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The ABC of OVARIAN CANCER
It is a silent killer, deadly in many respects and often unstoppable once it takes flight in the body of their victims. Ovarian Cancer is one of such deadly diseases and women are the victims. Recently, the death of Maryam Babangida, wife of former Nigerian military ruler has brought the deadly power of Ovarian cancer home. Two US based medical doctors, experts in their field in this piece walk us through the nature of ovarian cancer, prevention, detection and treatment.
The early recognition and detection of ovarian cancer still remains a challenge in the medical world. The mystery of its diagnosis lies in the fact that there is still no suitable screening test and/or recommendation that has been endorsed by any expert panel around the world. The expert panel groups such as the United States Preventive Task Force (USPTF), Canadian Task Force (CTF), American Cancer Society (ACS), American Association of Family Physicians (AAFP), World Health Organization (WHO) etc, decide on evidencedbased methodologies for screening and early recognition of diseases in asymptomatic individuals (i.e. individuals that may have a disease but are yet to manifest any signs or symptoms of the disease) amongst other things. What makes the diagnosis of ovarian cancer more puzzling is the fact that the early symptoms are so vague and non-specific for the disease that a high index of suspicion as well as a detailed risk assessment is needed prior to any further work up in order to establish the diagnosis.
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INCIDENCE
Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs. Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer. In developed countries like the United States approximately 21,500 cases are diagnosed annually, and there are more than 15,000 deaths attributable to ovarian cancer each year. It is the leading cause of death from gynecologic malignancies in the United States. The lifetime probability of a woman developing ovarian cancer in the US is less than 2 percent. The incidence of ovarian cancer increases with age; the highest proportion are diagnosed in women 50 to 59 years of age. |
CAUSES
The cause of ovarian cancer like so many other cancers remains unknown. The risk for developing ovarian cancer appears to be affected by several factors. The risk of ovarian cancer appears to be decreased in women with a history of; multiple child births; use of the oral contraceptive pill; early age at first pregnancy; breastfeeding whereas, the risk may be increased in patients with a history of infertility or long term use of estrogen only pills due to the unopposed effect of the hormone. Certain genes (BRCA 1 and BRCA 2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer especially in close relatives referred to as first degree (mother, sister, brother etc) or second degree relatives (aunt, niece, uncle) i.e. FDR and SDR respectively have an increased risk of ovarian cancer. Advancing age also increases the risk with the highest incidence occurring in women 50 to 59 years of age. |
TESTS AND DIAGNOSIS
Once there is a high index of suspicion based on the symptoms and the risk assessment, a physical examination should be performed by a doctor preferably a trained family physician or a gynecologist, which must include a pelvic examination. Several signs may be discovered during this examination, which include; ascites (fluid in the abdominal cavity), a mass or fullness in the abdomen or pelvis.
TREATMENT
Surgery is the preferred treatment and is often needed to make the diagnosis of ovarian cancer. This is usually performed by a gynecologist oncologist (a gynecologist who specializes in cancers of the female reproductive tract). Successful treatment with surgery can be achieved only if the cancer is detected early and it is still confined to the ovaries without any spread outside this area. Chemotherapy is also used after surgery to treat any remaining disease or in situations of spread or recurrence. Radiation therapy is rarely used in the treatment of ovarian cancer. After treatment women are commonly monitored with the tumor marker CA-125 and CT scans. |
PROGNOSIS
Unfortunately ovarian cancer is rarely diagnosed in its early stages.
It is usually quite advanced by the time of diagnosis is made. Thus the result is a poor outcome. There are several reasons for this, which include lack of a good and reliable evidence based screening tool for asymptomatic individuals. Also because the prevalence of the disease is so low, screening of large population groups is not justifiable. So far there is no recommendation for screening women with average risk for ovarian cancer; however evidence suggests that it is appropriate to screen women who are at high risk based on their personal and/or family history as mentioned earlier. Such individuals should be screened using trans-vaginal sonograms and tumor markers CA-125. Expert panels also endorse the use of early symptoms as a prompt
for evaluation for ovarian cancer.
• About 76% of women with ovarian cancer survive 1 year after diagnosis
• About 45% live longer than 5 years after diagnosis
• If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is about 94%. |
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