Management Of Epithelial Ovarian Cancer.pptx

obstetrics and gynaecology

1. Management Of Epithel ial Ovarian Cancer Presented by : Adithya S MBBS, Govt Thiruvarur Medical College

2. Introduction Ovarian cancer is the fourth most common cancer in woman Ovarian cancer is staged according to the FIGO staging : 2014 The management usually involves a combined modality of treatment by cytoreductive surgery followed by chemotherapy Prognosis depends upon the amount of residual disease left after the surgery

3. Management of epithelial ovarian cancer depends on the FIGO stage of the disease In early stages ( Stage 1 and 2) Management of disease includes total abdominal hysterectomy with bilateral salpingo-oophorectomy Surgery is followed by chemotherapy ( except in stages 1A and 1B) In advanced stages ( Stage 3 and 4) Management of disease includes debulking / cytoreductive surgery Surgery is followed by chemotherapy

4. STEPS OF SURGERY FOR OVARIAN CANCER Open abdomen by vertical midline incision Obtain ascetic fluid for cytology Evaluate extent of disease by careful examination of abdomen and pelvis Obtain small peritoneal biopsy from subdiaphragmatic area, right and left paracolic gutters, surface of bladder, Douglas pouch Perform total abdominal hysterectomy with bilateral salpingo-oophorectomy Perform intracolic omentectomy Remove any other structure which may be involved by the disease Make a note of residual tumour left in spite of maximum surgical effort SURGICAL MANAGEMENT

5. CONSERVATIVE SURGERY FOR EPITHELIAL OVARIAN CANCER On rare occasions if the cancer is limited to one or both ovaries in a young patient who is desirous of pregnancy in future, a conservative surgical approach is preferred A conservative approach is preferred in stage 1A if family is not complete A unilateral or bilateral salpingo-oophorectomy with preservation of uterus Such patients if remain disease free for 2 years or more can undergo IVF

6. INTERVAL DEBULKING SURGERY If a newly diagnosed case of carcinoma ovary is found to have advanced disease and is considered unfit for anesthesia the patient is managed initially by giving 3 cycles of chemotherapy The chemotherapy is given in three weeks interval followed by debulking surgery Such a surgery is called ‘Interval Debulking Surgery’ By such an approach general conditions of the patient improves, ascites reduces and she becomes fit for anesthesia and surgery A patient managed by this approach get remaining 3 cycles of chemotherapy after surgery

7. SECONDARY DEBULKING SURGERY If treated case of carcinoma ovary develops recurrence, she can be managed by a second operation The aim of surgery is to remove recurrence However with widespread recurrence chemotherapy is usually the preferred approach

8. Ovarian cancer are one the most lethal tumors In spite of surgical and chemotherapeutic management a great majority of women experience recurrences and may die The recurrence rate depends upon the stage of disease at diagnosis, surgical procedure and chemotherapy 80% of patients experience recurrence within 3 years PROGNOSIS OF SURGICAL TREATMENT

9. FIGO STAGING & 5 YEAR SURVIVAL RATE

10. CHEMOTHERAPEUTIC MANAGEMENT

11. CHEMOTHERAPY FOR OVARIAN CARCINOMA After initial surgical management almost all cases need adjuvant chemotherapy. Only patients who can be kept on follow-up by avoiding postoperative chemotherapy are the ones who had Stage 1A and 1B disease. Patients who were reported to have borderline ovarian malignancy’ on histopathology are also kept on follow-up only without giving any chemotherapy.

12. Currently most commonly used combination of drugs in the treatment of epithelial ovarian carcinoma is Paclitaxel +Carboplatin. These drugs are given intravenously every 3 weeks for 6 cycles. Paclitaxel: Dose 175mg/m^2, intravenously over 3 hours. Main side effect: Neurotoxicity. Carboplatin: Dose is calculated by area under curve(AUC) which is generally taken as 5-6 hours. Side effects: Nephrotoxicity ,bone marrow suppression. DRUGS USED FOR CHEMOTHERAPY

13. Newer Drugs For Treatment Of Epithelial Ovarian Carcinoma Topotecan 1.5 mg/m^2/day x 5 days Pegylated liposomal doxorubicin(PLD) 50 mg/m^2 orally x 28 days Gemcitabine 1000mg/m^2 on day 1,8 and 15. Nanoparticle albumin bound Paclitaxel(Nab Paclitaxel) Etoposide 50 mg/m^2 orally x 21 days Trabectedin 1300 mcg/m^2 over 3 hours every three weekly. Bevacizumab(Avastin):It is an anti-angiogenic ‘Human Monoclonal Antibody’ to VGEF(Vascular Growth Endothelial Factor).Drug is initially given weekly for 20-21 cycles, but can be extended up to 22 weeks.

14. Neo Adjuvant Chemotherapy (NACT) Neoadjuvant chemotherapy (NACT) is a treatment for advanced ovarian cancer – cancer at stage III or IV. It uses chemo drugs to shrink tumours before any surgery is done to remove them. NACT uses a reverse approach to the standard treatment of having primary debulking surgery (PDS) before chemo.

15. FOLLOW-UP OF EPITHELIAL OVARIAN CANCER Cases of epithelial ovarian cancers treated by surgery and chemotherapy are seen at regular intervals of 3 months for initial 2 years For the next three years follow up is done every 6 months Clinical examination and serum CA-125 every 3 months helps in detection of recurrences Imaging studies are done in case of any suspicion of recurrences.

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