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Krukenberg tumors

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on June 13, 2022.

A Krukenberg tumor is a rare and specific type of tumor that grows in the ovaries. However, a Krukenberg tumor isn’t strictly an ovarian cancer. These tumors are caused by another cancer, usually stomach cancer, that has spread (metastasized) to the ovaries. The name comes from the German doctor Friedrich Krukenberg who discovered this ovarian tumor in 1896 without knowing its true origin.

While most Krukenberg tumors are caused by stomach cancer, some originate from cancer elsewhere. According to a study published in the Journal of Medical Case Reports, about 76 percent come from stomach cancer, 11 percent from intestinal cancer, 4 percent from breast cancer and 3 percent from cancer of the appendix. In rare cases, Krukenberg tumors can originate from cancer in organs such as the gallbladder or pancreas.

Cancer can spread from your stomach (or another location) to the ovaries through the bloodstream or lymph system. As a tumor grows, its cancer cells begin to invade nearby tissues. If the cancer reaches a lymph node or blood vessel, cells can use these systems to travel to another part of the body and form a new tumor.

According to the journal Oncology: Tumor & Research, women who develop a Krukenberg tumor are most often diagnosed between the ages of 40 and 45, with 35 percent to 45 percent diagnosed under the age of 40. Also, 1 percent to 2 percent of all cancerous ovarian tumors in American women are Krukenberg tumors. While these tumors are rare, their frequency can fluctuate depending on the prevalence of stomach cancer in a given region of the world. For example, in Japan, where the incidence of stomach cancer is high, almost 18 percent of all ovarian cancers are Krukenberg tumors, according to a study in the Archives of Pathology & Laboratory Medicine.

Symptoms

Krukenberg tumors may not show any apparent signs or symptoms. When symptoms are present, they may include:

  • Abdominal mass that can be felt under the skin
  • Pain or discomfort in the pelvis or lower abdomen
  • Pain with intercourse
  • Bloating
  • Weight loss
  • Changes in menstrual cycle
  • Abnormal vaginal bleeding
  • Excessive hair growth in areas where women don’t typically grow hair, such as the face, chest and back
  • Anemia (low red blood cell count)

Among potential symptoms, abdominal pain and bloating are the most common. Excessive hair growth and menstrual changes may result from the tumor’s effect on hormone production in the ovaries. According to the Archives of Pathology & Laboratory Medicine study, about 50 percent of Krukenberg tumors lead to ascites, a condition in which fluid builds up in the abdomen.

Diagnosis

Krukenberg tumors may be discovered before or after the primary cancer. For example, in some women, stomach cancer may be diagnosed first, and then a Krukenberg tumor is found, or vice versa.

Sometimes doctors have difficulty locating the primary tumor, as it may be small. The cancers that are mostly responsible for causing Krukenberg tumors, such as stomach or breast cancer, can sometimes be present for a long time and spread to the ovaries before being detected.

The following diagnostic tests may be used to help locate and diagnose a Krukenberg tumor.

Imaging tests: An ultrasound or a computed tomography (CT) scan may help reveal a tumor in an ovary. Ultrasound devices use sound waves, which bounce off structures in the body to produce an image on a monitor. CT scans create detailed images using a machine to take X-rays of the body from multiple angles.

Biopsy: This procedure takes a small sample of the tumor so that it can be analyzed in a laboratory. The tumor sample may be extracted surgically or through a needle biopsy. At the lab, a pathologist—an expert in diagnosing diseases—performs various tests on the sample. These tests reveal characteristics of its cells to indicate the type of tumor. Treatment depends on the type of cancer, so it’s imperative to characterize the tumor precisely.

Blood tests: Measuring the levels of a protein called CA-125 in your blood may help diagnose and guide treatment of a Krukenberg tumor. Elevated levels of CA-125 can be an early indicator of malignant ovarian tumors. Doctors may recommend this blood test to look for signs of a Krukenberg tumor in patients with a gastrointestinal cancer or to monitor the progress of patients who’ve already had a Krukenberg tumor removed.

Endoscopy: If a Krukenberg tumor is diagnosed first, an endoscopy may be performed to look for the primary tumor in the gastrointestinal tract. This procedure involves inserting a thin, lighted tube with a camera through the mouth to look for signs of cancer inside the digestive tract.

Treatment

Doctors don’t have a well-established treatment protocol for Krukenberg tumors. It isn’t clear which treatment options, if any, lead to the best outcomes. The mortality rate among patients with Krukenberg tumors is high, with a median survival of about 14 months, according to a study published in Cancer Management and Research. Research published in the Archives of Pathology & Laboratory Medicine suggests that most patients survive for less than two years after their diagnosis.

While there’s a debate among researchers about the level of success of the following options, treatment for Krukenberg tumors may include:

Surgery: Doctors may recommend using surgical procedures including metastasectomy, which involves removing one or more metastatic tumors, or debulking, which involves taking out as much of the cancer as possible. Some studies suggest that these surgeries extend overall survival rates among patients with Krukenberg tumors.

Chemotherapy: Chemotherapy drugs may be used after surgery to try to improve results. Drugs may be delivered throughout the body via an infusion into a vein, or directly to the tumor using a method called hyperthermic intraperitoneal chemotherapy (HIPEC).

In some cases, these or other treatments are given as palliative care, which involves therapies used to help ease symptoms and improve quality of life for cancer patients.

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