She had no significant medical history, including no history of hypertension and no allergies, and reported that she has been generally healthy her whole life. She had no family history of breast or ovarian cancer, but her father died of colon cancer at the age of Physical exam revealed an enlarged ovary, cul-de-sac nodularity, and a fluid wave. Her history and symptoms were suspicious for ovarian cancer; laboratory studies and imaging were ordered to confirm this diagnosis.
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Her serum creatinine was slightly elevated at 1. No suspicious lung nodules or effusion were visible on chest CT, but CT of the abdomen and pelvis showed ascites, a large pelvic mass with peritoneal thickening, omental cake, and enlarged retroperitoneal adenopathy. Frequently, patients who are ultimately diagnosed with ovarian cancer have a long duration of nonspecific symptoms such as bloating, pelvic or abdominal pain, early satiety, and urinary urgency or frequency that are minimized by the patient and dismissed by medical professionals.
Critical steps in evaluating these patients at diagnosis include documenting the extent of the disease, assessing the medical feasibility of surgical resection, and establishing the diagnosis. Once a cancer is established as being ovarian, fallopian tube, or peritoneal in origin, the goal is surgical resection to complete removal of disease.
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Following diagnosis, the patient in this case underwent an optimal debulking surgery with no visible residual disease. Pathology confirmed high-grade serous ovarian cancer in all resected specimens, including the retroperitoneal nodes. She had stage IIIC disease.
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Most patients receive adjuvant chemotherapy following surgery. Docetaxel plus carboplatin is associated with an increased risk of neutropenia; paclitaxel and carboplatin is associated with increased risk of sensory neuropathy; and dose-dense paclitaxel is associated with an increased risk of anemia and decreased quality of life. Based on toxicity profiles and patient preference, the first-line adjuvant therapy chosen for this patient was dose-dense paclitaxel and everyweek carboplatin for six cycles, although she would also have been a good candidate for IP chemotherapy.
She tolerated this therapy well and had a complete clinical response at the completion of primary therapy, although her final two cycles were associated with a 1-week delay. Following therapy, surveillance should entail frequent physical exams and CA determinations in patients for whom this will serve as a good biomarker of disease progression, such as the patient in this case. After 2 years of surveillance, this patient returned with a distended abdomen.
Imaging and biopsy were performed, and confirmed recurrent disease with a diffuse distribution. However, the diffuse distribution of her disease made a complete resection unlikely.
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Therefore, it was decided to pursue a second line of systemic therapy. Platinum-free interval is defined as the interval between the date of the last platinum dose and the date relapse is detected; this is currently the major criterion for predicting chemotherapy success at relapse, with different treatment strategies dependent on the length of the platinum-free interval. The most used combination therapies for this patient population are pegylated liposomal doxorubicin and carboplatin, paclitaxel and carboplatin, or gemcitabine and carboplatin.
In the phase III CALYPSO trial, patients with platinum-sensitive recurrent ovarian cancer were randomized to receive either carboplatin plus pegylated liposomal doxorubicin or carboplatin plus paclitaxel. Based on these data, the patient in this case began treatment with pegylated liposomal doxorubicin and carboplatin, which produced an initial complete response. She completed five cycles of therapy.
The patient in this case unfortunately progressed just 3 months after completing her second-line therapy with pegylated liposomal doxorubicin and carboplatin. At this second recurrence, she continued to have a good performance status and measurable disease, while having a low probability to respond to platinum reintroduction.
Treatment of secondary recurrence Eventually, resistance to platinum-based chemotherapy occurs in nearly all patients with recurrent ovarian cancer.
In addition to standard chemotherapy, patients with ovarian cancer recurrence may also be treated with a biologically targeted agent. Conflicts of Interest The authors declare no conflicts of interests. References 1. Tan D. Mechanisms of transcoelomic metastasis in ovarian cancer. Lancet Oncol. Kenny H. Use of a novel 3D culture model to elucidate the role of mesothelial cells, fibroblasts and extra-cellular matrices on adhesion and invasion of ovarian cancer cells to the omentum.
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Ovarian carcinoma spheroids disaggregate on type I collagen and invade live human mesothelial cell monolayers. Disaggregation and invasion of ovarian carcinoma ascites spheroids.
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Ovarian cancer development and metastasis. Elloul S. Expression of E-cadherin transcriptional regulators in ovarian carcinoma. Virchows Arch. Aguilar-Gallardo C.
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Mesothelial cells promote early ovarian cancer metastasis through fibronectin secretion.
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Casey R. Beta 1-integrins regulate the formation and adhesion of ovarian carcinoma multicellular spheroids. Iwanicki M. Ovarian cancer spheroids use myosin-generated force to clear the mesothelium. Cancer Discov. Landen C.
officegoodlucks.com/order/17/3917-como-localizar-a.php Tumor-selective response to antibody-mediated targeting of alphavbeta3 integrin in ovarian cancer. Shield K. Alpha2beta1 integrin affects metastatic potential of ovarian carcinoma spheroids by supporting disaggregation and proteolysis. Symowicz J. Engagement of collagen-binding integrins promotes matrix metalloproteinasedependent E-cadherin ectodomain shedding in ovarian carcinoma cells. Stoeck A.