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Ovarian Cancer

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INTRODUCTION
Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries, each about the size of an almond, produce eggs as well as the hormones estrogen, progesterone and testosterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is difficult to treat and is often fatal. Ovarian cancer treatments are available. Researchers are studying ways to improve ovarian cancer treatment and looking into ways to detect ovarian cancer at an earlier stage.

SYMPTOMS
Symptoms of ovarian cancer are not specific to the disease, and they often mimic those of many other more-common conditions, including digestive and bladder problems. When ovarian cancer symptoms are present, they tend to be persistent and worsen with time. Signs and symptoms of ovarian cancer may include:
• Abdominal pressure, fullness, swelling or bloating
• Pelvic discomfort or pain
• Persistent indigestion, gas or nausea
• Changes in bowel habits, such as constipation
• Changes in bladder habits, including a frequent need to urinate
• Loss of appetite or quickly feeling full
• Increased abdominal girth or clothes fitting tighter around your waist
• A persistent lack of energy
• Low back pain

CAUSES
It is not clear what causes ovarian cancer. In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they do not die. The accumulating abnormal cells form a mass, or tumor. Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body.

Types of ovarian cancer
The type of cell where the cancer begins determines the type of ovarian cancer one has.
Ovarian cancer types include:
• Cancer that begins in the cells on the outside of the ovaries: Called epithelial tumors; these cancers begin in the thin layer of tissue that covers the outside of the ovaries. Most ovarian cancers are epithelial tumors.
• Cancer that begins in the egg-producing cells: Called germ cell tumors; these ovarian cancers tend to occur in younger women.
• Cancer that begins in the hormone-producing cell: These cancers, called stromal tumors, begin in the ovarian tissue that produces the hormones estrogen, progesterone and testosterone.
The type of ovarian cancer one has helps determine her prognosis and treatment options.

RISKS FACTORS
Certain factors may increase one’s risk of ovarian cancer. Having one or more of these risk factors does not mean that one is sure to develop ovarian cancer, but her risk may be higher than that of the average woman. These risk factors include:
• Inherited gene mutations: A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.
• Family history of ovarian cancer: If women in your family have been diagnosed with ovarian cancer, you have an increased risk of the disease.
• A previous cancer diagnosis: If a woman has been diagnosed with cancer of the breast, colon, rectum or uterus, her risk of ovarian cancer is increased.
• Increasing age: Risk of ovarian cancer increases as a woman ages. Ovarian cancer most often develops after menopause, though it can occur at any age.
• Never having been pregnant: Women who have never been pregnant have an increased risk of ovarian cancer.

TEST AND DIAGNOSIS
Tests and procedures used to diagnose ovarian cancer include:
• Pelvic examination: During a pelvic exam, your doctor carefully inspects the outer exposed part of your genitals, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can visually check your vagina and cervix for abnormalities.
• Ultrasound: Ultrasound uses high-frequency sound waves to produce images of the inside of the body. An ultrasound helps your doctor investigate the size, shape and configuration of your ovaries. To create a picture of your ovaries, your doctor may insert an ultrasound probe into your vagina. Ultrasound imaging can create pictures of the structures near your ovaries, such as your uterus.
• Surgery to remove samples of tissue for testing: If other tests suggest you may have ovarian cancer, your doctor may recommend surgery to confirm the diagnosis. During surgery, a gynecologic oncologist makes an incision in your abdomen and explores your abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible. In some cases, the surgeon may make several small incisions in your abdomen and insert special surgical tools and a tiny camera, so the procedure won’t require a larger incision.
• CA 125 blood test: CA 125 is a protein found on the surface of ovarian cancer cells and some healthy tissue. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. For this reason, a CA 125 test is not usually used for diagnosis.

Staging ovarian cancer
Doctors use the results of your surgery in order to determine the extent — or stage — of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), to determine whether cancer has spread within the abdomen. Your cancer’s stage helps determine your prognosis and your treatment options. Stages of ovarian cancer include:
• Stage I: Ovarian cancer is confined to one or both ovaries.
• Stage II: Ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
• Stage III: Ovarian cancer has spread beyond the pelvis or to the lymph nodes within the abdomen.
• Stage IV: Ovarian cancer has spread to organs beyond the abdomen, such as the liver or the lungs.

TREATMENTS AND DRUGS
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery
Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. The surgeon also removes as much cancer as possible from your abdomen. Less extensive surgery may be possible if the ovarian cancer was diagnosed at a very early stage. For women with Stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children in the future.
Chemotherapy
After surgery, the patient most likely be treated with chemotherapy (drugs designed to kill any remaining cancer cells). Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be administered in a vein or injected directly into the abdominal cavity, or both methods of administering the drugs can be used. Chemotherapy drugs can be given alone or in combination.

CASE STUDIES
• A Swedish study, which followed more than 61,000 women for 13 years, has found a significant link between milk consumption and ovarian cancer. According to the BBC, “Researchers found that milk had the strongest link with ovarian cancer, those women who drank two or more glasses a day were at double the risk of those who did not consume it at all, or only in small amounts. Recent studies have also shown that women in sunnier countries have a lower rate of ovarian cancer, which may have some kind of connection with exposure to Vitamin D.”
• Other studies have showed that, the more children a woman has and the earlier in life she gives birth, the lower her risk for ovarian cancer. They also suggest that, birth control pills decrease the risk of ovarian cancer.
• AJ is a 20-year-old Caucasian female who visited her gynecologist complaining of abdominal pain, pelvic pain, and pain in the small of her back, which had begun to worsen. She also felt bloated and was having frequent problems with indigestion and gas. In addition, she was tired all the time and rarely went to the gym anymore.
AJ’s medical history showed her to be a healthy and athletic female. She admitted to drinking occasionally at social events but denied having ever smoked. AJ had been receiving annual gynecological exams since she was 18 years old, and her menstrual history has been unremarkable. Her family history showed that her mother was a breast and ovarian cancer survivor. The patient was not on birth control medication, but she stated that she practices safe sex with the use of condoms.
The GYN performed a pelvic examination of the patient’s vagina, uterus, rectum and pelvis, including ovaries, and checked for masses or growths. He followed the pelvic exam with a transvaginal ultrasound to better detect the presence of abnormal growths in the reproductive organs. AJ’s transvaginal ultrasound revealed a mass on her right ovary. Additional laboratory work-up, including a CA-125 assay of her blood sample, was ordered.
When AJ went back to her GYN for a follow-up visit to discuss her lab results, the physician had concerning news. He said, “I am very sorry but your CA-125 level is very high and your ovary may have a tumor and not a cyst. I’m going to refer you to a gynecologic oncologist for further evaluation.”
Her GYN-ONC biopsied the lesion and consulted with a pathologist to verify the diagnosis of ovarian cancer. He recommended removal of both ovaries, fallopian tubes, and the uterus. AJ was stunned. She told in her physician, “I’m only 20 years old; how could I have ovarian cancer? Isn’t this an illness older women get?”

Bibliography

American Cancer Society, National Ovarian Cancer Coalition (n.d.). What is Ovarian Cancer. ovarian.org. Retrieved October 21, 2001 from http://www.ovarian.org/what_is_ovarian_cancer.php

Bougatsos, C., Huffman H., L., Harris L., E., Nelson D., H., & Walker, M. (2005, September) Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility. ncbi.nlm.nih.gov. Retrieved October 21, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0008140/

Mayo Clinic. (2010, November 11). Ovarian cancer. mayoclinic.com. Retrieved October 21, 2011 from http://www.mayoclinic.com/health/ovarian-cancer/DS00293/DSECTION=symptoms

Mayo Clinic. (2010, November 11). Ovarian cancer. mayoclinic.com. Retrieved October 21, 2011 from http://www.mayoclinic.com/health/ovarian-cancer/DS00293/DSECTION=causes

PRIME, Inc. (n.d.). Ovarian Cancer in a Young Woman . primeinn.org. Retrieved October 21, 2011 from http://primeinc.org/casestudies/casemanager/study/847/Ovarian_Cancer_in_a_Young_Woman

What is relapsed platinum-sensitive ovarian cancer? (n.d.). Retrieved October 21, 2011 from http://www.ovarianstudies.com/cancer.aspx

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