Clinical Management of Ovarian Cancer [Hardcover]

Jonathan A. Ledermann (Editor), William J. Hoskins (Editor), Stanley B. Kaye (Editor), Ignace B. Vergote (Editor)

Book Description

ISBN-10: 1853177040 | ISBN-13: 978-1853177040 | Publication Date: January 15, 2001 | Edition: 1

Ovarian cancer is the fourth most common cause of cancer-related death in women, and like many other malignancies, its manifestations are diverse, often requiring complex management decisions to be made. This text examines a range of clinical presentations of ovarian cancer through the use of clinical cases. Each chapter explores one key aspect of the management, integrating recently published data to provide a complete review of the optimum treatment approach. Using clinical cases from their own practice, an international team of experts provided a useful overview of ovarian cancer for oncologists, gynaecologists, and other healthcare professionals.

Editorial Reviews

From The New England Journal of Medicine

Epithelial ovarian cancer, the second most common cancer of the female genital tract, accounts for 5 percent of cancers in women. In the United States this year, 23,400 new cases will be diagnosed, and 13,900 women afflicted with the disease will die. The five-year survival rate is 50 percent overall, 95 percent in patients with localized disease, 79 percent in those with regional disease, and 28 percent in those with distant disease. Clinical Management of Ovarian Cancer synthesizes the extensive literature in order to outline systematically the evaluation and treatment of ovarian cancer. Topics are discussed in the context of believable case histories that engage readers as evidence-based strategies for treatment are described. Bulleted key points reinforce learning.

The book begins with a description of the appropriate preoperative assessment of a woman with a pelvic mass. In postmenopausal women, the combination of an elevated serum CA-125 level (higher than 35 U per milliliter) and suspicious findings on ultrasonography is highly predictive of ovarian cancer, but the same findings often indicate benign conditions in younger women. Specialized studies (computed tomographic scanning, barium enema, and colonoscopy) should be performed only when they are indicated. When ovarian cancer is considered likely, consultation with a specialist who is knowledgeable about current methods of operative management is advised.

The importance of appropriate operative management is stressed repeatedly. Complete surgical staging includes, at a minimum, cytologic studies, peritoneal and subdiaphragmatic biopsies, and regional lymphadenectomy, since microscopic metastases are found in 20 percent of patients with disease that appears to be stage I. When low-grade lesions are found, chemotherapy is unnecessary for patients with stage I disease, and the survival rate is excellent, provided that surgical staging is complete; the preservation of reproductive function is feasible, with close follow-up and definitive surgery after childbearing is completed. As compared with laparotomy, laparoscopy leads to a higher rate of ovarian rupture and has been associated with more recurrences at the site of the trocar insertion; laparoscopy is still considered experimental.

For patients with metastatic disease, the two factors most likely to influence survival are the extent of cytoreduction and chemosensitivity. Whenever feasible, all visible tumor should be removed, since the likelihood of survival is improved when any residual tumor is smaller than 1 cm. Although the authors make a compelling argument for aggressive cytoreduction, less aggressive surgery is appropriate if gross disease will remain despite radical surgery and if there are substantial coexisting conditions. After two or three cycles of chemotherapy, interval cytoreduction is a viable alternative and apparently leads to survival rates similar to those achieved with aggressive initial resection of the tumor, although this must be confirmed by prospective clinical trials. Six cycles of a taxane combined with platin-based therapy is now standard. Because of its improved therapeutic index, carboplatin will probably replace cisplatin. Large, randomized clinical trials will be needed to determine the role, if any, of newer agents (gemcitabine, liposome-encapsulated doxorubicin, and topotecan) in front-line therapy.

In women with recurrent ovarian cancer, the appropriate therapy must be determined on the basis of the response to chemotherapy and the duration of disease-free interval. Chemoresistance is defined as the progression of disease during treatment or within six months after treatment, whereas a disease-free interval of more than six months characterizes chemosensitivity. In patients with chemosensitive disease, platin-based therapy is the treatment of choice. The overall response and the duration of response are strongly influenced by the disease-free interval. Patients with an isolated recurrence may benefit from surgical resection. Because chemoresistance is associated with a dismal prognosis, investigational therapy is encouraged in such cases.

An increase in the CA-125 level after an initial normalization accurately predicts recurrence in more than 90 percent of cases, but it is unknown whether the decision to begin therapy should be made on the basis of increases in CA-125 levels, the presence of measurable disease, or the development of symptoms. Since recurrent ovarian cancer is incurable, therapy that controls the symptoms while causing the fewest possible adverse effects is reasonable. There is no evidence that combination therapy is superior to single-agent therapy. The authors address many social and psychological ramifications of ovarian cancer and outline effective strategies for managing various manifestations of terminal disease, including gastrointestinal symptoms, ascites, and pain. The importance of open and caring communication with the patient and her family, advance directives, and addressing the needs of the bereaved, particularly young children, is emphasized.

Hereditary ovarian cancer, which accounts for approximately 10 percent of cases, is characterized by autosomal dominant transmission with varying degrees of penetrance. Most hereditary ovarian and breast cancers are caused by mutations in the BRCA1 and BRCA2 genes, on chromosomes 17q and 13q, respectively. The remainder develop in members of families with hereditary nonpolyposis colon cancer and result from mutations in mismatch-repair genes. ``Founder mutations,'' or mutations linked to a common ancestor, have been detected among Ashkenazi Jewish women and include two BRCA1 mutations, 185delAG and 5382insC, and a BRCA2 mutation, 6174delT. The authors address genetic testing, prophylactic oophorectomy, and chemoprevention with oral contraceptives.

There are chapters devoted to rare tumors -- germ-cell tumors, granulosa-cell tumors, mucinous tumors mimicking primary gastrointestinal tract tumors, fallopian-tube tumors, and borderline tumors. In the United States, the BEP regimen of chemotherapy (bleomycin, etoposide, and cisplatin) is recommended for all malignant ovarian germ-cell tumors except stage IA dysgerminomas and stage IA grade I or II immature teratomas. For stage IA lesions, however, the authors made a convincing argument for observation; most recurrences can be treated with chemotherapy, and therapeutic regimens containing cisplatin or etoposide are toxic, adversely affect ovarian function, and can cause lethal secondary cancers. Other than occasional typographic errors, little in this book warrants rectification, except the introductory statement -- ``epithelial ovarian cancer is the commonest tumor within the genital tract'' -- and the P values in Table 3.6, which do not correspond to the data given. Overall, the style and design of this amazingly comprehensive book make for enjoyable reading, and the book should serve as an invaluable resource to health care providers caring for women with ovarian cancer.

Harriet Smith, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

'The style and design of this amazingly comprehensive book make for enjoyable reading ... an invaluable source.' - New England Journal of Medicine

'Undoubtedly this book is very useful for eveyone who works in this field.' - European Journal of Gynaecological Oncology

Product Details

• Hardcover: 298 pages
• Publisher: Informa Healthcare; 1 edition (January 15, 2001)
• Language: English
• ISBN-10: 1853177040
• ISBN-13: 978-1853177040
• Product Dimensions: 9.6 x 7.7 x 1 inches
• Shipping Weight: 2.2 pounds
• Amazon Best Sellers Rank: #4,307,560 in Books (See Top 100 in Books)