• Family history
• Nulliparity
• First child after age 35
• Advanced age
• North American or Northern European descent
• Prolonged use of ovulation-inducing drugs

• First child before age 25
• Oral contraceptive use
• At least two full term pregnancies
• Breast feeding
• Tubal ligation?

• Most patients present with advanced disease (Stage III or IV)
• Nonspecific symptoms

Nausea

Dyspepsia

Flatulence

Bloating

Early satiety

• Direct symptoms

Abnormal vaginal bleeding

Abdominal distention and discomfort

Ascites

Amenorrhea

Abdominal/pelvic masses

• Stage
• Histological grade (III)
• Presence of ascites at diagnosis
• Tumor on ovary surface
• Age > 65
• Volume of residual disease after surgery
• High post-op CA-125

Everyone!

• If need to preserve fertility and only one ovary involved, can spare the unaffected ovary
• Otherwise all patients get total abdominal hysterectomy/bilateral salpingo oopherectomy

Surgery then observation (rarely)

OR

Surgery then Chemo with Carboplatin/paclitaxel

Quick

Hypersensitivity

Short Term

• NV
• Myelosuppression
• Mucositis
• Alopecia
• Neuropathies
• Nephrotoxicity

Long Term

Hepatoxicity

Surgery then Intraperitoneal Chemo

• IV palitaxel then
• IP Cisplatin and IP Paclitaxel

Quick

Hypersensitivity

Short Term

• PAIN
• FATIGUE
• NV
• Myelosuppression
• Neuropathies
• Mucositis

Long Term

Hepatotoxicity

• Pts should be seen every 2-4 months for first 2 yrs then every 6 months for 3 yrs
• Check CA-125 if elevated at presentation
• Physical exam including pelvic
• Abdominal CT
• Chest X-ray

Relapse > 6 months

If platinum sensitive, repeat initial chemotherapy

• Topotecan
• Liposomal doxorubicin
• PO Etoposide
• Altretamine
• Gemcitabine