Ovarian cancer

Question 1

Epidemiology

Answer 1

Leading cause of death from gynecologic malignancies

Question 2

Pathophysiology

Answer 2

“Incessant ovulation”

Women’s risk of developing ovarian cancer is related to her number of ovulatory cycles due to disruption and repair of epithelial line of ovaries

Question 3

Genetic mutations/Hereditory

Answer 3

BRCA1
BRCA2
TP53
HNPCC (Lynch II syndrome)

Question 4

Risk factors

Answer 4

Age
Family history: increases with two or more 1st degree relatives
Early menarche (<12 yo) or late menopause (>55 yo)
Nulliparity
IVF

Question 5

Prevention

Answer 5

Multiple pregnancies
OC (> 50% after 5 years of use)
Prophylactic oophorectomy

Question 6

Presentation

Answer 6

Most patients with Stage 1 and II disease are asymptomatic

Question 7

Signs/Symptoms

Answer 7

Bloating, fatigue, abdominal pain, vaginal bleeding, pelvic pain, back pain, urinary incontinence, pain with intercourse, weight loss, nausea

In advanced disease symptoms could include:
ascites, pleural effusion, constipation, small bowel obstruction, N/V

If a women experiences the symptoms above for more than 12 days out of the month for 2 consecutive months, she should seek medical attention by her gynecologist

Question 8

History of disease

Answer 8

Disease is extensive before it is detected

60-70% of patients present with advanced disease

Question 9

Initial treatment approach

Answer 9

Goal is cure

Standard + adjuvant chemotherapy is standard approach first line

+/- neoadjuvant chemo

Question 10

Homologous Recombination Deficiency

Answer 10

50% high-grade serous ovarian carcinomas are homologous recombination deficient

Includes germ line and somatic BRCA pathogenic pathways

Question 11

Screening

Answer 11

There is no effective screening tool

Women at low risk: annual physical and pelvic

Women at high risk (FH, BRCA1/2): Pelvic exam, transvaginal ultrasound, and CA-125 every 6 to 12 months starting at age 25-35)

Question 12

Surgery

Answer 12

“Debulking” surgery

Outcomes:
Optimally debulked: < 1 cm of disease
Sub-optimally debulked: > 1 cm of disease remaining

Question 13

Stage IA or IB

Answer 13

Observation and follow up every 3 months

Question 14

All other stages

Answer 14

Debulking surgery followed by adjuvant chemo

Paclitaxel over 3 hours + Carboplatin every 21 days x 6 cycles

Question 15

Carboplatin dosing

Answer 15

Carboplatin dose=AUC x (GFR +25)

AUC is usually 5-7.5

Question 16

Type I Hypersensitivity

Answer 16

Initial contact with agent

Anaphylaxis, itching, rash, chest tightness

PACLITAXEL

Question 17

Type IV Hypersensitivity

Answer 17

With repeated exposure to agent

Erythema, induration

Question 18

Drug allergic reaction

Answer 18

symptoms persist after stopping infusion

Question 19

Infusion related reactions

Answer 19

symptoms resolve quickly after stopping infusion

Question 20

Paclitaxel standard pre medications

Answer 20

Dexamethasone
Diphenhydramine
Famotidine

Question 21

PARP inhibitors

Answer 21

Olaparib
Niraparib
Rucaparib

Monitor: CBC baseline then monthly
Renal function

SE: ANEMIA

Question 22

Platinum sensitive

Answer 22

If the pt relapses > 6 months following completion of their initial platinum containing regimen

May be treated with the initial chemo again

Paclitaxel + carboplatin

Question 23

Platinum resistant

Answer 23

If the patient relapses < 6 months after receiving platinum containing regimen

salvage regimen is chosen

Question 24

Treatment if platinum sensitive

Question 25

Treatment if platinum resistant

Answer 25

liposomal doxorubicin