OVARIAN CANCER – CLINICAL AND THERAPEUTIC PERSPECTIVES Edited by Samir A. Farghaly           Ovarian Cancer – Clinical and Therapeutic Perspectives Edited by Samir A. Farghaly Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Dragana Manestar Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Ovarian Cancer – Clinical and Therapeutic Perspectives, Edited by Samir A. Farghaly p. cm. ISBN 978-953-307-810-6   Contents  Preface IX Chapter 1 Ovarian Cancer Incidence: Current and Comprehensive Statistics 3 Sherri L. Stewart Chapter 2 Preventive Strategies in Epithelial Ovarian Cancer 15 Gina M. Mantia-Smaldone and Nathalie Scholler Chapter 3 Screening for Ovarian Cancer in Women 43 Duangmani Thanapprapasr and Sarikapan Wilailak Chapter 4 Borderline and Malignant Surface Epithelial – Stromal Tumors of the Ovary 55 Susanna Syriac, Faith Ough and Paulette Mhawech-Fauceglia Chapter 5 Central Nervous System Involvement from Epithelial Ovarian Cancer 87 Gennaro Cormio, Maddalena Falagario and Luigi E. Selvaggi Chapter 6 Peripheral Neuropathy in Ovarian Cancer 109 Yi Pan Chapter 7 Therapeutic Strategies in Ovarian Cancer 129 Dan Ancuşa, Octavian Neagoe, Răzvan Ilina, Adrian Carabineanu, Corina Şerban and Marius Craina Chapter 8 Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer 143 Antonios-Apostolos K. Tentes, Nicolaos Courcoutsakis and Panos Prasopoulos Chapter 9 Minimally Invasive Surgical Procedures for Patients with Advanced and Recurrent Ovarian Cancer 167 Samir A. Farghaly VI Contents Chapter 10 Management of Recurrent or Persistent Ovarian Cancer 191 Constantine Gennatas Chapter 11 Antiprogestins in Ovarian Cancer 207 Carlos M. Telleria and Alicia A. Goyeneche Chapter 12 Intraperitoneal Radionuclide Therapy – Clinical and Pre-Clinical Considerations 231 J. Elgqvist, S. Lindegren and P. Albertsson Chapter 13 Vitamin K2 as a Chemotherapeutic Agent for Treating Ovarian Cancer 259 K. Nakaya, Y. Masuda, T. Aiuchi and H. Itabe Chapter 14 Second-Line Chemotherapy for Platinum- and Taxane-Resistant Epithelial Ovarian Cancer: Pegylated Liposomal Doxorubicin (PLD), Irinotecan, and Combination Therapies at Lower Doses 275 Toru Sugiyama Chapter 15 HER2 as a Therapeutic Target in Ovarian Cancer 289 Lukas C. Amler, Yulei Wang and Garret Hampton Chapter 16 Sexuality After Ovarian Cancer Therapy 313 Juliane Farthmann and Annette Hasenburg Chapter 17 Quality of Life of Patients with Ovarian Cancer 327 Wei-Chu Chie and Elfriede Greimel   Preface  204,449 new cases of ovarian cancer are diagnosed worldwide each year, with an estimated 124,860 disease-related deaths. Ovarian cancer is the second most gynecological cancer in the United States of America, but most common cause of gynecological cancer related death, primarily because most patients present with advanced disease. 65-70 % of patients are diagnosed at an advanced stage, conferring a 5-year survival rate of 30-55%. Ovarian cancer is associated with such a significant burden of disease for the individual and for society. The ovarian cancer statistics for incidence, indicate it is highest in the USA and Northern Europe and lowest in Africa and Asia. The approach to women with ovarian cancer has become multidisciplinary, with many professionals contributing to the excellent care and outcome that we wish to see for those individuals we are privileged to look after. This book discusses a range of diagnostic and therapeutic considerations, including epidemiologic, pathologic, open surgical, minimally invasive surgical, and chemotherapeutic aspects. The most current and comprehensive statistics associated with ovarian cancer incidence is detailed in Chapter 1. Screening for epithelial ovarian cancer (EOC), and the development of novel diagnostic tests such as bead-based ELISA assays using recombinant anti bodies produced by yeast is presented in Chapter 2. Screening for ovarian cancer in the general and increased-risk population is reviewed in Chapter 3. Macroscopic, histology grading, immunohistochemistry, and differential diagnosis of malignant and borderline surface epithelial-stromal tumors of the ovary is discussed in Chapter 4. Clinico-pathological features of the central nervous system involvement in epithelial ovarian cancer and the different therapeutic approaches for such a disease are discussed in Chapter 5. Comprehensive review of peripheral neuropathy relative to ovarian cancer, including symptoms, pathogenesis, incidence, risk factors, diagnosis, and management is covered in Chapter 6. A therapeutic strategy for the treatment of primary and secondary ovarian cancer which involves surgery, chemotherapy, radiation therapy, biological therapy, and hormones is presented in Chapter 7. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of locally advanced ovarian cancer is described in Chapter 8. Recent advances and state-of-the-art minimally invasive surgical techniques for advanced and recurrent ovarian cancer, in reference to involvement of lower urinary tract, X Preface gastrointestinal tract, spleen, and liver are presented in Chapter 9. The medical and surgical management principals of recurrent and persistent ovarian cancer are reviewed in Chapter 10. Feasibility of repositioning antiprogestins, originally designed for contraceptive purposes, for ovarian cancer therapy is covered in Chapter 11. Current status and aspects of intraperitoneal radioimmunotherapy (RIT) of ovarian cancer is reviewed in Chapter 12. Efficacy and safety of Vitamin K2 as a chemotherapy agent for the treatment of ovarian cancer is reviewed in Chapter 13. Second-line combination therapy for platinum and taxane-resistant epithelial ovarian cancer is described in Chapter 14. HER2 as a therapeutic target for ovarian cancer inidentifying and treating the right patient is presented in Chapter 15. Sexual functions and body image of patients with ovarian cancer following therapy is detailed in Chapter 16. Finally, Scale structures, psychometric properties, and clinical validities of extrinsic instruments for the assessment of health related quality of life of patients with ovarian cancer is detailed in Chapter 17. This book is intended for all clinicians caring for women with ovarian cancer, including attending surgeons and physicians, fellows, and residents in the disciplines of gynecologic oncology, surgical oncology, medical oncology, and primary care. Allied medical staff, palliative services, and nurse specialists will also find it a useful adjunct to getting current information on ovarian cancer. I hope that you enjoy this book, and benefit from the extensive experience of the contributors to this book from the USA, Europe, and Asia who have authored its contents.  Samir A. Farghaly, MD, PhD The Joan and Sanford Weill Medical College of Cornell University The New York Presbyterian Hospital Cornell University Medical Center New York USA [...]... 10 Ovarian Cancer – Clinical and Therapeutic Perspectives reduction in the misclassification of PPC and PFTC as ovarian cancer (Stewart et al., 2007, Goodman & Shvetsov, 2009b) 5 Discussion Ovarian cancer incidence rates reported from countries with nationwide cancer registration and those from more developed countries are generally similar to each other In less developed countries and regions, ovarian. .. spread Although there is limited 18 Ovarian Cancer – Clinical and Therapeutic Perspectives data to support symptomatology as a sole screening modality for ovarian cancer, recognition of ovarian cancer symptoms by both patients and caregivers may help to identify individuals with early stage disease 29 and in 2007 the Gynecologic Cancer Foundation, American Cancer Society and Society of Gynecologic Oncologists... Table 2 Ovarian cancer incidence counts and rates for selected regions and continents worldwide Rates are per 100,000 women and age-standardized to the 1960 world standard population Source: Ferlay et al., 2011 Ovarian Cancer Incidence: Current and Comprehensive Statistics 5 Fig 1 Map of ovarian cancer rates worldwide Rates are per 100,000 women and are agestandardized to the 1960 world standard population... 6 Ovarian Cancer – Clinical and Therapeutic Perspectives These numbers do not take into account the population, and may likely be reflective of the population coverage of cancer registration in these areas In the United States, ovarian cancer incidence rates are similar among the Northeast, Midwest, and South U.S Census regions (11.7-12.9), and individual state rates range from 7.3 to 15.4 (U.S .Cancer. .. Program NR=not reported Source: (U.S .Cancer Statistics Working Group, 2010) 8 Ovarian Cancer – Clinical and Therapeutic Perspectives 3.1 Clinical factors (histology, stage, laterality) and ovarian cancer incidence Ovarian cancers are classified into three main histologic groups: epithelial tumors, sex cord-stromal tumors, and germ cell tumors (Cannistra et al., 2011) Epithelial tumors are believed to... Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 9th Edition., DeVita, V.T.; Lawrence, T.S & 12 Ovarian Cancer – Clinical and Therapeutic Perspectives Rosenberg, S.A.pp (1368-1391) Lippincott, Williams, & Wilkins, ISBN 978-1-45110545-2, Philadelphia, PA, USA Chen, V.W.; Ruiz, B.; Killeen, J.L.; Cote, T.R.; Wu, X.C & Correa, C.N.(2003) Pathology and classification of ovarian tumors Cancer, ... relative with ovarian cancer have a three- 24 Ovarian Cancer – Clinical and Therapeutic Perspectives fold increase in risk 104 Hereditary ovarian cancers are commonly attributed to genetic mutations which are transmitted in families in an autosomal dominant fashion Germline mutations in BRCA1 and BRCA2, tumor suppressors which participate in homologous recombination repair of double-stranded DNA breaks,... Amatruda, J.F & Ross, J A (2010) Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006 Cancer, Vol 116, pp ( 4882-4891) Prat, J.; Ribé, A & Gallardo A (2005) Hereditary ovarian cancer Hum Pathol., Vol 36, No 8, (August 2005), pp (861-70) 14 Ovarian Cancer – Clinical and Therapeutic Perspectives Riska, A.; Leminen, A & Pukkala E (2003)... cervical cancer and its immediate precursors worldwide 23, the exact etiology for ovarian cancer remains largely debated Precursors for ovarian cancer should be “morphologically recognizable lesions that are reproducible thereby permitting early clinical intervention” 24 It has been 17 Preventive Strategies in Epithelial Ovarian Cancer generally accepted that ovarian cancer originates from the ovarian. .. information on cancer diagnoses in the geographic areas covered For that reason, most incidence data reported is two to three years behind the current calendar year 2 Ovarian Cancer – Clinical and Therapeutic Perspectives Incidence rates take into account the number of new cases of cancer (numerator), and also the population at risk for the cancer (denominator) Most incidence rates are age-adjusted or standardized . OVARIAN CANCER – CLINICAL AND THERAPEUTIC PERSPECTIVES Edited by Samir A. Farghaly           Ovarian Cancer – Clinical and Therapeutic Perspectives Edited. Tumor Registry and the SEER Program. NR=not reported. Source: (U.S .Cancer Statistics Working Group, 2010). Ovarian Cancer – Clinical and Therapeutic Perspectives 8 3.1 Clinical factors. 2011. Ovarian Cancer – Clinical and Therapeutic Perspectives 6 These numbers do not take into account the population, and may likely be reflective of the population coverage of cancer registration