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Ovarian Cancer
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| Ovarian Cancer Frequently Asked Questions |
What is Ovarian Cancer? Ovarian Cancer is the deadliest of all the cancers of the female reproductive organs. More than 22,000 American women will be diagnosed with Ovarian Cancer this year and about 16,000 women will die from it. The ovaries have 2 functions. One function is to produce the female hormones estrogen and progesterone which regulate the menstrual cycle. The second function is to release eggs each month with the monthly cycle. The egg travels down the fallopian tubes and once it reaches the uterus it is either fertilized by sperm and the woman becomes pregnant or has her monthly period. There are three types of cells in the ovaries and they all have different functions. Germ cells produce the eggs that are formed on the inside of the ovary. Stromal cells produce the hormones, and epithelial cells provide a covering on the outside of the ovary. Ovarian cancer can occur in any one of these different types of cells but about 90% of women with ovarian cancer have the epithelial type. This presentation will focus on this most common type. Epithelial ovarian cancer occurs when the cells that cover the ovary for some unknown reason multiply and cause a cancerous tumor. There are four stages of ovarian cancer. Women who are diagnosed in the earliest stages I and II have the best chance of survival. Stage I represents early disease where the cancer is only on one or both ovaries. In Stage II the cancer has spread to the fallopian tubes or uterus or other organs in the pelvic area such as the bladder or rectum. In Stage III the cancer has spread up into the abdominal cavity and possibly the lymph nodes. Stage IV means the cancer has spread to the liver, lungs or other organs. The cancer doesn’t grow as one big tumor, it appears sporadically on the various organs. When caught in the earliest stages of I or II, it is very treatable and rarely fatal. 80-90% of women who are diagnosed today with stage I disease will be alive 5 years from now, whereas only about 20% of women with stage IV will survive that long. Unfortunately the majority of women who are diagnosed with ovarian cancer are usually in the later stages. The longer this disease goes undetected and untreated, the more deadly it becomes. Why isn’t it caught earlier? Because the symptoms are so vague and so common to so many other things, many women and even doctors and nurse practitioners fail to recognize the symptoms as anything serious. When caught in the earliest stages of I or II, it is very treatable and rarely fatal. 80-90% of women who are diagnosed today with stage I disease will be alive 5 years from now, whereas only about 20% of women with stage IV will survive that long. Unfortunately the majority of women who are diagnosed with ovarian cancer are usually in the later stages. The longer this disease goes undetected and untreated, the more deadly it becomes. What are some of the symptoms? The most common symptoms are constipation, stomach upsets like gas, indigestion, nausea, bloating or stomach swelling, always feeling full, having to urinate more often or losing control of urination, unexplained weight loss or weight gain, feeling tired all the time, abnormal bleeding, even if you don’t have a monthly period anymore, or pain during sexual intercourse. The bloated feeling is often from fluid in the abdomen called “ascites” that collects as a reaction to the tumor. Now lots women have these symptoms everyday. Most of the time they don’t mean anything and they go away after a few days or after taking some over the counter medicine. But with ovarian cancer these symptoms will not go away and the woman usually doesn’t feel better with over the counter remedies. If these symptoms go on for longer than 4-6 weeks, the woman must see her doctor right away and insist on a thorough exam. What kind of exam do they need to have? They need to have a pelvic exam just like the yearly exam that all women should have regularly. You can’t diagnose ovarian cancer with the pap smear test, that is a screening for cervical cancer. The health care provider must do what is called the bi-manual exam, where one hand is in the vagina and the other presses on top of the lower abdomen. When the examiner does this they are trying to feel the ovaries between their fingers and can tell if the ovaries are enlarged or tender. It is also very important to have a rectovaginal exam where one finger is in the vagina and one inside the rectum. This helps the examiner feel for abnormal swelling or tenderness. All women over age 35 should have this exam every year. What if something abnormal is found during the exam? Are there other tests that are done? Very often ultrasound, either abdominal or transvaginal is used. CT scan or MRI’s are often used also. These tests can provide details about the size of the ovarian mass and whether they are a solid mass or filled with fluid, which could suggest only a benign cyst. A blood test called the CA125 is often done. However this test can sometimes be abnormal when no cancer actually exists and can even be falsely normal when cancer does exist. Unfortunately there does not exist at this time a reliable and accurate screening tool to help diagnose Ovarian Cancer. There is however lots of research going on right now to find more accurate screening methods. The public really needs to be educated about this deadly disease and we need to support these researchers with financial donations. Patients themselves need to participate in clinical trials. That is where the work is done to find better ways to diagnose and treat all diseases, through research. What are some of the treatments? The only way to definitively diagnose ovarian cancer is to have surgery. This could be a laproscopic procedure where a scope is inserted into a small cut in the abdomen to take biopsies or it could be a laparotomy where an up and down incision is made so the surgeon can see any suspicious areas and remove them or take biopsies. A laparotomy is done usually if the doctor feels pretty certain that the woman has ovarian cancer. If she does then the surgeon would possibly continue with a complete hysterectomy and a procedure called tumor debulking, where as much cancer as possible is removed. This is also when the staging occurs that was discussed earlier. It is very important to be staged correctly because it guides the treatment afterwards. Women with late stage disease usually are given chemotherapy after surgery to suppress or kill any remaining cancer. Some doctors like to perform “second look” surgeries after the chemotherapy is finished to see if any cancer remains. However this is controversial because it has not been found that women who have second look surgeries have better survival rates. If there is no one reliable screening tool, how is ovarian cancer diagnosed? Because the symptoms are so vague and so common to so many other things, many women and even doctors and nurse practitioners fail to recognize the symptoms as anything serious. When caught in the earliest stages of I or II, it is very treatable and rarely fatal. 80-90% of women who are diagnosed today with stage I disease will be alive 5 years from now, whereas only about 20% of women with stage IV will survive that long. Unfortunately the majority of women who are diagnosed with ovarian cancer are usually in the later stages. The longer this disease goes undetected and untreated, the more deadly it becomes. Is my gynecologist trained to take care of me if he or she suspects I have ovarian cancer? No, a woman diagnosed with ovarian cancer needs to be treated by a doctor called a Gynecologic Oncologist. They are doctors who have special training in this type of surgery and often they continue to care for the patient during chemotherapy. Research has shown that women who had their initial surgeries performed by a gynecologic oncologist have better survival rates. Who is at risk for ovarian cancer? Women at increased risk of having ovarian cancer may have a personal or family history of breast, ovarian, endometrial, prostate or colon cancer. Women who have never used birth control pills or have never been pregnant have been shown to be at higher risk, and women over 40 are at increased risk. There has been some research to suggest that women who use talc, such as baby powder around their genitals may have some increased risk of ovarian cancer. If a woman has been told she has ovarian cysts does that mean she is at risk for ovarian cancer? Not usually, ovarian cysts are often a normal part of the menstrual cycle. Most of them are very small and they come and go with each monthly period. However, ovarian cysts that stay around for several monthly cycles and are larger than about 6 cm should be monitored frequently with physical exam and ultrasound detect the presence of cancer. There has not been enough research to support whether it does or not, this is a decision that women need to make after discussing it at length with their health care providers. Is there any way to prevent ovarian cancer? No, currently there is no method to prevent it. But premenopausal women can reduce their risk by taking oral contraceptives. Compared with women who never used oral contraceptives, those who used them for 3 or more years had about a 30-50% lower chance of developing ovarian cancer. Tubal ligation is a birth control procedure that “ties” the fallopian tubes. This procedure may decrease the chance of developing ovarian cancer by about 70%. And research has shown that having children and breast feeding can also reduce a woman’s chance of getting it. Also women who include lots of vegetables their diet have been found to have a decreased risk of the disease. The American Cancer Society recommends at least five servings of fruits and vegetables as well as whole grain breads and pastas to prevent lots of other diseases as well. If the symptoms of ovarian cancer are so vague and there aren’t really any good screening tools to diagnose it, doesn’t talking about it only cause a lot of anxiety? It is a scary disease and just talking about it does cause a lot of anxiety. But it is true that it is a very curable type of cancer when it is caught early. Women need to be vigilant with their health. If a woman has any of the persistent symptoms that were mentioned earlier, she needs to insist on a workup for ovarian cancer and not be satisfied with a diagnosis of constipation or gas. Another reason we need to talk about it is to focus the attention of the Federal Government who provides funding for research to find better diagnostic tools and better ways to treat this disease. Women who are diagnosed with this disease should be encouraged to participate in clinical trials where they volunteer to undergo new experimental treatments. This is where treatments and cures for all diseases take place. It would be great to see fund raising events like “Race for the Cure” that are held for Breast Cancer Reasearch become popular for ovarian cancer. This is how this disease will become less deadly and perhaps curable, by research. There is research going on now to find new blood tests to diagnose the disease more accurately. Scientists are also studying what role genetics plays in getting the disease and new treatments are on the horizon. Where can people go to learn more about ovarian cancer? They can call 1888 OVARIAN or find information on the web at the National Ovarian Cancer Coalition.
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