Exam 2: Ovarian Cancer Flashcards
(39 cards)
1
Q
A
2
Q
incessant ovulation
A
- women’s risk of developing ovarian cancer is related to her number of ovulatory cycles
3
Q
Risk Factors
A
- early menarche
- late menopause
- increased age
- nulliparity
- in vitro
- two or more first degree relatives with ovarian cancer
- BRCA-1, BRCA-2, p53
- lynch syndrome
4
Q
Decreased risk
A
- multiple pregnancies
- prolonged use of oral contraceptives
- prophylactic oophorectomy
5
Q
Why is ovarian cancer called the silent killer?
A
- most patients with Stage I and II are asymptomatic
- people present with advance disease (III and IV)
6
Q
Clinical Presentation
A
- lack of definitive symptoms
- if a woman experiences symptoms for 12 or more days out of a month for 2 consecutive months, she should seek medical attention by her gynecologist
7
Q
What is the most common presenting symptom
A
ascities
8
Q
Initial treatment approach
A
- goal is cure (up to stage III)
- surgery + chemo is standard approach first line
- with relapse, any therapy is palliative
9
Q
Homologous Recombination
A
50% high grade serious ovarian carcinomas are HRD
10
Q
Surgery
A
- dubulking
11
Q
Optimally debulked
A
< 1 cm of disease
12
Q
sub-optimally debulked
A
> 1 cm of disease
poorer prognosis
13
Q
Stage IA or 1B grade 1 disease treatment
A
- observation and follow up every 3 months
14
Q
Stage II and up treatment
A
adjuvant paclitaxel carboplatin
15
Q
Calvert equation
A
carboplatin dose = AUC x (GFR +25)
AUC is usually 5-7.5
16
Q
Type I Hypersensitivity
A
- Initial contact with agent
- cross linking to mast cells and basophils which trigger release of histamine and other inflammatory mediators
- anaphylaxis, itching, rash, chest tightness
17
Q
Type IV Hypersensitivity
A
- with repeated exposure to agent
- MHC and APC, T-cells recognize antigens
- erythema, induration
18
Q
Drugs that cause allergic reactions
A
- carboplatin
- cisplatin
- docetaxel
- paclitaxel
- need desensitization
19
Q
Infusion related reactions
A
- paclitaxel - cremophor EL
- doxil - liposome
- decrease rate
20
Q
Drug allergic reaction symptoms
A
- hives, rash
- projectile vomiting
- swelling
- SOB
- symptoms persist after stopping infusion
21
Q
Infusion related reactions signs and symptoms
A
- flushing
- redness
- tingling
- headach
- SOB
- pain (abdominal and chest)
- symptoms resolve after stopping infusion
22
Q
Paclitaxel
A
- most manifest as type I reaction
- happens with first dose, non-IgE mediated
- due to cremophor el diluent as opposed to the chemo itself
23
Q
taxane infusion reactions
A
- occurs during first or second exposure
- risk of having recurrent rxn decreases with repeated exposure
24
Q
Paclitaxel standard premedications
A
- dex
- diphenhydramine
- pepcid
25
carboplatin hypersensitivity
mechanism can be type I or type IV
- ≥ 8 cycles of carboplatin can increase risk of hypersensitivity
26
Maintenance Bevacizumab
- recommended in those that received bevacizumab with chemo upfront prior to surgery to continue monotherapy
- not recommended in those with BRCA mutations
27
Parp inhibitors
prevent parp protein from repairing damaged DNA in cancer cells
28
Parp inhibitors approved in oviarian cancer
- olaparib
- rucaparib
- niraparib
29
Monitoring parameters PARP inhibitors
CBC, anemia
30
Prevention of Adverse Effects
- patient education
- medication review for drug/drug interactions
- antiemetics
- nutrition
- multivitamin with iron
31
Monitoring parp
- cbc
- albumin
- SCr
- liver enzymes
- cholesterol
32
rare adverse events parp
- MDS or AML
- pneumonitis
33
Metastatic disease
- ultimately, 60-80% of patients will relapse
- the goal is no longer cure
34
If the patient relapses > 6 months following completion of their initial counting regimen
- platinum sensitivie
- may be treated with initial chemo regimen again
= paclitaxel/carboplatin
35
If the patient relapses < 6 months following completion of their initial counting regimen
platinum resistant
36
Platinum progressive
- no response or progression of disease during primary therapy with paclitaxel/carboplatin
37
chemo options if platinum resistant
liposomal doxorubicin (single agent)
38
combination chemo
platinum combo with paclitaxel
39
ovarian screening
no effective screening tool
