette HE et al. National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age. Cancer 1994;73:1245–1250.
33. 35. Smedley H, Sikora K. Age as a prognostic factor in epithe- lial ovarian carcinoma. Br J Obstet Gynaecol 1985;92:839–842.
34. 36. Swenerton KD, Hislop TG, Spinelli J. Ovarian carcinoma: a multivariate analysis of prognostic factors. Obstet Gynecol 1985;65:264–270.
35. 37. Morice P, Denschlag D, Rodolakis A. Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011;21:951–963.
36. 38. Kajiyama H, Shibata K, Mizuno M et al. Long-term survival of young women receiving fertility-sparing surgery for ovarian cancer in comparison with those undergoing radical surgery. Br J Cancer 2011; 105: 1288–1294.
37. 39. Hu J, Zhu LR, Liang ZQ et al. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma. J Zhejiang Univ Sci B 2011; 12: 787–795.
38. 40. Schlaerth AC, Chi DS, Poynor EA et al. Long-term survival after fertility-sparing surgery for epithelial ovarian cancer. Int J Gynecol Cancer 2009; 19: 1199–1204.
39. 41. Wright JD, Shah M, Mathew L et al. Fertility preservation in young women with epithelial ovarian cancer. Cancer 2009;115: 4118–4126
40. 42. Park JY, Kim DY, Suh DS et al. Outcomes of fertilitysparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes. Gynecol Oncol 2008; 110: 345–353
41. 43. Young RC, Brady MF, Nieberg RK, et al. Adjuvant treatment for early ovarian cancer: a randomized phase III trial of intraperitoneal 32P or intravenous cyclophosphamide and cisplatin—a Gynecologic Oncology Group Study. J Clin Oncol. 2003;21:4350–4355