Ovarian cancer is the fifth most common cause of cancer-related deaths among females and causes more deaths than any other type of female reproductive cancer Siegel et al 2016. Signs and symptoms of this type of cancer are often absent or indefinite in the early stages and many patients have been diagnosed in advanced stages due to a lack of early detection strategies. These patients with advanced stages of ovarian cancer have less than 50 of a five-year survival rate despite the recent developments in chemotherapy Miller et al 2016. A more recent recommended treatment for advanced ovarian cancer is neoadjuvant therapy or the use of chemotherapy or radiation prior to surgery for patients with stage IIIC or IV ovarian cancer to decrease tumor burden and mitigate extensive metastases Morgan et al 2012. In spite of this after initial treatment patients enter into clinical remission and recurrence occurs in 70 of patients some months or years after initial treatment Krasner Duska 2009 Leitao Chi 2009. Moreover, the chance of undetectable and untreated residual disease after chemotherapy and surgery is high Chefetz et al 2013 Craveiro et al 2013. While there are other novel procedures to cure cancer there is still a high recurrence of cancer either leading to a higher stage of cancer or death. In the Philippines ovarian cancer is the 7th most prevalent type of cancer in women with 2.657 new cases and . 610 deaths in 2015 Laudico et al 2015.
Treatment. The main aim of the treatment is to get the blood counts back to normal. If this is achieved and the bone marrow looks healthy under the microscope the cancer is said to be in remission i.e the absence of any detectable cancer cells in the body. Over the past decade's effective treatments for acute lymphoblastic leukemia have been developed, hence survival rates have increased. There are many treatments available for ALL including steroids, chemotherapy, radiation, therapy, stem cell or bone marrow transplants etc www mountsinai org 37. Chemotherapy is the first treatment of choice with a goal of achieving a remission. There are three stages in chemotherapy. A remission induction, B intensification, and C maintenance therapy. A Remission Induction. The major goals are 1 Rapidly kill all the tumor cells and restore normal hematopoiesis, 2 Reduce blast cells in the bone marrow to 5 and eliminate tumor cells from blood, 3 Cause absence of other symptoms of the disease. The following drugs are used in combination steroids like dexamethasone, vincristine, asparaginase etc Hoffbrand et al 2013 38. B Intensification High doses of chemotherapy is helpful in removing the tumor burden.