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Cancer of the Ovary

Cancer of the Ovary
Cancer of the Ovary

Introduction

Epithelial tumours comprise 90% of all ovarian malignancies. Due to anatomical location, most patients present with advanced disease.

Management: Surgery

Total hysterectomy with Bilateral Salpingo –Oophorectomy (TAH+BSO) and omentectomy should be performed in resectable tumor. If total tumor removal is not possible, then maximum debulking (Cyto –reductive) surgery is done. Unilateral salpingooophorectomy is only justified for stage IA tumour with favourable histology

Signs and Symptoms

Diagnostic criteria

Minimal or no symptoms in early stage

Abdominal distension with palpable mass, pain and ascites are all late signs Investigations:
Inspection and bimanual examination under anesthesia (EUA) recto–vagina are mandatory to exclude primary disease or extension from other sites such as cancer of the cervix

FBC, RFT, LFT, CA 125 & CEA
CXR
CT scan of the Abdominal and pelvic
Pelvic and abdominal ultrasound
Histology of oophorectomy specimen or biopsy obtained at laparotomy
Staging: Is based on surgical diagnosis (laparotomy): FIGO: IA, IB, IC, IIA, IIB, IIC, III, and IV

Investigation

Treatment

  • Pharmacological

    Adjuvant chemotherapy Indicated in all patients at high risk i.e. stage IC or II, high grade or clear cell cancers of any stage. Standard regimens include combination of platinum and taxanes
    Carboplatin AUC 6 IV Day 1 + IV Paclitaxel 175 mg/m2 over 3 hrs day1,repeated every 3weeks for 6 cycles

    For recurrent disease give same regimen if tumor is platinum sensitive (recurrence after 6 months since last chemotherapy cycle)

    For platinum resistant disease give gemcitabine or bevacizumab as single agent or in combination with taxanes. When available, liposomal doxorubicin is active and indicated in recurrent disease.

    Gemcitabine IV 1000 mg/m2 Day 1, D8 and D15, Repeat every 4 weeks for 6 courses.
    Bevacuzimab 15 mg/kg IV day1, every 3 weeks until disease progression
    Endocrine therapy is indicated in selected cases with recurrent disease.

    Tamoxifen 20mg PO bid, daily + s/c Goserelin 3.6mg once a month

    Note: All patients must be referred to a gynecologist and cancer specialized center for evaluation and proper management
  • Non-pharmacological

Prevention

Updated on,

5 Novemba 2020 10:08:13

References

1.STG

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