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December 27, 2016 00:06

Chemotherapy in ovarian cancer |Plans and preparations for chemotherapy of ovarian cancer

often hear the question of whether an ovarian cancer verdict.Do I need chemotherapy in ovarian cancer or is it - vestiges of the past?Let's investigate.

Ovarian cancer is the second most common after uterine cancer and is one of the most frequent causes of death among all malignant cancer.The cause of cancer in general is not completely clear.It is considered that the development of the disease play a role heredity, toxic substances, infections.The presence of ovarian cancer in several close relatives - mother, daughter or sister - increases the risk of disease by half and contribute to its development for ten years previously.There are four stages of the disease:

  • first stage - struck by the ovary, usually on one side.
  • At the second stage in the malignant process involved both ovaries.
  • third stage - the cancer spreads to the omentum.
  • fourth stage - the cancer cells take up the adjacent organs, metastatic spread throughout the body.

Age sixty years considered the peak of the disease.Women who

are under forty-five years, rarely get sick.

initial stages of the disease often occur without obvious clinical manifestations.Frequently observed symptoms such as a violation of the menstrual cycle, problems with urination and defecation (constipation), abdominal pain Expander and pressing nature, pain during sex, abdominal bloating, occasionally - discharge bloody nature in the middle of the menstrual cycle, in the pelvis and abdomenpossible presence of exudate.

The main signs and symptoms of ovarian cancer is considered to be the discovery of the fixed surround hillocky or rough education in the pelvis.If a woman has after menopause are well palpated appendages, it can also indicate the presence of a tumor.

of the leading areas of treatment of ovarian cancer can be called a combination therapy that includes surgery and chemotherapy.Radiation therapy for this ailment is used very rarely.Nowadays more and more popular in treating cancer, especially malignant ovarian tumors, radiosurgery is gaining.The method is practically painless, beskroven, it does not damage healthy tissue.In a place where there is a cancer, radioactive rays are directed through the so-called gamma-knife.Location of the tumor should be calculated very precisely.But this method is only applicable for small tumors.

If the patient early stages of the disease, the cancer of the ovaries removed.If the process involves the uterus, the ovaries are removed, the uterus and fallopian tubes.The fact that you can never completely eliminate errors in diagnosis, so the experts in the field of gynecologic oncology believe that it is better to be safe.Despite all the advances in medicine, surgery combined with chemotherapy is considered to be the main method of treatment of ovarian cancer and in our days.

Indications for carrying out chemotherapy in ovarian cancer

each patient operated on for ovarian cancer should undergo chemotherapy.The indications for chemotherapy in ovarian cancer are:

  • Ovarian cancer first b-fourth stages, which is confirmed by histology and cytology.
  • general health of women does not exceed the two on a scale of WHO activity.
  • radical removal of malignant ovarian tumors in order to prevent the development of metastases and recurrence of malignant ovarian tumors.In order
  • deceleration third and fourth degree of tumor growth when it is partially erased.
  • When the operation is performed in order to alleviate the condition of women, if the tumor can not be removed.Chemotherapy, in this case to improve survival.
  • before surgery to enhance its effectiveness, reducing the volume of transactions.

chemotherapy in ovarian cancer may be appointed in the following cases:

  • after surgery to completely remove the tumors, in order to prevent the development of metastases and tumor recurrence;
  • after surgery for partial removal of tumors grade III or IV, for the inhibition of growth or destruction of malignant tissue residues;
  • after palliative treatment when surgery is performed not radically, but only in order to facilitate the patient's condition;in this case, chemotherapy can significantly affect the survival of cancer patients;
  • before surgery, to improve the efficiency of operations.

after surgery is usually carried out at least 3 courses of chemotherapy treatment:

  • directly in the postoperative period;
  • 40-60 days after surgery;
  • through 90-120 days after the second year.

Further, at the doctor's discretion, chemotherapy can be carried out every six months.

contraindications to chemotherapy of ovarian cancer

Despite the effectiveness of chemotherapy, this treatment has a number of contraindications to be considered when appointing treatment:

  • severe concomitant diseases, for which can significantly worsen after chemotherapy;
  • severe liver and renal disorders filtration system and blood-forming organs;
  • severe disorders of the nervous system, mental disorders that may interfere with the patient to assess the situation and expresses its consent to the passage of chemotherapy;

There are contraindications to specific chemotherapeutic agents.For example, topotecan and doxorubicin are not prescribed for the sick poor condition (with severe weakness, feeling unwell), with intestinal obstruction, with significant changes in blood parameters.

Based on the foregoing, it must be concluded that every oncology patient should be considered individually, depending on the characteristics of the organism.

contraindication to chemotherapy in ovarian cancer are also severe concomitant disease or any disease in the stage of decompensation.

  • impaired renal function, liver hematopoiesis;significant deviations from the norm creatinine indicators;total bilirubin more than 40 mm / l;ALT - above 1.8;AST - 1.3 above;Neutrophils - below 1500 mm3;platelet count less than 100 thousand / mm3.
  • Disorders neurological higher than the second degree.
  • intellectual disabilities and behavior that may affect the ability to agree to chemotherapy.
  • Hypersensitivity reactions to the proposed chemotherapy, allergy.

course of chemotherapy in ovarian cancer

After surgical treatment of ovarian cancer is almost always carried out chemotherapy.Chemotherapy in ovarian cancer conducted an average of three or four (or more) course.The first course she passes immediately after surgery, and subsequent: one and a half or two months - the second year, in three or four months - three, if you want more, they spend six months each.

During the first course of chemotherapy in ovarian cancer patients received the largest amount of drug at the time of the next dose rates should be not less than seventy-five per cent of the previous one.To achieve long-term survival of ovarian cancer chemotherapy continue from one to three years.

chemotherapy treatment for ovarian cancer has its own characteristics.They are connected with the fact that tumor appendages can not be seen with the naked eye before surgery.For this reason, if the patient is not expected to operate, for the assurance that the tumor is destroyed assigned chemotherapy.Even after surgery chemotherapy may serve as prevention of recurrence of the tumor.

  • chemotherapy treatment can be carried out at all stages of the disease: for the destruction of the tumor, to inhibit its growth, for the prevention of metastases.
  • Chemotherapy has a lot of adverse events, which we will discuss below.But the unquestionable advantage of chemotherapeutic agents in that they affect all tissues of the body, and this greatly reduces the risk of near and distant metastases.
  • chemotherapy treatment has advantages even before radiation therapy, as active substances of such drugs through the bloodstream or lymph penetrate directly into the lesion.
  • Chemotherapy affects even those cancer cells that are already growing and actively proliferate, but not yet identified by a particular symptoms (latent cancer).
  • Chemotherapy - an important stage in the treatment of cancer, and it is not necessary to refuse from it.

chemotherapy regimens for ovarian cancer

When chemotherapy of ovarian cancer best effect seen with combination treatment than during administration of certain drugs.

One of the most commonly used chemotherapy regimens for ovarian cancer is a diagram of the SAR:

  • Cisplatin at a dose of 50 mg / m;
  • Cyclophosphamide 400 mg / m;
  • adriablastin to 30 mg / m.

the treatment of germ cell tumors is active and effective scheme VFS:

  • vincristine in a dosage of 1 mg / m;
  • Cyclophosphamide 400 mg / m;
  • Actinomycin D to 0.25 mg / m.

RVV scheme is also often used for tumors of germ nature:

  • Cisplatin 50 mg per meter;Vinblastine
  • 0.2 mg per kg;
  • Bleomycin dose of 105 milligrams.

If there was a recurrence of cancer or cancer was previously insensitive to chemotherapy in ovarian cancer, there may be other dosing of drugs.

scheme TIP:

  • Paclitaxel 175 mg per square meter;
  • ifosfamide 3-5 grams per square meter;
  • Cisplatin 75 mg per square meter.

scheme VeIP:

  • Vinblastine 0.2 mg / kg;
  • ifosfamide three to five grams per square meter;
  • cisplatin per square meter of 75 milligrams.

Driving VIP:

  • Etoposide from 50 to 100 mg per square meter;
  • Ifofosfamid three to five milligrams per square meter;
  • Cisplatin seventy-five milligrams per square meter.

Much less monotherapy - treatment of any one drug.Experience shows that a combination of medication involves the maximum benefit from the treatment.

It is considered that for the complete destruction of tumors, treatment should consist of six courses, but an explicit opinion on the matter experts have not yet given.Most doctors are inclined to believe that it is enough to have three or four courses of chemotherapy treatment.In any case, the application of the scheme "surgery plus chemotherapy" has the maximum beneficial effect and significantly increases the chances of survival.Each case

prescribing requires an individual approach, as experience shows, that in some cases patients have to go through eight or even ten courses to complete deliverance from the tumor.

drugs in chemotherapy of ovarian cancer

During chemotherapy for ovarian cancer used cytotoxic drugs that are harmful to cancer cells and stops the growth of cancerous tumors.Cytotoxic drugs are injected into a vein or intraperitoneal administration is used, using a special tube, very rarely - orally in tablet form.

most common anticancer drug used in chemotherapy of ovarian cancer, - carboplatin - belongs to the group of platinum.Only enter into a vein.Cisplatin

also relates to platinum.It can cause tumor regression or tumor shrinkage.Assign as an independent drug or in combination with other drugs.

Paclitaxel - herbal remedy extracted artificial and half by artificial means, an alkaloid that is extracted from the bark of the yew tree - is also frequently used in chemotherapy for ovarian cancer.

semisynthetic drug docetaxel has a vegetable origin, as for its production using the needles of yew European.

cyclophosphamide used in the case where it is necessary or transplant tissue ingrowth when to reduce the immune response to changes in the body.This is possible due to the drug's ability to suppress immune forces of the body.

Doxorubicin is an antibiotic containing an anthracycline.

gemcitabine used alone and with other anticancer agents.Topoisomerase inhibitor is topotecan.Often used together with cisplatin.

Oxaliplatin is used as an independent agent in metastatic forms of cancer, as a second-line therapy.

side effects of chemotherapy for ovarian cancer

The most common side effect of chemotherapy for ovarian cancer is alopecia.After some time, the growth of hair is restored.Often there are nausea, vomiting, dizziness, diarrhea, since most chemotherapy drugs are very toxic.At this time, patients may lose weight due to a lack of appetite.These phenomena also quickly pass after the end of treatment.Can change the blood picture: decreased hemoglobin, white blood cell count, platelet count.In order to control blood picture patient undergoing chemotherapy in ovarian cancer, conducted weekly CBC.

Most experts in the appointment of intravenous chemotherapy drugs carboplatin is recommended to use, as this drug has less severe side effects compared to cisplatin.However, the impact of these funds is almost identical.

also possible to use other drugs, and combinations thereof.

effect of chemotherapy is aimed at the destruction and the destruction of cancer cells.At the same time, and these drugs affect healthy tissue.All this allows for a doctor in the appointment of treatment - he would certainly try to choose a medicine that will be the minimum number of adverse events.

number and degree of side effects depends upon the particular drug, duration of treatment and the dosage used.

The most characteristic manifestations include:

  • skin rash, mainly on the palmar surface and feet;
  • hair loss;
  • nausea and vomiting;
  • no craving for food;
  • sores in the mouth.

Chemotherapy drugs also affect the organs of hematopoiesis, which affects the number of blood cells.Disorders of the blood, in turn, can cause the following symptoms:

  • feeling of fatigue, weakness (as a consequence of anemia);
  • drop immunity (subject to frequent colds and infectious diseases);
  • increased vascular permeability (bleeding, bruising on the body).

After completion of chemotherapy, the bulk of the adverse events were held.Thus, renewed hair growth, restores appetite.However, it happens that some medications cause lasting side effects, or even such manifestations, which subsequently remain for life.For example, Cisplatin can cause renal failure, and in combination with taxanes this drug can cause neuropathy (damage to the nerves and fibers).Neuropathy usually manifests a feeling of "pins and needles", pain, numbness in the distal extremities.In addition, chemotherapy can lead to infertility or early menopause - these effects can be temporary or permanent.

In extremely rare cases, chemotherapy can cause damage to white blood cells and lead to the development of myeloid leukemia - a malignant blood diseases.However, this is a very rare phenomenon, and the doctor should carefully monitor the treatment process to prevent such complications.