Graphic staging of colon cancer
Graphic staging of colon cancer
However, there are more deaths from this form cancer each year in the United States as endometrial cancer and cervical cancer combined. Staging Table of colon cancer, the lifetime risk of spontaneous ovarian cancer is about 1.7%. Epithelial ovarian cancer is expected to cause 15,520 deaths in 2008. The mean age at diagnosis is 60. There was a significant improvement in survival at five years for ovarian cancer patients. It is probably a combination of improving the volume reduction surgery for tumor and better possibilities of chemotherapy.
Most patients with this cancer Ovarian no signs or symptoms until the disease is spreading in the upper abdomen. 70% of patients with advanced illness. The symptoms of early stage ovarian cancer may include nonspecific pelvic discomfort, urinary frequency and constipation are caused by an enlarged pelvic mass. In advanced stages, patients suffer from abdominal pain, bloating, anorexia, nausea and constipation.
The best tumor marker for ovarian cancer is CA 125. Lower elevations in CA 125 can also be seen in endometriosis, benign tumors, fibroids and pregnant and postpartum women. Furthermore, moderately elevated CA 125 adnocarcinoma can be seen in others such as breast and endometrial cancer. The sensitivity of CA 125 is 70% to 80% and specificity of 98.6% to 99.4%. However, in the middle risk population with low prevalence of ovarian cancer, false positives may be too high.
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The National Cancer Institute recommended cancer screening in women with polycystic ovary syndrome known associated with this genetic disease and for women with strong family history. Routine screening for women without a family history of ovarian cancer is not recommended. Known genetic syndromes are hereditary breast and ovarian cancer syndrome associated with BRCA 1 and BRCA 2 hereditary colorectal cancer syndrome without polyposis (HNPCC). The absolute risk of ovarian cancer in the presence of two genes BRCA 1 and BRCA 2 mutation ranges from 16% to 60%. For patients with HNPCC, the risk of Ovarian cancer is 9% to 12%.
Epithelial cancer approximately 90% of ovarian cancer. The ongoing transition histologies include the types serous cell, mucinous, endometrioid and clear. Germ cell tumors are dysgerminoma, endodermal sinus tumor, embryonal carcinoma or choriocarcinoma, teratoma Primary malignant. Stromal tumors are granulosa or Sertoli-Leydig tumor tumor.
At initial presentation, surgery is used for confirmation and staging cancer. Stage I is limited to one or both ovaries. Stage II is composed of one or both ovaries with extension to the pelvic viscera. Stage III is associated with implants in the abdominal and pelvic wall or serosal surface of the liver or intestine or omentum means hail. Stage IV disease involves distant metastases. Survival to 5 years of disease in stage IA and grade 1 or 2 histology is over 90%. High potential of the disease in stages I and II disease, survival at 5 years is 80%. For patients with stage III cancer after optimal debulking 5-year survival is 20% to 30%. This reduced to less than 10% of patients stage III optimally debulked and stage IV disease.
Ovarian cancer stage I with favorable prognostic features can be treated with surgery alone. For women at high risk of cancer agents in early stage (stage I, grade 3 or stage II), platinum-based adjuvant chemotherapy showed a 11% improvement in progression-free survival and 8% improvement in overall survival. For stage III and IV disease, the current standard of care include attempted maximum debulking surgery followed by platinum-based chemotherapy, with agents.
Is an optimal debulking important in the treatment of ovarian cancer. Retrospective data showed that survival was better for women receiving chemotherapy in the presence of the disease low volume. In the framework in which optimal surgical cytoreduction can be achieved, an alternative approach is that patients receive chemotherapy at the front. For patients which showed a partial response to neoadjuvant chemotherapy may be appropriate to attempt surgical removal of macroscopic disease at the time.
As the standard of care chemotherapy for advanced ovarian cancer type, studies have shown that the combination of paclitaxel with cisplatin is superior to cyclophosphamide / Cisplatin. Later studies showed that carboplatin / paclitaxel is at least as effective as cisplatin and paclitaxel.
Intraperitoneal chemotherapy is an approach interesting for the treatment of a disease largely confined to the peritoneal space. GOG 172 was a clinical phase III have shown that this regional approach initiated survival free of progression free and overall survival compared with the intravenous approach. The disadvantage of this approach are the local toxicity, and requirements for catheter intraperitoneally.
Due to the high recurrence rate in patients in patients with advanced ovarian cancer, the question of whether consolidation chemotherapy can improve time to progression and overall survival was examined in a phase III study comparing 3 and 12 cycles of Taxol. Survival progression-free for the branch 12 of the cycle. However, overall survival was not different between the two arms. Therefore, the oncologist should discuss with the patient and allow them to decide whether the improved survival progression free justification of toxicities, including peripheral neuropathy and alopecia.
For many patients with advanced ovarian cancer who initially responded to treatment, relapse of the disease at a later time. The treatment of patients suffering a relapse or resistance must be individualized. For people with a long treatment free interval of many similar drugs be reused. There are a number Monotherapy drug, with activity in ovarian cancer. These include altretamine, bevacizumab, docetaxel, etoposide, gemcitabine, liposomal doxorubicin, paclitaxel, tamoxifen, topotecan and vinorelbine.
Radiation can also play a role in the palliative treatment of selected patients with recurrent ovarian cancer. Symptoms such as pain of more and more pelvic mass or bone metastasis can be mitigated. Very rarely can develop brain metastases, which also can be treated with radiotherapy.
The best treatment of ovarian cancer requires a team approach between primary care physician, surgeon, oncology gynecological, medical oncologists and radiation oncologists. Like many chemotherapy drugs are available and also to understand the biology of cancer epithelial ovarian cancer, is hope to promote better overall survival and quality of life of our patients.
Gigi P. Chen, MD, received his training in oncology medical and Hematology, University of California at Davis.
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