Chapter 093. Gynecologic Malignancies (Part 3)

Table 93-1 Staging and Survival in Gynecologic MalignanciesSt ageOvarian -Year5 trialEndome5 -Year x Surviv al, %Cervi -Year5Surviv al, %Surviv al, %0——Carcin oma in situ 001IConfined9Confine8Confin8to ovary0d tocorpus9ed to uterus5IIConfined to pelvis 07 corpus cervixInvolves and 08 sInvade beyond 56uterus but not to pelvic wallIIIIntraabdo minal spread 5–201Extends outside the 03Exten3ds to pelvic 5 wall and/oruterus but not outside the true pelvislower third of vagina, orhydronephros isIVSpread outside abdomen –51Extends outside the true pelvis involves bladder rectum or the or9Invade ...
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Chapter 093. Gynecologic Malignancies (Part 3) Chapter 093. Gynecologic Malignancies (Part 3) Table 93-1 Staging and Survival in Gynecologic Malignancies St Ovarian 5 Endome 5 Cervi 5age -Year trial -Year x -Year Surviv Surviv Surviv al, % al, % al, % 0 — — Carcin 1 oma in situ 00 I Confined 9 Confine 8 Confin 8 to ovary 0 d tocorpus 9 ed to uterus 5II Confined 7 Involves 8 Invade 6 to pelvis 0 corpus and 0 s beyond 5 cervix uterus but not to pelvic wallIII Intraabdo 1 Extends 3 Exten 3 minal spread 5–20 outside the 0 ds to pelvic 5 uterus but not wall and/or outside the true lower third of pelvis vagina, or hydronephros isIV Spread 1 Extends 9 Invade 7 outside abdomen –5 outside the true s mucosa of pelvis or bladder or involves the rectum or bladder or extends rectum beyond the true pelvis Prognosis in ovarian cancer is dependent not only on stage but on the extentof residual disease and histologic grade. Patients presenting with advanced diseasebut left without significant residual disease after surgery have a median survival of39 months, compared to 17 months for those with suboptimal tumor resection. If initial surgery does not produce minimal residual disease, a secondcytoreductive surgery has been used after the first three cycles of chemotherapy; inone trial it was associated with a 6-month improvement in median duration ofsurvival. Another randomized trial where more aggressive debulking surgery wasinitially carried out was unable to confirm this benefit. Prognosis of epithelial tumors is also highly influenced by histologic gradebut less so by histologic type. Although grading systems differ amongpathologists, all grading systems show a better prognosis for well- or moderatelydifferentiated tumors than for poorly differentiated histologies. Estimated 5-yearsurvivals for patients by tumor grade are: well-differentiated, 88%; moderatelydifferentiated, 58%; poorly differentiated, 27%. The prognostic significance of pre- and postoperative CA-125 levels isuncertain. CA-125 levels generally reflect volume of disease, and high levelsusually indicate unresectability and a poorer survival. Postoperative levels, ifelevated, usually indicate residual disease. The rate of decline of CA-125 levelsduring initial therapy or the absolute level after one to three cycles ofchemotherapy correlates with prognosis but is not sufficiently accurate to guideindividual treatment decisions. Even when the CA-125 level falls to normal aftersurgery or chemotherapy, second-look laparotomy identifies residual disease in60% of women. Genetic and biologic factors may influence prognosis. Increased tumorlevels of p53 are associated with a poorer prognosis in advanced disease.Epidermal growth factor receptors in ovarian cancer are associated with a decreasein disease-free survival, but the increased expression of HER-2/neu has givenconflicting prognostic results. HER-2/neu is overexpressed in 20% of ovariancancers, and responses have been seen to trastuzumab in this subset of patients. Ovarian Cancer: Treatment The selection of therapy for patients with epithelial ovarian cancer dependson the stage, extent of residual tumor, and histologic grade. In general, patients areconsidered in three separate treatment groups: (1) those with early (stages I and II)ovarian cancer and micro ...