obstetrics and gynaecology

1. Management
Of Epithelial
Ovarian
Cancer
Presented by : Adithya S
MBBS, Govt Thiruvarur Medical College

2. Introduction
 Ovarian cancer is the fourth most common cancer
in woman
 Ovarian cancer is staged according to the FIGO
staging : 2014
 The management usually involves a combined
modality of treatment by cytoreductive surgery
followed by chemotherapy
 Prognosis depends upon the amount of residual
disease left after the surgery

3. Management of epithelial ovarian cancer depends on the FIGO stage of the disease
 In early stages ( Stage 1 and 2)
1. Management of disease includes total abdominal hysterectomy with
bilateral salpingo-oophorectomy
2. Surgery is followed by chemotherapy ( except in stages 1A and 1B)
 In advanced stages ( Stage 3 and 4)
1. Management of disease includes debulking /
cytoreductive surgery
2. Surgery is followed by chemotherapy

4. STEPS OF SURGERY FOR OVARIAN CANCER
• Open abdomen by vertical midline incision
• Obtain ascetic fluid for cytology
• Evaluate extent of disease by careful examination of
abdomen and pelvis
• Obtain small peritoneal biopsy from subdiaphragmatic area,
right and left paracolic gutters, surface of bladder, Douglas
pouch
• Perform total abdominal hysterectomy with bilateral
salpingo-oophorectomy
• Perform intracolic omentectomy
• Remove any other structure which may be involved by the
disease
• Make a note of residual tumour left in spite of maximum
surgical effort
SURGICAL MANAGEMENT

5. CONSERVATIVE SURGERY FOR EPITHELIAL
OVARIAN CANCER
 On rare occasions if the cancer is limited to one or both ovaries in a young
patient who is desirous of pregnancy in future, a conservative surgical
approach is preferred
 A conservative approach is preferred in stage 1A if family is not complete
 A unilateral or bilateral salpingo-oophorectomy with preservation of uterus
 Such patients if remain disease free for 2 years or more can undergo IVF

6. INTERVAL DEBULKING SURGERY
 If a newly diagnosed case of carcinoma ovary is found to have advanced disease and is considered unfit
for anesthesia the patient is managed initially by giving 3 cycles of chemotherapy
 The chemotherapy is given in three weeks interval followed by debulking surgery
 Such a surgery is called ‘Interval Debulking Surgery’
 By such an approach general conditions of the patient improves, ascites reduces and she becomes fit
for anesthesia and surgery
 A patient managed by this approach get remaining 3 cycles of chemotherapy after surgery

7. SECONDARY DEBULKING SURGERY
If treated case of carcinoma ovary develops
recurrence, she can be managed by a second
operation
The aim of surgery is to remove recurrence
However with widespread recurrence chemotherapy is
usually the preferred approach

8.  Ovarian cancer are one the most lethal tumors
 In spite of surgical and chemotherapeutic management a great majority of women experience recurrences
and may die
 The recurrence rate depends upon the stage of disease at diagnosis, surgical procedure and
chemotherapy
 80% of patients experience recurrence within 3 years
PROGNOSIS OF SURGICAL TREATMENT

9. FIGO STAGING & 5 YEAR SURVIVAL RATE

10. CHEMOTHERAPE
UTIC
MANAGEMENT

11. CHEMOTHERAPY FOR OVARIAN
CARCINOMA
• After initial surgical management almost all cases
need adjuvant chemotherapy.
• Only patients who can be kept on follow-up by
avoiding postoperative
• chemotherapy are the ones who had Stage 1A and
1B disease.
• Patients who were reported to have borderline
ovarian malignancy’ on histopathology are also kept
on follow-up only without giving any chemotherapy.

12. ● Currently most commonly used combination of drugs in the
treatment of epithelial ovarian carcinoma is Paclitaxel
+Carboplatin.
● These drugs are given intravenously every 3 weeks for 6
cycles.
● Paclitaxel: Dose 175mg/m^2, intravenously over 3 hours.
Main side effect: Neurotoxicity.
● Carboplatin: Dose is calculated by area under curve(AUC)
which is generally taken as 5-6 hours. Side effects:
Nephrotoxicity ,bone marrow suppression.
DRUGS USED FOR CHEMOTHERAPY

13. Newer Drugs For Treatment Of Epithelial Ovarian
Carcinoma
• Topotecan 1.5 mg/m^2/day x 5 days
• Pegylated liposomal doxorubicin(PLD) 50 mg/m^2 orally x 28
days
• Gemcitabine 1000mg/m^2 on day 1,8 and 15.
• Nanoparticle albumin bound Paclitaxel(Nab Paclitaxel)
• Etoposide 50 mg/m^2 orally x 21 days
• Trabectedin 1300 mcg/m^2 over 3 hours every three weekly.
• Bevacizumab(Avastin):It is an anti-angiogenic ‘Human
Monoclonal Antibody’ to VGEF(Vascular Growth Endothelial
Factor).Drug is initially given weekly for 20-21 cycles, but can be
extended up to 22 weeks.

14. Neo Adjuvant Chemotherapy (NACT)
 Neoadjuvant chemotherapy (NACT) is a treatment for
advanced ovarian cancer – cancer at stage III or IV.
 It uses chemo drugs to shrink tumours before any surgery is done to
remove them.
 NACT uses a reverse approach to the standard treatment of having
primary debulking surgery (PDS) before chemo.

15. FOLLOW-UP OF EPITHELIAL OVARIAN
CANCER
 Cases of epithelial ovarian cancers treated by surgery and
chemotherapy are seen at regular intervals of 3 months for
initial 2 years
 For the next three years follow up is done every 6 months
 Clinical examination and serum CA-125 every 3 months helps
in detection of recurrences
 Imaging studies are done in case of any suspicion of
recurrences.

16. CREDITS: This presentation template was created by
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images by Freepik
CREDITS: This presentation template was created by
Slidesgo, including icons by Flaticon and infographics &
images by Freepik
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