Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature

Abstract

Epithelial ovarian cancer is the leading cause of death from gynecological cancer in the Western countries. Approximately 20%-30% of patients with early-stage disease and 50%-75% of those with advanced disease who obtain a complete response following first-line chemotherapy will ultimately develop recurrent disease, which more frequently involves the pelvis and abdomen. Few formal guidelines exist regarding the surveillance of these patients, and there is no agreement in the literature about the type and timing of examinations to perform. Moreover, the objective of follow-up is unclear as recurrent epithelial ovarian cancer continues to be a therapeutic dilemma and quite all the relapsed patients will eventually die of their disease. The follow-up of asymptomatic patients generally include complete clinical history, serum cancer antigen (CA)125 assay, physical examination, and often ultrasound examination, whereas additional radiologic imaging techniques are usually performed when symptoms or signs appear. (18)Fluoro-2-deoxy-glucose ((18)FDG)-positron emission tomography (PET) has a sensitivity of 90% and a specificity of 85% approximately for the detection of recurrent disease, and this examination appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Recently, technologic advances have led to novel combined (18)FDG-PET/computed tomography (CT) devices, which perform contemporaneous acquisition of both (18)FDG-PET and CT images. The role of (18)FDG-PET/CT for the detection of recurrent ovarian cancer is very promising, and this technique may be especially useful for the selection of patients with late recurrent disease who may benefit from secondary cytoreductive surgery.

Selective treatment and monitoring of disseminated cancer micrometastases in vivo using dual-function, activatable immunoconjugates

“…The sensitivity and specificity of ∼90% achieved here for untreated tumors as small as 30 μm represents a significant improvement over the 86% and 53% tumor sensitivity and specificity reported for always-on verteporfin (32). This level of selectivity also results in a two order-of-magnitude improvement in tumor-imaging resolution compared with current clinical imaging technologies (e.g., positron emission tomography, computed tomography, and magnetic resonance imaging), which have 40-50% sensitivity for subcentimeter tumors (10,11). These developments address the lack of imaging technologies for detecting and monitoring micrometastatic disease (3) and open the door to patient-tailored therapeutic regimens based upon real-time feedback regarding the presence and response of residual disease.…”

“…These residual micrometastases are clinically occult until gross recurrence, which is often refractory to standard treatments (1,2,4). Laparotomy, an invasive surgical reassessment, frequently fails to detect residual disease (9) while noninvasive clinical imaging modalities also have poor sensitivity for subcentimeter tumors (10,11).…”

A case of inflammatory ascites

“…Ricordiamo pertanto che la contemporanea presenza di elevate proteine nel liquido ascitico e di un elevato gradiente siero-ascite di albumina deve oggi indirizzare la diagnosi verso un'eziologia cardiaca. Sottolineiamo infine che il marker neoplastico CA-125 non è efficace nella diagnosi di neoplasie per l'elevata frequenza di falsi positivi, mentre, in accordo con la letteratura, la sua applicazione clinica dovrebbe essere limitata al monitoraggio della terapia nel carcinoma ovarico [41][42][43][44].…”

Microarray expression profiling of long non-coding RNAs in epithelial ovarian cancer

“…Epithelial ovarian cancer accounts for nearly 90% of all ovarian tumors (5). The high mortality of epithelial ovarian cancer is attributed to late-stage diagnosis in >70% of the patients (6). Constant damage and repair of ovarian surface epithelial cells, use of gonadotropin-releasing hormone and steroid hormones, inflammation, genetic factors, and environmental factors have been previously shown to be associated with epithelial ovarian cancer (7)(8)(9); however, the exact molecular mechanisms of its occurrence and development remain to be fully identified.…”