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Ovarian Cancer

Ovarian cancer is also not a rare disease. It is not as common, obviously, as breast or colon or lung cancer but it is a fairly high number of cases and to make matters worse, there is a very high case fatality rate. It is hard to diagnose ovarian cancer early so about two-thirds of cases of ovarian cancer that are ever diagnosed end up as a fatality. Only about 25% of the patients present with disease that is localized in the ovary, only so-called stage I disease. Most of these are patients who are found either because they have had a pelvic ultrasound or laparotomy for some other ovary cancer. There are usually no symptoms associated with localized ovarian cancer. We would like to have good screening for this disease but we really havenít been able to generate this as yet. This EA-125 antibody is a reasonable test but the sensitivity of this test is really too low to be a good screening technique. It was first developed at Duke.

Now the prognosis in ovarian cancer is related to the stage of the disease. Of course, the histology grade of the tumor and also to the residual bulk of tumor that is left after the initial operation. These three factors are very useful in separating patients out as to what to expect. The histologic grade I think is probably the greatest in determining what will happen. Patients with high grade malignancies, even on the low stage, have a very worrisome prognosis. Assuming the ability to resect down to no residual tumor mass left greater than one centimeter at the time the belly is closed is a favorable prognostic factor. It isnít necessarily favorable because you have eliminated so much tumor, it may be that someoneís ability to resect patients help us identify more biologically favorable lesion than a patient who has a less respectable tumor. We try to get these patients resected down to minimal disease if possible at the initial operation.

The major therapy for localized ovarian cancer, if you are lucky enough to find it, is a lateral salpingo-oophorectomy and transabdominal hysterectomy. For these patients who are truly stage I, about 80-85% of them will be cured. If the patients however have stage I disease that happened at the highest grade I think there is some data to justify the use of adjuvant chemotherapy for six months or so after surgery. For patients with more advanced ovarian cancer, which is the bulk of them, the management would be through resections to minimal residual disease as possible, and then some form of chemotherapy. At present a combination of cisplatin or carboplatin combined with Taxol is the present treatment of choice. The interesting thing about ovarian cancer is that even when it is advanced, when it has diffuse intraperitoneal spread - so-called stage III disease - about 15% and 20% will enter into continuous long term remission after this type of chemotherapy. So this is a bad disease in every way but it is, I think, notable among adult solid tumors for the proportion of patients who actually appear to be cured in the face of advanced malignancy cells it is worth, even for stage III disease, trying to get the patient into the hands of an optimal surgeon and follow it up with chemotherapy.