Ovarian cancer
Ovarian cancer
Epidemiology:
Ovarian cancer, though less prevalent in comparison to other malignancies, remains one of the leading causes of cancer-related mortality among women, with an estimated annual incidence of approximately 21,410 new cases in the United States 1. The phenomenon of spontaneous remission (SR) within this context is exceedingly rare, occurring in less than 1% of ovarian cancer cases. These occurrences of SR are often under-recognized, as many clinicians may attribute observed remission s to other causes or misdiagnosis 2. Furthermore, spontaneous remission cases often go unreported or are poorly documented, leading to a lack of comprehensive understanding about their true incidence and associated mechanisms 3.
Clinical Characteristics:
To date, eleven cases of SR involving either primary or metastatic ovarian carcinoma have been reported. These cases collectively highlight the exceptional rarity and clinical variability of SR in ovarian malignancies. Reported patient ages at the time of remission ranged from 23 to 79 years, with all cases occurring in females, consistent with the gender-specific nature of this cancer. See Table 1 below for further information.
Histological Characteristics:
Of the cases analyzed, the tumors were exclusively reported as originating from the ovary, with several exhibiting remission at metastatic sites including the peritoneum, lymph nodes, and endometrium. Instances of non-ovarian malignancies or unrelated gynecologic tumors were excluded from this dataset to maintain diagnostic precision and ensure an accurate representation of spontaneous remission in ovarian carcinoma.
Proposed Contributing Mechanisms:
Among the reported cases, proposed mechanisms included apoptosis, hormonal influences, sepsis-induced cytokines, and prosurvival factors, though several reports did not specify a cause. Overall, apoptosis, immune activation, and hormonal regulation appear to contribute to the spontaneous remission of ovarian carcinoma.
Site and Extent of Remission :
The majority of documented cases exhibited complete remission localized to the primary ovarian site, while others demonstrated remission at both primary and metastatic sites, including the peritoneum, lymph nodes, and endometrium. The longest reported remission persisted for 21 years, indicating durable disease control without therapeutic intervention. Although follow-up durations varied among reports, these findings suggest that spontaneous remission in ovarian carcinoma can occasionally result in sustained and clinically significant remission .
Table 1 Ovarian cancer SR Cases and Clinical Characteristics
Age/sex | Primary site | Remission site | Proposed mechanisms | Follow-up | |
|---|---|---|---|---|---|
32/F | Ovary | Peritoneum | Not reported | Not reported | |
23/F | Ovary | Peritoneum | Not reported | Not reported | |
26/F | Ovary | Not reported | Not reported | 8 years | |
Not reported | Ovary | Not reported | Not reported | Not reported | |
26/F | Ovary | Peritoneum | Not reported | 21 years | |
Not reported | Ovary | Not reported | Not reported | Not reported | |
49/F | Ovary | Peritoneum | Prosurvival factors | 6 months | |
26/F | Ovary | Lymph nodes | Apoptosis | 11 years 2 months | |
26/F | Ovary | Peritoneum | Apoptosis | 2 years | |
79/F | Ovary | Peritoneum | Sepsis-induced cytokines | 6 months |
References:
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- Codman EA. The Treatment of Malignant Peritonitis of Ovarian Origin. Ann Surg. 1918;68:338–346.
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- Taylor HC Jr. Studies in Clinical and Biological Evolution of Adenocarcinoma of the Ovary. J Obstet Gynaecol Br Emp. 1959;66:827–842.
- Gaudrault GL. Papillary Carcinoma of the Ovary; Report of a Case with Prolonged Dormancy and Spontaneous Remission of Metastases. N Engl J Med. 1961;264:398.
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- Morice P, Thoury A, Sabourin JC, Camatte S, Atallah D, Armand JP, Madelenat P, Duvillard P, Castaigne D. Case 2. Spontaneous remission of peritoneal implants in borderline ovarian tumor after salpingo-oophorectomy. J Clin Oncol. 2003;21(18):3536–3538. doi:10.1200/JCO.2003.12.021
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- Roelofsen T, Wefers C, Gorris MAJ, Textor JC, Massuger LFAG, de Vries IJM, van Altena AM. Spontaneous remission of ovarian carcinoma after septic peritonitis: a unique case report. Front Oncol. 2018;8:562. doi:10.3389/fonc.2018.00562
- Daley D, Padwick M, Mistry S, Malhotra V, Vikram RS, Stanciu P. Case report: Spontaneous remission of synchronous endometrial and ovarian cancers following pregnancy. Front Oncol. 2022;12:1001677. doi:10.3389/fonc.2022.1001677