Ovarian cancer is a malignancy that begins in the ovaries, a reproductive organ in women that produces hormones and eggs. This cancer is the fifth leading cause of death for women. It is the second most common cause of gynecological malignancy. What causes ovarian cancer to begin to grow in the body is unknown. In the United States 1 out of 40-60 women have a lifetime chance of developing this cancer.
Women who are older have a higher risk with over fifty percent of fatalities occurring in women aged 55 to 74. Twenty five percent of deaths from ovarian cancer are in women aged 35 to 54. The risk is lowered by a few factors: women who have more than one child, an early first pregnancy, older ages for final pregnancy, using low dose hormones for contraceptive and tubal ligation.
There are some genetic factors that indicate a risk. Women who have a certain mutation in the BRCA1 or BRCA2 gene are at a higher risk for both ovarian and breast cancer, occurring at an earlier age than the typically affected population. Family histories of uterine cancer and gastrointestinal cancer have also been associated with an increased risk of developing ovarian cancer. Some women have chosen to have their ovaries removed after their last child as a preventative measure.
Unfortunately symptoms do not appear until the later stages of the disease. The symptoms that have been associated with ovarian cancer are vaginal bleeding. weight gain or loss, heavy pelvic feeling, atypical menstrual cycles, unexplained, worsening back pain, increase growth in the abdomen, and non specific gastrointestinal symptoms such as increased gas, abdominal discomfort, bloating, nausea, vomiting, lack of appetite, indigestion and inability to eat common portions of food. Other symptoms that have been associated with ovarian cancer are excessive hair growth, pleural effusions (excess fluid in the lining of the lungs) and increased urge to urinate.
It is very difficult to diagnose ovarian cancer during the early stages of the disease because the symptoms are non-specific or can be attributed to many other conditions. A blood test that checks for CA-125 is used to follow the disease, but has not been recommended for an early screening procedure, like the test for prostate cancer blood test for PSA levels.
Ovarian cancer is diagnosed via internal pelvic exam, medical imaging and biopsy of tumors. Classification is important to determine which course of treatment would work best. Classification defines the type of tumor present on the ovary. Surface epithelial-stromal tumors are the most common of ovarian cancers. This group of tumors includes serus cystadenocarcinoma and mucinous cystadenocarcinoma. Sex cord-stromal tumors are lesions that produce hormones, such as the estrogen secreting ganulosa tumor, the virilising Sertoli-leydia tumor and the arrhenoblastoma. Germ cell tumors are another classification. Germ cell tumors appear from dysplastic germ material and are common in young women and girls. Germ cell lesions are dysgerminoma, a type of choriocarcinoma and the malignant version of the teratoma. Other lesions are metastasized cancer cells form other origins such as breast cancer or Krukenberg cancer which begins with gastrointestinal cancer.
Staging is part of the diagnosis of ovarian cancer. Staging uses information that is obtained after surgery, which might be the removal of one or both ovaries, the fallopian tubes, total hysterectomy, the omentum and a sampling of pelvic washing for microscopic evaluation. Ovarian Cancer staging has four categories. Stage 1 through 3 has three subcategories.
Stage 1 cancer is limited to both or just one ovary.
1A one ovary is affected, the ovary is intact, no tumor on the surface and no malignant cells are present in any washing, ascites or peritoneal.
1B both ovaries are affected, ovary is intact, no tumor on the surface and washings are negative
1C tumor is limited to the ovaries, ovary has ruptured, tumor is on the surface and washings are positive for cancer cells
Stage 2 cancer is involved as pelvic implants or extensions
2A cancer has spread to uterus or fallopian tubes with negative wasings
2B cancer has spread to other structures or organs in the pelvis, washings are negative.
2C cancer ha sspread into the pelvis with positive washing of the peritoneal
Stage 3 mircroscopic extension of the cancer outside of the pelvis or limted to the pelvis and small bowel or omentum
3A microscopic peritoneal metastasis beyond the pelvis
3B microscopic peritoneal metastasis outside of the pelvis that are less than 2 cm in size
3C macroscopic peritoneal metastasis outside the pelvis that are 2cm or larger or are in the lymph nodes
Stage 4 is ovarian cancer with distant spreading to other organs.
Surgery is the most common treatment and is often required for definitive diagnosis. Using a specialist that focuses on gynecologic oncology provides the best results. The type of surgery depends on the presence of the cancer when it is diagnosed or the staging. The type and grade of the cancer also determines the kind of surgery that will be performed.
Surgery for ovarian cancer may include the removal of one ovary (unilateral oophorectomy) or two ovaries (bilateral oophorectomy), the fallopian tubes (salpingectomy) and/or the uterus (hysterectomy). Sometimes when a tumor is stage 1, only the affected ovary and falopion tube is removed, known as a unilateral salpingo-oophorectomy or USO.
After surgery, chemotherapy is administered to kill any residual cancer cells. The current treatment is systemic chemotherapy that is a platinum derivative with a taxene. Radiation therapy is not considered for advanced stages of the disease because the high doses of radiation cannot be delivered to other vital organs within the area of the ovarian cancer.
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