Ovarian Cancer, OC

Notes
  • The 2nd most important gynecological cancer with 90% of it being epithelial in nature.
  • Statistics: contribution of OC to all cancers affecting women globally – 6.3%; proportion of OC that is detected at advanced stage – 75 to 85%
Symptoms
  • OC is mostly asymptomatic and when symptoms are present, they are often non-specific (hence it is detected at advanced stage, making it very lethal)
  • Abdominal distension / ascites
  • Bloating
  • Constipation
  • Diffuse nodularity
  • Dyspareunia
  • Early satiety
  • Fatigue
  • Irregular vaginal bleeding
  • Low back pain
  • Mass or masses in the abdomen
  • Nausea
  • Vomiting
  • Pelvic pressure
  • Poor appetite
  • Severe abdominal pain
  • Urinary frequency
  • Weight loss
  • Hyperthyroidism
  • Feminization
  • Virilization
Diagnosis
  • Laparotomy, biopsy, histology and staging
  • Ultrasonography of pelvic and liver
  • Detection of elevated serum tumour marker CA-125 (most important), hCG, alpha-fetoprotein and carcinoembryonic antigen (CEA)
  • CT scan
  • MRI (for suspected advanced tumor)
  • PET
  • Chest X-ray
  • Ascitic tap for cytology, chemistry and microscopy in order to rule out Tuberculosis
  • Other routine tests that include: FBC, urea/electrolytes, AST, ALT, serum calcium and albumin
Differential
  • Pelvic Inflammatory Disease (PID)
  • Irritable Bowel Syndrome (IBS)
  • Metastases to the ovary
  • Fibroid
  • Endometriosis
  • Urinary Tract Obstruction
  • Ectopic Pregnancy
  • Diverticular disease
  • Ascites
  • Anovulation
  • Appendicitis
  • Meigs' syndrome
  • Cervicitis
  • Colon Cancer
  • Colonic Obstruction
  • Gastric Cancer
  • Ovarian Cysts
  • Pancreatic Cancer
  • Peritoneal Cancer
  • Uterine Cancer
Prevention
  • No proven way to completely prevent OC
  • Chances of OC are reduced by: tubal ligation, use of contraceptives, breast feeding and giving birth.
Management

##Surgery that may include;

  • Partial or complete removal of uterus (hysterectomy)
  • If the tumor is less than 1cm cytoreduction (removal of as many tumor cells as possible) is done.
  • Removal of ovaries and their fallopian tubes (bilateral salpingo-ophorectomy, BSO)
  • Removal of a thin fold of abdominal tissue (omentum) that encases the stomach, large intestine and other abdominal organs (omentectomy)

##Chemotherapy

  • Cyclophosphamide/doxorubicin combination is preferred in the low- resource settings
  • Cisplatin or carboplatin (or other platinum-based anti-cancers) and paclitaxel or docetaxel (other taxanes)
  • Cyclophosphamide and platinum-based anti-cancers

> Other anti-cancers  such as:

  • Topotecan
  • Bevacizumab
  • Gemcitabine
Drug Index 2.0 is here
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