Krukenberg tumor is a secondary tumor of gastrointestinal carcinoma. Metastasis usually occurs bilaterally, on both sides. If detected early, a good chance of survival can be achieved by means of neoadjuvant chemotherapy or radiotherapy including radical surgery. In the advanced stage, the chance is rather low.
What is a Krukenberg tumor?
Secondary Krukenberg tumor, Latin fibrosarcoma ovarii mucocellulare carcinomatodes, is a form of ovarian metastasis and was named after Friedrich Ernst Krukenberg, who first described it before he died in 1946. In simple terms, a Krukenberg tumor is the metastasis of a gastrointestinal carcinoma to the ovaries or Douglas space, which is located between the uterus and rectum and is also categorized as a drip metastasis (distant metastasis). Metastases develop in body cavities by caudal migration of detached tumor cells by gravity to other organs or even organ parts. Metastasis is often bilateral, cavitary. The histologic picture shows mucus-forming signet ring cells. Because the ovarian stroma proliferates strongly, the cells proliferate. At approximately 14 percent, Krukenberg tumor, which often occurs bilaterally, is the third most common ovarian metastasis. Otherwise, the percentage is five to ten percent.
Causes
Hematogenous spread is thought to be, especially in the early stages. Is the most likely cause. In addition, direct spread of tumor cells to the abdomen, reaching the ovaries, may also be a cause. In this case, we would be talking about drip metastases. However, since the omentum majus, which lies between the stomach and the ovaries, is never affected by metastases, this hypothesis is considered rather unlikely. Another argument against this is that a Krukenberg tumor does not occur on the outside but inside the ovary, the ovarian stroma. Not to be forgotten as a cause are also genetically determined hereditary information. Taking into account that a Krukenberg tumor is a secondary tumor of gastric carcinoma, the causes that can trigger gastric cancer should be considered. These include infections originated by Helicobacter pylori, as well as a chronic inflammation of the stomach (chronic gastritis or pernicious anemia) or heavy nicotine consumption. A diet rich in nitrosamines can also promote a Krukenberg tumor. These include beer, smoked, salty or cured foods (meat), and high consumption of fish and cheese with high nitrosamine levels. In addition, lack of exercise and severe obesity play a not insignificant role in the disease. However, by far not everyone who suffers from one or more of these symptoms develops stomach cancer. On the other hand, patients are diagnosed with gastric cancer who have never had any of these symptoms before.
Symptoms, complaints, and signs
The symptomatology of a Krukenberg tumor is often very discrete and also nonspecific, especially in the early stages. Consequently, diagnosis is very difficult. Patients often suffer from pain in the abdominal region. These are often localized in the lower abdomen. Furthermore, vaginal bleeding and dyspareunia (pain during sexual intercourse) are frequently reported. An altered menstrual cycle is also frequently mentioned. In addition, there is a feeling of fullness and a decrease in performance. In advanced stages, fever occurs as well as night sweats and unwanted weight loss. The symptoms should also take into account those of a stomach carcinoma, because the primary tumor is usually found there, from which the Krukenberg tumor develops as a secondary tumor (foreign tumor). Therefore, in addition to the previously mentioned symptoms, it is necessary to observe whether tarry stools, dysphagia, nausea and vomiting, and loss of appetite exist.
Diagnosis and course of the disease
Women are particularly affected at the time of perimenopause or postmenopause. Sometimes Krukenberg tumor can be palpated in the lower abdomen. Imaging by MRI (magnetic resonance therapy) or laparotomy (surgical procedure) followed by histologic examination of the tissue will provide clarity. Histology reveals characteristic signet ring cells filled with mucus.
Complications
In many cases, Krukenberg tumor leads to patient death.For this reason, early detection of this tumor is particularly necessary so that it can still be removed and treated in time. As a rule, the Krukenberg tumor also significantly reduces the patient’s life expectancy. Patients primarily suffer from severe weight loss. Furthermore, pain occurs during sexual intercourse and there is a bloated abdomen or a feeling of fullness. It is not uncommon for patients to sweat at night, and women suffer more frequently from vaginal bleeding. The patient’s quality of life is significantly limited and reduced by the Krukenberg tumor. Furthermore, there is also nausea or nausea. It is also not uncommon for those affected to exhibit dysphagia and be unable to take in food and liquids in the usual way. A tarry stool also presents itself. Krukenberg tumor is treated with radiotherapy or chemotherapy. In many cases, various side effects occur due to the chemotherapy. It is usually not possible to generally predict whether this will result in a positive course of the disease.
When should you go to the doctor?
Because Krukenberg tumor forms only in people of the female sex, women or girls are among the group of people at risk. They should see a doctor as soon as irregularities develop in the lower abdomen that cannot be attributed to the menstrual cycle or to an existing pregnancy. If there is pain in the lower abdomen, a pulling sensation when moving around, or discomfort during the sexual act, a visit to the doctor is advised. If the pain gradually increases in intensity or extent, a doctor should be consulted as soon as possible. Since the tumor can be life-threatening, a doctor should be consulted at the first signs and symptoms. If unexplained bleeding occurs, fever sets in or night sweats form on the body, a doctor is needed. If there is a loss of appetite, an unwanted decrease in weight, or abnormalities in bowel movements, a doctor’s visit is required. Nausea, vomiting, a general feeling of malaise or a drop in the usual level of performance are other indications that should be followed up. A doctor should be consulted as soon as the symptoms persist unabated for several days or weeks. Swelling of the body, a feeling of tightness in the abdomen as well as swallowing difficulties may indicate an existing imbalance. A visit to the doctor should be initiated immediately so that medical attention can be given.
Treatment and therapy
Because a Krukenberg tumor is a secondary tumor of gastric cancer, the first priority is to locate the primary tumor in order to treat it. Therapeutic options include neoadjuvant chemotherapy or radiotherapy including radical surgery. This involves removal of the ovaries as well as the affected bowel sections. This therapy is successful if the Krukenberg tumor is limited to the ovaries as well as the pelvis. If the tumor has already spread, the prognosis is rather unfavorable. Therefore, at the beginning of a therapy (preoperatively) there is also the classification, the determination of the tumor stage with the TNM formula. The exact determination of the present anatomical extension is the basis for the course of treatment with microscopic examination of the tumor tissue. After removal of the affected tissue and the surrounding marginal zones and possibly the lymph nodes, the resection stage is determined postoperatively. The result provides information on whether tumorous tissue is still present.
Outlook and prognosis
The prognosis of Krukenberg tumor is unfavorable in most cases. Treatment is very complex and requires immediate intervention by a physician. The disease is a secondary tumor disease, which requires that a primary tumor disease is already present in the organism. Without medical treatment, the cancer cells continue to spread in the body unhindered. Ultimately, this leads to a multiple failure of various functional abilities or organs and thus to a premature death of the affected person. There is only a chance of alleviating the symptoms or even curing the disease if the initial and secondary disease can be diagnosed at an early stage. Comprehensive treatment must be initiated as quickly as possible.In therapy, it is important to localize the primary tumor and, if possible, to eliminate it completely. In addition to cancer therapy, surgery is necessary in most cases. If the primary as well as the secondary tumor can be completely removed during surgery, the prognosis improves considerably. Nevertheless, there is a risk of additional complications from the surgery and the initiated therapy. In addition, when making the prognosis, it must be taken into account that metastases may have already formed in the organism at other sites, leading to the spread of cancer cells.
Prevention
A healthy and varied diet rich in fiber can prevent. This includes fresh and gently cooked vegetables. The color palette of red as well as yellow and green should be considered. Onion and potato as well as brown rice also belong on the menu. Fresh fruit, preferably in organic quality, should also be part of the daily diet. Meat and fish, preferably organic, should be consumed in moderation because of nitrosamine levels. Healthy organic whole grain bread (without pesticide contamination) made from rye, spelt, buckwheat or emmer flour stimulates digestion and thus helps to purify and detoxify the body. The consumption of beer should be limited. In addition, sufficient exercise is important. Walking briskly for at least an hour every day is a good start. Better still two to three times the week extensively a kind of sport pursue, so that the organism comes on speed. Excess weight should be strictly avoided as a preventive measure.
Aftercare
In most cases of a Krukenberg tumor, the measures of aftercare are severely limited or not available to the affected person at all. In this case, the patient is primarily dependent on a rapid diagnosis and treatment so that no further complications or complaints occur. A complete cure is usually not possible, so that the life expectancy of many affected persons is greatly reduced due to the Krukenberg tumor. Most patients are dependent on chemotherapy or radiation therapy for this disease. They often need the support of parents or friends. Loving support in everyday life has a very positive effect on the course of the disease. Likewise, loving and intensive conversations with those affected are necessary to prevent psychological complaints or depression. After an operation, the patient should rest and take care of his or her body. Efforts or stressful activities should be avoided in order not to put unnecessary strain on the body. After the removal of the Krukenberg tumor, regular examinations with a doctor should take place in order to detect and remove further tumors at an early stage.
What you can do yourself
Patients with a Krukenberg tumor can take several measures to relieve discomfort and support medical treatment. First, rest and bed rest apply. In the case of a smaller tumor underlying a comparatively harmless form of cancer, the affected person can continue to work and participate in daily life. In the case of a severe disease, strenuous activities should be avoided. The individual symptoms can be alleviated by means of the typical measures. In the case of fever and chills, cooling compresses and moderate exercise as well as bed rest and relaxation help. If sore throat or swallowing difficulties occur, herbal tea with honey is recommended. A proven remedy from homeopathy is Argentum nitricum in the potency D12. Weight loss, loss of appetite and gastrointestinal complaints require medical clarification. This should be accompanied by a change in diet. A low-carbohydrate, high-fat diet can also help to inhibit the growth of cancer cells. Tumor patients should consult their physician and work out an individual diet together. This can not only inhibit tumor growth, but also counteract individual symptoms. If the above measures and remedies do not have any effect, medical advice is required.
