Case Report: Ovarian Cancer

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
↓
???

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/m²)
• 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