Ovarian cancer staging

Current recommended treatment of advanced ovarian cancer (stage III or IV) is based on initial surgical debulking followed by paclitaxel plus carboplatin for six cycles. 

Joyce, a psychologist. Ovarian cancer, stage 3, diagnosed in 2004 at age fifty-eight. (Treatment surgery, hysterectomy, splenectomy, and colon resection. Chemo carboplatin, paclitaxel, cisplatin, gemcitabine, topotecan, doxorubicin.)... 

Forstner R, Hricak H, Occhipinti K et al (1995) Ovarian cancer staging with CT and MRI. Radiology 197 619-626... 

Pelvic examinations are effective in detecting obvious tumors with a sensitivity of 67% for detecting all tumors minimal or microscopic disease cannot be detected on physical examination.9 Pelvic examinations are non-invasive and well accepted, but they do not usually detect ovarian cancer until it is in an advanced stage. Therefore, routine pelvic examinations will not improve earlier diagnosis or help to decrease overall mortality.9... 

Ovarian cancer often has been denoted as the "silent killer" because of the non-specific signs and symptoms. By the time symptoms become unrelenting and bothersome, patients have advanced stage disease. 

Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer a gynecologic oncology group study. J Clin Oncol 2003 21 3194-3200. 

Detection/staging/follow up of colorectal and ovarian cancers... 

McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY et al. Cyclophosphamide and cis-platin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl JMed 1996 334 1-6. 

Avril et al. [99] evaluated sequential [ F]-FDG-PET to predict patient outcome after the first and the third cycle of neoadjuvant chemotherapy in 33 patients with advanced-stage ovarian cancer. A significant correlation was observed between [ F]-FDG-PET metabolic response after the first (p = 0.008) and the third (p = 0.005) cycle of chemotherapy and overall survival. After the first cycle, a threshold of 20% SUV decrease for differentiation of metabolic responders and nonresponders revealed the following median overall survival 38.3 months for metabolic responders compared to 23.1 months for metabolic nonresponders. 

N. Avril, S. Sassen, B. Schmalfeldt, J. Naehrig, S. Rutke, W.A. Weber, M. Werner, H. Graeff, M. Schwaiger, W. Kuhn, Prediction of response to neoadjuvant chemotherapy by sequential F-18-fluorodeoxyglucose positron emission tomography in patients with advanced-stage ovarian cancer, J. Clin. Oncol. 23(30) (2005) 7445-7453. 

Investigators found that human breast cancer cell lines with BRCAl mutations showed a twofold to fourfold increase in apoptosis after treatment with ionizing radiation, cisplatin, or doxorubicin, compared with cells free of mutations. They also found that BRCAl tumor cell lines were resistant to other agents, such as paclitaxel (Taxol) and docetaxel (Taxotere), treatments used commonly in ovarian cancer and advanced-stage breast cancers. 

Like patients with breast carcinoma, those with ovarian cancer may benefit from treatment with Herceptin in combination with chemotherapeutic drugs. Herceptin treatment is effective, in both early and advanced stages of ovarian cancer (when the majority of tumor cells express HER-2 protein), for eliminating the potentially more malignant HER-2-positive tumor cells. The effectiveness of Herceptin is based on the affinity of this monoclonal antibody for the extracellular domain of HER-2, which is common as ovarian carcinomas progress. However, a tumor vaccine inducing antibody and/or T-cell immunity to HER-2 epitopes will ultimately provide the most effective means to prevent the emergence of HER-2-positive cells. 

Suzuki, M., Ohwada, M., Saga, Y., Kohno, T., Takei, Y., and Sato, I. 2001. Micrometastatic p53-pos-itive cells in the lymph nodes of early stage epithelial ovarian cancer Prognostic significance. Oncology 60 170-175. 

KLK7/hK7 mRNA from normal, benign, and cancerous ovarian tissues and late-stage serous ovarian cancer cell lines mRNA from cancerous ovarian tissue... 

Schink JC. Current initial therapy of stage III and IV ovarian cancer Challenges for managed care. Semin Oncol 1999 26 2-7. 

Compared to other solid tumors, ovarian cancer is relatively responsive to chemotherapy, but unlike testicular cancer, cure is not common for patients with advanced disease. Prior to the incorporation of cisplatin or carboplatin into treatment regimens, chemotherapy for advanced-stage ovarian cancer consisted of combinations of alkylating agents and doxorubicin. Response rates from such regimens were of the order of 33-65%, and fewer than 10% of patients survived 5 years [51]. 

Prior to the mid 1990 s, the standard treatment for advanced-stage ovarian cancer had become either cisplatin or carboplatin in combination with cyclophosphamide, although some clinicians still favored single-agent carboplatin. The basis lay in comparative studies of cisplatin- vs. carboplatin-... 

Begum FD, Hogdall CK, Kjaer SK, Christensen L, Blaakaer J, Bock JE, et al. The prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) levels in stage III ovarian cancer patients. Anticancer Res 2004 24(3b) 1981-1985. 

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