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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
topotecan
liposomal doxorubicin
oral etoposide
altretamine
gemcitabine |
|
|
