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Ovarian
Cancer: Detecting the Silent Killer
By Heather C. Guidone
Called the "silent killer", ovarian
cancer has claimed the lives of hundreds of
thousands of women, including funny ladies
Gilda Radner and Madeline Kahn, best known
for their comedic television and film roles.
Each of them hoped that their celebrity status
would bring awareness to the disease and help
others; their legacies live on through such
organizations as Gilda´s Club, founded
by Joanna Bull, and the Ovarian Cancer National
Alliance, founded by the leaders of seven
ovarian cancer groups.
According
to the American Cancer Society, ovarian cancer
accounts for 4% of all cancers among women,
and ranks 5th as a cause of their deaths from
cancer. The Society estimates that there will
be 23,400 new cases diagnosed and 13,900 deaths
from the disease this year alone. This rate
has barely improved over the last 50 years.(1)
Ovarian
cancer comes from cells of the ovary that
grow and divide uncontrollably. These cells
may grow to form a tumor on the ovary, and
may spread to other parts of the body. There
are different types of tumors that can start
in the ovaries. Some are benign (non-cancerous);
others are malignant (cancerous). Although
ovarian cancer can spread throughout the entire
body, in most cases it stays in the abdomen
and affects organs such as the intestines,
liver, and stomach.(2)
Early
diagnosis is crucial: the 5-year survival
rate for Stage I patients is nearly 90%; 70%
for Stage II patients. Unfortunately, almost
70% of
women with ovarian cancer are not diagnosed
until the disease is in advanced Stages (III-IV),
and the 5-year survival rate for those women
is only 15-20%. (3)
Ovarian
Cancer Symptoms & Risk Factors
While
varying from patient to patient, common symptoms
of ovarian cancer include abdominal pressure,
bloating or discomfort; nausea, indigestion
or gas; urinary frequency; constipation or
diarrhea; abnormal vaginal bleeding; unusual
fatigue; and unexplained weight gain or loss.
Symptoms are often associated with the location
of the tumor and its impact on the surrounding
organs. Symptoms can mimic other conditions
such as irritable bowel syndrome, endometriosis,
ovarian cysts, etc. Women who are concerned
about symptoms they may be experiencing should
see their gynecologist.
While
all women are at risk for ovarian cancer,
studies by the National Cancer Institute show
that the following factors may elevate risk:
personal or family history of ovarian, breast,
or colon cancer; increasing age (56% of women
diagnosed with ovarian cancer are older than
age 65); and childbearing status (women who
have never had children are more likely to
develop ovarian cancer than those who have).
Use of fertility drugs or hormone replacement
therapy (HRT) after menopause may also cause
a slightly increased risk. Researchers are
studying these possible links, as well as
performing further investigation into the
role genetics play and potential environmental
causes of the disease. (4)
Some
studies have shown that breastfeeding and
taking oral contraceptives may decrease a
woman´s likelihood of developing ovarian
cancer. Women who have had a tubal ligation
or hysterectomy (removal of uterus) also have
a lower risk of developing the disease. In
addition, researchers suggest that reducing
the amount of fat in the diet may also lower
a woman´s risk of developing ovarian
cancer. Women who are at high risk for ovarian
cancer due to a family history of the disease
may consider having their ovaries removed
before the cancer develops, through a surgical
procedure called a prophylactic oophorectomy.
(5)
Diagnosing
Ovarian Cancer
Ovarian
cancer may be diagnosed through a series of
exams and tests, such as a pelvic exam; an
ultrasound; a CA-125 assay (a blood test used
to measure the level of CA-125, a tumor marker
that is often found in higher-than-normal
amounts in the blood of women with ovarian
cancer); a lower GI series or barium enema
(a series of x-rays of the colon and rectum);
a CT Scan; and a surgical biopsy, in which
tissue is removed for examination under a
microscope.
According
to the National Ovarian Cancer Resource Center,
the 3 main types of tumors are:
-
Epithelial: epithelial ovarian tumors develop
from the cells that cover the outer surface
of the ovary. Most epithelial ovarian tumors
are benign. Cancerous epithelial tumors are
carcinomas. These are the most common and
most deadly of all types of ovarian cancers,
and epithelial ovarian carcinomas account
for 85% of all ovarian cancers. Although most
epithelial ovarian cancers occur in women
who do not have a family history of the disease,
about 5-10% of women with ovarian epithelial
cancer have other family members who have
also had the same kind of cancer.
-
Germ Cell: ovarian germ cell tumors develop
from the cells that produce the ova (eggs).
Most germ cell tumors are benign, although
some are cancerous and may be life threatening.
Germ cell malignancies occur most often in
teenagers and women in their twenties. An
estimated 90% of patients with ovarian germ
cell malignancies can be cured and their fertility
preserved.
-
Ovarian: stromal tumors develop from connective
tissue cells that hold the ovary together
and from those that produce the female
hormones (estrogen and progesterone).
These tumors are quite rare and are usually
considered low-grade cancers, with approximately
70% presenting as stage I disease.
"Stage"
of disease is ascertained during surgery and
is based on how far the tumor has spread.
With Stage I, growth of the cancer is limited
to one or both ovaries. With Stage II, growth
of the cancer involves one or both ovaries,
with pelvic extension. With Stage III, growth
of the cancer involves one or both ovaries,
the cancer has spread beyond the pelvis to
the lining of the abdomen, and/or the cancer
has spread to lymph nodes. Stage IV is the
most advanced, in which growth of the cancer
involves one or both ovaries and distant,
lymphatic spread has occurred.
Treatment
Options
Treatment
options and patient outcomes depend on the
type of cancer and how far it has spread before
it is diagnosed. Treatments include:
-
Radical surgery, in which the ovaries,
fallopian tubes, uterus and cervix are
usually removed, through an operation
known as hysterectomy with bilateral salpingo-oophorectomy.
Often, the surgeon will also remove the
omentum (the thin tissue covering the
stomach and large intestine) and lymph
nodes (small organs located along the
channels of the lymphatic system) in the
abdomen. If the cancer has spread, the
surgeon usually removes as much of the
cancer as possible in a procedure called
tumor debulking. Tumor debulking reduces
the amount of cancer that will have to
be treated later with chemotherapy or
radiation therapy.
-
Chemotherapy
is the use of drugs to kill cancer cells
("chemical therapy"). Chemotherapy
may be given to destroy any cancerous
cells that may remain after surgery, to
control tumor growth, and/or to relieve
symptoms of the disease. After chemotherapy
is completed, a second-look surgery may
be performed to examine the abdomen directly.
The surgeon may remove fluid and tissue
samples to see whether the drugs have
been successful in eradicating the disease.
-
Radiation therapy, also called radiotherapy,
involves the use of high-energy rays to
kill the cancer cells.
Side
effects of these treatments range from surgical
pain and induction of surgical menopause to
nausea and vomiting, loss of appetite, diarrhea,
fatigue, numbness and tingling in hands or
feet, headaches and hair loss.
Follow-up
care after treatment for ovarian cancer is
important and should include regular checkups,
complete with physical and pelvic exams, Pap
tests, a urinalysis, a CBC (complete blood
count) and a CA-125 assay.
Ovarian
cancer is curable if diagnosed and treated
early!! Be aware of symptoms and request tests
of your doctor that may save your life.
Where to find help:
References:
1) American
Cancer Society
2) Gilda
Radner Familial Ovarian Cancer Registry
3) "What
Is Ovarian Cancer?" by the National
Ovarian Cancer Resource Center
4) & 5): "Ovarian
Cancer," by the National Cancer
Institute. NIH Publication No. 00-1561
Heather
C. Guidone is a freelance writer and researcher
with a special interest in women's health.
She has served as the Director of Operations
and an Executive Board Member of the Endometriosis
Research Center, a 501(c)3 non-profit organization
for education, research facilitation and support
since the organization was founded. She is
a member of the American Medical Writer's
Association and the World Endometriosis Society.
Heather resides outside NYC with her family.
For more information, visit: www.hcgresources.com/endoindex.html
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