Female Genital Tract Malignancies

15,641 views
15,393 views

Published on

Définition - classification-clinical Manifestations- Diagnosis - Management

Published in: Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
15,641
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
192
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Female Genital Tract Malignancies

  1. 1. Marius Beniet YouanBi, Pharm D, Master of Clinical Pharmacy University of Nairobi. Female Genital tract malignancies
  2. 2. OUTLINES 1. VULVAR CANCER 3. CERVICAL CANCER 2. VAGINAL CANCER 4. WOMB CANCER 6. OVARIAN CANCER 5. FALLOPIAN CANCER
  3. 3. Human Female genital system
  4. 4. 1. VULVAR CANCER
  5. 5. The vulva is the external genitalia of the female reproductive tract Vulva
  6. 6. Vulvar cancer Vulvar cancer is a cancer that starts in the external female sex organs – inner edges of the labia majora or labia minora
  7. 7. Vulvar cancer epidemiology • 4th most common gynecologic cancer (following uterus, ovary and cervix) • Comprises 5% of gynecologic malignancies • Mean age at diagnosis is 65y, but is decreasing
  8. 8. • Cigarette smoking • Human Papilloma Virus (HPV) infection • Immunosuppression • Chronic vulvar conditions such as lichen sclerosus • VIN/CIN • Prior history of cervical cancer Causes & Risk Factor
  9. 9. Pathogenesis 1. HPV infection (60%) Two pathways of vulvar carcinogenesis: 2. Chronic inflammatory (vulvar dystrophy) or autoimmune processes
  10. 10. THE CLINICAL MANIFESTATIONS OF VULVAR CANCER
  11. 11. Clinical Manifestations • Most patients present with a single vulvar plaque, ulcer or mass • Labia major is the most common site • Lesions are multifocal in 5% of cases A synchronous second malignancy is found in 22% of cases, usually CIN/cervical cancer
  12. 12. Clinical Manifestations
  13. 13. Clinical Manifestations
  14. 14. Clinical Manifestations
  15. 15. Clinical Manifestations
  16. 16. Clinical Manifestations • Pruritus is the most common presenting symptom (especially if associated with vulvar dystrophy such as lichen sclerosus) • Vulvar bleeding or discharge • Dysuria • Enlarged groin lymph node
  17. 17. Diagnosis • Biopsy of gross lesions • If no gross lesion present but high clinical suspicion, perform colposcopy
  18. 18. Types of Vulvar Cancer • Squamous cell carcinoma SCCA (>90% of cases) • Melanoma • Sarcoma • Basal cell carcinoma • Verrucous carcinoma • Adenocarcinoma (Bartholin gland)
  19. 19. Vulvar Cancer Staging (Surgical) Stage Description IA Lesion <2 cm with <1 mm stromal invasion, no nodal metastases IB Lesion >2 cm with >1 mm stromal invasion, no nodal metastases II Lesion any size, extension to adjacent structures, no nodal metastases III Lesion of any size with involvement of the lower urethra, vagina or anus OR groin lymph node metastases IVA Tumor invading upper urethra, bladder mucosa, rectal mucosa, pelvic bone IVB Any distant metastases, including pelvic lymph nodes
  20. 20. Treatment of SCCA Vulvar Stage Treatment IA Wide local excision (WLE) IB WRE and inguinal-femoral lymphadenectomy II WRE and inguinal-femoral lymphadenectomy III WRE and inguinal-femoral lymphadenectomy OR chemoradiation +/- surgery to resect residual disease as needed IVA chemoradiation +/- surgery to resect residual disease as needed IVB Chemotherapy
  21. 21. Treatment of SCCA Vulvar : Surgery Wide Radical Excision (WRE): • Excision of vulvar lesion down to the fascia of the urogenital diaphragm • 2 cm tumor-free margin Inguinal-Femoral Lymphadenectomy: • Removal of the superficial inguinal and deep femoral lymph nodes
  22. 22. • Radiation in combination with chemotherapy is an alternative to surgery in women with stage III/IVA disease • Indicated if positive inguinal/pelvic nodes • Indicated if positive margins after WRE if re-excision not possible or desirable (i.e. around the clitoris or anal sphincter) Treatment of SCCA Vulvar : Radiation therapy
  23. 23. Treatment of SCCA Vulvar : Chemotherapy • Indicated for metastatic disease (stage IVB) • Platinum-based • Treatment is palliative
  24. 24. Chemotherapy regimens SCCA Vulvar First-Line Combination Therapy REGIMEN DOSING Paclitaxel (Taxol) + cisplatin (Platinol; CDDP) Day 1: Paclitaxel 135mg/m2 IV, admi over 24 hr plus Day 2: Cisplatin 50mg/m2 IV at a rate of 1mg/min. Repeat cycle every 3 weeks for 6 cycles. Carboplatin (Paraplatin) + paclitaxel Day 1: Carboplatin AUC=5mg/mL/min administered over 1 hr, followed by paclitaxel 175mg/m2 administered over 3 hrs. Repeat cycle every 3 weeks for 6–9 cycles or until disease progression or unacceptable toxicity
  25. 25. Chemotherapy regimens SCCA Vulvar First-Line Combination Therapy cont’d REGIMEN DOSING Cisplatin + topotecan (Hycamtin) Days 1–3: Topotecan 0.75mg/m2 IV administered over 30 min plus Day 1: Cisplatin 50mg/m2 IV. Repeat cycle every 3 weeks. Cisplatin + gemcitabine (Gemzar) Days 1 and 8: Cisplatin 30mg/m2 + gemcitabine 800mg/m2. Repeat cycle every 4 weeks.
  26. 26. Chemotherapy regimens SCCA Vulvar First-Line Monotherapy REGIMEN DOSING Cisplatin (preferred as a single agent) Day 1: Cisplatin 50mg/m2. Repeat cycle every 3 weeks for a total of 6 cycles.
  27. 27. Chemotherapy regimens SCCA Vulvar Second-Line Therapy REGIMEN DOSING Bevacizumab (Avastin) Day 1: Bevacizumab 15mg/kg IV. Repeat cycle every 3 weeks. Docetaxel (Taxotere) Day 1: Docetaxel 100mg/m2 IV, administered over 1 hr. Repeat cycle every 3 weeks
  28. 28. OTHERS TYPES OF VULVAR CANCER
  29. 29. Melanoma of the Vulva • 2nd most common type of vulvar cancer (5-6%) • Occurs more frequently in white women • Mean age at diagnosis is 68y • Treatment is wide local excision with 2 cm margins and sentinel lymph node biopsy
  30. 30. Melanoma of the Vulva
  31. 31. Basal Cell Carcinoma • 2% of vulvar cancers • Usually occur in white, postmenopausal women • May be locally invasive but usually do not metastasize • Slow-growing • Treatment is wide local excision
  32. 32. Basal Cell Carcinoma
  33. 33. Paget Disease of the Vulva • <1% of vulvar malignancies • Most common presenting symptom is pruritus • Lesion is usually well demarcated slightly raised edges and a red background • Most patients are postmenopausal and Caucasian • Treatment is wide local excision
  34. 34. Paget Disease of the Vulva
  35. 35. Summary – Vulvar Cancer • Comprises 5% of gynecologic malignancies • 2 pathways of vulvar carcinogenesis: – HPV infection (60%) – Chronic inflammatory (vulvar dystrophy) • Most common histology is squamous cell carcinoma • Treatment includes surgery, radiation and/or chemotherapy depending on stage
  36. 36. 2. VAGINAL CANCER
  37. 37. Vagina the muscular passage that leads from the cervix to the vulva
  38. 38. Vaginal cancer • Vaginal cancer, sometimes referred to as primary vaginal cancer. • Cancer that starts in the vagina.
  39. 39. Vaginal cancer There are two main kinds of vaginal cancer: primary vaginal cancer secondary vaginal cancer the cancer originates in the vagina cancer spreads to the vagina from another organ Represents 2-3% of Pelvic Cancers
  40. 40. Primary vaginal cancer • Squamous cell carcinoma: :80-85% , 50 yrs. and up . • Clear cell adenocarcinoma :10%, teenagers and young women [14 – 20 yrs. ] • Melanoma :2-3%, women over 50
  41. 41. Secondary vaginal cancer 84% of cancers in vaginal area are secondary • Cervical • Uterine • Colorectal • Ovary
  42. 42. Causes & Risk Factor • Cigarette smoking • Human Papilloma Virus (HPV 16 and 18) infection • Immunosuppression • VIN/CIN • Prior history of cervical cancer • Treatment for womb cancer by radiotherapy
  43. 43. Clinical Manifestations • Painless vaginal bleeding, between periods, after menopause, or after sex Symptoms appear , often in later stages. They can include: • Vaginal discharge (may smell or be bloody)pain during sex • A lump in the vagina that you can feel • A persistent itch in the vagina
  44. 44. Clinical Manifestations Advanced vaginal cancer can also cause: • constipation • pain when peeing • swelling in the legs (oedema) • persistent pelvic pain
  45. 45. Diagnosis • Biopsy to look for either precancerous (VAIN) or cancerous cells • Scans and x-rays to see if the cancer has spread to other parts of your body.
  46. 46. Vagina cancer Staging • Stage I : Confined to Vaginal Wall • Stage II : Subvaginal tissue but not to pelvic sidewall • Stage III : Extended to pelvic sidewall • Stage IVA: Bowel or Bladder • Stage IVB: Distant metastasis
  47. 47. Treatment of vaginal cancer • Surgery with Radical Hysterectomy and pelvic lymph dissection in selected stage I tumors high in Vagina • All others treated with radiation with chemosensitization
  48. 48. Treatment of vaginal cancer cont’d radiotherapy concurrently with weekly intravenous Cis-platinum chemotherapy (40 mg/m2) • Radiation with chemosensitization
  49. 49. 5 year Survival • Stage I 70% • Stage II 51% • Stage III 33% • Stage IV 17%
  50. 50. Prevention The few things known to help, though, are avoiding smoking, and getting regular smear tests to detect precancerous or cancerous cells early: VAIN VIN ; HPV CIN
  51. 51. Pap smear test
  52. 52. Summary – Vagina Cancer • Represents 2-3% of Pelvic Cancers • 84% of cancers in vaginal area are secondary • Clear cell adenocarcinoma most occurs teenagers and young women • Treatment includes most surgery, radiation • Chemosensitization with cisplatin
  53. 53. 3. CERVICAL CANCER
  54. 54. Cervix
  55. 55. Cervical cancer Cervical cancer begins in the cervix (the neck of the womb), which is a strong muscle that forms the passage between the womb and the vagina.
  56. 56. Cervical cancer epidemiology • Approximately 570,000 cases expected worldwide each year • 275,000 deaths • Number one cancer killer of women worldwide • With the advent of the Pap smear, the incidence of cervical cancer has declined
  57. 57. Cervical Cancer Etiology • Cervical cancer is a sexually transmitted disease. • HPV is the primary cause of cervical cancer. • Some strains of HPV have a predilection to the genital tract and transmission is usually through sexual contact (16, 18 High Risk).
  58. 58. Cervical Cancer Risk Factors • smoking • giving birth to more than 7 children having your first child before 17yrs • Number of sexual partners • Early age of intercourse
  59. 59. Cervical Cancer Risk Factors • High-risk male partner • Taking the pill • Having a weakened immune system
  60. 60. Pathogenesis
  61. 61. Clinical Manifestations • May be silent until advanced disease develops • Symptoms of Invasion :  Post-coital bleeding  Foul vaginal discharge  Abnormal bleeding
  62. 62. Clinical Manifestations cont’d  Unilateral leg swelling or pain  Pelvic mass  Pelvic pain  Gross cervical lesion
  63. 63. the stages of cancer progression The pre-cancerous stage before the cells turn cancerous is called Cervical Intra-epithelial Neoplasia commonly in short called CIN
  64. 64. Clinical Manifestations cont’d
  65. 65. Diagnosis • A cone or hysterectomy specimen • MRI, a CT or PET-CT scan, blood tests or a chest X-ray • Colposcopy, • Biopsy
  66. 66. Cold cone biopsy
  67. 67. Colposcopy Medical Test a procedure that allows doctor to look at the surface of your cervix and biopsy any abnormal areas
  68. 68. Staging of cervical cancer
  69. 69. Treatment of Early Disease • Conization or simple hysterectomy - microinvasive cancer • Radical hysterectomy - removal of the uterus with its associated connective tissues, the upper vagina, and pelvic lymph nodes.. • Chemoradiation therapy
  70. 70. Radical hysterectomy - removal of the uterus
  71. 71. Advanced Staging • Chemoradiation is the mainstay of treatment • 4-5 weeks of external radiation treats the primary tumor and adjacent tissues and lymph nodes • Chemotherapy acts as a radiation sensitizer and may also control distant disease
  72. 72. Locally advanced cervical cancer regimens First-Line Therapy with Radiotherapy REGIMEN DOSING Cisplatin 40mg/m2 IV on days 1, 8, 15, 22, 29, and 36 (total dose not to exceed 70mg per week). Cisplatin + 5-FU Days 1 and 29: 4 hrs prior to external- beam radiotherapy: Cisplatin 50mgDinfusion /m2 IV at 1mg/min with standard hydration, plus Days 2–5, and 30–33: 5-FU 1000mg/m2 IV continuous infusion over 24 hrs (total dose 4000mg/m2 each course).
  73. 73. Locally advanced cervical cancer regimens cont’d First-Line Therapy with Radiotherapy REGIMEN DOSING Cisplatin + 5-FU Days 1–5 of radiotherapy: Cisplatin 75mg/m2 IV over 4 hrs followed by 5-FU 4000mg/m2 IV over 96 hrs. Repeat cycle every 3 weeks for 2 additional cycles. Cisplatin + 5- FU +hydroxyurea Days 1 and 29: Cisplatin 50mg/m2 IV followed by 4000mg/m2 5- FU over 96 hrs; hydroxyurea 2g orally twice weekly for 6 weeks.
  74. 74. Locally advanced cervical cancer regimens cont’d First-Line Therapy with Radiotherapy REGIMEN DOSING Cisplatin + gemcitabine + radiotherapy +brachytherapy Induction therapy Days 1, 8, 15, 22, 29 and 36: Cisplatin 40mg/m2 + gemcitabine 125mg/m2 + concurrent external- beam radiotherapy 50.4Gy in 28 fractions, followed by brachytherapy 30–35Gy in 96 hrs. Adjuvant therapy Day 1: Cisplatin 50mg/m2, plus Days 1 and 8: Gemcitabine 1,000mg/m2. Repeat every 3 weeks for 2 cycles.
  75. 75. Metastatic or Recurrent Cervical Cancer Regimens Similar regimens as those used for metastatic vulvar cancer
  76. 76. Reduce the risk • reduce the risk of contracting the virus, which in turn can reduce the risk of getting cervical cancer • start having sex when mature , and less sexual partners because more you have higher your chances are of developing cervical cancer
  77. 77. Summary – Vagina Cancer • Number one cancer killer of women worldwide • HPV is the primary cause of cervical cancer • Number of sexual partners • Treatment includes surgery, and chemotherapy asso radiotherapy • Prevent by a frequent Pap smear test
  78. 78. 4. UTERINE CANCER
  79. 79. wall of Uterus
  80. 80. Womb cancer • Also known as, cancer of the uterus, uterine cancer or endometrial cancer(++) • begins in the lining or walls of the uterus.
  81. 81. Epidemiology • Most common gynecologic malignancy • Eighth leading cause of female mortality from cancer • 97% arise from the endometrium (endometrial carcinoma) • 3% arise from the mesenchymal components (sarcoma)
  82. 82. Types of womb cancer • Uterine : sarcoma There are two main types of womb cancer: 95% of womb cancers “starts in the womb’s lining, or endometrium often caught early, and treated successfully. both less common and harder to treat. starts in the muscle wall of the womb • Endometrial: cancer
  83. 83. Sub-types • Leiomyosarcoma : Cancer of the muscle wall - the most common sarcoma of the womb • Papillary serous : carcinoma Around 5% of womb cancers • Clear cell carcinoma: Extremely rare, 1 to 2% of womb cancers • Adenocanthomas: combine both glandular and cervical types of malignant cells
  84. 84. Two main types of womb cancer Endometrial carcinoma Uterine sarcoma
  85. 85. THE FIRST TYPE OF WOMB CANCER: ENDOMETRIAL CARCINOMA (95%)
  86. 86. Endometrial carcinoma
  87. 87. Epidemiology • Median age of diagnosis: 60 years • Most common in women > age 50 years • Incidence is highly dependent on age • 75% of uterine cancers occur in post- menopausal women
  88. 88. Endometrial carcinoma Risk factors RISK FACTORS OESTROGEN OTHERS OBESITY DIABETES HYPERTENSION HNPCC
  89. 89. Estrogen exposure EXOGENOUS HORMONE REPLACEMENT THERAPY  TAMOXIFEN FOR BREAST CANCER ENDOGENOUS EARLY MENARCHE LATE MENOPAUSE PCOS OBESITY FUNCTIONING OVARIAN TUMORS
  90. 90. • NULLIPAROUS WOMEN & WOMEN WITH PCOD NON OVULATION HIGH OESTROGEN ENDOMETRIAL HYPERPLASIA NULLIPAROUS WOMEN ENDOMETRIAL CANCER
  91. 91. • Obesity reduces level of serum hormone binding protein free estrogen circulates in body OBESITY • Peripheral fat : conversion of epiandrostenedione to oestrone
  92. 92. RISK FACTORS NULLIPARITY PCOS EARLY MENARCHE LATE MENOPAUSE OBESITY DIABETES HYPERTENSION LYNCH 2 / HNPCC TAMOXIFEN HRT
  93. 93. Clinical manifestations • Bleeding – Present in 90% of all cases – 15% of patients with postmenopausal bleeding will have endometrial cancer
  94. 94. Clinical manifestations • Other Signs/Symptoms – Vaginal Discharge(80-90%) – Pelvic Pain, Pressure – Referred Leg Pain – Change in Bowel Habits – Pyometria/Hematometria
  95. 95. Diagnosis • Pap Smear – Only 30-50% patients with cancer will have an abnormal result • Endometrial Biopsy – False negative rate of 5-10%
  96. 96. Diagnosis • Transvaginal Ultrasound – Not for routine screening or diagnosis • Fractional Dilation and Curettage – Use in cases of cervical stenosis, patient intolerance to exam, recurrent bleeding after negative biopsy
  97. 97. Endometrial Cancer Grade • The grade is based on the percentage of the solid component. – Well Differentiated (Grade 1): <5% – Moderately Differentiated (Grade 2): 5-50% – Poorly Differentiated (Grade 3): > 50%
  98. 98. Endometrial carcinoma type • There are two major pathogenic types of endometrial carcinoma : Type II Type I
  99. 99. Type I Endometrial Carcinoma • Well differentiated endometrioid • Better prognosis • Superficial myometrial invasion • Infrequent lymph node metastases • Associated with hyperplasia • Younger/peri-menopausal women
  100. 100. Type II Endometrial Carcinoma • Older/post-menopausal women • Thin • Poorly differentiated carcinoma – Papillary Serous – Clear Cell • Deep myometrial invasion • Frequent lymph node metastases • Associated with atrophy
  101. 101. Endometrial Carcinoma Treatment • Surgery is the mainstay of treatment followed by adjuvant radiation and/or chemotherapy based on stage of disease. • Primary radiotherapy or hormonal therapy may be employed in patients who have contraindications to surgery.
  102. 102. Hormone Therapy • Appropriate in patients that desire fertility preservation • ONLY-G1 tumors!! • High dose progestins – Young patient – Well differentiated cancer
  103. 103. Endometrial Cancer hormonal regimens Hormonal Regimens (for Endometrioid Only) Tamoxifen (Nolvadex) Tamoxifen 20mg orally twice daily. Medroxyprogesterone acetate(MPA) Medroxyprogesterone acetate 200mg orally once daily. Tamoxifen +medroxyprog esterone acetate Medroxyprogesterone acetate 80mg orally twice daily for 3 weeks alternating with tamoxifen 20mg orally twice daily. Repeat cycle every 3 weeks. Combination is associated with grade 4 thromboembolic events in a few patients.1
  104. 104. Endometrial Cancer chemotherapy regimens Chemotherapy Regimens and other Treatment Regimens REGIMEN DOSING Cisplatin (Platinol; CDDP) +doxorubicin (Adria mycin) (for adjuvant use) Day 1: Doxorubicin 45mg/m2 IV + cisplatin 50mg/m2 IV, followed by Days 2–11: Optional filgrastim 5mcg/kg/day. Repeat cycle every 3 weeks; maximum 6 cycles. Cisplatin + doxorubicin +p aclitaxel (Taxol) Day 1: Doxorubicin 45mg/m2 IV + cisplatin 50mg/m2 IV followed by Day 2: Paclitaxel 160mg/m2 3-hr IV infusion, followed by Days 3–12: Filgrastim 5mcg/kg SC. Repeat cycle every 3 weeks for max 7 cycles. Maximum BSA of 2.0 was used for calculations.
  105. 105. THE SECOND TYPE OF WOMB CANCER: UTERINE SARCOMA( 3%)
  106. 106. Uterine Sarcoma • 3% of all uterine cancers • 15% of all deaths from uterine cancer • Types  Carcinosarcoma  Leiomyosarcoma  Endometrial Stromal Tumors
  107. 107. Carcinosarcoma • Post-menopausal- median age of 62 years • Associated with diabetes, hypertension, and obesity • 7-37% of patients have prior pelvic irradiation • Poor prognosis
  108. 108. Leiomyosarcoma • Median age 52 years • Premenopausal have a better prognosis • Leiomyosarcoma: 1. Mitotic count: > 10 mitosis per HPF 2. Cellular atypia 3. Coagulative necrosis
  109. 109. Uterine Sarcoma Treatment: Surgery 3. Bilateral salpingo-ophorectomy NOT in premenopausal women 1. Stage I/II sarcomas should be treated with hysterectomy 2. Lymphadenectomy is indicated in all sarcomas except leiomyosarcoma
  110. 110. Uterine Sarcoma Treatment: Recurrence • Isolated lesions -surgical excision • Recurrent carcinosarcoma -paclitaxel, platinum or ifosfamide • Recurrent leiomyosarcoma -doxorubicin, ifosfamide, docetaxel and gemcitabine
  111. 111. Uterine Sarcoma Chemotherapy regimens Chemotherapy REGIMEN DOSING Doxorubicin (Adriamycin) Day 1: 75mg/m2 IV bolus. Repeat cycle every 31 days OR 60mg/m2–70mg/m2 IV typically dosed every 3 weeks. Gemcitabine (Gemzar) +do cetaxel (Taxotere) +granulo cyte-colony-stimulating factor (G-CSF) Days 1 and 8: Gemcitabine 900mg/m2 IV over 90 min, followed by Day 8: Docetaxel 100mg/m2 IV over 60 min, followed by Days 9–15: G-CSF 150mcg/m2 SC OR on Day 9 or 10: Pegfilgrastim 6mg SC. Repeat cycle every 3 weeks until disease progression or toxicity occurs. Gemcitabine Days 1, 8 and 15: Gemcitabine 1,000mg/m2 IV. Repeat cycle every 4 weeks.
  112. 112. 5. FALLOPIAN TUBES CANCER
  113. 113. The Fallopian tubes The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes leading from the ovaries into the uterus, via the utero- tubal junction
  114. 114. WHAT IS FALLOPIAN TUBE CANCER
  115. 115. Fallopian tube cancer • Fallopian tube cancer begins in a woman’s fallopian tubes • Adenocarcinoma • sarcoma • chorisarcoma • others • Secondary + + +
  116. 116. Epidemiology • 5 years survival 56%  0.3% of all gynecology malignancies  3.6 / million women • One of the most rare malignancy of the female genital tract • Mean age of diagnosis 50 yrs.  2/3 menauposal
  117. 117. Risk factors • Nulliparity • Chronic salpingistis • Infertility 70% cases • inflammatory disease (such as TB)
  118. 118. Pathogenesis • Similar to endometrial and ovarian cancer  Oncogene : crb  Tumeurs suppressors genes : p53
  119. 119. Clinical manifestations of FTC •A pelvic mass or lump •Vaginal bleeding, especially after menopause •Abdominal or pelvic pain or feeling of pressure •Vaginal discharge, which may be clear, white, or tinged with blood
  120. 120. Diagnosis of FTC • Preoperative diagnosis very rare • Sonography • Serum ca 125
  121. 121. Staging of FTC • Stage I : confined to fallopian • Stage II : confined to pelvis • Stage III: extra pelvic disease • Stage IV: distant Metastasis
  122. 122. Treatment of FTC • For early disease • As an adjuvant therapy • Reassessment laparotomy Surgery • Platinum based combination chemotherapy Chemotherapy
  123. 123. Summary • Very rare genecology malignancy • 5 years Survival is 56 % • Staging and treatment similar to ovarian cancer
  124. 124. 6. OVARIAN CANCER
  125. 125. Ovary ovary is an ovum- producing reproductive organ, in pairs they are both gonads and endocrine glands
  126. 126. WHAT IS OVARIAN CANCER
  127. 127. Ovarian cancer Ovarian Cancer is cancer that forms in the tissue of the ovary
  128. 128. Epidemiology • It causes more deaths than any other gynecologic cancer. • 80 percent will survive one year and about 50% will survive five years. • Ovarian cancer is the second most common gynecologic cancer after uterine cancer.
  129. 129. Risk factors • Family history of the disease is one of the most significant risk factors • The risk of ovarian cancer increases with age • Rates are highest where diets tend to be high in fat. Animal fats (red meats, whole milk or cheese)
  130. 130. Types of ovarian cancer • There are many different types, but the most common are three:  Ovarian Epithelial Carcinoma; begins in the cells of the surface of the ovaries.(90%)  Malignant Germ Cell Tumor; Cancer that begins in the egg cells.
  131. 131. Types of ovarian cancer cont’d  Stromal; Cancer that develops on the connective tissue that holds the ovary together and produces most of the female hormones. • malignant and stromal make up about 10%
  132. 132. Pathogenesis 1. Genetic Mutation: Inherited 5 to 10% of Ovarian Cancer 2. Genetic Mutation: Environmental  Infertility & infertility drugs  Estrogen & Hormone Replacement Therapy  Obesity in adulthood  Talcum Powder
  133. 133. Pathogenesis cont’d 3. Oncogenes and Tumor-suppressors  The genes most affected in families with a history of Ovarian Cancer are BRCA1 and BRCA2  The suppressor Gene p53
  134. 134. Clinical manifestations • Abdominal pressure, swelling, or bloating • Urinary urgency or burning with no infection • Pelvic discomfort or pain • Persistent indigestion, gas, or nausea
  135. 135. Clinical manifestations cont’d • Changes in bladder and bowel habits • Persistent lack of energy • Low back pain • Changes in menstruation.
  136. 136. Diagnosis • Physical Malignancy: irregular, solid consistency, is fixed, nodular, or bilateral, is associated with ascites • Ultrasound Low positive predictive value for cancer
  137. 137. Diagnosis cont’d • Tumor markers Epithelial: CA 125, elevated in 80% 35 U/mL is upper limit of normal Also elevated in many benign conditions
  138. 138. Stage of ovarian cancer
  139. 139. Ovarian Cancer Treatments There are many different kinds of treatments available, depends on certain factors, like: • the stage and size of the tumors, • your age, • general health, • Desire to have kids
  140. 140. Ovarian Cancer Treatments cont’d • Surgery -Is the most common. The surgeon tries to remove as much of the tumor as possible • Chemotherapy-. Chemo is commonly used after surgery to kills cancer cells that weren’t removed
  141. 141. Ovarian Cancer Treatments cont’d • Radiation Therapy- The main goal is to reduce pain symptoms  Biotherapy/Immunotherapy- Boosts the body’s immune system to fight the disease.
  142. 142. Ovarian cancer chemotherapy regimens Intravenous First-Line Primary Chemotherapy/Primary Adjuvant Therapy (Stage II–IV) REGIMEN DOSING Paclitaxel (Taxol) + carboplatin(Pa raplatin) Day 1: Paclitaxel 175mg/m2 IV administered over 3 hrs + carboplatin AUC=5–7.5mg/mL/min IV administered over 1 hr. Repeat every 3 weeks for 6 cycles. Docetaxel (Taxotere) +carboplatin Day 1: Docetaxel 60–75mg/m2 IV followed by carboplatin AUC=5–6mg/mL/min IV. Repeat every 3 weeks for 6 cycles. Dose-dense paclitaxel +carboplatin Day 1: Carboplatin AUC=6mg/mL/min IV administered over 1 hr, plus Days 1, 8, and 15: Paclitaxel 80mg/m2 IV administered over 1 hr. Repeat every 3 weeks for 6 cycles.
  143. 143. Ovarian cancer chemotherapy regimens Intraperitoneal First-Line Therapy for Advanced Disease REGIMEN DOSING Paclitaxel + cisplatin (Platinol; CDDP) Day 1: Paclitaxel 135mg/m2 continuous IV infusion over 24 hrs,followed by Day 2: Cisplatin 75– 100mg/m2 IP, followed by Day 8: Paclitaxel 60mg/m2 IP (maximum body surface area 2m2). Repeat every 3 weeks for 6 cycles.
  144. 144. General Conclusion FGTM occur in each of the know anatomical segment : vulvar, vagina, cervix, uterus, fallopian and ovary FGTM is common and cervical cancer is responsible for more deaths following by ovarian cancer then womb cancer Option exist now for prevention, detection and treatment , Abnormal bleeding and discharge is the most common clinical manifestation Surgery and chemotherapy are the main treatment option , hence the need for us to master the adverse effects of cytotoxic drugs

×