gopalan031607

Ovarian Cancer Priya Gopalan 3/16/07

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk factors ,[object Object],[object Object],[object Object],[object Object]

Genetics of ovarian cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Genetics ,[object Object],[object Object],[object Object],[object Object]

Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]

Physical Exam ,[object Object],[object Object]

Work-up of Ovarian Mass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tumor Markers ,[object Object],[object Object],[object Object],[object Object],[object Object]

Tumor Markers ,[object Object],[object Object],[object Object],[object Object],[object Object],*Dupont JCO 2004

Screening ,[object Object],[object Object],[object Object],[object Object],* NIH consensus conf. JAMA 1995 ** Jacobs et al., Lancet 1999

Screening/prevention in high-risk patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathology From Up-to-date 3 main histological types Pap. (90%)

Psammoma Body From: Indiana University Dept. of Pathology and Laboratory Medicine (erl.pathology.iupui.edu)

Staging for Epithelial Ovarian Cancer From: Cannistra S. N Engl J Med 2004;351:2519-2529 I - Ovaries II - Pelvic viscera III - Peritoneal implants, liver serosa, small bowel, omentum IV - Distant mets (liver parenchyma)

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical debulking of advanced disease ,[object Object],[object Object],[object Object],[object Object],Bristow RE et al. JCO 2002, 20:1248-59.

Bristow, R. E. et al. J Clin Oncol 2002; 20:1248-1259.

Favorable Prognostic Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Adjuvant chemotherapy ,[object Object],[object Object],[object Object],[object Object],*Ozols et al. JCO 2003, 21:3194-3200. **Vasey et al. JNCI 2004, 96:1682-91.

Adjuvant Chemotherapy ,[object Object],[object Object],*Ozols et al. JCO 2003, 21:3194-3200. **Vasey et al. JNCI 2004, 96:1682-91.

Alternative Adjuvant Chemo ,[object Object],[object Object],[object Object],[object Object]

Current controversies in chemo ,[object Object],[object Object],[object Object]

Intraperitoneal chemotherapy ,[object Object]

Phase III trials of intraperitoneal cisplatin/paclitaxel Alberts et al, NEJM 1996 Markman et al, JCO 2001 Armstrong et al, NEJM 2006 IV taxol + IP cis, IP taxol on d8 IV carbo x 2, IV taxol + IP cis IV cytoxan + IP cis Chemo-study 42% got 6 IP (41% ≤ 2 IP) IV:50 mo IP:66 mo (p=0.03) IV:18 mo IP:24 mo (p=0.05) IV taxol + IV cis Armstrong 18% ≤ 2 IP IV:52 mo IP:63 mo (p=0.05) IV:22 mo IP:28 mo (p=0.01) IV taxol + IV cis Markman 18% ≤ 2 IP IV:41 mo IP:49 mo (p=0.02) --- IV cytoxan + IV cis Alberts %receiving IP OS PFS Chemo-control Trial

Intraperitoneal chemo ,[object Object],[object Object],[object Object],[object Object],[object Object]

Chemo in “high-risk” early stage patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ICON1. JNCI, 2003, 95:125-32. Trimbos et al. JNCI, 2003, 95:113-124.

Copyright restrictions may apply. Trimbos, J. B. et al. J. Natl. Cancer Inst. 2003 95:113-125. Copyright restrictions may apply. OS, optim. debulked OS, suboptim. debulked RFS, optim. debulked RFS, suboptim. debulked * *

Maintenance Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Markman et al. JCO 2003, 21:2460-65.

Role of radiation ,[object Object],[object Object],[object Object],[object Object]

Stage I ,[object Object],[object Object],[object Object],[object Object]

Stage II ,[object Object],[object Object],[object Object],[object Object]

Stages III, IV ,[object Object],[object Object]

Routine Monitoring ,[object Object],[object Object],[object Object]

Recurrent/persistent disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of asymptomatic recurrence ,[object Object],[object Object],[object Object]

2nd Line Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

2nd line Chemotherapy (cont’d) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Biological agents ,[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of non-epithelial cancers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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