- 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%.
- 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%.
- 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.
- 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.
- 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 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.
- 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.
- The interperitoneal (IP) route of chemotherapy administration has demonstrated a significant route of administration; however, it is dependent on appropriate patient selection.
- A platinum-containing doublet chemotherapy regimen is the standard of care for the first recurrence of platinum-sensitive ovarian cancer.
- Despite recent advances, enrollment still primary treatment recommendation for patients with recurrent platinum-resistant ovarian cancer.
On completion of the chapter, the reader will be able to:
Discuss the etiology and risk factors associated with the development of ovarian cancer.
Debate the utility of the screening tests and serological markers for diagnosing ovarian cancer.
Differentiate the nonspecific physical signs and symptoms of ovarian cancer.
Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed and recurrent ovarian cancer patients.
Determine the patient characteristics for implementing interperitoneal chemotherapy.
Interpret the role of consolidation chemotherapy in the treatment of ovarian cancer.
Design appropriate monitoring plan for ovarian cancer patients after achieving complete response to first-line treatment.
Formulate the potential chemotherapy options for women with recurrent platinum-resistant ovarian cancer.
Create a supportive care plan for ovarian cancer patients ...