This study was performed to evaluate the clinical risk profile of patients with ovarian tumors who were surgically treated, measuring the survival rate at 5 years. Furthermore, the surgical treatment by TNM stages was achieved, measuring the survival rate after five years of follow-up. Most of the patients with malignant disease were multiparous Moreover, from menopausal patients, the higher prevalence was seen at the group between 45 and 55 years old, not being dependent on the earlier appearance.
The highest incidence of gynecological pathology was seen in women with polycystic ovaries i. Regarding serum CA tumoral marker, higher values were noticed in the majority of patients The highest prevalence of surgical treatment in the first and second stages was represented by total hysterectomy with bilateral anexectomy, omentectomy and peritoneal lavage, and for the third and fourth stages, total hysterectomy, bilateral anexectomy, omentectomy, peritonectomy and lymphadenectomy, with a better survival rate at five years seen in patients under the age of 30 years old.
Thus, our study shows the need to create a screening for patients at risk for ovarian cancer which present higher age, multiparity, early menarche, polycystic ovaries association, and higher serum CA marker values. The survival rate at five years of folow-up shows a higher incidence of survival in patients under 30 years old, probably due to the earlier stages detected. Keywords malignant tumors, ovarian cancer, surgical treatment, management Rezumat Context.
Acest studiu a fost rectal cancer liver metastases peritoneal cancer after total hysterectomy pentru a evalua caracteristicile profilului de risc clinic al pacientelor cu tumori ovariene care au fost tratate chirurgical, măsurând rata de supravieţuire la cinci ani. Mai mult, a fost realizat tratamentul chirurgical prin etapele TNM, măsurând rata de supravieţuire după cinci ani de urmărire. Mai mult, din de paciente la menopauză, prevalenţa crescută a fost observată la grupul cuprins între 45 şi 55 de ani, fără a depinde de precocitatea apariţiei.
Prevalenţa crescută a tratamentului chirurgical în stadiile I şi II a fost reprezentată de histerectomie totală cu anexectomie bilaterală, omentectomie şi lavaj peritoneal, iar pentru stadiile III şi IV, de histerectomie totală, anexectomie bilaterală, omentectomie, peritonectomie şi limfadenectomie, cu o rată mai mare de peritoneal cancer after total hysterectomy la cinci ani la pacientele cu vârsta sub 30 de ani.
Riscul apariţiei tumorilor ovariene maligne este asociat mai mult cu vârsta, paritatea, menarha timpurie, asocierea ovarelor polichistice şi bazată pe stadializarea TNM. Rata de supravieţuire la cinci ani ulterior arată o incidenţă mai mare a supravieţuirii la pacientele cu vârsta sub 30 de ani, probabil datorită detecţiei în stadiile incipiente. Cuvinte cheie tumori maligne cancer ovarian tratament chirurgical management Introduction Being the leading cause of gynecological diseases, ovarian tumors are estimated as the fifth cause of death among women 1.
Many of the published studies are institutional-single center analyses which enrolled only a small number of patients and the majority of reports were not relating to general population 7,8. Although many studies have been published about ovarian tumors, only a few have analyzed the importance of the clinical factors implicated 9. And currently, only a limited number of studies regarding detailed surgical staging have been published, including the survival rate of younger women diagnosed with ovarian tumors Although for most of the early-detected cases the treatment consisted in total hysterectomy, infracolic omentectomy, peritoneal biopsy and lymph node extraction, maximal cytoreductive surgery remains the basic surgery treatment for advanced ovarian tumors Besides many other tumoral markers involved in diagnosis and prognosis of ovarian cancer, serum cancer antigen CA is generally used in the differentiation of other pelvic mases 16, This marker can be evaluated as a prognostic factor, before the initiation of any treatment However, the implication of serum CA levels in ovarian cancer prognostic is more controversial, considering other variabilies such as staging The present study was undertaken on ovarian cancer patients, in which we proposed to determine the risk associated with age, parity, menarche and peritoneal cancer after total hysterectomy precocity, gynecological pathologies, serum CA tumoral marker, tumor, lymph node and metastasis TNM staging, and surgical treatment associated with improved five-year survival outcome.
Our study group consisted in patients with malignant ovarian tumors who were selected from a total of skin papilloma excision tumors which presented at least one ovarian tumor formation with a 5-mm minimal diameter.
Peritoneal cancer after total hysterectomy patients underwent surgery as primary treatment.
The study was approved by our institution, and the informed consent from each patient was taken. The inclusion criteria were as follows: age between 15 years old peritoneal cancer after total hysterectomy more than 60 years old at the time of the initial diagnosis, all stages of ovarian neoplasms, and receiving only surgical treatment.
High-grade ovarian serous carcinoma in a young woman - case report and literature review
We excluded women with a history of tubal sterilization techniques, pelvic radiation therapy either pre- or postoperatively, including pregnant women. The characteristics were expressed in percentages. Descriptive statistics was used in order to correlate the data. Results Distribution by age Regarding the age of the patients, most malignant ovarian tumors were encountered in the age group over 60 years old, follwed by year-old patients, with Table 1.
Одна из проблем, связанных с приемом на работу самых лучших специалистов, коммандер, состоит в том, что иной раз они оказываются умнее.
- Молодой человек, - вскипел Стратмор, - я не знаю, откуда вы черпаете свою информацию, но вы переступили все допустимые границы.
Distribution of cases with malignant ovarian tumors by age Parity of the patients Out of the studied women, Figure 1. Distribution of cases Age of menarche Malignant tumors occurred in patients Figure 2. Distribution of cases with ovarian tumors depending Menopause precocity Of the cases analyzed, patients were menopausal, with the remaining 76 being in a younger age group. Out of these, 44 Figure 3.
Distribution of cases with ovarian tumors depending Association of gynecological pathology Malignant ovarian tumors were associated more with polycystic peritoneal cancer after total hysterectomy, in 13 patients 5. Table 2. Distribution of ovarian cancers studied according to associated gynecological pathology Figure 4. Ovarian tumors, intraoperative aspects personal archive Figure 5.
Peritoneal cancer after total hysterectomy aspects in ovarian tumors personal archive Serum CA tumoral marker Only cases of malignant tumors were tested for serum CA tumor marker. Out of these, Figure 6. The distribution of CA marker in the ovarian neoplasm in the study group TNM staging In stage I, there were peritoneal cancer after total hysterectomy malignant ovarian tumors Stage II represented In the third stage, In the fourth stage, there were 49 malignant ovarian tumors Table 3.
Distribution of ovarian cancer patients studied according to TNM staging Surgical treatment The therapeutic strategies have been chosen according to the TNM stage.
For stage Ia, unilateral anexectomy was chosen only under certain conditions. Adjuvant chemotherapy was not necessary in all cases.
Second-look laparoscopy was practiced at six months per-pelviscopic and was addressed to patients who apparently responded fully to chemotherapy or just to surgical treatment. This allows an assessment of residual risk and consolidation treatment, directing subsequent attitudes.
Clinical risk profile associated with ovarian cancer
Thus, the following intervention was generally performed for the first and second stages: total hysterectomy with bilateral anexectomy and omentectomy. Therefore, malignant ovarian tumors in the first and second stages of development have received the following surgical treatments according to the TNM stage: unilateral anexectomy in 8.
Table 4. Distribution of surgical treatment in the first and second stages of malignant ovarian tumo For the third and fourth stages, radical interventions were performed: hysterectomy with bilateral anexectomy with omentectomy, to which the large locoregional and visceral extensions could be added.
Ovarian cancers in the third and fourth stages were subjected to the following surgical interventions according to the TNM stage: total hysterectomy with bilateral anexectomy, with omentectomy, with peritonectomy and lymphadenectomy in 86 cases Table 5.
The age group counted 94 cases peritoneal cancer after total hysterectomy ovarian cancer. Out of these, 50 patients Patients over the age of 60 wereof whom only 26 Discussion Many studies involving the clinical risk profile of the malignant tumors are still in debate. Until present, many reports have showed the importance of younger age in the disease prognostic, with better outcome and survival rates 5, In this respect, other studies have found opposite results, considering that age was not an independent factor after adjusting the tumor stage In the present study, we proposed to perform a large population-based study to evaluate the clinical peritoneal cancer after total hysterectomy between younger and older patients with malignant ovarian cancer.
Furthermore, we sought to show if younger age is an important factor for improved survival rate, among other features like parity, menarche and menopause, gynecological pathology association, serum CA tumoral marker, TNM staging, and surgical treatment. In our study, the malignant tumors occurred in In this respect, one study among women population reported lower risk with late age at menarche i. The inconsistent features regarding age at menarche and menopause could show differences and misclassification bias, or differences in study population Ovarian cancer is predominantly a disease with peritoneal cancer after total hysterectomy median age at diagnosis of peritoneal cancer after total hysterectomy years old, most of the women being at menopause.
Profilul de risc clinic asociat cancerului ovarian
Regarding our study population, it was not surprising to find that the women aged less than 30 were more likely to be in the first stage, and the higher prevalence of malignant ovarian cancer was seen at ages more than 60 years old Interestingly, another study showed that preoperative CA marker is a prognostic feature in advanced malignant ovarian tumors However, the role of serum CA remains unknown Serum CA represents a glycoprotein expressed in the epithelium lining of body cavities 29and our study revealed elevated values in majority of patients peritoneal cancer after total hysterectomy.
These values could also predict advanced extraovarian disease before surgery The choice for surgical treatment, especially in early stages of ovarian cancer, usually consist in aspiration of ascites, hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, bilateral pelvic and para-aortic lymph node sampling peritoneal cancer hpv warts vaccine total hysterectomy Hysterectomy and bilateral salpingo-oophorectomy are more important considering the leac pentru oxiuri that uterine serosa and endometrium are often sites of occult metastasis 31, In our study, the higher survival rate at five years of follow-up was seen in patients under the age of 30 years old, comparing with the rest of the patients.
Greenlee el al. In the case of patients at fertility ages, they should be informed about surgery consequences and about further fertility preservation therapy The specific risks in the ovarian cancer in earlier stages before subsequent chemotherapy must be considered and further discussed individually. In the cases when patients undergo chemotherapy, they should wait for about six months in order to eliminate the peritoneal cancer after total hysterectomy effects on the oocytes Therefore, careful consideration of the ovarian cancer risk profile should better increase the variability in the disease incidence.
Profilul de risc clinic asociat cancerului ovarian
Conclusions In the present study, we sustained the need to create a screening for patients at risk of ovarian cancer which present higher age, multiparity, early menarche, polycystic ovaries association and higher serum CA marker values.
Furthermore, the prognosis of ovarian cancer showed to be dependent on the clinical profile, in order to better predict the appearance of the disease in early stages. Conflict of interests: The authors declare no conflict of interests. Bibliografie 1.
Cancer statistics. CA Cancer J Clin. National survey of ovarian carcinoma. Critical assessment of current International Federation of Gynecology and Obstetrics staging system. Smedley H, Peritoneal cancer after total hysterectomy K. Age as a prognostic factor in epithelial ovarian carcinoma.
Br J Obstet Gynaecol. Ovarian carcinoma: a multivariate analysis of prognostic factors. Obstet Gynecol. National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age. Ovarian cancer in the elderly: an analysis of Surveillance, Epidemiology, and End Results Program data. Am J Obstet Gynecol. Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades. Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors.
Epithelial ovarian cancer. Practical Gynecology Oncology, Fourth ed. Williams and Wilkins. Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer. Eur J Gynaecol Oncol.
Memarzadeh S, Berek JS. Advances in the management of epithelial ovarian cancer. J Reprod Med. Int J Gynecol Cancer. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers.
Ovarian high-grade serous carcinoma is a type of malignancy that is rare among young adult women, being more frequent in postmenopausal women. We present the case of a young woman with this type of malignant tumor, who in addition already had extension beyond the pelvis at the time of diagnosis, which is a poor prognostic factor. Case report. We repot the case of a year-old woman who was admitted in our hospital with pelvic pain and ascites and also with suspicion of peritoneal carcinomatosis.
Clin Chem. MUC16 CA : tumor biomarker to cancer therapy, a work in progress.
Я так испугалась, увидев. - Не стоит, - удивился Беккер - Я зашел куда не следовало. - Моя просьба покажется вам безумной, - сказала она, заморгав красными глазами, - но не могли бы вы одолжить мне немного денег.
Mol Cancer. The prognostic value of pretreatment CA in patients with advanced ovarian carcinoma: a Gynecologic Oncology Group Study. Brierly, Mary K. Use of serum CA to define response to first and second line chemotherapy for ovarian cancer — Mount Vernon Hospital, Middlesex.
Proceedings of ASCO. SEER cancer statistics review,National cancer institute. Epithelial ovarian tumors in the reproductive age group: age is not an independent prognostic factor. Population-based casecontrol study of ovarian cancer in Shanghai.
Cancer Res. The epidemiology of ovarian cancer in Greece: a case-control study.