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Ovarian cancer

Definition


Disease: Ovarian cancer Ovarian cancer
Category: Tumors

Disease Definition:

In the past, because ovarian cancer usually wasn’t discovered until it had spread to other areas of the body, it used to be called “silent killer”. However, treatment nowadays is more effective thanks to medical advances. New evidence proves that most women might have symptoms even in the early stages, and awareness of symptoms might contribute to earlier detection. About 93% of women with ovarian cancer that is diagnosed in its earliest stages have a five-year survival rate. However, only about 20 % of ovarian cancers are discovered before the tumor has spread beyond the ovaries. The earlier the discovery of cancer, the better the chances of survival.
 

Work Group:


Symptoms, Causes

Symptoms:

The symptoms of ovarian cancer are not specified and mimic those of many other more common conditions, such as digestive and bladder disorders. Before a woman finds out that she has ovarian cancer, she may be diagnosed with other conditions. Irritable bowel syndrome, depression and stress are included in common misdiagnoses.

 

The symptoms of most digestive disorders seem to appear and disappear, or they could take place in certain conditions or after eating certain foods. The key to discovering ovarian cancer tends to be lasting or worsening signs and symptoms. There’s commonly little fluctuation with ovarian cancer, with constant and gradually worsening symptoms.

 

Recent studies have proven that women suffering from ovarian cancer are more likely than others to constantly experience the below symptoms:

 

  • Urinary urgency
  • Pelvic pain or discomfort
  • Abdominal pressure, swelling, bloating or fullness

 

Other signs and symptoms that women suffering from ovarian cancer might experience include:

 

  • Changes in bladder habits, including a frequent need to urinate
  • Persistent indigestion, nausea or gas
  • Loss of appetite or quickly feeling full
  • Pain throughout intercourse (dyspareunia)
  • A persistent lack of energy
  • Increased abdominal girth or clothes fitting tighter around the waist
  • Unexplained changes in bowel habits, like constipation
  • Changes in menstruation
  • Low back pain

 

In the case of experiencing bloating, swelling, pressure or pain in the abdomen or pelvis that lingers for more than a few weeks, a doctor should be consulted. If a person has already seen a doctor and received a diagnosis other than ovarian cancer but isn’t getting relief from the treatment, a second opinion could be taken or a follow-up visit could be scheduled with the doctor. Pelvic exam should be a part of the evaluation. When having a history of ovarian cancer or a strong history of breast cancer in the family, it is strongly recommended to consult a doctor trained to detect and care for ovarian cancer patients to be able to get informed about screening, genetic testing and treatment alternatives while being disease-free.
 

Causes:

Located on each side of the uterus, women have two ovaries; each ovary is about the size of an almond and produces eggs (ova) as well as the female sex hormones estrogen and progesterone.

 

An ovarian tumor is a development of abnormal cells that might be either noncancerous (benign) or cancerous (malignant). Even though benign tumors are made up of abnormal cells, but these cells don’t spread or metastasize to other body tissues. In one of two ways can ovarian cancer cells metastasize. In general, they spread directly to adjacent tissue or organs in the pelvis and abdomen. Additionally, they could spread to other portions of the body through the bloodstream or lymph channels.
Ovarian tumors have three basic forms designated by where they form in the ovary. Such as:

Germ cell tumors: 

In the egg-producing cells of the ovary is where these tumors usually occur. Younger women are more commonly affected by this type. 

Epithelial tumors:

About 85 to 90% of ovarian cancers grow in the epithelium, which is the thin layer of tissue covering the ovaries.

Stromal tumors: 

In the estrogen- and progesterone-producing tissue that holds the ovary together is where these tumors grow.

 

It is not known why ovarian cancer occurs. Some researchers believe that during a woman’s reproductive years, the process of tissue-repair that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) may be associated with the cancer. The formation and division of new cells at the rupture site might set up a condition in which genetic errors take place. Other researchers propose that the development of abnormal cells may be stimulated by the raised hormone levels before and throughout ovulation.

 

The risk of developing ovarian cancer may increase due to certain factors. Having one or more of these risk factors doesn’t assure growing ovarian cancer, but the risk might be higher in comparison with average women. These risk factors include the following:

Inherited gene mutations: 

The most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA1), despite the fact that the vast majority of women developing ovarian cancer don’t have an inherited gene mutation. These genes were identified in the first place in families with multiple conditions of breast cancer, which is how they got their names. However, a significantly high risk of ovarian cancer is also found in people with these mutations.

 

Women with the BRCA1 mutation have a 35 to 70% higher risk of ovarian cancer than do women without this mutation, while for women with a BRCA2 mutation, the risk is between 10 and 30% higher. People of Ashkenazi Jewish descent are at especially high risk of carrying these forms of mutations.

 

An inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC) is involved in yet another known genetic link. Women in HNPCC families are at a higher risk of cancers of the colon, stomach, ovary and uterine lining (endometrium). The risk of ovarian cancer associated with BRCA mutations is higher than that associated with HNPCC.

A history of breast cancer: 

A woman’s risk of ovarian cancer is increased in case she has been diagnosed with breast cancer.

Family history: 

In some cases, ovarian cancer takes place in more than one family member but isn’t the outcome of any known inherited gene alteration. Someone’s risk of having ovarian cancer is increased 10 to 15% in the case of having a family history of the disease.

Age: 

After menopause is when ovarian cancer usually develops. Through a person’s late 70s, the risk of ovarian cancer is increased.
The risk of ovarian cancer is raised with age through the late 70s. The disease also occurs in premenopausal women despite the fact that most ovarian cancers are diagnosed in postmenopausal women.

Childbearing status: 

Women who have had at least one pregnancy seem to have a lower risk of growing ovarian cancer. The use of oral contraceptives seems to also provide some protection against ovarian cancer.

Infertility:

There’s a high risk of ovarian cancer in women who have had trouble conceiving. Studies indicate that infertility raises the risk of ovarian cancer, even without the use of fertility medications, but the link is poorly understood. Additionally, some studies have suggested that taking fertility medications for more than one year, like clomiphene, might raise the risk of ovarian cancer, but it’s not certain whether the raised risk is the result of the infertility or the medication.

Hormone replacement therapy (HRT): 

Findings about the potential link between postmenopausal use of the hormones estrogen and progestin and risk of ovarian cancer have been inconsistent. Yet, a recent analysis of several studies has confirmed a relation between HRT and ovarian cancer, specifically for those who took estrogen only. Among women who took HRT for more than five years the risk seems to be highest.

Obesity: 

An increased risk of ovarian cancer is found in women who are obese. Additionally, obesity might be associated with a reduction in the overall survival rate and more-aggressive ovarian cancers that could cause shorter time to disease relapse.

Male hormones: 

Endometriosis is treated with the male hormone androgen in the form of the medication danazol, which has been associated with an increased risk of ovarian cancer. To define this association further, more study is needed.
 

Complications

Complications:

None

Treatments:

Usually, a combination of surgery and chemotherapy is used in the treatment of ovarian cancer.

 

SURGERY:

Gynecologic oncologists usually have more training and experience with ovarian cancer surgery.
Women with ovarian cancer usually need an extensive procedure that includes removing fallopian tubes, both ovaries, the uterus, as well as nearby lymph nodes and a fold of fatty abdominal tissue called omentum, where ovarian cancer frequently spreads.

 

Throughout this operation, cancer will be removed as much as possible from the abdomen, a method called surgical debulking. Ideally, after surgery, less than a total of 1 cubic centimeter of tumor matter should stay in the abdominal cavity (optimal debulking). Part of the intestines may be removed in this surgery. Additionally, to examine for cancer cells, samples of tissue and fluid will be taken from the abdomen. To identify the stage of the disease and determine whether additional therapy is required or not, this evaluation is very important.

 

Only the involved ovary and its fallopian tube could be removed in case the patient wants to preserve the option of having children and if the tumor is found early. However, infertility may result from subsequent chemotherapy. Yet, sometimes, it is possible to successfully bear children after treatment. The patient should make certain to talk to their doctor about their wish to bear children.

 

CHEMOTHERAPY:

The patient will most likely be treated with chemotherapy after surgery, the method in which medications are used to kill any persistent cancer cells. The combination of carboplatin and paclitaxel injected into the bloodstream is the initial regimen for ovarian cancer. Although researchers are consistently looking for ways to improve on this combination, but clinical trials have discovered that it is effective.

 

Combining standard intravenous chemotherapy injected directly into the abdominal cavity through a catheter placed at the time of the primal procedure; this more intensive regimen has been proven recently to improve survival in women with advanced ovarian cancer. This intra-abdominal infusion exposes hard-to-reach cancer cells to higher levels of chemotherapy than could be reached intravenously. Abdominal pain, vomiting and nausea are some of the side effects that leave several women unable to complete a full course of treatment or others to entirely give up treatment. However, this treatment could help women live longer even if it is not completed.

 

New chemotherapy medications, vaccines, gene therapy and immunotherapy that boost the immune system to help combat cancer are some of the other treatments that are being studied. In the case of failure of chemotherapy, the latest alternative is a medication called bevacizumab. It works by disrupting the blood supply to the tumor, probably resulting in its shrinking. Bowel perforation that occurs in about 7% of people using bevacizumab is the most serious side effect of this medication.

 

RADIATION: 

In general, radiation isn’t believed to be effective for ovarian cancer, despite the fact that it is a mainstay in the treatment of some other cancers. Occasionally, symptoms of advanced cancer can be treated with external beam radiation therapy (EBCT).
 

Prognosis:

Not available

Expert's opinion

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