Huisarts en wetenschap

, Volume 55, Issue 10, pp 460–463 | Cite as

Ovarium- en tubacarcinoom, nieuwe ontwikkelingen

  • R. F. P. M. Kruitwagen
  • T. van Gorp
Nascholing

Samenvatting

Kruitwagen RFPM, Van Gorp T. Ovarium- en tubacarcinoom, nieuwe ontwikkelingen. Huisarts Wet 2012;55(10):460-3.

In Nederland krijgen ieder jaar ongeveer 1400 vrouwen, van wie de meeste in de menopauze, de diagnose ovarium- of tubacarcinoom. De gemiddelde huisarts zal ongeveer eens in de vijf jaar een nieuwe patiënte op het spreekuur krijgen. Het ovariumcarcinoom staat bekend als silent killer: het wordt veelal pas in een vergevorderd stadium ontdekt en driekwart overlijdt aan de gevolgen van de ziekte. Voor de huisarts is het zaak alert te zijn op postmenopauzale vrouwen met ‘vage’ klachten zoals buikpijn en een toegenomen buikomvang. De behandeling bestaat uit chirurgische verwijdering van de tumor met aanvullend complete stadiëring indien bij inspectie en palpatie geen metastasen worden ontdekt. Bij gevorderde stadia worden zo mogelijk alle tumorlokalisaties en eventuele uitzaaiingen in de buikholte verwijderd (debulking), gevolgd door chemotherapie. De rol van de huisarts omvat, naast zo vroeg mogelijke signalering, vooral de behandeling en begeleiding van eventuele gevolgen van de chirurgie en/of chemotherapie, en in veel gevallen onvermijdelijk ook de palliatieve begeleiding.

Abstract

Kruitwagen RFPM, Van Gorp T. Ovarian and fallopian tube cancer, new developments. Huisarts Wet 2012;55(10):460-3. In the Netherlands, about 1400 women, mainly menopausal women, are annually

diagnosed with ovarian or fallopian tube cancer. The average general practitioner will see a new patient with ovarian or tubal cancer about once every 5 years. Ovarian cancer is known as a silent killer because it is often detected in an advanced stage, and three-quarters of patients die of the consequences of the disease. Treatment consists of surgical extraction of the tumour followed by a complete staging procedure if no metastases are discovered. In macroscopical advanced stages, resection of all intra-abdominal tumour locations and metastases is performed, followed by chem otherapy. General practitioners should be alert to vague symptoms, such as abdominal pain, and increased abdominal size and girth, reported by postmenopausal women. The role of the general practitioner is to detect the disease as early as possible and to treat possible consequences of surgery or chemotherapy, and in many inevitable cases provide the palliative care.

Literatuur

  1. 1.
    Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009;339:b2998.PubMedCrossRefGoogle Scholar
  2. 2.
    Kurman RJ, Shih I. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer: Shifting the paradigm. Hum Pathol 2011;42:918–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal stat us for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990;97:922–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. Br J Obstet Gynaecol 1996;103:826–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Tingulstad S, Hagen B, Skjeldestad FE, Halvorsen T, Nustad K, Onsrud M. The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol 1999;93:448–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer 2009;115:1234–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Rutten MJ, Gaarenstroom KN, Van Gorp T, Van Meurs HS, Arts HJ, Bossuyt PM, et al. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): A multicentre randomized controlled study. BMC Cancer 2012;12:31.PubMedCrossRefGoogle Scholar
  9. 9.
    Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006;354:34–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Alberts DS, Liu PY, Hannigan EV, O'Toole R, Williams SD, Young JA, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 1996;335:1950–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Markman M, Bundy BN, Alberts DS, Fowler JM, Clark-Pearson DL, Carson LF, et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: An intergroup study of the Gynecologic Oncology Group, South western Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 2001;19:1001–7.PubMedGoogle Scholar
  12. 12.
    Perren TJ, Swart AM, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 2011;365:2484–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011;365:2473–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Rustin GJ, Van der Burg ME, Griffin CL, Guthrie D, Lamont A, Jayson GC, et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/ EORTC 55955): A randomised trial. Lancet 2010;376:1155–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: A meta-analysis. Gynecol Oncol 2009;112:265–74.PubMedCrossRefGoogle Scholar
  16. 16.
    Galaal K, Naik R, Bristow RE, Patel A, Bryant A, Dickinson HO. Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev 2010, Issue 6. Art. No.: CD007822.Google Scholar
  17. 17.
    Boven E, Ossenkoppele GJ. Targeted therapieën tegen kanker. Huisarts Wet 2011;54:266–71.CrossRefGoogle Scholar

Copyright information

© Bohn, Stafleu van Loghum 2012

Authors and Affiliations

  • R. F. P. M. Kruitwagen
    • 1
  • T. van Gorp
    • 1
  1. 1.afdeling GynaecologieMaastricht Universitair Medisch CentrumMaastrichtThe Netherlands

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