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Ovarian Cancer (Ab Ovo)
Ovarian cancer is the 5th most common cancer in women after lung, breast, colorectal and pancreatic cancers. It represents only 3% of cancers in women and, fortunately, the incidence of this type of cancer has decreased by approximately 1% over the past twenty years. Unfortunately, the diagnosis is usually late because there are very subtle and often protean symptoms and signs. Ovarian cancer is not only a cancer of old age, it can occur at any age, even in early childhood, however, the incidence of this cancer increases dramatically after the age of 50.
There are certain risk factors for ovarian cancer, the main ones being family history and certain associated genetic syndromes. A blood relative with ovarian cancer increases the risk of this cancer for his relative by 5%. There is a hereditary breast and ovarian cancer syndrome that occurs in one in 500 women and being an autosomal dominant genetic disease, it results in a mutation of the BRCA1 and/or BRCA2 genes. The other is Lynch II syndrome, a hereditary nonpolyposis colorectal cancer syndrome, again autosomal dominant, which increases the risk of ovarian cancer by 12%. However, the majority of women diagnosed with ovarian cancer have no family history and the etiology remains unknown. When ovarian cancer occurs and is not detected early when localized to one ovary, the cancer usually spreads first to the unaffected ovary and uterus, but can spread to the liver, lungs, adrenal glands, spleen and other intraperitoneal organs.
Some things that reduce the risk are the protective effects of birth control pills, late menarche, early menopause, multiparity (having more than one child), and breastfeeding. Progesterone appears to be protective, but there is controversy as a 2009 Danish study suggests that all HRT carries an increased risk (the study was done with estrogen alone (unopposed) or estrogen and progestogen (the progestogen is a synthetic progesterone compound).The use of natural bioidentical hormones for prevention will need to be done to clear up this controversy as previous studies have shown HRT to be protective.There are modifiable factors such as reduction in weight (avoiding obesity), stopping smoking, reducing high starch and fatty foods which can reduce the risk of this cancer It has been shown that a well-balanced diet rich in carotene, vitamins C and E and unsaturated fats associated with moderate physical activity helps reduce the risk of ovarian cancer.
It is very difficult to make an early diagnosis due to the fact that the signs and symptoms are very often subtle and nonspecific, and unless you look for this disease with specific laboratory and radiology tests, you will not find it. probably not soon. Some symptoms include abdominal pain and fullness, back pain, nausea, constipation, diarrhea, fatigue, pelvic pain, and urinary symptoms. Laboratory tests should be considered in women over 40 if these symptoms persist, as they are a higher risk population for ovarian cancer. The tests usually involve a CBC, a metabolic panel, and serum CA 125 levels. CA 125 is a cancer marker that is rather sensitive and specific for ovarian cancer, but there are other conditions that can elevate this. marker such as pelvic inflammatory disease (PID), endometriosis, ovarian cysts and pregnancy. CA 125 is a good but not perfect test as it is elevated in 90% of patients with advanced disease but only over 50% with stage I tumors. useful, including the beta-subunit of human chorionic gonadotropin (Beta-HCG), serum alpha-fetoprotein (AFP), neuron-specific enolase (NSE), and lactate dehydrogenase (LDH). Diagnosis is also made by diagnostic imaging, such as transvaginal Doppler ultrasound (ultrasound or ultrasonography), often used as an initial workup for a pelvic mass. Ultrasound is useful in distinguishing benign ovarian lesions such as simple cysts from those that appear more malignant such as complex solid tumors. Other modes of radiological imaging useful to the diagnostician are computed tomography and gadolinium MRI.
Treatment usually includes (after thorough diagnostic testing and staging) surgical excision of the mass/tumor. Depending on the stage of the disease, other organs may also be removed, for example the appendix is usually removed because of its potential target for metastasis. After tumor removal, chemotherapy is usually initiated with a combination of platinum and taxane agents. Carboplatin and taxol are two commonly used chemotherapy drugs. For women beyond their childbearing years, a total hysterectomy is often considered, while radiation therapy is reserved for palliative and persistent conditions that recur after a regiment of chemotherapy.
Prognosis is a bit complicated as it is based on disease staging as well as histological grade (type of tumor etiology) which usually plays a role in recurrence rates. For example, epithelial ovarian cancer (histologically) has low malignant potential if diagnosed at stage I and has a 95-99% survival rate at 10 years.
Screening for ovarian cancer should include an annual physical examination and marker- and imaging-directed examinations only when warranted. Routine screening with CA 125 gives too many false positives and misses too many tumors early to be a good general screening test. BRCA testing should be reserved for offspring of people with mutated BRCA1 and BRCA2 genes, it is not recommended as a general screening tool. Current recommendations for women meeting the criteria for high or very high risk of ovarian cancer should be screened by transvaginal ultrasound and have a CA 125 measured every six months during days 1 to 10 of their menstrual cycle from 35 years.
The take-home message here is that women need to be diligent about their annual physicals and not ignore lingering symptoms that may point to a more serious underlying condition.
Roett, M. Evans, P., “Ovarian Cancer: An Overview,” American Family Physician, vol. 80, Number 6, September 15, 2009, p.609-616.
www.ncbi.nlm.nih.gov/pubmed/10933270 (accessed 2009/8/10)
www.medicinenet.com/script/main/art.asp?articlekey=103822 (accessed 2009/8/10)
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