Ovarian cancer

The term ovarian cancer is commonly referred to the type of cancer arising from the epithelial covering of the ovary. The epithelium that covers the ovary are subjected to hundreds of ruptures and repairs during the life of a normal woman and probably this process predispose the ovarian epithelium to development of cancer.

Ovary cancer rarely develops in pre-menopausal women, and the large majority of ovary cancers develop in women aged between 50 and 75 years. The chance of developing ovary cancer increases with age and the risk of development of this disease is highest between ages of 75 and 79.

The exact cause of development of ovary cancer remains unknown. It appears that ovary cancer is the cumulative effect of multiple genetic mutations that occurs during the lifetime of a woman. The exact mechanisms by which these genetic mutations lead to the development of ovary cancer is unknown. It has been suggested that the repeated disruption and repair of the outer surface of the ovaries as it happens with ovulation during the monthly menstrual cycle may

Causes

Ovary cancer is the fourth leading cause of cancer death in women, the leading cause of death from gynecologic malignancies and the second most usually 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 percent to 2.5 percent (1 out of 40-60 women) lifelong chance of developing ovary cancer.

Older women are at highest risk. More than half of the deaths from ovary cancer occur in women between 55 and 74 years of age and approximately one quarter of ovary cancer deaths occur in women between 35 and 54 years of age.

The risk for developing ovary cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovary cancer. Early age at first pregnancy, older ages of final pregnancy, and the use of some oral contraceptive pills have also been shown to have a protective effect. Ovary cancer is reduced in women after tubal ligation.

The link to the use of fertility medicine has been controversial. An analysis in 1991 raised the possibility that use of drugs that stimulate ovulation may increase the risk for ovary cancer. Several cohort studies and case-control studies have been conducted since then without providing conclusive evidence for such a link with the possible exception that prolonged use (andgt; 1 year) of clomiphene citrate should be avoided.

There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1 or the BRCA2 gene (particularly Ashkenazi Jewish women) are at a higher risk of both breast cancer and ovary 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 ovary cancer, may have an elevated risk. A strong family history of uterine cancer, colon cancer, or other gastrointestinal cancers may indicate the presence of a syndrome known as hereditary non-polyposis colon cancer (HNPCC), which confers a higher risk for developing ovary cancer. Patients with strong genetic risk for ovary cancer may consider the use of prophylactic oophorectomy after completion of child-bearing.

Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial and have not been definitively proven.

A study funded by American Cancer Society conducted at the H. Lee Moffitt Cancer Center of the University of South Florida has found a correlation between high levels of lysophospholipids (a type of fatty acid) with ovary cancer patients and low levels of lysophospholipids with healthy women. This potential biomarker can be detected by a simple blood test. The blood test was 93 percent accurate as predictor of ovary cancer with less than 4 percent false positives of the 117 women studied. Other indicators of ovary cancer could be used to increase accuracy to 100 percent.

Symptoms

• sense of pelvic heaviness
• vaginal bleeding
• weight gain or weight loss
• abnormal menstrual cycles
• unexplained back pain that worsens over time
• increased abdominal girth
• non specific gastrointestinal symptoms:
  • vague lower abdominal discomfort
  • increased gas
  • indigestion
  • lack of appetite
  • nausea and vomiting
  • inability to ingest usual volumes of food
  • bloating
• Additional symptoms that may be associated with this disease:
  • increased urinary frequency/urgency
  • excessive hair growth

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

Women 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 therapy. Normal values range from 0 to 35. Elevated levels in post-menopausal women are commonly an indication that further screening is necessary. In pre-menopausal women, the test is less reliable as values are often elevated due to many non-malignant causes, and a value above 35 is not necessarily a cause for concern.

Further screening may involve Computerized axial tomography 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.

Classification

Ovary cancer is classified according to the histology of the tumor. Lesions differ significantly in clinical features, management, and prognosis:

• Epithelial ovarian tumors are the most common and prototypic ovary cancers. They are thought to originate from the ovarian surface lining, including the serous cystadenocarcinoma, and the mucinous cystadenocarcinoma.
• Stromal ovary cancer includes lesions that are hormonally active such as the estrogen-producing granulosa cell tumor and the virilizing arrhenoblastoma.
• Germ cell cancer originates from dysplastic germ material and tends to occur in young women and girls. Lesions include the dysgerminoma, a form of the choriocarcinoma, and the cancerous form of the teratoma.
• Other lesions include metastasis to the ovary, for instance from breast cancer. Krukenberg cancer is ovary cancer originating from gastrointestinal cancer.

Staging

Ovary cancer staging is by the FIGO staging 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.

• Stage I - limited to one or both ovaries.
  • IA - involves one ovary; capsule intact; no tumor on ovarian surface; no cancerous cells in ascites or peritoneal washings
  • IB - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
  • IC - tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
• Stage II - pelvic extension or implants.
  • IIA - extension or implants onto uterus or fallopian tube; negative washings
  • IIB - extension or implants onto other pelvic structures; negative washings
  • IIC - pelvic extension or implants with positive peritoneal washings
• Stage III - microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum.
  • IIIA - microscopic peritoneal metastases beyond pelvis
  • IIIB - macroscopic peritoneal metastases beyond pelvis less than 2cm in size
  • IIIC - peritoneal metastases beyond pelvis andgt; 2 cm or lymph node metastases
• Stage IV - distant metastases

Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC).

Treatment

Surgery is the preferred therapy and is frequently necessary for diagnosis. Studies have shown that surgery performed by a specialist in gynecologic oncology results in a higher rate of cure. Chemotherapy is used as after surgery to treat any residual disease. Chemotherapy can also be used to treat women who have a recurrence. Radiation treatment is rarely used in ovary 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 still not 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)

Ovary cancer is disproportionately deadly for many 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, ovary cancers shed cancerous 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 ovary cancer exists, more than 50 percent of women with ovary cancer are diagnosed in the advanced stages of the disease.

Ovary cancer is rarely diagnosed in its early stages; it is commonly quite advanced by the time diagnosis is made. The outcome is often poor. The five-year survival rate for all stages is only 35 percent to 38 percent. If, however, diagnosis is made early in the disease, five-year survival rates can reach 90 percent to 98 percent. Germ Cell Ovarian Cancer has 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

• spread of the cancer to other organs
• progressive function loss of various organs
• ascites (fluid in the abdomen)
• blockage of the intestines

Victims of ovary cancer

• Evelyn Ankers, actress (died at age 67)
• Laurie Beechman, singer (died at age 43)
• Cassandra Harris, Australian actress/wife of Pierce Brosnan (died at age 39)
• Diana Dors, actress, also known as Diana d'Ors (died at age 52)
• Congresswoman Rosa DeLauro, surviving
• Dolly Haas, actress/singer also known as Dolly Hirschfeld (died at age 84)
• Janet Margolin, actress (died at age 50)
• Helen Morosini, mother of actress Dana Reeve, and mother-in-law of the late Christopher Reeve.
• Bess Myerson, surviving
• Gilda Radner, actress/comedienne (died at age 42)
• Patsy Ramsey, mother of the late JonBenet Ramsey, still alive - but at stage 4
• Ida Rollin, mother of breast cancer survivor, writer and former NBC correspondent, Betty Rollin
• Dinah Shore, actress/singer (died at age 77)
• Jessica Tandy, actress (died at age 85)
• Elizabeth Tilberis, Harper's Bazaar Editor-in-chief (died at age 51)
• Joyce Wadler, New York Times reporter, in remission
• Annie Ward, mother of actress Sela Ward
• Loretta Young, actress (died at age 87)

References

The study is published in the 7 July 2004 journal of Cancer Epidemiology, Biomarkers andamp; Prevention.

External links

• Ovarian cancer
• Ovarian cancer news