Ovarian Cancer

Ovarian cancer is the eighth common cancer in women. This type of cancer is formed in the tissues of the ovary (which are one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells). The estimated of case and deaths to ovarian cancer in the U. S. in 2010 are 21,880 for new cases and 13,850 death have been reported. Ovarian cancer represents a group of different tumors that arise from diverse types of tissue contained only within the ovary.

The most common type of ovarian cancer arises from the epithelial cells (the outside layer of cells) of the surface of the ovary. The other, rare types of ovarian cancer develop from the egg-forming germ cells or from the supporting tissue (stroma) of the organ. Benign (non-cancerous) tumors and cysts are also found in the ovary and are much more common than ovarian cancers.

The early stages of ovarian cancer may not cause any obvious symptoms but these are the symptoms that have been report by indigestion, heartburn, nausea, gas, abdominal swelling or discomfort, pelvic pain or cramping, bloating or a feeling of fullness, even after a small meal, painful, frequent, or burning urination with no infection, diarrhea or constipation, loss of appetite, unexplained weight loss or gain, unusual fatigue, low back pain, shortness of breath, abnormal vaginal bleeding or irregular periods, and pain during intercourse. Doctors don’t know exactly what causes ovarian cancer.

There are some factors and conditions may increase a woman’s risk of developing this condition. Risk factors for the development of ovarian cancer include: family history of ovarian cancer, women who have one or more close relatives with the disease have an increased risk.

Genes may play part in inheriting the trait for ovarian cancer. If a family history of breast cancer or colon cancer can increase the risk of developing ovarian cancer. Women over 50 are more like than younger women to get ovarian cancer and the risk is greater after age 60. Studies have shown that 50% of women over 63 years of age have gotten ovarian cancer. Women who have never given birth have a greater risk of developing ovarian cancer than women who have had children. The number of childbirths correlates directly with a decreased risk.

The explanation of risk factor seems to be related to the number menstrual cycles a woman has had in her lifetime taking into account if a women started her cycle early. Also women who have had their first child after age 30 and/or experienced menopause after age 50 also show a higher risk for ovarian cancer. Some fertility drugs or hormone therapy after menopause might also increase the risk for developing ovarian cancer even though oral contraceptives pills seem to decrease the chances of the disease. The American Cancer society reports women who are obese may have a higher rate of death than those of normal weight.

Diagnosis of ovarian cancer starts with a physical examination which should include a pelvic exam. There is blood test (for CA-125 and sometimes other markers), and transvaginal ultrasound. The diagnosis must be confirmed with surgery to inspect the abdominal cavity, take biopsies (tissue samples for microscopic analysis) and look for cancer cells in the abdominal fluid. Since in the early stages of ovarian cancer it is hard to determine since the symptoms are non-specific and doctors usually have to wait until it spreads to advanced stages (III/IV) to test run further test.

(This year a new test approved by the FDA in 2011, OVA1 improves ovarian cancer detection over CA125 blood test and clinical assessment. An article published in the June 2011 issue of Obstetrics & Gynecology showed that adding OVA1 to a physician’s preoperative assessment of a woman’s ovarian mass would identify more ovarian and ovarian related cancers, than a physician’s preoperative assessment alone. OVA1 is intended only for women, 18 years and older, who are already selected for surgery because of their pelvic mass. It is not intended for ovarian cancer screening or for a definitive diagnosis of ovarian cancer.

OVA1 was developed in conjunction with researchers at the Johns Hopkins University in Baltimore)1. The general treatment of ovarian cancer is chemotherapy, surgery and radiotherapy treatments. . The type of surgery depends upon how widespread the cancer is when diagnosed as well as the presumed type and grade of cancer. The surgeon may remove one or both ovaries, the fallopian tubes, and the uterus (hysterectomy). For some very early tumors (stage 1, low grade or low-risk disease), only the involved ovary and/or fallopian tube will be removed, especially in young females who wish to preserve their fertility.

In advanced malignancy, where complete resection is not feasible, as much tumor as possible is removed (debulking surgery). In cases where this type of surgery is successful (i. e. < 1 cm in diameter of tumor is left behind, the prognosis is improved compared to patients where large tumor masses (> 1 cm in diameter) are left behind. Minimally invasive surgical techniques may facilitate the safe removal of very large (greater than 10 cm) tumors with fewer complications of surgery. Chemotherapy has been a general standard of care for ovarian cancer for decades, although with highly variable protocols.

Chemotherapy is used after surgery to treat any residual disease, if appropriate. This depends on the histology of the tumor; some kinds of tumor (particularly teratoma) are not sensitive to chemotherapy. In some cases, there may be reason to perform chemotherapy first, followed by surgery. For patients with stage IIIC epithelial ovarian adenocarcinomas who have undergone successful optimal debulking, a recent clinical trial demonstrated that median survival time is significantly longer for patient receiving intraperitoneal (IP) chemotherapy. [46]

Patients in this clinical trial reported less compliance with IP chemotherapy and fewer than half of the patients received all six cycles of IP chemotherapy. Despite this high “drop-out” rate, the group as a whole (including the patients that didn’t complete IP chemotherapy treatment) survived longer on average than patients who received intravenous chemotherapy alone.

Some specialists believe the toxicities and other complications of IP chemotherapy will be unnecessary with improved IV chemotherapy drugs currently being developed. 1 HTTP://WWW. FDA. GOV/NEWSEVENTS/NEWSROOM/PRESSANNOUNCEMENTS/UCM182057. HTM Food and Drug administration press release, Sept. 2009.

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