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International Journal of Clinical Therapeutics and Diagnosis (IJCTD)    IJCTD-2332-2926-01-004e

Synchronous Primary Endometrial and Ovarian Cancers: Pathogenesis, Treatment and Prognosis



Georgios Androutsopoulos1*, Georgios Decavalas1

1. Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion, Greece.

*Corresponding Author

Georgios Androutsopoulos MD,
Lecturer, Department of Obstetrics and Gynecology,
University of Patras, Medical School,
Rion 26504, Greece.
Tel: +306974088092
E-mail: androutsopoulos@upatras.gr

Received: August 02, 2014; Published: August 27, 2014.

Citation: Androutsopoulos G, Decavalas G (2014) Synchronous Primary Endometrial and Ovarian Cancers: Pathogenesis, Treatment and Prognosis. Int J Clin Ther Diagn. 2(4e), 1-2. doi: dx.doi.org/10.19070/2332-2926-140005e

Copyright: Georgios Androutsopoulos © 2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.


Synchronous primary cancers are relatively uncommon in general population.[1] Only 0.5-1.7% of women with gynecological malignancies, have synchronous primary cancers of the female genital tract.[2-6] Among them, the most common combination is synchronous primary endometrial and ovarian cancers.[2,3,5]

The pathogenesis of synchronous primary endometrial and ovarian cancers, remains unclear [5,7] The theory of the secondary Müllerian system has been proposed to explain the development of multiple primary cancers of the female genital tract.[5-9] According to this theory, epithelia of the female genital tract simultaneously respond to a carcinogenic stimulus.[7,8]

Perhaps those patients have a more fragile genome and prior genetic damage may predispose to the development of synchronous primary cancers of the female genital tract.[7,10-14] Thus, embryologic, hormonal or other phenomena may be associated with the development of synchronous primary endometrial and ovarian cancers.[5-10,12]

Systematic surgical staging is the treatment of choice, for most patients with synchronous primary endometrial and ovarian cancers[2,3,5,15-21] More specifically, systematic surgical staging in those patients includes: total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy, complete resection of all disease, biopsy of any suspected lesion and pelvic washings. [1,2,5,15-19,21-23]

It is obvious that systematic surgical staging allows a more clear decision for stage related postoperative adjuvant treatment. [1,17,18] Appropriate surgical staging facilitates targeted therapy that minimize the morbidity of overtreatment (radiation injury, chemotherapy toxicity), the effects of undertreatment (recurrent disease, increased mortality) and maximize survival.[24]

Pelvic and para-aortic lymphadenectomy has diagnostic, therapeutic and prognostic value.[1,22,23] It defines accurately the extent of disease and determines the prognosis of patients.[1] Undoubtedly, it is necessary for the identification of patients with stage III disease. [22,23] The extension of pelvic and para-aortic lymphadenectomy (more than 14 lymph nodes) is an independent risk factor for postoperative complications.[17,18,25-27] Especially in elderly patients and in patients with relevant comorbidities (obesity, diabetes, coronary artery disease), morbidity must be carefully weighed against any survival advantage.[24,28,29]

The significance of postoperative adjuvant treatment in patients with synchronous primary endometrial and ovarian cancers, remains controversial and needs further investigation.[16,20,30] In most cases, postoperative adjuvant treatment should be individualized according to the risk of relapse of each primary cancer.[30,31] Moreover, the treatment of one primary cancer does not compromise the treatment of the other primary cancer.[32]

Especially in patients with unfavorable histologic types, high grade and/or advanced stage disease, required postoperative adjuvant treatment tailored to both tumors.[3,5,15,17-21,30,32-36] More specifically, postoperative adjuvant treatment in those patients includes: radiotherapy and/or chemotherapy.[1,21,30,36]

Postoperative adjuvant radiotherapy includes: external pelvic radiotherapy and/or brachytherapy. It is the appropriate treatment for high risk primary endometrial cancer.[1,17,18]

Postoperative adjuvant chemotherapy is the appropriate treatment for advanced stage primary endometrial and ovarian cancers.[31] The most active chemotherapeutic agents for those patients, are:taxanes, anthracyclines and platinum compounds.[20,21]

Prognostic factors for synchronous primary endometrial and ovarian cancers are: age, grade of endometrial cancer, stage of ovarian cancer and adjuvant treatment.[35,37,38] Patients with synchronous primary endometrial and ovarian cancers have 5-year overall survival 85.9% and 10 year overall survival 80.3%.[16] However, patients with synchronous primary endometrial and ovarian cancers endometrioid type have a better overall survival compared with patients with non-endometrioid or mixed histologic types. [39] Moreover, patients with synchronous primary endometrial and ovarian cancers have better overall survival compared with patients with single primary ovarian cancer.[30,32,35,39]

The reason for the better overall survival of patients with synchronous primary endometrial and ovarian cancers, is not intuitively obvious.[16] Perhaps favorable prognosis related with the detection of patients at early stage and low grade disease.[3,5,11-13,15-34,40]


References


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