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PEDOMAN ian di
UNTUK PASIEN ®
Kanker ovarium
Disajikan dengan dukungan dari:
Buku ini berfokus pada pengobatan kanker ovarium. poin kunci dari buku ini
dirangkum dalamNCCN Panduan Cepat ™ seri untuk kanker ovarium. NCCN
juga menawarkan buku pasien pada kanker payudara, kanker paru-paru,
melanoma, dan banyak jenis kanker lainnya. MengunjungiNCCN.org/patients
untuk perpustakaan penuh buku pasien, ringkasan, dan sumber daya lainnya.
Misi NCCN adalah untuk meningkatkan perawatan kanker sehingga orang dapat
hidup lebih baik. Pada inti dari NCCN adalah Pedoman Clinical Practice NCCN di
Oncology (Pedoman NCCN®). Pedoman NCCN®mengandung informasi untuk
membantu petugas kesehatan berencana perawatan kanker yang terbaik.
Mereka daftar pilihan untuk perawatan kanker yang paling mungkin untuk
memiliki hasil terbaik. Pedoman NCCN untuk Pasien® menyajikan informasi dari
Pedoman NCCN dalam format yang mudah-untuk-belajar.
Panel ahli menciptakan Pedoman NCCN. Sebagian besar ahli dari Lembaga
Anggota NCCN. bidang keahlian mereka yang beragam. Banyak panel juga
termasuk advokat pasien. Rekomendasi dalam Pedoman NCCN didasarkan
pada uji klinis dan pengalaman para panelis. Pedoman NCCN diperbarui
setidaknya sekali setahun. Ketika didanai, buku-buku pasien diperbarui untuk
mencerminkan versi terbaru dari Pedoman NCCN untuk dokter.
NCCN Foundation yang didirikan oleh NCCN untuk mengumpulkan dana bagi
pendidikan pasien berdasarkan Pedoman NCCN. NCCN Foundation
menawarkan bimbingan untuk orang-orang dengan kanker dan pengasuh
mereka di setiap langkah perjalanan kanker mereka. Hal ini dilakukan dengan
berbagi informasi kunci dari para ahli kanker terkemuka. Informasi ini dapat
ditemukan di perpustakaan Pedoman NCCN untuk Pasien®dan sumber daya
pendidikan pasien lainnya. NCCN Yayasan juga berkomitmen untuk memajukan
pengobatan kanker dengan mendanai dokter menjanjikan bangsa di pusat
penelitian kanker, pendidikan, dan kemajuan terapi kanker.
Seluruh hak cipta. Pedoman NCCN untuk Pasien®dan ilustrasi di sini tidak boleh direproduksi dalam bentuk apapun untuk tujuan apapun tanpa izin tertulis dari NCCN.
Pedoman NCCN yang bekerja di sebuah kemajuan yang dapat didefinisikan ulang sesering data yang signifikan baru telah tersedia. The NCCN tidak memberikan jaminan
apapun apapun mengenai konten mereka, penggunaan, atau aplikasi dan tidak bertanggung jawab atas aplikasi atau penggunaannya dengan cara apapun.
Kanker Jaringan Komprehensif Nasional (NCCN) • 275 Perdagangan Drive, Suite 300 • Fort Washington, PA 19.034 • 215.690.0300
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 2
pendukung
Disahkan oleh
Ovarium Cancer Research Fund Alliance (OCRFA) Yayasan Kanker Wanita
Sebagai penelitian kanker ovarium terbesar, advokasi dan Yayasan Kanker Wanita senang untuk mendukung
organisasi dukungan pasien, Kanker ovarium Research Fund sumber daya yang komprehensif ini untuk pasien dan
Aliansi memuji NCCN untuk menyediakan sumber daya yang keluarga mereka. Hal ini terutama penting bagi wanita
penting dan berguna untuk masyarakat kita. ocrfa.org untuk menyadari risiko dan gejala kanker ini, serta pilihan
pengobatan, termasuk perawatan oleh seorang ahli
onkologi ginekologi. foundationforwomenscancer.org
The Society of Gynecologic Oncology (SGO)
The Society of Gynecologic Oncology (SGO) sepenuhnya
mendukung Pedoman NCCN untuk Pasien: Kanker Sharsheret
ovarium. SGO mendesak individu yang menduga mereka Sharsheret bangga untuk mendukung sumber daya ini
memiliki kanker ginekologi, atau yang telah begitu penting, Pedoman NCCN untuk Pasien: Kanker ovarium.
didiagnosis, untuk mencari pengobatan dari seorang ahli Dengan alat yang penting ini di tangan, wanita nasional
onkologi ginekologi, seorang dokter yang mengkhususkan memiliki pengetahuan yang mereka butuhkan untuk bermitra
diri dalam mendiagnosis dan mengobati kanker yang dengan tim kesehatan mereka untuk menavigasi dunia
terletak di organ reproduksi.sgo.org sering rumit perawatan kanker ovarium dan membuat
keputusan pengobatan.sharsheret.org
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 3
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 4
Kanker ovarium
Isi
6 Cara menggunakan buku ini 63 bagian 6
panduan pengobatan untuk
7 Bagian 1 LCOH (jenis kurang umum
Kanker ovarium dari histopathologies ovarium)
Menjelaskan di mana kanker ovarium dimulai, Menyajikan kursus direkomendasikan
bagaimana penyebarannya, dan gejala dapat tindakan untuk jenis kurang umum dari
menyebabkan. kanker ovarium dari diagnosis untuk
setelah pengobatan kanker.
13 Bagian 2
Pengujian untuk kanker ovarium 81 bagian 7
Menjelaskan tes dokter gunakan untuk Membuat keputusan
menemukan dan mengkonfirmasi pengobatan
(mendiagnosa) kanker ovarium dan Menawarkan tips untuk mendapatkan
rencana perawatan. rencana pengobatan yang memenuhi
semua kebutuhan Anda.
22 bagian 3
kanker stadium 88Glossary
Menjelaskan bagaimana dokter menilai dan Kamus
menilai sejauh mana kanker ovarium dalam Akronim
tubuh Anda.
Gambar 1
Perempuan sistem reproduksi
Sistem reproduksi adalah sekelompok organ yang bekerja sama untuk membuat bayi.
Sistem reproduksi wanita meliputi ovarium, saluran tuba, rahim, leher rahim, dan vagina.
Tuba fallopi
Rahim Tuba fallopi
Indung
Indung telur
telur
tengkuk
Vagina
Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com
Sel-sel kanker membuat sel-sel baru yang tidak Hal ini membantu untuk memahami bahwa istilah
diperlukan dan tidak cepat mati ketika tua atau carcinoma dan ganas keduanya merujuk kanker
rusak. Seiring waktu, sel-sel kanker tumbuh dan bila digunakan dalam nama-nama LCOH tersebut.
membelah cukup untuk membentuk suatu massa Karsinoma Istilah berarti kanker yang dimulai di
yang disebut tumor. tumor pertama kali dibentuk sel-sel yang membentuk kelenjar atau lapisan atau
oleh pertumbuhan berlebih dari sel-sel kanker organ. Ganas juga digunakan dalam nama dan
disebut tumor primer. juga berarti kanker.
Gambar 3
kanker ovarium epitel
Sebagian besar kanker ovarium
epitel
mulai di sel-sel epitel. sel epitel
membentuk lapisan luar jaringan di
Indung telur
sekitar ovarium. Lapisan ini
jaringan disebut epitel. Kanker
tumor epitel
yang dimulai di sel-sel ini disebut
kanker ovarium epitel. Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com
Gambar 4
pembuluh limfe dan kelenjar
pembuluh getah bening dan
kelenjar yang ditemukan di
seluruh tubuh. Kelenjar getah
bening adalah kelompok kecil sel
melawan penyakit khusus.
kelenjar getah bening yang
terhubung satu sama lain oleh
jaringan tabung kecil yang
disebut pembuluh getah bening.
Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com
berbahaya daripada bentuk-bentuk lain dari ???? Baru dan mulai kurang dari 1 tahun yang
hormon.
Dokter Anda mungkin juga berpikir Anda
memiliki kanker ovarium berdasarkan tanda-
???? Kanker ovarium sering dimulai di sel-sel
tanda tertentu. Tanda-tanda kanker
yang membentuk lapisan luar jaringan di
ovariumtermasuk perasaan massa di pelvis atau
sekitar ovarium. Ini disebut kanker ovarium
penumpukan cairan di perut Anda. Dokter Anda
epitel.
mungkin merasa massa di panggul karena
tumor atau ovarium membesar.kanker ovarium ???? Borderline tumor epitel (LMP [low
juga dapat menyebabkan kelebihan penumpukan malignant potential] juga mulai di epitel
cairan (Ascites) di panggul dan perut. Hal ini yang
dapat menyebabkan pembengkakan dan sel.
membuat tampilan perut Anda atau merasa
diperbesar. ???? Sel-sel kanker membentuk tumor
mestinya.
Dokter Anda mungkin menduga kanker ovarium
Bagian 2 menggambarkan tes yang Dokter Anda mungkin menduga kanker ovarium jika
direkomendasikan untuk kanker ovarium. Anda memiliki gejala tertentu. Atau, kanker ovarium
Tes ini digunakan untuk mencari dan mungkin telah ditemukan oleh operasi sebelumnya.
pastikan (mendiagnosa) kanker ovarium Untuk mengkonfirmasi (mendiagnosa) kanker
dan rencana perawatan. Mereka juga ovarium dan rencana perawatan, sejumlah tes yang
digunakan untuk memantau kesehatan diperlukan.panduan 1mencantumkan jenis tes yang
dan periksa hasil perawatan. digunakan untuk kanker ovarium. Membaca halaman
berikutnya untuk mempelajari lebih lanjut tentang tes
ini, termasuk kapan dan mengapa setiap tes
dianjurkan. Beberapa tes yang dilakukan pada
kunjungan awal, sedangkan tes lain dilakukan segera
setelah diagnosis. Hal ini membantu untuk meminta
dokter Anda yang menguji Anda akan memiliki dan
ketika Anda dapat mengharapkan hasil.
Panduan 1. Tes
• Ultrasound
• GI (gastrointestinal) Evaluasi
• Biopsi
tes jaringan
tes pencitraan mengambil gambar (foto) dari Tes ini menggunakan perangkat genggam yang
dalam tubuh Anda. Dokter menggunakan tes disebut probe ultrasound. probe mengirimkan
pencitraan untuk memeriksa apakah ada tumor di gelombang suara yang memantul dari organ dan
indung telur Anda. Gambar-gambar dapat jaringan untuk membuat gema. Probe juga mengambil
menunjukkan ukuran tumor, bentuk, dan lokasi. gema. Sebuah komputer menggunakan gema untuk
Mereka juga dapat menunjukkan apakah kanker membuat gambar yang ditampilkan pada layar. Ada
telah menyebar ke luar ovarium Anda. Berbagai dua jenis ultrasound yang dapat digunakan untuk
jenis tes pencitraan yang digunakan untuk mencari kanker ovarium: USG transabdominal dan
mencari kanker ovarium, rencana pengobatan, USG transvaginal.
dan memeriksa hasil pengobatan. Lihat Gambar 5.
Untuk USG transabdominal, Gel akan menyebar Tapi, Anda mungkin merasa sedikit ketidaknyamanan
pada daerah kulit dekat ovarium Anda. Ini termasuk ketika probe dimasukkan untuk USG transvaginal.
perut Anda (perut) dan daerah antara tulang pinggul USG dapat mengambil antara 20 dan 60 menit untuk
Anda (pelvis). gel membantu untuk membuat gambar menyelesaikan.
lebih jernih. Dokter Anda akan menempatkan probe Lebih atau kurang waktu mungkin diperlukan
pada kulit Anda dan membimbing itu bolak-balik tergantung pada daerah tubuh Anda sedang
dalam gel. melihat.
Untuk USG transvaginal, dokter akan USG menggunakan gelombang suara untuk
memasukkan probe ke dalam vagina Anda. Hal membuat gambar bagian dalam tubuh. Probe USG
ini dapat membantu dokter melihat ovarium Anda mengirimkan gelombang suara. Untuk USG
lebih jelas. Ultrasound umumnya tidak transabdominal, probe akan ditempatkan pada kulit
menimbulkan rasa sakit. perut Anda. Untuk USG transvaginal, itu akan
dimasukkan ke dalam vagina Anda.
Gambar 5
USG
USG menggunakan gelombang suara untuk membuat gambar bagian dalam tubuh. Probe
USG mengirimkan gelombang suara. Untuk USG transabdominal, probe akan ditempatkan
pada kulit perut Anda. Untuk USG transvaginal, itu akan dimasukkan ke dalam vagina Anda.
USG pemeriksaan
Gelombang suara
USG pemeriksaan
Gelombang suara
Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com Ilustrasi
Copyright © 2016 Inti Medis Media, All rights reserved. www.nucleusinc.com
Gambar 6
CT Scan mesin
MRI scan
Scan MRI menggunakan gelombang radio dan
magnet yang kuat untuk mengambil gambar dari
bagian dalam tubuh. Tidak menggunakan x-ray.
Jenis scan baik yang menunjukkan tulang
belakang dan jaringan lunak seperti otak.
PET Scan
Sebuah PET (positron emission tomography) scan
menunjukkan bagaimana sel-sel Anda menggunakan
bentuk sederhana dari gula. Untuk membuat gambar,
sebuah radiotracer gula pertama perlu dimasukkan
tidak menimbulkan rasa sakit dan memakan waktu
sekitar 20 menit untuk menyelesaikan.
radiotracer memancarkan sejumlah kecil energi yang
terdeteksi oleh mesin yang mengambil gambar. sel- evaluasi GI
sel kanker aktif menggunakan gula lebih cepat dari Saluran GI terbuat dari organ bahwa makanan
sel normal. Dengan demikian, sel-sel kanker tampak melewati ketika Anda makan. Ini termasuk perut,
lebih cerah dalam gambar. usus kecil, usus besar, dan rektum. Evaluasi GI
adalah tes pencitraan yang digunakan untuk
PET sangat baik yang menunjukkan kelompok- melihat saluran pencernaan Anda. Tes ini dapat
kelompok kecil dari sel-sel kanker. Tes ini juga digunakan dalam kasus-kasus tertentu untuk
dapat berguna untuk menunjukkan jika kanker memeriksa tanda-tanda penyebaran kanker.
ovarium telah menyebar. Kadang-kadang, PET
dikombinasikan dengan CT-disebut PET / CT Tes pencitraan ini menggunakan lingkup untuk
melihat ke dalam saluran pencernaan Anda. Sebuah
scan.
lingkup adalah, tabung tipis panjang yang dapat
Dada x-ray dipandu ke dalam tubuh Anda, sering melalui mulut,
X-ray menggunakan sejumlah kecil radiasi untuk anus, atau
membuat gambar organ dan jaringan dalam tubuh. pemotongan bedah. Salah satu ujung ruang
Tumor mengubah cara radiasi yang diserap dan lingkup memiliki lensa cahaya dan kamera kecil
akan muncul pada gambar x-ray. Sebuah dada x- untuk melihat ke dalam tubuh Anda. Di ujung lain
ray dapat digunakan untuk menunjukkan apakah dari lingkup adalah lensa mata yang dokter Anda
kanker telah menyebar ke paru-paru Anda. Tes ini terlihat melalui untuk melihat gambar-gambar
dapat diberikan dengan tes awal lain ketika kanker yang ditunjukkan oleh kamera.
ovarium pertama dicurigai atau ditemukan. Hal ini
juga dapat diberikan setelah pengobatan untuk
memeriksa hasil perawatan. Sebuah dada x-ray
Untuk tes darah, dokter akan memasukkan jarum tes fungsi hati
ke dalam vena Anda untuk menghapus sampel Hati adalah organ yang melakukan banyak
darah. Darah sering dihapus dari pembuluh darah pekerjaan penting, seperti racun menghapus dari
di lengan. jarum mungkin memar kulit Anda dan darah Anda. fungsi hati tes kimia ukuran yang
Anda mungkin merasa pusing sesudahnya. Sampel dibuat atau diproses oleh hati. Tingkat yang terlalu
darah kemudian akan dikirim ke laboratorium untuk tinggi atau rendah mungkin merupakan tanda
pengujian. Jenis-jenis tes darah yang digunakan kerusakan hati atau penyebaran kanker. tes fungsi
untuk kanker ovarium dijelaskan berikutnya. hati sering dilakukan bersama dengan profil kimia
darah.
CBC (hitung darah lengkap)
Sebuah CBC mengukur jumlah sel-sel darah merah, CA-125 dan penanda tumor lainnya
sel darah putih, dan trombosit. Dokter Anda akan Sebuah penanda tumor adalah zat yang ditemukan
ingin tahu apakah Anda memiliki cukup sel darah dalam jaringan tubuh atau cairan yang mungkin
merah untuk membawa oksigen ke seluruh tubuh merupakan tanda kanker. CA-125 adalah
Anda, sel-sel darah putih untuk melawan infeksi, dan penanda tumor untuk kanker ovarium. Ini adalah
trombosit untuk mengontrol perdarahan. jumlah protein dengan molekul gula yang melekat
darah Anda mungkin abnormal-terlalu rendah atau padanya yang dibuat oleh sel-sel normal dan sel
terlalu tinggi karena kanker atau masalah kesehatan kanker ovarium. Tingginya kadar CA-125 dalam
lain. darah mungkin merupakan tanda dari kanker
ovarium atau kondisi kesehatan lain.
profil kimia darah
Sebuah profil kimia darah mengukur tingkat bahan Sebuah CA-125 tes mengukur jumlah CA-125
kimia yang berbeda dalam darah Anda. Bahan kimia dalam darah. Tes ini tidak digunakan sendiri untuk
dalam darah Anda berasal dari hati, tulang, dan mendiagnosa kanker ovarium. Tapi, hal itu dapat
organ lainnya dan jaringan. Dokter menggunakan tes dilakukan bersama dengan tes awal lain jika dokter
ini untuk menilai kesehatan organ seperti hati dan Anda mencurigai kanker ovarium. Hal ini juga dapat
ginjal. dilakukan selama dan setelah pengobatan untuk
memeriksa hasil perawatan.
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 20
2 Pengujian untuk kanker ovarium tes Tissue | Ulasan
pementasan bedah. Ini adalah cara yang paling Dokter akan mengambil sampel dari tempat-
lengkap dan akurat untuk tahap kanker ovarium. tempat di mana kanker ovarium sering
menyebar.
Apa yang harus tahu ... Sebuah onkologi ginekologi
adalah seorang dokter bedah
yang ahli dalam kanker yang
ahli NCCN merekomendasikan dimulai di organ reproduksi
bahwa pementasan bedah wanita.
dilakukan oleh seorang ahli
onkologi ginekologi.
Jumlah sampel yang diambil tergantung pada ???? omentum - lapisan penutup jaringan
seberapa jauh dokter Anda berpikir kanker lemak organ di perut
telah menyebar. situs biopsi mungkin
???? selaput perut - jaringan yang melapisi
termasuk yang berikut:
bagian dalam dari perut dan panggul dan
???? kelenjar getah bening di dekatnya - mencakup sebagian besar organ dalam
kelompok khusus sel melawan penyakit ruang ini
???? daerah perut - daerah perut antara Jika Anda tidak memiliki ascites, dokter Anda
mungkin “mencuci” ruang di dalam perut Anda
dada dan panggul
(rongga peritoneum) dengan cairan khusus. Ini
???? spiral - otot-otot di bawah tulang rusuk disebut cuci peritoneal. Sampel cairan kemudian
yang membantu seseorang bernapas akan diuji untuk kankersel. Sampel ini disebut
pencucian peritoneal, tetapi sering disebut sebagai
“pembasuhan.”
Gambar 7
situs biopsi mungkin
dalam perut dan
spiral
panggul omentum
Bedah digunakan untuk selaput perut
pementasan kanker ovarium.
asites
sampel biopsi akan diambil dari
tumor serta organ dan jaringan
kelenjar
lain di dekat ovarium. Ini Kanker ovarium di
mungkin termasuk diafragma, getah bening
omentum, peritoneum, ascites,
dan kelenjar getah bening di
dekatnya.
Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com
Saran terbaik yang saya bisa menawarkan seseorang menghadapi penyakit adalah untuk tetap positif
tidak peduli berapa banyak air mata Anda ke bawah, berjuang untuk kehidupan Anda layak, dan
harap pro-aktif karena tidak ada satu pada setiap usia, kelas, atau ras tak terkalahkan kanker, penyakit,
dan penyakit.
- Christa
tahap I tahap II
Tumor (kanker) hanya dalam ovarium. Kanker adalah salah satu atau kedua indung telur
Kankerdapat ditemukan dalam satu atau kedua dan telah menyebar ke organ atau jaringan lain
ovarium. Tapi, itu belummenyebar ke setiap dalam panggul. Kanker belum menyebar di luar
organ atau jaringan lain dalam tubuh. panggul atau ke kelenjar getah bening.
Lihat Gambar 8. Lihat Gambar 9.
tahap IA - Kanker hanya dalam satu ovarium dan tahap IIA - Kanker telah tumbuh ke dalam
tumor yang terkandung di dalam ovarium. dan / atau penyebaran implan pada rahim,
Kantung luar (kapsul) dari ovarium utuh. Tidak saluran tuba, atau keduanya.
ada kanker pada permukaan luar ovarium. Tidak
tahap IIB - Kanker telah tumbuh ke dalam dan /
ada sel-sel kanker ditemukan di asites atau
atau penyebaran implan pada organ atau
pencucian.
jaringan lain di panggul. Inimungkin termasuk
kandung kemih, usus besar sigmoid, rektum, atau
tahap IB - Kanker adalah di kedua ovarium. peritoneum dalam panggul. peritoneum adalah
kapsul utuh dan tidak ada kanker pada jaringan yang melapisi bagian dalam perut dan
Angka 8
Tahap I kanker ovarium
Ilustrasi Copyright © 2016 Inti Medis Media, All rights reserved. www.nucleusinc.com Dengan Cancer
Research UK (Original email dari CRUK) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-
sa/4.0)], melalui Wikimedia Commons
Gambar 9
Tahap II kanker ovarium
Dengan Cancer Research UK (email asli dari CRUK) [CC BY-SA 4.0
(http://creativecommons.org/licenses/by-sa/4.0)], melalui Wikimedia Commons Ilustrasi Copyright ©
2016 Inti Medis Media, All rights reserved. www.nucleusinc.com
lebih kecil.
perut.
luar perut.
Gambar 10
Tahap III kanker ovarium
Tahap III kanker ovarium adalah ketika
kanker telah menyebar di luar
panggul ke organ atau jaringan di
perut.
Dengan Cancer Research UK (Original email dari CRUK) [CC BY-SA 4.0
(Http://creativecommons.org/licenses/by-sa/4.0)], melalui Wikimedia Commons
Gambar 11
kanker ovarium stadium IV
Dengan Cancer Research UK (Original email dari CRUK) [CC BY-SA 4.0
(Http://creativecommons.org/licenses/by-sa/4.0)], melalui Wikimedia Commons Ilustrasi
Copyright © 2016 Inti Medis Media, All rights reserved. www.nucleusinc.com
???? Tingkat 1 sel kanker terlihat mirip Beberapa ahli patologi menggambarkan grading
dengan yang normal sel. Ini juga disebut hanya dalam dua kelas: kelas tinggi atau kelas
rendah. kelas rendah termasuk
kelas rendah. Sel kanker ini tumbuh
definisi kelas 1 di atas. kelas tinggi termasuk kelas
lambat dan cenderung menyebar.
2 dan kelas 3 definisi.
onkologi ginekologi harus melakukan operasi terbaik untuk semua pasien. Sering ada lebih
awal untuk kanker ovarium bila memungkinkan. dari satu pengobatanpilihan, termasuk uji klinis.
kanker ovarium dapat ditemukan di Bagian 5 tidurobat. obat-tidur Perilaku jenis bicara
dan 6. pengobatan yang Anda dan dokter Anda terapi-mungkin juga membantu.
punya.
adalah respon yang sangat normal. Anda ???? Menurunkan stres pengasuh
Mendapatkan perawatan
perencanaan perawatan muka
Berbicara dengan dokter Anda tentang
yang baik
prognosis Anda dapat membantu dengan
perencanaan pengobatan. Jika kanker tidak
dapatdikendalikan atau disembuhkan, rencana
perawatan untuk akhir hidup dapat dibuat. Namun,
pembicaraan seperti itu sering terjadi terlambatatau
tidak sama sekali. Dokter Anda dapat menunda
pembicaraan ini untuk
perencanaan perawatan muka dimulai dengan untuk Anda. Ini adalah kertas hukum yang dokter
pembicaraan yang jujur antara Anda dan dokter Anda harus mengikuti. Hal ini dapat
Anda. Anda tidak perlu tahu persis rincian dari mengungkapkan keinginan Anda tentang hidup-
mempertahankan mesin, seperti tabung makan.
prognosis Anda. Hanya memiliki ide umum akan
Bisajuga termasuk perawatan Anda ingin jika
membantu dengan perencanaan. Dengan
jantung atau paru-paru adalah untuk berhenti
iniinformasi, Anda dapat memutuskan pada titik
bekerja. Jika Anda sudah memilikimuka direktif,
apa Anda ingin menghentikan kemoterapi atau
perawatan lainnya, jika sama sekali. Anda juga mungkin perlu diperbarui untuk menjadi sah secara
pengobatan kanker.
dalam tahap untuk membantu rencana ???? rencana perawatan Anda harus mencakup
- Alicia
Bagian 4 menjelaskan jenis utama dari kanker dari tubuh Andamungkin. Untuk
pengobatan untuk kanker ovarium. melakukannya, tumor diangkat bersamadengan
Informasi ini dapat membantu Anda
memahami pilihan pengobatan yang organ dan jaringan lain di mana sel-sel kanker
tercantum dalam panduan pengobatan di memiliki atau mungkin telah menyebar.
Bagian 5 dan 6. Hal ini juga dapat
membantu Anda tahu apa yang diharapkan Sejumlah prosedur dapat dilakukan selama
selama pengobatan. Tidak setiap orang
dengan kanker ovarium akan menerima perawatan bedah untuk kanker ovarium. Jenis
setiap perlakuan terdaftar. dan tingkat operasi Anda akan memiliki
ooforektomi) adalah operasi untuk sebanyak kanker mungkin. Ini disebut debulking
mengeluarkan hanya satu ovarium dan operasi atauoperasi Cytoreductive. Selama operasi
satu ovarium.
Debulking operasi dapat menghapus semua atau Dengan demikian, laparotomi adalah metode yang
bagian dari organ terdekat di mana kanker telah paling umum dan disukai untuk operasi kanker
menyebar. Lihat Gambar 12. ovarium. ahli NCCN merekomendasikan bahwa itu
Ini mungkin termasuk menghapus organ seperti harus digunakan ketika pementasan bedah atau
limpa, kandung empedu, dan usus buntu. Hal ini operasi debulking direncanakan.
juga dapat menghapus bagian dari Anda perut,
hati, pankreas, kandung kemih, diafragma, dan Laparoskopi adalah metode operasi lain yang dapat
usus. Kelenjar getah bening yang terlihat digunakan dalam beberapa kasus. Laparoskopi
berbeda atau lebih besar dari normal juga harus menggunakan potongan kecil di dalam perut bukan
dihapus jika memungkinkan. satu besar. alat-alat kecil yang dimasukkan melalui
pemotongan untuk melakukan operasi. Salah satu
metode operasi alat yang disebut laparoskopi. Ini adalah tabung
Paling sering, operasi dilakukan dengan panjang dengan cahaya dan kamera di akhir. Kamera
menggunakan laparotomi. Sebuah laparotomi memungkinkan dokter melihat ovarium Anda dan
adalah luka bedah panjang di perut. Hal ini sering jaringan lain di dalam perut Anda. Alat-alat lain yang
up-dan-down (vertikal) dipotong dari atas pusar ke digunakan untuk menghilangkan jaringan.
tulang panggul. Hal ini memungkinkan dokter
melihat tumor dan organ dan jaringan lain di perut
dan panggul.
Gambar situs
operasi 12
debulking spiral
Limpa
Debulking operasi
menghilangkan sebanyak Hati Perut
kanker mungkin. Tingkat Kandung
empedu Pankreas
operasi tergantung pada
seberapa jauh kanker telah selaput perut omentum
menyebar. Ini dapat
menghapus semua atau Usus besar Usus halus
bagian dari organ terdekat Lampiran
seperti Anda hati, limpa, Kandung
lambung, kandung kemih
empedu, pankreas, usus,
usus buntu, dan kandung
kemih.
Ilustrasi Copyright © 2017 Inti Medis Media, All rights reserved. www.nucleusinc.com
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 36
4 pengobatan kanker kemoterapi
Beberapa efek samping yang umum dari operasi
untuk kanker ovarium meliputi pembengkakan
Laparoskopi dapat digunakan dalam kasus-kasus kaki, kesulitan buang air kecil, dan sembelit. Jika
tertentu, seperti ketika kanker hanya dalam ovarium. Anda belum mengalami menopause, maka
Jarang, hal itu dapat digunakan ketika kanker telah operasi yang menghilangkan kedua ovarium akan
menyebar di luar ovarium. menyebabkan menopause.
Operasi ini hanya boleh dilakukan oleh seorang
ahli onkologi ginekologi dengan banyak
pengalaman.
Altretamine Hexalen®
capecitabine Xeloda®
carboplatin -
cisplatin Platinol®
siklofosfamid -
docetaxel Taxotere®
doxorubicin adriamycin®
Doxorubicin, liposom
Doksorubisin®
injeksi
Etoposid, lisan -
gemcitabine Gemzar®
ifosfamida -
irinotecan Camptosar®
melphalan Alkeran®
oxaliplatin Eloxatin®
paclitaxel Taxol®
Paclitaxel, albumin-
Abraxane®
terikat
pemetrexed Alimta®
topotecan Hycamtin®
siklus memungkinkan tubuh memiliki
Karena obat kemoterapi berbeda dalam kesempatan untuk pulih sebelum pengobatan
bagaimana mereka bekerja, lebih dari satu berikutnya. Siklus panjang bervariasi tergantung
obat yang sering digunakan.
pada obat yang digunakan.Seringkali, siklus yang
SEBUAHKombinasi rejimen adalah
7, 14, 21, atau 28 hari panjang. Itujumlah hari
penggunaan dua atau lebih narkoba. Bila
hanya satu obat digunakan, itu disebut perawatan per siklus dan jumlah siklus yang
agen tunggal. Sebuah rejimen adalah diberikan juga bervariasi tergantung pada
gen,mereka sekarang harus bergantung pada Pazopanib adalah jenis terapi yang ditargetkan
PARP untuk memperbaiki DNA. Obat ini disebut TKI (tyrosine kInase sayanhibitor). tirosin
memblokir aksi PARP sehingga PARP tidak bisa kinase adalah protein dalam sel yang penting
lagi memperbaiki kerusakan DNA dalam sel bagi banyak fungsi sel. Ini termasuk
apapun. Ini sekarang membuat sangat sulit mengirimkan sinyal pada sel untukpertumbuhan
sel, kelangsungan hidup, dan kematian.
bagi sel-sel kanker denganBRCAmutasi untuk
memperbaiki DNA yang rusak. Jika sel Beberapa kinase tirosin mengirim sinyal yang
tidakmampu memperbaiki DNA yang rusak, itu memberitahu sel-sel kanker tumbuh dan
akan mati.
membelah untuk membuat sel-sel baru.
Sementara semua tiga obat bekerja sama,
masing-masing agen ini telah disetujui untuk
digunakan tertentu untuk mengobati kanker
ovarium. Biasanya pasien harus memilikiBRCA1
atau BRCA2mutasi germline. UntukMisalnya,
olaparib digunakan pada pasien dengan BRCA
mutasi yang telah berkembang setelah tiga
baris pengobatan kemoterapi sebelumnya.
Rucaparib diberikan kepada mereka yang
memiliki penyakit kambuhan yang sensitif
platinum. Platinum sensitif berarti kanker
awalnya menanggapi dengan kemoterapi
berbasis platinum tetapi kanker datang
kembali (kambuh) lebih dari 6 bulan setelah
pengobatan. Niraparib digunakan dalam
pengaturan berulang tetapi sebagai terapi
pemeliharaan (untuk membantu menjaga
respon yang baik) setelah kemoterapi berbasis
platinum.
Estrogen dan progesteron adalah hormon yang
membantu beberapa jenis kanker ovarium
Beberapa mengirim sinyal untuk pembuluh
tumbuh. Estrogen sebagian besar dibuat oleh
darah baru untuk tumbuh ke dalam tumor
ovarium dan dibuat dalam jumlah kecil
sehingga dapat bertahan hidup. target
olehkelenjar adrenal, hati, dan lemak tubuh.
Pazopanib beberapa kinase tirosin dan blok
progesteron
sinyal yang membantu kanker tumbuh dan juga sebagian besar dibuat oleh indung telur.
menyebar. Memblokir sinyal-sinyal ini dapat Memblokir hormon ini dari bekerja atau
memperlambat pertumbuhan kanker. menurunkan tingkat hormon dapat membantu
meliputi:
memberikan, sisinya efek, dan seberapa sering ???? Anda akan diawasi ketat oleh medis
memberikan pengobatan. Anda tim
kelayakan).
???? Seperti tes atau pengobatan, mungkin utama yang digunakan untuk
???? tes baru atau perawatan mungkin tidak ???? Pembedahan sering digunakan sebagai
bekerja
pengobatan utama untuk kanker ovarium.
- Risa
tahap IA
pementasan + debulking yang diperlukan (kesuburan yang
diinginkan)
• Pembedahan untuk mengangkat kedua ovarium, baik saluran
Kanker hanya dalam satu ovarium
tuba, dan
uterus + pementasan bedah
• Pembedahan untuk mengangkat kedua ovarium dan tuba
fallopi nya +
tahap IB pementasan bedah (kesuburan yang diinginkan)
Kanker adalah di kedua ovarium • Pembedahan untuk mengangkat kedua ovarium, baik saluran
hanya tuba, dan
uterus + pementasan bedah + debulking yang diperlukan
• Pembedahan untuk mengangkat satu ovarium dan tuba
tahap IC fallopi nya + bedah
Kanker adalah salah satu atau
kedua ovarium pementasan (pasien tertentu)
dan kanker pada ovarium
permukaan, kapsul ovarium
memiliki
pecah, dan / atau sel-sel kanker
yang •tuba,
Pembedahan untuk mengangkat kedua ovarium, baik saluran
dan
di asites atau pencucian uterus + pementasan bedah + debulking yang diperlukan
Pedoman NCCN untuk Pasien®:
Kanker ovarium, Versi 1,2017 45
5 panduan pengobatan Tahap I kanker ovarium
Operasi dan pementasan lengkap • Tidak ada lagi operasi yang dibutuhkan
Kemungkinan stadium IA atau IB, kelas 1
Cancer is in one or both ovaries only and it is low • Surgical staging
grade (slow-growing)
Guide 4 shows the primary treatment options for The main factor is whether or not the prior surgery
stage I ovarian cancer that was confirmed by a prior and staging were complete. Surgical staging is
surgery or biopsy. Stage I ovarian cancer is when considered complete if the prior surgery removed
cancer is only in the ovaries and has not spread to all of the cancer, both ovaries, both fallopian tubes,
other tissues or organs. Primary treatment is the the uterus, nearby supporting tissues, the
main treatment used to rid the body of cancer. omentum, and nearby lymph nodes.
Surgery is often used as primary treatment for The cancer stage and cancer grade are also
stage I ovarian cancer. But, there is more than important. The cancer stage describes how far the
one option and more than one type of surgery to cancer has grown and spread. The cancer grade
choose from. Which option is best for you describes how fast the cancer will likely grow based
depends on a few key factors. on how much the cancer cells look like normal cells.
Grade 1 cancer tends to grow more slowly, grade 3 The third option is to start treatment with
tends to grow more quickly, and grade 2 is in chemotherapy instead of having more surgery. If your
between. See page 30 for more details about doctor thinks some cancer remains, then completion
cancer grades. surgery and surgical staging are recommended.
Primary treatment options For ovarian cancer that is likely stage IA or IB,
To plan primary treatment, your doctor will first grade 3 or clear cell, or stage IC, the treatment
assess the results of the prior surgery. If the prior options depend on whether or not the prior surgery
surgery and staging were complete, then no more removed all of the cancer. If your doctor thinks no
surgery is needed at this time. See Next steps at cancer remains, then one option is to have
the end of this section. completion surgery and surgical staging. Another
option is to start treatment with chemotherapy
If surgery and staging were not complete, then instead of having more surgery. If your doctor
more surgery is recommended. This is to confirm thinks some cancer remains, then completion
the cancer stage and, if needed, remove any surgery and surgical staging are recommended.
remaining cancer. The type and extent of surgery
depends on the likely cancer stage, cancer grade,
and how much (if any) cancer remains.
Guide 5 shows the options that are recommended Another key factor is your risk for peripheral
after surgery for stage I ovarian cancer. Most women neuropathy—a nerve problem that causes pain,
with ovarian cancer will receive chemotherapy after tingling, and numbness typically in the hands
primary treatment with surgery. This is called adjuvant and feet.
treatment. Your doctor may also refer to this as
primary chemotherapy. Neuropathy is a common side effect of paclitaxel
and to a less degree carboplatin. If you have a high
Which option is recommended after surgery depends risk for nerve problems, then docetaxel and
on the cancer stage and the cancer grade. The carboplatin may be a better option for you. Some
cancer stage is a rating of how much the cancer has patients may not be able to tolerate the severe side
grown and spread. The cancer grade describes how effects of chemotherapy. This includes patients
fast the cancer will likely grow based on how much who are older than 65, have other health problems,
the cancer cells look like normal cells. Grade 1 cancer or have trouble doing daily activities. For these
tends to grow more slowly, grade 3 tends to grow patients, paclitaxel and carboplatin given once a
more quickly, and grade 2 is in between. week may be a good option. Giving these drugs
once a week may cause fewer side effects than
Treatment options
when they are given once every three weeks. It
For stage IA or IB ovarian cancer, the options depend
may be better tolerated by certain patients.
on the cancer grade. For grade 1, observation with
follow-up tests is recommended. Observation is a Testing during chemotherapy treatment
period of testing to watch for cancer growth after During treatment, your doctor will give tests to check
treatment. For grade 2, observation with follow-up how well the chemotherapy is working and to assess
tests is still an option. A second option is to receive for side effects. A physical and pelvic exam may be
chemotherapy given in a vein. This is called IV done at least every 2 to 3 cycles. You may also have
chemotherapy. For all other stage I ovarian cancers, other tests as needed. This may include imaging
IV chemotherapy is the only recommended option. tests, CBC, blood chemistry profile, and tests of CA-
125 or other tumor markers.
The number of chemotherapy cycles recommended
depends on whether or not surgical staging was
completed. It may have been completed during the
initial surgery or a second surgery. If so, 3 to 6
Next steps
cycles of chemotherapy should be given. If surgical See Guide 10 on page 58 for follow-up tests
staging was not completed, then at least 6 cycles that are recommended during observation and
should be given. after completing chemotherapy treatment.
Stage III or IV
(surgery may not be an option, • Seek an expert opinion from a gynecologist oncologist
disease is large)
Cancer has spread outside the pelvis • Biopsy to confirm type of ovarian cancer
to the tissue lining the abdomen and/or • Start chemotherapy to shrink the cancer (neoadjuvant
to nearby lymph nodes, or cancer has treatment), then surgery as described above
spread to organs outside the abdomen
Guide 6 shows the primary treatment options for For stage II ovarian cancer, you will have surgery to
newly diagnosed stage II, III, and IV ovarian cancer. remove both ovaries, both fallopian tubes, the
For ovarian cancer confirmed by a prior surgery, see uterus, and all cancer that can be seen. Surgical
Guide 7. Primary treatment is the main treatment staging procedures should also be done. This is to
given to rid the body of cancer. The primary check for cancer cells that have spread outside the
treatment options depend on the cancer stage. The pelvis and can only be seen with a microscope.
cancer stage is a rating of how far the cancer has During surgical staging, biopsy samples will be
grown and spread. taken from nearby organs and tissues where
ovarian cancer often spreads. The omentum and
Stage II ovarian cancer is when cancer has spread
nearby lymph nodes will also be removed.
to nearby organs in the pelvis such as the other
ovary, the fallopian tubes, and the uterus. Stage III For stage III or IV ovarian cancer, the treatment
ovarian cancer has spread outside the pelvis to options depend on how much tissue the cancer has
tissues in the abdomen. Stage IV ovarian cancer grown into. If the cancer hasn’t grown into a lot of
has spread outside the abdomen to distant sites. tissue and can be safely removed, then surgery is
recommended. In this case, surgery will remove both
Primary treatment ovaries, both fallopian tubes, the uterus, and all or as
Surgery is often used as primary treatment for much cancer as possible. Surgery may also remove
ovarian cancer. The type and extent of surgery all or part of organs or tissues the cancer has spread
depends on the cancer stage. For more details to. This is called debulking surgery or cytoreductive
about each type of surgery, see page 35. surgery. It aims to reduce the amount of cancer in
your body as much as possible.
The goal is to not leave behind any tumors that are Guide 7 shows the primary treatment options for
1 cm or larger. Surgical staging isn’t needed stage II, III, and IV ovarian cancers confirmed by a
because the cancer has spread outside the pelvis. prior surgery or biopsy. The cancer stage is a rating
of how far the cancer has grown and spread.
If the cancer has grown into a lot of tissue, it might
not be possible to safely remove it all with initial Stage II ovarian cancer is when cancer has spread
surgery. Your doctors may decide to give to nearby organs in the pelvis such as the other
chemotherapy first to try to shrink the cancer ovary, the fallopian tubes, and the uterus. Stage III
before surgery. This is called preoperative or ovarian cancer has spread outside the pelvis to
neoadjuvant chemotherapy. (See Guide 2 on tissues in the abdomen. Stage IV ovarian cancer
page 38 for chemotherapy recommendations.) It is has spread outside the abdomen to distant sites.
important that a gynecologic oncologist is involved
in this assessment and treatment decision. You Surgery is often used as primary treatment for
will likely have a biopsy (core biopsy preferred) to ovarian cancer. But, there is more than one
confirm ovarian cancer before starting option and more than one type of surgery to
chemotherapy treatment. choose from. Which option is best for you
depends on a few key factors.
After a few cycles of chemotherapy, your doctor will
check the status of the cancer. If your doctor thinks If the remaining cancer can likely be removed,
all the cancer can be safely removed, then you will then tumor reductive surgery is recommended.
have surgery as described above. You will likely Your doctor will remove as much as the cancer as
then receive additional chemotherapy after an he or she possibly can. This is called tumor
interval surgery. reduction or a “debulking” procedure.
• Some cancer remains and
can likely be removed by • Tumor reductive surgery
surgery
Guide 8. Treatment after surgery for stages II, III, and IV ovarian cancer
Stage II or III
Cancer has spread to nearby
organs and tissues in the • Chemotherapy given in the abdomen (IP), or
pelvis, or it has spread to
tissues in the abdomen
• Chemotherapy given in a vein (IV) for a total of 6 cycles
Stage IV
• Completion surgery based on tumor response and possibility or
Cancer has spread outside
the abdomen to organs and being able to remove the cancer (certain patients)
tissues in other parts of the
body
Bevacizumab with paclitaxel and carboplatin Injection in a vein (IV) 21 days (3 weeks)
Guide 8 shows the options that are recommended There are a few adjuvant treatment options to
after surgery for stage II, III, or IV ovarian cancer. choose from. Which option is best for you depends
Most women with ovarian cancer will receive on the cancer stage and how much cancer is left
chemotherapy after primary treatment with surgery. after surgery. The cancer stage is a rating of how
This is called adjuvant treatment. Your doctor may much the cancer has grown and spread. The goal
also refer to this as primary chemotherapy. of surgery is to not leave behind any tumors that
are 1 cm or larger.
• Clinical trial
or
Complete response • Observation with follow-up tests
Tests show that the cancer is
completely gone; all signs and or
symptoms have disappeared • Maintenance treatment with pazopanib
or
• Maintenance treatment with paclitaxel
• Clinical trial
Partial response and/or
The cancer has improved but it’s
not completely gone; some signs • Start recurrence treatment
and symptoms remain and/or
• Best supportive care
• Clinical trial
Persistent or progressive disease and/or
The cancer stayed the same or it • Best supportive care
continued to grow during treatment and/or
• Start recurrence treatment
Follow-up visits every 2 to 4 months for 2 years, then every 3 to 6 months for 3
years, then once a year after 5 years with:
• Physical exam and pelvic exam
• CA-125 blood test or other tumor markers if initial results were high
• CT, MRI, PET/CT of the chest, abdomen, and pelvis, or PET (bottom of the skull to mid-thigh) as needed
Guide 10 shows the follow-up tests that are Blood tests to measure CA-125 or other tumor
recommended during observation and after markers are recommended if levels were high when
completing cancer treatment. Observation is a period the cancer was first found. Rising CA-125 levels
of testing to watch for cancer growth. Follow-up tests after treatment may be an early sign that the cancer
are used to check for signs of cancer return (relapse) has come back.
or spread (metastasis). Doctors also use follow-
up tests to monitor your health and check for A CBC measures the number of each type of blood
side effects of treatment. cell in a sample of blood. A blood chemistry profile
may be done to check the health of certain organs
Follow-up tests
and body systems.
Follow-up tests are recommended every 2 to 4
months for 2 years, then every 3 to 6 months for 3 Imaging tests of your chest, abdomen, and pelvis
years, then once a year. Many of the tests used may be used to check if the cancer has spread. A
for follow-up will be the same as those used to CT, MRI, PET, or PET/CT scan may be used. A
find and confirm (diagnose) ovarian cancer. chest x-ray may be used to show if cancer has
spread to your lungs. If you had fertility-sparing
The physical exam and pelvic exam help your surgery, then ultrasound may be used to check for
doctor check for physical signs that the cancer has cancer in the other ovary. Once you are finished
come back. Such signs may include swelling or having babies, you should have surgery to remove
bloating in your belly, abnormal lumps, or sudden the remaining ovary, fallopian tube, and uterus.
changes in weight. This is called completion surgery.
Guide 11. Treatment for ovarian cancer that has come back
• Clinical trial
• Currently on and/or
chemotherapy • Best supportive care
(disease keeps growing) and/or
• Start recurrence treatment
• Clinical trial
• Clinical trial
or
• Delay recurrence treatment until
Biochemical relapse symptoms appear (clinical relapse)
(increase in CA-125 levels
is the only sign that cancer • Prior chemotherapy or
has come back) • Start recurrence treatment now, this may
include platinum-based chemotherapy
or
• Best supportive care
Genetic counseling is also recommended if it was If it looks like the cancer has spread outside your
not done before treatment. Genetic counseling is a pelvis, then you will have surgery to remove as
discussion with a health expert about the risk for a much cancer as possible.
disease caused by changes in genes. This is
recommended because some health problems, For a biochemical relapse after prior chemotherapy
including ovarian cancer, can run in families. New (elevated CA-125 tumor marker level but no other
targeted therapies may also be available for woman evidence of recurrence), there are some options to
with certain genetic mutations. Thus, it is important choose from. The preferred option is to join a
for you to know if you have any genetic mutations. clinical trial. A clinical trial is a type of research that
studies how safe and helpful a test or treatment is.
Guide 11 (on page 59) shows the options for
ovarian cancer that has come back after prior For a clinical or radiographic relapse after
treatment. The return of cancer after treatment is chemotherapy, the options depend on long it’s been
called a recurrence or relapse. The treatment options since you finished treatment. If you finished
are based on the type of relapse and whether or not chemotherapy less than 6 months ago, there are
you’ve had chemotherapy before. three options to choose from. The first option is to
receive treatment within a clinical trial. The second
A biochemical relapse is when CA-125 levels are
option is to start recurrence treatment. The third
increased, but you don’t have any symptoms and
option is to receive best supportive care. Supportive
imaging tests show no signs that cancer has come
care is treatment given to relieve the symptoms of
back. A radiographic relapse is when imaging tests
cancer or side effects of cancer treatment. It aims
show signs that the cancer has come back. A
to improve quality of life and relieve any discomfort
clinical relapse is when you have symptoms that
you have. Supportive care may be given alone. It
signal the cancer has come back. Symptoms of
may also be given along with recurrence treatment
a relapse include pain or bloating in your pelvis or
or treatment within a clinical trial.
belly, unexplained weight loss, upset stomach,
constipation, trouble eating or feeling full fast, If you finished chemotherapy at least 6 months ago,
fatigue, and needing to urinate often or urgently. then you may have surgery to remove as much of
the cancer as possible. After surgery, or without
Once follow-up tests or symptoms signal a relapse, surgery, you still have other options to choose from.
you may have imaging tests if they weren’t done One option is to receive treatment within a clinical
recently. This may include a CT, MRI, PET, or trial. The second option is to receive platinum-
PET/CT scan of your chest, abdomen, and pelvis. based chemotherapy as recurrence treatment. This
is the preferred option especially for the first
Treatment options
recurrence. The third option is to receive a different
If cancer comes back and you haven’t had
type of drug for recurrence treatment. Best
chemotherapy yet, then the options are the same as
supportive care is also recommended.
those used for newly diagnosed ovarian cancer. This
means that you will have surgery to remove the The second option is to wait and not start
cancer and chemotherapy may be given next. The treatment until you have symptoms of a relapse.
type and extent of surgery depends on how far the The third option is to start recurrence treatment
cancer has spread. If it looks like the cancer is only in right away, which may not be chemotherapy. Best
your pelvis, then surgical staging may be done. supportive care is also recommended.
Preferred options
Targeted therapy
If cancer is platinum-sensitive: If cancer is platinum-resistant:
(single agent)
• Carboplatin • Docetaxel • Bevacizumab
• Cisplatin • Topotecan/bevacizumab
• Cisplatin/gemcitabine
Other options
• Altretamine • Melphalan
• Cyclophosphamide • Paclitaxel
• Carboplatin/paclitaxel/bevacizumab
• Paclitaxel, albumin-bound
(if cancer is plantinum-sensitive)
• Doxorubicin • Pazopanib
• Ifosfamide • Pemetrexed
Guide 12 (on page 61) shows the options that are therapy. Bevacizumab may continue until the
recommended for recurrence treatment. Recurrence disease or side effects worsen.
treatment is given after prior chemotherapy treatment
failed to kill all of the cancer or keep it away. Maintenance therapy is given to continue (maintain)
Recurrence treatments include chemotherapy, good results of prior treatment. Another example of
hormone therapy, and targeted therapy drugs. (See maintenance therapy is a newly approved targeted
Part 4 for more details about each type of drug.) agent called niraparib. This drug is considered for
Which option is best for you depends on a number of maintenance therapy after recurrence treatment.
factors, including the type and length of the treatment Niraparib may be an option for patients with
response to prior chemotherapy. platinum-sensitive disease that has a partial or
complete response after recurrence treatment.
Recurrence treatment is used to treat ovarian cancer
that has come back after a partial or complete
response to prior chemotherapy. It is also used to
treat ovarian cancer that did not respond or
continued to grow during prior chemotherapy
treatment. When cancer comes back after a
complete response, the options depend on how long
it has been since chemotherapy ended.
Guide 13 shows that surgery is the main treatment Surveillance and follow-up care follows the same
for a MMMT. Once surgery is complete and the path as for epithelial ovarian cancer. See Guides
cancer stage is known, other treatment may be 10 and 11 for follow-up tests, test results, and next
offered. This next treatment is known as adjuvant steps of care. Further treatment may be needed if
treatment — treatment given after the primary (first) the cancer comes back (recurs). Your doctor will
treatment for MMMT. follow you closely to watch for any signs or
symptoms of disease. If more treatment is needed,
Adjuvant treatment options include different types
options may include a clinical trial, recurrence
of chemotherapy. Some patients may benefit from
treatment, and/or best supportive.
using the same types of chemotherapy drugs
recommended for epithelial ovarian cancer. This
may include the option of getting an IP regimen
of cisplatin and paclitaxel. See Guide 8 on
page 54 for a list of chemotherapy drugs that may
be recommended. Other drug combinations given
as adjuvant treatment include cisplatin and
ifosfamide, carboplatin and ifosfamide, or paclitaxel
and ifosfamide.
Borderline •
See Guide 17 and 18
Clear cell is one of the subtypes of epithelial If the disease is considered borderline, treatment
ovarian cancer. Most epilthelial ovarian cancers options may include those recommended in
are the serous subtype. The two other subtypes Guides 17 and 18 for borderline epithelial tumors.
are mucinous (see Guide 15) and endometriod The adjuvant treatment options are fertility-
(see Guide 16). Clear cell is considered to be high sparing surgery, observation, hormone therapy,
grade. Thus, it may grow and spread more quickly. or chemotherapy.
• Observe
• Stage IA-IB or
• If not done before, fertility-sparing surgery for certain
patients
• Observe
or
• IV taxane/carboplatin for 3 to 6 cycles
If not done before: or
• GI tests
• CEA
• Stage IC • 5-FU + leucovorin + oxaliplatin
or
(carcinoembryonic
• Capecitabine + oxaliplatin
antigen) blood test
• Consider or
surgical staging • If not done before, fertility-sparing surgery for certain
patients
• Chemotherapy
or
Mucinous carcinoma of the ovary is usually diagnosed Mucinous carcinoma of the ovary is usually
early on. This cancer involves large tumors that tend diagnosed after surgery for a suspicious tumor in
to fill the whole belly (abdomen) and pelvic area. The the belly and pelvic area. The same tests that are
diagnosis occurs at a young age; usually at 20 to 40 ordered to diagnose other ovarian cancer are used
years. Most people with mucinous carcinoma of the for mucinous tumors. See Part 2, Testing for
ovary respond well to treatment. ovarian cancer.
Guide 16 covers adjuvant treatment options for For those with borderline low-grade serous/
stage I to IV, and borderline disease. For stages I and endometrioid epithelial carcinoma, fertility-sparing
II, observation may be option. Chemotherapy is a surgery is an option. Adjuvant treatment options
treatment option for stage IC to IV, but low-grade for borderline disease are listed in Guides 17 and
serous/endometrioid epithelial carcinoma may not 18. The options include observation,
respond as well to this treatment. Stage IC to II chemotherapy, or hormone therapy.
chemotherapy may include IV carboplatin with either
paclitaxel or docetaxel. Another recommended
treatment is hormone therapy, which includes
anastrozole, letrozole, leuprolide, or tamoxifen. Stage
III to IV treatment options include
chemotherapy (same given for epithelial
ovarian cancer) or hormone therapy.
This type of cancer is slow growing and may not If surgical staging was complete and no invasive
invade other tissue. An LMP tumor may be found implants were found, then this is the only option
by chance during surgery or tests for another recommended. If invasive implants were found, a
health problem. Most often, it is diagnosed after second option is to receive chemotherapy. If surgical
surgery. Surgery is also used as primary staging was not complete, then another option is to
treatment for this type of tumor. have more surgery. This may include fertility-sparing
surgery and surgical staging procedures.
There is more than one primary treatment option for
an LMP tumor. Your doctor will consider more than For surgical staging, biopsy samples will be taken
one factor when deciding on treatment. First, surgical from the tumor and nearby tissues. The omentum
staging will be done to assess the extent of disease. and nearby lymph nodes may also be removed. If
Second, your doctor will check whether or not invasive you don’t want to have babies, then you may have
implants were found. Tumor cells that spread and completion surgery. Completion surgery removes
grow on the surface of nearby organs are called the remaining ovary (or ovaries), fallopian tubes,
noninvasive implants. The tumor cells rarely grow into uterus, omentum, and any tumor cells found on
(invade) tissue—called invasive implants. Lastly, he or nearby tissue. In some cases, nearby lymph nodes
she will factor in whether or not you want to have may also be removed.
babies after treatment. Fertility-sparing surgery is
always an option for an LMP tumor. If invasive implants were found, then surgery may
be followed by chemotherapy. If no invasive
Observation with follow-up tests is an option for all implants were found, then no other treatment is
patients. See Guide 17. recommended after either surgery. Instead, you will
begin observation with follow-up tests.
Guide 18. Borderline epithelial tumors (LMP) with incomplete surgical staging
•orObserve
or
• Consider treatment for grade 1 (low-grade)
• Residual serous epithelial carcinoma (see Guide 16)
disease
remaining Fertility not desired, no invasive implants or
unknown:
CT of the chest, after surgical
staging • Observe
or
abdomen, and
pelvis with
contrast • Completion surgery and removal of residual
disease
Fertility not desired, invasive implants at prior
surgery:
• Completion surgery and removal of residual
disease
or
• Observe
or
• Consider treatment for grade 1 (low-grade)
serous epithelial carcinoma (see Guide 16)
• No residual
disease
remainingaftersurgical
• Observe
staging
Follow-up visits every 3 to 6 months for 5 years, then once a year with:
• Physical exam and pelvic exam
• CA-125 blood test or other tumor markers as needed
• CBC and blood chemistry profile as needed
• CT, MRI, PET/CT of the chest, abdomen, and pelvis, or PET (bottom of the skull to mid-thigh) as needed
Guide 18 shows adjuvant treatment options if treatment. Many of the follow-up tests are the
surgical staging was not complete. One option is to same as those used to find and confirm the tumor.
have more surgery. Fertility-sparing surgery is an
option for patients with residual disease that remains Follow-up visits are recommended every 3 to 6
after surgical staging. If you don’t want to have months for 5 years. After that, they are recommended
babies, then you may have completion surgery. once a year. A physical exam and pelvic exam should
Completion surgery removes the remaining ovary (or be done at every follow-up visit. These exams help
ovaries), fallopian tubes, uterus, omentum, and any your doctor check for physical signs that the tumor has
tumor cells found on nearby tissue. In some cases, come back. Such signs may include swelling or
nearby lymph nodes may also be removed. bloating in your belly, abnormal lumps, or sudden
changes in weight. Blood tests to measure CA-125 or
If invasive implants were found, chemotherapy is other tumor markers are recommended if levels were
another option for those who want or don’t want high when the tumor was first found. Rising CA-125
fertility-sparing surgery. If no invasive implants levels after treatment may be an early sign that the
were found, no systemic treatment is tumor has come back. A CBC measures the number
recommended after either surgery. You may begin of each type of blood cell in a sample of blood. A
observation or have fertility-sparing surgery with blood chemistry profile may be done to check the
removal of residual disease. health of certain organs and body systems.
Guide 19 shows the follow-up tests that are Ultrasound uses sound waves to make pictures of
recommended during observation and after primary the inside of the body. It may be used to look for
treatment for an LMP tumor. Observation is a period signs of tumor growth if you had fertility-sparing
of testing to watch for tumor growth. Follow-up tests
surgery. This type of surgery only removes one
are given on a regular basis to watch for signs that
ovary and its fallopian tube so that you will still be
tumor cells have come back or spread after
able to have babies. Once you are finished having
babies, you should have completion surgery.
Guide 20. Treatment for borderline epithelial tumors (LMP) tumor relapse
If no invasive implants
• Observe
• Surgical
Clinical relapse evaluation If invasive implants or low-grade invasive
Relapse based on symptoms, carcinoma
imaging test results, or and
• See Guide 16 for grade 1 (low-grade)
increase in CA-125 levels • Debulking if
serous epithelial carcinoma options
needed
Invasive carcinoma (high-grade)
• See Part 5 for treatment of epithelial
ovarian cancer
Stage IA to IC
• Fertility sparing • Stage I low risk • Observe
surgery with
complete staging
• Stage I high risk • Observe
or or
• Intermediate risk • Consider platinum-based chemotherapy
All others
• Platinum-based chemotherapy
• Complete staging
• Stage II-IV or
• Radiation for limited disease
Malignant sex cord-stromal tumors include granulosa Chemotherapy drugs given to treat malignant sex
cell tumors and Sertoli-Leydig cell tumors. Granulosa cord-stromal tumors include BEP (bleomycin,
cell tumors are the more common of the two. etoposide, and cisplatin), as well as paclitaxel and
Malignant sex cord-stromal tumors are rare. cisplatin or carboplatin. If you are prescribed
Malignant sex cord-stromal tumors are usually a bleomycin, pulmonary function tests may be before
slow-growing (indolent) type of ovarian cancer. It is treatment. The pulmonary function tests will check
often found at an early stage of disease. to see if your lungs are working properly.
• Clinical trial
Clinical relapse of stage II-IV or
Relapse based on symptoms,
imaging test results, or • Consider secondary cytoreductive surgery
increase in CA-125 levels or
• Recurrence treatment
Initial surgery
• Fertility desired • Fertility-sparing surgery and comprehensive staging
Initial surgery
• Fertility not desired • Completion staging surgery
Prior surgery
• Completely staged • See Guides 25 and 26 for treatment options per stage
Guide 24. Malignant germ cell tumors with incomplete surgical staging
Fertility desired
• Fertility-sparing surgery and
• Positive imaging and
positive tumor markers comprehensive staging
Dysgerminoma Fertility not desired
or • Completion staging surgery
Grade 1 immature • Negative imaging and
Guide 24 covers diagnosis, tests results, and If you are negative on imaging and tumor
treatment options for germ cell tumors. If diagnosed marker tests, you will be observed.
with dysgerminoma or grade 1 immature teratoma,
you will have imaging tests and blood tests (tumor For embryonal, endodermal sinus (yolk sac tumor),
markers will be measured). Tumor markers can be grade 2 to 3 immature teratoma, and tumors of
high in blood levels and indicate that cancer or mixed histology you will also have imaging and
another medical condition is present. Tumor markers blood tests (tumor markers will be measured). If
cannot be used alone to diagnose cancer. positive on imaging and tumor marker tests, you
will be are offered fertility-sparing surgery and will
Your imaging and tumor marker test results will have surgical staging. If you don’t want to have
determine which treatment options you are babies, you will have completion surgery. If other
offered. If positive on imaging and tumor marker remaining cancer can likely be removed, then
tests, you will be offered fertility-sparing surgery tumor reductive surgery is recommended. Your
and will have surgical staging. If you don’t want to doctor will remove as much of the cancer as
have babies, completion surgery will come next. possible This is called tumor reduction surgery.
Guide 25. Malignant germ cell tumors adjuvant treatment options by stage
Stage I dysgerminoa
or
Stage I, grade 1 immature
• Observe
teratoma
Guide 26. Possible response to chemotherapy for malignant germ cell tumors
Consider surgery or
observe
• Observe
• If necrotic tissue
Consider surgery or
Residual tumor on imaging
with normal tumor markers observe • CT of the chest, abdomen, and
pelvis or MRI as needed
• If benign teratoma
Consider surgery or
• Consider more platinum-based
observe
• If residual malignancy chemotherapy for 2 cycles
• TIP (paclitaxel + ifosfamide + cisplatin)
or
Elevated tumor markers
(persistent) with definitive • High-dose chemotherapy (strong
residual disease recommendation for care at a major
hospital for possible stem-cell transplant
and curative therapy)
Guide 27. Follow-up testing after treatment for malignant sex cord-
stromal tumors and malignant germ cell tumors
Follow-up tests
• Physical exam
• CA-125 blood test or other tumor markers (after 2 years for malignant germ cell tumors, only as needed)
• Chest x-ray; CT of the chest, abdomen, and pelvis; MRI; PET/CT; or PET as needed for germ cell
tumors only
• For concern of recurrence of malignant sex cord-stromal tumors and malignant germ cell tumors:
• CT of the chest, abdomen, and pelvis with contrast. Other imaging tests can be considered like
chest x-ray, MRI, PET/CT, or PET.
• CA-125 blood test or other tumor markers
Guide 27 covers follow-up tests that are Imaging tests of your chest, abdomen, and pelvis
recommended every 2 to 4 months for 2 years for may be used to check if the cancer is present. An x-
women with malignant sex cord-stromal tumors and ray, CT, MRI, PET, or PET/CT scan may be used for
malignant germ cell tumors. Those with malignant germ cell tumors only. There are not enough scientific
sex cord-stromal tumors then will have a physical data for doctors to recommend regular imaging tests
exam and serum tumor marker test done every 6 for malignant sex cord-stromal tumors.
months after 2 years. These tests may continue past
5 years if your doctor thinks they are necessary. A If there is concern that the cancer has come back
follow-up physical exam is done once a year, after 2 (recurred) for both malignant sex cord-stromal
years treatment for malignant germ cell tumors. tumors and malignant germ cell tumors, a CT of the
chest, abdomen, and pelvis with contrast may be
The physical exam and pelvic exam help your considered. Other imaging tests can be also be
doctor check for physical signs that the cancer has done and include a chest x-ray, MRI, PET/CT, or
come back. Such signs may include swelling or PET. Your CA-125 level and other tumor markers
bloating in your belly, abnormal lumps, or sudden may also be measured at this time.
changes in weight. Blood tests to measure CA-125
or other tumor markers are recommended to check
for early signs that the cancer has come back.
Finding out you have cancer can be very Your doctors know the science behind your plan
stressful. While absorbing the fact that you but you know your concerns and goals. By
have cancer, you also must learn about working together, you can decide on a plan that
tests and treatments. In addition, the time works best for you when it comes to your
you have to decide on a treatment plan may personal and health needs.
feel short. Parts 1 through 6 aimed to teach
you about ovarian cancer. Part
7 addresses ways to assist you
when deciding on a treatment plan. Questions to ask your doctors
You will likely meet with experts from different fields
of medicine. It is helpful to talk with each person.
Prepare questions before your visit and ask
It’s your choice questions if the information isn’t clear. You can also
get copies of your medical records. It may be
The role patients want in choosing their treatment helpful to have a family member or friend with you
differs. You may feel uneasy about making treatment at these visits to listen carefully and even take
decisions. This may be due to a high level of stress. It notes. A patient advocate or navigator might also be
may be hard to hear or know what others are saying. able to come. They can help you ask questions and
Stress, pain, and drugs can limit your ability to make remember what was said.
good decisions. You may feel uneasy because you
don’t know much about cancer. You’ve never heard The questions below are suggestions for
the words used to describe cancer, tests, or information you read about in this book. Feel free
treatments. Likewise, you may think that your to use these questions or come up with your own
judgment isn’t any better than your doctors’. personal questions to ask your doctor and other
members of your treatment team.
Letting others decide which option is best may
make you feel more at ease. However, whom do
you want to make the decisions? You may rely on
your doctors alone to make the right decisions.
However, your doctors may not tell you which to
choose if you have multiple good options. You can
also have loved ones help. They can gather
information, speak on your behalf, and share in
decision-making with your doctors. Even if others
decide which treatment you will receive, you still
have to agree by signing a consent form.
2. Where will the tests take place? Will I have to go to the hospital?
11. Can I have a copy of the test results and pathology report?
12. Who will talk with me about the next steps? When?
3. What are the risks and benefits of each treatment? What about side effects?
4. Will my age, general health, and other factors affect my treatment choices?
6. How soon should I start treatment? How long does treatment take?
7. Where will I be treated? Will I have to stay in the hospital or can I go home after each treatment?
10. How much will the treatment cost? How can I find out how much my insurance company
will cover?
12. What is the chance that the cancer will come back?
14. Are there supportive services that I can get involved in? Support groups?
4. What are the tests and treatments for this study? And how often will they be?
5. Has the treatment been used before? Has it been used for other types of cancers?
6. What side effects can I expect from the treatment? Can the side effects be controlled?
10. Who will help me understand the costs of the clinical trial?
Websites Review
American Cancer Society Shared decision-making is a process in
dex together.
org
“
National Coalition for Cancer
Survivorship
canceradvocacy.org/toolbox
Oncology sgo.org
- Joel Van Antwerp
Catharine F. and Joel C. Van Antwerp
Charitable Fund
NCCN Guidelines for Patients®:
Ovarian Cancer, Version 1.2017 87
Glossary
89 Dictionary
95 Acronyms
Dictionary
abdomen cancer antigen 125 (CA-125)
The belly area between the chest and pelvis. A protein with sugar molecules on it that is made by
ovarian cancer cells and normal cells.
adjuvant treatment
Treatment given after the main treatment used to rid the cancer grade
body of disease. A rating of how much the cancer cells look like normal cells.
bladder chemotherapy
An organ that holds and expels urine from the body. Drugs that kill fast-growing cells throughout the
blood chemistry profile body, including normal cells and cancer cells.
A test that measures the amounts of many chest x-ray
different chemicals in a sample of blood. A test that uses x-rays to make pictures of the inside of
metastases pelvis
Tumors formed by cancer cells that have spread from The body area between the hip bones.
the first tumor to other parts of the body.
peritoneal cavity
metastasis The space inside the belly (abdomen) that contains abdominal
The spread of cancer cells from the first tumor to organs such as the intestines, stomach, and liver.
another body part.
peritoneal washing
microscope A test in which a special liquid is used to wash the inside
A tool that uses lenses to see very small things the of the belly (peritoneal cavity) to check for cancer cells.
eyes can’t.
peritoneal washings
microscopic metastases Sample of liquid that is tested for cancer cells after it is
Cancer cells that have spread from the first tumor to another used to “wash” the inside of the belly (peritoneal cavity).
body part and are too small to be seen with the naked eye.
peritoneum
mutation The layer of tissue that lines the inside of the belly (abdomen)
An abnormal change in the instructions in cells for making and pelvis and covers most organs in this space.
and controlling cells.
persistent disease
neuropathy Cancer that stayed the same—didn’t get better or
A nerve problem that causes pain, tingling, and numbness worse— during treatment.
in the hands and feet.
physical exam
noninvasive implant A review of the body by a health expert for signs of disease.
Cancer cells that broke away from the first tumor and
platinum agent
are growing on the surface of nearby organs, but are
A cancer drug that is made with platinum. These drugs
not growing into (invading) tissue.
damage DNA in cells, which stops them from making
observation new cells and causes them to die.
A period of testing to watch for cancer growth.
platinum-based chemotherapy
omentum Treatment with two or more chemotherapy drugs and
The layer of fatty tissue that covers organs in the the main drug is made with platinum. Such drugs
belly (abdomen). include cisplatin and carboplatin.
ovaries platinum-resistant
The pair of organs in women that make eggs for When cancer drugs made with platinum, such as cisplatin
reproduction (making babies) and make hormones. and carboplatin, do not work well against the cancer.
ovary platinum-sensitive
One of a pair of organs in women that make eggs for When cancer drugs made with platinum, such as cisplatin
reproduction (making babies) and make hormones. and carboplatin, work well against the cancer.
partial response poly ADP-ribose polymerase (PARP)
Cancer improved as a result of treatment—tests show a A protein that helps repair damaged DNA in cells.
decrease in the amount of cancer, tumor size, or CA-125
positron emission tomography (PET) scan
levels—but it’s not completely gone.
A test that uses a sugar radiotracer—a form of sugar that is
pathologist put into your body and lets off a small amount of energy that
A doctor who’s an expert in testing cells and tissue to is absorbed by active cells—to view the shape and function
find disease. of organs and tissues inside your body.
pelvic exam
A medical exam of the female organs in the pelvis.
taxane
A type of cancer drug that blocks certain cell parts to stop a
cell from dividing into two cells.
treatment plan
A written course of action through cancer treatment and
beyond.
treatment response
An outcome or improvement related to treatment.
tumor
An abnormal mass formed by the overgrowth of cells.
tumor marker
A substance found in body tissue or fluid that may be a
sign of cancer.
U.S. Food and Drug Administration
A federal government agency that regulates drugs and food
in the United States.
ultrasound
A test that uses sound waves to take pictures of the inside
of the body.
uterus
The female organ where babies grow during pregnancy.
Also called womb.
vagina
The hollow, muscular tube in women through which babies
are born.
vein
A blood vessel that carries blood back to the heart from all
parts of the body.
washings
Sample of liquid that is tested for cancer cells after it is
used to “wash” the inside of the belly (peritoneal cavity).
white blood cell
A type of blood cell that helps fight infections in the body.
Acronyms
NCCN® IP
National Comprehensive Cancer Network® intraperitoneal
AJCC IV
American Joint Committee on Cancer intravenous
AFP LCOH
alpha-fetoprotein less common ovarian histopathologies
BEP LHRH
bleomycin, etoposide, and cisplatin luteinizing hormone-releasing hormone
BSO LMP
bilateral salpingo-oophorectomy low malignant potential
CA-125 mm
cancer antigen 125 millimeter
CAM MMMT
complementary and alternative medicine malignant mixed Müllerian tumor
CBC MRI
complete blood count magnetic resonance imaging
CEA PARP
carcinoembryonic antigen poly ADP-ribose polymerase
cm PET
centimeter positron emission tomography
CT PET/CT
computed tomography positron emission tomography/computed tomography
DNA TAH
deoxyribonucleic acid total abdominal hysterectomy
FDA TKI
U.S. Food and Drug Administration tyrosine kinase inhibitor
FIGO USO
International Federation of Gynecology and Obstetrics unilateral salpingo-oophorectomy
FNA
fine-needle aspiration
GI
gastrointestinal
HNPCC
heredity non-polyposis colorectal cancer syndrome
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Index
adjuvant treatment 37, 50, 54, 65–72, 74, 78 malignant sex cord-stromal tumor 68, 74–75, 80
biopsy 14, 21, 23–24, 46–48, 51–53, 70 mucinous carcinoma of the ovary 67–68 primary
blood test 14, 20–21, 55–56, 58, 67–68, 72, 75, 77, chemotherapy 37, 50, 54, 56
80
primary treatment 35, 37, 42, 45–48, 50–54, 68, 70,
borderline epithelial tumors (LMP [low 72–73, 76
malignant potential] 10, 12, 70–73
recurrence 56–57, 59–62, 65, 73, 75, 80
CA-125 14, 20, 50, 55–56, 58–60, 72–73, 75, 80
recurrence treatment 56–57, 59–62, 65, 75
carcinosarcoma (MMMT [malignant mixed
Müllerian tumor] 10, 64–65 relapse 58–60, 62, 73, 75
cancer stage 22–23, 23–29, 32, 45–54, 65 side effect 20, 31, 37, 39–42, 50, 55, 57–58, 60
chemotherapy 30, 32, 35, 37–42, 47–50, 52–56, supportive care 56–57, 59–60
59–60, 62, 65–70, 72–74, 77–79 surgery 14, 21, 23–24, 26, 30, 32, 35–37, 39, 42,
clear cell carcinoma of the ovary 66 45–55, 58–79
clinical trial 30, 41–42, 56–57, 59–60, 65, 75, 85 surgical staging 23–24, 32, 36, 45–48, 50–52, 60,
65–68, 70–72, 76–77
completion surgery 47–48, 52, 54, 58, 66, 68,
symptom 12, 14–15, 31–32, 37, 41, 57, 60, 65, 73,
70–72, 76–77
75
debulking surgery 35–36, 51, 73, 75
targeted therapy 39–40, 42, 62
fertility-sparing surgery 35, 46, 58, 66–72, 74,
76–77 treatment response 55–56, 62
Ovarian Cancer
Version 1.2017
NCCN Foundation® gratefully acknowledges our our advocacy supporter, National Ovarian Cancer Coalition and our industry
supporters, AstraZeneca and Pfizer Inc., for their support in making available these NCCN Guidelines for Patients ®. NCCN
independently develops and distributes the NCCN Guidelines for Patients. Our industry supporters do not participate in the development
of the NCCN Guidelines for Patients and are not responsible for the content and recommendations contained therein.
PAT-N-0985-0617