Ovarian metastasis in carcinoma of the uterine cervix
Introduction
Although concurrent chemoradiotherapy results in a good outcome for patients with cervical cancer [1], [2], exposure to radiation can lead to early ovarian failure [3]. In the literature, radiation doses of less than 3 Gy to the ovary led to ovarian failure in 11% of women, more than 3 Gy in 60% of women, and over 5 Gy were sufficient to sterilize the ovary [4]. On the other hand, surgical treatment that preserves the ovaries benefits premenopausal women with cervical cancer. Ovarian transposition is reportedly useful to avoid damage to ovaries from radiation exposure [5].
Radical hysterectomy is generally considered a therapeutic option for patients with stage Ib to IIa cervical cancer [6], whereas, in Japan, most patients with stage Ib to IIb are treated with radical hysterectomy. Many authors have proposed risk factors for ovarian metastasis in cervical cancer to facilitate the decision to preserve the ovaries during radical hysterectomy [7], [8], [9], [10], [11], [12]. However, the number of studies and size of patients population have been too small to substantiate the frequency and clinicopathologic features of ovarian metastasis. We, therefore, analyzed a large number of cervical cancer patients with stage Ib to IIb cervical cancer who underwent radical hysterectomy including bilateral salpingo-oophorectomy. To our knowledge, the present study is the largest series of patients with ovarian metastasis from cervical cancer.
Section snippets
Material and methods
A total of 3471 patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib to IIb cervical cancer who underwent radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection (type III) at Hyogo Medical Center for Adults, Aichi Cancer Center Hospital, Jichi Medical School, National Defense Medical College, Saga University Hospital, and Tottori University Hospital between 1981 and 2000 were enrolled in this study. Data were collected from the
Results
The incidence of ovarian metastases is shown in Table 1. Patients with ovarian metastases were distributed as follows: 6 in stage Ib1 (3 for squamous cell carcinoma and 3 for adenocarcinoma), 12 in stage Ib2 (one for squamous cell carcinoma and 11 for adenocarcinoma), 5 in stage IIa, and 29 in stage IIb. Twenty-three patients had squamous cell carcinoma, and 29 had adenocarcinoma including adenosquamous cell carcinoma. Ovarian metastasis were more frequently observed in patients with
Discussion
A review of published studies indicated that the incidence of ovarian metastasis from uterine cervical cancer is less than 0.5% of squamous cell carcinoma and 1.4% of adenocarcinoma [13]. However, the details are not clear due to the small number of subjects studied. Toki et al. reported that one of 525 (0.19%) patients with squamous cell carcinoma and 2 of 36 (5.5%) patients with adenocarcinoma had ovarian metastasis [12]. No patients with stage Ib had ovarian metastasis. Other authors found
References (17)
- et al.
Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis
Lancet
(2001) - et al.
Ovarian transposition in cervical cancer
Gynecol. Oncol.
(1993) - et al.
Sequelae of lateral ovarian transposition in irradiated cervical cancer patients
Int. J. Radiat. Oncol. Biol. Phys.
(1991) - et al.
Sequelae of lateral ovarian transposition in unirradiated cervical cancer patients
Gynecol. Oncol.
(1990) - et al.
A comparison of ovarian metastasis between squamous cell carcinoma and adenocarcinoma of the uterine cervix
Gynecol. Oncol.
(2001) - et al.
Ovarian metastasis in stage Ib and II cervical adenocarcinoma
Gynecol. Oncol.
(1999) - et al.
Ovarian metastasis from cervical carcinoma
Int. J. Gynaecol. Obstet.
(1997) - et al.
Microscopic ovarian metastasis of the uterine cervical cancer
Gynecol. Oncol.
(1991)
Cited by (176)
Gastric-type adenocarcinoma of the cervix: Clinical outcomes and genomic drivers
2022, Gynecologic OncologyLocally advanced cervical carcinoma patients treated with chemoradiation followed by radical surgery: clinical response and oncological outcomes according to histotype after propensity score analysis
2022, European Journal of Surgical OncologyCitation Excerpt :Possible explanations for the growing incidence of AC/ASC histology could be due to a relative reduction of SCC neoplasms due to the prompt detection by pap smear, as well as obesity, nulliparity, or presence of human papilloma virus (HPV)-18 infection registered more frequently in AC/ASC patients compared to SCC ones [3,4]. Moreover, AC histology is frequently diagnosed in young women as bulky tumors associated with higher risk of distant metastases and poor prognosis [5–7]. When considering locally advanced cervical cancer (LACC), many studies suggested that AC/ASC histology is less sensitive to exclusive chemoradiation (eCT/RT) compared to SCC patients, thus leading to a lower rate of clinical complete response, and worse prognosis [8–15].
Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyImportance of tumor subtypes in cancer imaging
2022, European Journal of Radiology OpenCitation Excerpt :Adenocarcinoma and SCC of the cervix share many of the same prognostic factors, including stage, nodal status, tumor volume, grade, depth of stromal invasion and lymphovascular invasion [75,76]. However, adenocarcinomas more commonly exhibit ovarian metastasis (5 % compared to 0.8 %) [77], distant metastasis (36.8 % compared to 21.2 %) [78], hydrothorax and ascites [79]. Adenocarcinoma of the cervix also has a higher predilection for spreading to the paraaortic lymph nodes and uterine body [79].
The Current Trend of Fertility Preservation in Patients with Cervical Cancer
2024, Gynecology and Minimally Invasive Therapy