Marius Beniet YouanBi, Pharm D,

Master of Clinical Pharmacy

University of Nairobi.

Female Genital tract malignancies

OUTLINES

1. VULVAR CANCER

3. CERVICAL CANCER

2. VAGINAL CANCER

4. WOMB CANCER

6. OVARIAN CANCER

5. FALLOPIAN CANCER

Human Female genital system

1. VULVAR CANCER

The vulva is

the external

genitalia of

the female

reproductive

tract

Vulva

Vulvar cancer

Vulvar cancer is a

cancer that

starts in the

external female

sex organs –

inner edges of

the labia majora

or labia minora

Vulvar cancer epidemiology

• 4th most common gynecologic cancer

(following uterus, ovary and cervix)

• Comprises 5% of gynecologic

malignancies

• Mean age at diagnosis is 65y, but is

decreasing

• Cigarette smoking

• Human Papilloma Virus (HPV)

infection

• Immunosuppression

• Chronic vulvar conditions such as

lichen sclerosus

• VIN/CIN

• Prior history of cervical cancer

Causes & Risk Factor

Pathogenesis

1. HPV infection (60%)

Two pathways of vulvar carcinogenesis:

2. Chronic inflammatory (vulvar

dystrophy) or autoimmune

processes

THE CLINICAL

MANIFESTATIONS

OF VULVAR

CANCER

Clinical Manifestations

• Most patients present with a single vulvar

plaque, ulcer or mass

• Labia major is the most common site

• Lesions are multifocal in 5% of cases A

synchronous second malignancy is found

in 22% of cases, usually CIN/cervical cancer

Clinical Manifestations

Clinical Manifestations

Clinical Manifestations

Clinical Manifestations

Clinical Manifestations

• Pruritus is the most common presenting

symptom (especially if associated with

vulvar dystrophy such as lichen

sclerosus)

• Vulvar bleeding or discharge

• Dysuria

• Enlarged groin lymph node

Diagnosis

• Biopsy of gross lesions

• If no gross lesion present but high

clinical suspicion, perform colposcopy

Types of Vulvar Cancer

• Squamous cell carcinoma SCCA (>90% of cases)

• Melanoma

• Sarcoma

• Basal cell carcinoma

• Verrucous carcinoma

• Adenocarcinoma (Bartholin gland)

Vulvar Cancer Staging (Surgical)Stage Description

IA Lesion <2 cm with <1 mm stromal invasion, no nodal

metastases

IB Lesion >2 cm with >1 mm stromal invasion, no nodal

metastases

II Lesion any size, extension to adjacent structures, no

nodal metastases

III Lesion of any size with involvement of the lower urethra,

vagina or anus OR groin lymph node metastases

IVA Tumor invading upper urethra, bladder mucosa, rectal

mucosa, pelvic bone

IVB Any distant metastases, including pelvic lymph nodes

Treatment of SCCA VulvarStage Treatment

IA Wide local excision (WLE)

IB WRE and inguinal-femoral lymphadenectomy

II WRE and inguinal-femoral lymphadenectomy

III WRE and inguinal-femoral lymphadenectomy

OR chemoradiation +/- surgery to resect

residual disease as needed

IVA chemoradiation +/- surgery to resect residual

disease as needed

IVB Chemotherapy

Treatment of SCCA Vulvar : Surgery

Wide Radical Excision (WRE):

• Excision of vulvar lesion down to the

fascia of the urogenital diaphragm

• 2 cm tumor-free margin

Inguinal-Femoral Lymphadenectomy:

• Removal of the superficial inguinal

and deep femoral lymph nodes

• Radiation in combination with chemotherapy

is an alternative to surgery in women with

stage III/IVA disease

• Indicated if positive inguinal/pelvic nodes

• Indicated if positive margins after WRE if

re-excision not possible or desirable (i.e.

around the clitoris or anal sphincter)

Treatment of SCCA Vulvar : Radiation therapy

Treatment of SCCA Vulvar : Chemotherapy

• Indicated for metastatic disease (stage

IVB)

• Platinum-based

• Treatment is palliative

Chemotherapy regimens SCCA Vulvar

First-Line Combination Therapy

REGIMEN DOSING

Paclitaxel (Taxol) + cisplatin

(Platinol; CDDP)

Day 1: Paclitaxel 135mg/m2 IV, admi over

24 hr plus

Day 2: Cisplatin 50mg/m2 IV at a rate of

1mg/min.

Repeat cycle every 3 weeks for 6

cycles.

Carboplatin (Paraplatin) +

paclitaxel

Day 1: Carboplatin AUC=5mg/mL/min

administered over 1 hr, followed

by paclitaxel 175mg/m2 administered

over 3 hrs.

Repeat cycle every 3 weeks for 6–9

cycles or until disease progression or

unacceptable toxicity

Chemotherapy regimens SCCA Vulvar

First-Line Combination Therapy cont’d

REGIMEN DOSING

Cisplatin + topotecan

(Hycamtin)

Days 1–3: Topotecan 0.75mg/m2 IV

administered over 30 min plus

Day 1: Cisplatin 50mg/m2 IV.

Repeat cycle every 3 weeks.

Cisplatin + gemcitabine

(Gemzar)

Days 1 and 8: Cisplatin

30mg/m2 + gemcitabine 800mg/m2.

Repeat cycle every 4 weeks.

Chemotherapy regimens SCCA Vulvar

First-Line Monotherapy

REGIMEN DOSING

Cisplatin (preferred as a

single agent)

Day 1: Cisplatin 50mg/m2.

Repeat cycle every 3 weeks

for a total of 6 cycles.

Chemotherapy regimens SCCA Vulvar

Second-Line Therapy

REGIMEN DOSING

Bevacizumab (Avastin)

Day 1: Bevacizumab 15mg/kg

IV.

Repeat cycle every 3 weeks.

Docetaxel (Taxotere)Day 1: Docetaxel 100mg/m2 IV,

administered over 1 hr.

Repeat cycle every 3 weeks

OTHERS TYPES OF

VULVAR CANCER

Melanoma of the Vulva

• 2nd most common type of vulvar cancer (5-6%)

• Occurs more frequently in white women

• Mean age at diagnosis is 68y

• Treatment is wide local excision with 2

cm margins and sentinel lymph node

biopsy

Melanoma of the Vulva

Basal Cell Carcinoma

• 2% of vulvar cancers

• Usually occur in white, postmenopausal women

• May be locally invasive but usually do not metastasize

• Slow-growing

• Treatment is wide local excision

Basal Cell Carcinoma

Paget Disease of the Vulva

• <1% of vulvar malignancies

• Most common presenting symptom is pruritus

• Lesion is usually well demarcated slightly raised edges and a red background

• Most patients are postmenopausal and Caucasian

• Treatment is wide local excision

Paget Disease of the Vulva

Summary – Vulvar Cancer

• Comprises 5% of gynecologic malignancies

• 2 pathways of vulvar carcinogenesis:

– HPV infection (60%)

– Chronic inflammatory (vulvar dystrophy)

• Most common histology is squamous cell carcinoma

• Treatment includes surgery, radiation and/or chemotherapy depending on stage

2. VAGINAL CANCER

Vagina

the muscular

passage that

leads from the

cervix to the

vulva

Vaginal cancer

• Vaginal cancer,

sometimes referred

to as primary

vaginal cancer.

• Cancer that starts in

the vagina.

Vaginal cancer

There are two main kinds of vaginal cancer:

primary

vaginal cancer

secondary

vaginal cancer

the cancer originates in the vagina

cancer spreads to

the vagina from

another organ

Represents 2-3% of Pelvic Cancers

Primary vaginal cancer

• Squamous cell

carcinoma::80-85% , 50 yrs. and up

.

• Clear cell

adenocarcinoma

:10%, teenagers and young women[14 – 20 yrs. ]

• Melanoma :2-3%, women over 50

Secondary vaginal cancer

84% of cancers in vaginal area are secondary

• Cervical

• Uterine

• Colorectal

• Ovary

Causes & Risk Factor

• Cigarette smoking

• Human Papilloma Virus (HPV 16 and 18) infection

• Immunosuppression

• VIN/CIN

• Prior history of cervical cancer

• Treatment for womb cancer by radiotherapy

Clinical Manifestations

• Painless vaginal bleeding, between periods,

after menopause, or after sex

Symptoms appear , often in later stages.

They can include:

• Vaginal discharge (may smell or be bloody)pain

during sex

• A lump in the vagina that you can feel

• A persistent itch in the vagina

Clinical Manifestations

Advanced vaginal cancer can also cause:

• constipation

• pain when peeing

• swelling in the legs (oedema)

• persistent pelvic pain

Diagnosis

• Biopsy to look for either precancerous

(VAIN) or cancerous cells

• Scans and x-rays to see if the cancer

has spread to other parts of your body.

Vagina cancer Staging

• Stage I : Confined to Vaginal Wall

• Stage II : Subvaginal tissue but not

to pelvic sidewall

• Stage III : Extended to pelvic sidewall

• Stage IVA: Bowel or Bladder

• Stage IVB: Distant metastasis

Treatment of vaginal cancer

• Surgery with Radical Hysterectomy and

pelvic lymph dissection in selected

stage I tumors high in Vagina

• All others treated with radiation with

chemosensitization

Treatment of vaginal cancer cont’d

radiotherapy concurrently with

weekly intravenous Cis-platinum

chemotherapy (40 mg/m2)

• Radiation with chemosensitization

5 year Survival

• Stage I 70%

• Stage II 51%

• Stage III 33%

• Stage IV 17%

Prevention

The few things known to help, though,

are avoiding smoking, and getting

regular smear tests to detect

precancerous or cancerous cells early:

VAIN VIN ; HPV CIN

Pap smear test

Summary – Vagina Cancer

• Represents 2-3% of Pelvic Cancers

• 84% of cancers in vaginal area are secondary

• Clear cell adenocarcinoma most occurs

teenagers and young women

• Treatment includes most surgery, radiation

• Chemosensitization with cisplatin

3. CERVICAL CANCER

Cervix

Cervical cancer

Cervical cancer

begins in the cervix

(the neck of the

womb), which is a

strong muscle that

forms the passage

between the womb

and the vagina.

Cervical cancer epidemiology

• Approximately 570,000 cases

expected worldwide each year

• 275,000 deaths

• Number one cancer killer of women

worldwide

• With the advent of the Pap smear, the

incidence of cervical cancer has declined

Cervical Cancer Etiology

• Cervical cancer is a sexually transmitted disease.

• HPV is the primary cause of cervical cancer.

• Some strains of HPV have a predilection to

the genital tract and transmission is usually

through sexual contact (16, 18 High Risk).

Cervical Cancer Risk Factors

• smoking

• giving birth to more than 7 children

having your first child before 17yrs

• Number of sexual partners

• Early age of intercourse

Cervical Cancer Risk Factors

• High-risk male partner

• Taking the pill

• Having a weakened immune system

Pathogenesis

Clinical Manifestations

• May be silent until advanced disease develops

• Symptoms of Invasion :

Post-coital bleeding

Foul vaginal discharge

Abnormal bleeding

Clinical Manifestations cont’d

Unilateral leg swelling or pain

Pelvic mass

Pelvic pain

Gross cervical lesion

the stages of cancer progression

The pre-cancerous

stage before the

cells turn cancerous

is called Cervical

Intra-epithelial

Neoplasia commonly

in short called CIN

Clinical Manifestations cont’d

Diagnosis

• A cone or hysterectomy specimen

• MRI, a CT or PET-CT scan, blood

tests or a chest X-ray

• Colposcopy,

• Biopsy

Cold cone biopsy

Colposcopy Medical Test

a procedure that

allows doctor to

look at the

surface of your

cervix and biopsy

any abnormal

areas

Staging of cervical cancer

Treatment of Early Disease

• Conization or simple hysterectomy -

microinvasive cancer

• Radical hysterectomy - removal of the uterus

with its associated connective tissues, the

upper vagina, and pelvic lymph nodes..

• Chemoradiation therapy

Radical hysterectomy - removal of the

uterus

Advanced Staging

• Chemoradiation is the mainstay of treatment

• 4-5 weeks of external radiation treats the primary

tumor and adjacent tissues and lymph nodes

• Chemotherapy acts as a radiation sensitizer

and may also control distant disease

Locally advanced cervical cancer regimens

First-Line Therapy with Radiotherapy

REGIMEN DOSING

Cisplatin

40mg/m2 IV on days 1, 8, 15, 22, 29, and

36 (total dose not to exceed 70mg per

week).

Cisplatin + 5-FU

Days 1 and 29: 4 hrs prior to external-

beam radiotherapy: Cisplatin

50mgDinfusion /m2 IV at 1mg/min with

standard hydration, plus

Days 2–5, and 30–33: 5-FU

1000mg/m2 IV continuous infusion over

24 hrs (total dose 4000mg/m2 each

course).

Locally advanced cervical cancer

regimens cont’d

First-Line Therapy with Radiotherapy

REGIMEN DOSING

Cisplatin + 5-FU

Days 1–5 of radiotherapy: Cisplatin

75mg/m2 IV over 4 hrs followed by 5-FU

4000mg/m2 IV over 96 hrs.

Repeat cycle every 3 weeks for 2

additional cycles.

Cisplatin + 5-

FU +hydroxyurea

Days 1 and 29: Cisplatin

50mg/m2 IV followed by 4000mg/m2 5-

FU over 96 hrs; hydroxyurea 2g orally

twice weekly for 6 weeks.

Locally advanced cervical cancer

regimens cont’d

First-Line Therapy with Radiotherapy

REGIMEN DOSING

Cisplatin + gemcitabine +

radiotherapy +brachytherapy

Induction therapy

Days 1, 8, 15, 22, 29 and 36: Cisplatin

40mg/m2 + gemcitabine

125mg/m2 + concurrent external-

beam radiotherapy 50.4Gy in 28

fractions, followed by brachytherapy

30–35Gy in 96 hrs.

Adjuvant therapy

Day 1: Cisplatin 50mg/m2, plus

Days 1 and 8: Gemcitabine

1,000mg/m2.

Repeat every 3 weeks for 2 cycles.

Metastatic or Recurrent

Cervical Cancer Regimens

Similar regimens as those used for

metastatic vulvar cancer

Reduce the risk

• reduce the risk of contracting the virus, which

in turn can reduce the risk of getting cervical

cancer

• start having sex when mature , and less sexual

partners because more you have higher your

chances are of developing cervical cancer

Summary – Vagina Cancer

• Number one cancer killer of women worldwide

• HPV is the primary cause of cervical

cancer

• Number of sexual partners

• Treatment includes surgery, and chemotherapy asso radiotherapy

• Prevent by a frequent Pap smear test

4. UTERINE CANCER

wall of Uterus

Womb cancer

• Also known

as, cancer of the

uterus, uterine cancer

or endometrial

cancer(++)

• begins in the lining

or walls of the

uterus.

Epidemiology

• Most common gynecologic malignancy

• Eighth leading cause of female mortality from cancer

• 97% arise from the endometrium (endometrial carcinoma)

• 3% arise from the mesenchymal components (sarcoma)

Types of womb cancer

• Uterine :

sarcoma

There are two main types of womb cancer:

95% of womb cancers

“starts in the womb’s lining, or endometrium

often caught early, and treated

successfully.

both less common and harder to treat.

starts in the muscle wall of the womb

• Endometrial:

cancer

Sub-types

• Leiomyosarcoma : Cancer of the muscle wall - the most

common sarcoma of the womb

• Papillary serous :

carcinomaAround 5% of womb cancers

• Clear cell carcinoma: Extremely rare, 1 to 2% of

womb cancers

• Adenocanthomas: combine both glandular and

cervical types of malignant cells

Two main types of womb cancer

Endometrial

carcinoma Uterine

sarcoma

THE FIRST TYPE OF

WOMB CANCER:

ENDOMETRIAL

CARCINOMA (95%)

Endometrial carcinoma

Epidemiology

• Median age of diagnosis: 60 years

• Most common in women > age 50 years

• Incidence is highly dependent on age

• 75% of uterine cancers occur in post-

menopausal women

Endometrial carcinoma Risk factors

RISK

FACTORS

OESTROGEN

OTHERS

OBESITY

DIABETES

HYPERTENSION

HNPCC

Estrogen exposure

EXOGENOUS

HORMONE

REPLACEMENT

THERAPY

TAMOXIFEN FOR

BREAST CANCER

ENDOGENOUSEARLY

MENARCHE

LATE

MENOPAUSE

PCOS

OBESITY

FUNCTIONING

OVARIAN TUMORS

• NULLIPAROUS WOMEN & WOMEN

WITH PCOD

NON OVULATION

HIGH OESTROGEN

ENDOMETRIAL HYPERPLASIA

NULLIPAROUS WOMEN

ENDOMETRIAL CANCER

• Obesity reduces level of serum

hormone binding protein

free estrogen circulates in body

OBESITY

• Peripheral fat : conversion of

epiandrostenedione to

oestrone

RISK FACTORS

NULLIPARITY

PCOS

EARLY MENARCHE

LATE MENOPAUSE

OBESITY

DIABETES

HYPERTENSION

LYNCH 2 / HNPCC

TAMOXIFEN

HRT

Clinical manifestations

• Bleeding

– Present in 90% of all cases

– 15% of patients with postmenopausal

bleeding will have endometrial cancer

Clinical manifestations

• Other Signs/Symptoms

– Vaginal Discharge(80-90%)

– Pelvic Pain, Pressure

– Referred Leg Pain

– Change in Bowel Habits

– Pyometria/Hematometria

Diagnosis

• Pap Smear

– Only 30-50% patients with cancer will have

an abnormal result

• Endometrial Biopsy

– False negative rate of 5-10%

Diagnosis

• Transvaginal Ultrasound

– Not for routine screening or diagnosis

• Fractional Dilation and Curettage

– Use in cases of cervical stenosis,

patient intolerance to exam, recurrent

bleeding after negative biopsy

Endometrial Cancer Grade

• The grade is based on the percentage of the

solid component.

– Well Differentiated (Grade 1): <5%

– Moderately Differentiated (Grade 2): 5-50%

– Poorly Differentiated (Grade 3): > 50%

Endometrial carcinoma type

• There are two major pathogenic types of

endometrial carcinoma :

Type II

Type I

Type I Endometrial Carcinoma

• Well differentiated endometrioid

• Better prognosis

• Superficial myometrial invasion

• Infrequent lymph node metastases

• Associated with hyperplasia

• Younger/peri-menopausal women

Type II Endometrial Carcinoma

• Older/post-menopausal women

• Thin

• Poorly differentiated carcinoma

– Papillary Serous

– Clear Cell

• Deep myometrial invasion

• Frequent lymph node metastases

• Associated with atrophy

Endometrial Carcinoma Treatment

• Surgery is the mainstay of treatment

followed by adjuvant radiation and/or

chemotherapy based on stage of disease.

• Primary radiotherapy or hormonal therapy

may be employed in patients who have

contraindications to surgery.

Hormone Therapy

• Appropriate in patients that desire fertility

preservation

• ONLY-G1 tumors!!

• High dose progestins

– Young patient

– Well differentiated

cancer

Endometrial Cancer hormonal regimens

Hormonal Regimens (for Endometrioid Only)

Tamoxifen (Nolvadex) Tamoxifen 20mg orally twice daily.

Medroxyprogesterone

acetate(MPA)Medroxyprogesterone acetate 200mg

orally once daily.

Tamoxifen +medroxyprog

esterone acetate

Medroxyprogesterone acetate 80mg

orally twice daily for 3 weeks

alternating with tamoxifen 20mg orally

twice daily.

Repeat cycle every 3 weeks.

Combination is associated with grade 4

thromboembolic events in a few

patients.1

Endometrial Cancer chemotherapy regimensChemotherapy Regimens and other Treatment Regimens

REGIMEN DOSING

Cisplatin (Platinol;

CDDP) +doxorubicin (Adria

mycin) (for adjuvant use)

Day 1: Doxorubicin

45mg/m2 IV + cisplatin

50mg/m2 IV, followed by

Days 2–11: Optional filgrastim

5mcg/kg/day.

Repeat cycle every 3 weeks; maximum 6

cycles.

Cisplatin + doxorubicin +p

aclitaxel (Taxol)

Day 1: Doxorubicin

45mg/m2 IV + cisplatin

50mg/m2 IV followed by

Day 2: Paclitaxel 160mg/m2 3-hr IV

infusion, followed by

Days 3–12: Filgrastim 5mcg/kg SC.

Repeat cycle every 3 weeks for max 7

cycles.

Maximum BSA of 2.0 was used for

calculations.

THE SECOND TYPE OF

WOMB CANCER:

UTERINE SARCOMA( 3%)

Uterine Sarcoma

• 3% of all uterine cancers

• 15% of all deaths from uterine

cancer

• Types Carcinosarcoma

Leiomyosarcoma

Endometrial Stromal Tumors

Carcinosarcoma

• Post-menopausal- median age of 62 years

• Associated with diabetes, hypertension, and obesity

• 7-37% of patients have prior pelvic irradiation

• Poor prognosis

Leiomyosarcoma

• Median age 52 years

• Premenopausal have a better prognosis

• Leiomyosarcoma:

1. Mitotic count: > 10 mitosis per HPF

2. Cellular atypia

3. Coagulative necrosis

Uterine Sarcoma Treatment: Surgery

3. Bilateral salpingo-ophorectomy

NOT in premenopausal women

1. Stage I/II sarcomas should be treated with

hysterectomy

2. Lymphadenectomy is indicated in all

sarcomas except leiomyosarcoma

Uterine Sarcoma Treatment: Recurrence

• Isolated lesions

-surgical excision

• Recurrent carcinosarcoma

-paclitaxel, platinum or ifosfamide

• Recurrent leiomyosarcoma

-doxorubicin, ifosfamide, docetaxel and

gemcitabine

Uterine Sarcoma Chemotherapy regimens

Chemotherapy

REGIMEN DOSING

Doxorubicin (Adriamycin)

Day 1: 75mg/m2 IV bolus.

Repeat cycle every 31 days OR

60mg/m2–70mg/m2 IV typically dosed every

3 weeks.

Gemcitabine (Gemzar) +do

cetaxel (Taxotere) +granulo

cyte-colony-stimulating

factor (G-CSF)

Days 1 and 8: Gemcitabine 900mg/m2 IV

over 90 min, followed by

Day 8: Docetaxel 100mg/m2 IV over 60

min, followed by

Days 9–15: G-CSF

150mcg/m2 SC OR on Day 9 or

10: Pegfilgrastim 6mg SC.

Repeat cycle every 3 weeks until disease

progression or toxicity occurs.

Gemcitabine

Days 1, 8 and 15: Gemcitabine

1,000mg/m2 IV.

Repeat cycle every 4 weeks.

5. FALLOPIAN TUBES CANCER

The Fallopian tubes

The Fallopian tubes, also

known as oviducts, uterine

tubes, and salpinges are

two very fine tubes leading

from the ovaries into

the uterus, via the utero-

tubal junction

WHAT IS

FALLOPIAN TUBE

CANCER

Fallopian tube cancer

• Fallopian tube cancer begins in a

woman’s fallopian tubes

• Adenocarcinoma

• sarcoma

• chorisarcoma

• others

• Secondary + + +

Epidemiology

• 5 years survival 56%

0.3% of all gynecology malignancies

3.6 / million women

• One of the most rare malignancy of the female

genital tract

• Mean age of diagnosis 50 yrs.

2/3 menauposal

Risk factors

• Nulliparity

• Chronic salpingistis

• Infertility 70% cases

• inflammatory disease (such as TB)

Pathogenesis

• Similar to endometrial and ovarian cancer

Oncogene :

crb

Tumeurs suppressors genes :

p53

Clinical manifestations of FTC

•A pelvic mass or lump

•Vaginal bleeding, especially after menopause

•Abdominal or pelvic pain or feeling of pressure

•Vaginal discharge, which may be clear, white,

or tinged with blood

Diagnosis of FTC

• Preoperative diagnosis very rare

• Sonography

• Serum ca 125

Staging of FTC

• Stage I : confined to fallopian

• Stage II : confined to pelvis

• Stage III: extra pelvic disease

• Stage IV: distant Metastasis

Treatment of FTC

• For early disease

• As an adjuvant therapy

• Reassessment laparotomy

Surgery

• Platinum based combination

chemotherapy

Chemotherapy

Summary

• Very rare genecology malignancy

• 5 years Survival is 56 %

• Staging and treatment similar to

ovarian cancer

6. OVARIAN CANCER

Ovary

ovary is an ovum-

producing reproductive

organ, in pairs

they are both gonads

and endocrine

glands

WHAT IS

OVARIAN CANCER

Ovarian cancer

Ovarian Cancer

is cancer that

forms in the tissue

of the ovary

Epidemiology

• It causes more deaths than any other

gynecologic cancer.

• 80 percent will survive one year and about

50% will survive five years.

• Ovarian cancer is the second most common

gynecologic cancer after uterine cancer.

Risk factors

• Family history of the disease is one of the most

significant risk factors

• The risk of ovarian cancer increases with age

• Rates are highest where diets tend to be

high in fat. Animal fats (red meats, whole

milk or cheese)

Types of ovarian cancer

• There are many different types, but the most

common are three:

Ovarian Epithelial Carcinoma; begins in

the cells of the surface of the ovaries.(90%)

Malignant Germ Cell Tumor; Cancer

that begins in the egg cells.

Types of ovarian cancer cont’d

Stromal; Cancer that develops on the

connective tissue that holds the ovary

together and produces most of the

female hormones.

• malignant and stromal make up about 10%

Pathogenesis

1. Genetic Mutation: Inherited 5 to 10% of Ovarian

Cancer

2. Genetic Mutation: Environmental

Infertility & infertility drugs

Estrogen & Hormone Replacement Therapy

Obesity in adulthood

Talcum Powder

Pathogenesis cont’d

3. Oncogenes and Tumor-suppressors

The genes most affected in families with

a history of Ovarian Cancer are BRCA1

and BRCA2

The suppressor Gene p53

Clinical manifestations

• Abdominal pressure, swelling, or bloating

• Urinary urgency or burning with no infection

• Pelvic discomfort or pain

• Persistent indigestion, gas, or nausea

Clinical manifestations cont’d

• Changes in bladder and bowel habits

• Persistent lack of energy

• Low back pain

• Changes in menstruation.

Diagnosis

• Physical

Malignancy: irregular, solid consistency, is

fixed, nodular, or bilateral, is associated

with ascites

• Ultrasound

Low positive predictive value for cancer

Diagnosis cont’d

• Tumor markers

Epithelial: CA 125, elevated in 80%

35 U/mL is upper limit of normal

Also elevated in many benign conditions

Stage of ovarian cancer

Ovarian Cancer Treatments

There are many different kinds of treatments

available, depends on certain factors, like:

• the stage and size of the tumors,

• your age,

• general health,

• Desire to have kids

Ovarian Cancer Treatments cont’d

• Surgery -Is the most common. The surgeon

tries to remove as much of the tumor as possible

• Chemotherapy-. Chemo is commonly

used after surgery to kills cancer cells that

weren’t removed

Ovarian Cancer Treatments cont’d

• Radiation Therapy- The main goal is to

reduce pain symptoms

Biotherapy/Immunotherapy- Boosts the

body’s immune system to fight the disease.

Ovarian cancer chemotherapy regimensIntravenous First-Line Primary Chemotherapy/Primary Adjuvant

Therapy (Stage II–IV)

REGIMEN DOSING

Paclitaxel (Taxol) + carboplatin(Pa

raplatin)

Day 1: Paclitaxel 175mg/m2 IV

administered over 3 hrs + carboplatin

AUC=5–7.5mg/mL/min IV administered

over 1 hr.

Repeat every 3 weeks for 6 cycles.

Docetaxel (Taxotere) +carboplatin

Day 1: Docetaxel 60–75mg/m2 IV followed

by

carboplatin AUC=5–6mg/mL/min IV.

Repeat every 3 weeks for 6 cycles.

Dose-dense

paclitaxel +carboplatin

Day 1: Carboplatin AUC=6mg/mL/min IV

administered over 1 hr, plus

Days 1, 8, and 15: Paclitaxel 80mg/m2 IV

administered over 1 hr.

Repeat every 3 weeks for 6 cycles.

Ovarian cancer chemotherapy regimens

Intraperitoneal First-Line Therapy for

Advanced Disease

REGIMEN DOSING

Paclitaxel + cisplatin (Platinol;

CDDP)

Day 1: Paclitaxel 135mg/m2 continuous

IV infusion over 24 hrs,followed by

Day 2: Cisplatin 75–

100mg/m2 IP, followed by

Day 8: Paclitaxel 60mg/m2 IP

(maximum body surface area 2m2).

Repeat every 3 weeks for 6 cycles.

General Conclusion

FGTM occur in each of the know anatomical segment :

vulvar, vagina, cervix, uterus, fallopian and ovary

FGTM is common and cervical cancer is responsible

for more deaths following by ovarian cancer then

womb cancer

Option exist now for prevention, detection and treatment ,

Abnormal bleeding and discharge is the most

common clinical manifestation

Surgery and chemotherapy are the main treatment

option , hence the need for us to master the adverse

effects of cytotoxic drugs