Zusammenfassung
Etwa 25% der Ovarialkarzinome werden im FIGO-Stadium I, etwa 7% im Stadium IIA diagnostiziert. Die Verdachtsdiagnose eines Ovarialkarzinoms macht immer eine operative Abklärung mit histologischer Diagnosesicherung durch Laparotomie oder evtl. Laparoskopie notwendig, da es präoperativ unmöglich ist, mit halbwegs akzeptabler Sicherheit abzuschätzen, dass es sich um ein Frühstadium eines Ovarialkarzinoms handelt. Der Nachweis eines einzigen positiven Lymphknotens bedeutet, dass die Erkrankung einem FIGO-Stadium IIIc zuzuordnen ist. Im klinischen Stadium I oder II liegt in 31% tatsächlich ein höheres Stadium vor, da sich intraoperativ Metastasen im Omentum majus, Peritoneum oder den Lymphknoten finden. Die Primäroperation umfasst ein operatives Staging per Abdominallängsschnitt und eine Radikaloperation mit dem Ziel der Feststellung des Ausmaßes der Erkrankung sowie einer primären maximalen Tumorreduktion im Becken und Abdomen einschließlich pelviner und paraaortaler Lymphadenektomie. Ungünstige Prognosefaktoren beim FIGO-Stadium I sind v. a. eine intraoperative Kapselruptur und ein Grading G3.
Abstract
About 25% and 7% of ovarian cancer patients are diagnosed as having FIGO stage I or IIA disease, respectively. If the suspicion of ovarian cancer exists, operative exploration and histologic confirmation are necessary. It is almost never possible to preoperatively diagnose ovarian cancer at an early stage. For example, if only one positive lymph node in the paraaortic region is diagnosed at final histology, the patient will be allocated to stage IIIC disease. In stages I and II disease in which ovarian cancer is limited to the pelvis, accurate surgical staging leads to upstaging of the disease to stage III in 31% of cases because of subclinical metastases in the greater omentum, the peritoneum, and/or retroperitoneal lymph nodes. Primary surgery comprises operative staging via midline laparotomy and radical surgery with the intent to accurately diagnose the extent of the disease and to resect all visible disease in the pelvis and abdomen, including a pelvic and paraaortic lymphadenectomy. Unfavorable prognostic factors in FIGO stage I disease mainly include intraoperative rupture of the capsule of the tumor as well as tumor grading of G3.
Literatur
Bell J, Brady M, Young R et al. (2006) Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol 102: 432–439
Bolis G, Colombo N, Pecorelli S et al. (1995) Adjuvant treatment for early epithelial ovarian cancer: results of two randomised clinical trials comparing cisplatin to no further treatment or chromic phosphate (32P). Ann Oncol 6: 887
Burghardt E, Girardi F, Lahousen M et al. (1991) Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecol Oncol 40: 103–106
Maggioni A, Benedetti Panici P, Dell’Anna T et al. (2006) Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer 95: 699–704
Morice P, Wicart-Poque F, Rey et al. (2001) Results of conservative treatment in epithelial ovarian carcinoma. Cancer 92: 1412–2418
Petru E, Lahousen M, Tamussino K et al. (1994) Lymphadenectomy in stage I ovarian cancer. Am J Obstet Gynecol 170: 656–662
Petru E, Kurschel S, Walsberger K et al. (2003) Can bowel endoscopy predict colorectal surgery in patients with an adnexal mass? Int J Gynecol Cancer 13: 292–296
Schelling M, Braun M, Kuhn W et al. (2000) Combined transvaginal B-mode and color Doppler sonography for differential diagnosis of ovarian tumors: results of a multivariate logistic regression analysis. Gynecol Oncol 77: 78–86
Schueler J, Trimbos B, Hermans J et al. (1998) The yield of surgical staging in presumed early stage ovarian cancer: Benefits or doubts? Int J Gynecol Cancer 8: 95–102
Swart A (2007) Long-term follow-up of women enrolled in a randomized trial of adjuvant chemotherapy for early stage ovarian cancer (ICON 1). J Clin Oncol [Suppl 18] 25: 276s
Trimbos B, Vergote I, Bolis G et al. (2003) Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer – adjuvant chemotherapy in ovarian neoplasm trial. J Natl Cancer Inst 95: 113–125
Vergote I, Brabanter J, Fyles A et al. (2001) Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357: 176–182
Young R, Decker D, Wharton et al. (1983) Staging laparotomy in early ovarian cancer. JAMA 250: 3072–3076
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Petru, E., Benedicic, C., Kimmig, R. et al. Frühes Ovarialkarzinom (FIGO Stadium I–IIA). Onkologe 14, 1130–1139 (2008). https://doi.org/10.1007/s00761-008-1472-4
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DOI: https://doi.org/10.1007/s00761-008-1472-4