Over ve Tuba Kanserleri
Özet
Jinekolojik kanserler, her yaş grubundan milyonlarca kadını etkileyen ve görülme oranları coğrafi bölge ve etnik gruplara göre değişiklik gösteren kanser türleridir. Jinekolojik kanserler ağırlıklı olarak serviks, over ve endometriyum kanserlerini içermektedir. Over kanserleri birçok histolojik alt tipten oluşur. En sık görülen alt tip olan epitelyal over kanserleri, jinekolojik kanserlerden kaynaklanan ölümlerin başlıca nedenlerindendir. Hastaların yaklaşık yarısı ileri evrelerde başvurur. Kılavuzlar genel popülasyonda over kanseri için rutin taramayı önermemektedir. Genel olarak biyopsi veya cerrahi örneklerin patolojik analizi sonrasında teşhis edilmektedir. Hastaların çoğu cerrahi sonrası sistemik tedavi almaktadır. Tuba kanserlerinin takip ve tedavisi epitelyal over kanseri ile aynı şekildedir. Hastalara nüksü işaret edebilecek pelvik ağrı, şişkinlik, erken doyma, tıkanıklık, kilo kaybı ve yorgunluk gibi belirti ve semptomlar hakkında eğitim verilmelidir. Takiplerde nüks hastalık, klinik olarak, biyokimyasal olarak ve/veya görüntüleme ile tanımlanabilir. Bu bölümde over ve tuba kanserlerinde takip parametreleri ele alınacaktır.
Gynecological cancers are malignancies affecting millions of women across all age groups, with incidence rates varying by geographical region and ethnicity. Gynecological cancers primarily include cervical, ovarian, and endometrial cancers. Ovarian cancers comprise multiple histological subtypes, with epithelial ovarian cancer being the most common. Epithelial ovarian cancers are a leading cause of death among gynecological malignancies. Approximately half of the patients present at advanced stages. Current guidelines do not recommend routine screening for ovarian cancer in the general population. Diagnosis is generally made after pathological analysis of biopsy or surgical specimens. Most patients receive systemic therapy following surgery. The management and follow-up of fallopian tube cancers are identical to those of epithelial ovarian cancers. Patients should be educated about symptoms and signs suggestive of recurrence, such as pelvic pain, bloating, early satiety, obstruction, weight loss, and fatigue. In follow-ups, recurrent disease may be identified clinically, biochemically, and/or through imaging. This section will address follow-up parameters for ovarian and fallopian tube cancers.
Referanslar
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021;71(3):209-49.
Giusti F, Martos C, Trama A, Bettio M, Sanvisens A, Audisio R, et al. Cancer treatment data available in European cancer registries: Where are we and where are we going? Frontiers in oncology. 2023;13:1109978.
Peres LC, Cushing-Haugen KL, Köbel M, Harris HR, Berchuck A, Rossing MA, et al. Invasive epithelial ovarian cancer survival by histotype and disease stage. JNCI: Journal of the National Cancer Institute. 2019;111(1):60-8.
Robboy SJ. Robboy's pathology of the female reproductive tract: Elsevier Health Sciences; 2009.
Mørch LS, Løkkegaard E, Andreasen AH, Krüger-Kjær S, Lidegaard Ø. Hormone therapy and ovarian cancer. Jama. 2009;302(3):298-305.
Ozols R. Epithelial ovarian cancer. Principles of Gynaecologic Oncology. 1992:731-81.
Wentzensen N, Poole EM, Trabert B, White E, Arslan AA, Patel AV, et al. Ovarian cancer risk factors by histologic subtype: an analysis from the ovarian cancer cohort consortium. Journal of Clinical Oncology. 2016;34(24):2888-98.
Foong KW, Bolton H. Obesity and ovarian cancer risk: A systematic review. Post reproductive health. 2017;23(4):183-98.
Faber MT, Kjær SK, Dehlendorff C, Chang-Claude J, Andersen KK, Høgdall E, et al. Cigarette smoking and risk of ovarian cancer: a pooled analysis of 21 case–control studies. Cancer causes & control. 2013;24:989-1004.
Jordan SJ, Whiteman DC, Purdie DM, Green AC, Webb PM. Does smoking increase risk of ovarian cancer? A systematic review. Gynecologic oncology. 2006;103(3):1122-9.
Jervis S, Song H, Lee A, Dicks E, Tyrer J, Harrington P, et al. Ovarian cancer familial relative risks by tumour subtypes and by known ovarian cancer genetic susceptibility variants. Journal of medical genetics. 2014;51(2):108-13.
Aarnio M, Sankila R, Pukkala E, Salovaara R, Aaltonen LA, De La Chapelle A, et al. Cancer risk in mutation carriers of DNA‐mismatch‐repair genes. International journal of cancer. 1999;81(2):214-8.
Lilyquist J, LaDuca H, Polley E, Davis BT, Shimelis H, Hu C, et al. Frequency of mutations in a large series of clinically ascertained ovarian cancer cases tested on multi-gene panels compared to reference controls. Gynecologic oncology. 2017;147(2):375-80.
Kurian AW, Hughes E, Handorf EA, Gutin A, Allen B, Hartman A-R, et al. Breast and ovarian cancer penetrance estimates derived from germline multiple-gene sequencing results in women. JCO Precision Oncology. 2017;1:1-12.
Norquist BM, Harrell MI, Brady MF, Walsh T, Lee MK, Gulsuner S, et al. Inherited mutations in women with ovarian carcinoma. JAMA oncology. 2016;2(4):482-90.
Song H, Cicek MS, Dicks E, Harrington P, Ramus SJ, Cunningham JM, et al. The contribution of deleterious germline mutations in BRCA1, BRCA2 and the mismatch repair genes to ovarian cancer in the population. Human molecular genetics. 2014;23(17):4703-9.
Schorge JO, Modesitt SC, Coleman RL, Cohn DE, Kauff ND, Duska LR, et al. SGO White Paper on ovarian cancer: etiology, screening and surveillance. Gynecologic oncology. 2010;119(1):7-17.
Havrilesky LJ, Dinan M, Sfakianos GP, Curtis LH, Barnett JC, Van Gorp T, et al. Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass. Journal of the National Cancer Institute. 2015;107(1):dju322.
Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al. Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. Jama. 2011;305(22):2295-303.
Pinsky PF, Yu K, Kramer BS, Black A, Buys SS, Partridge E, et al. Extended mortality results for ovarian cancer screening in the PLCO trial with median 15 years follow-up. Gynecologic oncology. 2016;143(2):270-5.
Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. The Lancet. 2016;387(10022):945-56.
Pinsky PF, Zhu C, Skates SJ, Black A, Partridge E, Buys SS, et al. Potential effect of the risk of ovarian cancer algorithm (ROCA) on the mortality outcome of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial. International journal of cancer. 2013;132(9):2127-33.
Marchetti C, De Felice F, Perniola G, Lecce F, Vertechy L, Monti M, et al. Screening program in ovarian cancer: A logical step in clinical management? A meta-analysis. Current Problems in Cancer. 2018;42(2):235-40.
Jacobs IJ, Skates SJ, MacDonald N, Menon U, Rosenthal AN, Davies AP, et al. Screening for ovarian cancer: a pilot randomised controlled trial. The Lancet. 1999;353(9160):1207-10.
Atri M, Alabousi A, Reinhold C, Akin EA, Benson CB, Bhosale PR, et al. ACR appropriateness criteria® clinically suspected adnexal mass, no acute symptoms. Journal of the American College of Radiology. 2019;16(5):S77-S93.
Sadowski E, Rockall A, Maturen K, Robbins J, Thomassin-Naggara I. Adnexal lesions: imaging strategies for ultrasound and MR imaging. Diagnostic and interventional imaging. 2019;100(10):635-46.
Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, et al. ACR Appropriateness Criteria® staging and follow-up of ovarian cancer. Journal of the American College of Radiology. 2018;15(5):S198-S207.
Yamamoto Y, Oguri H, Yamada R, Maeda N, Kohsaki S, Fukaya T. Preoperative evaluation of pelvic masses with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography. International Journal of Gynecology & Obstetrics. 2008;102(2):124-7.
Risum S, Høgdall C, Loft A, Berthelsen AK, Høgdall E, Nedergaard L, et al. The diagnostic value of PET/CT for primary ovarian cancer—a prospective study. Gynecologic oncology. 2007;105(1):145-9.
Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, et al. Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nuclear medicine communications. 2007;28(8):589-95.
Juretzka MM, Barakat RR, Chi DS, Iasonos A, Dupont J, Abu-Rustum NR, et al. CA125 level as a predictor of progression-free survival and overall survival in ovarian cancer patients with surgically defined disease status prior to the initiation of intraperitoneal consolidation therapy. Gynecologic oncology. 2007;104(1):176-80.
Krivak TC, Tian C, Rose GS, Armstrong DK, Maxwell GL. A Gynecologic Oncology Group Study of serum CA-125 levels in patients with stage III optimally debulked ovarian cancer treated with intraperitoneal compared to intravenous chemotherapy: an analysis of patients enrolled in GOG 172. Gynecologic oncology. 2009;115(1):81-5.
Hawkins R, Roberts K, Wiltshaw E, Mundy J, Fryatt I, McCREADY V. The prognostic significance of the half‐life of serum CA 125 in patients responding to chemotherapy for epithelial ovarian carcinoma. BJOG: An International Journal of Obstetrics & Gynaecology. 1989;96(12):1395-9.
Karam AK, Karlan BY. Ovarian cancer: the duplicity of CA125 measurement. Nature reviews Clinical oncology. 2010;7(6):335.
Hawkins R, Roberts K, Wiltshaw E, Mundy J, McCready V. The clinical correlates of serum CA125 in 169 patients with epithelial ovarian carcinoma. British journal of cancer. 1989;60(4):634-7.
Vergote I, Rustin GJ, Eisenhauer EA, Kristensen GB, Pujade-Lauraine E, Parmar MK, et al. Re: new guidelines to evaluate the response to treatment in solid tumors [ovarian cancer]. Journal of the National Cancer Institute. 2000;92(18):1534-5.
Ledermann J, Raja F, Fotopoulou C, Gonzalez-Martin A, Colombo N, Sessa C. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology. 2018;29(Suppl 4):iv259-iv.
Bristow RE, Chang J, Ziogas A, Anton-Culver H. Adherence to treatment guidelines for ovarian cancer as a measure of quality care. Obstetrics & Gynecology. 2013;121(6):1226-34.
Erickson BK, Martin JY, Shah MM, Straughn Jr JM, Leath III CA. Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center. Gynecologic oncology. 2014;133(2):142-6.
Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology. 2016;34(28):3460-73.
Van Meurs HS, Tajik P, Hof MH, Vergote I, Kenter GG, Mol BWJ, et al. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. European journal of cancer. 2013;49(15):3191-201.
Tew WP, Lacchetti C, Ellis A, Maxian K, Banerjee S, Bookman M, et al. PARP inhibitors in the management of ovarian cancer: ASCO guideline. Journal of Clinical Oncology. 2020;38(30):3468-93.
Rizzo S, Avesani G, Panico C, Manganaro L, Gui B, Lakhman Y, et al. Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group. European Radiology. 2025:1-11.
