Objective: Our aim was to identify factors favoring long term survival in patients presenting with stage IV epithelial ovarian cancer.Methods: We did retrospective analysis of thirty patients with stage IV epithelial ovarian cancer diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan from 2006 to 2013. Patient’s demographics, clinical data and histopathology were abstracted from cancer registry department of our hospital. Chi-square test was used to find the association between clinic-pathological variables and long term survival. Result: All patients received chemotherapy and surgery as per ovarian cancer guidelines. Of the thirty patients, eleven patients survived greater than four years median survival was recorded as thirty five months. Absence of co-morbidities and good performance status indicated good results of therapy however did not have statistically significant impact on survival. Higher CA-125 at presentation i.e.>1000(normal range : <21 U/ml), response to initial chemotherapy, interval cytoreductive surgery and complete response after induction therapy were significantly associated with long term survival (P<0.05).Conclusion: Prognosis of patients presenting with stage IV epithelial ovarian cancer remains poor. Very high values of CA-125 (>1000) at presentation, response to initial chemotherapy, interval surgical resection and complete remission after induction therapy, appear to be significant prognostic factors for long term survival. Further studies exploring molecular profiling and immunological factors are warranted.
Objective: Our aim was to identify factors favoring long term survival in patients presenting with stage IV epithelial ovarian cancer.Methods: We did retrospective analysis of thirty patients with stage IV epithelial ovarian cancer diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan from 2006 to 2013. Patient’s demographics, clinical data and histopathology were abstracted from cancer registry department of our hospital. Chi-square test was used to find the association between clinic-pathological variables and long term survival. Result: All patients received chemotherapy and surgery as per ovarian cancer guidelines. Of the thirty patients, eleven patients survived greater than four years median survival was recorded as thirty five months. Absence of co-morbidities and good performance status indicated good results of therapy however did not have statistically significant impact on survival. Higher CA-125 at presentation i.e.>1000(normal range : <21 U/ml), response to initial chemotherapy, interval cytoreductive surgery and complete response after induction therapy were significantly associated with long term survival (P<0.05).Conclusion: Prognosis of patients presenting with stage IV epithelial ovarian cancer remains poor. Very high values of CA-125 (>1000) at presentation, response to initial chemotherapy, interval surgical resection and complete remission after induction therapy, appear to be significant prognostic factors for long term survival. Further studies exploring molecular profiling and immunological factors are warranted.
The small cell carcinoma of ovaries co-occurring with mucinous ovarian cancer is a rare event. We report a 21-years-old lady with a composite tumour comprising small cell carcinoma and mucinous carcinoma of ovaries. The incidental finding of the left ovarian cyst led to further workup and revealed a solid cystic mass in the left adnexal area pathologically proven to be mucinous ovarian carcinoma. The initial surgery was deferred upon the patient's request. After a few more cycles of chemotherapy, at the completion of surgery as per ovarian protocol, the pathological evaluation showed small cell carcinoma in the left ovary with a residual focus of mucinous carcinoma. In contrast, the right ovary also showed surface deposits of small cell carcinoma. The patient's clinical condition deteriorated very rapidly after that, and she passed away. Early recognition of small cell carcinoma in a composite tumour is critically essential for timely intervention.
Rhabdomyosarcoma is a malignancy of mesenchymal tissue origin typically occurring in childhood and adolescence, with an incidence rate of of 4.3 patients per million population per anum. Primary rhabdomyosarcoma of para-testicular origin is an infrequent condition, making up to 7% of all the cases of rhabdomyosarcoma tumors in children and adolescents. Here we describe a case of a 25 years old man with left paratesticular solid mass. He underwent left sided orchiectomy with histopathology revealing paratesticuler embryonal rhabdomyosarcoma. He underwent definitive chemo-radiotherapy and orchidopexy with complete remission and is on active surveillance for 4 years.
Objective: To determine the 5-year overall survival of all the germ cell tumour stages and to identify prognostic factors affecting advanced and metastatic disease outcomes in our institution. Study Design: Cross-sectional analytical study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from 2008 to 2013. Methodology: We analyzed the overall survival (OS) of the whole study population and sub-analyzed metastatic disease according to the International germ cell cancer group (IGCCCG), and their overall survival was calculated. Clinical, radiological, biochemical, and histopathological evaluation was used to identify risk factors determining disease outcome. Results: After analysing 186 male patients with germ cell tumours, 5-year overall survival for stages I, II, and III was 99%, 72%, and 62%, respectively. IGCCCG subgroup analysis showed that five-year overall survival for seminoma was slighter worse than non-seminoma. Five-year overall survival for reasonable risk and intermediate-risk seminoma was 68% and 46%, respectively. For non-seminoma, good, intermediate, and poor-risk categories carried five-year OS as 94%, 61%, and 49%, respectively. The presence of liver/brain metastasis, size of residual disease, primary mediastinal tumour, and tumor marker failure to decline post-chemotherapy were poor prognostic factors for metastatic disease. Conclusion: While identifying stages in germ cell tumours and classifying metastatic patients according to IGCCCG, individual factors including the location of the primary tumor, brain/ liver metastasis, a failure of tumor markers to decline less than 20% after the first chemotherapy cycle and size of residual disease are considered poor prognostic signs.
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