Ovarian metastasis in stage IB cervical adenocarcinoma

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Kian Behbakht, MD
University of Pennsylvania Cancer Center
Last Modified: November 1, 2001

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The concept of ovarian preservation at the time of radical hysterectomy for stage IB squamous cell cancers of the cervix is well established. McCall et al. in 1957 published a series demonstrating that ovarian preservation was technically feasible and the preserved ovaries were capable of hormonal function [1]. The GOG studied ovarian metastases in 770 stage IB squamous cell carcinomas of the cervix and found only 4 patients (0.5%) with evidence of ovarian metastases, all with other extraovarian sites of tumor spread [2]. Given these two findings, ovarian preservation at the time of radical hysterectomy in pre-menopausal women has become accepted.

Ovarian preservation has also been practiced in the treatment of stage IB cervical adenocarcinomas, but the incidence of ovarian metastases has been postulated to be higher. In the GOG series, 121 patients with stage IB adenocarcinoma of the cervix were studied and 2 patients (1.7%) with ovarian metastases, also occurring in the presence of other extraovarian disease sites, were identified [2]. This percentage was not significantly different from the percentage of ovarian involvement from squamous cell cancers of the cervix in the same study (p=0.19 Fischer's exact test), although the number of identified cases with ovarian metastases were small [2]. The GOG study concluded that ovarian preservation was also acceptable in cervical adenocarcinomas.

Case reports and series in the literature continue to infer a higher risk of ovarian metastases from cervical adenocarcinoma. The highest incidence of ovarian metastases from stage IB cervical adenocarcinoma was reported by Tabata et al. using surgical and autopsy specimens [3]. In that study 2/26 patients (7.7%) with IB tumors were identified as having ovarian metastases. In the same study 22/77 (17.4% ) of ovaries examined at autopsy had evidence of metastases from cervical adenocarcinoma. DiSaia et al. in 1994 reported a case of tumor recurrent in a preserved ovary of a patient with stage IB adenocarcinoma of the cervix and reviewed the literature [4]. They concluded that increased awareness of the possibility of ovarian metastases is prudent in the surgical approach to the treatment of cervical adenocarcinoma. Gross intraoperative inspection of the endocervical and endometrial cavities may be necessary and spread to the lower uterine segment or other evidence of extrauterine spread may indicate the need for bilateral salpingo-oophorectomy. Based on the GOG series, routine bilateral salpingo-oophorectomy at the time of radical hysterectomy for cervical adenocarcinoma is not warranted.

References:

1 McCall, M. L., Keaty, E. C., and Thompson, J. D. Conservation of ovarian tissue in the treatment of carcinoma of the cervix with radical surgery, Am. J. Obstet. Gynecol 75, 590-605 (1958).

2 Sutton, G. P., Bundy, B. N., Delgado, G., Sevin, B., Creasman, W. T. et al. Ovarian metastases in stage IB carcinoma of the cervix: A Gynecologic Oncology Group study, Am. J. Obstet. Gynecol. 166, 50-53 (1992).

3 Tabata, M., Inchoe, K., Sakuragi, N., Shiina, Y., Yamaguchi, T. et al. Incidence of ovarian metastases in patients with cancer of the uterine cervix. Gynecol. Oncol 28:255-261 (1986).

4 Grosebeck, P., Heppard, M.C. S., DiSaia, P. J. Metasatses from a stage IB cervical adenocarcinoma in a transposed ovary: A case report and review of the literature. Gynecol Oncol. 55:469-472 (1994).


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