Ovarian Metastasis from Colorectal Adenocarcinoma

Abstract

Introduction Ovarian metastases of gastrointestinal origin, also called Krukenberg tumors, have a guarded prognosis. Physicians need to look for alternatives in diagnosis and treatment for this clinical condition in order to improve the outcome of the patients. Objectives To report the experience of the authors in the treatment of these patients, and to perform a review of the literature on the epidemiology, clinical presentation, diagnosis, treatment, and prognosis for ovarian metastases from colorectal cancer. Methods We collected clinical information regarding the patients treated for ovarian metastasis from colorectal adenocarcinoma at our coloproctology service, and performed a search on the PubMed database using the terms colorectal cancer, ovarian metastasis, Krukenberg tumor and surgery. Conclusion Large abdominal tumors are the most frequent presentation of ovarian metastasis from colorectal cancer. The diagnosis is based on a histopathological analysis, levels of carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125), and immunohistochemical studies for the cytokeratin 20 (CK20), caudal-type homeobox 2 (CDX2) and vilina markers. Citoreductive surgical procedures are the most promising approach to treatment, with the highest impact on overall survival. The prognosis is negatively influenced by the extent of the metastasis, by citoreductive surgical procedures with persistence of macro- or microscopic foci of the disease, and by low scores on the general well-being index of the patient.

Romic

“…Other reports have shown that OM results in shortened survival compared with patients with only extra-ovarian metastases, and that resection of OM could result in improved overall survival. 8,44,[49][50][51] The reduced chemotherapeutic sensitivity, as well as factors mentioned above, could therefore be seen as arguments in favor of prophylactic salpingo-oophorectomy, or a metastasectomy, when OM occurs.…”

“…[48][49][50] Alternatively, when oophorectomy is not eligible, PSO could be waived and after adequate counseling prophylactic salpingectomy could be done safely during elective surgery to prevent ovarian cancer. [51][52][53] Several other disciplines already perform surgery to prevent OM. Gynecologists generally perform oophorectomies in patients operated for endometrial cancer to reduce the risk of OM which is approximately 6% in these patients.…”

“…According to different cohort studies that performed prophylactic salpingooophorectomies, this incidence varied from 0-23.5%. 37,[46][47][48][49][50][51] Our results could therefore be biased since patients with normal appearing ovaries during primary tumour resection could still have microscopically OM, or as the result of inadequate inspection of the…”

“…47 During the followup of these operated patients, the presence of anorexia, changes in stool or voiding pattern, an (palpable) abdominal mass, abdominal pain, abdominal distension, ascites, or abnormal uterine bleeding can indicate the presence of an ovarian malignancy. [48][49][50][51] If one or more of these symptoms occur, additional radiological examinations or referral to a gynecologist should be applied. Since OMs generally appear within two years after CRC diagnosis, 52,53 female CRC patients, especially premenopausal patients, may benefit from a closer follow-up performed by a gynecologist within the early (two-year) post-operative period.…”

“…Young-Fadok et al 21 Furthermore, prophylactic resection of the ovaries in CRC patients has mainly been studied in small non-randomized studies and is generally recommended only in patients with increased risk for ovarian cancer (patients that carry BRCA 1/2, MSH6, and PMC2 mutations). 15,[17][18][19][20]22,[49][50][51][52][53] Other disciplines, such as gynecology and urology, offer or routinely perform prophylactic resection of the ovaries during abdominal surgery (for endometrial and muscle-invasive bladder cancers, respectively). [54][55][56] In addition, in CRC patients, the potential prevention of ovarian malignancies, which impact disease-free and overall survival, stresses the need for 'shared decision making' regarding prophylactic surgery to improve patient satisfaction.…”