Introduction:
Epithelial ovarian, fallopian tube, or peritoneal cancer in women has the same characteristics and symptoms. So they are often called together as epithelial ovarian cancer (EOC). After the initial treatment of advanced epithelial ovarian cancer, in most women, there will be a relapse of cancer, and it requires additional therapy.
What Are Platinum-Resistant Diseases?
Platinum-resistant diseases are cancers that relapse after the completion of platinum-based treatment within the time period of six months. Cancer relapse will occur for most women with a history of epithelial ovarian cancer and requires retreatment. The management or treatment of relapsed cancer depends on the time between the completion of platinum-based treatment and the detection of the relapse. This time period is called platinum-free interval (PFI). People with six months or more duration of the platinum-free interval may have a platinum-sensitive disease. People with less than six months of platinum-free intervals may have a platinum-resistant disease. Platinum refractory disease is when women have disease progression during the first-line therapy with platinum-based drugs. They are also considered to have platinum-resistant diseases.
What Are the Symptoms of Epithelial Ovarian, Fallopian Tube, or Peritoneal Cancer?
During the early stage, there are rarely any symptoms. As cancer progresses, the signs and symptoms become evident. Some of the signs and symptoms are -
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Pain in the abdomen.
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Decreases appetite.
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Abdominal bloating.
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Pain in the pelvic region.
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Nausea or vomiting.
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Frequent urination.
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Bleeding from the vagina.
What Risk Factors Can Cause Epithelial Ovarian, Fallopian Tube, or Peritoneal Cancer?
The risk factors that can cause epithelial ovarian, fallopian tube, or peritoneal cancer are-
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As age increases, the chance of getting epithelial ovarian cancer also increases.
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A familial history.
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Inherited gene mutations.
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Endometriosis (formation of endometrial tissue outside the uterus).
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Post menopausal hormonal therapy.
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In obese people.
How Is Epithelial Ovarian, Fallopian Tube, or Peritoneal Cancer Diagnosed?
A physical examination of the pelvic region is performed, and past medical and family history is also considered. Diagnostic tests performed to detect ovarian cancer include -
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Blood Test - A blood test is done to check the increased levels of cancer antigens or proteins.
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Ultrasound - Transvaginal vaginal ultrasound is done by using high-frequency sound waves, which produce echoes that help in viewing images of the internal organs.
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Magnetic Resonance Imaging (MRI) - A three-dimensional image of the pelvic region and organs is produced using a large magnetic field and computer technology.
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Computed Tomography (CT) - Using high X-ray radiation and computer technology, a cross-sectional image of the ovary and pelvic region is produced.
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Positron Emission Tomography (PET) - Usage of radioactive substances to know the presence of abnormal cell growth.
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Chest X-Rays - Chest X-rays are taken to check for metastases or the spread of cancer to the lungs.
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Biopsy - A tissue sample is removed from cancer and observed under a microscope to know about the abnormal growth of the cells.
What Is the Treatment for Relapsed Epithelial Ovarian, Fallopian Tube, or Peritoneal Cancer?
The treatment of epithelial ovarian, fallopian tube, or peritoneal cancer includes surgical cytoreduction (complete removal of the tumor, surrounding tissues, and organs). After the surgical therapy, platinum or taxane combination chemotherapy is advised. In 60 percent of cases, there will be a relapse or recurrence of epithelial ovarian cancer. For women with platinum-sensitive disease or recurrence of cancer after six months, platinum-based therapy like Carboplatin with Paclitaxel is used as first-line treatment. Carboplatin can also be used in combination with Gemcitabine or Doxorubicin.
For women having platinum-resistant disease and platinum-refractory disease, that is, cancer recurrence occurring in less than six months after the initial therapy or cancer starts to progress during the first-line treatment with platinum-based therapy, they are not completely curable. Retreatment goals focus on decreasing symptoms like pain, controlling treatment-related toxicity, and improving the quality of life. After the surgical removal of cancer, chemotherapy, radiotherapy, immunotherapy, and targeted therapy is used to treat epithelial ovarian cancer.
What Are the Medications That Are Used in Platinum-Resistant Diseases?
The first line of treatment for platinum-resistant disease in recurrent epithelial ovarian, fallopian tube, or peritoneal cancer is non-platinum-based chemotherapy. They are -
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Doxorubicin - Pegylated liposomal Doxorubicin is the first line of treatment for platinum-resistant diseases. It stops the growth of cancerous cells. Doxorubicin can cause several adverse effects like threatening heart problems or hand-foot syndrome (skin reaction seen on the hands and feet, usually present as swelling or redness).
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Docetaxel - It is an anticancer or antineoplastic drug that stops the growth and spread of cancer cells.
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Paclitaxel - It is a microtubule inhibitor. The route of administration of the drug is intravenous. It can cause neurotoxicity.
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Etoposide - It is a topoisomerase inhibitor. It is a cytotoxic drug that slows down tumor growth.
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Gemcitabine - It is an antimetabolite that stops tumor growth. It can cause bone marrow suppression.
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Topotecan - It is also a topoisomerase inhibitor. It is an antineoplastic agent that is used to kill cancerous cells. It can cause hematotoxicity.
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Irinotecan - It is used as a second line of treatment in platinum-resistant diseases. It is an antineoplastic enzyme inhibitor that is used to stop the growth of cancer cells.
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Vinorelbine - It is a second-line treatment therapy. It is an antimitotic chemotherapeutic drug used to decrease cancer growth. Vinorelbine can cause bone marrow suppression.
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Ifosfamide - It is the second line of treatment in platinum-resistant diseases. It is an immunosuppressive agent used to treat cancer. It can also cause myelosuppression or bone marrow suppression.
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Leucovorin - It is the second line of treatment therapy. It is a folic acid analog. It protects healthy cells when other medications kill cancerous cells.
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Fluorouracil - It is used as the second line of treatment therapy. It is an antineoplastic medication that kills cancerous cells and prevents the spread of cancer cells.
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Bevacizumab - It can be used with a combination of drugs like Doxorubicin or Paclitaxel.
Conclusion:
Epithelial ovarian, fallopian tube or peritoneal cancer has a high mortality rate in gynecologic cancer. In 75 percent of women, epithelial ovarian cancer is diagnosed at an advanced stage. The prognosis of women with platinum-resistant diseases is inferior in 80 percent of the cases. Hence regular follow-up is needed to increase the survival rate.
