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Ovarian cancer
ICD9 = 183| ICDO = varied | Image = | Caption = | OMIM = | OMIM_mult = | MedlinePlus = 000889 | eMedicineSubj = med | eMedicineTopic = 1698 | DiseasesDB = 9418 | }} Ovarian cancer is a malignantovarian neoplasm(an abnormal growth located on the ovaries).
CausesOvarian cancer is the fourth leading cause of cancerdeath in women, the leading cause of death from gynecologic malignanciesand the second most commonly diagnosed gynecologic malignancy [1]. It is idiopathic, meaning that the exact cause is unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4 % to 2.5 % (1 out of 40-60 women) lifelong chance of developing ovarian cancer. Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age. The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older ages of final pregnancy, and the use of some oral contraceptive pillshave also been shown to have a protective effect. Ovarian cancer is reduced in women after tubal ligation. The link to the use of fertility medicationhas been controversial. An analysis in 1991 raised the possibility that use of drugs tation may increase the risk for ovarian cancer. Several cohortstudies and case-controlstudies have been conducted since then without providing conclusive evidence for such a link with the possible exception that prolonged use (> 1 year) of clomiphene citrateshould be avoided.1 It will remain a complex topic to study as the infertile population differs in parity from the "normal" population. There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1or the BRCA2gene(especially Ashkenazi Jewishwomen) are at a higher risk of both breast cancerand ovarian cancer, often at an earlier age than the general population. Patients with a personal history of breast cancer, or a family history of breast and/or ovarian cancer, may have an elevated risk. A strong family history of uterine cancer, colon cancer, or other gastrointestinal cancersmay indicate the presence of a syndrome known as hereditary non-polyposis colon cancer(HNPCC), which confers a higher risk for developing ovarian cancer. Patients with strong genetic risk for ovarian cancer may consider the use of prophylactic oophorectomyafter completion of child-bearing. Other factors that have been investigated, such as talcuse, asbestosexposure, high dietary fat content, and childhood mumpsinfection, are controversial and have not been definitively proven. A study funded by American Cancer Societyconducted at the H. Lee Moffitt Cancer Center of the University of South Florida has found a correlationbetween high levels of lysophospholipids(a type of fatty acid) with ovarian cancer patients and low levels of lysophospholipids with healthy women. This potential biomarkercan be detected by a simple blood test. The blood test was 93 % accurate as predictor of ovarian cancer with less than 4 % false positivesof the 117 women studied. Other indicators of ovarian cancer could be used to increase accuracy to 100 %. 2 Symptoms
Note: There may be no symptoms until late in the disease. In particular, women should watch for symptoms occurring in groups and lasting two weeks or more. DiagnosisWomen experiencing these symptoms may want to request a blood test called CA-125, along with a complete pelvic examination. While this test is not generally regarded as useful for large scale screening by the medical community, a high value may be an indication that the woman should receive further diagnostic screening or treatment. Normal values range from 0 to 35. Elevated levels in post-menopausal women are usually an indication that further screening is necessary. In pre-menopausal women, the test is less reliable as values are often elevated due to a number of non-cancerous causes, and a value above 35 is not necessarily a cause for concern. Further screening may involve CT scans, trans-vaginal ultrasounds, or retesting of the CA-125 value at a later date (to see if the value is normalising, or increasing). Physical examination may reveal increased abdominal girth and /or ascites(fluid within the abdominal cavity). Pelvic examination may reveal an ovarian or abdominal mass. The pelvic exam should include a rectovaginal component for better palpation of the ovaries. ClassificationOvarian cancer is classified according to the histology of the tumor. Lesions differ significantly in clinical features, management, and prognosis (ICD-Ocodes provided where available):
StagingOvarian cancer staging is by the FIGOstaging system and uses information obtained after surgery, which should include a total abdominal hysterectomy, removal of (usually) both ovaries and fallopian tubes, (usually) the omentum, and pelvic (peritoneal) washings for cytology. The AJCC stage is the same as the FIGO stage.
Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC). TreatmentSurgeryis the preferred treatment and is frequently necessary for diagnosis. Studies have shown that surgery performed by a specialist in gynecologic oncologyresults in a higher rate of cure. Chemotherapyis used as after surgery to treat any residual disease. Until recently, intravenous chemotherapy was used in treating patients with advanced ovarian cancer. A recent study has shown that women with advanced ovarian cancer live longerif chemotherapy is given into the abdomen. Now doctors are recommending chemotherapy delivered to the abdomen as a preferred method of treating advanced ovarian cancer. Chemotherapy can also be used to treat women who have a recurrence. Radiation therapyis rarely used in ovarian cancer in the United States. ChemoSensitivity Testing is being done by a few labs in the USA. It may or may not be covered by your insurance. It is not snake oil, but it's not yet proven that it yields better results. If you are interested in having this done, you must contact a lab which offers this service and have them ship you the proper containers ahead of your surgery. Your surgeon will then be able to take tumor samples and send them in for testing. Expectations (prognosis)Ovarian cancer is disproportionately deadly for a number of reasons. First, symptoms are vague and non-specific, so women and their physicians frequently attribute them to more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries. Also, ovarian cancers shed malignant cells that frequently implant on the uterus, urinary bladder, bowel, and lining of the bowel wall (omentum). These cells can begin forming new tumor growths before cancer is even suspected. Second, because no cost-effective screening test for ovarian cancer exists, more than 50 % of women with ovarian cancer are diagnosed in the advanced stages of the disease. Ovarian cancer is rarely diagnosed in its early stages; it is usually quite advanced by the time diagnosis is made. The outcome is often poor. The five-year survival rate for all stages is only 35 % to 38 %. If, however, diagnosis is made early in the disease, five-year survival rates can reach 90 % to 98 %. Germ Cell Ovarian Cancerhas a much better prognosis, but is rarer. Despite this poor prognosis, patients should keep in mind that all such studies are retrospective in nature: i.e., they can only look into past results. Therefore they cannot take into account the benefits on survival that newer therapies may provide. Complications
Victims of ovarian cancer
References1Brinton LA et al. Ovulation induction and cancer risk. Fertil Steril 2005;83:261-74. 2The study is published in the 7 July2004journal of Cancer Epidemiology, Biomarkers & Prevention. 3American Association for Clinical Chemistry (2002). CA-125 At a Glanceat Lab Tests Online. Retrieved on March 1, 2005. See also
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