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  • Image not available. Ovarian cancer is denoted “the silent killer” because of the nonspecific signs and symptoms that contribute to the delay in diagnosis. The few patients who present with disease still confined to the ovary will have a 5-year survival rate greater than 90%, but most patients present with advanced disease and have a 5-year survival rate of 10 to 30%.
  • Image not available. Ovarian cancer is a sporadic disease with less than 10% of cases of ovarian cancer attributed to heredity. However, a history of two or more first-degree relatives with ovarian cancer increases a woman's risk of developing ovarian cancer by greater than 50%.
  • Image not available. CA-125 is a nonspecific antigen used as a tumor marker for diagnosis and monitoring epithelial ovarian carcinoma. If CA-125 is positive at the time of diagnosis, changes in CA-125 levels correlate with disease response and progression.
  • Image not available. Ovarian cancer is staged surgically with the International Federation of Gynecology and Obstetrics (FIGO) staging algorithm. Tumor debulking and total abdominal hysterectomy–bilateral oophorectomy surgery are the primary surgical interventions for ovarian cancer. After the completion of the staging and primary surgical treatment, the current standard of care is six cycles of a taxane/platinum-containing chemotherapy regimen.
  • Image not available. Although most patients will achieve a complete response to initial treatment, over 50% will have recurrence within the first 2 years. If recurrence is less than 6 months after completion of chemotherapy, tumor is defined to be platinum-resistant. The antitumor activity of second-line chemotherapy regimens is similar, and the choice of treatment for recurrent platinum-resistant ovarian cancer depends on residual toxicities, physician preference, and patient convenience. Participation in a clinical trial is also a reasonable option for these patients.

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Upon completion of the chapter, the student will be able to:

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  • 1. Describe the etiology of ovarian cancer.
  • 2. Identify the possible risk factors associated with the development of epithelial ovarian cancer.
  • 3. Assess the advantages and disadvantages of preventive strategies based on individual patient risk factors.
  • 4. Describe the utility of the screening tests and serological markers for diagnosing ovarian cancer.
  • 5. List the nonspecific physical signs and symptoms of ovarian cancer.
  • 6. Describe the clinical presentations of early-stage, late-stage, and recurrent disease and patterns of metastasis.
  • 7. Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed ovarian cancer patients.
  • 8. Describe the factors to consider when selecting intraperitoneal versus intravenous first-line chemotherapy in patients with advanced ovarian cancer.
  • 9. Define the role of second-look surgery in the management of ovarian cancer.
  • 10. Compare and contrast treatment options for platinum-sensitive versus platinum-resistant ovarian cancer.
  • 11. Develop a treatment plan based on the patient’s initial clinical presentation and previous treatment, if applicable.
  • 12. Describe the risks and benefits of the surgical and chemoprevention options available for decreasing the potential risk of developing ovarian cancer.
  • 13. Define the role of radiation in the treatment of ovarian cancer.

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Ovarian cancer is a gynecologic cancer that usually arises from disruption or mutations in the epithelium of the ovary....

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