Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C1140680 (ovarian cancer)
 28,141 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Altretamine is a National Cancer Institute-designated group C antineoplastic agent used in the treatment of advanced ovarian cancer. Altretamine is a highly lipid-soluble drug available only for oral administration as a capsule. The drug is activated through metabolic oxidation to intermediate methylol derivatives and formaldehyde. It is unclear which metabolite is the major species responsible for cytotoxicity or the primary mechanism of cytotoxicity. As a single agent in the treatment of ovarian cancer, altretamine demonstrates a response rate similar to other active agents in this disease (21-39 percent). The major utility of altretamine is in combination with other agents such as cyclophosphamide, doxorubicin, fluorouracil, melphalan, and cisplatin. However, few randomized trials have evaluated the contribution of altretamine in these multiagent combinations. Dose-limiting toxicities include gastrointestinal (nausea, vomiting, anorexia), hematologic, and neurotoxic (peripheral neurotoxicity). The therapeutic role of altretamine is limited because of a toxicity profile similar to that of cisplatin, one of the more active agents in ovarian cancer. Its use should be reserved for patients who are not candidates for more standard platinum-based regimens.
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PMID:Altretamine. 190 41

A diagnosis of ovarian cancer should be suspected when a postmenopausal woman presents with a pelvic mass. The presence of ascites, which can be detected clinically or by ultrasound, increases the accuracy of the diagnosis. CA 125, although nonspecific in the premenopausal patient population, is very sensitive in postmenopausal patients when used in combination with clinical impression and an abnormal ultrasound. CAT scan is more sensitive than ultrasound, but may not alter surgical management. Preoperative preparation of the bowels should consist of a polyethylene glycol lavage in combination with oral and systemic antibiotics and is indicated for any woman with a mass adherent to the cul de sac. Preoperative total parenteral nutrition should be reserved for severely malnourished patients as determined by objective criteria. Early surgical intervention is a key component for the treatment of these patients, and extensive diagnostic testing should be used temperately in order to ensure expeditious treatment of these patients. In the future, the most significant impact on the survival of patients with ovarian cancer will be in the development of improved methods of screening and early detection. It is hopeful that clinical trials currently being conducted will bring us closer to that goal.
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PMID:Preoperative evaluation of patients with suspected ovarian cancer. 783 14

As a result of recent technological advances, laparoscopic lymphadenectomy is becoming the standard method for the staging of pelvic cancer. More extensive procedures, such as para-aortic lymph node dissection and radical hysterectomy, have also been demonstrated to be feasible by advanced laparoscopic surgery. This new approach appears to be very promising. In the future, because of its well documented advantages, laparoscopic surgery may appear as a way to decrease the morbidity of cancer treatment in patients with low-risk tumors and to propose more aggressive treatments of patients with tumors associated with a poor prognosis. These new techniques should be reserved for surgical teams trained in oncologic and major laparoscopic surgery. More clinical research is required before this approach can be proposed as an alternative to laparotomy, and guidelines have to be established. Training in oncology is essential to ensure optimal patient care and to avoid the consequences of inadequate laparoscopic management with regard to cases of tumor dissemination reported after laparoscopic biopsy or resection of undiagnosed ovarian cancer.
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PMID:The role of laparoscopic surgery in gynecologic oncology. 803 6

The rapid development of ultrasound technology and its routine application during gynecological examinations has led to the more frequent detection of ovarian cysts. Such cysts can be diagnosed at any age or stage of a woman's life, and detected as early as the fetal stage or as late as the postmenopause. Ovarian cysts in female fetuses are usually detected during screening in pregnancy and followed after delivery as neonates. A few months are usually sufficient for spontaneous regression, although symptomatic cysts should be promptly operated. In fertile women, most cases present benign functional cysts which disappear after menstruation or can be managed easily with the combined oral contraceptive pill. When pregnancy is complicated with an adnexal mass, the second trimester is the preferable time of action in cases when operation is demanded. Transvaginal sonography plays an important role, not only in the detection of ovarian cysts but also in the diagnosis of malignancy. Large cysts, multiloculi, septa, papillae and increased blood flow are all suspected signs of neoplasia. The incidence of ovarian cancer increases with age and is predominantly a disease of peri- and postmenopausal women with an average patient age of 50-59 years. Vaginal sonography has been established as the examination of choice in screening and follow-up of patients, with complementary color Doppler studies and determination of serial serum levels of CA-125. If a malignant cyst is suspected, at any age, explorative laparotomy should be performed promptly. Sonographic or computerized tomographic scanner aspiration procedures, as well as laparoscopic surgery, should be reserved for diagnostic or therapeutic purposes in low-risk cancer patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ovarian cysts: a clinical dilemma. 805 20

Symptomatic malignant pleural effusions should be treated systemic chemotherapy in chemo-sensitive tumors such as small cell lung cancer, breast cancer, lymphoma, or ovarian cancer. In other non-chemo-sensitive malignancies including non-small cell lung cancer, water-sealed tube drainage and pleurodesis is the standard treatment of choice in most of the cases. Drugs for instillation should be blomycin or OK-432 if commercially available. Instead of the former standard drug tetracycline, doxycycline has been frequently used. As we have no randomized trials, this drug awaits phase III trials. Talc slurry has been accepted and counted as one of the standard choices in the western countries, however, it usually needs general anesthesia and adverse effects are not negligible. As we have little experience on this modality, it should not be considered as a standard treatment. Other antitumor drugs instillation, thoraco-abdominal shunting, and pleuro-pneumonectomy should be considered experimental because of the lack of randomized trials. Symptomatic pericardial malignant effusion or cardiac tamponade is an oncologic emergency. We had better to treat the patient immediately by pericardiocentesis under the cardiac echographic guidance. It should be reserved to solve in randomized trials that the best method would be pericardiocentesis alone, percutaneous continuous drainage, pericardial fenestration, or pericardio-thoraco fenestration. Instillation of drug like doxycycline, OK-432, or bleomycin, lacks phase III comparison and it should be categorized as experimental.
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PMID:[State of the art: treatment of malignant pleural and pericardial effusions]. 936 17

The aim of this paper is to report the risk of development of gynecological cancer in women receiving hormone replacement therapy and to review the current knowledge on the administration of hormone replacement therapy following treatment of gynecological cancer. Estrogens alone may act as promoting factors for endometrial carcinogenesis. However, the addition of progestins reduces the risk of endometrial cancer to that of nonusers. Hormone replacement therapy could be given to selected patients following treatment for endometrial cancer. However, we think that this therapy should be reserved only for patients enrolled in controlled clinical trials. Ovarian cancer does not seem to be sensitive to estrogens, even if current literature does not allow firm conclusions to be drawn. Hormone replacement therapy should be offered to patients previously treated for ovarian cancer and cervical cancer.
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PMID:Hormone replacement therapy and gynecological cancer. 942 82

Recurrent ovarian cancer is a common clinical problem and the management of each patient must be individualized. Diagnosis is usually based on a progressively rising CA-125 titre, and a CT scan of the pelvis and abdomen, together with a chest X-ray should be performed in this situation. Although there is no study to support immediate treatment in the asymptomatic patient, our approach is to commence such patients on Tamoxifen. Chemotherapy is reserved for symptomatic patients or those who progress on Tamoxifen. The choice of non-platinum second or subsequent line chemotherapy is based on many factors including likelihood of benefit, potential toxicity, schedule and convenience to the patient, as well as organ function and residual toxicity from prior treatment. Aggressive secondary cytoreductive surgery can significantly prolong survival in those with a disease-free interval of 24 months or more, and in those in whom all macroscopic disease can be removed. Radiation therapy to the tumour bed following resection of localized disease may be beneficial in selected patients. Quality of life issues are particularly important for this group of patients and have not been adequately studied. Communication regarding the objectives of therapy is important, and the multidisciplinary approach should include palliative care and psycho-social support, in addition to the more traditional medical options.
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PMID:Treatment of recurrent ovarian cancer. 1555 3

All the surgical procedures, which may be required to treat a gynecologic cancer, can be performed endoscopically. However prospective randomized studies required to confirm the oncologic efficacy of the technique are still lacking in gynecology, whereas such studies are available in digestive surgery. Animal studies suggested that the risk of tumor dissemination in non traumatized peritoneum is higher after a pneumoperitoneum than after a laparotomy. Experimental studies also emphasized two points: the surgeon and the surgical technique are essential, all the parameters of the pneumoperitoneum may influence the postoperative dissemination. Changing these parameters we may, in the future, be able to create a peritoneal environment adapted to oncologic patients in order to prevent or to decrease the risks of peritoneal dissemination and/or of postoperative tumor growth. Until the results of prospective randomized studies become available, the preoperative selection of the patients and the surgical technique should be very strict. In patients with endometrial cancer, the laparoscopic approach should be reserved to clinical stage I disease, if the vaginal extraction is anticipated to be easy accounting for the volume of the uterus and the local conditions. In cervical cancer, the laparoscopic approach should be reserved to patients with favorable prognostic factors: stage IB of less than 2 cm in diameter. Laparoscopy is the gold standard for the surgical diagnosis of adnexal masses. But the puncture should be avoided whenever possible. The surgical treatment of invasive ovarian cancer should be performed by laparotomy whatever the stage. In contrast restaging of an early ovarian cancer initially managed as a benign mass, is a good indication of the laparoscopic approach. The laparoscopic management of low malignant potential tumors should include a complete staging of the peritoneum. Knowledge of the principles of endoscopy and of oncologic surgery is required. Teaching and diffusion of endoscopic oncological techniques are among the major challenges of gynecologic surgery within the next few years.
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PMID:[Laparoscopy and gynecologic cancer in 2005]. 1657 58

Ovarian cysts occur frequently in women of reproductive age. These are usually functional cysts which resolve spontaneously and whose evolution can be followed with ultrasound. Non-functional cysts have diverse histologic origins. The most common are serous and mucinous cystadenomas which arise from the epithelial wall of the ovary, endometriomas which arise in the setting of pelvic endometriosis, and dermoid cysts which arise from the germinal cells of the ovary. Endovaginal ultrasound with Doppler enhancement is the best imaging technique to establish the nature of cysts and to distinguish cysts suspicious for malignancy which require more invasive investigation. Pelvic laparoscopy is the surgical approach of choice for the treatment of non-functional benign ovarian cysts. Conservative treatment to shell out the cyst and preserve functional ovarian tissue should be reserved for women desirous of future pregnancies. The risk of ovarian cancer remains a major preoccupation of the surgeon. Where malignancy is suspected, laparoscopy is contraindicated and a median laparotomy is appropriate for radical extirpative surgery. This article describes the diagnostic techniques which allow a laparoscopic approach to presumably benign cysts and discusses surgical techniques specifically adapted to their different histologic nature of ovarian cysts.
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PMID:[Management of ovarian cysts]. 1718 53

All the different surgical procedures used to treat gynecologic cancers have already been performed with the endoscopic approach. However, the prospective randomized trials required to confirm the oncologic efficacy of this approach are still lacking in gynecology, whereas such studies are available for abdominal surgery. Animal studies suggest that the risk of tumor dissemination in the non traumatized peritoneum may be higher after pneumoperitoneum than after laparotomy, and they also show the importance of the surgeon's experience and technique. All the parameters of pneumoperitoneum can influence the risk of postoperative dissemination. By controlling these parameters we may, in future, be able to create a peritoneal environment suitable for oncologic indications and thereby prevent or minimize the risk of peritoneal dissemination and postoperative tumor growth. In endometrial cancer, the laparoscopic approach should be reserved for clinical stage I disease, if the volume of the uterus and local conditions are appropriate for vaginal extraction. In cervical cancer, the laparoscopic approach should be reserved for patients with favorable prognostic factors (stage IB, less than 2 cm in diameter). Laparoscopy is the gold standard for surgical diagnosis of adnexal masses, but puncture should be avoided whenever possible. Surgical treatment of invasive ovarian cancer should use laparotomy, whatever the stage. In contrast, restaging of early ovarian cancer initially managed as a benign mass is a good indication for the laparoscopic approach. Laparoscopic management of tumors with low malignant potential should include complete staging of the peritoneum. An excellent knowledge of the principles of endoscopy and of oncologic surgery is required. Training in endoscopic oncological techniques will be a major challenge in the field of gynecologic surgery in coming years.
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PMID:[Endoscopic management of gynecological malignancies: an update. 2007]. 1844 57


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