Management of Ovarian Epithelial Cancer, a Review of Chemotherapeutic and Surgical Treatment of Ovarian Epithelial Cancer and the Current Approach to Recurrent Ovarian Epithelial Cancer in Clinical Practice with Emphasis on the Role of Secondary Cytoreductive Surgery
Absztrakt
Ovarian cancer is one of the leading causes of death from gynecological malignancy. This thesis aims to look at the current treatment and management of ovarian epithelial cancer in clinical practice.The prognosis for women suffering from ovarian epithelial cancer remains poor and some 80 % will experience relapsed disease. This thesis will therefore look at the approach to recurrent ovarian cancer in regards to detection, diagnosis and chemotherapeutic and surgical treatment. Secondary cytoreductive surgery for the treatment of recurrent ovarian cancer remains a highly debated subject and with a review of literature on this topic this thesis aims to clarify which patients can possibly benefit from a secondary cytoreductive surgery. The literature review will demonstrate that only a small subgroup of patients suffering from relapsed disease and undergoing secondary cytoreductive surgery can expect increased post-recurrence survival time and that the indications for a secondary cytoreductive surgery largely depends on a prolonged disease free interval preceding relapse and that patients where optimal or complete surgical cytoreduction is possible and localized residuum is present without widespread disease with great impairment of the general condition, carcinomatosis or severe involvement outside the pelvis and abdominal cavities are more likely to benefit from a second debulking.Patient selection for secondary cytoreductive surgery largely depend on precise history taking including exact length of disease free interval, the probable platinum-sensitive status of recurrent disease, CA-125 levels at time of recurrence at the anatomical localization and residuum size.This thesis will show that positron-emission tomography imaging has showed to be a great tool in detecting recurrent ovarian cancer when otherwise traditional computer tomography has failed to reveal relapsed disease.