Ovarian management at the time of radical hysterectomy for cancer of the cervix

Abstract

GYNECOL ONCOL 1989,35/3 (349-351) Ovarian management at the time of radical hysterectomy for cervical cancer was reviewed retrospectively over a 7-year period. All patients had early-stage cancer except three who had stage IIB disease. Approximately 80% of patients had squamous cancer and 20% adenocarcinoma or adenosquamous carcinoma. The mean age was 44, and 24% of patients were 35 or younger. Ninety-nine patients had their ovaries removed. None of the ovaries contained metastatic disease including 22 patients with adenocarcinoma or adenosquamous carcinoma. Of the 17 patients with retained ovaries 14 had transposition into the paracolic gutters. Only one of the 14 patients with transposed ovaries developed symptoms of ovarian failure. No patients with retained ovaries developed metastatic disease or required reoperation secondary to new ovarian pathology. It is our opinion that normal ovaries can be preserved in young women at the time of radical hysterectomy for early cervical cancer regardless of histologic type.Use of CA 125 monoclonal antibody to monitor patients GYNECOL ONCOL 1989,35/3 (323-329) The monoclonal antibody (mAb) OC 125 reacts with an antigen on human ovarian carcinama (OVCA) cells that is also shed into the body fluids and can be detected in patients' sera and/or ascites with a radioimmunometric assay. For the present study, serum CA 125 levels of patients (n = 36) with different stages of OVCA were investigated. Serum levels seem to correlate with tumor burden. In stages I and II (n = 12), 33qo of patients were CA 125 positive, whereas 70% of stage III and IV patients (n = 24) were CA 125 positive. Mean serum levels were in 93 U/ml (stages I, II) and 279 U/ml (stages III, IV). CA 125 levels in ascites and in pleural effusions were manyfold higher than serum levels of the same patients (P < 0.0001). Immunohistochemical investigations of CA 125 in different ovarian tumors (n = 91) revealed that 85% of malignant and 75% of borderline serous cystadenocarcinomas had detectable CA 125 surface expression. Furthermore, 71% of benign tumors showed the CA 125 epitope, whereas mutinous tumors were negative for this marker. One of six ovarian cancer cell lines was CA 125 positive, whereas in 6 of 11 patients, ascitesderived ovarian cancer cells (fresh and gradient isolated) were positive for this marker. The proportion of positive cells ranged from 10 to 90% in these samples. Intraperitoneal recombinant interferon-gamma (rIFN-gamma) therapy resulted in an increase in the number of cells reacting with CA 125. The results of monitoring in patients receiving different therapeutic regimens and/or agents demonstrate the usefulness of this marker. lead-212 and bismuth-212 to low-LET X-rays on ovarian carcinoma GYNECOL ONCOL 1989,35/3 (297-300) We are investigating the potential use of short-lived a-emitting radionuclides for the treatment of ovarian carcinoma. These radionuclides transfer dense high ionizing linear energy (high LET) over a short path length without dependence upon cellular oxygen. The o-...

Benefits and side effects of lateral ovarian transposition (LOT) performed during radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer

“…Of the 36 patients who did not receive adjuvant pelvic radiotherapy, 2 (5.5%) became postmenopausal, whereas 5 (28%) of the patients who received adjuvant pelvic radiotherapy became postmenopausal. This is consistent with several other studies which report a postmenopausal rate in irradiated patients with LOT of 0% to 30% (6–9,11) .…”

“…Six other studies have also examined the sequelae of LOT in irradiated cervical cancer patients (7–12) . Five studies reported no ovarian cyst formation (8–12) .…”

Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy

“…Regarding the association of tumor histology and ovarian metastasis, Tabata et al (12) noted that ovarian metastasis is frequently found in patients with adenocarcinoma. Other investigators have reported that the rate of ovarian metastasis was not related with histologic type (11,13,14). The risk of ovarian metastasis in transposed ovary increases in patients with a bulky tumor (12,13).…”

“…The effectiveness of lateral ovarian transposition for ovarian preservation after adjuvant radiation has been studied. In three studies, the rate of ovarian failure after adjuvant radiation in patients after lateral ovarian transposition varied widely from 17.0%-88.6% (9,14,15). Another study reported that 57% of patients experienced ovarian failure after transposition of ovary more than 3 cm above the umbilical line (17).…”

Safe limits for ovarian conservation in patients with adenocarcinoma of the cervix

“…Brown et al 11 have reported that ovarian metastases are rare in stage I adenocarcinoma of the cervix, and that only one of 25 stage I adenocarcinoma patients (4.0%) had had a microscopic ovarian metastasis. Owens et al 12 have argued that in stage I adenocarcinoma patients without lymph node metastasis, ovaries can be left. Ovarian metastasis has been observed to occur more frequently in patients with adenocarcinoma than in patients with squamous cell carcinoma.…”