ovarian%20cancer
OVARIAN CANCER
Ovarian cancer is a type of cancer that begins in the ovaries.
It is the 7th most common cancer in women (excluding skin cancer) and the leading cause of death from gynecologic cancer in developed countries.
The 3 histologic types of ovarian cancer are epithelial (primarily seen in women >50 years of age), germ cell (most commonly seen in women <20 years of age) and sex cord stromal (rare and produces steroid hormones).
The median age at the time of diagnosis is 63 years old and >70% present with advanced disease.

    Surgical Intervention

    Surgery for Epithelial Ovarian Carcinoma

    • Primary treatment for presumed ovarian cancer consists of appropriate surgical staging and cytoreduction followed by systemic chemotherapy in most patients
    • Initial surgery should be a comprehensive staging laparotomy, including a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO)
    • Omentectomy, peritoneal washing, peritoneal biopsies, evaluation of the entire abdominal cavity and retroperitoneal assessment that involves both the pelvic and para-aortic areas should be performed
    • For patients who wish to maintain their fertility, unilateral salpingo-oophorectomy (USO) or BSO may be adequate for young patients with stage I tumors (IA and IC) and/or low-risk tumors (ie early stage, low-grade invasive tumors, low malignant-potential lesions, malignant germ cell or sex cord-stromal tumors)

    Cytoreductive Surgery

    • Initial treatment recommendation for patients with clinical stage II, III or IV disease
    • Recommended to all patients with stage II-IV diseases with potentially resectable residual disease
    • Optimal if the residual tumor nodules are <1 cm in maximum diameter or thickness
    • Extensive resection of upper abdominal ovarian metastases is recommended for patients who can tolerate this surgery
    • Procedures that may be considered for optimal surgical cytoreduction (in all stages) include radical pelvic dissection, bowel resection, diaphragm or other peritoneal surface stripping, splenectomy, partial hepatectomy, cholecystectomy, partial gastrectomy or cystectomy, ureteroneocystostomy, distal pancreatectomy, or appendectomy

    Secondary Cytoreduction

    • Considered in patients with recurrent ovarian CA who recur >6-12 months since completion of primary chemotherapy, do not have ascites and have a limited foci of disease amenable to complete resection

    Interval Debulking Surgery

    • Considered in patients responsive to 3 cycles of chemotherapy or in patients with stable disease
      • Evaluation for potential interval debulking surgery should be done prior to the 4th cycle of neoadjuvant chemotherapy 
    • Should be followed with 3 additional cycles of the same chemotherapy regimen

    Completion Surgery

    • Considered in patients with stage II-IV disease who have residual disease that is considered unresectable after 3-6 cycles of chemotherapy

    Surgery for Malignant Germ Cell Tumors

    • Completion surgery with comprehensive staging is recommended as initial surgery for patients who do not desire fertility preservation
    • Fertility-sparing surgery should be considered for those desiring fertility preservation regardless of stage
      • Should be monitored with ultrasound examinations, if necessary
      • Completion surgery should be considered after finishing childbearing

    Surgery for Sex Cord Stromal Ovarian Carcinoma

    • Patients with stage IA or IC sex cord-stromal tumors desiring to preserve their fertility should be treated with fertility-sparing surgery with complete staging
      • Should be monitored with ultrasound examinations, if necessary
      • Completion surgery should be considered after finishing childbearing
    • Complete staging is also recommended for all other patients but lymphadenectomy may be omitted
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