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Ovarian Cancer

Ovarian Cancer. Gloria S. Huang, M.D. Assistant Professor Department of Obstetrics & Gynecology and Women ’ s Health Division of Gynecologic Oncology.

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Ovarian Cancer

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  1. Ovarian Cancer Gloria S. Huang, M.D. Assistant Professor Department of Obstetrics & Gynecology and Women’s Health Division of Gynecologic Oncology Albert Einstein College of Medicine Montefiore Medical Center Albert Einstein Cancer Center

  2. Ovarian Cancer Who gets it? What are the signs and symptoms? How do you work it up? How do you treat it? What are the chances of survival?

  3. Ovarian Cancer: U.S. Epidemiology • Eighth most common cancer among women • Estimated 20,180 new cases in 2006 • Lifetime risk of getting ovarian cancer is approximately 1 in 67 (1.5%) • Accounts for 3% of cancers in women American Cancer Society 2006

  4. Ovarian cancer: U.S. Epidemiology • 5th most common cause of cancer death in women • Estimated 15,310 deaths in 2006 • Lifetime risk of dying from ovarian cancer is 1 in 95 (1%)

  5. Histology • 85% Epithelial • Serous carcinoma-most common • Endometrioid • Mucinous carcinoma • Clear cell carcinoma • 5% Germ Cell • 10% Sex cord Stromal

  6. Ovarian Cancer

  7. Ovarian Cancer: Risk Factors

  8. Hereditary factors • BRCA 1 and BRCA 2 • 10% of ovarian cancers • Lifetime risk 40-50% • HNPCC • 1% of ovarian cancers

  9. Ovarian Cancer Who gets it? What are the signs and symptoms? How do you work it up? How do you treat it? What are the chances of survival?

  10. Ovarian Cancer: Symptoms • 95% of women DO report symptoms. • Symptoms can be vague and not gynecologic: • Abdominal bloating, increased girth • Fatigue • Gastrointestinal disturbances • Urinary symptoms • Abdominal/pelvic pain • Menstrual irregularities • Increased flatulence

  11. Ovarian Cancer Who gets it? What are the signs and symptoms? How do you work it up? How do you treat it? What are the chances of survival?

  12. Ovarian Cancer: Diagnostic Modalities • Rectovaginal pelvic exam • TVS and/or CT scan or MRI • CA-125 • If diagnosis uncertain, laparoscopy may be useful diagnostic tool • Surgical exploration

  13. Normal Ovary

  14. Ovarian Cancer

  15. Ovarian Cancer

  16. Ovarian Cancer Who gets it? What are the signs and symptoms? How do you work it up? How do you treat it? What are the chances of survival?

  17. Ovarian Cancer: Surgical Rx for Early Stage Disease • Optimal therapy: TAH BSO + staging (including pelvic and PALN) • In younger women, reproductive conservation may be appropriate • Approximately 30% will have histologic evidence of metastatic disease

  18. Ovarian Cancer: Staging by Surgical Specialty

  19. Ovarian Cancer: Surgical Treatment for Advanced Disease • Significant survival advantage for women optimally cytoreduced • Procedures may include: • En bloc resection of uterus, ovaries and pelvic tumor • Omentectomy • Bowel resection • Removal of diaphragmatic and peritoneal implants • Splenectomy, appendectomy

  20. Ovarian Cancer: Survival by Residual Disease GOG Protocols (PR) 52 and 97

  21. Ovarian Cancer: Chemotherapy • Almost all patients should receive adjuvant chemotherapy with platinum and a taxane • >70% response rate • I.P. chemo in optimally debulked pts • Many new agents being tested • Encourage clinical trial participation

  22. Taxol and ovarian cancer McGuire W.P. et al. New Engl J of Med, 334 (1996)

  23. Ovarian Cancer Who gets it? What are the signs and symptoms? How do you work it up? How do you treat it? What are the chances of survival?

  24. Ovarian Cancer: Follow-up Healthcare • RV pelvic exam and CA-125 q 3-4 mo x 2 years, q 6 mo for years 3-5 • CT scan for symptoms • General health maintenance(mammography, Pap smear, bone density, colon-rectal screening, cholesterol, etc.) • Discuss HRT, diet, exercise

  25. Ovarian Cancer: Recurrence • 75% of patients relapse • Treatment options include: • Secondary cytoreduction • Retreatment with platinum/taxane • Second-line therapies, including chemo, radiation, immunologic, gene therapies • Encourage clinical trials

  26. Ovarian Cancer: U.S. Patterns of Care 785 women with ovarian cancer studied Munoz JCO 1997

  27. Ovarian Cancer: Importance of Surgeon • 1,866 women with ovarian cancer • Significant advantage for those women managed by Gynecologic Oncologist • More likely to have optimal cytoreduction • Reduction in death by 25% (p= 0.005) compared to Ob/Gyn and General Surgeons • Junor et al, Brit J Ob/Gyn, 11/99

  28. Ovarian Cancer: Stage Distribution and 5-year Survival American Cancer Society 2002

  29. Relative Survival: Ovarian & Breast Cancers

  30. Ovarian Cancer: Future Directions • Cost-effective screening • Early detection • Prevention • Reversing chemoresistance • Targeted therapies • Immunotherapy • Gene therapy

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