OCT 09, 2019 10:30 AM PDT

Newly Diagnosed Ovarian Cancer: Surgical Options

C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Full-time faculty member, Department of Gynecologic Oncology, Moffitt Cancer Center, and Professor, USF Morsani College of Medicine
    Biography
      Dr. Hoffman is a full-time faculty member in the Department of Gynecologic Oncology at Moffitt Cancer Center, and Professor at USF Morsani College of Medicine. He was Director of Medical Student Education in Obstetrics and Gynecology from 1987-1999, and Director of the Division of Gynecologic Oncology and Program Director of the Gynecologic Oncology Fellowship Training Program from 1999-2015. He is the author of one textbook, over 250 articles in scientific journals, and 21 textbook chapters. He is an examiner for the American Board of Obstetrics and Gynecology. Dr. Hoffman has been president of the South Atlantic Association of Obstetricians and Gynecologists and The Society of Pelvic Surgeons.

    Abstract

    A subset of women with ovarian cancer will present with an apparently isolated adnexal mass. Many of these women will have early stage ovarian cancer with a relatively good prognosis. Unfortunately, the majority of women with ovarian cancer present with advanced disease due to widespread intraperitoneal metastases. The surgical management of advanced ovarian cancer has undergone dramatic transformations over the past 20 years and that will be the focus of this presentation. A large body of retrospective data accumulated which indicated that women undergoing cytoreductive surgery for ovarian cancer did much better if all gross disease was resected (“R0”). Based on this, radical upper abdominal surgery to achieve R0 has been adopted into management. Many patients with advanced ovarian cancer are too ill or too advanced for surgery. Such patients are frequently do receive treatment with chemotherapy. It was recognized that many such patients respond well with subsequent improvement in performance status and operability. Based on this, data accumulated on management with neoadjuvant chemotherapy followed by interval cytoreductive surgery for selected patients. This data led to a series of prospective, randomized trials which demonstrated non-inferiority (when compared to primary cytoreductive surgery), along with a reduction in morbidity. Based on this, clinical practice guidelines (combined SGO/ASCO) were published in 2016 (Wright AA, et al.. Gynecol Oncol 2016; 143: 3-15) for primary management of women with advanced ovarian cancer that included evaluation by gynecologic oncologist, imaging with CT scan, utilization of neoadjuvant chemotherapy for women at high risk for surgery or low likelihood of achieving optimal cytoreduction, and histologic confirmation prior to initiation of neoadjuvant chemotherapy.

    Learning objectives:

    1. To gain an understanding of the evolution over the past 20 years in the surgical management of primary advanced ovarian cancer.
    2. To gain insight into the technical aspects of cytoreductive surgery for advanced ovarian cancer.


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