14 Jul 2011

Ovarian cancer

Cancer – ovaries

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.
Causes, occurrence, and risk factors
Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer.
The cause is unknown.
The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has and the earlier in life she gives birth, the lower her risk for ovarian cancer. Certain genes defects (BRCA1 and BRCA2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer.
Women who take estrogen replacement only (not with progesterone) for 5 years or more seem to have a higher risk of ovarian cancer. Birth control pills, however, decrease the risk of ovarian cancer.
Studies suggest that fertility drugs do not increase the risk for ovarian cancer.
Older women are at highest risk for developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.
Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.
You should see your doctor if you have the following symptoms on a daily basis for more than a few weeks:
    Difficulty eating or feeling full quickly
    Pelvic or abdominal pain
Other symptoms are also seen with ovarian cancer. However, these symptoms are also common in women who do not have cancer:
    Abnormal menstrual cycles
    Digestive symptoms:
        Increased gas
        Lack of appetite
        Nausea and vomiting
    Sense of pelvic heaviness
    Swollen abdomen or belly
    Unexplained back pain that worsens over time
    Vaginal bleeding
    Vague lower abdominal discomfort
    Weight gain or loss
Other symptoms that can occur with this disease:
    Excessive hair growth
    Increased urinary frequency or urgency
Cipher and tests
A physical examination may reveal a swollen abdomen and fluid in the abdominal cavity (ascites). A pelvic examination may reveal an ovarian or abdominal mass.
A CA-125 blood test is not considered a good screening test for ovarian cancer. However, it may be done if a woman:
    Has symptoms of ovarian cancer
    Has already been diagnosed with ovarian cancer to determine how well treatment is working
Other tests that may be done include:
    Complete blood count and blood chemistry
    Pregnancy test (serum HCG)
    CT or MRI of the pelvis or abdomen
    Ultrasound of the pelvis
Surgery such as a pelvic laparoscopy or exploratory laparotomy may be done to evaluate symptoms and perform a biopsy to help make the diagnosis.
No lab or imaging test has ever been shown to be able to diagnose ovarian cancer in its early stages.
Action - Treatment
Surgery is used to treat all stages of ovarian cancer. For earlier stage ovarian cancer, it may be the only treatment. Surgery involves:
    Removal of the uterus (total hysterectomy)
    Removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
    Partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen
    Examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen
Surgery performed by a specialist in female reproductive cancer has been shown to result in a higher success rate.
Chemotherapy is used after surgery to treat any remaining disease. Chemotherapy can also be used if the cancer comes back. Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal)
Radiation therapy is rarely used in ovarian cancer in the United States.
After surgery and chemotherapy, patients should have:
    A physical exam (including pelvic exam) every 2 - 4 months for the first 2 years, followed by every 6 months for 3 years, and then annually
    A CA-125 blood test at each visit if the level was initially high
    Your doctor may also order a computed tomography (CT) scan of your chest, abdomen, and pelvic area and a chest x-ray.
    Mørch LS, Løkkegaard E, Andreasen AH, Krüger-Kjaer S, Lidegaard O. Hormone therapy and ovarian cancer. JAMA. 2009;302:298-305. [PubMed]
    National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Ovarian Cancer. 2009;v.2. [PubMed]
    Jensen A, Sharif H, Frederiksen K, Kjaer SK. Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study. BMJ. 2009;338:B249. [PubMed]
    Berek JS, Chalas E, Edelson M, Moore DH, Burke WM, Cliby WA, et al. Prophylactic and risk-reducing bilateral salpingo-oophorectomy: Recommendations based on risk of ovarian cancer. Obstet Gynecol. 2010 Sep;116(3):733-43.

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