Marie Claude Renaud

Metastatic Gastrointestinal Tract Cancer Presenting as Ovarian Carcinoma

OBJECTIVES (1) To assess if there has been an increase of metastatic gastrointestinal (GI) cancers presenting as ovarian cancer; (2) to determine from which areas of the GI tract malignancies are most frequently associated with ovarian metastasis; (3) to determine if a higher proportion of premenopausal women present with an ovarian tumour of GI tract origin. METHODS A retrospective chart review of women presenting to the Hôtel-Dieu de Québec Hospital from January 1993 to June 2002, searching for the diagnosis of ovarian metastasis of GI origin at the time of primary surgery. RESULTS Colon cancer accounted for 65% of the malignancies found to have ovarian metastases at the time of primary surgery, with an increased percentage of cases in recent years. Metastatic GI cancer mimicking ovarian primary was equally as frequent in pre- and postmenopausal women. The use of the cancer antigen (CA) 125/carcinoembryologic antigen (CEA) ratio may help to discriminate GI carcinoma from ovarian carcinoma. CONCLUSION Because GI tumours may present as advanced ovarian cancer, increased vigilance is required in order to make the right diagnosis and offer the best treatment.

Medical Treatment of Endometrial Carcinoma for the Premenopausal Woman Wanting to Preserve her Ability to Have Children

Abstract Endometrial cancer occurs in less than five percent of patients younger than 40 years of age. The standard treatment is to surgically stage with a hysterectomy and bilateral salpingo-oophorectomy with or without lymph node biopsies. However, some of these young patients may wish to retain their fertility potential. Well-differentiated adenocarcinoma can regress with high dose progestin therapy in 62 to 75 percent of cases. However, due to the rare occurrence of this condition in that age group, data on the optimal progestional agent, dose or duration of treatment is scarce. Caution should be exercised because of the documented occurrence of coexisting early stage endometrial carcinoma with early stage ovarian carcinoma in some of these patients. Additionally, patients have recurred after initial successful medical treatment; thus, rigorous follow-up should be performed. Physicians should thus be aware of the high dose progestin therapy option for the treatment of endometrial carcinoma in young patients wanting to preserve their fertility potential, but should also counsel these patients on the potential failure of this treatment and of the risk to worsen a potentially curable disease.

Optimal Cytoreduction With Neutral Argon Plasma Energy in Selected Patients With Ovarian and Primitive Peritoneal Cancer

INTRODUCTION Epithelial ovarian cancer (EOC) is a deadly disease for which optimal cytoreduction to microscopic disease has shown the best correlation with survival. Electrically neutral argon plasma technology is a novel surgical tool to allow aggressive cytoreduction in selected patients with EOC, primary peritoneal cancer, and tubal cancer. METHODS We conducted a prospective feasibility study of the use of neutral argon plasma technology to complete cytoreductive surgery in order to assess its ability to obtain optimal cytoreduction. RESULTS Six patients had their surgery completed with the neutral argon plasma device. None of the patients would have had optimal surgery unless the device had been available. All patients had cytoreduction to less than 5 mm to 10 mm without additional morbidity. One patient had complete cytoreduction, and two had residual disease of less than 2 mm. CONCLUSION Electrically neutral plasma argon technology is a useful technology to maximize cytoreduction and to reduce tumour burden in selected cases of EOC.

Primitive Clear Cell Carcinoma of the Vagina Treated Conservatively

BACKGROUND Clear cell adenocarcinoma of the vagina is rare tumour that is usually treated aggressively. We report a case of clear cell adenocarcinoma in which conservative treatment using new technology was successfully completed. CASE A 19-year-old woman with a biopsy proven clear cell adenocarcinoma of the vagina was referred to our clinic. There was no history of in utero diethylstilbestrol exposure. Colposcopic examination and pelvic MRI confirmed a superficial vaginal lesion. Fertility-sparing surgery, comprising radical local vaginal excision, laparoscopy, sentinel node mapping, pelvic node dissection, and omentectomy, was planned. A staging surgical procedure including a unilateral sentinel lymph node was negative. CONCLUSION Conservative surgery can be offered to a young woman presenting with this rare tumour in order to preserve fertility. Sentinel node mapping is an adjunct to the conservative surgery.

Ovarian Cancer in the Elderly Patient: Are We Doing Enough?

INTRODUCTION ovarian cancer is deadly and frequently affects older patients. In the next 20 years, the number of patients over 65 will double, and cancer, including ovarian cancer, will increase in incidence. We wished to determine whether surgical morbidity, outcomes, and survival rates were worse in the older age group than in younger patients, and whether measuring serum CA 125 could be helpful in triaging patients for surgery. METHODS we conducted a retrospective chart review of patients undergoing surgery for ovarian cancer in our institution from April 1996 to May 2006. A total of 127 patients met the inclusion criteria and were divided by age into two groups: patients aged under 70 and those aged 70 or older. We used Fisher test, two-tailed Student t test, chi-square test, and Kaplan-Meyer statistical methods to obtain survival curves and to test hypotheses and probabilities. RESULTS patients aged 70 and over were less likely to have stage I disease and to undergo optimal surgery. They also presented with more advanced disease, but this did not translate into a difference in survival rates. Serum CA 125 levels did not enable identification of older patients who would benefit from surgery. CONCLUSION older patients with ovarian cancer did not have reduced survival rates compared to younger patients, but they were more likely to undergo suboptimal surgery and to have more advanced disease. Preoperative serum CA 125 measurements did not identify patients in the older age group for whom surgery would be optimal.