What is the growth rate of ovarian cancer tumors after ovarian removal?

Growth Rate of Ovarian Cancer Tumors After Ovarian Removal

After ovarian removal, there is still a 1-4.3% residual risk for primary peritoneal carcinoma in high-risk women, with recurrence typically occurring within 2 years of primary therapy in 75% of patients with advanced disease. 1, 2

Understanding Post-Oophorectomy Cancer Risk

• Risk-reducing bilateral salpingo-oophorectomy (RRSO) reduces ovarian cancer risk by 80-90% in BRCA mutation carriers but does not eliminate it completely 1, 3
• A residual risk for primary peritoneal carcinoma remains even after complete ovarian removal 1
• Analysis of 36 BRCA1/2 carriers who developed peritoneal carcinomatosis following RRSO showed that 86% were carriers of a BRCA1 pathogenic variant specifically 1
• Women with serous tubal intraepithelial carcinoma in their RRSO specimen have a higher risk of developing peritoneal carcinomatosis 1

Tumor Growth Patterns After Ovarian Removal

• Approximately 75% of patients with advanced ovarian cancer relapse within 2 years of primary therapy, even after complete surgical removal and chemotherapy 2
• Despite initial remission rates of 80%, the majority of advanced-stage patients experience recurrence within this timeframe 4
• Tumor growth rates can be monitored using circulating markers such as CA-125 kinetic parameters 1
• Circulating tumor cells (CTCs) and circulating tumor DNA can provide early indicators of recurrence or persistent disease 1

Factors Affecting Tumor Growth Rate

• BRCA mutation status significantly impacts tumor growth and response to treatment:
  • BRCA-mutated tumors show higher likelihood of complete/partial response to chemotherapy (100% vs 85% in wild-type) 1
  • BRCA-mutated tumors have longer platinum-free duration (18.0 vs 11.7 months) 1
• Tumor chemosensitivity is a critical factor in determining growth rate after surgical intervention 1
• The modeled CA-125 kinetic parameter (KELIM) calculated during the first 3-4 cycles of chemotherapy correlates with tumor growth rate and probability of platinum-resistant relapse 1

Monitoring for Recurrence

• Serum CA-125 assay before surgery and before chemotherapy is standard practice for monitoring tumor activity 1
• For ongoing monitoring, CA-125 measurement before each chemotherapy course and one month after the last course is recommended 1
• Human Epididymis Protein 4 (HE4) can be used as an additional marker, especially when CA-125 is not elevated 1
• Undetectable circulating tumor DNA after first-line treatment is associated with better progression-free survival 1

Prevention and Risk Reduction

• Complete removal of the fallopian tubes should be standard care during hysterectomy and/or oophorectomy, as the fallopian tube is increasingly recognized as the origin site for many high-grade serous ovarian cancers 1
• For high-risk women, screening with transvaginal ultrasound every 6 months and CA-125 blood tests is recommended, although benefits are not entirely clear 5
• The absence of reliable early detection methods and poor prognosis of advanced ovarian cancer underscore the importance of risk-reducing surgery in high-risk populations 1

Understanding the growth rate of ovarian cancer after ovarian removal is crucial for developing appropriate surveillance strategies and interventions to improve survival outcomes in affected patients.