EPITHELIAL CANCER
Treatment
Treatment of ovarian cancer usually involves several types of therapy. Surgical therapy is the initial form of intervention, but it is curative in only a small percentage of cases. Usually, adjunctive chemotherapy, radiation therapy, or both are necessary. Surgical reassessment after adjunctive therapy
is necessary for most patients with advanced disease. In a large percentage of patients, some type of salvage therapy is important. Table 10 outlines current therapies and therapeutic options for epithelial ovarian cancer.
• TABLE 8. Gynecologic and Nongynecologic
Cancers That May Have Serum Elevations of CA 125
Gynecologic Cancers Nongynecologic Cancers
Epithelial ovarian cancer Pancreatic cancer
Some germ cell tumors Lung cancer
Some stromal tumors Breast cancer
Fallopian tube cancer Colon cancer
Endocervical cancer
• TABLE 9. Gynecologic and Nongynecologic Benign Conditions That May Have Serum Elevations of CA 125
Gynecologic Conditions Nongynecologic Conditions
Endometriosis Pancreatitis
Adenomyosis Cirrhosis
Leiomyomata uteri Passive liver congestion
Ectopic pregnancy Peritonitis
Normal pregnancy Peritoneal tuberculosis
Pelvic inflammatory disease Peritoneal sarcoidosis
Menses Recent laparotomy
TABLE 10. Optional Therapy for Epithelial Ovarian Cancer*
Category of Ovarian Cancer Recommended (Standard) Therapy
Early ovarian cancer
Low risk (stages IA & B, grade 1) TAH, BSO, full surgical staging
High risk (stages IA & B, grades 2 & 3, TAH, BSOt, full surgical staging
stages IC, IIA, B & C, no residual} Adjunctive therapy with combination platinum-based chemotherapy
Second look: Not recommended
Alternative: Whole abdominal radiation therapy
Investigational: Paclitaxel in combination with a platinum compound
Advanced ovarian cancer
Optimal§ Maximal surgical cytoreduction
Combination chemotherapy with a platinum compound and paclitaxel
Second look: Recommended
Alternative: Whole abdominal radiation therapy for patients with no gross residual
Investigational: High-dose chemotherapy with stem cell rescue
Suboptimal Maximal surgical cytoreduction
Combination chemotherapy with cisplatin and paclitaxel
Second look: Recommended
Alternative: None
Investigational: High-dose chemotherapy with stem cell rescue
Recurrent or persistent ovarian cancer Investigational therapy or topotecan, ifosfamide, or hexamethylmelamine
Canadian pharmacy xanax
*TAH indicates total abdominal hysterectomy; BSO, bilateral salpingo-oophorectomy. Some investigators include grade 2 in the low-risk category. t Unilateral salpingo-oophorectomy permissible in patients who desire further childbearing. §Optimal (stage III, <1 cm residual).
I I Suboptimal (stage III, >1 cm residual, or stage IV).