Ovarian metastasis in carcinoma of the uterine cervix
Introduction
Although concurrent chemoradiotherapy results in a good outcome for patients with cervical cancer [1], [2], exposure to radiation can lead to early ovarian failure [3]. In the literature, radiation doses of less than 3 Gy to the ovary led to ovarian failure in 11% of women, more than 3 Gy in 60% of women, and over 5 Gy were sufficient to sterilize the ovary [4]. On the other hand, surgical treatment that preserves the ovaries benefits premenopausal women with cervical cancer. Ovarian transposition is reportedly useful to avoid damage to ovaries from radiation exposure [5].
Radical hysterectomy is generally considered a therapeutic option for patients with stage Ib to IIa cervical cancer [6], whereas, in Japan, most patients with stage Ib to IIb are treated with radical hysterectomy. Many authors have proposed risk factors for ovarian metastasis in cervical cancer to facilitate the decision to preserve the ovaries during radical hysterectomy [7], [8], [9], [10], [11], [12]. However, the number of studies and size of patients population have been too small to substantiate the frequency and clinicopathologic features of ovarian metastasis. We, therefore, analyzed a large number of cervical cancer patients with stage Ib to IIb cervical cancer who underwent radical hysterectomy including bilateral salpingo-oophorectomy. To our knowledge, the present study is the largest series of patients with ovarian metastasis from cervical cancer.
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Material and methods
A total of 3471 patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib to IIb cervical cancer who underwent radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection (type III) at Hyogo Medical Center for Adults, Aichi Cancer Center Hospital, Jichi Medical School, National Defense Medical College, Saga University Hospital, and Tottori University Hospital between 1981 and 2000 were enrolled in this study. Data were collected from the
Results
The incidence of ovarian metastases is shown in Table 1. Patients with ovarian metastases were distributed as follows: 6 in stage Ib1 (3 for squamous cell carcinoma and 3 for adenocarcinoma), 12 in stage Ib2 (one for squamous cell carcinoma and 11 for adenocarcinoma), 5 in stage IIa, and 29 in stage IIb. Twenty-three patients had squamous cell carcinoma, and 29 had adenocarcinoma including adenosquamous cell carcinoma. Ovarian metastasis were more frequently observed in patients with
Discussion
A review of published studies indicated that the incidence of ovarian metastasis from uterine cervical cancer is less than 0.5% of squamous cell carcinoma and 1.4% of adenocarcinoma [13]. However, the details are not clear due to the small number of subjects studied. Toki et al. reported that one of 525 (0.19%) patients with squamous cell carcinoma and 2 of 36 (5.5%) patients with adenocarcinoma had ovarian metastasis [12]. No patients with stage Ib had ovarian metastasis. Other authors found
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