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Ovarian Cancer 101 PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Ovarian Cancer 101” by Christopher Morse, MD.

This medical PowerPoint presentation is about ovarian cancer, a type of cancer that begins in the ovaries, the female reproductive organs that produce eggs. It is the fifth most common cause of cancer-related deaths in women, and it typically affects women over the age of 50. Ovarian cancer can be difficult to detect early because the symptoms are often vague and can be attributed to other conditions.

There are several types of ovarian cancer, but the most common type is epithelial ovarian cancer, which develops from the cells that line the surface of the ovary. Other types of ovarian cancer include germ cell tumors and stromal tumors, which are less common.

Tags : Ovarian Cancer, ovaries, female reproductive organs, epithelial ovarian cancer, Gynecologic Oncology, Gynecologic Oncology PowerPoint presentation

Published on : May 29, 2023 | Views : 2661 | Downloads : 2

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Slide 1-

Ovarian Cancer 101: Breakout session for recently diagnosed ovarian cancer patients Christopher Morse, MD Fellow, Gynecologic oncology UW MEDICINE CONFIDENTIAL – DO NOT DISTRIBUTE
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Overview Introduction to ovarian cancer Diagnosis and treatment Surgery and chemotherapy Surveillance Genetic testing Quality of life and managing effects of treatment Open Q&A CONFIDENTIAL – DO NOT DISTRIBUTE
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Ovarian Cancer - Introduction In 2019 there will be an estimated 22,530 new cases of ovarian cancer diagnosed. Ovary, fallopian tube, primary peritoneal Second most common GYN cancer (uterine more common) Most common cause of GYN cancer related death and ovarian cancer is the 5th leading cause of cancer related death among females CONFIDENTIAL – DO NOT DISTRIBUTE American Cancer Society 2019
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Ovarian cancer - Survivorship While many patients (75%) be diagnosed with an advanced stage (III or IV), after surgery and chemotherapy most (80%) will enter remission. In 2016, there were an estimated 230,000 ovarian cancer survivors living in the US Patients with ovarian cancer are unique: Undergo major abdominal surgery Chemotherapy Maintenace therapy Many unique issues that ovarian cancer survivors face that impact QOL CONFIDENTIAL – DO NOT DISTRIBUTE
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Ovarian cancer - Risk factors The lifetime risk of developing ovarian cancer is 1.3% 1:80 women will be diagnosed with ovarian cancer The average age of diagnosis is 63, younger in women with hereditary cancers Risk factors: Age, family history, PCOS, infertility, PID, endometriosis, cigarette smoking, environment and location Protective factors: Prior pregnancy, history of breastfeeding, OCP use, tubal ligation CONFIDENTIAL – DO NOT DISTRIBUTE
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Ovarian Cancer – diagnosis Presenting symptoms are common and can be overlooked Women with ovarian cancer experience frequent symptoms – 20 to 30x month Bloating (7.4x) Increased abdominal size (3.6x) Urinary symptoms (2.5x) Ultrasound and/or CT scan Pelvic mass Ascites Blood work CA-125, HE4 CONFIDENTIAL – DO NOT DISTRIBUTE Goff 2004
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Ovarian Cancer – subtypes The majority (95%) of ovarian cancers originate from the surface epithelium of the ovary or from the fallopian tube Serous histology ~75% Other types are less common Sex cord stromal tumors Germ cell tumors Rare subtypes CONFIDENTIAL – DO NOT DISTRIBUTE Image from UpToDate 2019.
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Ovarian Cancer – FIGO staging CONFIDENTIAL – DO NOT DISTRIBUTE
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Ovarian Cancer – initial treatment Evaluation by a Gynecologic Oncologist Approach 1: surgery -> chemotherapy Traditional approach to ovarian cancer treatment For patients who are surgical candidates with resectable disease Approach 2: neoadjuvant chemotherapy -> surgery -> chemotherapy For patients that are not surgical candidates (medical comorbidities) For patients with disease distribution that is not resectable Surgery: removal of uterus, cervix, fallopian tubes, ovaries, staging, debulking Several large randomized trials have compared these approaches and demonstrated that neoadjuvant chemotherapy is not worse than doing surgery first CONFIDENTIAL – DO NOT DISTRIBUTE Vergote 2010; Kehoe 2015
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Ovarian Cancer – chemotherapy Chemotherapy – every 21 days for six cycles Carboplatin – inhibits DNA synthesis Side effects: low counts (esp platelets), cleared by kidneys Paclitaxel – derived from the bark of the Pacific yew tree, prevents cancers cells from dividing Side effects: low counts (esp WBC), neuropathy, hair loss, cleared by liver Both: nausea/vomiting, fatigue Alternative delivery/dosing strategies Dose-dense paclitaxel Weekly low-dose carbo/paclitaxel Intraperitoneal chemotherapy CONFIDENTIAL – DO NOT DISTRIBUTE Pacific Yew Tree
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Surveillance and monitoring - overview Following aggressive surgery and chemotherapy most patients (80%) will enter remission. Recommended to have close follow up with Gynecologic Oncologist. CONFIDENTIAL – DO NOT DISTRIBUTE SGO Post-treatment surveillance guidelines 2017.
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Surveillance and monitoring – tumor markers CA-125 – a protein in the blood that is commonly elevated in ovarian cancer Most commonly followed tumor marker Approximately 1 of 4 patients will have normal CA-125 at diagnosis Non-specific – many things can elevate HE4 – an alternative biomarker, may be elevated in patients with normal CA-125 May be elevated in endometrioid subtype CONFIDENTIAL – DO NOT DISTRIBUTE Structure of CA-125
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Surveillance and monitoring – tumor markers Do you have to follow CA-125? 529 women with ovarian cancer randomized to exam and CA-125 every 3 months Patients and investigators blinded to CA-125 results Once CA-125 >2x upper limit of normal: Early treatment – chemotherapy started with CA-125 elevation Delayed treatment - chemotherapy started with symptoms There was no difference in overall survival between the two groups 2nd line chemotherapy was started on average 5 months earlier in early treatment arm To follow (or not) is an individual decision to make with your Gynecologic Oncologist. CONFIDENTIAL – DO NOT DISTRIBUTE Rustin 2011, EORTC 55955
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Surveillance and monitoring – imaging Do I need a CT scan on a regular basis? There is no role for routine imaging in ovarian cancer surveillance Most providers do not routinely perform imaging studies in asymptomatic ovarian cancer patients in surveillance However, with onset of new symptoms or elevated tumor markers CT or PET CT is recommended CONFIDENTIAL – DO NOT DISTRIBUTE CT scan of a patient with ovary cancer
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Genetic testing All patients diagnosed with ovarian cancer should undergo genetic testing for hereditary breast and ovarian cancer (HBOC) genes 15-20% of patients will have a mutation germline (in all the cells) somatic (in the tumor) It is important to undergo testing for many reasons: Counseling and genetic testing of other family members Maintenance strategies after primary chemotherapy (PARP inhibitors) Clinical trial eligibility Future treatment options Don’t wait, ask your provider for a referral to a genetic counselor CONFIDENTIAL – DO NOT DISTRIBUTE
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Quality of life – during and after treatment How does treatment affect my quality of life (QOL)? Patients on two GOG protocols (#152 and 172) completed QOL surveys during and after treatment. Functional Assessment of Cancer Therapy – Ovarian (FACT-O) Physical, functional, social, emotional well being Scores lower in physical, functional and emotional well being Higher scores in social well being May be reflective of increased social support during/after diagnosis and treatment Baseline physical well-being may be associated with improved overall survival CONFIDENTIAL – DO NOT DISTRIBUTE Wenzel 2005, von Gruenigen 2010, von Gruenigen 2012
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Managing the effects of treatment Neurologic and cognitive Fatigue and energy Gastrointestinal toxicity Loss of fertility and sexual dysfunction Menopause and hormone therapy Psychiatric/psychosocial issues Living a healthy life style CONFIDENTIAL – DO NOT DISTRIBUTE
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Neurologic and cognitive effects Chemotherapy-induced peripheral neuropathy (CIPN) can affect to 50% of patients Numbness/tingling, sensitive to touch, burning, decreased hot/cold sensation During treatment Modify dosing and chemotherapy agent Gabapentin – decrease in patient reported CIPN Cold mitts and socks – limited data but intriguing Other – multivitamins, glutamic acid, glutathione More limited and mixed outcomes After treatment Physical therapy Gabapentin, duloxetine, glutamine Acupuncture CONFIDENTIAL – DO NOT DISTRIBUTE
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Neurologic and cognitive effects Cognitive changes GOG prospectively studied 231 women with ovarian cancer undergoing primary treatment, assessed cognitive impairment After 4th cycle chemo – 25.2% After 6th cycle chemo – 21.1% 6 month follow up – 17.8% A subset of patients had evidence of cognitive decline during chemotherapy but was limited to no more than one domain Hard to separate the effects of treatment from the underlying effects of the disease itself CONFIDENTIAL – DO NOT DISTRIBUTE Hess 2015
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Fatigue Some fatigue is almost universal during treatment Fatigue may persist for 6-12 months after chemotherapy Among survivors of ovarian cancer, 22% experience chronic fatigue. Fatigue can have a negative impact of emotional functioning and QOL Small studies support a benefit of physical activity behavioral interventions to combat fatigue CONFIDENTIAL – DO NOT DISTRIBUTE Liavaag 2007, Donnelly 2011
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Gastrointestinal effects Many women had gastrointestinal (GI) symptoms at time of diagnosis Persistent worry that new GI symptoms related to recurrence GI symptoms may be a result of complications from surgery (adhesions), related to disease recurrence, or from unrelated medical conditions (IBS) Should always be reported to treatment team and investigated Pain and abdominal symptoms associated with lower QOL, emotional status, and more fear of recurrence in ovarian cancer survivors CONFIDENTIAL – DO NOT DISTRIBUTE Mirabeau-Beale 2009
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Gynecologic effects Fertility – 15% of ovarian cancer pts will be <40 yo at diagnosis. Fertility loss is an important part of counseling at diagnosis and should be addressed with referral to fertility specialist as soon as possible. Sexual dysfunction - 60% of ovarian cancer survivors report that cancer has affected their sexual life in a negative way Decrease interest in sex and decreased sexual activity Treatment: vulvovaginal atrophy, addressing dyspareunia, loss of libido, partner and relationship factors - sexual health programs for cancer survivors Session 4, Saturday afternoon breakout session Sexual Health after Cancer (Saketh Guntupalli, Colorado) CONFIDENTIAL – DO NOT DISTRIBUTE
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Gynecologic effects Menopause Average age of ovarian cancer diagnosis – early 60s. Many patients are postmenopausal will not experience significant side effects Symptoms: hot flushes, mood changes, sleep disturbances, vaginal atrophy Hormone replacement therapy (HRT) Vulvovaginal atrophy – topical estrogen, low systemic absorption May consider systemic treatment with estrogen in select women No conclusive data that HRT negatively affects survival or recurrence CONFIDENTIAL – DO NOT DISTRIBUTE
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Psychiatric effects Depression Up to 15% of ovarian cancer survivors meet criteria for depression Symptoms of depression are associated with sleep disorders Anxiety - may have an even greater impact on QOL than depression Fear of recurrence – affects more than half of survivors Preoccupation with CA-125 value - anxiety about CA-125 is common Guilt and cancer-related distress Delay in diagnosis, familial guilt (HBOC), survivors' guilt CONFIDENTIAL – DO NOT DISTRIBUTE
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Living a healthy lifestyle Living healthy Obesity is a risk factor for cancer (breast, endometrial, colon) American Cancer Society Recommendations Maintain a healthy weight, attempt weight loss if overweight/obese Engage in 30 minute of moderate activity 5x weekly Consume a healthy diet with 5 or more servings of fruits or vegetables daily Limit alcohol intake No more than 1 drink/day for women, 2/day for men Clinical trial opportunity Currently enrolling patients in a study of Moderate Exercise in Ovarian Cancer Survivors (University of Washington, PI: Pennington) CONFIDENTIAL – DO NOT DISTRIBUTE
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Patient Resources SGO.org Survivorship toolkit for gynecologic cancers OCRAhope.org Patient resources: general information, support groups, financial assistance, end of life, advocacy American Cancer Society Nat'l Cancer Survivorship Resource Center Survivorship support groups through your local cancer center CONFIDENTIAL – DO NOT DISTRIBUTE
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CONFIDENTIAL – DO NOT DISTRIBUTE
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Questions What side effects from treatment (surgery or chemotherapy) did you find most difficult? What did you find most effective to treat or cope with these side effects? When during your treatment did you discuss the role of genetic testing? How has ovarian cancer affected your well-being? Physical, functional, emotional, and social CONFIDENTIAL – DO NOT DISTRIBUTE
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Thank you! CONFIDENTIAL – DO NOT DISTRIBUTE