Overview of the approach to survivors of epithelial ovarian, fallopian tube, or peritoneal carcinoma
- Linda R Duska, MD
Linda R Duska, MD
- Associate Professor
- Fellowship Director
- Gynecologic Oncology
- University of Virginia
- Section Editors
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Director of Cancer Research
- Department of Population Medicine
- Associate Professor
- Harvard Medical School
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
Although epithelial carcinoma of the ovary, fallopian tube, and peritoneum (collectively called epithelial ovarian carcinoma [EOC]) is the most fatal of the gynecologic cancers, as of 2014, there are almost 200,000 survivors in the United States alone . Although nearly 80 percent enter remission following primary treatment, the majority of EOC survivors are living with disease; the recurrence rates are 25 and 80 percent for women with early stage and advanced disease, respectively [2,3]. However, there are long-term survivors of EOC with reported 5 and 10-year survival rates of 43 and 33 percent, respectively . Due to the older age at onset or the surgical treatment of EOC, most survivors will be postmenopausal.
This topic will review the approach to EOC survivors. For the purposes of this review, we will limit discussion to EOC survivors who have completed initial therapy and are without evidence of disease because these are the patients most likely to be seen by their primary care provider in a coordinated care setting. In contrast, the care and needs of women with recurrent EOC are dependent on whether they are on active treatment and are discussed separately. (See 'Coordination of care' below and "Adjuvant therapy of early stage (stage I and II) epithelial ovarian, fallopian tubal, or peritoneal cancer", section on 'Treatment of recurrent disease'.)
Further information on the diagnosis, staging, and treatment of EOC is available elsewhere. (See "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum".)
OVARIAN CANCER SURVIVORSHIP
Issues pertaining to survivorship in ovarian cancer are not as well studied as they are for other cancers. This may be due to the overall poor prognosis of women with EOC and smaller populations of affected individuals compared with patients with other cancers (eg, endometrial or breast cancer). However, survivorship-related issues are important because in addition to affecting quality of life (QOL), they may also influence survival outcomes [5,6]. As an example, a randomized trial by the Gynecologic Oncology Group (GOG 152) evaluated QOL at the third and sixth treatment cycles and then at 6 and 12 months after starting treatment . The study found that baseline QOL score was significantly associated with overall survival. In addition, while QOL decreased during treatment, it significantly improved after the start of treatment at both 6- and 12-month assessment points.
OVERVIEW OF PRIMARY TREATMENT
The approach to treatment is dependent on the clinical stage at presentation:
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- OVARIAN CANCER SURVIVORSHIP
- OVERVIEW OF PRIMARY TREATMENT
- Initial surgical management
- Adjuvant chemotherapy
- Neoadjuvant therapy
- SPECIFIC LONG TERM EFFECTS IN OVARIAN CANCER SURVIVORS
- Physical toxicities
- - Neurotoxicity
- - Cognitive dysfunction
- - Fatigue
- - Gastrointestinal toxicity
- Surgical complications
- Medical complications
- Unrelated causes
- - Gynecologic effects
- Loss of fertility
- Sexual dysfunction
- Psychological effects
- - Depression
- - Anxiety
- - Guilt
- - Poor body image
- Spiritual well-being
- Social well-being
- PROMOTING A HEALTHY LIFESTYLE
- GUIDELINES FOR POSTTREATMENT FOLLOW-UP
- Role of CA 125 surveillance
- Risk of recurrence
- Breast cancer risk management in BRCA-positive mutation carriers with EOC
- Coordination of care