Term
| What are risk factors for ovarian cancer? |
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Definition
- Incr #/duration of ovarian cycles
- Caucasian race
**Protective - Fewer ovulation cycles, pregnancy |
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Term
| What are types of ovarian cancer? |
|
Definition
Adenocarcinomas: 90%
- Serous - most common
- Clear cell - most virulent and rare
**Grade - most important prognostic factor |
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Term
| Is Ovarian cancer screened for? |
|
Definition
Not currently recommended
**Prevention - reduce # of ovarian cycles. Prophylactic surgery for high risk patients |
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Term
| How does ovarian cancer present? |
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Definition
The silent killer
- Bloating - ascites
- Pelvic pain
- Difficulty eating
- Urinary sx
- Pulmonary sx - SoB, tachypnea
- Labs: elevated ca-125, normal <35 |
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Term
| How is ovarian cancer diagnosed? |
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Definition
- Pap smear
- Pelvic exam
- Rectovaginal exam |
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Term
| How is ovarian cancer staged? |
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Definition
Findings of exploratory laparotomy - not staged until surgery. 50% are diagnosed at stage 3
I - limited to ovaries. Rupture in IC
II - ovarian + pelvic extension
III - Involves upper abdomen/lymph nodes
IV - distant organ involvement |
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Term
| What are general ovarian cancer treatments? |
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Definition
- Comprehensive surgical staging - total hysterectomy or BSO for ALL PATIENTS
- Radiation - palliative, not primary
- Chemo - taxanes and platinum |
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Term
| How is ovarian cancer treated by stage? |
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Definition
- Early stage favorable IA/IB - CSS
- Early stage unfavorable IA/IB, II - CSS + taxane + carboplatin
- Advanced Stage (III or IV) - CSS + taxane + carboplatin |
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Term
| When can IP chemo not be used in ovarian cancer? |
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Definition
Stage IV, residual/relapsed disease, co-morbid conditions.
**21.6% reduction in risk of death, hard to tolerate. Cisplatin + paclitaxel |
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Term
| How is paclitaxel used for ovarian cancer? |
|
Definition
Give BEFORE cisplatin to avoid neurotoxicity.
Must pretreat to avoid hypersensitivity: benedryl, dexamethasone, H2 due to Cremophor |
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Term
| How is docetaxel used for ovarian cancer? |
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Definition
Combined w/ carboplatin - for patients at risk for PN
Premedicate w/ dexamethasone 1 day before chemo due to FLUID RETENTION |
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Term
| What is considered the gold standard for ovarian cancer chemo? |
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Definition
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Term
| How is recurrent ovarian cancer managed? |
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Definition
60-80% relapse
- Marker only - Tamoxifen or AI
Dependent on response to initial therapy:
- Platinum sensitive - Response > 6 months. CONTINUE w/ platinum based therapy
- Platinum resistant - Initial response < 6 mo. CLINICAL TRIAL or HOSPICE
- Platinum refractory - no response, no shrinkage --> HOSPICE |
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Term
| How is bevacizumab used for ovarian cancer? |
|
Definition
Use as single agent in recurrent ovarian cancer for reduction in GI perforation.
**Use is not recommended upfront |
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