TREATMENT OF OVARIAN CANCER
The treatment of ovarian cancer is depend on diagnosis as majority of cases present with disease that has spread into the abdomen (stage III and IV).These patients require a combination of surgical and chemotherapeutic managment .indeed,only those patients with disease confined to the ovaries (stage I) can be cured by surgery alone. Overall survival has remained mostly unvaried,with 5-year survival of approximately 30 % among patients with advanced cancer.The sub group with the worst survival comprises the 15% of patients with stage IV disease in whom tumor is grossly present beyond the abdomenal cavity, most commonly liver ,five-year overall survival in this group of patients in less than 20% in most series.From a surgical standpoint,primary tumor debulking(type of surgery) should be attempted in most patients with stage III disease who are reasonable candidates of surgery.
A. SURGERY AND CHEMOTHERAPY
The role of surgery remains important to the managment of ovarian cancer and it is shows to produce a better outcomes for a significant number of women with advanced ovarian cancer.Surgery is the initial therapeutic procedure for women with presumed ovarian cancer.Surgical cytoreduction also called debulking refers to surgical removal of as much of the cancer as possible.It is beneficial because it reduces the number of cancer cells that altimately need to be destroyed by chemotherapy.Of two type,optimal cytoreduction is the removal of cancer cells less than 1cm and suboptimal cytoreductive is removal of ovarian cancer cells abit more than 1 cm in size.Following cytoreduction all pateints with stage II,stage III and stage IV undergoes additional treatment known as chemotherapy.Because the majority of pateints will experiance recurrence of their cancer after complete surgical removal.Chemotherapy typically consists of paclitoxin and platinum compound for stage IV ovarian cancer administered every 3 week for 6-8 cycles,where as paraplatin plus taxol is used for stage II ovarian cancer.Now adays there are strategies to improve treatment and some of these are as follows.
A. Intraperitoneal(IP) chemotherapy: This treatment approaches delivers chemotherapy directly into the body hollow space , where there is the greatest number of cancer cells.The chemotherapy is administered through alarge catheter that is placed into the abdomen during the surgery to remove the cancer.
B. Targeted therapy:Interfere with specific pathways in the cancer cell growth or survival.Some may block growth signal from reaching cancer cell and reduce blood supply to cancer cells
C. Consolidation therapy: Extrachemoterapy that is given completion standard chemotherapy.The delivery of ovarian cancer treatment following local surgery is reffered to as adjuvant therapy.Neoadjuvant chemotherapy that is given prior to surgery(interval cytoreduction).
C. RADIOTHERAPY
Radiotherapy is not often used to treat ovarian cancer. The main treatment is surgery and most women will have also chemotherapy.But radiotheray may be used to treat cancer (generally before or after surgery) and in some cases it is used as alternative to surgery or to relieve symptoms of stage 1c or stage 2 cancers or advanced disease that causing symptoms.Before a patient receives radiotherapy ,calculation must be made about the radiation dose and type, the area to be treated and the distribution of the dose.Treatment is prescribed by clinical oncologist(Doctor),but others are involved in making the calculations,giving treatment and maintaing the machine.The modern radiotherapy uses machines called linear accelerators(linAcs)which deliver high energy X-ray and electrons to kill tumors cells(cancer cells).
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