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Ovarian cancer

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Important: In their effort to be who they are, many female to male transsexuals find it difficult or simply ignore the fact that there is a continuing need for regular testing to detect the presence of ovarian cancer until after oophorectomy. Early detection is the only way to prevent its spread. Robert Eads is the most famous trans man to die from ovarian cancer.

Ovarian cancer is a cancerous growth arising from different parts of the ovary.

The most common form of ovarian cancer (≥80%) arises from the outer lining (epithelium) of the ovary.[1]. However, recent evidence shows cells that line the Fallopian tube (epithelium) also to be prone to develop into the same kind of cancer as seen in the ovaries. Since the ovaries and tubes are closely related to each other, it is hypothesized that these cells can mimic ovarian cancer.[2]. Other forms arise from the egg cells (germ cell tumor).

Epidemiology

In 2004, in the United States, 25,580 new cases were diagnosed and 16,090 women died of ovarian cancer. The risk increases with age and decreases with pregnancy. Lifetime risk is about 1.6%, but women with affected first-degree relatives have a 5% risk. Women with a mutated BRCA1 or BRCA2 gene carry a risk between 25% and 60% depending on the specific mutation.[3] Ovarian cancer is the fifth leading cause of death from cancer in women and the leading cause of death from gynecological cancer.

In early stages ovarian cancer is associated with abdominal distension.[4]

10-year relative survival ranges from 84.1% in stage IA to 10.4% in stage IIIC.

Symptoms

Ovarian cancer causes non-specific symptoms.[5] Early diagnosis would result in better survival, on the assumption that stage I and II cancers progress to stage III and IV cancers (but this has not been proven). Most women with ovarian cancer report one or more symptoms such as abdominal pain or discomfort, an abdominal mass, bloating, back pain, urinary urgency, constipation, tiredness and a range of other non-specific symptoms, as well as more specific symptoms such as pelvic pain, abnormal vaginal bleeding or involuntary weight loss.[6][7][8] There can be a build-up of fluid (ascites) in the abdominal cavity.

Diagnosis and Treatment

Diagnosis of ovarian cancer starts with a physical examination (including a pelvic examination), a blood test (for CA-125 and sometimes other markers), and transvaginal ultrasound. The diagnosis must be confirmed with surgery to inspect the abdominal cavity, take biopsies (tissue samples for microscopic analysis) and look for cancer cells in the abdominal fluid. Treatment usually involves chemotherapy and surgery, and sometimes radiotherapy.[9]

Cause

In most cases, the cause of ovarian cancer remains unknown. Older women, and in those who have a first or second degree relative with the disease, have an increased risk. Hereditary forms of ovarian cancer can be caused by mutations in specific genes (most notably BRCA1 and BRCA2, but also in genes for hereditary nonpolyposis colorectal cancer). Infertile women and those with a condition called endometriosis, those who have never been pregnant and those who use postmenopausal estrogen replacement therapy are at increased risk. Use of combined oral contraceptive pills is a protective factor. The risk is also lower in women who have had their uterine tubes blocked surgically (tubal ligation).[10][11]

References

  1. ↑ EBSCO database verified by URAC; accessed from Mount Sinai Hospital, New York
  2. ↑ [1]accessed from VU University medical center, Amsterdam http://dare.ubvu.vu.nl/handle/1871/9013
  3. ↑ Robert C. Young (2005). "Ch. 83, Gynecologic Malignancies", in Jameson JN, Kasper DL, Harrison TR, Braunwald E, Fauci AS, Hauser SL, Longo DL: Harrison's principles of internal medicine, 16th, New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-140235-7. 
  4. ↑ doi:10.1136/bmj.b2719
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  5. ↑ Goff BA, Mandel L, Muntz HG, Melancon CH (November 2000). "Ovarian carcinoma diagnosis". Cancer 89 (10): 2068–75. <2068::AID-CNCR6>3.0.CO;2-Z doi:10.1002/1097-0142(20001115)89:10<2068::AID-CNCR6>3.0.CO;2-Z. PMID 11066047. 
  6. ↑ Bankhead CR, Kehoe ST, Austoker J (July 2005). "Symptoms associated with diagnosis of ovarian cancer: a systematic review". BJOG 112 (7): 857–65. doi:10.1111/j.1471-0528.2005.00572.x. PMID 15957984. 
  7. ↑ Ryerson AB, Eheman C, Burton J, et al. (May 2007). "Symptoms, diagnoses, and time to key diagnostic procedures among older U.S. women with ovarian cancer". Obstet Gynecol 109 (5): 1053–61. doi:10.1097/01.AOG.0000260392.70365.5e. PMID 17470582. 
  8. ↑ Goff BA, Mandel LS, Melancon CH, Muntz HG (June 2004). "Frequency of symptoms of ovarian cancer in women presenting to primary care clinics". JAMA 291 (22): 2705–12. doi:10.1001/jama.291.22.2705. PMID 15187051. 
  9. ↑ Chobanian N, Dietrich CS (April 2008). "Ovarian cancer". Surg. Clin. North Am. 88 (2): 285–99, vi. doi:10.1016/j.suc.2007.12.002. PMID 18381114. 
  10. ↑ Vo C, Carney ME (December 2007). "Ovarian cancer hormonal and environmental risk effect". Obstet. Gynecol. Clin. North Am. 34 (4): 687–700, viii. doi:10.1016/j.ogc.2007.09.008. PMID 18061864. 
  11. ↑ Bandera CA (June 2005). "Advances in the understanding of risk factors for ovarian cancer". J Reprod Med 50 (6): 399–406. PMID 16050564. 

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