world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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Fig. 5.71 Five-year relative survival rates after<br />
diagnosis of ovarian <strong>cancer</strong>.<br />
Management<br />
Surgery is most often the first recourse in<br />
diagnosis and treatment. Treatment of<br />
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222 Human <strong>cancer</strong>s by organ site<br />
early disease includes bilateral salpingooophorectomy<br />
and total abdominal hysterectomy,<br />
total omentectomy, appendectomy,<br />
collecting samples of peritoneal<br />
washings for cytological analysis and possibly<br />
removal of pelvic retroperitoneal and<br />
aortic lymph nodes. Reproductive function<br />
and fertility may be conserved in patients<br />
with a unilateral, low-grade, unruptured<br />
epithelial ovarian tumour. Advanced stage<br />
ovarian <strong>cancer</strong> requires cytoreductive surgery<br />
to remove all gross tumour, followed<br />
by chemotherapy. External beam radiotherapy<br />
may play a limited role in selected<br />
patients with minimal residual disease.<br />
Intraperitoneal implants may be used as<br />
adjuvant treatment for high-risk patients<br />
with early disease.<br />
A standard chemotherapy for advanced<br />
stage ovarian <strong>cancer</strong> using cisplatin and<br />
paclitaxel achieves response rates of up to<br />
60-80%. Germ cell tumours are very sensitive<br />
to chemotherapy and may be treat-<br />
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ed with vincristine, actinomycin and<br />
cyclophosphamide; cisplatin, vinblastine<br />
and bleomycin; or cisplatin, etoposide and<br />
bleomycin. Recurrent ovarian <strong>cancer</strong> may<br />
be treated with cytoreductive surgery plus<br />
chemotherapy and palliative radiotherapy.<br />
Hormonal therapy may include progestational<br />
agents and anti-estrogens.<br />
Tumour stage (determined surgically) is<br />
the most important prognostic factor.<br />
Clear cell and small cell carcinomas are<br />
associated with a worse prognosis than<br />
other histological types. Aneuploidy has<br />
been linked to poor survival. In the assessment<br />
of response to treatment, decrease<br />
in serum CA-125 measurements indicates<br />
a more favourable prognosis. Early stage<br />
disease has a very good prognosis. Overal<br />
five-year survival rates for all stages combined<br />
(Fig. 5.71) range from 30-50%. Most<br />
women, however, present with late stage<br />
disease which is associated with a fiveyear<br />
survival rate of about 20%.<br />
WEBSITES<br />
NCI Homepages for Cervical Cancer, Endometrial Cancer<br />
and Ovarian Cancer:<br />
http://www.<strong>cancer</strong>.gov/<strong>cancer</strong>_information/<strong>cancer</strong>_type/<br />
The Alliance for Cervical Cancer Prevention:<br />
http://www.alliance-cxca.org/<br />
National Ovarian Cancer Coalition (USA):<br />
http://www.ovarian.org/