Metastatic gastric cancer to the female genital tract

Abstract

Abstract. Metastases to the female genital tract from gastric cancer are rare, but they significantly worsen the prognosis of such patients. The potential routes for metastasis to the female genital tract from gastric cancer include hematogenous spread, lymphatic spread and surface implantation. The rate of lymphatic metastasis to the ovary from gastric cancer has been reported to be higher compared with that from colorectal cancer. Uterine or Fallopian tube metastases are usually secondary to ovarian metastases, which are typically identified prior to the detection of gastric cancer in half of all synchronous cases, with complaints of abdominal distention, pain, palpable mass, or abnormal uterine bleeding. The prognosis of patients with female genital tract metastases from gastric cancer is extremely poor, and is worse compared with that of other primary sites, such as the breast and colorectum. In the past, surgical intervention in such patients consisted mainly of palliative resection to relieve the symptoms associated with a sizeable pelvic mass. However, recent retrospective studies based on a relatively small number of patients have reported that surgical tumor debulking plus chemotherapy may improve the prognosis of patients with metastatic ovarian cancer originating from gastric cancer.

A case of Krukenberg tumor, eight years after treatment of gastric cancer

“…Gastric cancers metastasize to the ovaries more frequently than colon cancers, though the reason for this is not fully understood. Ovarian metastases from gastric cancer have worse prognosis than metastases from other organs [9,10]. Consistent with the literature, our patient also had poor prognosis and survived 16 months after metastasis to the ovary.…”

Is a Surgical Approach Justified in Metachronous Krukenberg Tumor from Gastric Cancer? A Systematic Review

“…Of these, 1,687 papers were excluded because of not addressing the topic of this review. Finally, 29 articles were selected for full-text review, and of these, 16 more were excluded: 4 because of reporting less than 10 cases [9,10,16,17], 7 because of not dividing outcomes according to presentation of the disease (synchronous vs. metachronous) [11,14,18,19,20,21,22], 1 because of not dividing outcomes based on treatment (surgical vs. non-surgical) [23], 2 because of including patients with metastasis other than to the ovaries and peritoneum [24,25], 1 review article [13], and 1 because of redundant series from the same institute [12]. Other papers from the same institute were attentively reviewed with the aim to include them if not reporting outcomes of patients already included in other articles.…”

“…Furthermore, no separate analysis in the subgroup of patients with primary gastric cancer who underwent curative-intent gastrectomy is available. In this setting, the role of surgery in the management of mKT disease remains unexplored, with few articles reporting oncologic outcomes [12,13,14]. Furthermore, the role of chemotherapy in addition to surgical resection is unclear as well as regimens and modalities.…”

Surgical treatment of gastric carcinoma with ovarian metastases

“…The current standard treatment for patients with metastatic gastric cancer is systemic chemotherapy, however best treatment strategy for KTs from gastric cancer has not been clearly established. Usually surgeons do not remove ovarian neoplasms when KTs are diagnosed preoperatively, although surgical treatment is considered for metachronous metastases [22,23]. There are many factors, such as peritoneal carcinosis or other site of metastases, a delay in diagnosis which leads to a lower rate of resectability, poor patient tolerance for surgery, and relatively high operation-related morbidity, as well as overall dismal prognosis, that discourages surgeons from operating.…”