Mucinous Adenocarcinoma of Ovary

Mucinous Adenocarcinoma of Ovary

Article
Sexual Health
Women's Health
+2
Contributed byMaulik P. Purohit MD MPHNov 27, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Malignant Mucinous Carcinoma of Ovary
  • Ovarian Malignant Mucinous Carcinoma

What is Mucinous Adenocarcinoma of Ovary? (Definition/Background Information)

  • Mucinous Adenocarcinoma of Ovary is a common malignant ovarian tumor that generally affects middle-aged women. The causal factors for Mucinous Adenocarcinoma of Ovary are unknown, but genetic mutations such as mutations in KRAS gene have been reported in some cases
  • Tumors of the ovaries can be benign, borderline or low malignant potential (LMP), or malignant tumors. Thus, not all ovarian tumors are cancers
  • Benign tumors are not cancerous and do not spread or metastasize. Borderline or low malignant potential (LMP) tumors are usually benign, but some of them can behave like cancers. Malignant tumors are cancers that spread and metastasize
  • Mucinous Adenocarcinoma of Ovary is a rapidly-growing epithelial tumor that is usually present as a single solid mass within an ovary. Rarely though, it can occur as multiple masses within a single ovary, or may affect both the ovaries as well
  • These tumors can occur in association with certain syndromes. They are considered to be of mucinous type, based on their appearance under a microscope
  • Mucinous Adenocarcinoma of Ovary usually presents with sign and symptoms, such as abdominal pain, weight loss, vaginal bleeding, and increased abdominal girth. The complications due to these ovarian tumors include metastasis to local and distant organs
  • The treatment for Mucinous Adenocarcinoma of Ovary may involve chemotherapy, surgery, radiation therapy, or a combination of these procedures
  • The prognosis depends on many factors that include the stage of the tumor. Lower stage tumors have better prognosis than higher stage tumors

Who gets Mucinous Adenocarcinoma of Ovary? (Age and Sex Distribution)

Mucinous Adenocarcinoma of Ovary can occur worldwide in women of any race or ethnicity, and age; though, it is mostly observed in the age group of 30-50 years.

What are the Risk Factors for Mucinous Adenocarcinoma of Ovary? (Predisposing Factors)

The risk factors, in general, for ovarian cancers include some of the following. Some individuals may have multiple risk factors that compound the risk for Mucinous Adenocarcinoma of Ovary:

  • Increasing age: A majority of women who are diagnosed with ovarian cancer are over the age of 55 years
  • Childbearing status: Studies have found that women, who have had at least one child before the age of 30 years, have a lower risk
  • Breastfeeding status: It has been found that women who breastfeed are at a lower risk of ovarian cancer
  • Body weight: Women who are overweight are at an increased risk of developing cancer of the ovaries
  • Genetics: Women with genetic mutations in KRAS, BRCA-1, and BRCA-2 genes are at an increased risk
  • Hormone replacement therapy (HRT) in post-menopausal women increases the risk for ovarian cancer
  • Family history: Women with a family history of ovarian cancer may have an increased risk
  • Past history of breast cancer, colorectal cancer, or endometrial cancer: Having a past diagnosis of these cancers increase the risk of developing ovarian cancer
  • Smoking: Some studies have shown that long-standing smoking can increase the risk
  • Prior history of chemotherapy for a different cancer

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Mucinous Adenocarcinoma of Ovary? (Etiology)

The exact cause of Mucinous Adenocarcinoma of Ovary is unknown in many cases. The possible causes may include:

  • Genetic defects in KRAS gene have been reported in some cases
  • Infectious cause
  • Autoimmune disorders
  • Smoking
  • Sun exposure
  • Exposure to allergic substances
  • Exposure to ultraviolet light
  • Family history of Mucinous Adenocarcinoma of Ovary

What are the Signs and Symptoms of Mucinous Adenocarcinoma of Ovary?

The signs and symptoms of Mucinous Adenocarcinoma of Ovary depend on a number of factors such as:

  • Size of the tumor
  • Histological type of the tumor
  • Whether a single ovary or both the ovaries are involved
  • The tumor is a cystic mass or a solid mass
  • Whether the tumor produces hormones
  • Local spread of tumor
  • Rupture of the cystic mass
  • Extent of bleeding within the tumor
  • Whether the tumor is present as part of a syndrome. In such cases, the signs and symptoms associated with the accompanying syndrome may exist

Following are the common signs and symptoms associated with this tumor type:

  • Abdominal pain (the pain is usually a pelvic pain)
  • Abdominal swelling due to the mass or due to fluid accumulation in the belly (called ascites)
  • Increased abdominal girth due to fluid accumulation (ascites)
  • Persistent feeling of abdominal bloating with nausea or vomiting
  • Changes in bowel movements, such as constipation
  • Feeling full soon after eating less (having a feeling of satiety after eating less)
  • Loss of appetite
  • Weight loss
  • Fatigue, feeling tired easily
  • Frequent urination (polyuria) and difficulty while urinating
  • Frequent pain during sex (dyspareunia)
  • Abnormal menstrual bleeding

Some of the other features of Mucinous Adenocarcinoma of Ovary include:

  • Mucinous Adenocarcinoma of Ovary usually presents as a single poorly-defined mass in the ovary. Rarely, the tumor can occur as multiple nodules within the same ovary too
  • The nodule is typically less than 10 cm in size (along the larger dimension); however, some may grow to greater sizes
  • These tumors can be locally aggressive, meaning that the tumor may spread to local areas. Some tumors can cause distant metastasis to different organs in the body

The Mucinous Adenocarcinoma of Ovary may occur as a new growth that develops over weeks and months.

How is Mucinous Adenocarcinoma of Ovary Diagnosed?

The following are the diagnostic tools for Mucinous Adenocarcinoma of Ovary:

  • A thorough physical examination and a complete medical history evaluation is very vital
  • Pelvic examination
  • Complete blood count (CBC) with differential of white blood cells
  • Liver function test (LFT)
  • Blood tests called serum tumor markers that include:
    • CA-125 test
    • Human chorionic gonadotropin (HCG)
    • Alpha-fetoprotein (AFP)
    • Lactate dehydrogenase (LDH)
    • Inhibin (hormone)           
    • Estrogen levels
    • Testosterone levels
  • Exploratory laparoscopy (diagnostic laparoscopy): This is a procedure wherein the abdomen is examined using a minimally invasive technique. During this procedure, a tissue biopsy may be performed. A minimally invasive approach helps decrease the complications and length of stay at the hospital. A diagnostic laparoscopy is also helpful in the staging of the tumor
  • A tissue biopsy of the tumor: A tissue biopsy is performed and sent to a laboratory for a pathological examination

A pathologist examines the biopsy under a microscope. After putting together the clinical findings, special studies on tissues (if needed), and the microscope findings, the pathologist arrives at a definitive diagnosis. Sometimes, the pathologist may perform special studies that may include immunohistochemical stains, histochemical stains, molecular testing, and very rarely, electron microscopic studies. Examination of the biopsy under a microscope by a pathologist is considered to be the gold standard in arriving at a conclusive diagnosis

Radiological imaging studies may include:

  • X-ray of the abdomen and pelvic region
  • Barium enema x-ray
  • CT scan of the abdomen and pelvic region
  • MRI scan of abdomen and pelvic region
  • Ultrasound scans of the pelvic region; usually transvaginal ultrasonography (TVS) and abdominal ultrasound scans are performed

If the tumor has metastasized to other regions, then radiological examination to determine the extent of metastasis may be performed. These may include:

  • X-ray of the affected region
  • CT scan of the affected region
  • MRI scan of the affected region
  • Positron emission tomography (PET) scan or PET/CT scan

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Mucinous Adenocarcinoma of Ovary?

The complications due to Mucinous Adenocarcinoma of Ovary may include:

  • There may be a rapid growth of the tumor which may invade into the surrounding tissues causing tissue damage
  • A distance metastasis of the tumor from its primary site may also occur. Usually by the time Mucinous Adenocarcinoma of Ovary is detected, it is likely that it has grown and metastasized aggressively, damaging organs and tissues beyond repair. The frequent sites of metastasis are the lungs, lymph nodes, liver, and bones
  • This kind of ovarian tumor is also known to have a high recurrence rate, even after its surgical excision and removal
  • Inadvertent damage to vital nerves, blood vessels, and surrounding structures during surgery, depending on the location of the tumor: Some tumors that are away from the vital organs can be removed usually with no significant damage. However, some tumors may grow close to vital organs and structure which makes the surgical removal difficult and challenging
  • There may be side effects from the chemotherapy (such as toxicity) and radiation therapy administered

How is Mucinous Adenocarcinoma of Ovary Treated?

The treatment for Mucinous Adenocarcinoma of Ovary may include a combination of chemotherapy (drugs), radiation therapy, and surgical procedures that are employed by the healthcare provider to treat the condition.

  • A debulking surgery to reduce the tumor mass, followed by a combination of chemotherapy and radiation therapy may be employed. The debulking procedure helps the chemotherapy treatment in being more effective, because there is lesser tumor mass left for the drugs to act on
  • The surgery may involve a total abdominal hysterectomy (complete removal of the uterus), removal of both the ovaries and fallopian tubes (called bilateral salpingo-oophorectomy, omentectomy (removal of fat around the intestines), biopsy of lymph nodes within the abdomen, or the removal of other tissues in the pelvis and abdomen as needed
  • Removal of the tumor to the extent possible (debulking procedure) is performed before chemotherapy in advanced stages of tumor
  • Post-operative care is important: A minimal physical activity is advised, until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important (to monitor the status of the tumor)

The healthcare provider will determine and plan the best course of treatment on a case-by-case basis.

How can Mucinous Adenocarcinoma of Ovary be Prevented?

The cause of Mucinous Adenocarcinoma of Ovary is unknown. Hence, there are no known methods to prevent the tumor occurrence.

  • Early diagnosis with close monitoring and treatment of the tumor is important. A timely tumor recognition and prompt treatment will help in having optimal outcomes
  • Due to its high chances of recurrence (after its surgical removal), regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations, are mandatory for those who have already endured the tumor
  • The US Preventive Services Task Force (USPSTF) currently does not have any recommendation for screening against ovarian cancer for the general population. Tests such as blood serum CA125 level or trans-vaginal ultrasonography are not really helpful as screening tools
  • The National Cancer Institute (NCI) recommends that women who are at high risk for ovarian cancer take regular (annual) examinations. The healthcare provider may perform studies such as ultrasonography examinations and CA125 testing as part of one’s annual physical examination

What is the Prognosis of Mucinous Adenocarcinoma of Ovary? (Outcomes/Resolutions)

The prognosis of Mucinous Adenocarcinoma of Ovary is poor despite treatment. However, the prognosis depends upon a number of factors that include the following:

  • The stage of the tumor: Tumors that are staged lower have a better prognosis than tumors that are staged higher
  • The size of the tumor
  • Age of the individual
  • Overall health of the individual
  • Presence of metastasis and the organs involved with metastasis
  • The patient’s response to treatment such as chemotherapy or radiation therapy

Given the high rate of recurrence and metastasis of Mucinous Adenocarcinoma of Ovary, the long-term outcome (5 year period) is poor for most individuals.

Additional and Relevant Useful Information for Mucinous Adenocarcinoma of Ovary:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/cancer/

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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