What is ovarian cancer and how can you fight it?

What is ovarian cancer and how can you fight it?

According to a study conducted by the World Health Organisation, one in every 12 women in urban India will, potentially, suffer from cancer. 

The five main types of cancer that can affect a woman's organs are cervical, ovarian, uterine, vaginal and vulvar. Among these, breast cancer is a leading cause behind the maximum number of cancer-related female deaths in India, closely followed by ovarian cancer.Ovarian cancer is more dangerous than any other cancers because the survival rate of a woman suffering from ovarian cancer is far lower than any other cancer that affects women, as it is difficult to detect in the early stages. Today, we take a look at this slow killer and tell you how you can prevent it. 

What is ovarian cancer? 

According to ovariancancer.org, 'Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries.'

Ovarian cancer can be of two types: Benign (non-cancerous) and malignant (cancerous).

The only difference between the two is that in its benign form, the tumors do notspread to the other parts of the body; whereas in its malignant form, the tumor spreads to other parts of the body through the bloodstream. 

What are its symptoms? 

Early stages may not show many symptoms, but as the cancer grows there may be symptoms like:-

Pain in the abdomen, pelvis or legs

Swollen abdomen

Nausea, diarrhea or constipation

Feeling tired all the time

Difficulty in eating 

Weight loss or weight gain

Fatigue

Pain during intercourse

Frequent urination

The above symptoms are very common and may be associated with normal health worries, but if the problem persists over a longer duration, take medical assistance quickly as negligence may prove fatal. 

Is ovarian cancer treatable? 

Ovarian cancer is treatable, if detected in the early stages. If diagnosed at the right time, medical treatment can prevent the tumor/s from spreading to different parts of the body.

Depending on the stages of the cancer, your doctor may suggest a combination of treatments. Mostly a surgery is carried out, followed by chemotherapy. The various treatments are as follows. 

Surgery 

A surgery is carried out, both to diagnose ovarian cancer and to treat it as well. Tissue is removed from the ovary to examine it. Once examined, the main goal of the surgeon is to remove the tumor completely. To prevent the spreading of the tumor, your doctor may remove ovaries and the surrounding tissues. A second surgery may also be carried out after all other treatments. 

Chemotherapy 

This treatment uses drugs to slow down the growth of cancer and reduce the chances of reoccurrence. 

Radiation therapy 

Women with ovarian cancer are mostly treated with external radiation. The treatment uses a high energy X-ray to kill all the cancer causing cells. 

Risks factors 

The fact is that ALL women, are at a risk of developing ovarian cancer, simply because they are women. Therefore all women's should check the signs and prevent it from happening. Besides this, some other risk factors are 

Family history 

According to the American Cancer Society, 10% of ovarian cancer can be hereditary. Having a family history of ovarian, breast or colorectal cancer increases the chances of ovarian cancer in women. The possibility of developing ovarian cancer is due to the mutations in BRCA1 or BRCA2 genes. The younger you are or the family member who got diagnosed with the disease, the higher are your chances of developing ovarian cancer. 

Post menopausal 

Most of the ovarian cancer cases have been diagnosed in women who have crossed the age of 55-60 or after a women has entered menopause. 

Overweight 

According to Dr. Sheetal, there is a high chance of developing ovarian cancer if you are obese. The American Cancer Society has also correlated a higher rate of ovarian cancer in obese women. 

Infertility 

Women who have never been pregnant or have used some sort of drugs to achieve pregnancy seem to have a higher risk of developing ovarian cancer. 

What can one do to prevent ovarian cancer? 

The appropriate medicine has still not been discovered, but here are a few tips to reduce one's risk of developing ovarian cancer. 

Oral contraception 

Consumption of birth control pills for more than 5 years can reduce the risk of developing ovarian cancer. The longer the birth controls pills are used, the lesser are the chances of developing ovarian cancer. However, you must consult your doctor before assuming that the pills you take will prevent ovarian cancer, especially if you take them regularly. 

Breastfeeding and pregnancy 

Bearing children before the age of 28 can reduce the risk of ovarian cancer. Breastfeeding may also decrease one's risk of developing ovarian cancer. 
Surgical prevention 

Women who are at a higher risk of developing ovarian cancer due to genetics or who are outside of their reproductive stages can opt for surgical preventions. The various surgical preventions such as tubal ligation and oophorectomy can greatly reduce the risk of developing ovarian cancer.Read more Personal Health, Diet & Fitness stories on www.healthmeup.com

Ovarian cancer detection made easy with simple symptom survey

Published: Saturday, Sep 22, 2012, 20:57 IST 

A simple three-question paper-and-pencil survey, given to women in the doctor’s office in less than two minutes, can effectively identify those who are experiencing symptoms that may indicate ovarian cancer, a new study has revealed.

The study by researchers at Fred Hutchinson Cancer Research Center represents the first evaluation of an ovarian cancer symptom-screening tool in a primary care setting among normal-risk women as part of their routine medical-history assessment.

Early detection of ovarian cancer is key to survival. Cure rates for those diagnosed when the disease is confined to the ovary are approximately 70% to 90%. However, more than 70% of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20% to 30%.

The researchers evaluated the effectiveness and feasibility of several different symptom screening surveys.

After a few tweaks to formatting and content, the version that proved most effective contained three questions that asked whether a woman was currently experiencing one or more of the following symptoms, all of which have been identified previously as potentially indicative of ovarian cancer.

The symptoms were abdominal or pelvic pain, feeling full quickly or unable to eat normally and abdominal bloating or increased abdomen size.

The survey also asked about the frequency and duration of these symptoms: how many days a month and for how long.

“Symptoms such as pelvic pain and abdominal bloating may be a sign of ovarian cancer but they also can be caused by other conditions. What's important is to determine whether they are current, of recent onset and occur frequently,” M. Robyn Andersen, lead author of the study, said.

Previous research by Andersen and colleagues has found that about 60% of women with early-stage ovarian cancer and 80% of women with advanced disease report symptoms that follow this distinctive pattern at the time of diagnosis.

“Women with symptoms that are frequent, continual and new to them in the past year should talk to their doctor, as they may be candidates for further evaluation with ultrasound and blood tests that measure markers of ovarian cancer such as CA-125,” she said.

“Recent research indicates that approximately one in 140 women with symptoms may have ovarian cancer. Aggressive follow-up of these symptoms can lead to diagnosis when ovarian cancer can be caught earlier and more effectively treated,” she said.

The study involved 1,200 women, age 40 to 87, who were seen in a Seattle women's health clinic. More than half of the study participants reported being postmenopausal and approximately 90% were white.

About half of the clinic visits were for a current health concern or for follow-up of a health problem reported at an earlier visit. The other half were for routine appointments such as mammography screening.

Of those surveyed, 5% had a positive symptom score that indicated the need for further testing. Of this group of about 60 women, one was diagnosed with ovarian cancer shortly thereafter.

Of the 95% of women who tested negative on the symptom survey, none developed ovarian cancer during a 12-month follow-up period, which attests to the accuracy of the screening tool.

Those who reported current symptoms on the questionnaire or reported other medical concerns scored higher than those who did not. Non-white women were also about twice as likely to receive a positive symptom score as compared to white women.

“If ovarian cancer screening using symptoms is widely adopted, maximising the specificity of screening programs will be important,” the authors wrote.

“Until better biomarkers are identified and tested, collecting information about symptoms appears to have promise,” they added.

The bottom line, Andersen said, is that the screening tool can be used easily in a primary-care setting, is acceptable to patients and providers, and identifies women with symptoms that are worthy of concern with minimal false-positive results.

The study has been published online in the Journal of Obstetrics and Gynecology.

DNA Daily News & Analysis

Signs and symptoms of ovarian cancer

Posted: 09/20/2012
Last Updated: 13 hours and 38 minutes ago

Arizona Onology is a paid advertiser of Sonoran Living Live 

Arizona oncology encourages the community to know the signs and symptoms of ovarian cancer. 

Nearly 21,990 women are expected to be diagnosed with ovarian cancer this year.  Unfortunately, because most ovarian cancer cases are diagnosed at an advanced stage when the disease has already spread beyond the ovaries, nearly 15,460 will lose their lives. Ovarian cancer is the fifth leading cause of cancer related deaths in women.   

The five-year survival rate for ovarian cancer, if caught in early (stage one), is a promising 90 percent. If detected in an advanced stage (stage three or four), that survival rate drops to just 15-20 percent. Currently, there is no dependable screening for ovarian cancer, but because early diagnosis is so important, women should be aware of the risk factors and symptoms and consult their healthcare provider if they are at risk or notice any changes that may be signs of the disease. 

Factors that may increase the likelihood of developing ovarian cancer include: 
·    Age - most ovarian cancers develop after menopause, and half of all ovarian cancers are found in women over the age of 63 
·    Obesity - a study by the American Cancer Society found a higher rate of death from ovarian cancer in obese women 
·    Reproductive history - women who started menstruating before age 12, had no children or had their first child after age 30, and/or experienced menopause after age 50 may have an increased risk of ovarian cancer 
·    Fertility drugs - prolonged use of the fertility drug clomiphene citrate, especially without achieving pregnancy may increase the risk for developing ovarian tumors 
·    Family history - a woman's chance of developing ovarian cancer is increased if her mother, sister or daughter had ovarian, breast or colorectal cancer 
·    Breast cancer - women with BRCA mutation have an increased risk of ovarian cancer 
·    Talcum powder - women who use talc in the genital area may have a slight increase in risk 
·    Estrogen or hormone replacement therapy - some studies suggest using estrogen replacement therapy may increase a woman's risk of developing the disease 
·    Smoking and Alcohol use - Some studies have found an increased risk for one type of ovarian cancer (mucinous). 

Factors that may decrease the likelihood of developing ovarian cancer include: 
·    Female Surgery - Having your "tubes tied" (tubal ligation) may reduce the chance of developing ovarian cancer. A hysterectomy (removal of the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer. 
·    Diet - A recent study of women who followed a low-fat diet for at least 4 years had a lower risk of ovarian cancer. Some studies have shown a reduced rate of ovarian cancer in women who ate a diet high in vegetables, but other studies disagree. 

While early cancer of the ovaries tends to cause symptoms that are relatively vague, women who experience any of these symptoms should consult their healthcare providers: 
·    abnormal swelling of the stomach 
·    unusual vaginal bleeding 
·    pelvic pressure 
·    back pain 
·    leg pain 
·    digestive problems such as gas, bloating, indigestion, or long term stomach pain 
·    trouble eating or feeling full quickly 
·    having to urinate often or feeling like you have to "go" right away 

In addition to being aware of the risk factors and symptoms of ovarian cancer, Arizona Oncology reminds all women to speak with their healthcare providers about this disease and have an annual vaginal exam beginning at age 18. 

Arizona Oncology is proud to help Arizona patients in their battle against ovarian cancer by providing easy access a full range of advanced cancer care services. Our medical and radiation oncologists and their staff offer chemotherapy, injections, infusion services, radiation therapy and diagnostic imaging services in a convenient location that allows patients to remain close to their homes and support network of family and friends. As a result, patients have access the best possible treatment with the least amount of disruption to their daily lives.   

Our affiliation with The US Oncology Network, one of the nation's foremost cancer treatment and research networks, allows us to enhance access to the latest advances in therapies, clinical research and technology to patients in our community. In fact, The US Oncology Network is currently is involved in approximately 90 research trials for breast, colorectal, lung, ovarian, pancreatic and prostate cancer therapies, and has contributed to the development of 42 cancer-fighting drugs approved by the FDA.

ArizonaOncology.com 
Biltmore, Chandler, Deer Valley, Glendale, Phoenix, Scottsdale 
480-253-5300

Read more: http://www.abc15.com/dpp/lifestyle/sonoran_living/sl_sponsors/signs-and-symptoms-of-ovarian-cancer#ixzz277CkXKjA

Ovarian Cancer: The Fifth Leading Cause of Cancer Death

Sunday September 16, 2012

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the ovaries, it is called ovarian cancer. Women have two ovaries that are located in the pelvis, one on each side of the uterus. The ovaries make female hormones and produce eggs.

Ovarian cancer causes more deaths than any other cancer of the female reproductive system. But when ovarian cancer is found in its early stages, treatment is most effective. Ovarian cancer often causes signs and symptoms, so it is important to pay attention to your body and know what is normal for you. Symptoms may be caused by something other than cancer, but the only way to know is to see your doctor, nurse, or other health care professional.

Who Gets Ovarian Cancer?

All women are at risk for ovarian cancer, but older women are more likely to get the disease than younger women. About 90% of women who get ovarian cancer are older than 40 years of age, with the greatest number of cases occurring in women aged 60 years or older.

Each year, about 20,000 women in the United States get ovarian cancer. Among women in the United States, ovarian cancer is the eighth most common cancer and the fifth leading cause of cancer death, after lung and bronchus, breast, colorectal, and pancreatic cancers. Ovarian cancer causes more deaths than any other cancer of the female reproductive system, but it accounts for only about 3% of all cancers in women. When ovarian cancer is found in its early stages, treatment is most effective.

Ovarian cancer is difficult to detect, so listen to your body

By Tara M. Ibarbo / For Healthy U

Posted:   09/03/2012 12:03:23 AM MDT

"It whispers, so listen." This slogan will always remind me of ovarian cancer. When I was in my second semester of nursing school, one of our first presentation style assignments was to pick a chapter in our nursing book and create a learning experience for our peers. Naturally my deep appreciation for cancer as a subject led me straight to its chapter. I was not only given an opportunity to research and uncover more about cancer, but I had the chance to choose one specific type of cancer and educate my peers. I opted for not only one of the most serious forms of cancer, but a cancer that always seems to have the least amount of attention. During my investigation I discovered one of the most profound slogans I have ever read and will forever remain aware of "It whispers, so listen."

So what exactly does this slogan mean? What it means is ovarian cancer usually does not produce any early symptoms, and when it does, they are so similar to typical symptoms of constipation, stomach upset, menstrual cramping and back pain, they essentially "whisper" and are commonly ignored. The key to "listening" to symptoms is really being familiar with your body. Usually if the unusual changes last longer than two weeks, it is important to seek medical attention. The major changes to pay attention to are: vaginal bleeding or discharge that is not normal for you, pelvic or low abdominal pain, back pain that persists, bloating in the lower region of your abdomen, feeling full quickly after eating, or a change in your bathroom habits — for instance prolonged constipation or diarrhea.

There is no screening for ovarian cancer, and please keep in mind that a Pap smear test will not detect this particular type of cancer; it is used as a screening tool for cervical cancer. The only prevention is listening to your body and noticing changes.

There are a few risk factors linked to ovarian cancer, which include: age, being of Eastern European (Ashkenazi) Jewish background, never giving birth, having a history of endometriosis, and genetic mutations. Two particular mutations called BRCA1 or BRCA2, are not only connected to breast cancer, but ovarian as well. They stand for BR (br-east) and CA (ca-ncer) and there are two susceptibility genes, thus the 1 and 2. If this gene is inherited, a woman's risk is significantly increased. The National Cancer Institute indicates that 1.4 percent (14 out of 1,000) will be diagnosed with ovarian cancer, compared with 15 to 40 percent (150-400 out of 1,000) of women who have a harmful BRCA1 or BRCA2 mutation. So, if there is a family history, especially close family, such as mother, sister, aunt or grandmother on either your father or mother's side of the family, it is important that your doctor is aware. Testing can be expensive and controversial, so it is important to talk to your health care provider if you feel you should have this done.

Teal is the awareness color for ovarian cancer and also stands on its own as a motto for bringing awareness. TEAL=Take Early Action & Live. As a reminder, September is Ovarian Cancer Awareness Month. If you would like to learn more about ovarian cancer, visit the National Ovarian Cancer Coalition website, www.ovarian.org.

Tara M. Ibarbo is a BSN/RN/ CTR employed at Memorial Medical Center Cancer Center and a current MPH graduate student at New Mexico State University.

LCSunNews

Ovarian Cancer Facts

Ovarian Cancer Facts

The ovaries

The ovaries are two small, oval-shaped organs that are part of the female reproductive system. They are in the lower part of the tummy (abdomen), which is known as the pelvis. Other organs are very close to the ovaries (see diagrams below). These include:

• The ureters, which drain urine from the kidneys to the bladder.
• The bladder.
• The back passage (rectum).
• The lower part of the small bowel.
• The omentum (a membrane which surrounds all of the pelvic and abdominal organs and keeps them in place). It is also called the peritoneum.
• Groups of lymph nodes.

Each month, in women of childbearing age, one of the ovaries produces an egg. The egg passes down the fallopian tube to the womb (uterus). If the egg is not fertilised by a sperm it passes out of the womb and is shed, along with the lining of the womb, as part of the monthly period.

The ovaries also produce the female sex hormones, oestrogen and progesterone. As a woman nears the menopause (‘change of life’) the ovaries make less of these hormones and periods gradually stop.

 

Types of Ovarian Cancer

Most ovarian cancers are a type called epithelial cancer. Epithelial ovarian cancer means the cancer has started in the cells that cover the surface of the ovary. There are several types of epithelial cancers of the ovary. The most common types are:

• serous
• endometrioid.

Less common types of epithelial ovarian cancer are:

• mucinous
• clear cell
• undifferentiated or unclassifiable.

They are currently all treated in a similar way.

There are also less common types of ovarian cancer. These include germ cell tumours (ovarian teratomas) and sarcomas. Germ cell tumours tend to affect younger women and behave very differently to other types of ovarian cancer.

Risk factors and causes of ovarian cancer

Each year, about 6600 women in the UK are diagnosed with ovarian cancer. The causes are not yet completely understood. The risk of developing ovarian cancer is very low in young women and increases as women get older. Over eight out of ten (85%) ovarian cancers occur in women over the age of 50. Most ovarian cancers occur in women who have had their menopause.

Some factors are known to affect a woman’s chance of developing ovarian cancer – they may increase the risk or decrease it. These are described below.

Hormonal Factors

Women who have not had children are slightly more likely to develop ovarian cancer than women who have, although the risk is still very low. Having two or more children may provide more protection than just one.

Breast feeding your children may slightly decrease your risk.

Starting your periods early or having a late menopause slightly increases your risk of ovarian cancer.

Women who take the contraceptive pill are less likely to develop ovarian cancer.

Using oestrogen-only hormone replacement therapy (HRT) can slightly increase the risk. When HRT is stopped the risk of ovarian cancer gradually reduces to the same level as women who haven’t taken HRT.

Infertility and fertility treatments

Research has shown that infertility treatment may slightly increase the risk of developing ovarian cancer. However, other research doesn’t support this.

Health Factors

Having endometriosis may increase your risk of ovarian cancer.

Lifestyle factors

Being overweight may increase your risk of developing ovarian cancer.

Eating a diet high in animal fats and low in fresh fruit and vegetables may increase your risk.

Genetic factors

About 5–10 in 100 (5–10%) ovarian cancers are caused by an inherited faulty gene in the family.

Women who have had breast cancer have an increased risk of ovarian cancer. This is because breast and ovarian cancer can be caused by the same faulty genes.

If any of the following are present in one side of your family, it is possible that there may be an inherited faulty gene:

• Ovarian cancer in at least two close relatives (mother, sisters or daughters).
• One close relative with ovarian cancer and one close relative with breast cancer diagnosed when they were under the age of 50 (or both cancers in the same person).
• Ovarian cancer in one close relative and breast cancer in two family members diagnosed when they were under the age of 60.
• Three close relatives with colon (bowel) orwomb (endometrial) cancer, and one relative with ovarian cancer.

Having one elderly relative with ovarian cancer doesn’t necessarily increase your risk of ovarian cancer.

Women who are worried that they may have an increased risk of developing ovarian cancer, because of cancer in their family, can be referred to a genetic counselling clinic. Contact your GP or our information service for more details about genetic counselling clinics. The clinics are based in hospitals and you will be seen by a genetics specialist who can check your family history to see whether you are likely to be at increased risk.

If two or more of your close relatives have had ovarian cancer you may want to consider having testing (screening) for ovarian cancer. However, it is not yet known how effective screening is at detecting ovarian cancer (screening).

Screening for ovarian cancer

Research trials are being carried out to see whether ovarian cancers can be detected early so that they can be treated more effectively. The trials are testing women who have no symptoms of ovarian cancer, to see if testing can detect a cancer at an early stage. This is known as screening. Currently it is not known whether screening can help to detect ovarian cancers at an earlier stage, so there is no national screening programme for ovarian cancer in the UK.

Women who may have an increased risk of ovarian cancer can ask their GP to refer them to take part in an ovarian cancer screening research trial.

A recent research study is looking at the benefits of screening postmenopausal women with either a blood test for a protein called CA125 or a vaginal ultrasound (see diagnosis). The aim of the trial is to see if either of these tests will help doctors diagnose women with ovarian cancer when their cancer is at an early stage. The trial has recently closed and it will be a few years before we know the results.

Symptoms of ovarian cancer

Most women with early-stage cancer of the ovary don’t have any symptoms for a long time. When symptoms occur they may include any of the following:

• loss of appetite
• vague indigestion, nausea, excessive gas (wind) and a bloated, full feeling
• unexplained weight gain
• swelling in the abdomen – this may be due to a build up of fluid (ascites), which can cause shortness of breath
• pain in the lower abdomen
• changes in bowel or bladder habits, such as constipation, diarrhoea or needing to pass urine more often
• lower back pain
• pain during sex
• abnormal vaginal bleeding, although this is rare.

If you have any of the above symptoms it is important to have them checked by your doctor, but remember they are common to many other conditions and most women with these symptoms will not have cancer.

Diagnosis

Usually you begin by seeing your GP, who will examine you and arrange for you to have any tests (usually ultrasound scans and/or blood tests) that may be necessary. If your GP suspects that you have ovarian cancer they will refer you to a cancer centre to be seen by a specialist gynaecology cancer team for the tests and for specialist advice and treatment.

At the hospital

At the hospital, the gynaecologist (specialist in women’s illnesses) will ask you about your general health and any previous medical problems, before examining you. This will include an internal (vaginal) examination to check for any lumps or swellings.

The specialist may arrange for you to have a blood test and chest x-ray to check your general health.

You may have a specific blood test to check whether there are higher than normal levels of the CA125 protein in your blood. CA125 is a protein that most women have in their blood. The level may be higher in women with ovarian cancer, as it is sometimes produced by ovarian cancer cells. However, CA125 is not specific to ovarian cancer, and the level can also be raised in women who have other non-cancerous conditions.

Several tests may be used to diagnose cancer of the ovary. The tests may also show the stage of the cancer – whether or not it has spread to other parts of the body. These tests help your doctor to know the best way to treat the cancer.

Ultrasound scan          

An ultrasound uses sound waves to build up a picture of the inside of the abdomen, the liver and the pelvis. It will be done in the hospital scanning department.

If you have a pelvic ultrasound you will be asked to drink plenty of fluids so that your bladder is full. This helps to give a clearer picture. Once you are lying comfortably on your back a gel is spread onto your abdomen. A small device, which produces sound waves, is then rubbed over the area. The sound waves are converted into a picture by a computer.

If you have a vaginal ultrasound scan, a probe with a rounded end is put into your vagina. The probe produces sound waves, which are then converted into a picture by a computer. Although this type of ultrasound scan may sound uncomfortable, many women find it more comfortable than having a pelvic ultrasound, as it is not necessary to have a full bladder.

Pelvic or vaginal ultrasound can be used to check for any enlargement or abnormalities of the ovaries which may be due to a cyst or tumour. It can also be used to show the size and position of a cancer.

CT scan

A CT (computerised tomography) scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand. You will probably be able to go home as soon as the scan is over.

MRI scan

An MRI (magnetic resonance imaging) scan is similar to a CT scan, but uses magnetic fields instead of x-rays to build up a series of cross-sectional pictures of the body. During the test you will be asked to lie very still on a couch inside a metal cylinder that is open at both ends. The whole test may take up to an hour and is painless – although the machine is very noisy. You will be given earplugs or headphones to wear.

The cylinder is a very powerful magnet, so before going into the room you should remove all metal belongings. You should also tell your doctor if you have ever worked with metal or in the metal industry or if you have any metal inside your body (for example, a cardiac monitor, pacemaker, surgical clips, or bone pins). You may not be able to have an MRI because of the magnetic fields.

Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort. You may feel claustrophobic inside the cylinder, but you may be able to take someone with you into the room to keep you company. It may also help to mention to the staff beforehand if you do not like enclosed spaces. They can then offer extra support during your test.

Abdominal fluid aspiration

If there has been a build up of fluid in the abdomen, a sample of the fluid can be taken to check for any cancer cells. The doctor will use a local anaesthetic to numb the area before passing a small needle through the skin. Some fluid is drawn off into a syringe and examined under a microscope.

Laparoscopy                                                                             

This operation allows the doctor to look at the ovaries, fallopian tubes, the womb and the surrounding area. It’s done under a general anaesthetic. Most women usually go home the same day but you may have to stay in hospital overnight.

While you are under anaesthetic, the doctor makes 3–4 small cuts, approximately 1cm (½ inch) in length, in the skin and muscle of the lower abdomen. A thin fibre-optic tube (laparoscope) is then inserted. By looking through the laparoscope the doctor can look at the ovaries and take a small sample of tissue (biopsy) for examination under a microscope.

During the operation, carbon dioxide gas is passed into the abdominal cavity and this can cause uncomfortable wind and/or shoulder pains. The pain is often eased by walking about or by taking sips of peppermint water. If the pain continues when you are at home you should contact the hospital for advice.

After a laparoscopy you will have one or two stitches in your lower abdomen. You should be able to get up as soon as the effects of the anaesthetic have worn off.

Eploratory laparotomy                 

Sometimes cancer of the ovary cannot be diagnosed before a full operation (laparotomy) is carried out.

It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. Obviously, this waiting period is an anxious time and it may help you to talk things over with a close friend, a relative, the hospital specialist nurse, or asupport organisation.

Staging and grading of ovarian cancer

Staging       

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body. Knowing the extent of the cancer and the grade helps the doctors to decide on the most appropriate treatment. It’s often not possible to stage an ovarian cancer before a laparotomy is done and the results of any biopsies are known (see diagnosis). A commonly used staging system is described below.

Borderline tumours are made up of low-grade cells that are unlikely to spread. They are usually completely cured by surgery and rarely require further treatment.

Stage 1 ovarian cancer only affects the ovaries. This stage is divided into three sub-groups:

• Stage 1a The cancer is only in one ovary
• Stage 1b There are tumours in both ovaries.
• Stage 1c The cancer is either at stage 1a or 1b, and there are cancer cells on the surface of one of the ovaries, or in the fluid taken from within the abdomen during surgery, or the ovary has burst (ruptured) before or during surgery.

Stage 2 ovarian cancer has begun to spread outside the ovaries within the pelvis. There are three sub-groups:

• Stage 2a The cancer has spread to the womb or fallopian tubes.
• Stage 2b The tumour has spread to other structures within the pelvis, such as the rectum or bladder.
• Stage 2c The cancer is either at stage 2a or 2b, and there are cancer cells on the surface of one of the ovaries, or in the fluid taken from within the abdomen during surgery, or the ovary has burst (ruptured) before or during surgery.

Stage 3 The cancer has spread beyond the pelvis to the lining of the abdomen (a fatty membrane called the omentum), and/or to abdominal organs such as the lymph nodes in the abdomen, or the upper part of the bowel.

• Stage 3a The tumours in the abdomen are very small and cannot be seen except under a microscope.
• Stage 3b The tumours in the abdomen can be seen but they are smaller than 2cm.
• Stage 3c The tumours in the abdomen are larger than 2cm.

Stage 4 The cancer has spread to other parts of the body such as the liver, lungs, or distant lymph nodes (for example in the neck).

If the cancer comes back after initial treatment this is known as recurrent cancer.

Grading

Grading refers to the appearance of the cancer cells when they are looked at under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades: grade 1 (low-grade), grade 2 (moderate-grade) and grade 3 (high-grade).

• Low-grade means that the cancer cells look very like the normal cells of the ovary. They usually grow slowly and are less likely to spread.

• Moderate-grade means that the cells look more abnormal than low-grade cells.

• High-grade means that the cells look very abnormal. They are likely to grow more quickly and are more likely to spread.

Ovarian cancer

Cancer - ovaries

Last reviewed: December 15, 2011.

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.

Causes, incidence, 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.

Symptoms

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:

• Bloating or swollen belly area
• Difficulty eating or feeling full quickly
• Pelvic or lower abdominal pain; the area may feel "heavy" to you (pelvic heaviness)

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:
  • Constipation
  • Increased gas
  • Indigestion
  • Lack of appetite
  • Nausea and vomiting
• Unexplained back pain that worsens over time
• Vaginal bleeding that occurs in between periods
• Weight gain or loss

Other symptoms that can occur with this disease:

• Excessive hair growth that is coarse and dark
• Sudden urge to urinate
• Needing to urinate more often than usual (See: Increased urinary frequency or urgency )

Signs and tests

A physical examination is often normal. However, if you have advanced ovarian cancer, it may reveal a swollen belly area and fluid in the area (called 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 screen for or diagnose ovarian cancer in its early stages.

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.

Support Groups

For additional information and resources, see cancer support group.

Expectations (prognosis)

Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made

• About 3 out of 4 women with ovarian cancer survive 1 year after diagnosis.
• Nearly half of women live longer than 5 years after diagnosis.
• If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is very high

Complications

• Spread of the cancer to other organs
• Loss of organ function
• Fluid in the abdomen (ascites)
• Blockage of the intestines

Calling your health care provider

Call for an appointment with your health care provider if you are a woman over 40 years old who has not recently had a pelvic examination. Routine pelvic examinations are recommended for all women over 20 years old.

Call for an appointment with your provider if you have symptoms of ovarian cancer.

Prevention

There are no standard recommendations for screening for ovarian cancer. Screening women with pelvic ultrasound or blood tests, such as the Ca-125 has not been found to be effective and is not recommended.

BRCA testing may be done in women at high risk for ovarian cancer.

Removal of the ovaries and tubes in women who have a mutation in the BRCA1 and BRCA2 genes may reduce the risk of developing ovarian cancer, although ovarian cancer may still develop in other areas of the pelvis.

PubMed