Ovarian metastases from gastric cancer are also known as Krukenberg’s tumor. The incidence of ovarian metastases from gastric cancer is reported to be 0.3% to 6.7%, but the incidence of metastases found at autopsy is 33% to 41%, which is much higher than clinical statistics, meaning that a significant proportion of gastric cancer patients who develop ovarian metastases are not actually found to have ovarian metastases. So, does gastric cancer need to be treated after the development of ovarian metastasis in the line and what are the treatments available?
Surgical treatment
For patients with gastric cancer who present with ovarian metastases or recurrence, physicians generally choose which treatment option to take based on the extent of the recurrence or metastases and the patient’s general condition, which usually falls into the following three categories: tumor resectable and the patient can tolerate surgery; tumor resectable, but the patient cannot tolerate surgery; and tumor unresectable.
Studies have shown that patients with gastric cancer with ovarian metastases have longer postoperative survival after resection of the metastases, with a significantly longer median survival of 17 months for patients with resected ovarian metastases compared with 3 months for patients who did not undergo surgical resection. Therefore, for patients with resectable metastases that can tolerate surgery, physicians generally consider surgical resection, whereas for patients who cannot surgically remove metastases or cannot tolerate surgery, physicians consider palliative tumor reduction surgery when symptoms of compression are present, otherwise a combination of chemotherapy-based treatment is generally indicated.
Adjuvant therapy
There is no consensus on the value of adjuvant chemotherapy in patients with ovarian metastases from gastric cancer; there is also a lack of corresponding evidence-based medical evidence for targeted therapy. Therefore, for patients with ovarian metastases from gastric cancer, physicians generally communicate with them fully before choosing the most appropriate adjuvant treatment option based on a comprehensive assessment of their physical condition and treatment wishes.
Usually, doctors will consider a combination of systemic chemotherapy and abdominal chemotherapy. Because patients with ovarian metastases from gastric cancer are not sensitive to radiotherapy, physicians do not routinely use radiotherapy, but will consider palliative radiotherapy in the presence of pelvic recurrence or bone metastases. Physicians may also consider endocrine therapy for patients with ovarian metastases from gastric cancer who are estrogen receptor-positive.
In conclusion, there is no ideal treatment strategy for patients with gastric cancer who develop ovarian metastases, and patient outcomes are often poor. Therefore, raising awareness of postoperative ovarian metastasis in gastric cancer, early detection, and aggressive radical resection have become the key to improving patient outcomes. (Contributed by Hou Wenbin, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)