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  • image 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 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 Considerable education efforts have been made to identify patients with the persistence, greater than 2 weeks, of nonspecific presenting symptoms of ovarian cancer including: abdominal pressure/pain, difficulty eating or feeling full quickly, urinary urgency/frequency, change in bowel habits, or unexplained vaginal bleeding.

  • image 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 Although most patients will achieve a complete response to initial treatment, more than 50% of patients will have recurrence within the first 2 years. If recurrence occurs less than 6 months after completion of chemotherapy, the 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.

  • image 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 The intraperitoneal (IP) route of chemotherapy administration has significantly improved progression-free and overall survival, but patients must be carefully selected.

  • image A platinum-containing doublet chemotherapy regimen is the standard of care for the first recurrence of platinum-sensitive ovarian cancer.

  • image Despite recent advances, enrollment in an investigational study is still the primary treatment recommendation for patients with recurrent platinum-resistant ovarian cancer.

  • image The activity of the new class of the poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors in the maintenance treatment of recurrent or refractory advanced ovarian cancer depends on BCRA status or “BRCAness” of the tumor.


Preclass Engaged Learning Activity

Create a summary table of the chemotherapy agents used in the initial treatment of ovarian cancer (refer to Table 150-1). Identify each agent’s drug class, mechanism of action, main adverse event profile, and important patient counseling information. This table will enhance the student’s ability to appropriately utilize the patient care process with particular emphasis on the Implement and Follow-up steps.

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