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Management of Gynecologic Malignancies in the Elderly Women
Korean J Clin Geri 2018 Dec;19(2):81-88
Published online December 30, 2018;  https://doi.org/10.15656/kjcg.2018.19.2.81
Copyright © 2018 The Korean Academy of Clinical Geriatrics.

Min Chul Choi

Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
Received October 23, 2018; Revised November 14, 2018; Accepted December 1, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
In 2018, Korea officially enters an “aged society” likewise most of developed countries. Cancer is one of common diseases in older adults and its prevalence increases with prolonged life expectancy among older adults. Ovarian and endometrial carcinomas are most common in postmenopausal women. Cervical cancer in the elderly is common and the stage at time of initial diagnosis is later compared with their counterparts, middle-aged and young women. Advanced age, by itself, should not alter care plans of diagnostic or therapeutic approach to gynecologic malignancy. The Papanicolaou test remains the primary screening test of cervical cancer in the elderly. However, serologic tests such as CA-125 or transvaginal ultrasound are not widely accepted as the screening tests of ovarian or uterine cancers. The cost-effectiveness of these tests as screening tools remains unclear. Radical pelvic surgery, multi-drug chemotherapy as well as radiation therapy can be applied to elderly women with gynecologic malignancy as curative or palliative therapy purposes. This article is a comprehensive review of the management of gynecologic malignancy in the elderly women.
Keywords : Elderly, Gynecology, Malignancy, Treatment
References
  1. Statistics Korea. Active Ageing Index. 2018 [cited;
  2. Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, et al. EORTC elderly task force position paper:approach to the older cancer patient. Eur J Cancer 2010;46:1502-13.
    Pubmed CrossRef
  3. Goodwin JS, Samet JM, Key CR, Humble C, Kutvirt D, Hunt C. Stage at diagnosis of cancer varies with the age of the patient. J Am Geriatr Soc 1986;34:20-6.
    Pubmed CrossRef
  4. Grover SA, Cook EF, Adam J, Coupal L, Goldman L. Delayed diagnosis of gynecologic tumors in elderly women: relation to national medical practice patterns. Am J Med 1989;86:151-7.
    CrossRef
  5. Scher KS, Hurria A. Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol 2012;30:2036-8.
    Pubmed CrossRef
  6. Kennedy AW, Flagg JS, Webster KD. Gynecologic cancer in the very elderly. Gynecol Oncol 1989;32:49-54.
    CrossRef
  7. Collins KS, Schoen C, Joseph S, Duchun L, Simantov E, Yellowitz M. Health concerns across a woman's lifepan : The commonwealth fund 1998 survey of women's health. New York, NY: The Commonwealth Fund; 1999.
  8. Womeodu RJ, Bailey JE. Barriers to cancer screening. Med Clin North Am 1996;80:115-33.
    CrossRef
  9. Woodwell DA. National Ambulatory Medical Care Survey:1996 Summary. Advance data from vital and health statistics;no. 295. Hyattsville, Maryland: National Center for Health Statistics; 1997.
  10. Ganz PA. Does (or should) chronologic age influence the choice of cancer treatment? Oncology 1992;6 suppl 2:45-9.
    Pubmed
  11. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat 2017;49:292-305.
    Pubmed KoreaMed CrossRef
  12. Min KJ, Lee YJ, Suh M, Yoo CW, Lim MC, Choi J, et al. The Korean guideline for cervical cancer screening. J Korean Med Assoc 2015;58:398-407.
    CrossRef
  13. Chen F, Trapido EJ, Davis K. Differences in stage at presentation of breast and gynecologic cancers among whites, blacks, and Hispanics. Cancer 1994;73:2838-42.
    CrossRef
  14. Parazzini F, Negri E, La Vecchia C, Bocciolone L. Screening practices and invasive cervical cancer risk in different age strata. Gynecol Oncol 1990;38:76-80.
    CrossRef
  15. Kim YT. Causes and diagnoses of cervical cancer. J Korean Med Assoc 2007;50:769-77.
    CrossRef
  16. Park JH, Ha SY, Cho HY, Chung DH, Kim NR, Park S. The usefulness of cervicovaginal cytology as a primary screening test. Korean J Cytopathol 2008;19:107-10.
    CrossRef
  17. Dodd LG, Sneige N, Villarreal Y, Fanning CV, Staerkel GA, Caraway NP, et al. Quality-assurance study of simultaneously sampled, non-correlating cervical cytology and biopsies. Diagn Cytopathol 1993;9:138-44.
    Pubmed CrossRef
  18. Kulasingam SL, Hughes JP, Kiviat NB, Mao C, Weiss NS, Kuypers JM, et al. Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral. JAMA 2002;288:1749-57.
    Pubmed CrossRef
  19. Wright TC Jr, Schiffman M. Adding a test for human papillomavirus DNA to cervical-cancer screening. N Engl J Med 2003;348:489-90.
    Pubmed CrossRef
  20. Gostout BS, Podratz KC, McGovern RM, Persing DH. Cervical cancer in older women: a molecular analysis of human papillomavirus types, HLA types, and p53 mutations. Am J Obstet Gynecol 1998;179:56-61.
    CrossRef
  21. Lash AF. Surgical geriatric gynecology. Am J Obstet Gynecol 1947;53:766-75.
    CrossRef
  22. Lichtinger M, Averette H, Penalver M, Sevin BU. Major surgical procedures for gynecologic malignancy in elderly women. South Med J 1986;79:1506-10.
    Pubmed CrossRef
  23. Susini T, Scambia G, Margariti PA, Giannice R, Signorile P, Benedetti Panici P, et al. Gynecologic oncologic surgery in the elderly: A retrospective analysis of 213 patients. Gynecol Oncol 1999;75:437-43.
    Pubmed CrossRef
  24. Radwan RW, Evans MD, Davies M, Harris DA, Beynon J. Pelvic exenteration for advanced malignancy in elderly patients. Br J Surg 2016;103:e115-9.
    Pubmed CrossRef
  25. Geisler JP, Geisler HE. Radical hysterectomy in patients 65 years of age and older. Gynecol Oncol 1994;53:208-11.
    Pubmed CrossRef
  26. Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53.
    Pubmed CrossRef
  27. Sakurai H, Mitsuhashi N, Takahashi M, Yamakawa M, Akimoto T, Hayakawa K, et al. Radiation therapy for elderly patient with squamous cell carcinoma of the uterine cervix. Gynecol Oncol 2000;77:116-20.
    Pubmed CrossRef
  28. Ikushima H, Takegawa Y, Osaki K, Furutani S, Yamashita K, Kawanaka T, et al. Radiation therapy for cervical cancer in the elderly. Gynecol Oncol 2007;107:339-43.
    Pubmed CrossRef
  29. Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ. Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 1998;71:291-8.
    Pubmed CrossRef
  30. Eggemann H, Ignatov T, Geyken CH, Seitz S, Ignatov A. Management of elderly women with cervical cancer. J Cancer Res Clin Oncol 2018;144:961-7.
    Pubmed CrossRef
  31. Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al. Effect of screening on ovarian cancer mortality:the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 2011;305:2295-303.
    Pubmed CrossRef
  32. Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2016;387:945-56.
    CrossRef
  33. Clarke-Pearson DL. Clinical practice. Screening for ovarian cancer. N Engl J Med 2009;361:170-7.
    Pubmed CrossRef
  34. DePriest PD, Shenson D, Fried A, Hunter JE, Andrews SJ, Gallion HH, et al. A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol 1993;51:7-11.
    Pubmed CrossRef
  35. Mol BW, Boll D, De Kanter M, Heintz AP, Sijmons EA, Oei SG, et al. Distinguishing the benign and malignant adnexal mass: an external validation of prognostic models. Gynecol Oncol 2001;80:162-7.
    Pubmed CrossRef
  36. Muralikrishnan S, Hatzis C, Katz A, Santin A, Schwartz PE, Abu-Khalaf MM. Chemotherapy for Elderly Ovarian Cancer Patients. Gynecol Obstet 2016;6(8).
    Pubmed KoreaMed CrossRef
  37. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392-7.
    Pubmed KoreaMed CrossRef
  38. Thyss A, Saudes L, Otto J, Creisson A, Gaspard MH, Dassonville O, et al. Renal tolerance of cisplatin in patients more than 80 years old. J Clin Oncol 1994;12:2121-5.
    Pubmed CrossRef
  39. Lichtman SM, Hurria A, Cirrincione CT, Seidman AD, Winer E, Hudis C, et al. Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: combined analysis of CALGB 9342 and 9840. Ann Oncol 2012;23:632-8.
    Pubmed KoreaMed CrossRef
  40. Ansari L, Shiehzadeh F, Taherzadeh Z, Nikoofal-Sahlabadi S, Momtazi-Borojeni AA, Sahebkar A, et al. The most prevalent side effects of pegylated liposomal doxorubicin monotherapy in women with metastatic breast cancer: a systematic review of clinical trials. Cancer Gene Ther 2017;24:189-93.
    Pubmed CrossRef
  41. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011;10:CD007565.
    CrossRef
  42. Scarabelli C, Gallo A, Franceschi S, Campagnutta E, De G, Giorda G, et al. Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma. Cancer 2000;88:389-97.
    CrossRef
  43. Sharma S, Driscoll D, Odunsi K, Venkatadri A, Lele S. Safety and efficacy of cytoreductive surgery for epithelial ovarian cancer in elderly and high-risk surgical patients. Am J Obstet Gynecol 2005;193:2077-82.
    Pubmed CrossRef
  44. Aghajanian C, Blank SV, Goff BA, Judson PL, Teneriello MG, Husain A, et al. OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol 2012;30:2039-45.
    Pubmed KoreaMed CrossRef
  45. Ledermann J, Harter P, Gourley C, Friedlander M, Vergote I, Rustin G, et al. Olaparib maintenance therapy in platinumsensitive relapsed ovarian cancer. N Engl J Med 2012;366:1382-92.
    Pubmed CrossRef
  46. Averette HE, Janicek MF, Menck HR. The National Cancer Data Base report on ovarian cancer. American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1995;76:1096-103.
    CrossRef
  47. Sengupta PS, Jayson GC, Slade RJ, Eardley A, Radford JA. An audit of primary surgical treatment for women with ovarian cancer referred to a cancer centre. Br J Cancer 1999;80:444-7.
    Pubmed KoreaMed CrossRef
  48. Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Steren A. National survey of ovarian carcinoma. IV: Patterns of care and related survival for older patients. Cancer 1994;73:377-83.
    CrossRef
  49. Farley JH, Nycum LR, Birrer MJ, Park RC, Taylor RR. Age-specific survival of women with endometrioid adenocarcinoma of the uterus. Gynecol Oncol 2000;79:86-9.
    Pubmed CrossRef
  50. Gonzalez-Rodilla I, Boix M, Verna V, Munoz AB, Estevez J, Jubete Y, et al. Patient age and biological aggressiveness of endometrial carcinoma. Anticancer Res 2012;32:1817-20.
    Pubmed
  51. Eggemann H, Ignatov T, Burger E, Costa SD, Ignatov A. Management of elderly women with endometrial cancer. Gynecol Oncol 2017;146:519-24.
    Pubmed CrossRef
  52. Jacobs I, Gentry-Maharaj A, Burnell M, Manchanda R, Singh N, Sharma A, et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 2011;12:38-48.
    CrossRef
  53. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-88.
    Pubmed CrossRef
  54. Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM. Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994;86:527-37.
    Pubmed CrossRef
  55. Gerber B, Krause A, Muller H, Reimer T, Kulz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 2000;18:3464-70.
    Pubmed CrossRef
  56. American College of Obstetrics and Gynecologists. Tamoxifen and uterine cancer. Committee opinion No. 601. Obstet Gynecol 2014;123:1394-7.
    Pubmed CrossRef
  57. Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 2017;18:384-92.
    CrossRef
  58. Suh DH, Kang S, Lim MC, Lee TS, Park JY, Kim TJ, et al. Management of the elderly patient with gynecologic cancer:report of the 2011 workshop in geriatric gynecologic oncology. Int J Gynecol Cancer 2012;22:161-9.
    Pubmed CrossRef

 

December 2018, 19 (2)