Rare case of stage IA epithelial ovarian cancer with bone as the first site of recurrent metastasis

Ovarian cancer is one of the main gynecological malignancies including cervical cancer and endometrial cancer. Epithelial ovarian cancer generally presents with already advanced disease at the time of diagnosis and is accompanied by poor prognosis. However, stage I ovarian cancer defined as lesions confined to the ovary is usually considered to have a good prognosis, illustrated by a 5-year survival rate of greater than 70–80%. Also, recurrences tend to be late and are usually in the abdominopelvic cavity. Metastases to the skeletal structures are rare. We report a rare case of early stage IA ovarian cancer, in which the first recurrent lesion was bone metastasis.

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Outcome of Reproductive Age Women With Stage IA or IC Invasive Epithelial Ovarian Cancer Treated With Fertility-Sparing Therapy

Obstetrical & Gynecological Survey ◽

10.1097/01.ogx.0000058684.18516.cf ◽

2003 ◽

Vol 58 (4) ◽

pp. 254-255

Author(s):

Jeanne M. Schilder ◽

Amy M. Thompson ◽

Paul D. DePriest ◽

Frederick R. Ueland ◽

Michael L. Cibull ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Reproductive Age ◽

Reproductive Age Women ◽

Fertility Sparing ◽

Stage Ia ◽

Invasive Epithelial Ovarian Cancer

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Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.8617 ◽

2010 ◽

Vol 28 (10) ◽

pp. 1727-1732 ◽

Cited By ~ 119

Author(s):

Toyomi Satoh ◽

Masayuki Hatae ◽

Yoh Watanabe ◽

Nobuo Yaegashi ◽

Osamu Ishiko ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Clear Cell ◽

Stage I ◽

Healthy Children ◽

Favorable Histology ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

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Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: Hacettepe experience and review of literature

World Journal of Surgical Oncology ◽

10.1186/1477-7819-8-106 ◽

2010 ◽

Vol 8 (1) ◽

Cited By ~ 17

Author(s):

Guldeniz Aksan Desteli ◽

Murat Gultekin ◽

Alp Usubutun ◽

Kunter Yuce ◽

Ali Ayhan

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Epithelial Ovarian Cancer ◽

Clinical Stage ◽

Review Of Literature ◽

Node Metastasis ◽

Clinical Stage Ia ◽

Stage Ia

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Fertility-Sparing Surgery for Ovarian Cancer

Journal of Clinical Medicine ◽

10.3390/jcm10184235 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4235

Author(s):

Geoffroy Canlorbe ◽

Nathalie Chabbert-Buffet ◽

Catherine Uzan

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Germ Cell Tumors ◽

Cochrane Library ◽

Borderline Ovarian Tumor ◽

Low Grade ◽

Early Stage Disease ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia

(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.

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Methods and conditions of fertility preservation in early-stage ovarian tumors

Orvosi Hetilap ◽

10.1556/oh.2013.29581 ◽

2013 ◽

Vol 154 (14) ◽

pp. 523-530

Author(s):

Erzsébet Szatmári ◽

Szabolcs Máté ◽

Norbert Sipos ◽

András Szánthó ◽

Mihály Silhavy ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Fertility Preservation ◽

Early Stage ◽

Ovarian Tumors ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1–2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be primary. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended. Orv. Hetil., 2013, 154, 523–530.

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The Influence of Cyst Emptying, Lymph Node Resection and Chemotherapy on Survival in Stage IA and IC1 Epithelial Ovarian Cancer

Anticancer Research ◽

10.21873/anticanres.11111 ◽

2016 ◽

Vol 36 (10) ◽

pp. 5373-5380 ◽

Cited By ~ 4

Author(s):

MIKKEL ROSENDAHL ◽

BERIT JUL MOSGAARD ◽

CLAUS HØGDALL

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Lymph Node Resection ◽

Stage Ia

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Benefit of adjuvant chemotherapy for stage I epithelial ovarian cancer according to the histologic type.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5552 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5552-5552

Author(s):

Hiroyuki Fujiwara ◽

Yuji Takei ◽

Yasushi Saga ◽

Shizuo Machida ◽

Naoto Sato ◽

...

Keyword(s):

Ovarian Cancer ◽

Adjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Recurrence Rate ◽

Histological Type ◽

Stage I ◽

Clear Cell Adenocarcinoma ◽

Observation Group ◽

Chemotherapy Group ◽

Stage Ia

5552 Background: The benefit of adjuvant chemotherapy in stage I epithelial ovarian cancer (EOC) remains controversial. We retrospectively examined stage I EOC patients to clarify the benefits of adjuvant chemotherapy according to the histological type. Methods: The outcomes of 131 patients with stage I EOC that was diagnosed by exact staging laparotomy at the Jichi Medical University Hospital over a 22-year period from 1988 to 2009 were evaluated. Eighty-seven of the patients had received adjuvant chemotherapy (stage: IA 17, IC(intraoperative rupture;R) 27, IC(other) 43; histological type: clear cell adenocarcinoma(CCC) 38, mucinous adenocarcinoma(MC) 18, endometrioid adenocarcinoma(EC) 18, serous adenocarcinoma(SAC) 13), while 44 had undergone observation alone (stage: IA 31, IC(R) 12, IC(other) 1; histological type: CCC 11, MC 17, EC 11 and SAC 5). Outcomes for patients were compared between the two groups. Results: The overall recurrence rate in the adjuvant chemotherapy group was 18.4% (16/87). The rates of recurrence according to stage were IA 5.9% (1/17), IC(R) 14.8% (4/27), and IC (other) 25.6% (11/43). Recurrence by histological type were CCC 12, SAC 2(G1and G2), and one each for EC and MC. Recurrence was seen in all stages in CCC patients; however, there was no recurrence in stage IA in patients with non-CCC. The overall recurrence rate in the observation group was 11.4% (5/44). All five recurrences occurred in CCC patients, and no recurrence was observed in the 33 non-CCC patients (IA 26, IC(R) 7). In patients with IC(R) CCC, the recurrence rate was significantly higher in the observation group (80%;4/5) than in the adjuvant chemotherapy group (18.8%; 3/16) (p = 0.025). Conclusions: This retrospective study showed that the CCC is associated with recurrence in stage I EOC and adjuvant chemotherapy for these patients may improve outcomes. The recommended states for adjuvant chemotherapy in stage I EOC are as follow: 1) all subtype of stage I for CCC, and 2) IC(other) for non-CCC. Although further prospective studies are required, these results afford useful information with which to determine the adjuvant chemotherapy in stage I EOC.

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