Ovarian cancer surgery

Surgery is the primary treatment intervention for ovarian cancer. 

After initial surgery, the gold standard of care is six cycles of a taxane/platinum-containing regimen for patients with advanced ovarian cancer. 

Health care providers use a multimodality approach including surgery and chemotherapy in the initial treatment of ovarian cancer with a curative intent. Although most patients will achieve a complete response initially, more than 50% of cancers will recur within the first 2 years,2,35 Complete response to treatment is defined as no evidence of disease can be detected by physical examination or diagnostic tests, and patient has a normalized CA-125 value. 

Gold standard first-line chemotherapy after initial surgery for treatment of ovarian cancer. 

Ovarian cancer patients with progressed disease often present with ascites/ peritoneal fluid. In some women, ovarian cysts are detected containing cystic fluid. The concentrations of suPAR in these body fluids were compared with those in serum made from peripheral blood and blood aspirated from the surface veins on the tumor in 77 patients admitted for surgery of ovarian tumors [21]. In this study, elevated levels of suPAR were measured in serum from peripheral blood and tumor blood in the patients with more advanced disease. However, the concentrations of suPAR in the body fluids were quite different, in serum the measured concentrations were between 46 and 98 pmol/liter, in ascites/peritoneal fluid concentrations were between 293 and 586 pmol/liter, and in cystic fluids the concentrations were even higher, that is 651-8468 pmol/liter. The concentrations of suPAR in cystic fluids clearly separated benign and malignant cysts with predictive values above 90%. The levels of suPAR in cystic fluids could therefore be used in the early diagnosis of ovarian cancer patients. The suPAR in the cystic fluids was present both in intact and cleaved forms and at least some of the suPAR(I-III) was not occupied by uPA [21]. In another study, tumor tissue, serum, ascites, and urine from ovarian cancer patients were analyzed for their content of the different uPAR forms. Whereas all of tumor lysates, ascites, and urine contained uPAR(I-III) and uPAR(II-III), domain I was only present in urine samples. In serum, only intact suPAR was detected [82], The antibodies used for identification were mAb R3 (domain I) and mAb R2 (domain III). 

HPi ML is a 57-year-oid woman with advanced ovarian cancer. She has recently recovered from debulking surgery and presents to receive her first course of adjuvant chemotherapy with cartx>platln and paclitaxel. Past medical history is noncontributory and she has no known (hug allergies. She recenms an antiemetic (ondansetron) as premedkation. 

A second, independent study repeated the visual inspection analysis and compared the sensitivities and specificities obtained using visual inspection and a precursor of the SCS analysis on the same data set.43 Biopsy samples of postmenopausal ovaries, benign ovarian neoplasms and ovarian cancers ( 0.5 g) were obtained during surgery. The histological types of these samples were normal (19), benign tumour (3), borderline tumour (3), serous carcinoma (13), endometroid carcinoma (17), mixed epithelial carcinoma (3), and small cell carcinoma (4). Proton MRS measurements were performed at 37°C at 8.5 T.43... 

Once an asymptomatic, mutation-positive woman has been identified, she may wish to undergo prophylactic bilateral mastectomy, oophorectomy, or specialized surveillance and prevention strategies for the early detection of both breast and ovarian cancer. The risk of breast cancer can be significantly lower in women choosing prophylactic surgery than in those opting for increased surveillance. ... 

Unfortunately, most patients have disseminated disease at diagnosis because symptoms are nonspecific and may not be recognized until late in the disease course." Overall 5-year survival is slightly higher for white Americans (44%) as compared with African-Americans (38%). Survival for patients with localized disease is similar for white Americans and African-Americans (93%). Surgery is an integral part of ovarian cancer management. Chemotherapy,... 

Callahan MJ, Crum CP, Medeiros F, et al. Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction. J Clin Oncol. 2007 25 3985-3990. 

The chnical spectrum of activity for cyclophosphamide is very broad. It is a component of many effective drug combinations for non-Hodgkin s lymphomas, ovarian cancers, and solid tumors in children. Complete remissions and cures have been reported when cyclophosphamide was given as a single agent for Burkitt s lymphoma. It frequently is used in combination with methotrexate (or doxorubicin) and fluorouracil as adjuvant therapy after surgery for breast cancer. 

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.)... 

However, perhaps the key to this problem would be careful selection of the cancer to be treated. In many cancers, the first line of treatment includes surgery to try to eliminate the initial source of neoplasia. In many patients, however, the cancer is not eliminated and later returns and metastasizes. In some cancers, this process is relatively predictable. That is the case for ovarian cancer, for example. For this reason, this may be a good candidate for initial clinical trials. Another reason it is a good candidate is because CXCR4 is the only chemokine receptor expressed in ovarian cancer [28]. 

Understaging of ovarian cancer remains a common problem (20%-40%) in clinical routine. It occurs frequently, when the initial surgery had been performed under the presumption of a benign process, due to laparoscopy technique, and lack of oncologic specialist expertise [4]. 

Fig. 10.14a,b. Stage IV ovarian cancer. CT in the pelvis (a) and lower thorax (b).At the time of diagnosis, the patient presented with bilateral ovarian tumors encasing the uterus (a). Furthermore, left cardiophrenic lymph node enlargement and a pleural mass (arrow) were found (b). Biopsy of the latter confirmed metastases from ovarian adenocarcinoma. No evidence of ascites or peritoneal dissemination was found at imaging and surgery... 

---