| Objectives:The aim of this research is to study the role of ovarian rupture during ovulation, as the possible route of metastasis of cancer cells from primary GI cancer to the ovary.Methods:Out of 689 GI cancer female patients, a total of 27 consecutive patients diagnosed with KTs of the ovary at our institution between 2006 and 2015 were retrospectively evaluated. We have categorized female of age less than 50 years as pre-menopause and those of age 50 or more as post-menopause. Only T stage of primary cancer has been used to define the advancement of the primary cancer, where T0-T2 is termed early whereas T3-T4 is termed advanced as a common sense suggest that the tumors of T3 or greater are easier to have a transcoelomic metastasis. Each clinical manifestations related with the mechanism of KT were evaluated using Pearson Chi-Square test.Results:Out of 689 females with GI cancer,594 were post-menopausal and only 95 were pre-menopausal, where 11 out of 95 but only 16 out of 594 had KT (p<0.001) suggesting significantly high incidence of KT in pre-menopausal than in post-menopausal women.466 patients had advanced T stage of primary cancer and 223 had early T stage of primary cancer, where 26 out of 466 and only 1 out of 223 patients had KT (p=0.001). Among 95 pre-menopausal women 61 had advanced T stage out of which 11 had KT where as 34 had early T stage, none of which had KT (p=0.022). Similar result was seen for 594 post-menopausal women where out of 404 with advanced T stage,15 had KT and for 190 with early T stage only 1 had KT (p=0.026); suggesting significantly high incidence of KT in patients with advanced T stage of primary cancer regardless of menopausal status. But out of 466 patients whose primary GI cancer was in advanced stage; 405 were post-menopausal and only 61 were pre-menopausal women.11 out of 61 but only 15 out of 405 women had KT (p<0.001); signifying in advanced T stage of primary cancer group, KT is significantly high in premenopausal women than in post-menopausal women. Further we compared KT in 50-60 and >60y age groups considering early post-menopausal and later post-menopausal respectively. Out of 594 post-menopausal women 143 were between age 50-60 and 451 were aged >60y.9 out of 143 had KT where as only 7 out of 451 had KT (p=0.006); signifying KT in 50-60 age group is significantly high than in >60 age group.Conclusions:The current understanding of the mechanism of Krukenberg tumor suggests three possible pathways of metastasis:lymphatic, hematogenous, and transcoelomic metastasis. Among these 3, transcoelomic spread is considered least likely in the literature. But in our comparison the incidence of KT in pre-menopausal women with advanced T stage of primary cancer compared to the incidence of KT in post-menopausal women with advanced T stage of primary cancer, the incidence of KT in pre-menopausal women with advanced primary is significantly high. This supports our hypothesis because in advanced primary cases transcoelomic spread cannot be denied and in pre-menopausal women their ovary do form a rupture wound during menstruation. Thus there may be a potential role of transcoelomic spread in the formation of KT. And we believe the rich vascularity of ovary in the pre-menopausal and early post-menopausal women and the rupture of the ovary every month during ovulation provides ovary the favorable seeding site for the free floating cancer cells to metastasize via the transcoelomic route. |
PDF Full Text Request