Ovarian Cancer Lecture 3.doc

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Western University
Anatomy and Cell Biology
Anatomy and Cell Biology 4461B
Geordie Shepherd

TS Lecture 3: Clinical Management of Ovarian Cancer Surgery • Patients with early Stage I disease are effectively cured with surgery alone Laparotomy • • Most commonly practiced • Most effective for complete removal of widespread disease • Increased morbidity due to post surgical complications • Laparoscopy • Instruments and video camera through small openings or ports in the abdominal wall • Much less morbidity and faster recovery • Conversion to laparotomy if complicated • Interval Debulking • If chemotherapy is used first (neoadjuvant) to reduce tumor burden, surgery is done af- ter 2-3 cycles. This is a good way to evaluate tumor response to chemotherapy. • Optimal vs. Suboptimal Debulking • Target is to have only microscopic or <2cm residual disease. If >2cm, poorer prognosis for the patient • Complicated by • Extent of disease • Organ/major vessel involvement • Fixed/adherent lesions • Complications during surgery • Secondary Cytoreductive Surgery • Used in some cases of recurrent disease for localized large masses after the patient has already had surgery • Only for good surgical candidates Complete Surgery • • Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO) Omentectomy - the omentum is the most common site of ovarian cancer metastasis • • Peritoneal stripping - remove secondary lesions off of serosal surfaces of the peri- toneum • Lymphadnectomy - sometimes performed at least if nodes are “bulky” Chemotherapy • Adjuvant chemotherapy - administered IV after surgical debulking (usually 6 cycles); stan- dard drugs are carboplatin and paclitaxel. First line chemotherapy is effective for about 75% of patients. • Carboplatin • Crosslinks with DNA like alkylating agents • Single most effective agent in ovarian cancer • Longer half life than cysplatin so lower doses required • Long-term treatment eventually leads to haematological toxicity which outweights clinical benefit • Paclitaxel • Stabilizes microtubules, inhibiting mitosis • Used in combination with carboplatin as first-line therapy for ovarian cancer • Used alone in patients with carboplatin-resistant disease (palliative) or in patients that no longer tolerate carboplatin because of myelosuppression • Neoadjuvant chemotherapy - 2-3 cycles administered prior to surgery (interval debulking), surgery is followed by another 3 cycles • Tumor is considered sensitive to chemotherapy if recurrence happens after 6 months; re- sistant if recurrence happens in less than 6 months - must ident
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