Treatment of ovarian cancer (MF) Flashcards
age for ovarian cancer
risk factors
FH
genetics
> 50
nulliparity (or low parity), delayed pregnancy
FH of breast or ovarian cancer
BRAC1 (40%) and BRAC2 (18%)
when does ovarian cancer present
usually late - 60% late stage at diagnosis
how does ovarian cancer present
ascites/bloating
pelvic mass/bladder dysfunction
pleural effusion/SOB
incidental finding
which women should be offered BRAC1 and BRAC2 mutation testing
non mucinous ovarian or fallopian tube cancer
which women should have a genetic risk assessment
women with ovarian tumour who have a family history of breast, ovarian or colon cancer
ovarian cancer diagnosis
CA125 - can be raised in other conditions
US - transsvaginal/abdominal
cytology - pleural fluid/ascites
pathology - usually gold standard
US features
multilodular cyst solid areas bilateral lesions ascites intra abd mets
0=none
1=1
3=2 or more
score given for menopausal
pre 1
post 3
RMI score
when should be referred
US X menopausal score X CA123 U/ml
If over 200
FIGO 1 2 3 4
1 = confined to 1 or both ovaries
2=spread to other pelvic organs
3=spread beyond pelvis within the abdomen
4=spread into other organs eg. liver, lungs
prognosis of ovarian cancer 5 yr survival
1 80-90%
2 65%
3 15-35%
4 up to 15%
the three types of ovarian cancer spread
transcoelemic spread/peritoneal seeding within pelvis -> abd cavity
heat -> liver, lungs, brain (late and rare)
incident of brain mets in ovarian cancer is <2%
pathology of ovarian cancer
> 90% epithelial cell tumours of ovary - serous, mucinous, endometriod, clear cell, undifferentiated
<10% germ cell, granulosa cell
ovarian cancer treatment
surgery - TAH, BSO, omentectomy, optimal bulking
surgery and chemo
chemo and surgery
timing and sequence
ovarian cancer chemo response rate
relapses?
palliative chemo?
response rates of 60-70% with carboplatin/paclitaxel
relapse rates are high
palliative - carboplantin, pac, etoposide, calyx, topotecan, gemcitabine, chlorambucil
hope for cure chemo/at presentation
platinum/paclitaxel
relapse chemo
caelyx, plat/pac, topotecan
chronic disease/multiple lines of therapy
etop, tam
what is given to women are are unfit for comb therapy
carboplantin
women with platinum sensative ovarian cancer who relapse
platinum based combination with paclitaxel, PLDH or gemcitabine
women wth recurrent plat resistant ovarian cancer
hormonal therapy with tamoxifen or an aromatose inhibitor
