Increased risk of concurrent primary malignancies in patients diagnosed with a primary malignant epithelial ovarian tumor

Abstract

Ovarian cancer and second malignant neoplasms are found to occur rather frequently in the same patient. From a clinical perspective, it is important to have quantitative information on concurrent malignancies in the same year of diagnosis of the epithelial ovarian cancer. In this population-based study, we used data from the Netherlands Nationwide Network for Registry of histo-and cytopathology (PALGA) and the Netherlands Cancer Registry (NCR). Data of the ovarian cancer as well as data on previous or later cancers were obtained. Agespecific cancer rates from the NCR were used to calculate expected numbers of cancer. Between 1987 and 1993, histopathology reports were identified of 4577 patients with primary epithelial malignant or primary borderline malignant ovarian cancers and its longitudinal data. As the database may lack detailed information on histopathology, a recent sample of 789 patients diagnosed with ovarian cancer in 1996-2003 was comprehensively studied as well. In the eventual data analysis of 5366 patients, 244 cases (4.5%) of concurrent primary malignancy were reported in the same year that the malignant epithelial ovarian tumor had been diagnosed against 51 expected. The observed vs expected ratio was 4.8 and the 95% confidence interval (CI) (4.3-5.5). For cancer of the uterus/endometrium the observed vs expected ratio was 62.3 (95% CI 52.5-73.5). For skin, breast, colorectal, urinary bladder, renal and cervical cancer the ratio was also larger than unity. The elevated risk of concurrent cancer may lead to clinical screening protocols. The findings on endometrial cancer may prompt research on common etiologies and biomarkers.

The Association between Primary Endometrioid Carcinoma of the Ovary and Synchronous Malignancy of the Endometrium

“…Every record in the PALGA database contains a summary of the full pathology report and diagnostic codes similar to the Systematized Nomenclature of Medicine (SNOMED) classification of the College of American Pathologists. From the first sample of the years 1987–1993 we investigated 4577 patients and from a second sample of the years 1996–2003, a number of 789 cases [6]. Of these 5366 patients with a new malignant or borderline malignant epithelial ovarian cancer diagnosis we also obtained all the other histopathologically confirmed diagnoses of primary invasive malignancies in the endometrium if present, and earlier than, concurrently or after the ovarian tumor was diagnosed.…”

“…A strong association has first been quantified by Sheu et al [5]. More recently, Van Niekerk et al [6] calculated for ovary cancer the observed versus expected numbers of cancer in the endometrium to be a ratio of 62.3. This strong relationship prompted us to further evaluate the risk by histological subtype of the epithelial ovarian tumors.…”

Clinicopathologic Analysis With Immunohistochemistry for DNA Mismatch Repair Protein Expression in Synchronous Primary Endometrial and Ovarian Cancers

“…4,5 An association between endometrial cancer and ovarian cancer has been reported. 6 Both of these cancers are considered mechanistically linked to reproductive hormones, 7 and some of these cancers have similarities in deficient DNA mismatch repair (MMR) proteins. 8,9 Mutations of MMR genes, MLH1, MSH2, and MSH6, are associated with an autosomal dominant syndrome, Lynch syndrome (hereditary nonpolyposis colorectal cancer).…”

Why do Women With Double Primary Carcinoma of the Endometrium and Ovary Have a Favorable Prognosis?

“…The gynecologists treating either ovarian or endometrial cancer, as well as the pathologists, should be fully aware of this phenomenon as both of them can make a difference in treatment and In previous studies, the prevalence of second primary endometrial carcinoma in patients with ovarian cancer varied from 2.6% to 10% (6)(7)(8)10,15). The different prevalences may be related to the selection of the populations.…”

“…In 1998, Scully et al (4) described a more extensive set of clinicopathological criteria for ovarian and endometrial carcinoma and for double primary carcinoma (see Tables, Supplemental Digital Content 1, http://links.lww.com/IJGP/A8). Studies on DPC describe a prevalence of primary carcinomas of the ovary and endometrium in 2.6%-10% of patients with ovarian carcinoma and in 3.3%-12% of patients with endometrial carcinoma (5)(6)(7)(8), accounting for 0.3%-0.9% of all gynecologic malignancies (5,(9)(10)(11). The pathogenesis of DPC is still unclear.…”