Therapie von Keimstrang-Stroma-Tumoren und Keimzelltumoren des Ovars

Many of the sex cord-stromal tumors (thecoma, fibroma, gynandroblastoma, Leydig cell tumor, etc.) are benign or have a low malignant potential and good prognosis. Other sex cord-stromal tumors (granulosa cell tumors, moderately or poorly differentiated Sertoli-Leydig cell tumors, etc.) can have a malignant potential resulting in a fatal course. Except for pure fibromas, most produce steroids. This may result, depending on the patient’s age, in precocious pseudopuberty, disturbances in fertility and menstruation pattern and postmenopausal bleeding. Often, hyperplasia or even carcinoma of the endometrium are found. The therapy of sex cord-stromal tumors is resection, the extent of which depends on the malignant potential of the tumor. Ovarian germ cell tumors constitute a heterogenous group of tumors that develop from totipotent primordial germ cells. In general, the prognosis can be considered favorable if patients are treated according to current standards. Therapy follows a multimodal approach. Recent advances have aimed at the preservation of fertility. Appropriate intraoperative staging is crucial to adequately treat the cancer without comprising future fertility. The introduction of platinum-based chemotherapy represents a significant breakthrough in adjuvant treatment. Patients with stage I disease, except for dysgerminoma and low grade immature teratoma, as well as advanced-stage disease of all germ cell histologies, require adjuvant treatment with bleomycin, etoposide and cisplatin.     

Adjuvant and post-surgical treatment in non-epithelial ovarian cancer

Non-epithelial cancers arising from the ovary are uncommon malignancies. Germ cell tumors of the ovary arise from primordial germ cells, and sex cord-stromal tumors of the ovary represent a cluster of tumors arising from the sex cord and stromal compartment. Most patients diagnosed with germ cell tumors are young adults and adolescent females. In contrast, ovarian sex cord-stromal tumors more commonly occur in a mature age group.Advances in the adjuvant management of non-epithelial ovarian cancer following optimal surgical and pathological staging have improved patient survival outcomes. In addition, active surveillance is preferentially assigned to patients diagnosed with stage I germ cell tumor, stage 1A grade 1 immature teratoma, stage 1A yolk sac tumor, and stage 1AI sex cord-stromal tumors.This article discusses the importance of selecting the adjuvant treatment approach most suitable to the patients' surgical and pathological stages, thereby safeguarding patient outcomes.     

Management of Early Ovarian Cancer: Germ Cell and Sex Cord-Stromal Tumors

Malignant ovarian germ cell tumors (OGCT) and sex cordstromal tumors (OSCST), each of which account for less than 5% of all ovarian malignancies, are much less common than epithelial ovarian cancer. In young patients suspected of having an OGCT, laparotomy is initially indicated for both diagnosis and treatment. For most patients, unilateral salpingo-oophorectomy with preservation of the contralateral ovary and the uterus is appropriate. The basis for this surgical approach is retrospective studies that show an equivalent cure rate for patients who undergo unilateral or bilateral adnexectomy. No prospective studies have compared unilateral with bilateral adnexectomy. Surgical staging is also important to determine the extent of disease, to determine prognosis, and to guide postoperative management. If metastatic disease is encountered during initial surgery for OGCT, the same principles of cytoreductive surgery that have been applied to surgically manage advanced epithelial ovarian cancer are recommended, with resection of as much tumor as is technically feasible and safe. For all OGCT patients except those with well-documented stage IA grade 1 pure immature teratoma or stage IA pure dysgerminoma, postoperative chemotherapy is indicated. The current recommended regimen for OGCT is bleomycin, etoposide, and cisplatin—a combination that appears to result in at least a 95% cure rate for stage I disease and at least a 75% cure rate for advanced-stage disease. For patients with metastatic dysgerminoma, chemotherapy, which has the advantage of preserving fertility in the majority of patients, has supplanted radiotherapy as standard treatment. For patients with OSCST, no standard therapy exists. Surgery alone is currently acceptable treatment for all patients with OSCST except those who have metastatic disease or Sertoli-Leydig cell tumors with poor differentiation or heterologous elements. Currently, platinum-based combination chemotherapy is favored for these latter patients, but the activity of such regimens appears only modest.     

Treatment of malignant ovarian germ cell tumors with preservation of fertility

Preservation of fertility was practiced in 28 young patients with malignant germ cell tumors from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7, dysgerminoma in 2 and germ cell tumor of mixed type in 3. At laparotomy, 16 patients proved to have stage I disease, one stage II, 9 stage III and 2 stage IV disease. The tumor was confined to one ovary in all the 22 cases operated on for the first time and the preserved ovary and uterus were normal in all 6 referred cases for recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. A persistent remission was achieved in 22 patients, while 5 patients died and one was out of contact. The duration of survival was more than one year for all patients, more than 3 years in 16 cases (72.7%) and more than 5 years in 13 cases (59.1%). The menstrual periods were normal in all cases except 3, of which 2 were below the age of 12 and one failed to menstruate at the age of 19 with a hypoplastic uterus and underdeveloped secondary sex characteristics. Among 12 married patients, 7 of 10 desirous of childbirth became pregnant during follow-ups. Of these, 6 had normal term-deliveries and one is currently pregnant. The preliminary conclusion is that preservation of fertility for young patients with malignant ovarian germ cell tumor is a safe and practicable procedure in the absence of involvement of the contralateral ovary and uterus.     

卵巢卵黄囊瘤手术和化疗后自然周期体外受精-胚胎移植成功分娩一例并文献复习

卵巢卵黄囊瘤属卵巢恶性生殖细胞肿瘤,占卵巢恶性肿瘤的1%。由于卵巢恶性生殖细胞肿瘤多见于儿童及年轻女性,故保存生育能力是关键。卵巢卵黄囊瘤对化疗药物敏感,手术联合术后辅助化疗是标准治疗方案。对于对侧卵巢和子宫未受肿瘤累及,并且有生育需求的患者均应行保留生育功能的手术。但肿瘤本身、手术和放化疗均可能造成患者不孕,术后可能需要借助辅助生殖技术助孕,本文通过1例卵巢卵黄囊瘤患者手术和术后化疗后行自然周期-体外受精-胚胎移植(NC-IVF-ET)的个案报道和文献复习,探讨卵巢卵黄囊瘤患者的生育助孕策略。     

卵巢恶性肿瘤患者保留生育功能手术的指征及处理原则

年轻的卵巢恶性肿瘤患者施行保留生育功能手术应限于早期且组织学类型较好者,如高、中分化上皮性肿瘤而非透明细胞瘤。术后一般不影响预后,且妊娠结局良好。而对中、晚期患者一般不推荐施行保留生育功能手术。卵巢交界性肿瘤患者年龄相对较轻,而且在诊断时多为Ⅰ期肿瘤,施行保留生育功能手术后妊娠成功率甚高。对卵巢交界性肿瘤患者甚至可行卵巢囊肿剥除术,其并不影响预后。生殖细胞肿瘤患者行保留生育功能手术的文献报道多为无性细胞瘤,手术成功率较高。而对晚期或其他类型生殖细胞肿瘤患者也有尝试保留生育功能手术,但这仅为个案报道,通常并不推荐施行保留生育功能手术,除非患者及家属有强烈意愿。对于施行保留生育功能手术的卵巢恶性肿瘤患者,由于具体情况不同,手术应因人而异行个体化治疗。     

Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors

OBJECTIVES: Although cancer is predominantly a disease of aging, an increasing number of women survive malignancies before or during their reproductive years, which may interfere with their fertility potential. Although a variety of studies have tried to document the impact of conservative treatment aimed at preserving ovarian function and reproductive ability, little information has been available regarding survivors' attitudes, emotions, and choices to have children. The aim of this study is to evaluate the reproductive history, experiences, attitudes, and emotions with regard to having children in conservatively treated patients with Stage I epithelial ovarian cancer, any stage LMP tumors, malignant ovarian germ cell tumors (MOGCTs) and Stage I sex cord-stromal tumors (SCSTs). STUDY DESIGN: Between 1986 and 2000, a total of 75 patients with primary malignant ovarian tumors underwent conservative treatment. Out of 75 patients in the study, 14 women (19%) presented Stage I epithelial ovarian cancer, 23 (31%) LMP tumors, 33 (43%) MOGCTs, and five (7%) SCSTs. Information was obtained from medical records and from a questionnaire mailed to all patients who were at least 15 years old at the time of the diagnosis (68 subjects). Median time of follow-up was 102 months (35-192 months). There were four (5.2%) clinical recurrences within 35 months. Only 20 patients (49%) had tried to conceive after the completion of their treatment; of these, 15 women (75%) succeeded and delivered 19 healthy children. Seventy percent (32/41) of the respondents claimed that their disease did not have any impact on their desire to have children. Whereas 51% (21/41) fear that their ovarian disease could have damaged their reproductive potential, 76% (31/41) are not concerned about the effects of the treatment they received on offspring. The impact of the disease on the patients' attitudes toward life was reported as positive. CONCLUSION: The results from our study, in agreement with the data from the literature, confirm that management of Stage I (grade 1, grade 2) epithelial ovarian cancer, any stage LMP tumors, MOGCTs and Stage I SCSTs with fertility-sparing surgery is a safe, practicable treatment option. Though preliminary, this survey provides insight into the attitudes and experiences of young women ovarian cancer survivors regarding fertility.     

Keimzelltumoren des Ovars

This review deals with relevant aspects of ovarian germ cell tumors. Malignant ovarian germ cell tumors are rare, aggressive, and chemosensitive tumors of young women. The chances for cure are close to 100% for lower stages and approximately 80% for higher stages. Prognostic factors include staging, residual tumor after surgery, histological type, and tumor markers like AFP and HCG: fertility-sparing surgery followed by polychemotherapy containing platinum is currently the state of treatment. In stage I and in completely resected tumors two to three courses of chemotherapy are recommended. In higher stages and in residual disease after surgery, four courses could be applied. Even in higher stages a fertility-sparing surgical approach is feasible. In stage IA disease surveillance is a safe option. If the patient relapses, chemotherapy will then be commenced. Even in this case the chances of survival are high. Second-look surgery is not necessary.     

卵巢恶性肿瘤年轻患者保留生育功能手术的效果评价

目的总结评价卵巢恶性肿瘤年轻患者保留生育功能手术和术后辅助化疗的效果及对生育功能及卵巢功能的影响.方法回顾性分析四川大学华西第二医院1989-2004年收治的64例接受保留生育功能手术治疗的卵巢恶性肿瘤年轻患者的临床资料.结果初诊时患者中位年龄为20（7～30）岁.64例患者中,卵巢上皮性癌患者22例,恶性生殖细胞肿瘤38例,性索间质肿瘤4例.首次手术方式如下：单侧附件切除术23例;单侧附件切除＋大网膜切除＋阑尾切除术10例,单侧附件切除＋大网膜切除＋阑尾切除＋盆腔淋巴结切除或取样术10例;单侧附件切除＋肿瘤细胞减灭术4例;单侧附件切除＋对侧卵巢楔形切除活检术11例;6例仅行患侧肿瘤剥除术.64例患者平均随访76（5～192）个月,5例（8%）死亡,59例（92%）存活至今,其中卵巢恶性生殖细胞肿瘤患者存活率为89%（34/38）,上皮性癌患者为95%（21/22）,性索间质肿瘤患者全部健在（4/4）.15例患者行二次手术,其中发现癌灶者6例.生存病例中53例患者有月经,除2例周期缩短外,其余患者月经均正常.20例有生育计划的患者中,13例（65%）患者有15次妊娠,9次足月分娩.结论对卵巢恶性生殖细胞肿瘤患者,无论期别如何,行保留生育功能手术是可行的;对于卵巢上皮性癌患者行保留生育功能手术需慎重,仅限于年轻、有强烈生育要求、肿瘤为Ⅰ期、高分化且术后有条件密切随访的患者;坚持规范化疗对卵巢恶性肿瘤的治疗十分必要;化疗对卵巢及生育功能无明显影响.     

Conservative surgery for borderline ovarian tumors: a review

OBJECTIVE: Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low potential to invade or metastasize. This review will outline the most recent information regarding the molecular pathogenesis, pathology, fertility and tumor recurrence rate after conservative management of young women with early-stage borderline ovarian tumors. METHODS: We performed a MEDLINE literature search of relevant clinical trials for the scope of this review that evaluated conservative treatment of borderline ovarian tumors for young women with low-stage disease who wish to preserve their fertility. RESULTS: Recently, investigators have begun to identify subsets of patients with a worse prognosis, such as patients with aneuploid tumors. A number of oncogenes are under investigation to determine their role in the pathogenesis of borderline ovarian tumors. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Laparoscopic treatment of adnexal masses has proved to be a safe and effective diagnostic and therapeutic tool in the hands of experienced laparoscopists. For women who are treated conservatively, follow-up is important. Surgery remains the most effective therapy for later stage lesions. Adjuvant therapy for advanced stage of borderline ovarian tumors remains controversial. CONCLUSION: Conservative management of borderline ovarian tumors is an appropriate therapeutic option for young women with early-stage lesions who wish to preserve their childbearing potential. Available data indicate that in these patients fertility, pregnancy outcome and survival remain excellent.     

Two Concurrent Cancers in a 19-Year-Old Patient: Yolk Sac Ovarian Tumor and Metastatic Gastrointestinal Tract Malignancy—Case Report

BackgroundTwo concurrent malignancies present in a young person is an extremely rare condition. Diagnoses of gastric cancer primarily concern older patients. There are very few reports of concomitant Krukenberg tumor and germ-cell ovarian malignancy.CaseA 19-year-old girl was admitted to the gynecologic oncology department with symptoms of advanced malignancy. Radiological imaging revealed disseminated neoplastic disease with bulky adnexal tumors. Cytoreductive surgery was performed, achieving no visible disease (T = 0 cm). The final pathology report confirmed metastatic mixed adenoneuroendocrine carcinoma (MANEC) in both ovaries, originating from the gastrointestinal tract. Moreover, the primary germ cell yolk sac tumor was found in the left ovary.ConclusionIn cases of concomitant gastric and ovarian tumors, metastatic disease (Krukenberg tumor) should be considered in the differential diagnosis. This concerns even adolescent patients. In particular cases, including tumors with germ cell components, primary debulking surgery is crucial for prognosis.     

Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer

The rate of ovarian tumour diagnosis in reproductive age woman has increased parallel to the improvements in diagnostic methods and regular gynaecological visits. Because of this organ saving surgical procedures for the preservation of reproductive and endocrine functions have gained more interest. Conservative surgical approaches for ovarian tumours after surgical staging include cystectomy, unilateral salpingo-oophorectomy and unilateral salpingo-oophorectomy plus contralateral cystectomy. Ovarian tumours diagnosed in young ages tend to be low-stage low-grade malignancies. This not only enables but also necessitates preserving the fertility of women who have not completed their family. In invasive ovarian cancer, fertility saving surgery is confined to early-stage and low-grade disease. But, it also had been reported in advanced stages (up to Stage IIIc). Candidates for those procedures were selected according to the FIGO stage, grade, ploidy state, histological subtypes and patients' desire. Adjuvant chemotherapy is necessary for high-risk patients. The rate of recurrence following conservative and radical surgical procedures in low-stage and low-grade tumours are 9% and 11.6%, respectively; and disease-free and overall survival rates do not differ significantly. Prognosis of borderline ovarian tumours is excellent. Five and 20-year survival rates are 95% and 80%, respectively. Management of borderline tumours has evolved significantly in the last few decades. In contrast to invasive ovarian cancer, borderline tumours can be operated on conservatively at all stages. Chemotherapy is rarely prescribed even in advanced stages. Eighty percent of malignant germ cell tumours are diagnosed less than 30 years of age, and 70-75% of patients have Stage I disease. Conservative surgery is generally used in malignant germ cell tumours even in advanced stages. The relation between ovulation induction and tumour recurrence is not consistent in the literature. Spontaneous pregnancy rates following fertility saving surgery has been reported as 60-88%. Because of this over-treatment of these patients for fertility should be avoided. Briefly, fertility saving surgery can be performed safely in germ cell, borderline and early stage epithelial ovarian tumours in selected cases. Any increment in the rate of tumour recurrence following ovulation induction has not yet been demonstrated. Menstrual irregularities caused by chemotherapy are transient. The congenital malformation rate of ovarian cancer patients is slightly higher than that of the normal population, but no significant difference has been observed between patients who received or did not receive chemotherapy.     

Combination chemotherapy in the management of ovarian germ cell malignancies

Twenty-four patients with ovarian germ cell malignancies received combination chemotherapy in the present series. Fifteen patients received intensive vincristine, actinomycin-D, and cyclophosphamide therapy for 12 to 18 courses, and 13 are alive and free of disease 34 to 86 months later. One patient with a stage III pure endodermal sinus tumor and one patient with a stage III mixed germ cell tumor composed predominantly of endodermal sinus tumor elements failed vincristine, actinomycin-D, and cyclophosphamide therapy, but each transiently responded to cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy. Nine patients subsequently were treated on a new protocol that used the intensive vincristine, actinomycin-D, and cyclophosphamide regimen for five to six courses for all stage I ovarian germ cell malignancies and cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy for advanced stage tumors containing endodermal sinus tumor. Each patient on the new protocol is alive and free of disease 14 to 26 months later. Short-term intensive vincristine, actinomycin-D, and cyclophosphamide therapy is recommended for all stage I ovarian germ cell malignancies requiring adjuvant chemotherapy. Preservation of ovarian and reproductive function is appropriate in the present group of patients. Vincristine, actinomycin-D, and cyclophosphamide therapy is also recommended for biomarker negative advanced stage ovarian germ cell malignancies. Cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy is recommended for advanced stage biomarker positive ovarian germ cell malignancies. Serial alpha-fetoprotein (AFP) titers accurately reflect the status of endodermal sinus tumor elements and may be used as a guide to discontinue treatment for patients with pure endodermal sinus tumor malignancies, obviating the need for second-look surgery.     

Tumor chemoconversion following surgery, chemotherapy, and normalization of serum tumor markers in a woman with a mixed type germ cell ovarian tumor

BACKGROUND: Malignant germ cell tumors of the ovary are often curative after conservative surgery and adjuvant chemotherapy. Persistent tumors despite normalization of serum tumor markers may represent retroconversion to benign masses, but this is rare in ovarian tumors without teratoma elements. The management in such cases has not been defined. CASE: A young woman with a stage IIIC mixed germ cell ovarian tumor containing endodermal and dysgerminoma elements and elevated serum tumor markers underwent conservative surgery followed by chemotherapy. Residual tumor persisted on CT despite the normalization of serum tumor markers. The residual tissue was resected and contained benign tissue. CONCLUSIONS: In cases where masses persist and serum tumor markers normalize, attaining a histological diagnosis, and not chemotherapy, should be considered.     

Ovulatory failure, fertility preservation and reproductive strategies in the setting of gynecologic and non-gynecologic malignancies

The advances in assisted reproductive technology over time have paralleled the insights gained into the natural history of different gynecologic malignancies. Subgroups of young patients with early stage ovarian cancer, endometrial carcinoma and cervical carcinoma may be considered to be at relatively low risk of recurrence and may be treated conservatively with the aim to preserve fertility when this is of prime concern. Unilateral adnexectomy with preservation of the contralateral ovary and uterus may be appropriate for some patients with epithelial ovarian cancers, and certainly should be the procedure of choice for those young women with borderline tumors and early stage sex cord-stromal and malignant germ cell tumors. Administration of high-dose progestins may obviate the need for immediate hysterectomy in a young patient with a well-differentiated endometrial carcinoma desirous of childbearing. The performance of vaginal radical trachelectomy in conjunction with laparoscopic pelvic lymphadenectomies has emerged as a real breakthrough for a highly select group of young women with early invasive tumors of the cervix. In this review, we also discuss reproductive strategies for women who experience chemotherapy-induced ovulatory failure and also address the potential for ovarian cortex cryopreservation and transplantation, and uterine transplantation, all of which are looming on the horizon.     

Treatment of ovarian cancer in young women

Ovarian cancer accounts for approximately 22,000 cases annually in the United States. Although the vast majority of ovarian cancers occur in postmenopausal women and are of advanced stage, a significant subset occurs in young women. Among those subtypes having a predisposition for young women are malignant ovarian germ cell tumors, sex cord-stromal ovarian tumors, and tumors of low malignant potential. However, invasive epithelial ovarian cancers may also occur in young women, particularly the subtypes of low-grade serous carcinoma and mucinous carcinoma. This article details the diagnosis and optimal treatment of ovarian cancers subtypes in young women.     

Management of malignant ovarian germ cell tumors

Malignant ovarian germ cell tumors are rare, highly curable cancers of young women. The majority of patients can be cured with either fertility-preserving surgery alone or a combination of surgery and chemotherapy. Relapses occur in 10% to 20% of patients, and the significant proportion of them can be salvaged with chemotherapy. There is no evidence that treatment for malignant ovarian germ cell tumors will adversely affect menstrual or reproductive functions, increase future pregnancy loss, or increase the risk of congenital malformations of the fetus. Late effects, such as secondary leukemia, from chemotherapy are reported but rare. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVE: After completing this CME activity, physicians should be better able to diagnose ovarian germ cell tumors, outline management of malignant ovarian germ cell tumors, and understand the impact of treatment on fertility and late effects.     

Malignant germ cell tumors of the ovary

OBJECTIVE: To evaluate the efficacy of adjuvant therapy for ovarian germ cell tumors. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1977-1997. RESULTS: Seventy-two women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Fifty-six women (78%) presented with stage I disease, and 16 (22%) had more advanced disease. Tumor subtypes included dysgerminoma (n = 20), yolk sac tumor (n = 8), immature teratoma (n = 29) and mixed germ cell tumor (n = 15). Surgical management of the 56 with stage I disease consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and extensive surgical staging in ten women, whereas a conservative surgical approach, consisting of unilateral adnexectomy with or without comprehensive surgical staging, was adopted in later years (n = 46). Fifty-six women were treated with postoperative chemotherapy, predominantly platinum-based regimens. The 5-year actuarial survival rate was 93%. None of the 36 women who presented after 1984 have died of disease. CONCLUSION: These data confirmed that platinum-based adjuvant treatments allow most women with ovarian germ cell malignancies to have conservative surgery without compromising survival.     

Paraneoplastische neurologische Syndrome in der gynäkologischen Onkologie

Paraneoplastic neurological syndromes (PNS) are rare neurological disorders that are associated with a tumor without being directly triggered by the tumor itself or its metastases. PNS can affect every level of the nervous system through an autoimmune reaction against neuronal cells. Neurological symptoms can even occur several years before the tumor is diagnosed. The diagnosis is based on tumor detection, clinical symptoms, and antibody detection, while simultaneously excluding other causes. In addition to symptomatic therapy, the specific tumor therapy is the treatment of choice and depends primarily on tumor type and stage, not on the PNS. The most common PNS-associated gynecological tumor entities are breast cancer, ovarian cancer, and ovarian germ cell tumors. The detection of the well-characterized paraneoplastic antibodies and the search for associated tumors play very important roles in diagnosis. In gynecologic tumors (especially ovarian cancer), paraneoplastic cerebellar degeneration (PCD) is the best-known PNS, which is usually associated with anti-Yo antibodies. Most patients show a progressive course despite the specific tumor therapy. Overall, the prognosis is relatively poor.     

The role of tumor markers in gynecologic oncology.

Human chorionic gonadotropin is a highly sensitive and specific tumor marker for gestational trophoblastic neoplasia that accurately reflects tumor volume and the clinical course of disease. In women with endodermal sinus tumors and embryonal carcinomas, alpha-fetoprotein usually is a reliable marker, and it accurately predicts the presence of yolk sac elements in mixed germ cell tumors. CA 125 is the most widely utilized tumor marker presently available for use in patients with epithelial ovarian cancer. It has utility in monitoring therapy and differentiating benign from malignant pelvic masses. Measurement of serial CA 125 levels in postmenopausal women may facilitate screening for occult early stage disease. In the future, monoclonal antibodies that recognize tumor-associated antigens may prove useful for radionuclide imaging.