A Rarity In Breast Disease: Metastaticovarian Carcinoma To The Breastmimicking Inflammatory Breast Cancer
Ben Fauzi El Attrache1, Camryn Highsmith2, Bradley Gluck3 Alan Heimann4 and Edna Kapenhas5*
1 Department of Surgery at Southampton Hospital, NY, USA
2Junior at Southampton High School, NY, USA
3Department of Diagnostic Radiology at Southampton Hospital, NY, USA
4Department of Pathology at Stony Brook University Hospital NY, USA
5Department of Surgery at Southampton Hospital, NY, USA
Department of Surgery at SouthamptonHospital Community Surgery Program:Southampton Hospital 240 Meeting HouseLane, Southampton, NY 11968, USA.Tel: 516-528-2130E-mail:
Received date: June 05, 2017 Accepted date: June 19, 2017 June 25, 2017
Citation: Attrache BFE, Highsmith C,Gluck B, et al. A Rarity in Breast Disease: Metastatic Ovarian Carcinoma to the Breast Mimicking Inflammatory Breast Cancer. J Univer Surg. 2017, 5:3. doi: 10.21767/2254-6758.100081
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Metastatic ovarian cancer Extra mammary metastasis Inflammatory breast cancer
Figure 1: Left Breast sonogram showing a 1.7 cm mass in left breast at 4:00, 3cm from the nipple.
Figure 2: MRI Left Breast showing enhancement of the left outer breast consisting of multiple conglomerate masses with extension to the nipple areolar complex spanning 11.8 × 6.0 × 8.2 cm. Skin thickening with edema is present. Enlargement of internal mammary vasculature is seen.
|Papillary Serous Adenocarcinoma|
Limited Screening And Treatment Approaches
Nowadays, the most common tools used to screen for ovarian cancer are: pelvic exam, transvaginal ultrasound, CA-125 test and other blood tests. Most healthcare experts agree these current detection tools are not successful enough for accurately identifying and diagnosing ovarian cancer. This is due to the fact that research studies have yet to discover reliable screening methods, unless a woman is at high risk of ovarian cancer due to a family history of the disease with predisposed BRCA1 and BRCA2 genes. Moreover, there are limited treatment approaches to ovarian cancer when it has reached stage III or stage IV. At the point, the cancer may be incurable.
When diagnosed with ovarian cancer, it is important to be proactive. Genetic testing is highly recommended when striving to identify the risks associated with ovarian cancer. So that will allow the individual to make an informed decision about what to do next, whether to do something to prevent further development of ovarian cancer, such as lifestyle modification, the use of the birth control pill, or to consider risk-reducing surgery. So those are some of the options that are out there. But those decisions are better made in the context of genetic counseling said Dr. Kunle Odunsi.
How Does Chemotherapy Treat Cancer
In treating cancer, chemotherapy is the use of drugs that kill fast-growing cells. These are non-discriminatory killersthey kill any fast-growing cells in the body, not just cancer cells.
Traditional or standard chemotherapy treats cancer by interfering with cancer cells ability to grow and divide. The drugs do so by disrupting their cycle of cell division.
Cell division is when the cells make copies of their chromosomes and split into two. Many molecules, proteins, and genes work together to divide the cell into two, so there are many ways to disrupt this cycle.
In many cases, these drugs are applied to the entire body, called systemic treatment. Systemic chemotherapy can kill cancer cells that have already spread that doctors havent found yet. But it can also cause widespread side effects, affecting your digestive tract, immune system, hair, skin, and nails.
Doctors use chemotherapy to treat cancer in three ways:
- Cure cancer: Kill as much as possible, so it goes away and doesnt come back
- Control cancer: Shrink the tumors or stop them from growing and spreading
- Slow cancer: Slow the growth of cancers and reduce their symptoms
Chemotherapy drugs can be administered either through a tube that delivers liquid medicine into the blood or in pill form.
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Family History Of Breast Cancer
Ovarian cancer can run in families. If your mother, sister, or daughter has the disease, you have a greater chance of developing it, too. Likewise, if you have just one close relative with ovarian cancer, your chance of getting it increases by almost three times.
If you have a strong family history of breast or ovarian cancer, your chances of getting one of those cancers go up. A strong family history means:
- More than one family member has had ovarian or breast cancer, or
- Someone in your family has had both breast and ovarian cancer, or
- More than one generation in your family has had ovarian or breast cancer
Your risk increases because these cancers can be caused by a change in certain genes – BRCA 1 AND BRCA 2 – that is passed on throughout a family. Genetic testing can tell if you have these genetic mutations. There are also genes that have not yet been identified but undoubtedly play a role in inherited breast cancers.
Epidemiology And Risk Factors
Epithelial ovarian cancer is the leading cause of death among the gynecologic cancers and the fourth leading cause of cancer death in women in the United States . Incidence rates vary considerably but are highest in industrialized countries with the exception of Japan. Ovarian cancer is one-tenth as common as breast cancer but three times as lethal. The high mortality rate is generally attributed to its occult development, resulting in advanced, widespread disease occurring in approximately 75% of women at diagnosis. The overall 5-year survival rate of ovarian cancer is about 30%. However, in about 25% of women, disease is confined to the ovary , and 5-year survival is more than 90%, compared with 10% for women with advanced disease . The incidence of epithelial ovarian cancer is age related and is generally a disease of postmenopausal women. Malignant epithelial tumors are most common between the ages of 40 and 60 years.
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Can You Be Fully Cured Of Ovarian Cancer
Around two in ten women with advanced-stage ovarian cancer are effectively cured and survive at least 12 years after the treatment as per the research. Your response to cancer therapy and chances for a cure depend on the type and the staging of ovarian cancer at the time of diagnosis.
There are more than 30 types of ovarian cancers. Only three out of these are the main types of cancer: epithelial, germ cell, and stromal. These are the three main cell types that make up the ovary.
- Epithelial cells: The type of cells that cover the surface of your ovary
- Germ cells: These cells make your eggs
- Stromal cells: These cells hold the structure of your ovary together and secrete the female hormones
Most ovarian cancer deaths are due to epithelial ovarian cancer. Approximately 80% of patients with epithelial ovarian cancer eventually die of the disease.
As per research studies, if a patient is given chemotherapy via the abdomen, then they have a greater than 50% chance to survive for the next six years. With this therapy, epithelial ovarian cancer can go into remission and recur. However, once it recurs, it is not curable and will continue to come back.
Germ cell and stromal tumors have a much better prognosis than the epithelial type. They are often curable because they are more likely to be detected at early stages.
Around two in 10 women with advanced-stage ovarian cancer are effectively cured and survive at least 12 years after the treatment.
Being Overweight Or Obese
Obesity has been linked to a higher risk of developing many cancers. The current information available for ovarian cancer risk and obesity is not clear. Obese women probably have a higher risk of developing ovarian cancer, but not necessarily the most aggressive types, such as high-grade serous cancers. Obesity may also negatively affect the overall survival of a woman with ovarian cancer.
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Metastasis To Breast From Ovarian Cancer And Primary Ovarian Cancer Concurrently Diagnosis
Moon Il Lee1, Youn Joo Jung2^, Dong Il Kim2^, Hyun-June Paik2^, Seungju Lee2^, Chang Shin Jung2^, Jee Yeon Kim3, Hyun Yul Kim2^
1 Department of Surgery, Pusan National University Yangsan Hospital, Yangsan , Department of Pathology, Pusan National University Yangsan Hospital, Yangsan , Korea
^ORCID: Youn Joo Jung 0000-0002-9647-8556 Dong Il Kim 0000-0001-9874-1322 Hyun-June Paik 0000-0002-2749-4165 Seungju Lee 0000-0001-5100-0017 Chang Shin Jung 0000-0002-2945-4191 Hyun Yul Kim 0000-0001-7717-7734.
Keywords: Ovarian cancer breast metastasis case report
Submitted Aug 03, 2020. Accepted for publication Jan 15, 2021.
What Are The Different Stages Of Ovarian Cancer
The International Federation of Gynecology and Obstetrics staging system measures the size of the tumor, how invasive it is and whether it has spread.
It is crucial to accurately determine the stage so that your care team will know how to treat you and what your prognosis will be. Surgical removal ensures accurate staging of ovarian cancer.
There are 4 stages:
- Stage 1 is limited to 1 or both ovaries.
- Stage 2 is in 1 or both ovaries and has spread elsewhere in the pelvis.
- Stage 3 is 1 or both ovaries and the lining or the lymph nodes of the abdomen.
- Stage 4 has metastasized or spread to distant organs and is considered an advanced stage of ovarian cancer.
The stages of ovarian cancer can further be broken into the following categories.
- 1A: Limited to 1 ovary
- 1B: Limited to both ovaries
- 1C: One or both ovaries contain cancer cells and
- The outer capsule broke before or during surgery
- There are cancer cells on the outside of the ovary
- Cancer cells are found in fluid washings of the abdomen
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Does Your Family Health History Put You At Risk
Collect your family health history of breast, ovarian, and other cancers and share this information with your doctor. You can inherit BRCA and other mutations from your mother or your father, so be sure to include information from both sides of your family. Include your close relatives: parents, sisters, brothers, children, grandparents, aunts, uncles, nieces, nephews, and grandchildren. If you have had breast, ovarian, or other cancers, make sure that your family members know about your diagnosis.
Tell your doctor if you have a personal or family health history of any of the following:
- Breast cancer, especially at a younger age
- Triple-negative breast cancer at age 60 or younger in women
- Cancer in both breasts
- Breast cancer in a male relative
- Ovarian, fallopian tube, or primary peritoneal cancer
- Pancreatic cancer
- Metastatic or high grade prostate cancer
- Breast, ovarian, pancreatic, or high grade prostate cancer among multiple blood relatives
- Ashkenazi or Eastern European Jewish ancestry
- A known BRCA or other cancer-related mutation in the family
You can use the My Family Health Portrait tool to collect your family health history information and share this information with your doctor and other family members. Update your family health history information on a regular basis and let your doctor know if any new cases of breast or ovarian cancer occur.
Cancers Linked To Radiation Treatment
Lung cancer: The risk of lung cancer is higher in women who had radiation therapy after a mastectomy as part of their treatment. The risk is even higher in women who smoke. The risk does not seem to be increased in women who have radiation therapy to the breast after a lumpectomy.
Sarcoma: Radiation therapy to the breast also increases the risk of sarcomas of blood vessels , bone , and other connective tissues in areas that were treated. Overall, this risk is low.
Certain blood cancers: Breast radiation is linked to a higher risk of leukemia and myelodysplastic syndrome . Overall, though, this risk is low.
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Pathological Findings Of Previous Ovarian Tumor
Macroscopic examination of the surgical specimens revealed a 65 × 55 × 45-mm, lobulated, whitish-yellow, solid mass in the right ovary an 8-mm mass on the surface of the left ovary and multiple disseminated tumors, up to 16 mm in size, in the greater omentum.
Microscopically, the right ovarian tumor displayed a complex branching papillary architecture . The epithelium lining the papillae was stratified and was composed of endocervical-type mucinous epithelium and serous epithelium . There were multiple invasive cancer foci in the stroma composed of endocervical-type mucinous epithelium displaying tubular architecture and serous epithelium displaying micropapillary architecture with psammoma bodies . Thus, the tumor was diagnosed to be seromucinous carcinoma associated with seromucinous borderline tumor. The immunohistochemical analysis supported the diagnosis .
Pathological images of the primary ovarian tumor and omental dissemination. Hematoxylin-and-eosin-stainined images of the primary tumor: loupe view , intermediate-magnification views of seromucinous borderline tumor and seromucinous carcinoma .
The left ovary was also diagnosed with seromucinous carcinoma with seromucinous borderline tumor. In the omentum, there were multiple disseminations of serous carcinoma accompanied with psammoma bodies and desmoplastic stroma .
Does Ovarian Cancer Spread Quickly
Ovarian cancer grows quickly and can progress from early stages to advanced within a year. With the most common form, malignant epithelial carcinoma, the cancer cells can grow out of control quickly and spread in weeks or months.
It is critical to pay attention to symptoms, which may help improve your chances of being diagnosed early and treated promptly. Detecting cancer while it is early will improve the prognosis. Unfortunately, 80% of ovarian cancer patients are not diagnosed until the disease has spread throughout their abdominal cavity.
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What Are The Chances Of Having Ovarian Cancer
It is estimated that ovarian cancer affects over 22,000 American women this year alone. Surgery and chemotherapy are typically used to treat ovarian cancer.
Only around 19 percent of ovarian cancer is diagnosed in the early stages, according to the National Ovarian Cancer Coalition . The chances of a woman getting ovarian cancer in her lifetime are about 1 in 75, and her lifetime chance of ovarian cancer being fatal is 1 in 100, according to the American Cancer Society.
Rapid Spreading Of The Disease
Ovarian cancer does not present any symptoms in the early stages. For this reason, over 70% of women are diagnosed with the disease at an advanced stage , when the cancer has spread within the abdomen and pelvis. At this point, the cancer can be rather difficult to treat and it is often fatal. The symptoms of ovarian cancer are not very specific. And that’s one of the major challenges that leads to the majority of women being diagnosed at a later stage. Many of the symptoms are vague, such as abdominal discomfort, frequent urination, bloating, that will cause heartburn – these are symptoms that are vague that you really cannot ascribe to ovarian cancer. So if someone has any of these symptoms, the advice is to take them seriously and seek help as soon as possible said Dr. Kunle Odunsi, Deputy Director of Rosewell Park Cancer Institute. Unfortunately, to date, there are no reliable approaches to early-stage detection of ovarian cancer.
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Referral To A Gynaecological Oncologist
If your assessment and investigations suggest ovarian cancer is a possibility, ask your doctor for an immediate referral to a gynaecological oncologist.
Gynaecological oncologists are specialists gynaecologists who treat cancers such as ovarian cancer. It has been shown that women with ovarian cancer who are treated by a gynaecological oncologist have better outcomes.
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When To Seek Medical Help
Most abdominal pain and breast tenderness symptoms will subside after a menstrual period or with time. However, you should see a doctor if your symptoms last consistently for two weeks or if your abdominal pain increases or affects your ability to eat and drink. It is important to seek medical attention immediately if these symptoms are accompanied by fever.
Make an appointment to see your physician if you also have the following symptoms:
- menstrual cramps that disrupt your life for multiple days
- bloody or brown discharge from your nipple
- changing lumps in your breast tissue
- inability to sleep or perform daily tasks due to your symptoms
- loss of control over bladder or bowel movements
- one-sided lumps in your breast tissue
- positive home pregnancy test
Your physician may recommend tests, such as a mammogram or ultrasound, to evaluate abnormalities in breast tissue.
This information is a summary. Seek medical attention if you suspect you need urgent care.
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Prognosis Of Tumors Of Low Malignant Potential
Overall survival rate at 5 years according to FIGO is shown below. Others have reported better survival rates with 5-year, 10-year, 15-year, and 20-year survival for patients with serous LMP as 97%, 95%, 92%, and 89%, respectively.
Five-year-survival rate for LMP tumors by FIGO stage are as follows:
- Stage IA – 93%
Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007 Jan 15. 109:221-7. .
Ryerson AB, Eheman C, Burton J, McCall N, Blackman D, Subramanian S, et al. Symptoms, diagnoses, and time to key diagnostic procedures among older U.S. women with ovarian cancer. Obstet Gynecol. 2007 May. 109:1053-61. .
Henderson JT, Webber EM, Sawaya GF. Screening for Ovarian Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Feb 13. 319 :595-606. . .
The FDA recommends against using screening tests for ovarian cancer screening: FDA Safety Communication. U.S. Food & Drug Administration. Available at . September 7, 2016 Accessed: June 15, 2019.
Fleischer A. Ovarian cancer. Fleischer AC, Javitt MC, Jeffrey RB Jr, et al. Clinical Gynecologic Imaging. Philadelphia, Pa: Lippincott Williams & Wilkins 1996. 107.