Ovarian cancer Flashcards
ovarian cancer is the most _____gyne cancer
deadly
ovarian cancer is usually diagnosed _____
late
ovarian cancer is most common at what age
60-70
most significant factors for the development of ovarian cancer
+ age and family history
all risk factors ovarian cancer
little is known null parity early menarche 1st child after 35 smoking immunosuppression late menopause jewish descent (higher incidence of BRCA1&2)
MOST Ovarian cancers present with what type of spread
80% of pts present w/ abdominal cavity involvement- cells exfoliate into the fluid in the peritoneal cavity (peritoneal seeding)
areas of distant mets ovarian cancer
Distant mets to liver, lung, diaphragm, bladder, colon
natural history of ovarian cancer
Growth occurs in the ovary, spreading through the cyst wall onto the surface, spreads to the fallopian tubes, uterus, colon
Transcoelomic Spread: Across the peritoneal cavity resulting in the classic appearance of multiple seedlings
most common presenting stage in ovarian cancer
stage 3C
most common signs of ovarian cancer
abdo & pelvic pain, abdo distention and vague GI symptom
how s diagnosis and staging determined in ovarian cancer
determined via surgery- laparotomy (surgical investigation via a small incision in the lower abdo
what is effective in determining ovarian cancer in late stages but not early stages
ca-125 the levels are elevated in late stage but to early stage
how can early stage ovarian cancer be determined
Early stage cancers can be detected during routine exams as a palpable asymptomatic mass
peritoneal washing
used in the diagnosis of ovarian cancer ytologic evaluation of peritoneal fluid and examination and biopsy of peritoneal surfaces
most common histology of ovarian cancer
epithelial
staging ovarian cancer
Stage I: Confined to the ovaries
A) One ovary
B) Both ovaries
C) One or both ovaries with a ruptured capsule, tumour on ovarian surface, malignant cells in ascites or peritoneal washings
Stage II: One or both ovaries w/ pelvic extension
A) Extension or implants on uterus, fallopian tubes
B) Extension or implants onto other pelvic structures
Stage III: One or both ovaries w/ spread to the peritoneum or mets to retroperitoneal l/n
A) Microscopic peritoneal mets beyond the pelvis or limited to the pelvis w/ extension to the small bowel or omentum
B) Macroscopic perioneal mets beyond pelvis <2cm in size
C) Macroscopic perioneal mets beyond pelvis >2cm in size
Stage IV: Distant mets
**BASED ON FIGO STAGING **
INDICATIONS FOR SURGERY in the treatment of ovarian cancer
used as sole treatment with early disease
Maybe used w/ postop chemo for more extensive disease
Mainly used to debulk as much as possible as disease is typically extensive at time of diagnosis
surgeries for ovarian cancer
Total abdominal hysterectomy Bilateral salpingo-oopherectomy Omentectomy w/ paraortic l/n Liver & peritoneal surface examination Cytoreductive surgery (debulking surgery
indications for chemo in ovarian treatment
Currently the mainstay for treatment following surgery
May be used for inoperable pts
Postop for high grade stage 1 and stages 2-3
chemo agents and methods of administratuin
Single agent or multiagent
Platinum compounds and paclitaxel typically used
IV or intraperitoneal chemo
indications for XRT in ovarian cancer
Now rarely used due to severe side effects and better tumour control is seen with chemo
CT scanning limits for ovarian cancer
Sup Border – L3/L4
Inf Border – 5cm inf from ischial tuberosities
field borders for extended SSD ovarian treatment
Whole Abdo & Pelvis: Sup= 2cm sup to dome of diaphragm Inf= Encompass obturator foramen Lat= Clear peritoneum by 2cm Pelvic Boost: Sup= L5/S1 to include pelvic l/n OR T12/L1 when paraortics are included
phases for ovarian cancer extended SSD TX
Phase I:
2300cGy/23 to whole abdo with a concurrent pelvic boost of 1150cGy/23
Posterior 5 HVL renal shielding used to limit the renal dose, brought in at 1500cGy
Phase 2:
Pelvic boost of 1050cGy/7
Total dose of 45Gy/30
