• What Is Ovarian Cancer?
|What Is Ovarian Cancer?
It is a cancer which begins in the ovaries. The ovaries are the female reproductive glands which manufacture eggs (ova) for fertilization (image). The egg then travel along the fallopian tubes to the womb (uterus) where, if it is fertilized, it imbeds and develops into a baby. There are 2 ovaries, one on each side of the pelvis. The ovaries are also responsible for producing the body's main source of the hormones estrogen and progesterone. Every year there are about 22,000 new cases of ovary cancer (image) diagnosed in the United States and about 15,000 related deaths. Statistically 1 in every 70 newborn girls will develop the disease at some time in her life, with half of those cases occurring after the age of 65. Fortunately however the incidence rate has been dropping by about 1 percent a year over the past 20 years. This may be because so many women are taking the contraceptive pill which appears to offer some protection.
Cancer of the ovaries is a highly dangerous disease. It responsible for more deaths in women than any other gynecologic cancer. About 75 percent of women will still be alive one year after diagnosis, but this reduces to 46 percent by year 5 after diagnosis. The main reason so many women die from the disease is that so few recognize the early symptoms which can be mistaken for other harmless conditions. Often by the time the cancer is diagnosed the tumor has spread beyond the ovaries and is difficult to control (image). On the other hand, women who are diagnosed early have excellent long-term survival chances, the cure rates are nearly 90 percent. However only 15 percent of ovarian cancers are diagnosed early. Yet, these numbers may cause women undue fear. In reality cancer of the ovary is quite rare, accounting for only 3 percent of all cancers in women. An average gynecologist may only come across one case in their practice every several years. Additionally latest discoveries in cancer cell biology may soon result in new approaches to early detection and treatment breakthroughs from gynecologic oncology researchers are improving long-term ovarian cancer survival rates.
Types of ovarian cancer: The ovaries are complex organs and their 2 major functions is egg and hormone production. Each particular function of the cell is carried out by different types of cells. Any of those cell types can turn cancerous with their own unique properties. As a result of this complexity, tumors arising from the different cell types are complex too. That said, the vast majority (90 percent) of ovary cancers occur on the outside surface of the ovary (epithelium). This type of cancer is called ovarian epithelial cancer. Nonepithelial cancers account for 10 percent of cases.
Ovarian Epithelial Cancer
Nonepithelial Ovarian Cancer
The signs and symptoms of ovarian cancer are vague and can be easily attributed to other causes. Yet, we do know from recent studies that it is not a silent disease. It commonly produces the following symptoms:
The causes of ovarian cancer are unknown, but several risk factors appear to play a role. Genetic predisposition is a key factor. Up to 10 percent of women with epithelial type cancers will have the BRCA1 or 2 genetic mutations associated with breast cancer. Other risks include:
• Women who take estrogen replacement therapy (without progesterone) for 5 years.
Birth control pills and breastfeeding on the other hand seem to lower the overall risk.
Testing for a disease when a person has no symptoms is called screening. Currently there is no general screening process for ovarian cancer and it is probably not necessary for most women. Cervical cancer screening (Pap test) will not identify ovary cancer. If you feel you are at risk (because of a strong family history of ovarian, breast, uterine or even prostate or colon cancer) talk to your doctor about genetic testing. He may recommend you speak to a genetic counselor.
A doctor will carry out an extensive pelvic examination. If the doctor suspects abnormalities the woman will be referred to a specialist, usually a gynecologic oncologist. This is a doctor who specializes in cancers of the female reproductive system. The gynecologist will take a full medical history; carry out another physical examination and Pap smear test to rule out other female cancers. The rest of the diagnostic procedure (work-up) will depend on the woman's age, symptoms and condition of health. Tests may include:
• CA125 tumor marker blood test.
Ovarian cancer treatment is improving rapidly on an almost yearly basis. Women with the disease are encouraged to find out about the most up-to-date options. Those new techniques may be of particular interest to younger women who wish to preserve fertility if treatment requires the removal of their ovaries. For example, one possibility is to preserve fertilized embryos if they have a partner. New assisted reproductive technology also helps to preserve sections of ovarian tissue for later use. All this will need to be discussed and performed before treatment for the cancer begins. The main ovarian cancer treatment options are surgery, systemic chemotherapy and radiation therapy. Surgery is usually the main choice, and according to the stage of the disease chemotherapy may also be offered. If the pathologist and surgeon think cancer may have remained behind after surgery, radiation therapy might be recommended, although it is rarely recommended in the United States.
If you are a younger woman and have had your ovaries removed you may enter premature menopause. This means you will be prone to menopause symptoms such as hot flashes and night sweats. The side effects of chemotherapy can include vomiting, diarrhea, and nausea and hair loss. Your treatment team should fully advise you before starting therapy.
Once the treatment course has finished, your doctor will want to see you for regular checkups. This is known as follow-up. Every 2 to 4 months the doctor should perform a complete physical examination for the first 2 years. This cuts to every 6 months for the next 3 years and annually thereafter. The doctor may also order CT scans of the chest, abdomen and pelvic region. Read also about ovarian cancer recurrence.
This depends on how far the cancer has spread. For women of childbearing age with certain type of tumors, or ovarian cancer in the early stages, it may still be possible to treat the disease without removing both ovaries and the womb. In fact a new study of young women with early stages of the cancer found that those who kept their uterus and at least part of one ovary did not reduce their overall survival rate. In many instances however the disease will result in hysterectomy and the loss of fertility. This is why it is important for women who still wish to become pregnant to discuss fertility preservation technologies with their doctor before beginning treatment.
Women who take contraceptive pills for more than 5 years have their risk factor reduced by 50 percent. However the side effects of birth control pills must also be taken into account.
A genetic counselor can help predict if you are likely to have a BRCA gene mutation associated with ovarian cancer. If you are high risk they may recommend genetic testing. If you test positive, you may consider taking the birth control pill to lower your risks. Research shows that premenopausal women with BRCA mutations who have their ovaries removed cut their risk of ovarian cancer by 85 to 95 percent. They also reduce their breast cancer risk factor by 50 to 60 percent. For more read about ovarian cancer prevention.
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