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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Demonstrate understanding of the etiology and risk factors associated with the development of ovarian cancer.

  2. Justify the risk and benefits of the surgical and chemoprevention options available for decreasing the potential risk of developing ovarian cancer.

  3. Interpret and understand the utility of the screening tests and serologic markers for diagnosing ovarian cancer.

  4. Distinguish the nonspecific physical signs and symptoms of ovarian cancer.

  5. Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed, persistent, and recurrent ovarian cancer patients.

  6. Discuss the role of consolidation treatment for improving overall survival for ovarian cancer patients.

  7. Compare and contrast chemotherapy options for women with recurrent platinum-resistant ovarian cancer.

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INTRODUCTION

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Ovarian cancer is relatively uncommon but is the most incurable of the gynecologic cancers. Ovarian cancer is often denoted as the “silent killer.” KEY CONCEPT The primary reason for the high mortality rate associated with ovarian cancer is the nonspecific symptoms and difficulty for early detection or screening that result in patients presenting with advanced disease. The majority of ovarian cancers are of epithelial origin. Each time ovulation occurs, the epithelium of the ovary is broken followed by occurrence of cell repair. The incessant ovulation hypothesis proposes that the increasing number of times the ovary epithelium undergoes cell repair is associated with the increasing risk of mutations and ultimately ovarian cancer. Although the majority of patients will achieve a complete response (CR) to primary surgery and chemotherapy, disease recurs in more than 50% of patients in the first 2 years after completion of primary treatment. KEY CONCEPT Ovarian cancers often cause metastasis via the lymphatic and blood systems to the liver, and/or lungs. Common complications of advanced and progressive ovarian cancer include ascites and small bowel obstruction (SBO), which often are associated with the end of life.

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Patient Encounter 1, Part 1

The patient is a 66-year-old active woman, who has been in good health up until recently (about 6 weeks or so). At Thanksgiving, she mentioned to her daughter that she has had not been able to have a bowel movement in over 6 days despite use of OTC laxative medications. The following Monday she saw her gastroenterologist that completed CT scan that suggests minor colitis but no obvious reason for inability to have bowel movement. One week later, her symptoms persisted, so her physician did an exploratory laparoscopic surgery, which came back positive for an abdominal mass and thickening of the peritoneal lining and mass on right ovary extending to outside of colon wall which was removed by general surgeon and required temporary ostomy. Of note, she has been married for 41 years with only one sexual partner in her lifetime. They have three children who are all grown adults. Her first menses was when she was 11 years old and menopause was at age 54 years. She has had ...

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