Chin Med J (Taipei) 1998;61:S36.

Management of Ovarian Cancer- Japanese Experience

Tsuyoshi Kaneoka

Department of Obstetrics and Gynecology, Fukuoka University School of Medicine, Fukuoka, Japan

Abstract

Although Japanese women retain a protective genetic factor against the development of ovarian cancer when compared to white women, mortality rates due to malignant neoplasm of the ovary in Japan have gradually and constantly increased from 1947 to 1990 by 9 times. Transvaginal Doppler with color Doppler imaging and intraturnoral blood flow might be effective for the detection of early ovarian cancer in asymptornatic women. For those with ovarian tumor, tissue characterization with MRI and /or X-rays CT, and blood sampling for tumor markers are necessary. Standard surgery is TAH+BSO+tumor reduction+omentectomy+pelvic lymphadnectomy+paraortic node biosy. Cytoreductive surgery is also indicated for bulky tumor. Preservation of fertility might be necessary for those who entities. Adjuvant chemotherapy for epithelial cancer excluding clear cell carcinoma consist of 3 courses of CAP for stage la, lb, and Ic(b) and 6 courses of CAP for stage Ic~IV. Second look operation is indicated for those with residual tumor less than 2 cm, and IP chemotherapy might be followed. For those with residual tumor more than 2cm, 3 courses of induction chemotherapy and PBSCH might be started, followed by secondary cytoreductive surgery, two courses of CAP, and high dose chemotherapy(1,200mg/m² of CBDCA, 1,200mg/m² VP-16, and 2,000mg/m² of CPM) with PBSCT. Adjuvant chemotherapy for clear cell carcinoma consist of 3 courses of CPT-11 and CDDP for stage Ia, Ib, and Ic( b), and 6 courses of those for stage Ic~IV. BEP therapy is indicated for malignant germ cell tumor. For recurrent or ineffective cases, second line chemotherapy with CBDCA and / or TAX therapy might be indicated. Although five year survival rate for stage I and II was more than 93% in Japan. However, that of advanced ovarian cancer treated with surgical cytoreduction in connection with adjuvant chemotherapy was less than 33%. Thus, early dectection of ovarian tumor might be necessary for better prognosis.

[Chin Med J (Taipei) 1998;61:S36.]