Krukenberg Tumor

Excerpt

Krukenberg tumor is named after Friedrich Ernst Krukenberg (1871-1946), who reported what he thought was a newly identified primary ovarian cancer but was instead found to be a malignancy metastatic to the ovary. In much of the world, roughly 10% of ovarian tumors are metastatic disease, of which nearly half are Krukenberg tumors. However, the incidence of Krukenberg tumors in Japan, Korea, and China is approximately 18% due to their greater prevalence of gastric cancer.

Many Krukenberg tumors arise from the stomach, but they may also originate from the appendix, breast, colon, small bowel, gallbladder, pancreas, and genitourinary system. Spread is often via lymphatics but can be hematogenous or through direct invasion, depending in part on the proximity of the primary cancer to the ovaries and lymph nodes. On occasion, the primary tumor cannot be found. The symptoms from Krukenberg tumor may be the first indication of cancer. Krukenberg tumors may cause pain, bloating, and ascites, as well as irregular vaginal bleeding and dyspareunia. In addition, the tumors may induce changes within the ovarian stroma, resulting in hormone production.

Treatment of Krukenberg tumor is predicated on the biology of the primary cancer, and the prognosis is less favorable compared with other types of ovarian metastases or primary ovarian tumors. The mean survival following diagnosis is 14 months. Both surgery and pharmacologic therapy have roles in extending overall survival in some patients with Krukenberg tumors. Treatment of this advanced disease requires careful consideration of multiple factors, including tumor site of origin, extent of metastatic spread, and functional status of the patient.