Krukenberg tumors
Krukenberg tumors are bilateral ovarian tumors that typically arise from the metastasis of primary stomach cancer, though they can also originate from cancers of the breast, colon, or biliary tract. First described by Friedrich Ernst Krukenberg in 1896, these tumors are most commonly found in women, particularly those aged forty to fifty, and are more prevalent in Asian women due to the higher incidence of stomach cancer in that region. Symptoms often include abdominal pain, distension, and abnormal menstrual cycles, while some individuals may remain asymptomatic until gastrointestinal symptoms related to the primary cancer manifest. Diagnosis generally involves surgical procedures like laparotomy and imaging techniques, with a biopsy confirming the presence of characteristic "signet-ring" cells. Treatment typically includes surgical removal of the tumors when localized, along with chemotherapy or radiotherapy if the cancer has spread further. The prognosis for patients with Krukenberg tumors is generally poor, as their presence indicates advanced gastric cancer. Preventive measures, such as prophylactic surgery, may help reduce the risk of tumor development in at-risk patients. Advances in treatment are ongoing, providing some renewed hope for affected individuals.
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Subject Terms
Krukenberg tumors
ALSO KNOWN AS: Metastatic stomach cancer
RELATED CONDITIONS: Stomach cancer
DEFINITION: Krukenberg tumors are bilateral ovarian tumors resulting from the spread of primary stomach cancer. Other possible sources of primary malignancy include the breast, colon, and biliary tract. Friedrich Ernst Krukenberg of Germany first described this tumor in 1896.
Risk factors: Women between the ages of forty and fifty are most frequently affected. The tumor occurs more in women of Asian descent because stomach cancer is a common malignancy of adult women in this geographic region. A history of stomach cancer in a middle-aged female patient should alert the physician to the possible risk of developing a Krukenberg tumor.
Etiology and the disease process: Blood and lymph fluid flow are responsible for stomach tumor cell metastasis to the ovaries.
Incidence: Krukenberg tumors make up about 1 to 2 percent of all ovarian tumors. Japan, China, and Korea have a particularly high incidence of Krukenberg tumors.
Symptoms: Most patients complain of pain and abdominal distension, ascribed to both ovarian enlargement and ascites (fluid accumulation in the abdominal cavity). Abnormal menstruation, pain during sexual intercourse, and vaginal bleeding are other notable symptoms. A small number of patients remain asymptomatic or complain of gastrointestinal symptoms related to the primary cancer.
Screening and diagnosis: A laparotomy (a surgical of the abdominal wall) is important in diagnosing a Krukenberg tumor. Chest X-rays, abdominal computed tomography (CT) scans, and pelvic ultrasound are useful in determining the extent of tissue involvement. A biopsy of the ovary will confirm the diagnosis: Microscopically, Krukenberg tumors are characterized by cancer cells with a “signet-ring” appearance, that is, identical to tumor cells in stomach cancer tissue. The presence of a Krukenberg tumor signifies that the primary stomach cancer is in an advanced stage (Stage IV, distant metastasis).
Treatment and therapy: In cases in which the tumor is confined to the ovaries and the stomach, surgical removal of both the ovarian tumor and the primary cancer is recommended. Chemotherapy and radiotherapy may be required in cases in which cancer has spread beyond the ovaries and the stomach. In the twenty-first century, advances in treating Krukenberg tumors have given patients renewed hope. Cytoreductive surgery, combined with Hyperthermic Intraperitoneal Chemotherapyin which the tumor is removed, and heated chemotherapy is applied to remaining cancer cellshas significantly increased lifespan. However, due to the aggressive nature of this tumor, treatment remained challenging in the 2020s.
Prognosis, prevention, and outcomes: The prognosis is poor for patients diagnosed with a Krukenberg tumor. Prophylactic surgical removal of both ovaries during gastric cancer surgery may be the only way of preventing tumor growth. Because the tumor is a sign of advanced gastric cancer, the outcome is poor for patients with Krukenberg tumors.
Bibliography
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Kim, H. K., et al. “Prognostic Factors of Krukenberg’s Tumor.” Gynecological Oncology, vol. 82.1, 2001, pp. 105–109.
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Moghazy, Dalia, Omar Al-Hendy, and Ayman Al-Hendy. “Krukenberg Tumor Presenting as Back Pain and a Positive Urine Pregnancy Test: A Case Report and Literature Review.” Journal of Ovarian Research, vol. 7.36, 2014.
Peng, W., et al. “Surgical Treatment for Patients with Krukenberg Tumor of Stomach Origin: Clinical Outcome and Prognostic Factors Analysis.” PLoS ONE, vol. 8.7, 2013, p. e68227.
Woo, Yanghee. “Krukenberg Tumors - City of Hope.” Cancer Treatment Centers of America, 29 June 2023, www.cancercenter.com/risk-factors/krukenberg-tumors. Accessed 13 June 2024.