Chemotherapy for ovarian cancer

Often one has to hear the question of whether ovarian cancer is a verdict. Do I need chemotherapy for ovarian cancer or are they remnants of the past? Let's understand.

Ovarian cancer is the second most common cancer after cancer of the uterus and is one of the most common causes of death among all malignant oncology. The cause of cancerous tumors in general is not fully understood. It is generally believed that heredity, poisonous substances, and infections play a role in the development of this ailment. The presence of ovarian cancer in several close relatives - mothers, daughters or sisters - increases the risk of developing the disease by half and contributes to its development ten years earlier. There are four stages of the disease:

• The first stage - the ovary is affected, as a rule, on one side.
• In the second stage, both ovaries are involved in the malignant process.
• The third stage - cancer spreads to the omentum.
• The fourth stage - cancer cells capture neighboring organs, metastatically spread throughout the body.

Age of sixty years is considered the peak of the disease. Women under the age of forty-five are rarely ill.

The initial stages of the disease most often occur without obvious clinical manifestations. Often there are symptoms such as a violation of the monthly cycle, problems with urination and defecation (constipation), pain in the lower abdomen of a bursting and oppressive nature, tenderness in sex, bloating, occasionally bleeding in the middle of the menstrual cycle, in the pelvis and abdominal cavity possibly the presence of exudate.

The main and objective sign of ovarian cancer is considered to be the detection of immobile bulging, bulging or rough formation in the small pelvis. If the woman after the menopause is well probed appendages, it can also indicate the presence of a tumor.

Of the leading directions in the treatment of ovarian cancer, combined therapy, which includes surgical treatment and chemotherapy, can be called. Radiation therapy for this disease is very rarely used. Currently, increasing popularity in the treatment of cancer, in particular malignant neoplasms of the ovaries, is gaining radiosurgery. The method is practically painless, bloodless, does not damage healthy tissues. In the place where the cancerous tumor is located, radioactive rays are directed with the help of so-called gamma knives. The location of the tumor should be calculated very accurately. But this method is applicable only for small tumors.

If the patient has early stages of the disease, then the affected ovary is removed. If the uterus is involved in the process, the ovaries, uterus and fallopian tubes are removed. The fact is that one can never completely exclude mistakes in making a diagnosis, therefore specialists in gynecological oncology believe that it is better to be safe. Despite all the achievements in the field of medicine, surgical intervention in combination with chemotherapy is considered the main method of treatment of ovarian cancer today.

[1], [2], [3], [4]

Indications for chemotherapy for ovarian cancer

Each patient, operated for ovarian cancer, must undergo chemotherapeutic treatment. Indications for chemotherapy for ovarian cancer are:

• Ovarian cancer of the first b-fourth stage, which is confirmed by histology and cytology.
• The overall health status of a woman does not exceed two according to the WHO activity scale.
• Radical removal of a malignant tumor of the ovaries in order to prevent the development of metastases, as well as the recurrence of malignant tumors of the ovaries.
• In order to slow the growth of a tumor of the third and fourth degree with its partial removal.
• When the operation is performed in order to alleviate the condition of a woman, if the tumor can not be removed. Conducting chemotherapy in this case improves survival.
• Before surgery to improve its effectiveness, reduce the volume of surgery.

Chemotherapy for ovarian cancer can be prescribed in the following cases:

• after surgery to completely remove the tumor, to prevent the development of metastases and tumor recurrence;
• after surgery for partial removal of tumors of grade III or IV, for inhibition of growth or destruction of the remains of malignant tissues;
• after palliative treatment, when the operation is not carried out radically, but only to facilitate the patient's condition; In this case, chemotherapy can significantly affect the survival of cancer patients;
• before surgical intervention, to improve the efficiency of the operation.

After surgery, usually spend at least 3 courses of treatment chemotherapy:

• directly in the postoperative period;
• 40-60 days after the operation;
• 90-120 days after the second course.

Further, at the discretion of the doctor, chemotherapy can be performed every six months.

The course of chemotherapy for ovarian cancer

After the surgical treatment of a malignant tumor of the ovary, chemotherapy courses are almost always carried out. Chemotherapy for ovarian cancer is an average of three to four (or more) courses. The first course of a woman is performed right after the operation, and the next one: in a month and a half or two months - the second course, after three to four months - the third, if necessary, then they are carried out after six months each.

During the first course of chemotherapy for ovarian cancer, the patient receives the greatest amount of medicinal substance, during subsequent courses the dose should not be less than seventy five percent of the previous one. To achieve long-term survival, ovarian cancer chemotherapy continues for one to three years.

Treatment of chemotherapy ovarian cancer has its own characteristics. They are related to the fact that the neoplasm of appendages can not be seen with the naked eye before the operation. For this reason, if the patient is not supposed to operate, then to ensure that the tumor is destroyed, a course of chemotherapy is prescribed. Even after surgery, chemotherapy can serve as a prophylaxis for the re-development of the tumor.

• Treatment with chemo drugs can be carried out at all stages of the disease: to destroy the tumor, to slow its growth, to prevent metastases.
• Chemotherapy has many side effects, of which we will talk later. But the undeniable advantage of chemotherapy is that they affect all tissues of the body, and this significantly reduces the risk of developing near and distant metastases.
• Treatment with chemotherapy has advantages even before radiotherapy, since the active substances of such drugs with blood or lymph flow penetrate directly into the lesion.
• Chemotherapy affects even those cancer cells that are already growing and actively multiplying, but have not yet identified themselves with specific symptoms (latent cancer).
• Chemotherapy is an important stage in the treatment of cancer, and it should not be abandoned.

Chemotherapy regimens for ovarian cancer

With chemotherapy for ovarian cancer, the best effect is observed with combined treatment, rather than with the administration of individual drugs.

One of the most commonly used regimens for chemotherapy for ovarian cancer is the ATS scheme:

• Cisplatin in a dosage of 50 mg / m;
• Cyclophosphamide in a dose of 400 mg / m;
• Adriablastin at 30 mg / m.

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

• Vincristine in a dosage of 1 mg / m;
• Cyclophosphane at 400 mg / m;
• Actinomycin D at 0.25 mg / m.

The PvB scheme is also often used for germinogenic tumors:

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

If there is a relapse of cancer or a cancerous tumor has been insensitive to previous chemotherapy for ovarian cancer, other schemes for the administration of drugs may be used.

TIP scheme:

• Palitaxel 175 mg per square meter;
• Ifosfamide 3-5 g per square meter;
• Cisplatin 75 mg per square meter.

Scheme of VeIP:

• Vinblastine 0.2 mg / kg;
• Ifosfamide from three to five grams per square meter;
• Cisplatin per square meter is 75 milligrams.

VIP scheme:

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

It is much less often monotherapy - treatment with any one drug. Practice shows that a combination of drugs involves the maximum effect of treatment.

It is generally believed that for complete destruction of the neoplasm treatment should consist of six courses, but experts have not yet clearly formulated an opinion on this issue. Most doctors are inclined to the fact that there are enough three or four courses of treatment with chemotherapy. In any case, the application of the "surgery plus chemotherapy" scheme has the maximum beneficial effect and significantly increases the chances of survival of patients.

Each case of prescribing drugs requires an individual approach, since practice shows that in some cases, patients have to undergo 8 or even 10 courses to completely get rid of the tumor.

[5], [6], [7]

Preparations for chemotherapy of ovarian cancer

During the chemotherapy of ovarian cancer, cytotoxic drugs are used that are detrimental to cancer cells and stop the growth of a cancerous tumor. Cytotoxic drugs are injected into a vein or intraperitoneal injection using a special tube, very rarely - orally in a tablet form.

The most common antitumor drug used in chemotherapy for ovarian cancer - carboplatin - belongs to the group of platinum derivatives. It is entered only into a vein.

Cisplatin also belongs to platinum derivatives. It can cause tumor regression or a decrease in the tumor. Assign as an independent drug or in combination with other medicinal substances.

Paclitaxel is a herbal medicinal product extracted artificially and semi-artificially, an alkaloid that is extracted from the bark of yew tree - is also often used for chemotherapy of ovarian cancer.

Semisynthetic preparation of docetaxel is of vegetable origin, since for its production, yew yew needles are used.

Cyclophosphamide is used when a tissue graft survival is necessary or when it is necessary to reduce the immune system response to changes in the body. This is possible due to the ability of the drug to suppress the immune forces of the body.

Doxorubicin is an antibiotic containing anthracycline.

Gemcitabine is used alone and with other anti-cancer agents. Topotecan is an inhibitor of topoisomerase. More commonly used with cisplatin.

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

Contraindications to chemotherapy for ovarian cancer

Despite the effectiveness of chemotherapy, this method of treatment has a number of contraindications that should be considered when prescribing a course of treatment:

• severe co-morbidities, the course of which can significantly worsen after a course of chemotherapy;
• severe disorders of the liver and the system of renal filtration, as well as hemopoietic organs;
• severe disorders of the nervous system, mental disorders that can interfere with the patient in assessing the situation and expressing her consent to the course of chemotherapy;

There are also contraindications for specific chemotherapy drugs. For example, Topotecan and Doxorubicin are not prescribed for an unsatisfactory state of the patient (with severe weakness, poor health), with intestinal obstruction, with significant changes in blood counts.

Based on the above, it should be concluded that each oncological patient should be treated individually, depending on the characteristics of the body.

Contraindications to chemotherapy for ovarian cancer are also severe concomitant diseases or any ailment in the stage of decompensation.

• Disturbed function of the kidneys, liver, hematopoiesis; significant deviations from the norm of creatinine; total bilirubin more than 40 mm / l; ALT - above 1.8; AST is above 1.3; neutrophils - below 1500 mm ³; the number of platelets is less than 100 thousand / mm ³.
• Violations of the neurological nature are higher than the second degree.
• Violations of intelligence and behavior that may affect the ability to agree to chemotherapy.
• Hypersensitivity reactions to proposed chemotherapy, allergy.

[8], [9], [10], [11], [12]

Side effects of chemotherapy for ovarian cancer

The most common side effect of chemotherapy for ovarian cancer is baldness. After a while, hair growth is restored. Often there is nausea, vomiting, dizziness, loose stool, as most chemotherapeutic drugs are very toxic. At this time, patients may lose weight due to lack of appetite. These phenomena also quickly pass after the end of the course of treatment. The picture of blood can change: hemoglobin, the number of leukocytes, platelets decreases. In order to control the blood picture, patients undergoing chemotherapy for ovarian cancer receive a weekly clinical blood test.

Most specialists recommend the use of carboplatin in the appointment of intravenous chemotherapy, since this drug has less pronounced side effects, compared with Cisplatinum. At the same time, the impact of these funds is almost identical.

It is also possible to use other medications and their combinations.

The action of chemotherapy is aimed at the destruction and destruction of cancer cells. At the same time, these medicines also affect healthy tissue. All this is taken into account by the doctor at the appointment of treatment - he will certainly try to choose a medicine that will show a minimal amount of side effects.

The number and extent of side effects depends on the particular drug, the duration of therapy and the dosage used.

The most typical manifestations are:

• skin rashes, mostly on palmar surfaces and feet;
• loss of hair;
• attacks of nausea and vomiting;
• lack of craving for food;
• the appearance of ulcers in the oral cavity.

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

• a feeling of fatigue, weakness (as a consequence of anemia);
• falling immunity (frequent colds and infectious diseases are possible);
• increased vascular permeability (bleeding, appearance of bruises on the body).

After completing the course of chemotherapy, most of the side effects occur. So, hair growth resumes, appetite is restored. However, it happens that some medicines cause long-term side effects, or even such manifestations that later remain for life. For example, Cisplatin may cause impaired renal function, and in combination with taxanes, this drug can cause neuropathy (damage to nerve endings and fibers). Neuropathy is usually manifested by a sensation of "goosebumps," pain, numbness in the distal parts of the limbs. In addition, chemotherapy can lead to infertility or early menopause - these phenomena can be temporary or permanent.

In extremely rare cases, chemotherapy can provoke leukocyte damage and lead to the development of myeloid leukemia, a malignant blood disease. However, this is a very rare phenomenon, and the doctor should closely monitor the treatment process to prevent such a complication.

Complications of chemotherapy for ovarian cancer

One of the most common complications in chemotherapy for ovarian cancer is the severe oppression of the hematopoietic system. Severe anemia and leukopenia can develop. Complications from the kidneys, up to kidney failure, are also common. In order not to bring to this kind of complications, the patient undergoes ultrasound of the kidneys and donates blood to the kidney tests (follow the level of serum creatinine). Deviations from the cardiovascular system are possible. For the purpose of their avoidance, the patient before the beginning of treatment and during it do periodically a cardiogram of the heart. Observe the appetite and weight of the patient to avoid exhaustion and cachexia. There are complications in the form of toxic hepatitis, as the drugs are very toxic, and the liver is not always able to cope with them. The patient is prescribed periodically a blood test for hepatic assays.

Repeated appearance of tumors after the course of treatment is not uncommon. Usually, relapses can occur within one and a half to two years after the last course of chemotherapy. Ovarian cancer can manifest itself by the appearance of malignant cells in the space between the uterus and the intestine.

The risk of complications depends on many factors.

• Whether the operation was performed, and to what extent the tumor was removed;
• from the structure of the neoplasm (histological examination is carried out to determine the structure);
• from the duration of chemotherapy and dosage of drugs;
• from how many drugs were involved in the treatment.

To reduce the risk of complications, a woman should follow the following rules:

• completely abandon the harmfulness, such as drinking, smoking, drugs;
• in time to consult a doctor about any diseases of the genital area;
• to eat properly and fully;
• avoid exposure to the body of radiation, X-rays, chemical agents;
• once a half a year the patient should undergo a preventive examination by a gynecologist and an oncologist, with the obligatory ultrasound examination and venous blood analysis for oncomarkers.

If a person is diagnosed with cancer, you do not need to take this as the end of the world, but you can not delay too. But the mood for serious and long-term treatment is mandatory. The treatment, carried out on time, saved more than one life. Methods of cancer treatment, including chemotherapy of ovarian cancer, are constantly being improved, undergoing changes, in order to arrive at the right time to help doctors in the struggle for the main value on earth - human life and health.

[13], [14], [15]