Ovarian CancerOvarian Cancer
Amreen Husain, MDAmreen Husain, MD
Assistant ProfessorAssistant Professor
Gynecologic Oncolog...
Ovarian cancerOvarian cancer
• 25,000 cases annually25,000 cases annually
• 1/70 American women1/70 American women
• 14,00...
Risk factorsRisk factors
• Family history:Family history:
- One 1One 1° relative 3.6 times risk, or 5% lifetime° relative ...
BRCA1/2BRCA1/2
• Associated with site specific andAssociated with site specific and
breast/ovarian cancer syndromes.breast...
Reproductive factorsReproductive factors
• NulliparityNulliparity
• InfertilityInfertility
• Oral contraceptives protectiv...
ScreeningScreening
• General population : no good methodGeneral population : no good method
• High risk population : TV u/...
DiagnosisDiagnosis
• ““silent killer”silent killer”
• Vague symptoms : abd bloating, earlyVague symptoms : abd bloating, e...
StagingStaging
• Surgically basedSurgically based
• Ovarian cancer spreads by directOvarian cancer spreads by direct
exten...
Early stageEarly stage
• Stage IStage I Stage IIStage II
Advanced stageAdvanced stage
Intraabdominal dxIntraabdominal dx Lymph node dxLymph node dx
Treatment - surgicalTreatment - surgical
• Early stage:Early stage:
- Intact removal of affected ovaryIntact removal of af...
Surgical treatmentSurgical treatment
• Advanced stage :Advanced stage :
- Laparotomy via midline vertical incisionLaparoto...
Further therapyFurther therapy
• Majority of patients will require furtherMajority of patients will require further
treatm...
22ndnd
look surgerylook surgery
• Done now primarily in the study settingDone now primarily in the study setting
• Can be ...
Recurrent diseaseRecurrent disease
• ¾ patients who achieve a remission after¾ patients who achieve a remission after
init...
Recurrent diseaseRecurrent disease
• Surgery can be an option:Surgery can be an option:
- Goal is to achieve a complete re...
New therapies – current clinicalNew therapies – current clinical
trialstrials
• Immunotherapies – CA 125 antibody/Immunoth...
Ovarian Ca survivorsOvarian Ca survivors
• Issues in survivors:Issues in survivors:
- Psycho sexual recoveryPsycho sexual ...
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Ovarian Cancer Amreen Husain, MD

  1. 1. Ovarian CancerOvarian Cancer Amreen Husain, MDAmreen Husain, MD Assistant ProfessorAssistant Professor Gynecologic OncologyGynecologic Oncology
  2. 2. Ovarian cancerOvarian cancer • 25,000 cases annually25,000 cases annually • 1/70 American women1/70 American women • 14,000 deaths annually14,000 deaths annually • 44thth in cancer related deaths among womenin cancer related deaths among women • Mean age at diagnosis 59 yrsMean age at diagnosis 59 yrs
  3. 3. Risk factorsRisk factors • Family history:Family history: - One 1One 1° relative 3.6 times risk, or 5% lifetime° relative 3.6 times risk, or 5% lifetime risk.risk. - 5- 10% of all ovarian cancers associated with5- 10% of all ovarian cancers associated with known gene mutations.known gene mutations. - Three familial ovarian cancer syndromes:Three familial ovarian cancer syndromes: site-specific ovarian cancer, breast/ovariansite-specific ovarian cancer, breast/ovarian cancer syndrome, hereditary nonpolyposiscancer syndrome, hereditary nonpolyposis colorectal cancer syndrome.colorectal cancer syndrome.
  4. 4. BRCA1/2BRCA1/2 • Associated with site specific andAssociated with site specific and breast/ovarian cancer syndromes.breast/ovarian cancer syndromes. • BRCA1: 25-40% lifetime risk of Ov ca, 80%BRCA1: 25-40% lifetime risk of Ov ca, 80% lifetime risk of Breast Califetime risk of Breast Ca • BRCA2 : 10% lifetime risk of ov CaBRCA2 : 10% lifetime risk of ov Ca • Early age-onset, 10yrs younger thanEarly age-onset, 10yrs younger than relative, mean age 40’srelative, mean age 40’s
  5. 5. Reproductive factorsReproductive factors • NulliparityNulliparity • InfertilityInfertility • Oral contraceptives protective 50%Oral contraceptives protective 50% decrease with 5 or more years of use.decrease with 5 or more years of use. • Multiparity protectiveMultiparity protective • Lactation protectiveLactation protective
  6. 6. ScreeningScreening • General population : no good methodGeneral population : no good method • High risk population : TV u/s, Ca 125High risk population : TV u/s, Ca 125 though not fully proventhough not fully proven • Prophylactic oophorectomy : option inProphylactic oophorectomy : option in high-risk women who have completedhigh-risk women who have completed child-bearing or age 40 though small riskchild-bearing or age 40 though small risk (1-3%) of peritoneal cancer(1-3%) of peritoneal cancer
  7. 7. DiagnosisDiagnosis • ““silent killer”silent killer” • Vague symptoms : abd bloating, earlyVague symptoms : abd bloating, early satiety, indigestion, constipationsatiety, indigestion, constipation • 60-70% Stage III or IV at diagnosis60-70% Stage III or IV at diagnosis • ascites and upper abdominal disease atascites and upper abdominal disease at presentationpresentation
  8. 8. StagingStaging • Surgically basedSurgically based • Ovarian cancer spreads by directOvarian cancer spreads by direct extension within abdominal cavity, or toextension within abdominal cavity, or to lymph nodeslymph nodes • Staging based on location of metastaticStaging based on location of metastatic diseasedisease
  9. 9. Early stageEarly stage • Stage IStage I Stage IIStage II
  10. 10. Advanced stageAdvanced stage Intraabdominal dxIntraabdominal dx Lymph node dxLymph node dx
  11. 11. Treatment - surgicalTreatment - surgical • Early stage:Early stage: - Intact removal of affected ovaryIntact removal of affected ovary - complete staging includingcomplete staging including TAHBSO/omentectomy/biopsies/lymph nodeTAHBSO/omentectomy/biopsies/lymph node sampling/peritoneal washingssampling/peritoneal washings • 30% patients with clinical Stage I will be30% patients with clinical Stage I will be upstagedupstaged • Fertility preservation can be considered in StageFertility preservation can be considered in Stage I if fully stagedI if fully staged • Chemotherapy for all stages greater than IAChemotherapy for all stages greater than IA
  12. 12. Surgical treatmentSurgical treatment • Advanced stage :Advanced stage : - Laparotomy via midline vertical incisionLaparotomy via midline vertical incision - Hysterectomy/ oophorectomyHysterectomy/ oophorectomy - Maximal tumor debulking to any residual implantsMaximal tumor debulking to any residual implants <1cm<1cm - Bowel resection required in about 10% pts.Bowel resection required in about 10% pts. - Pts treated by gynecologic oncologists have higherPts treated by gynecologic oncologists have higher rates of debulkingrates of debulking - Optimal debulking impacts significantly on long termOptimal debulking impacts significantly on long term survivalsurvival
  13. 13. Further therapyFurther therapy • Majority of patients will require furtherMajority of patients will require further treatment with chemotherapytreatment with chemotherapy • Current standard is Carboplatin + TaxolCurrent standard is Carboplatin + Taxol for 6 courses given every three weeks.for 6 courses given every three weeks. • 70-80% complete response70-80% complete response • a complete clinical response (remission)a complete clinical response (remission) is : nl Ca125, nl exam,is : nl Ca125, nl exam, ++ nl CT.nl CT.
  14. 14. 22ndnd look surgerylook surgery • Done now primarily in the study settingDone now primarily in the study setting • Can be performed by laparoscopyCan be performed by laparoscopy • Patients with negative second looks havePatients with negative second looks have a 50% chance of recurrence.a 50% chance of recurrence. • Potential treatments includePotential treatments include intraperitoneal chemotherapy, vaccineintraperitoneal chemotherapy, vaccine trials, further IV chemotherapytrials, further IV chemotherapy
  15. 15. Recurrent diseaseRecurrent disease • ¾ patients who achieve a remission after¾ patients who achieve a remission after initial therapy will recur, usually within 2initial therapy will recur, usually within 2 yearsyears • Response to second-line therapy dependsResponse to second-line therapy depends on the time interval from primary therapyon the time interval from primary therapy • Several second line treatments includingSeveral second line treatments including taxol/Pt/Doxil/Topotecan/Gemcitabinetaxol/Pt/Doxil/Topotecan/Gemcitabine
  16. 16. Recurrent diseaseRecurrent disease • Surgery can be an option:Surgery can be an option: - Goal is to achieve a complete resectionGoal is to achieve a complete resection - Usually in patients who have had a longerUsually in patients who have had a longer disease free-intervaldisease free-interval - Complicated by fact that patients have hadComplicated by fact that patients have had prior surgeryprior surgery - Almost all still will need chemotherapyAlmost all still will need chemotherapy - Radiation an option in select casesRadiation an option in select cases
  17. 17. New therapies – current clinicalNew therapies – current clinical trialstrials • Immunotherapies – CA 125 antibody/Immunotherapies – CA 125 antibody/ vaccine (Ovarex)vaccine (Ovarex) • Angiogenesis inhibitors – Thalidomide,Angiogenesis inhibitors – Thalidomide, Bevacizumab (Avasttin)Bevacizumab (Avasttin) • Biologic modulators – Iressa, CleevecBiologic modulators – Iressa, Cleevec
  18. 18. Ovarian Ca survivorsOvarian Ca survivors • Issues in survivors:Issues in survivors: - Psycho sexual recoveryPsycho sexual recovery - Potential for FertilityPotential for Fertility • National advocacy groupsNational advocacy groups - Further researchFurther research - Access to appropriate specialistsAccess to appropriate specialists - Support networkSupport network

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