Which Histopathologic Subtype of Ovarian Cancer is Most Common?
Do you know which histopathologic subtype of ovarian cancer is most common? Or the appropriate management of a patient with clear cell carcinoma confined to the left ovary? Take this quiz to test your knowledge on the management of ovarian cancer.
Do you know which histopathologic subtype of ovarian cancer is most common? Or the appropriate management of a patient with clear cell carcinoma confined to the left ovary? Take this quiz to test your knowledge on the management of ovarian cancer.
Question 1
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Answer
D. Malignant epithelial tumors. Ovarian neoplasms consist of several histopathologic entities and treatment depends on the specific tumor type. Epithelial ovarian cancer comprises the majority (90%) of malignant ovarian neoplasms.
Reference: Kurman RJ, Carcangiu ML, Harrington CS, et al. WHO classification of tumors of female reproductive organs, 4th edition. WHO/IARC Classification of tumors. Vol 6. Lyon:IARC Publications; 2014.
Question 2
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Answer
C. Adjuvant chemotherapy with taxane/carboplatin 3–6 cycles. Clear cell carcinoma is a subtype of epithelial ovarian carcinoma with a high incidence of stage I presentation. Recurrences are more frequent with this subtype. The clinical management includes maximal cytoreduction and platinum plus paclitaxel–based chemotherapy. Ovarian clear cell carcinomas have poor response rates to platinum-based regimens, which may be related to the intrinsic chemoresistance of these tumors. Despite their aggressive clinical course, clear cell carcinomas are still treated similarly to other epithelial ovarian cancers. The rarity of these tumors prevents the conduction of randomized studies.
Reference: Pectasides D, Pectasides E, Psyrri A, Economopoulos T. Treatment issues in clear cell carcinoma of the ovary: a different entity? Oncologist. 2006;11:1089-94.
Question 3
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Answer
C.Combination of intraperitoneal and intravenous taxane and platinum. Based on the results of several randomized phase III trials a combination of intravenous and intraperitoneal chemotherapy has been shown to convey a significant survival advantage among women with optimally debulked epithelial ovarian cancer compared to intravenous administration alone. The three largest studies with the greatest survival advantage delivered cisplatin 100 mg/m2 intraperitoneally. The two most recent trials also included taxanes.
Reference: Chan DL, Morris DL, Rao A, Chua TC. Intraperitoneal chemotherapy in ovarian cancer: a review of tolerance and efficacy. Cancer Manag Res. 2012;4:413-22.
Question 4
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Answer
B. Delay treatment until clinical relapse. Results of a multi-institutional European trial on the utility of CA 125 in monitoring ovarian cancer after completion of primary therapy have previously reported by the Society of Gynecologic Oncology. Women with relapsed ovarian cancer did not live longer if chemotherapy was started earlier based on a rising CA 125, as opposed to delaying treatment until symptoms developed. It was found that the group undergoing CA 125 monitoring received 5 more months of chemotherapy overall, whereas quality of life measures were higher in women who were treated at the time of clinically evident recurrence.
Reference: Clarke T, Galaal K, Bryant A, Naik R. Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev. 2014;(9):CD006119.
Question 5
Answer
B. Fertility sparing surgery and resection of residual disease. Surgery is the primary treatment of borderline epithelial tumors including standard ovarian cancer debulking surgery or fertility sparing surgery.
Reference: Harter P, Gershenson D, Lhomme C, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian tumors of low malignant potential (borderline ovarian tumors). Int J Gynecol Cancer. 2014;24(9 suppl 3):S5-S8.
This study presents a male breast cancer case with a germline BRCA2 mutation and discusses the epidemiologic, pathologic, and clinical characteristics along with treatment and follow-up recommendations in view of our recent understanding of the disease.
Oncology Peer Review On-The-Go: COVID-19, Cancer, and the Potential of mRNA Vaccines
March 30th 2021Mehmet Sitki Copur, MD, discussed his article in the Journal ONCOLOGY® focusing on COVID-19, messenger RNA vaccines, and the excitement surrounding its integration into the future of cancer treatment.
ABSTRACT: Breast metastasis from extramammary malignancy is rare, with a reported incidence rate of 0.4% to 1.3% in the published literature. The primary malignancies that most commonly metastasize to the breast are leukemia, lymphoma, and malignant melanoma. Here, we report a very rare case of metastatic EGFR-mutated non–small cell lung cancer (NSCLC) in the breast detected by screening mammography. The patient had initially been diagnosed with a clinical stage IIIA NSCLC and had been treated with neoadjuvant chemoradiation followed by curative-intent surgery. Several interesting aspects of the case, along with a discussion of evolving adjuvant and frontline metastatic management options in EGFR-mutated NSCLC, will be presented.
Locally Advanced Gastrointestinal Stromal Tumor in a 33-Year-Old Woman Seeking to Conceive
ABSTRACT Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. They commonly present with nonspecific symptoms and thus are often discovered incidentally. They are best identified by CT scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. Several risk stratification classification systems have been developed based on tumor size, mitotic rate, location, and perforation. Traditional chemotherapy and radiation therapy have been very ineffective, making surgery the mainstay of treatment. The discovery of mutations associated with these tumors has revolutionized the treatment approach. Imatinib mesylate, a selective tyrosine kinase receptor inhibitor, used as adjuvant or neoadjuvant therapy, has greatly improved the morbidity and mortality associated with GISTs. As the survival of patients has increased with the long-term use of targeted therapies, quality-of-life issues now have become much more relevant and have come to the forefront of care. We present a young woman who was successfully treated for GIST but now faces associated long-term adverse effects of imatinib, including the challenge of preserving fertility and the potential for childbearing.
