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Ovarian Cancer

Ovarian Cancer. Zachary B. Self, M3. Incidence/Prevalence:. ~25,000 new cases diagnosed annually in U.S. #5 cancer in US women, #3 gyn cancer Most common cause of cancer death from gynecologic tumors in the United States. 1-2% lifetime risk (general population).

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Ovarian Cancer

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  1. Ovarian Cancer Zachary B. Self, M3

  2. Incidence/Prevalence: • ~25,000 new cases diagnosed annually in U.S. • #5 cancer in US women, #3 gyn cancer • Most common cause of cancer death from gynecologic tumors in the United States. • 1-2% lifetime risk (general population). • 15-54% lifetime risk of ovarian cancer for women with a deleterious mutation in BRCA1 or BRCA2 gene.

  3. BRCA1 & BRCA2 Mutations: • Associated with early onset of breast or ovarian cancer. • Inheritance follows an AUTOSOMAL DOMINANT transmission. It can be inherited from either parent. • Most cases are related to the BRCA1 gene mutation. • BRCA1 is a TUMOR SUPPRESSOR GENE that inhibits cell growth when functioning properly. • The inheritance of mutant alleles of BRCA1 leads to a considerable increase in risk for developing ovarian cancer.

  4. Prophylactic Surgery for BRCA1 & BRCA2 Mutation Carriers: • Prophylactic salpingo-oophorectomy may reduce risk of ovarian and fallopian tube carcinoma but not primary peritoneal carcinoma(JAMA 2006 Jul 12;296(2):185). • OVERALL REDUCTION IN CANCER RISKS ASSOCIATED WITH BILATERAL OOPHORECTOMY IS 80%. • There is substantial (4.3%) residual risk for peritoneal cancer in BRCA1 & BRCA2 mutation carriers following a prophylactic salpingo-oophorectomy.

  5. Clinical Presentation • Early disease causes minimal, nonspecific, or no symptoms. Therefore, most patients are diagnosed in an advanced stage. • Common symptom complex includes unusual bloating, fullness and pressure in abdomen or pelvis. • Other common symptoms included abdominal pain, low back pain, lack of energy, and frequent, urgent or burning urination. • Crampy abdominal pain was most common presenting symptom.

  6. Diagnosis • If ovarian cancer due to a pelvic or ovarian mass is suggested DIAGNOSTIC & STAGING LAPAROTOMY. • Routine preoperative tests include CBC count, chemistry panel (including liver function tests), and a cancer antigen 125 assay (CA-125). • Remember that CA-125 may be within normal limits in 50% of women with early ovarian cancer.

  7. Treatment • SURGERY: • STAGING AND CYTOREDUCTION. • Ascites or peritoneal wash for cytology • Inspect and palpate both ovaries, tubes, uterus, paracolic gutters, omentum, liver, spleen, diaphragm • Partial omentectomy. • Sample pelvic and periaortic lymph nodes.

  8. Treatment • CHEMOTHERAPY: • Epithelial Tumors (90% of ovarian cancers): • Drugs of choice - CARBOPLATIN with or without PACLITAXEL (Taxol). • Germ Cell Tumors (3% ovarian cancers, 60% ovarian cancers < 20): • Drugs of choice -bleomycin + etoposide + cisplatin (BEP).

  9. Note on Chemo Mode of Administration: • INTRAPEROTENIAL CHEMOTHERAPY REDUCES MORTALITY IN OVARIAN CANCER. • Addition of intraperitoneal chemotherapy to IV chemotherapy associated with increased median survival by about 12 months in women with optimally debulked epithelial ovarian cancer (National Cancer Institute Clinical Announcement 2006 Jan 5). • Intraperitoneal chemotherapy increases overall survival and progression-free survival compared to intravenous chemotherapy alone in advanced ovarian cancer (Cochrane Library 2006 Issue 1:CD005340). • Intraperitoneal cisplatin more effective than IV cisplatin (NEJM 1996 Dec 26;335(26):1950).

  10. Follow-up • CA 125, imaging, second look laparotomy • Unilocular ovarian cysts < 5 cm likely benign in postmenopausal women if normal CA 125 levels and not increasing in size.

  11. Prevention: • Oral contraceptives associated with decreased risk of ovarian cancer. • Increased vegetable consumption (but not fruit consumption) associated with lower risk for epithelial ovarian cancer. • Tea consumption (2 or more cups per day) associated with lower risk of ovarian cancer.

  12. Sources: • www.dynamicmedical.com (DynaMed). • Garcia, Augustin A. “Ovarian Cancer.” www.emedicine.com.

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