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Ovarian Cancer:
The ovaries are a pair of female reproductive organs, located in the pelvis on each side of the uterus. Their main functions are to produce eggs and female hormones. Ovarian epithelial cancer, the most common form of ovarian cancer, is a disease in which malignant cells form in the tissue covering the ovary.
According to the National Cancer Registry, ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia, making up five per cent of all female cancer cases.
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Risk Factors
Studies have identified several factors that may increase the chance of developing this disease.
A woman with a family history of ovarian cancer, particularly a first degree relative (like mother or sister), has an increased risk of developing this type of cancer.
Other risk factors include older age, a history of breast or colon cancer, and having no children. Women taking birth control pills (oral contraceptives) have a decreased risk of developing ovarian cancer. Having one or more risk factors does not mean that a woman is sure to develop ovarian cancer, but the risks may be higher than average.
Women who are concerned about their individual risk for ovarian cancer can consult a gynaecologist, gynaecologic oncologist or a medical /clinical oncologist.
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Early Detection
The sooner the cancer is detected and treated, the better a woman's chance for recovery.
However, ovarian cancer is not easy to detect early. Often women with ovarian cancer have no symptoms or show mild and non-specific symptoms, until the disease has reached an advanced stage.
Researchers are exploring ways to improve the early detection of ovarian cancer. This includes exploring the usefulness of a trans-vaginal ultrasound, and of measuring levels of CA-125, a tumour marker that is often found in higher than normal amounts in the blood of women with ovarian cancer.
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Symptoms
Symptoms may include general abdominal discomfort and / or pain (such as gas, indigestion, pressure, swelling, bloating, cramps); nausea, diarrhoea, constipation or frequent urination; loss of appetite; a feeling of fullness even after a light meal; unexplained weight gain or loss and abnormal vaginal bleeding
Since these symptoms may be caused by many other, less serious conditions, it’s important to consult a doctor about any of them.
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Diagnosing Ovarian Cancer
- A pelvic examination by the gynaecologist may reveal a pelvic mass that can be felt. Many of these masses are benign.
- An ultrasound examination can help to differentiate a fluid filled cyst, solid tumour masses and healthy tissues.
- The CA-125 Assay is a blood test used to measure the level of CA-125, a tumour marker, in the blood.
- Other tests include a CT or CAT scan, a barium enema (X-rays of the lower gastrointestinal tract) and an intravenous Urogram ( X-rays of the urinary tract)
Stages Of Ovarian Cancer A laparotomy, or surgical incision made in the wall of the abdomen, can be carried out to determine at what stage the disease has developed: * Stage I : The cancer is found in one or both ovaries * Stage II : The cancer is found in one or both ovaries and has spread into other areas of the pelvis * Stage III : The cancer is found in one or both ovaries and has spread to other parts of the abdomen * Stage IV : The cancer is found in one or both ovaries and has spread beyond the abdomen to other parts of the body. This stage includes cancer in the tissues of the liver.
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Treatment Options
Three kinds of standard treatment are used:
- Surgery
This is the initial treatment and usually involves the removal of the ovaries, fallopian tubes, uterus and cervix. This operation is called a hysterectomy with bilateral salpingo-oophorectomy.
Often the surgeon also removes the omentum (apron of tissues covering the stomach and large intestine) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen.
Surgical staging generally involves removing lymph nodes, sample of tissue from the diaphragm and other organs in the abdomen and fluid from the abdomen. If the cancer has spread, the surgeon usually removes as much of the cancer as possible in a procedure called tumour de-bulking. Tumour de-bulking reduces the amount of cancer that will have to be treated later with chemotherapy or radiation therapy.
- Chemotherapy
This uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, for example. It can be used when there is minimal residual disease (when no tumor mass is left after surgery), to control tumour growth (for residual disease) or to relieve symptoms of the disease (for advanced disease stage).
- Radiation Therapy
This uses high energy X-rays or other types of radiation to kill cancer cells. Although less commonly used nowadays due to the improvement in systemic chemotherapy, whole abdomino-pelvic radiotherapy is used in some cancer centres following surgery in Stage I and Stage II .
Other types of treatment that are being tested in clinical trials include targeted treatments against specific molecular abnormalities in the cancer cells. Treatments that use the immune system to fight cancer are also being explored.
Most patients require a combination of surgery and chemotherapy. Patients in Stage III and Stage IV of the disease obtain good responses to chemotherapy and provided optimal surgery is performed, they may remain disease-free for prolonged periods. Most, however, will eventually relapse.
Modern treatment with chemotherapy allows patients to have a reasonable quality of life. Most patients today do not experience significant problems with nausea or vomiting due to improvements in supportive care regimens.
Other side effects, such as hair loss, are temporary and patients will fully regain their hair following completion of chemotherapy.
Modern chemotherapy programs allow for outpatient treatment with a minimal disruption to patients (and their families) quality of life.
It is important that patients with ovarian cancer seek advice from a team of cancer specialists or multi-disciplinary cancer care.
CHINESE VERSION AVAILABLE. Please download here...
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By Dr. Joseph Kanianthra Joseph
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