Ovarian Cancer Treatment

Fatal variant with high proliferative activity. Includes high grade variants of serous, endometrioid, carcinosarcoma, undifferentiated carcinoma. Arise from STIC (serous tubal intraepithelial cancer).

RISK FACTORS

1. Age: postmenopausal
2. nulliparous
3. Family history: strongest risk factor
4. Late menopause, early menarche
5. Protective factors: multiparity, OCP use, tubal ligation, hysterectomy, BSO, lactation

PATHOLOGY

Three main types:
1. Epithelial (95%): serous, mucinous, endometrioid, clear cell, transitional cell, undifferentiated
2. Germ cell(3-4%): dysgerminoma, yolk sac tumour, teratoma, embryonal, choriocarcinoma, mixed
3. Stromal cell (1%): granulosa cell, sertoli-leydig cell tumour

DIAGNOSIS

  1. History & physical examination: history of nonspecific gastrointestinal complaints like nausea, dyspepsia, altered bowel habits, abdominal distension due to ascites.
  2. Tumour markers: CA125 ( may be elevated in non malignant conditions, less frequently elevated in mucinous, clear cell and borderline tumours), LDH (dysgerminoma), HCG(choriocarcinoma), AFP( yolk sac tumour)
  3. Imaging: CT/MRI/PETCT (metastatic work up)

TREATMENT

  • SURGERY: Mainstay of treatment. Aim is complete cytoreduction with hysterectomy, removal of tubes and ovaries, lymph node evaluation, omentectomy, peritoneal stripping. May include intestinal resection, stoma formation, splenectomy, urinary diversion.
  • CHEMOTHERAPY: Platinum based, most commonly combination of carboplatin & paclitaxel (three weekly). For germ cell tumours- BEP (bleomycin, etoposide, cisplatin).
  • RADIATION THERAPY: For oligometastatic recurrent disease.



Category:Ovarian Cancer Treatment

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