Ovarian Cancer
What is
ovarian cancer?
What are the symptoms of ovarian cancer?
How
is ovarian cancer diagnosed?
What are the treatment options for ovarian cancer?
What are the risk factors for ovarian cancer?
Is
ovarian cancer hereditary?
What can I do to prevent ovarian cancer?
Can I get ovarian cancer if I have my ovaries
removed?
Also
See:
Cancer
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What is ovarian cancer?
Most ovarian cancers
(eighty-five to ninety percent) develop from the cells that cover the
outer surface of the ovary, called the epithelial cells. The cells that
make up epithelial ovarian cancers have several histologic patterns, which
are recognized under the microscope. They are referred to as serous,
mucinous, endometrioid or clear cell types.
Some lack
distinctive features and may be considered "undifferentiated" epithelial
tumors.
Ten to fifteen
percent of ovarian cancers develop in the germ cells or sex
cord stromal cells of the ovary. Ovarian germ cell tumors developed
from the cells that produce the ova or eggs. Germ cell tumors may occur in
teenagers and in women in their twenties. However, overall, these are rare
tumors and have a good prognosis.
Ovarian stromal
tumors develop from connective tissue cells that hold the ovary together
and produce the female hormones estrogen and progesterone. These tumors
are generally much less aggressive than the other tumors. These are also
rare tumors.
What are the
symptoms of ovarian cancer?
There are usually no
obvious symptoms of ovarian cancer. Women complain about vague symptoms
including abdominal swelling or bloating, generalized abdominal
discomfort, early satiety, lack of appetite, dyspepsia, malaise, urinary
frequency or weight change (either gain or loss). Women may develop
unexplained ascites (fluid in the abdominal cavity) which contributes to
the abdominal discomfort. Because the symptoms are not unique to ovarian
cancer, the disease can be difficult to identify and diagnose.
How is ovarian cancer
diagnosed?
A definitive
diagnosis of ovarian cancer requires surgery. The initial surgery has two
aims. First, to remove any cancer that exists (or as much as possible),
including removing the ovaries, the uterus and the omentum. The best
results for survival are in those women in whom all the cancer can be
removed. Second, to sample tissues and surrounding nodes to determine
where the tumor has spread (to determine the stage of the disease).
In pre-menopausal
women, a more limited surgery may be appropriate depending upon the cell
type of the tumor.
What
are the treatment options for ovarian cancer?
After the initial
diagnosis has been established at surgery, additional therapy will depend
on several factors, including the histologic cell type, the stage, the
extent of spread of the cancer; and the residual tumor remaining at the
end of the initial surgery.
Treatment includes
chemotherapy (usually a combination of drugs), or radiation. Other
treatment options may include immunotherapy, or in the future, gene
therapy.
What are
the risk factors for ovarian cancer?
The causes of
ovarian cancer are unknown. The disease tends to be more common in women
from western industrialized countries, especially white women, who have
had no full-term pregnancies. There also have been noted associations with
exposure to talc or asbestos. In addition, there is an association with
infertility.
It appears that
factors that decrease ovulation have been associated with a lower risk of
ovarian cancer in the general population. Women who have had multiple
pregnancies or who have breast-fed have fewer ovulations and have been
noted to have a decrease in the occurrence of ovarian cancer. The use of
oral contraceptives has also been associated with a decrease in the
development of ovarian cancer. The protection provided by oral
contraceptives appears to be real and increases as the duration of the
pill use increases. A risk reduction of up to 60% may occur when oral
contraceptives are used for longer than five years. Recent studies have
noted that there is a decreased incidence of ovarian cancer in women with
a history of tubal ligation. The mechanism of this is unclear. The use of
powders containing talc should be avoided on the external female genitals.
Is ovarian cancer
hereditary?
Most of ovarian
cancers are sporadic and not inherited. However, five to ten percent of
individuals who develop ovarian cancer have an inherited genetic
susceptibility to the disease. Generally, the risk of developing ovarian
cancer increases as the number of family members affected by ovarian
cancer increases. Having a first-degree relative affected by ovarian
cancer (for example, a mother or a sister) increases a woman’s lifetime
risk from 1.4% to 3.1%. Those at greatest risk for inherited genetic
susceptibility have a personal or family history of ovarian and/or breast
cancer. Histories that include cancers with early age of onset, multiple
primary (new) cancers and Jewish ancestry reflect greater risk.
There are three
different syndromes that fall under the heading of familial ovarian
cancer. The first, is a site-specific, hereditary ovarian cancer syndrome
in which only ovarian cancer is manifested. More commonly, however, there
is the hereditary breast-ovarian cancer syndrome in which both ovarian
cancer and breast cancer may occur in the same family. And finally, there
is the Lynch II syndrome in which breast, ovarian, colon, endometrial and
other cancers occur throughout the family. The cases of familial ovarian
cancer, however, account again for only five to ten percent of ovarian
cancers.
Those people who are
interested in learning more about their hereditary risks should speak to
their physicians about the option of genetic counseling and testing.
What can I do
to prevent ovarian cancer?
There are no known
methods to guarantee prevention of ovarian cancer. Women who are diagnosed
in an early stage, however, have a higher survival rate. Unfortunately,
ovarian cancer is usually not diagnosed at an early stage. There are no
effective methods currently for diagnosing ovarian cancer early in all
women and thus intervening at an early stage. Currently, there are many
programs attempting to develop strategies for diagnosing ovarian cancer
early.
Can I
get ovarian cancer if I have my ovaries removed?
Women at a very high
risk of developing ovarian cancer can consider removal of the ovaries.
Such a "prophylactic" removal of the ovaries appears to lower the risk of
developing ovarian cancer, but does not eliminate the risk. Women with one
first-degree relative with ovarian cancer have a risk of developing the
disease, which is approximately 3.1%. A prophylactic oophorectomy (removal
of the ovaries) as an independent operation is not recommended, in
general, for these women. With two first-degree relatives, the risk of
developing ovarian cancer is approximately seven percent and a
prophylactic removal of the ovaries may be considered. In general, women
found to be carriers or who have a family history highly suggestive of a
syndrome may be appropriate candidates for prophylactic removal of the
ovaries.
Removal of the
ovaries results in lost hormone production, which can have side effects. A
woman considering prophylactive removal of the ovaries should discuss
possible side effects with her doctor.
from
The Office On Women's Health - US Department of Health and Human Services
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