| Colon Cancer Staging Chart | | | | women with high risk, early stage cancer (Stage I |
| However, there are more deaths from this form | | | | grade 3 or stage II disease), adjuvant |
| of cancer each year in the United States than | | | | chemotherapy with platinum based agents show |
| from endometrial cancer and cervical cancer | | | | an 11% improvement in progression free survival |
| combined. Colon Cancer Staging ChartThe lifetime | | | | and 8% improvement in overall survival. For stage |
| risk of developing spontaneous ovarian cancer is | | | | III and IV disease, the current standard of care |
| about 1.7%. Epithelial ovarian cancer was expected | | | | include maximal attempt at surgical cytoreduction |
| cause 15,520 deaths in 2008. Mean age at | | | | followed by chemotherapy with platinum based |
| diagnosis is 60. There has been a significant | | | | agents. |
| improvement in the five year survival rate for | | | | Optimal debulking is an important part in the |
| patients with ovarian cancer. This is likely a | | | | treatment of cancer in the ovaries. Retrospective |
| combination of better tumor debulking surgeries | | | | data have shown that survival is better for |
| and better chemotherapeutic options. | | | | women who receive chemotherapy in the |
| Most patients with this type of ovarian cancer do | | | | presence of low volume disease. In the setting |
| not have signs or symptoms until disease spreads | | | | where optimal surgical cytoreduction cannot be |
| to the upper abdomen. 70% of patients present | | | | achieved, an alternative approach is for the |
| with advanced disease. Symptoms for early stage | | | | patient to receive chemotherapy up front. For |
| ovarian cancer can include nonspecific pelvic | | | | patients who have a partial response to |
| discomfort, urinary frequency and constipation | | | | neoadjuvant chemotherapy, it may be appropriate |
| which are caused by an enlarging pelvic mass. | | | | to attempt surgical removal of macroscopic |
| With advanced disease, patients experience | | | | disease at that time. |
| abdominal pain, bloating, anorexia, nausea and | | | | As for the standard of care in chemotherapy for |
| constipation. | | | | advanced ovarian-type cancer, studies have |
| The best tumor marker for ovarian cancer is CA | | | | shown that paclitaxel/cisplatin combination is |
| 125. Minor elevations in CA 125 can also be seen in | | | | superior to cyclophosphamide/cisplatin combination. |
| endometriosis, benign tumors, fibroids and in | | | | Later studies showed that carboplatin/paclitaxel is |
| pregnant and postpartum women. In addition, | | | | at least as effective as cisplatin/paclitaxel. |
| moderate elevation of CA 125 can be seen in | | | | Intraperitoneal chemotherapy is an appealing |
| other adnocarcinoma such as breast and | | | | approach for treating a disease that is largely |
| endometrial cancer. The sensitivity of CA 125 is | | | | confined in the peritoneal space. GOG 172 which |
| 70% to 80% and the specificity is 98.6% to | | | | was a phase III clinical trials demonstrated that |
| 99.4%. However, in the average risk population | | | | this regional approach resulted in superior |
| with low prevalence of ovarian cancer, the false | | | | progression free survival and overall survival when |
| positive can be unacceptably high. | | | | compared with the intravenous approach alone. |
| Lung Cancer Secrets Revealed Click here | | | | The disadvantage of this approach includes local |
| The National Cancer Institute recommends | | | | toxicity, and requirement for intraperitoneal |
| screening for ovarian female cancer with known | | | | catheter placement. |
| genetic syndromes associated with this disease | | | | Because of the high recurrence rate in patients |
| and for women with strong family history. Routine | | | | with advanced ovarian cancer, the issue of |
| screening of women without family history of | | | | whether consolidation chemotherapy may |
| ovarian cancer is not recommended. The known | | | | improve time to progression and overall survival |
| genetic syndromes include hereditary breast and | | | | was examined in a phase III trial comparing 3 and |
| ovarian cancer syndrome associated with BRCA | | | | 12 cycles of taxol. Progression free survival |
| 1, BRCA 2 and Hereditary Nonpolyposis Colorectal | | | | favored the 12 cycle arm. However, overall |
| Cancer Syndrome (HNPCC). The absolute risk of | | | | survival was not different between the two arms. |
| ovarian cancer in the presence of either BRCA 1 | | | | Therefore, the oncologist needs to discuss with |
| or BRCA 2 mutation ranges from 16% to 60%. | | | | the patient and allow them to decide whether the |
| For patients with HNPCC syndrome, the lifetime | | | | improved progression free survival justifies |
| risk of ovarian cancer is 9% to 12%. | | | | toxicities including peripheral neuropathy and |
| Epithelial cancer accounts for about 90% of | | | | alopecia. |
| ovarian cancers. Common histologies include | | | | For many patients with advanced ovarian cancer |
| serous, mucinous, endometroid, transitiona and | | | | who have an initial treatment response, disease |
| clear cell types. Germ cell tumors include | | | | relapses at a later time. The treatment of |
| dysgerminoma, endodermal sinus tumor, malignant | | | | patients with recurrent disease or resistant |
| teratoma embryonal carcinoma or primary | | | | disease needs to be individualized. For people with |
| choriocarcinoma. Stromal tumors include granulose | | | | long treatment free interval, similar drugs many |
| tumor or Sertoli-Leydig tumor. | | | | be reused. There are also a number of single |
| Upon initial presentation, surgery is used for | | | | agent drugs with activity in ovarian cancer. These |
| confirmation and staging the cancer. Stage I | | | | include altretamine, bevacizumab, docetaxel, |
| disease is confined to one or both ovaries. Stage | | | | etoposide, gemcitabine, liposomal doxorubicin, |
| II involves one or both ovaries with extension to | | | | paclitaxel, tamoxifen, topotecan and vinorelbine. |
| the pelvic viscera. Stage III is associated with | | | | Radiation can also play a role in the palliation of |
| implants on the abdominopelvic wall or the serosal | | | | some patients with recurrent ovarian cancer. |
| surface of the liver or involves small bowel or | | | | Symptoms such as pain from growing pelvic |
| omentum. Stage IV disease involves distant | | | | mass or bone metastasis can be palliated. Very |
| metastasis. The 5 year survival for stage IA | | | | rarely cerebral metastasis can develop which can |
| disease and grade 1 or 2 histology is greater than | | | | also be treated with radiation. |
| 90%. For high risk stage I disease and stage II | | | | The best treatment of ovarian cancer needs a |
| disease, 5 year survival is 80%. For patients with | | | | team approach between the primary care |
| stage III disease after optimal debulking, 5 year | | | | physician, gynecological oncology surgeon, medical |
| survival is 20% to 30%. This reduces to be less | | | | oncologists and radiation oncologists. As more |
| than 10% for stage III patients with suboptimal | | | | chemotherapeutic agents become available and as |
| debulking and stage IV disease. | | | | we further understand the biology of epithelial |
| Stage I ovarian cancer with favorable prognostic | | | | ovarian cancer, we hope to further improve the |
| features can be treated with surgery alone. For | | | | overall survival and quality of life of our patients. |