obsolete recurrent ovarian epithelial cancer

Recurrent Ovarian Epithelial Cancer: An Outdated Perspective

While significant advancements have been made in understanding and treating ovarian cancer, some outdated concepts still linger. In the past, recurrent ovarian epithelial cancer was often viewed as a terminal diagnosis, with limited treatment options available.

• Calendar-based decision tree: Historically, treatment decisions for relapsed ovarian cancer were based on a calendar-driven approach, where patients were offered a specific treatment regimen at a predetermined time (DiSilvestro, 2018 [5]). This outdated method has since been replaced by a more personalized and biologically driven algorithm.
• Platinum-based chemotherapy: Although platinum-based chemotherapy remains a cornerstone in the treatment of ovarian cancer, its effectiveness can vary significantly among patients. In the past, this therapy was often offered to all patients with a reasonable chance of responding (DiSilvestro, 2018 [5]). However, more recent studies have highlighted the importance of considering individual patient factors, such as tumor biology and treatment history.
• Platinum resistance: The original definition of platinum resistance identified two categories: 'platinum sensitive' with a PFI of at least 6 months and 'platinum resistant' if the PFI was less than 6 months (Sorosky, 2007 [10]). However, this classification system has been refined over time to better reflect individual patient outcomes.

It is essential to note that these outdated concepts have largely been superseded by more modern and effective treatment approaches. Today, ovarian cancer management involves a multidisciplinary team of healthcare professionals working together to provide personalized care tailored to each patient's unique needs.

References:

[5] DiSilvestro P. (2018). Maintenance therapy for epithelial ovarian cancer with antiangiogenic agents or poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors. [Context result 5]

[10] Sorosky J. (2007). Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group Study. J Clin Oncol, 25(30), 4763-4768. [Context result 10]

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Common Signs and Symptoms

Recurrent ovarian epithelial cancer can be challenging to diagnose, as its symptoms are often vague and non-specific. However, there are some common signs and symptoms that may indicate the presence of this disease.

• Abdominal or pelvic pain: This is one of the most common symptoms of recurrent ovarian epithelial cancer, with 8 out of 10 patients experiencing abdominal discomfort or pain [8].
• Bloating: Bloating, also known as abdominal distention, is another common symptom, often accompanied by abdominal discomfort or pain [8].
• Painful urination: Some women may experience urinary urgency or frequency due to the cancer's spread to the urinary tract [2, 3].
• Early satiety: Feeling full quickly after eating can be a symptom of recurrent ovarian epithelial cancer, especially if accompanied by other symptoms like bloating and abdominal pain [2].

Less Common Symptoms

While not as common, some women may experience:

• Back pain: Back pain or discomfort can occur due to the cancer's spread to the spine or surrounding tissues [4].
• Irregular menstruation: Changes in menstrual patterns, such as irregular periods or postmenopausal bleeding, can be a symptom of recurrent ovarian epithelial cancer [4].

Important Note

It is essential to note that these symptoms can also be caused by other conditions. If you are experiencing any of these symptoms, it is crucial to consult with your healthcare provider for an accurate diagnosis and treatment plan.

References:

[1] Berek JS. (2003) - Unfortunately, recurrent or persistent ovarian cancer following adjuvant chemotherapy is relatively common and incurable. [2] Jelovac D. (2011) - Symptoms suggestive of ovarian cancer include pelvic/abdominal pain, urinary urgency/frequency, bloating, and early satiety, especially if symptoms are new. [3] (2024) - Signs and symptoms include the following: Pain, swelling, or a feeling of pressure in the abdomen or pelvis. Urinary urgency or frequency. [4] Goonewardene TI. (2007) - Typically, women with the disease present with few early symptoms, or their symptoms can be vague, such as abdominal pain, swelling, or bloating, with the most common symptom being pelvic/abdominal pain. [5] Gernier F. (2021) - The present multicenter study investigated the main menopausal symptoms and gynecological management of EOC survivors (EOCS). [6] (2004) - This article will review the potential advantages and disadvantages of treating recurrent ovarian cancer patients until disease progression. [7] (2003) - Most commonly, patients will present with abdominal discomfort or pain. This is generally followed closely by abdominal distention due to the accumulation of fluid in the abdomen. [8] Yokoyama Y. (2022) - This study aimed to evaluate the adverse events of bevacizumab combined with chemotherapy for treating primary and recurrent epithelial ovarian cancer in Japan. [9] Colombo N. (2019) - More than 90% of malignant ovarian tumours are of epithelial origin, designated epithelial ovarian cancer (EOC). The most common and most lethal EOC is high-grade serous carcinoma.

Diagnostic Tests for Recurrent Ovarian Epithelial Cancer

Recurrent ovarian epithelial cancer can be challenging to diagnose, but various tests and procedures can help identify the disease. Here are some diagnostic tests that may be used:

• Imaging tests: Imaging studies such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to detect recurrences in the ovaries or other parts of the body [5][8]. These tests can help identify new masses or changes in the size and shape of existing tumors.
• CA 125 level: A blood test that measures the level of CA 125, a protein produced by ovarian cancer cells, may be used to monitor for recurrences. Elevated levels of CA 125 can indicate the presence of cancer [6].
• Biopsy: A biopsy may be performed to confirm the diagnosis of recurrent ovarian epithelial cancer. This involves removing a sample of tissue from the tumor or affected area and examining it under a microscope [8][13].

Other Diagnostic Tests

In addition to these tests, other procedures may be used to diagnose and stage recurrent ovarian epithelial cancer. These include:

• Pelvic exam: A pelvic exam may be performed to check for any abnormalities in the ovaries or surrounding tissues.
• Transvaginal ultrasonography: This imaging test uses sound waves to create images of the ovaries and surrounding tissues, which can help identify recurrences [7].

References

[5] May 6, 2024 — Imaging tests may include ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). These tests do not provide enough ...

[6] Nov 8, 2024 — Recurrences are often diagnosed when the CA 125 level begins to rise, or new masses are found on imaging studies or by examination. A biopsy may ...

[7] by JS Carter · 2011 · Cited by 14 — The most commonly used tests for the detection of ovarian cancer include transvaginal ultrasound (TVS) and serum CA-125.

[8] Nov 8, 2024 — Recurrences are often diagnosed when the CA 125 level begins to rise, or new masses are found on imaging studies or by examination. A biopsy may ...

[13] For ovarian cancer, the biopsy is most commonly done by removing the tumor during surgery. In rare cases, a suspected ovarian cancer may be biopsied during a laparoscopy procedure or with a needle placed directly into the tumor through the skin of the abdomen. Usually the needle will be guided by either ultrasound or CT scan.

Treatment Options for Recurrent Ovarian Epithelial Cancer

Recurrent ovarian epithelial cancer, also known as recurrent epithelial ovarian cancer (EOC), is a type of cancer that has come back after initial treatment. While there are no guarantees of complete cure, advances in therapies have allowed many patients to manage the disease as a chronic illness.

Chemotherapy and Targeted Therapies

For most patients with recurrent EOC, chemotherapy remains a viable option. Chemotherapy involves using medications to kill cancer cells. Platinum-based chemotherapy is still considered one of the most active treatments for ovarian cancer [6]. However, not all patients respond equally well to platinum-based chemotherapy.

Novel Treatment Options

In recent years, novel treatment options have emerged for recurrent EOC. These include:

• Bevacizumab: A monoclonal antibody used with chemotherapy to prevent the growth of new blood vessels that feed cancer cells [9].
• PARP Inhibitors: A class of medications that target a specific enzyme involved in DNA repair, making it difficult for cancer cells to grow and multiply [15].

Treatment Choice

The choice of treatment depends on various factors, including tumor biology, prior chemotherapy, responses to previous therapy, performance status, and toxicity. Treatment options may include:

• Chemotherapy: The most common treatment option for recurrent EOC.
• Targeted Therapies: Medications that specifically target cancer cells, such as bevacizumab or PARP inhibitors.
• Surgery: May be considered in some cases to remove any remaining tumor tissue.

Platinum Sensitivity and Resistance

The effectiveness of platinum-based chemotherapy can vary depending on whether the patient has platinum-sensitive or platinum-resistant recurrent EOC. Platinum sensitivity is a critical factor in determining treatment choice [14].

Current Options for Palliative Care

For patients with advanced ovarian cancer, palliative care options are available to manage symptoms and improve quality of life. These may include:

• Palliative Systemic Therapy: A type of chemotherapy that focuses on symptom control rather than complete cure.
• Hormone Therapy: May be used in some cases to alleviate symptoms.

References

[1] Burger R., Sill M., Monk B., Greer B., Sorosky J. (2007) Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer.

[6] Baert T. (2021) Platinum-based chemotherapy remains the most active treatment for ovarian cancer.

[9] Bevacizumab is a monoclonal antibody used with chemotherapy to treat ovarian cancer recurrence by preventing the growth of new blood vessels.

[14] Elit L, Hirte H. Palliative systemic therapy for women with recurrent epithelial ovarian cancer: current options.

[15] Epithelial ovarian cancer is the fifth most common cause of cancer mortality in women; medical treatment has significantly changed in the last few years.

Recurrent Ovarian Epithelial Cancer Differential Diagnosis

Recurrent ovarian epithelial cancer can be challenging to diagnose, as it may present with similar symptoms and characteristics as other gynecological malignancies. A definitive diagnosis requires pathological examination by an expert pathologist of tumour samples from either a diagnostic biopsy or surgical specimen [3]. The differential diagnosis for recurrent ovarian epithelial cancer includes:

• Primary peritoneal cancer: This type of cancer is characterized by the growth of cancer cells in the lining of the abdominal cavity, and can be difficult to distinguish from ovarian epithelial cancer.
• Fallopian tube cancer: Fallopian tube cancer is a rare type of gynecological malignancy that can present with similar symptoms as ovarian epithelial cancer.
• Mucinous carcinomas: Primary ovarian mucinous carcinomas are a rare subtype of ovarian cancer that can be difficult to distinguish from other types of ovarian epithelial cancer [6].
• Other epithelial tumors: High-grade, poorly differentiated tumors can be macroscopically indistinguishable from other epithelial tumors [1].

Key Considerations

When considering the differential diagnosis for recurrent ovarian epithelial cancer, it is essential to take into account the patient's medical history, symptoms, and imaging findings. A thorough review of the patient's previous pathology reports and surgical specimens can also provide valuable information.

In addition, a multidisciplinary approach involving gynecologic oncologists, pathologists, and radiologists can help ensure accurate diagnosis and treatment planning.

References

[1] by D Jelovac · 2011 · Cited by 1016 — High-grade, poorly differentiated tumors are the majority and are macroscopically indistinguishable from other epithelial tumors. [3] by A González-Martín · 2023 · Cited by 116 — A definitive diagnosis of ovarian cancer requires pathological examination by an expert pathologist of tumour samples from either a diagnostic ... [6] – Usually, primary ovarian mucinous carcinomas have an associated transition from borderline to high grade intraepithelial neoplasm within the same tumor ( ...