Surgical Staging of Carcinoma of the Ovaries

Buchsbaum, Herbert J.; Brady, Mark F.; Delgado, Gregorio; Miller, Alexander W.; Hoskins, William J.; Manetta, Alverto; Sutton, Gregory P.

doi:10.1097/00006254-199006000-00020

Cited by 23 publications

(44 citation statements)

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“…Up to 30% of patients with presumed early-stage ovarian cancer will be upstaged if re-explored, and approximately two-thirds of these patients will have stage III disease (Bagley Jr et al, 1973;Piver, 1982;Young et al, 1983;Helewa et al, 1986;Buchsbaum et al, 1989;Soper et al, 1992). Despite attempts at improving staging through computed tomography (CT), magnetic resonance imaging (MRI), and other established imaging diagnostic tools, the detection of residual micrometastatic disease remains a challenge to the gynaecological oncologist and collaborating disciplines.…”

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confidence: 99%

Photodynamic diagnosis of ovarian cancer using hexaminolaevulinate: a preclinical study

et al. 2003

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The unfailing detection of micrometastases during surgery of patients suffering from ovarian cancer is mandatory for the optimal management of this disease. Thus, the present study aimed at determining the feasibility of detecting micrometastases in an ovarian cancer model using the intraperitoneal administration of the photosensitiser precursor hexaminolaevulinate (HAL). For this purpose, HAL was applied intraperitoneally at different concentrations (4 -12 mM) to immunocompetent Fischer 344 rats bearing a syngeneic epithelial ovarian carcinoma. The tumours were visualised laparoscopically using both white and blue light (D-light, Karl Storz, Tuttlingen, Germany), and the number of peritoneal micrometastases detected through HAL-induced photodiagnosis (PD) was compared to standard white light visualisation. Fluorescence spectra were recorded with an optical fibre-based spectrofluorometer and the fluorescence intensities were compared to the protoporphyrin IX (PpIX) fluorescence induced by 5-aminolevulinic acid under similar conditions. The number of metastases detected by the PD blue light mode was higher than when using standard white light abdominal inspection for all applied concentrations. Twice as many cancer lesions were detected by fluorescence than by white light inspection. The hexyl-ester derivative produced higher PpIX fluorescence than its parent substance aminolevulinic acid at the same concentration and application time. Fluorescence contrast between healthy and cancerous tissue was excellent for both compounds. To overcome poor diagnostic efficiency and to detect peritoneal ovarian carcinoma foci in the large surface area of the human peritoneal cavity, HAL fluorescence-based visualisation techniques may acquire importance in future and lead to a more correct staging of early ovarian cancer.

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confidence: 99%

Photodynamic diagnosis of ovarian cancer using hexaminolaevulinate: a preclinical study

et al. 2003

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“…At the disease onset, in fact, spleen or liver metastases are frequently found according to the tumour stage [26]. For this reason, staging must always include the study of upper abdominal organs.…”

Section: Indications For Ct Scans and Mrimentioning

confidence: 99%

“…The criteria for the tumor unresectability include the presence of metastases with a diameter greater than 2 cm localized in the following sites: mesenteric root; gastro-splenic ligament; epiploic pouch; hepatic hilum; hepatic, intrasegmental peritoneal reflection; diaphragm and liver dome. Besides other unresectability criteria are: lymphadenopathy greater than 1 cm above the celiac zone; presence of extraperitoneal, presacral disease [26].…”

Section: Indications For Ct Scans and Mrimentioning

confidence: 99%

Differential Diagnosis for Female Pelvic Masses

Alessandrino¹,

Dellafiore²,

Eshja³

et al. 2013

Medical Imaging in Clinical Practice

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“…Clinical inspection alone will result in misstaging 20-30% of patients [19]. Pelvic and paraaortic lymph node métastasés occur in approximately 20% of patients with earlystage disease (table 3) and increase with the extent of the disease.…”

Section: Surgerymentioning

confidence: 99%

Ovarian Carcinoma the Way Ahead

Lahousen¹

1994

Oncol Res Treat

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Ovarian carcinoma has the poorest prognosis of all malignancies of the female genital tract. The majority of patients are diagnosed with advanced disease. Efforts to diagnose the disease in early stages have remained largely fruitless. Modest advances have been made in treatment, particularly in patients with advanced disease. Today the operative treatment of ovarian cancer poses the greatest challenge to the gynecologic surgeon. The impetus that prodded us to fundamentally change our surgical strategy came from chemotherapy. New cytostatic agents (platinum-contaning agents, paclitaxel) offered hope of treating even seemingly inoperable patients. The results achieved by chemotherapy depend largely on the tumor burden after primary surgery. The smaller the residual tumor after primary surgery, the longer the survival rate. Accordingly, tumor masses, wherever they are, should be removed as completely as possible. The surgical pursuit of the routes of spread of ovarian cancer led to the recognition that ovarian cancer regularly spreads to retroperitoneal lymph node groups that previouly received scant attention. The frequency of lymphatic metastasis was unexpectedly high. This immediately led to the issue whether systematic lymphadenectomy should be considered a component of cytoreduction and thus an integral part of primary surgery. Now surgical tumor reduction is generally planned at the beginning of the therapeutic process to optimize the chances for adjuvant chemotherapy. Only a combination of modalities will improve treatment results. Thes efforts have led to 5-year survival rates of 40% in FIGO stage III.

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Surgical Staging of Carcinoma of the Ovaries

Cited by 23 publications

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Photodynamic diagnosis of ovarian cancer using hexaminolaevulinate: a preclinical study

Photodynamic diagnosis of ovarian cancer using hexaminolaevulinate: a preclinical study

Differential Diagnosis for Female Pelvic Masses

Ovarian Carcinoma the Way Ahead

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