Blogger's note: selected text referencing ovarian cancer:
Ovarian Cancer Survivors
Most ovarian cancer patients present with relatively late stage disease, and thus the overall 5-year survival rate is only 46% [1]. However, in women who survive ≥5 years following ovarian cancer, the risk for developing a second malignancy is high, with a 31% higher risk than in the general population [54]. The cancers most often seen after ovarian cancer are breast, colorectal, and bladder cancer and leukemia [55]. Breast and colon cancer are most often seen after ovarian cancer in younger women, largely because of the prevalence of genetic syndromes, such as BRCA mutation and hereditary nonpolyposis colorectal cancer (Lynch Syndrome), that predispose to these tumors and ovarian cancer [27, 29, 55]. Some rare tumors have also been associated with ovarian cancer, including biliary tract cancer and both the ocular and skin variants of malignant melanoma, and are also thought to be a result of genetic syndromes such as BRCA-2 mutation [26, 54, 56].
However, an excess risk for second malignancies has been seen in women diagnosed with primary cancer of the ovary at age 50–69 years as well, and these second cancers appear more likely to be a result of treatment. In particular, the risks for bladder, soft tissue, and bone cancers are substantially higher in women who received radiation, and these risks become most apparent ≥10 years following the initial radiation therapy [54, 57].
The risk with chemotherapy in the development of second cancers is also apparent across all age groups. The risk for the subsequent development of both AML and acute lymphocytic leukemia have been shown to be significantly higher in women following a primary diagnosis of ovarian cancer, even in women aged ≥70 years at the time of their primary diagnosis and in women who did not receive radiation [54]. Historically, this greater risk was attributed to alkylating chemotherapeutic agents, such as melphalan and chlorambucil [32], but these agents have largely fallen out of use in the treatment of ovarian cancer. More recently, platinum-based chemotherapy, which is routinely used in ovarian cancer treatment, has also been associated with a higher late risk for leukemia. This was demonstrated in a large registry case–control study of women who developed leukemia after ovarian cancer. Of note, 71% of patients who developed leukemia were aged ≥60 years at the time of their ovarian cancer diagnosis, whereas 29% were aged ≥70 years [31]......
......Further evidence-based guidelines are needed for early detection and treatment of second malignancies in older adults, and physicians caring for this population should integrate age, health status, projected life expectancy, and patient preferences when deciding upon screening and prevention measures.
......Further evidence-based guidelines are needed for early detection and treatment of second malignancies in older adults, and physicians caring for this population should integrate age, health status, projected life expectancy, and patient preferences when deciding upon screening and prevention measures.
