Replies to post #125652 on Biotech Values

[projectchris]

A quick search turned up the following abstract indicating that bone mets are more common than one might think in late stage gyn cancers:

I'm guessing a lot of these are asymptomatic while patient is living. Also suspect that it is possible that Ovarian cancers may not demonstrate osteoblastic activity in all cases. Hence, it could be possible metastatic lesions would not appear on bone scan.

Just speculating, as the data I seen with <1% of ovarian cancer present with bone mets came from some pretty prominent centers from 2003-2006. I will try to dig them up again. These were from living patients, and no postmortem.

I wonder how many from which you site were detected premortem?

[projectchris]

Here is an interesting Journal article.

http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2007;volume=3;issue=1;spage=34;epage=36;aulast=Tiwari



Ovarian cancer is the fourth most common type of female cancer and fifth leading cause of cancer death in women in the United States.[1] In India, the ICMR registry reports the crude incidence rate of this cancer as 4.2 per 100,000 women, making it the fourth most common malignancy in women.[2] Main route of dissemination in ovarian cancer is by transcoelomic spread and through lymphatics. Hematogenous spread is uncommon.[3],[4]

Metastasis to bones from these tumors is rare (0.1-0.12%) and is reported in a few series.[5],[6] We have registered 189 ovarian cancers in the department of radiotherapy, SGPGI, in the last 15 years and have not encountered single case of bone metastasis so far. This case was unique in presenting vertebral metastasis soon after chemotherapy.


Epithelial ovarian cancer should not be considered a disease that remains confined to the pelvis and abdomen. Like other adenocarcinomas this disease has significant potential for distant metastasis.[3] Bony metastasis from epithelial ovarian malignancies is anecdotal and has been reported rarely in literature. Mode of spread appears to be hematogenous although no definite route has been documented in literature.

In an autopsy series, Dauplat et al analyzed 336 patients of distant metastasis from ovarian cancers. Of these, four patients had bone metastasis, two of which belonged to thoracic vertebra; one to the clavicle and one had bone marrow involvement. None of the patients in this series had bone metastasis as first site of presentation. According to the authors bony metastasis is rarest to be presented as first site and median time to development ranged from 13-49 months.[3] In the present case report as well, bone involvement appears to be a part of hematogenous spread since both liver and bone were involved.

Rose et al in their autopsy series studied the metastatic pattern in 428 ovarian cancers and correlated different histologies with sites of metastasis. The incidence of bony metastasis was 0.06-0. 19% with epithelial histology. This reflects the rarity of bone involvement in this malignancy. There was no difference, however, in the spread pattern with different histological subtypes.[5]

Fadi et al did a clinico pathological audit of bone metastasis from different gynecological carcinomas. They analyzed 305 patients, of which 113 were ovarian cancers. Skeletal metastasis was seen in seven patients. Five were documented as postmortem findings and only two showed up radiologically and in premortem setting. Bone metastasis was seen in high grades tumors only. Most common site observed was thoracic vertebra, followed by clavicle and axial skeleton.[7]

In the present case too, high-grade features were documented in the TAH-BSO specimen. Lumbar vertebral involvement, which is less common than thoracic region, was seen in this case.

Rose et al had observed that presence of lymph nodes within the pelvis and para aortic regions were associated with greater incidence of bone metastasis as compared to absent lymphadenopathy i.e., 0.14% to 0.02%.[5] The present case did not have any lymph nodes yet bony secondaries developed five months following treatment.

Although there was no histological proof of spread to the vertebra but radiological and scintigraphic evidence was considered sufficient proof of dissemination to the bone. Pain palliation and growth restraint was done as one would do in any epithelial malignancy. Radiotherapy along with single agent Topotecan has been found to be effective thus far.