Risk Factors

  • Advancing age
  • Infertility
  • Endometriosis
  • Application of talcum powder to perineum
  • Genetic susceptibility (8-13% caused by BRCA1 or BRCA2)

Screening

  • Routine pelvic examination NOT effective
  • ACS, ACOG, SGO, NCCN do NOT recommend ovarian cancer screening for general population
  • Screening with ultrasound and CA125 is recommended for women BRCA (+) mutations

Screening Tests: CA 125

  • CA125 elevated in 90% of epithelial ovarian cancers
  • However:
    • CA125 levels are normal in 50% of women with early stage ovarian cancer
    • CA125 levels are elevated in 2-3% of postmenopausal women without ovarian cancer

Diagnosis

  • Most present with advanced stage diseases
  • Symptoms are vague (abdominal pain, bloating, gastrointestinal or urinary tract complaints)
  • àStudies show that most women recall having symptoms before diagnosis  high index of suspicion most important

Diagnosis

  • Definitive diagnosis surgery
  • Laparoscopy can be used for diagnosis (Avoid rupture/spillage of tumor)
  • Frozen section diagnosis of ovarian cancer
  • Staging is mandatory

Treatment

Therapy for Epithelial Ovarian Cancer Category of Ovarian Cancer Based on Surgical Staging Recommended (standard) Therapy Early ovarian cancer Low risk (stages IA and IB, grade 1) TAH, BSO High risk (stages IA and IB, grade 2 and 3; stages IC, IIA, IIB, and IIC, no residual) TAH, BSO Adjuvant therapy with combination carboplatin and paclitaxel chemotherapy Advanced ovarian cancer Stage III with optimal residual disease Maximal surgical cytoreduction Combination chemotherapy with systemic carboplatin and paclitaxel or systemic paclitaxel plus intraperitoneal cisplatinand paclitaxel Stage IV, or suboptimal disease, or both Maximal surgical cytoreduction Combination chemotherapy with carboplatin and paclitaxel

Primary Cytoreductive Surgery

  • Patients who undergo “optimal” cytoreduction have improved response rates to chemotherapy, prolonged disease-free survival, and improved overall survival
  • If cytoreduction is suboptimal, there is no survival benefit to surgical debulking
  • Overall survival for patients with optimally debulked advanced disease is 47-66 months compared with 33-36 months with suboptimally debulked disease
  • Meta-analysis showed improved survival rates among patient referred to expert centers for primary surgery (centers where ≥75% optimal cytoreduction rate)
  • Optimal cytoreduction generally defined as tumor measuring 1 cm or less, but best survival rates when no gross visible tumor remaining
  • SPLEEN
  • SPLEEN HILUS

Interval Cytoreductive Surgery

  • Chemotherapy followed by surgery
  • Used in patients who are not good operative candidates or where it is known that an optimal cytoreductive surgery can not be performed

Secondary Cytoreductive Surgery

  • The use of cytoreductive surgery in the setting of recurrent disease is not well defined
  • Selection should be based on disease-free interval from completion of primary therapy, the number of sites of recurrence, and the probability that cytoreduction to minimal residual disease can be achieved

Chemotherapy

  • 75-80% of patient will respond to chemotherapy, but many will eventually develop resistance
  • Standard therapy has been IV carboplatin and paclitaxel

At sunrise  laparoscopically staging , complete surgery done which includes radical hysterectomy , bilateral salpingoopherectomy , omentectomy , lymphadenectomy done by which we ensure  Lesser Blood loss, Shorter hospital stay ,better overall survival.

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