Peritoneal tuberculosis simulating advanced ovarian carcinoma: is clinical impression sufficient to administer neoadjuvant chemotherapy for advanced ovarian cancer?

Peritoneal tuberculosis mimics advanced ovarian cancer because of the similarities in clinical signs and symptoms such as ascites, pelvic and abdominal pain and mass, and elevation of serum CA125 level. We have presented four cases of peritoneal tuberculosis that underwent exploratory laparotomy for suspected advanced ovarian cancer during a 3-year period. Definitive diagnosis of tuberculosis was performed at laparotomy in all the cases. The frozen-section analysis seems to be the gold standard in the differential diagnosis. In view of these data, clinical diagnosis of advanced ovarian cancer is not sufficient for administering neoadjuvant chemotherapy. Cytologic or pathologic findings must be consistent with ovarian cancer for candidates who are being considered for neoadjuvant chemotherapy.

Download Full-text

Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: A series of 10 cases

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200107000-00006 ◽

2001 ◽

Vol 11 (4) ◽

pp. 290-294 ◽

Cited By ~ 5

Author(s):

T. Bilgin ◽

A. Karabay ◽

E. Dolar ◽

O. H. Develioğlu

Keyword(s):

Ovarian Cancer ◽

Ovarian Carcinoma ◽

Abdominal Mass ◽

Gynecologic Cancer ◽

Elevated Serum ◽

Advanced Ovarian Cancer ◽

Ca 125 ◽

Peritoneal Tuberculosis ◽

Advanced Ovarian Carcinoma ◽

Abdominal Paracentesis

Abstract.Bilgin T, Karabay A, Dolar E, Develioğlu OH. Peritoneal tuberculosis with pelvic abdominal mass, ascites, and elevated CA 125 mimicking advanced ovarian carcinoma.Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 ± 6.1 (median 37; range 18–72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40–560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients.

Download Full-text

Upfront cytoreductive surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer in Indian patients

Future Oncology ◽

10.2217/fon-2021-0077 ◽

2021 ◽

Author(s):

Mukur Dipi Ray ◽

Suryanarayana S.V. Deo ◽

Lalit Kumar ◽

Manish Kumar Gaur

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Ovarian Carcinoma ◽

Cytoreductive Surgery ◽

Advanced Ovarian Cancer ◽

Advanced Stages ◽

Selection For ◽

Selection Of Patients ◽

Selection Of

In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controversial. A total of 200 patients with advanced ovarian cancer were analyzed retrospectively, according to specific selection criteria. Primary CRS was performed in 95 patients (47.5%) and interval CRS after 3–6 cycles of NACT was performed in 105 patients (52.5%). After median follow-up of 35 months, 5-year overall survival was 53.7% in the upfront CRS group and 42.2% in the NACT group. Primary CRS is the standard in advanced stages of ovarian carcinoma, but in certain subset of patients, NACT is preferred. Identifying that group is challenging but feasible. Proper selection of patients is key to successful outcomes.

Download Full-text

Carboplatin (JM 8), Adriamycin and Cyclophosphamide (JAC) in Advanced Ovarian Carcinoma: A Pilot Study

Tumori Journal ◽

10.1177/030089168807400217 ◽

1988 ◽

Vol 74 (2) ◽

pp. 217-220 ◽

Cited By ~ 3

Author(s):

Pier Franco Conte ◽

Milena Bruzzone ◽

Silvana Chiara ◽

Riccardo Rosso ◽

Giuseppe Giaccone ◽

...

Keyword(s):

Ovarian Cancer ◽

Pilot Study ◽

Ovarian Carcinoma ◽

Dose Level ◽

Combination Treatment ◽

Renal Toxicity ◽

Advanced Ovarian Cancer ◽

Hematologic Toxicity ◽

Advanced Ovarian Carcinoma ◽

Dose Limiting Toxicity

Eleven untreated patients with advanced ovarian cancer were studied for tolerance and response to combination treatment with fixed doses of adriamycin (45 mg/m2) and cyclophosphamide (600 mg/m2) + escalating doses of carboplatin. At the first dose level of carboplatin (200 mg/m2), toxicity was acceptable. With carboplatin at 300 mg/m2, severe hematologic toxicity was observed. The dose-limiting toxicity was leukopenia. Although carboplatin was administered without any hydration, no patient experienced renal toxicity. Eight objective responses were observed in 9 clinically evaluable patients. At second look surgery, 3 complete responses and 4 partial responses were documented. Polychemotherapy with JAC (carboplatin, 200 mg/m2, adriamycin, 45 mg/m2, and cyclophosphamide, 600 mg/m2) is administrable with acceptable toxicity.

Download Full-text

Clinical efficacy and safety of apatinib combined with oral VP-16 for the treatment of advanced ovarian cancer: Preliminary evaluation of a clinical drug regimen

Biomedical Letters ◽

10.47262/bl/6.2.20200611 ◽

2020 ◽

Vol 6 (2) ◽

pp. 209-213

Keyword(s):

Ovarian Cancer ◽

Ovarian Carcinoma ◽

Clinical Efficacy ◽

Advanced Ovarian Cancer ◽

Symptomatic Treatment ◽

Drug Regimen ◽

Preliminary Evaluation ◽

Efficacy And Safety ◽

Advanced Ovarian Carcinoma ◽

Hand Foot Syndrome

To investigate the clinical efficacy and safety of apatinib in combination with oral VP-16 for the treatment of chemotherapy-resistant advanced ovarian carcinoma. Twenty-seven advanced ovarian carcinoma patients were treated with oral VP-16 chemotherapy combined with oral apatinib mesylate (500 mg/d). CA125, VEGF, and CEA were examined every 3-4 weeks, and tumour changes were monitored by CT every 8-12 weeks. PFS was obtained by follow-up after discharge. For all patients, the ORR (including CR and PR) was 25.0%, and the DCR (including CR, PR and SD) was 75.0%. CEA and CA199 significantly decreased (p<0.05), but the decrease in VEGF was not significant. The average PFS was 5.13 months. The ECOG score had a significant effect on PFS (p<0.05), while there were no significant differences in PFS based on age (p=0.394). The main side effects of this regimen were hypertension, proteinuria, hand-foot syndrome and myelosuppression, which were tolerated by patients after active symptomatic treatment. Apatinib combined with oral VP-16 is an effective regimen for the treatment of chemotherapy-resistant advanced ovarian cancer. This combination therapy should be widely used in clinical practice.

Download Full-text

Thoracoscopic Resection of Fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Associated with Advanced Ovarian Carcinoma

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1667325 ◽

2018 ◽

Vol 67 (08) ◽

pp. 692-696

Author(s):

Masatsugu Hamaji ◽

Ken Yamaguchi ◽

Sho Koyasu ◽

Hiroshi Date

Keyword(s):

Ovarian Cancer ◽

Lymph Nodes ◽

Ovarian Carcinoma ◽

Advanced Ovarian Cancer ◽

Mediastinal Lymph Nodes ◽

Thoracoscopic Resection ◽

Advanced Ovarian Carcinoma ◽

Histological Confirmation ◽

Long Term Mortality

AbstractThe indication for surgery is controversial in patients with advanced ovarian cancer and fluorodeoxyglucose (FDG)-avid mediastinal lymph nodes. Herein we report our experience in thoracoscopic resection of FDG-avid mediastinal lymph nodes associated with advanced ovarian cancer in six patients. No perioperative or long-term mortality was noted. FDG-avid mediastinal lymph nodes in advanced ovarian carcinoma may merit thoracoscopic resection with histological confirmation for more precise staging.

Download Full-text

Neoadjuvant chemotherapy in advanced epithelial ovarian cancer: An institutional experience.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17044 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17044-e17044

Author(s):

Kavitha Jain ◽

Arun Chaturvedi ◽

Sanjeev Misra ◽

Vijay Kumar ◽

Sameer Gupta ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Ovarian Carcinoma ◽

Epithelial Ovarian Cancer ◽

Advanced Ovarian Cancer ◽

Stage Iv ◽

Progression Free Survival ◽

Response To Therapy ◽

Stage Iii ◽

Gynecological Malignancy

e17044 Background: Epithelial ovarian cancer is the second most common gynecological malignancy among Indian women. Primary debulking surgery remains the standard of care in advanced operable ovarian cancer patients, but is associated with morbidity. Neoadjuvant chemotherapy followed by delayed primary cytoreductive surgery maybe a better treatment strategy in advanced ovarian cancer. We present our experience of neoadjuvant chemotherapy in advanced ovarian cancer with special emphasis on treatment outcomes. Methods: A retrospective analysis of advanced epithelial ovarian carcinoma (Stage IIIc and IV) patients treated at the Department of Surgical Oncology at King George’s Medical University, Lucknow between 2012 and 2017 was done. Results: A total of 151 patients with advanced ovarian carcinoma were treated during this period. Median age at diagnosis was 46 years. Among these patients, 137 underwent surgery, of which 59.1% were optimally cytoreduced. Papillary serous adenocarcinoma was the most common histological subtype (76.1%). Recurrence was seen in 79.3% patients, with a median time to recurrence 17 months (range 6.5 - 39 months). They were managed with second line chemotherapy and surgery. Median overall survival in this study for optimally cytoreduced stage III patients was 39 months and 18 months for optimally cytoreduced stage IV patients. Median progression free survival for stage III was 12 months and stage IV was 6 months. Conclusions: Neoadjuvant chemotherapy facilitates surgery in advanced ovarian cancer and helps in assessing chemotherapy responsiveness. It provides an opportunity to modify systemic treatment if there no response to therapy or disease progression.

Download Full-text