http://health.utah.gov/ucan/cancer/topicdocs/05052008OvarianTelehealth.ppt

1. Ovarian Cancer Treatment & Management Karen A. Zempolich, M.D. Monarch Women’s Cancer Center Utah Cancer Action Network May 5, 2008

5. Ovarian Cancer: Risk Factors Hysterectomy/Removal of Both Ovaries Personal breast cancer history Infertility / low parity Pregnancy and Breastfeeding Family history Oral Contraceptives (50% decrease) Age Decrease Increase

13. Ovarian Carcinoma Comprehensive surgical treatment- Hospital Goff et al, Cancer 2007 57% Low (1-9) Annual cases 69% Urban 56% Large rural 46% Small rural Location 74% High (>20) 69% Medium (10-19) Rate of Comprehensive Surgery

14. Ovarian Carcinoma Comprehensive surgical treatment- Surgeon Goff et al, Cancer 2007 55% Very Low (1) Annual cases 76% Gyn Onc 37% OB/ Gyn (Maine only) 38% Gen Surgeon Location 75% High (>10) 65% Medium (2-9) Rate of Comprehensive Surgery

15. Ovarian Carcinoma Comprehensive surgical treatment- Patient Goff et al, Cancer 2007 0.54 (0.41-0.72) >80 0.79 (0.64-0.97) 71-80 0.88 (0.74-1.05) 61-70 1.07 (0.92-1.26) 51-60 1.00 21-50 Age OR (95% CI)

16. Ovarian Carcinoma Comprehensive surgical treatment- Patient Goff et al, Cancer 2007 0.66 (0.44-0.99) Asian/ Islander 0.76 (0.60-0.95) Hispanic 0.66 (0.52-0.83) African American 1.00 Caucasian Race OR (95% CI)

18. Ovarian Carcinoma Primary Management—Debulking Baker et al, Cancer 1994 13% > 2 cm 20% 1 to 2 cm 50% < 1 cm 5 yr survival Residual Disease

19. Ovarian Carcinoma Primary Management—Debulking Hacker N, Ob & Gyn 1983 6 months > 1.5 cm 18 months 0.5 to 1.5 cm 40 months < 0.5cm Median survival Residual Disease

30. Ovarian Cancer: Hereditary Risks 20 - 65% Known BRCA1 or BRCA2 inherited mutation 40% Hereditary ovarian cancer syndrome 7% 2 first-degree relatives 5% 1 first-degree relative 1.8% None Lifetime Risk Family History of Ovarian Cancer

39. Referral Guidelines Predictive Value-- Premenopausal Im et al, Ob &Gyn 2005 92 34 Overall 82 19 Family Hx 89 64 Metastases 89 58 Ascites 85 70 CA125 NPV % PPV % Criteria

40. Referral Guidelines Predictive Value-- Postmenopausal Im et al, Ob &Gyn 2005 61 66 Pelvic Exam 91 60 Overall 56 42 Family Hx 77 84 Metastases 72 79 Ascites 85 74 CA125 NPV % PPV % Criteria

41. Referral Guidelines Patient Distribution Im et al, Ob &Gyn 2005 69% 30% OB/ Gyn 58% 6% OB/Gyn 42% 94% Gyn Onc Postmenopausal 31% 70% Gyn Onc Premenopausal Benign Mass Ovarian Cancer Specialty

43. Referral Guidelines-- Modified Patient Distribution Im et al, Ob &Gyn 2005 73% 15% OB/ Gyn 76% 10% OB/Gyn 24% 90% Gyn Onc Postmenopausal 27% 85% Gyn Onc Premenopausal Benign Mass Ovarian Cancer Specialty