Peripheral Neuropathy in Ovarian Cancer

Peripheral neuropathy is not uncommon in ovarian cancer. The incidence density of peripheral neuropathy was 21.5 per 1000 person-years in ovarian cancer, 15.3 per 1000 person-years in breast cancer and 18.3 per 1000 person-years in lung cancer for patients who received platinum-taxane combination chemotherapy (Nurgalieva et al., 2010). Carboplatin/paclitaxel is the chemotherapy of choice for advanced ovarian cancer, which has been reported to associate with chemotherapy induced neurotoxicity in as high as 54% of patients after their first-line 6 cycles of treatment and with 23% of patients with residual neuropathy after a median follow up of 18 months (Pignata et al., 2006 ). However, peripheral neuropathy in ovarian cancer is not always due to chemotherapeutic agents. Other etiologies of neuropathy in ovarian cancer patients are focal compression, nutritional deficiency, metabolic abnormalities, endocrine disorders, and paraneoplastic neurological syndromes. A detailed medical history is most important for the diagnosis of neuropathy including symptoms, distribution, duration and course of the neuropathy. The past medical and social history may reveal a possible cause such as diabetes, inflammation, or a toxic or nutritional etiology. A positive family history may suggest a hereditary neuropathy. A neurologic examination is required to confirm the presence of neuropathy. Electrodiagnostic studies, including nerve conduction study and electromyography, are used to reveal the severity and its distribution pattern; underlying process demyelination or axonal loss; sensory, motor or a combination. One limitation of nerve conduction study is that it assess the function of only the large diameter nerve fibers, and not small fibers. Quantitative sensory testing, epidermal nerve fiber density, or autonomic function testing are used to evaluate small fiber neuropathy. Blood tests may reveal the etiology of nutritional, metabolic, endocrine, inflammatory, paraneoplastic, infectious, toxic, or hereditary neuropathies.