Académique Documents
Professionnel Documents
Culture Documents
If regression fails to occur, assessment is indicated Diagnostic tests include laboratory blood studies and pelvic
examination. Usually, ultrasound studies with and without blood flow measurements to the involved ovary are used for diagnosis and to help determine the best therapy. malignancy, or to treat. If one ovary must be removed, normal conception and childbirth is possible as long as a normal ovary remains on the other side.
Medication
LAPAROSCOPY
Staging The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging.
confirmed peritoneal implants outside the pelvis. Superficial liver metastasis equals stage III. Stage IIIA: microscopic peritoneal metastasis beyond pelvis (no macroscopic tumour). Stage IIIB: macroscopic peritoneal metastasis beyond pelvis less than 2 cm in greatest dimension. Stage IIIC: peritoneal metastasis beyond pelvis greater than 2 cm in greatest dimension and/or regional lymph node metastasis.
tumours involving 1 or both ovaries with distant metastasis. Parenchymal liver metastasis equals stage IV.
Management
Treatment Options
The treatment of ovarian cancers based on the
stage of the disease which is a reflection of the extent or spread of the cancer to other parts of the body. It also depends on histologic cell type, and the patient's age and overall condition. There are basically three forms of treatment of ovarian cancer:
surgery Chemotherapy radiation treatment,
GENERAL GUIDELINES:
Standard treatment is surgery (staging and optimal
debulking) followed by adjuvant chemotherapy in most cases. Even if optimal surgery is not possible, removing as much tumor as possible will provide significant palliation of symptoms.
GENERAL GUIDELINES:
Germ cell tumors are treated with surgery and multiagent chemotherapy in most cases
chemotherapy with responses in the range of 70-80% to first-line chemotherapy. The majority, however, relapse and ultimately die of chemotherapy-resistant disease. Second-line chemotherapy to date is disappointing in all forms of epithelial ovarian cancer with virtually no chance of successful second-line treatment following failure of initial regime.
SURGERY
Stage I
Generally a total abdominal hysterectomy, removal of
both ovaries and fallopian tubes, omentectomy, biopsy of lymph nodes and other tissues in the pelvis and abdomen,is done. Young women whose disease is confined to one ovary are often treated by a unilateral salpingo-oophorectomy without a hysterectomy and removal of the opposite ovary being performed
tissue removed, there may be no further treatment if the cancer is low grade, or if the tumor is high grade the patient may receive combination chemotherapy.
Stage II
Treatment is almost always hysterectomy and bilateral
salpingo-oophorectomy as well as debulking of as much of the tumor as possible and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After the surgical procedure, treatment may be one of the following: 1) combination chemotherapy with or without radiation therapy or 2) combination chemotherapy.
Stage III
Following the surgical procedure, the patient may either receive combination chemotherapy possibly followed by additional surgery to find and remove any remaining cancer.
Stage IV
CYTOREDUCTIVE SURGERY/DEBULKING:
surgery to remove as much of the tumor as possible. Most researchers consider residual disease of <1 cm to be optimal debulking surgery. followed by combination chemotherapy
Trial of 146 patients with stage III and IV ovarian cancer treated with cisplatin at Rosewell park Cancer Institute:
SIZE OF RESIDUAL DISEASE
SURVIVAL
5 YEARS 8 YEARS
<1 CM
1-2 CMS >2 CMS
56%
19% 13%
42%
10% 8.7%
CHEMOTHERAPY
Prolongs remission and survival Also used for palliative treatment in advanced n
recurrent disease
CHEMOTHERAPY
No chemotherapeutic agent kills all cancer cells in one
treatment ,Tf treatment needs to be repeated several times
CHEMOTHERAPY
This allows each of them to be used as nearv to the full
dose as possible.
First-Line Chemotherapy
First-line chemotherapy for ovarian cancer typically
consists of two drugs given together. The combination =paclitaxel + platinum drugeither carboplatin or cisplatin. chemotherapy directly into the abdomencalled intraperitoneal therapyin addition to conventional intravenous administration.
Second-Line Chemotherapy
The choice of drugs for second-line therapy depends
largely on which drugs were administered for first-line therapy and how long it has been since the first-line therapy was stopped. cancer that has returned: GEMZAR (gemcitabine HCl for injection) plus another chemotherapy, carboplatin, is indicated ,6 months after their first-line therapy;
Second-Line Chemotherapy
Hycamtin (topotecan HCl for injection) is indicated as a
single agent (one drug) for the treatment of ovarian cancer upon failure of first-line therapy;
approved for use to treat women whose cancer has returned following first-line therapy.
months of completion of initial platinum-based chemotherapy.Platinum-refractory ovarian cancer: disease that does not respond to initial platinum-based chemotherapy.
CP
CT
DC
CAP
BEP
VBC
BEP
SIDE EFFECTS
While chemotherapy drugs kill cancer cells, they also damage some normal cells, causing side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Temporary side effects might include the following:
nausea and vomiting loss of appetite hair loss hand and foot rashes kidney or nerve damage mouth sores
RADIOTHERAPY:
Now, has a very small role since platinum based
protocols and paclitaxel have improved the median survival.
Second-Look Surgery
The use of second-look surgery can help diagnose and
manage ovarian cancer.
stage III and stage IV ovarian cancer after a standard course of chemotherapy have no clinical, biochemical, ro radiologic evidence of disease
and primary chemotherapy, and will be given salvage chemotherapy, may be placed into one of three groups (A-C):
GROUP A
are patients resistant to primary therapy and have
shown tumor growth during treatment. This persisting tumor is considered to be refractory i.e. have absolute platinum-resistance. Secondary non-cross resistant chemotherapies or biological therapies should be considered.
GROUP B
are patients who respond well to initial chemotherapy,
but develop recurrent cancer within months after the end of primary care. This group with relatively platinum resistant tumor has an intermediate prognosis.
GROUP C
are patients who showed a good response to primary
chemotherapy, and did not develop recurrent cancer for more than 6 months after the end of primary treatment. This group with platinum-sensitive tumor shows the best responses to re-treatment with a platinum-containing regimen.
prognosis
Overall 5-year survival in ovarian epithelial carcinoma is low because
of the preponderance of late-stage disease at diagnosis.
Stage I and II: 80-100% Stage III: 15-20% Stage IV: 5%
survival than older patients (40% compared to 15%) Dysgerminomas treated by surgery and radiation have an excellent cure rate in both early and late-stage disease Endodermal sinus tumour has poor prognosis.
prevention
Diet: a high-fat diet may play a role in the
aetiology of ovarian cancer. Oral contraceptives appear to reduce the risk of ovarian cancer for up to 10 years following cessation of use. This protective effect appears to apply to patients with BRCA mutations as well. Patients who have used fertility drugs should be counselled as to their possible increase in risk of ovarian cancer.
chemotherapy with responses in the range of 70-80% to first-line chemotherapy. The majority, however, relapse and ultimately die of chemotherapy-resistant disease.