Ovarian Cancer - Prognostic Factors and Prognosis Flashcards
Ovarian Cancer
Prognostic Factors
Initial extent of disease
Single most important prognostic factor
5 year survival:
- Localized - 92.7%
- Regional - 73.3%
- Distant - 28.5%
- Unstaged - 28.2%
Ovarian Cancer
Prognostic Factors
Histologic subtype and grade
** High Grade Tumors **
- more aggressive than low-grade tumors
** Clear Cell and Carcinosarcoma Histologies **
- considered POOR prognosis
Histology especially important in assessing prognosis and management for patients with early stage disease
Ovarian Cancer
Prognostic Factors
CA-125
- Grossly Correlated with volume of disease
- Prognosis and response to chemo predicted by rate of decline
- Normal 0-35 following three cylces of therapy
- Slow response or failure to normalize after 6 cycles = poor prognosis - Significant laboratory variation (draw at same lab)
Ovarian Cancer
Supportive Care for End-Stage
- Bowel obstruction (intermittent or complete).
- Low residue diet with frequent, small meals.
- Avoid agents that slow GI motility; use prokinetic agents cautiously (e.g. low dose metoclopramide).
- Paracentesis/thoracentesis for accumulating ascites/pleural effusions.
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Cancer-related anemia is common
- Preemptive therapy with IV iron may reduce the need for transfusions - Parenteral/enteral feeding (LIMITED VALUE)
- Palliative care and pain management.
- Psychosocial support of patient and family
Ovarian Cancer
Toxicity and Survivorship Issues
- Treatment with surgery, radiation, and chemotherapy are associated with both acute and chronic toxicities.
- In general, surgery for early stage disease is associated with less long-term toxicity than pelvic radiation
Treatment with surgery and chemotherapy is associated with both acute and chronic toxicities:
- Acute Toxicities: Nausea, vomiting, fatigue, anemia, mild bone marrow suppresion
- Premature Menopause: can be treated with hormonal/non-hormonal remidies
- Loss of fertility
- Psychological effects: depression, anxiety, guilt, body image
