Synchronous Primaries: Friday, April 17, 2009

Below is an article that Christina, who is an HIV researcher with Cornell University, received in her Medscape update shortly after I received the official diagnosis from Dr. E. This pretty clearly lays out exactly what I have, which as it turns out, is pretty rare and has better outcomes than single ovarian cancer. Finally, some relatively good news...

Synchronous Ovarian and Endometrial Cancers Linked With Better Outcomes

NEW YORK (Reuters Health) Apr 09 - Women with synchronous primary ovarian and endometrial cancers have better survival rates than women with single ovarian cancers do, according to a report in the April issue of Obstetrics & Gynecology.

"Women with synchronous tumors tend to get diagnosed at an earlier age and to have more localized disease than women with a single ovarian cancer," Dr. Elisa V. Bandera from The Cancer Institute of New Jersey, New Brunswick, told Reuters Health. "However, some women with synchronous ovarian and endometrial cancer get diagnosed at advanced stage, and they also do better than women with advanced single primary ovarian cancers."

Dr. Bandera and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) Program from 1973 to 2005 to estimate the occurrence of synchronous ovarian and endometrial cancers and to compare the survival experience of women with these synchronous cancers with that of women with single ovarian cancers.

Using the least stringent criteria, only 2.7% of women with primary epithelial ovarian cancers also had synchronous primary endometrial cancer, the authors report.

Women with synchronous cancers were more likely to be diagnosed at an early stage; more likely to have a lower ovarian tumor grade; and more likely to have endometrioid histology.
Similarly, endometrial cancers in women with synchronous ovarian cancer were more likely to be in an early stage, have lower grades, and be of endometrioid and adenocarcinoma histology.

The 5-year survival was significantly better in women with synchronous cancers (79%) than in women with single ovarian cancer (42%), the researchers note.

The survival advantage for women with synchronous cancers persisted after adjustment for age, tumor stage, year of diagnosis, and additional prognostic and treatment characteristics.

The survival benefit persisted even when analyses were restricted to women with more advanced disease.

These findings suggest that "synchronous tumors may be a different clinical entity; but we need further studies to confirm this and to improve the clinical management of these patients," Dr. Bandera said.

"We are currently planning a study with Kaiser Permanente of Northern California including a large number of cases and detailed clinical information, which will allow a more detailed investigation," Dr. Bandera added.

"Early detection of ovarian cancer remains a challenge, with most cases being diagnosed at late stage when survival rates are poor," Dr. Bandera added. "Therefore, improving our understanding of factors affecting ovarian prognosis is crucial."

Obstet Gynecol 2009;113:783-789.