## Sites of Recurrence in Ovarian Cancer **Key Point:** The pelvis and peritoneal surfaces are the most common sites of recurrence in ovarian cancer, reflecting the intra-abdominal spread pattern of this malignancy. ### Pattern of Spread and Recurrence Sites | Recurrence Site | Frequency | Mechanism | Clinical Significance | |---|---|---|---| | **Pelvis & peritoneal surfaces** | 60–70% | Direct peritoneal dissemination; implantation on viscera | Most common; often detected by imaging or CA-125 rise | | **Liver surface/peritoneum** | 20–30% | Peritoneal spread to hepatic surface; rarely parenchymal | Diaphragmatic involvement common | | **Lung parenchyma** | 10–15% | Hematogenous spread; late manifestation | Indicates advanced systemic disease | | **Brain parenchyma** | <5% | Hematogenous spread; very rare | Occurs in <2% of ovarian cancer patients | | **Bone** | 5–10% | Hematogenous spread | Uncommon but possible | **High-Yield:** Ovarian cancer spreads primarily by **direct peritoneal seeding** rather than lymphatic or hematogenous routes early in disease. This explains why pelvic and peritoneal recurrences vastly outnumber distant metastases. ### Clinical Implications **Clinical Pearl:** Recurrence in the pelvis and peritoneal surfaces is often amenable to **secondary cytoreductive surgery** if the patient has a prolonged treatment-free interval (typically >6 months) and good performance status. This contrasts with parenchymal lung or brain metastases, which carry poorer prognosis and limited surgical options. **Mnemonic:** **PPP** — **Pelvis, Peritoneum, Peritoneal surfaces** are the primary recurrence pattern in ovarian cancer due to its natural spread mechanism. [cite:Harrison 21e Ch 110]
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