Marija Bovinova


Ovarian cancer is one of the most common female cancer cases. Pleural effusion caused by this disease is a common complication and identifying the primary cause of the one is an important task for physician. Without being thoroughly examined pleural effusion may reoccur requiring additional treatment.
Study tasks. Select and analyse cases of pleural effusion caused by ovarian cancer, tests and methods used to prove the diagnosis and rate of reoccurrence. To assess the CA-125 marker’s value as diagnostic parameter of the ovarian cancer in women with pleural effusion.
Methods. In 2010 KUL hospital conducted a study to investigate how many patients were diagnosed with pleural effusion as the cause of the symptoms of ovarian cancer and effect. Cases of the hydrothorax in women with OC dated from 2006 01 01 to 2010 10 30 were counted into the study. The analysis is based on the information on patients’ age, complaints, in which department patients were hospitalised, or diagnosed for the first time, have patients passed any chemotherapy course, when and where were cancer markers sampled, the result of histological examination of pleural fluid, what were the indications for chest x-ray, how many patients were hospitalized for additional treatment. The data collection and analysis are performed using the Microsoft Office Access database. The statistical analysis was executed using SPSS version 17.0.
Results. On data obtained in 2006 – 2010 1400 women were hospitalized with ovarian cancer. Of these, 82 cases of pleural effusion, including 22 patients being diagnosed for the first time. Patients‘ age varies from 39 to 85 years. 15 per cent of all cases patients were hospitalized having acute symptoms. The breathing disability was the most common complaint among the patients. 34 per cent were complaining of abdominal volume increases. 68 per cent of women had ascites. 29 per cent of subjects complained about general weakness, 17 per cent complained about the lack of appetite, dyspepsia. Lower abdominal pain felt 27 per cent of women. 23 per cent of women who were diagnosed for the first time had dyspnoea as an only complaint. Also during the investigation 81 per cent of chemotherapy-treated patients were discovered experiencing pleural effusion symptoms during the period of up to six months after the last chemotherapy and 25 per cent during the first month period. The study showed that the cancer marker Ca125 concentration was increased in all patients (> 35U/ml). Concentration ranges from 100 to 8000 U / ml. 46 per cent of women had Ca125 concentration ranging from 100 to 500 U / ml, 54 per cent – from 500 to 8000 U / ml. 20 per cent of pleural effusion cases were not aspirated due to the lack of fluid volume. Atypical cells were detected in 70 per cent of taken pleural punctate.
28 per cent of women required a repeated hospitalization, due to reoccurring pleural effusion. 36 women were hospitalized only once during the period the research, 14 women with two or more hospitalizations (six patients hospitalized twice, five patients – three times, two patients – four times, one patient – 11 times). The rate of hospitalizing in some patients was once in every few months, even up to 11 times during the referred period. 32 of the 82 ovarian cancer cases had two episodes of pleural effusion (39 per cent), the patients with three and more episodes of reoccurring pleural effusion make up to 18 cases (22 per cent). 6 patients had a pleurodesis procedure done. One patient had repeated procedures.
Conclusions. Additional symptoms while having a pleural effusion may provide the reason to suspect the ovarian cancer that may require a differential diagnosis. A woman having fluid in the pleural cavity requires intensive additional testing for ovarian cancer, even having another possible  cause of the pleural effusion, running the CA 125 test, and assessing complaints. With the increase of concentration from 35 to 500 U / ml, patients should be carefully examined for ovarian cancer, but without excluding the prejudice infection disease such as tuberculosis. Concentration of more than 500 U / ml is more common for the risk of ovarian cancer and requires running all necessary tests in order to carry out the diagnosis, including invasive ones. Ovarian cancer is commonly accompanied with following symptoms: shortness of breath, chest pain, abdominal volume increase, general weakness, anorexia, dyspepsia. Specific and non-specific symptoms, family anamnesis increases the risk of ovarian cancer. The pleural effusion caused by ovarian cancer is usually accompanied by ascites and the presence of one increases the risk of ovarian cancer differential diagnosis. In order to avoid a repeated hospitalization caused by pleural effusion discomfort, the patient with a relatively high volume of reoccurring pleural effusion (> 1000 mL) should be advised to have a pleurodesis done. Women with a family anamnesis of ovarian or breast cancer and suffering from ovarian cancer should be advised to assess genetic BRCA1 or BRCA2 mutations and should consult with specialists about the removal of the ovaries and fallopian tubes in a certain age of maturity.

Keyword(s): ovarian cancer, pleural effusion, cancer marker, CA 125.
DOI: 10.5200/105
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