Diagnosis and Management of Epithelial Ovarian Cancer with Peritoneal Metastases

Chapter
First Online:

Abstract

With a steady incidence in the USA and worldwide, ovarian cancer remains the number one cause of death from gynecological malignancies. The conventional treatment approach for advanced ovarian malignancy is surgical debulking and systemic chemotherapy. More than 50 % of these patients relapse within 5 years. For advanced primary and recurrent disease, a comprehensive approach including cytoreductive surgery and perioperative intraperitoneal chemotherapy based on the experience with other peritoneal surface malignancies is proposed. The goal of these treatments is to surgically eradicate all visible tumors and to chemically and physically eradicate microscopic residual disease. Cytoreductive surgery includes peritonectomy procedures and visceral resections. At the Washington Cancer Institute, cisplatin and doxorubicin are administered through the intraperitoneal route with heat as part of the surgical procedure. Systemic ifosfamide is given by continuous infusion during the 90 min of intraperitoneal hyperthermia. In the first 5 postoperative days, patients receive normothermic intraperitoneal paclitaxel. Results of our phase II trial with this comprehensive approach suggested improved survival as compared with historical controls with reasonable morbidity and mortality.

Keywords

Epithelial Ovarian Cancer Peritoneal Metastasis Cytoreductive Surgery Intraperitoneal Chemotherapy Peritoneal Cancer Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.CrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society. Cancer facts and digures 2010, Available at: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010. Accessed 7 Oct 2010.
  3. 3.
    Horner MJ, Ries LAG, Krapcho M, et al. eds. SEER cancer statistics review, 1975–2006. Bethesda: National Cancer Institute, http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009. Accessed 7 Oct 2010.
  4. 4.
    Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S161–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Tavassoli FA, Devilee P. (eds.) Pathology and genetics of tumours of the breast and female genital organs. World health organization classification of tumours. Lyon: IARC Press; 2003.Google Scholar
  6. 6.
    Seidman JD, Russell P, Kurman RJ. Surface epithelial tumors of the ovary. In: Kurman RJ, editor. Blaustein’s pathology of the female genital tract. 5th ed. New York: Springer; 2002. p. 791–904.Google Scholar
  7. 7.
    Barda G, Menczer J, Chetrit A, et al. Comparison between primary peritoneal and epithelial ovarian carcinoma: a population-based study. Am J Obstet Gynecol. 2004;190(4):1039–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Gadducci A, Landoni F, Sartori E, et al. Analysis of treatment failures and survival of patients with fallopian tube carcinoma: a cooperation task force (CTF) study. Gynecol Oncol. 2001;81(2):150–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Tuma RS. Origin of ovarian cancer may have implications for screening. J Natl Cancer Inst. 2010;102(1):11–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Goodman MT, Shvetsov YB. Incidence of ovarian, peritoneal, and fallopian tube carcinomas in the United States, 1995–2004. Cancer Epidemiol Biomarkers Prev. 2009;18(1):132–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Prat J, Ribe A, Gallardo A. Hereditary ovarian cancer. Hum Pathol. 2005;36(8):861–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Trimble CL, Kosary C, Trimble EL. Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol. 2002;86(1):34–7.CrossRefPubMedGoogle Scholar
  13. 13.
    AJCC. Fallopian tube carcinoma. AJCC cancer staging handbook. 2009th ed. New York: Springer; 2009. p. 501–6.Google Scholar
  14. 14.
    AJCC. Ovary and primary peritoneal carcinoma. AJCC cancer staging handbook. 7th ed. New York: Springer; 2009. p. 493–506.Google Scholar
  15. 15.
    FIGO. Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet. 2009;105:3–4.CrossRefGoogle Scholar
  16. 16.
    Bergman F. Carcinoma of the ovary. A clinicopathological study of 86 autopsied cases with special reference to mode of spread. Acta Obstet Gynecol Scand. 1966;45(2):211–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Friedman GD, Skilling JS, Udaltsova NV, Smith LH. Early symptoms of ovarian cancer: a case–control study without recall bias. Fam Pract. 2005;22(5):548–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007;109(2):221–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Andersen MR, Goff BA, Lowe KA, et al. Use of a symptom index, CA125, and HE4 to predict ovarian cancer. Gynecol Oncol. 2010;116(3):378–83.CrossRefPubMedGoogle Scholar
  20. 20.
    Rossing MA, Wicklund KG, Cushing-Haugen KL, Weiss NS. Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst. 2010;102(4):222–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Bast Jr RC, Feeney M, Lazarus H, et al. Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest. 1981;68(5):1331–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Bast Jr RC, Klug TL, St John E, et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med. 1983;309(15):883–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Jacobs I, Bast RC. The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod. 1989;4(1):1–12.PubMedGoogle Scholar
  24. 24.
    Lenhard MS, Burges A, Johnson TRC, et al. PET-CT in recurrent ovarian cancer: impact on treatment planning. Anticancer Res. 2008;28(4C):2303–8.PubMedGoogle Scholar
  25. 25.
    Rustin GJ, Quinn M, Thigpen T, Rustin GJ, Quinn M, Thigpen T, et al. Re: new guidelines to evaluate the response to treatment in solid tumors (ovarian cancer). J Natl Cancer Inst. 2004;96(6):487–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Bristow RE, del Carmen MG, Pannu HK, et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol. 2003;90(3):519–28.CrossRefPubMedGoogle Scholar
  27. 27.
    Loyer EM, Whitman GJ, Fenstermacher MJ. Imaging of ovarian carcinoma. Int J Gynecol Cancer. 1999;9(5):351–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Coakley FV. Staging ovarian cancer: role of imaging. Radiol Clin North Am. 2002;40(3):609–36.CrossRefPubMedGoogle Scholar
  29. 29.
    Nelson RC, Chezmar JL, Hoel MJ, Buck DR, Sugarbaker PH. Peritoneal carcinomatosis: preoperative CT with intraperitoneal contrast material. Radiology. 1992;182(1):133–8.PubMedGoogle Scholar
  30. 30.
    Kawamoto S, Urban BA, Fishman EK. CT of epithelial ovarian tumors. Radiographics. 1999;19:S85–102; quiz S263-104.CrossRefPubMedGoogle Scholar
  31. 31.
    Forstner R, Hricak H, White S. CT and MRI of ovarian cancer. Abdom Imaging. 1995;20(1):2–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Forstner R, Hricak H, Occhipinti KA, et al. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619–26.PubMedGoogle Scholar
  33. 33.
    Meyer JI, Kennedy AW, Friedman R, Ayoub A, Zepp RC. Ovarian carcinoma: value of CT in predicting success of debulking surgery. Am J Roentgenol. 1995;165(4):875–8.CrossRefGoogle Scholar
  34. 34.
    Bristow RE, Duska LR, Lambrou NC, et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000;89(7):1532–40.CrossRefPubMedGoogle Scholar
  35. 35.
    Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer. 2004;101(2):346–52.CrossRefPubMedGoogle Scholar
  36. 36.
    Qayyum A, Coakley FV, Westphalen AC, et al. Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecol Oncol. 2005;96(2):301–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Axtell AE, Lee MH, Bristow RE, et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol. 2007;25(4):384–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Eisenkop SM, Spirtos NM, Lin WC. “Optimal” cytoreduction for advanced epithelial ovarian cancer: a commentary. Gynecol Oncol. 2006;103(1):329–35.CrossRefPubMedGoogle Scholar
  39. 39.
    Kurtz AB, Tsimikas JV, Tempany CM, et al. Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis–report of the Radiology Diagnostic Oncology Group. Radiology. 1999;212(1):19–27.CrossRefPubMedGoogle Scholar
  40. 40.
    Kubik-Huch RA, Dorffler W, von Schulthess GK, et al. Value of (18F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma. Eur Radiol. 2000;10(5):761–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Ak I, Stokkel MP, Pauwels EK. Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose in oncology. Part II. The clinical value in detecting and staging primary tumours. J Cancer Res Clin Oncol. 2000;126(10):560–74.CrossRefPubMedGoogle Scholar
  42. 42.
    Schroder W, Zimny M, Rudlowski C, Bull U, Rath W. The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) in diagnosis of ovarian cancer. Int J Gynecol Cancer. 1999;9(2):117–22.CrossRefPubMedGoogle Scholar
  43. 43.
    Charron M, Beyer T, Bohnen NN, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner. Clin Nucl Med. 2000;25(11):905–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Makhija S, Howden N, Edwards R, et al. Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review. Gynecol Oncol. 2002;85(1):53–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Risum S, Hogdall C, Loft A, et al. Does the use of diagnostic PET/CT cause stage migration in patients with primary advanced ovarian cancer? Gynecol Oncol. 2010;116(3):395–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Munnell E. The changing prognosis and treatment in cancer of the ovary. Am J Obstet Gynecol. 1968;100:790–5.PubMedGoogle Scholar
  47. 47.
    Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975;42:101–4.PubMedGoogle Scholar
  48. 48.
    Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 1992;47(2):159–66.CrossRefPubMedGoogle Scholar
  49. 49.
    Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248–59.CrossRefPubMedGoogle Scholar
  50. 50.
    Chi DS, Eisenhauer EL, Lang J, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006;103(2):559–64.CrossRefPubMedGoogle Scholar
  51. 51.
    Eisenkop SM, Spirtos NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer? Gynecol Oncol. 2001;82:489–97.CrossRefPubMedGoogle Scholar
  52. 52.
    Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998;69(2):103–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Eisenhauer EL, Abu-Rustum NR, Sonoda Y, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 2006;103(3):1083–90.CrossRefPubMedGoogle Scholar
  54. 54.
    Tentes AA, Tripsiannis G, Markakidis SK, et al. Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol. 2003;29(1):69–73.CrossRefPubMedGoogle Scholar
  55. 55.
    Van der Speeten K, Stuart OA, Mahteme H, Sugarbaker PH. Heat targeting of perioperative intravenous ifosfamide. Int J Surg Oncol. 2011; Volume 2011, Article ID 185092, 9 pages. doi: 10.1155/2011/185092.
  56. 56.
    Zylberberg B, Dormont D, Madelenat P, Darai E. First-line intraperitoneal cisplatin-paclitaxel and intravenous ifosfamide in stage IIIc ovarian epithelial cancer. Eur J Gynaecol Oncol. 2004;25:327–32.PubMedGoogle Scholar
  57. 57.
    Look M, Chang D, Sugarbaker PH. Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int J Gynecol Cancer. 2003;13:764–70.CrossRefPubMedGoogle Scholar
  58. 58.
    Bijelic L, Jonson A, Sugarbaker PH. Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol. 2007;18:1943–50.CrossRefPubMedGoogle Scholar
  59. 59.
    Yan TD, Zappa L, Edwards G, Alderman R, Marquardt CE, Sugarbaker PH. Perioperative outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy for non-appendiceal peritoneal carcinomatosis from a prospective database. J Surg Oncol. 2007;96:102–12.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Center for Gastrointestinal MalignanciesWashington Cancer Institute, MedStar Washington Hospital CenterWashington, DCUSA
  2. 2.Northern Gynaecological Oncology CentreQueen Elizabeth HospitalTyne and WearUK

Personalised recommendations