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Ovarian Cancer Amreen Husain, MD

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Ovarian Cancer Amreen Husain, MD Presentation Transcript

  • 1. Ovarian Cancer Amreen Husain, MD Assistant Professor Gynecologic Oncology
  • 2. Ovarian cancer
    • 25,000 cases annually
    • 1/70 American women
    • 14,000 deaths annually
    • 4 th in cancer related deaths among women
    • Mean age at diagnosis 59 yrs
  • 3. Risk factors
    • Family history:
      • One 1 ° relative 3.6 times risk, or 5% lifetime risk.
      • 5- 10% of all ovarian cancers associated with known gene mutations.
      • Three familial ovarian cancer syndromes: site-specific ovarian cancer, breast/ovarian cancer syndrome, hereditary nonpolyposis colorectal cancer syndrome.
  • 4. BRCA1/2
    • Associated with site specific and breast/ovarian cancer syndromes.
    • BRCA1: 25-40% lifetime risk of Ov ca, 80% lifetime risk of Breast Ca
    • BRCA2 : 10% lifetime risk of ov Ca
    • Early age-onset, 10yrs younger than relative, mean age 40’s
  • 5. Reproductive factors
    • Nulliparity
    • Infertility
    • Oral contraceptives protective 50% decrease with 5 or more years of use.
    • Multiparity protective
    • Lactation protective
  • 6. Screening
    • General population : no good method
    • High risk population : TV u/s, Ca 125 though not fully proven
    • Prophylactic oophorectomy : option in high-risk women who have completed child-bearing or age 40 though small risk (1-3%) of peritoneal cancer
  • 7. Diagnosis
    • “ silent killer”
    • Vague symptoms : abd bloating, early satiety, indigestion, constipation
    • 60-70% Stage III or IV at diagnosis
    • ascites and upper abdominal disease at presentation
  • 8. Staging
    • Surgically based
    • Ovarian cancer spreads by direct extension within abdominal cavity, or to lymph nodes
    • Staging based on location of metastatic disease
  • 9. Early stage
    • Stage I Stage II
  • 10. Advanced stage
    • Intraabdominal dx Lymph node dx
  • 11. Treatment - surgical
    • Early stage:
      • Intact removal of affected ovary
      • complete staging including TAHBSO/omentectomy/biopsies/lymph node sampling/peritoneal washings
    • 30% patients with clinical Stage I will be upstaged
    • Fertility preservation can be considered in Stage I if fully staged
    • Chemotherapy for all stages greater than IA
  • 12. Surgical treatment
    • Advanced stage :
      • Laparotomy via midline vertical incision
      • Hysterectomy/ oophorectomy
      • Maximal tumor debulking to any residual implants <1cm
      • Bowel resection required in about 10% pts.
      • Pts treated by gynecologic oncologists have higher rates of debulking
      • Optimal debulking impacts significantly on long term survival
  • 13. Further therapy
    • Majority of patients will require further treatment with chemotherapy
    • Current standard is Carboplatin + Taxol for 6 courses given every three weeks.
    • 70-80% complete response
    • a complete clinical response (remission) is : nl Ca125, nl exam, + nl CT.
  • 14. 2 nd look surgery
    • Done now primarily in the study setting
    • Can be performed by laparoscopy
    • Patients with negative second looks have a 50% chance of recurrence.
    • Potential treatments include intraperitoneal chemotherapy, vaccine trials, further IV chemotherapy
  • 15. Recurrent disease
    • ¾ patients who achieve a remission after initial therapy will recur, usually within 2 years
    • Response to second-line therapy depends on the time interval from primary therapy
    • Several second line treatments including taxol/Pt/Doxil/Topotecan/Gemcitabine
  • 16. Recurrent disease
    • Surgery can be an option:
      • Goal is to achieve a complete resection
      • Usually in patients who have had a longer disease free-interval
      • Complicated by fact that patients have had prior surgery
      • Almost all still will need chemotherapy
      • Radiation an option in select cases
  • 17. New therapies – current clinical trials
    • Immunotherapies – CA 125 antibody/ vaccine (Ovarex)
    • Angiogenesis inhibitors – Thalidomide, Bevacizumab (Avasttin)
    • Biologic modulators – Iressa, Cleevec
  • 18. Ovarian Ca survivors
    • Issues in survivors:
      • Psycho sexual recovery
      • Potential for Fertility
    • National advocacy groups
      • Further research
      • Access to appropriate specialists
      • Support network