Ami Fishman, MD

Case report
 Ovarian cancer
 Ami Fishman, M.D.
 Meir Hospital - Sapir Med Center
 Kfar-Saba, Israel
10.2001

57y-o, G3P2, 
upper abdominal pain ⊕ discomfort - 3mo, abdominal girth increase ~ 1mo 
◊
???

57y-o, G3P2, 
upper abdominal pain + discomfort - 3mo, abdominal girth increase ~ 1mo 
↓
H

History
 • General 
 • Gynecologic - Reproductive
 • Familial

Physical exam
 • HR - 90/min RR - 20/min BP - 130/70
 • Lung - ↓ Rt. base
 • Abdonminal distension / Clinical ascites
 • Abdominal / Pelvic mass

work-up
↓
 Blood: 
 - CBC + SMA + Coag. profile
 - Tu markers 
 - Genetics / molecular

work-up
↓
 Imaging: 
 -Chest X-ray
 - Abdominal CT
 - U/S
 - GITr/GUTr
 - Mammography

Chemotherapy
 Neo-adjuvant chemotherapy
 - Taxol + Carboplatin
 - No. of cycles?
 - Interval debulking
 - Response parameters

Ovarian Ca - advanced disease Treatment
 Standard of care: 
 ↓ 
 Primary surgical cytoreduction followed by platinum-based chemotherapy
 Ami Fishman, M.D.

Surgery
 • Objective - advanced disease - early disease

Pre-op work-up
 - Routine blood + Cross & Type
- Prophylactic heparin
 - Anesthesia clearance
 - G.I.Tr. Prep
 • mechanical 
 • antibiotics

Surgery
 Debulking
- rational
 - definitions
- procedures

Ovarian Ca - advanced disease 
 Optimal Residual Disease
 better prognosis
 no residual tumor
 < 0.5 cm
 0.5-1.5 cm
 Ami Fishman, M.D.

Surgery
 • Objective - early disease
 • Staging  - rational 
 - procedures

Ovarian Ca - advanced disease Treatment
 ~ 40 - 60% 
 Rate of achieving optimal primary cytoreductive surgery
 Ami Fishman, M.D.

Adjuvant chemotherapy
 • Definitions
 • Protocol 
 • Combinations

Adjuvant chemotherapy
 • Taxol + Carboplatin 
 • Side effects
 - Systems
 - Limiting
 • Routine F/U

Adjuvant chemotherapy
 • Carboplatin (Calvert AUC= 6-7) 
 • Taxol (175 mg/m

)
 • x6 courses q3 weeks
 Ami Fishman M.D.

Adjuvant chemotherapy 
 Platinum + Taxol 
 • Response Rate (clinical) = 70-80%
 • end of RX - ???
 • Platinum sensitive 
 • Platinum resistant
 Ami Fishman M.D.

Chemotherapy
• Response definitions: 
 - Complete
- Partial 
 - Stable disease 
 - Progression

15 mo following last chemotherapy cycle
 Asymptomatic
 CA-125 = 10/2000 => 17 
 01/2001=> 67
◊
 ???

Elevated CA-125
 • Asymptomatic patient
 - Evaluate disease
 To treat or not to treat??

2nd line chemotherapy
• Chemo-sensitive
 • Chemo-resistant

2nd line chemotherapy
 • Re-induction
 • Others - old agents 
 - new agents
 • High dose
 • Intra-peritoneal
 • Research protocols

Research protocol
• Phase I/II/III
 • protocol end points

37 y-o
 7cm ovarian complex cyst
 ↓ 
 • Larparoscopy
↓ 
 Procedures:
 • peritoneal washing for cytology
 • Frozen section

Frozen section
 ==> LMPT
↓ 
 • ??? 
 Procedures:
 • USO
 • Surgical staging: 
 omentectomy + peritoneal biopsies
 + retrop. LN sampling

37  y-o, Laparosscopic USO 
 Final histology (after 10 days) ==>
 Ovarian Ca
↓
???
 Review/confirm histology
 Consider: 
 - grade
 - age & reproductive plan 
 - site /experience of surgeon at 1st procedure 
 - referral to Gyn-Onc

Articles

Physical exam 
• HR - 90/min RR - 20/min BP - 130/70 
• Lung - ↓ Rt. base 
• Abdonminal distension / Clinical ascites 
• Abdominal / Pelvic mass

Ami Fishman, MD

Articles

Case Report: Ovarian Cancer

Case Report: Ovarian Cancer