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Hemat/Onc EXAM 3
Hemat/Onc EXAM 3 - Hecht Ovarian Cancer
19
Pharmacology
Graduate
02/07/2012

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Cards

Term
etiology of ovarian cancer
Definition
exact cause unknown

related to rupture and repair of epithelium related to ovulation
Term
ovarian cancer risk factors
Definition
family history:
familial - isolated cases within a family
hereditary ovarian cancer syndromes

nulliparity - not having kids

first child after age 35

advanced age

North American or Northern European descent

prolonged use of ovulation inducing drugs?
Term
hereditary ovarian cancer syndromes
Definition
account for 5-10% of ovarian cancers

occur earlier than non-hereditary patients

hereditary breast-ovarian cancer syndrome:
familial predisposition to breast and ovarian cancers
BRCA-1 mutation
tumor suppressor gene

hereditary nonpolyposis colorectal cancer (Lynch Syndrome):
risk of endometrial, colon, and ovarian cancers
non BRCA related mutation
Term
negative risk factors for ovarian cancer
Definition
first child before age 25

oral contraceptive use

at least 2 full term pregnancies

breast feeding

tubal ligation?
Term
ovarian cancer presentation
Definition
most patients present with advanced disease (stage III or IV)

nonspecific symptoms: nausea, dyspepsia, flatulence, bloating, early satiety

direct symptoms: ABNORMAL VAGINAL BLEEDING, ABDOMINAL DISTENTION AND DISCOMFOT, ascites, amenorrhea, abdominal/pelvic masses
Term
ovarian cancer diagnosis
Definition
complete history and physical

breast exam

CA-125: antigen produced by ovarian cancer cells that is frequently elevated in patients with ovarian cancer

transvaginal ultrasonography

beta-HCG and alpha fetoprotein - to detect if the tumor is from germ cells; treated differently than tumors of epithelial origin (more common)

CT of abdomen (advanced disease)

chest X-ray

hepatic and renal function

exploratory laparotomy
Term
ovarian cancer metastasis
Definition
primarily spreads through direct dissemination

can also have shedding from ovarian cpasule

lymphatic spread

most common sites of distant metastasis include liver and lung
Term
ovarian cancer screening
Definition
CA-125

> 25 U/mL = ELEVATED

NOT SENSITIVE OR SPECIFIC ENOUGH FOR SCREENING

used to monitor patients

what are the consequences of a screening test not being sensitive enough?
high rate of false negatives

what are the consequences of a screening test not being specific enough?
high rate of false positives
Term
poor prognostic indicators for ovarian cancer
Definition
stage

histological grade

presence of ascites at diagnosis

tumor on ovary surface

age > 65

volume of residual disease after surgery

high post-op CA-125
Term
treatment of ovarian cancer
Definition
initial goal of treatment is cure

after relapse, goal is palliation

EVERY PATIENT GETS SURGERY
Term
ovarian cancer surgery
Definition
EVERYONE GETS SURGERY TO DEBULK TUMOR
optimally debulked is < 2 cm residual disease

if need to preserve fertility, and only one ovary involved, can spare the unaffected ovary

otherwise, all patients get total abdominal hysterectomy/bilateral salpingo oopherectomy
Term
after surgery...then what?
Definition
chemotherapy with PLATINUM AGENT + PACLITAXEL

cisplatin and carboplatin shown to be equally effective

carboplatin better tolerated

cisplatin has been studied as intraparitoneal therapy
Term
chemotherapy regimen: carboplatin + paclitaxel
Definition
give pacelitaxel first (cisplatin may decrease paclitaxel clearance)

ADRs:

QUICK:

hypersensitivity

SHORT TERM:

N/V

myelosuppression

mucositis

alopecia

neuropathies

nephrotoxicity

LONG TERM:

hepatotoxicity
Term
intraperitoneal therapy
Definition
should be considered in stage III disease

must be optimally debulked (surgery)

IP chemotherapy diluted in 2L warm normal saline

only 42% completion rate (switched to standard IV therapy)

change positions every 15 minutes

ADRS:

QUICK:

hypersensitivity

SHORT TERM:

PAIN - primiary reason for discontinuation of the IP administration was abdominal pain

FATIGUE

N/V

myelosuppression

neuropathies

mucositis

LONG TERM:

hepatotoxicity
Term
treatment of stage I ovarian cancer
Definition
SURGERY

if grade 1 or 2 -> OBSERVATION

if grade 3 -> IV CHEMO (carboplatin + paclitaxel)
Term
treatment of stage II-IV ovarian cancer
Definition
SURGERY

IP CHEMO (cisplatin + paclitaxel)
Term
monitoring therapy
Definition
patients should be seen every 2-4 months for first 2 years, then every 6 months for 3 years

check CA-125 if elevated at presentation

physical exam, including pelvic exam

abdominal CT

chest X-ray
Term
ovarian cancer relapse
Definition
GOAL OF TREATING RELAPSE IS PALLIATION

PLATINUM SENSITIVE IS RELAPSE > 6 MONTHS AFTER PLATINUM CONTAINING THERAPY

PLATINUM RESISTANT IS RELAPSE < 6 MONTHS AFTER PLATINUM CONTAINING THERAPY

IF PLATINUM SENSITIVE, SHOULD REPEAT INITIAL CHEMOTHERAPY

secondary surgery or radiation may be option for LOCALIZED RECURRENCE
Term
salvage agents
Definition
topotecan

liposomal doxorubicin

oral etoposide

altretamine

gemcitabine
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