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Flavio Guzmán
Flavio Guzmán

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Ovarian Cancer Screening Mati Zolti M.D. Department of Obstetrics & Gynaecology Sheba Medical Center Tel Hashomer, Israel
Ovarian Cancer: Burden of suffering ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ovarian Cancer in Israel ,[object Object],[object Object],[object Object],[object Object]
Ovarian Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Ovarian Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epithelial Ovarian Cancer ,[object Object],[object Object],[object Object]
Early Detection and Mortality ,[object Object],[object Object],[object Object],[object Object]
The challenge ,[object Object],[object Object],[object Object],[object Object]
Risk factors ,[object Object],[object Object]
Risk factors: Heredity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Additional Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Protective factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delays in Diagnosis ,[object Object],[object Object],[object Object]
Diagnostic tools ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up of Adnexal Mass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic approach ,[object Object],[object Object],[object Object]
Diagnostic Approach ,[object Object],[object Object]
Surgical Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Evaluation ,[object Object]
Stages Ia, Ib, Ic
Stages IIa, IIb, IIc
Stages IIIa, IIIb, IIIc
Stage IV
Treatment ,[object Object],[object Object],[object Object]
Surgical treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chemotherapy and Radiation ,[object Object],[object Object],[object Object]
Why screening for ovarian cancer is so difficult? ,[object Object],[object Object],[object Object],[object Object]
Screening Strategies ,[object Object],[object Object],[object Object],[object Object]
Ultrasound ,[object Object],[object Object],[object Object],[object Object]
Color-flow Doppler ,[object Object],[object Object],[object Object]
CA-125 ,[object Object],[object Object],[object Object]
CA-125 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lysophosphatidic acid (LPA) ,[object Object],[object Object],[object Object]
Current Screening Guidelines ,[object Object]
Screening Guidelines– cont’d ,[object Object],[object Object],[object Object],[object Object]
Screening, cont’d ,[object Object],[object Object],[object Object]
Where do we go from here? ,[object Object],[object Object],[object Object],[object Object]
Ovarian Cancer Screening Trials ,[object Object],[object Object],[object Object]
Take home points ,[object Object],[object Object],[object Object],[object Object],[object Object]
Marker Updates - Ca 125 • Approved marker to test for recurrence • Remains the single most sensitive and specific marker for ovarian cancer to date • Addition of other markers might improve sensitivity and specificity • Longitudinal assessment may also improve sensitivity and specificity
ROCA: Risk of Ovarian Cancer Algorithm
Marker Updates—OvaCheck ,[object Object],[object Object],[object Object],[object Object]
Marker Updates—Ciphergen Panel ,[object Object],[object Object]
Marker Updates - Yale’s Panel ,[object Object],[object Object],[object Object]
Marker Updates - Luminex Panel ,[object Object],[object Object],[object Object],[object Object]

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  • 1. Ovarian Cancer Screening Mati Zolti M.D. Department of Obstetrics & Gynaecology Sheba Medical Center Tel Hashomer, Israel
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  • 40. Marker Updates - Ca 125 • Approved marker to test for recurrence • Remains the single most sensitive and specific marker for ovarian cancer to date • Addition of other markers might improve sensitivity and specificity • Longitudinal assessment may also improve sensitivity and specificity
  • 41. ROCA: Risk of Ovarian Cancer Algorithm
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Editor's Notes

  1. Half of all ovarian cancers are diagnosed in women > 65yo
  2. Stage I: confined to ovary or ovaries IA: unilateral, capsule intact, no tumor on ext surface. No ascites. IB: bilateral, same as above IC: 1 or both ovaries with ruptured capsule, surface tumor, + ascites or + peritoneal washing
  3. Stage II: Pelvic extension IIA: involvement of uterus or fallopian tubes, (-) peritoneal washings IIB: involvement of other pelvic tissues (bladder, sigmoid colon, rectum), (-) peritoneal washings IIC: IIA or IIB with ruptured capsule, surface tumor, + peritoneal washings or ascites
  4. Stage III: Peritoneal implants outside pelvis or + retroperitoneal or inguinal LN IIIA: grossly limited to true pelvis with microscopic seeding of abdom peritoneum IIIB: Implants on abdom peritoneum < or = 2cm diam IIIC: Implants on abdom peritoneum > 2cm or + retroperitoneal or inguinal LN
  5. Stage IV: distant mets (liver, lungs), + pleural fluid
  6. CA-125 elevated in: Malignant conditions Ovarian CA of various types Cervical CA Fallopian tube CA Endometrial CA Pancreatic CA Colon CA Breast CA Lymphoma Mesothelioma Benign conditions: Endometriosis Uterine fibroids PID Pregnancy Diverticulitis Pancreatitis Liver disease Renal failure Menstruation Appendicitis Inflammatory bowel disease