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Ovarian cancer originates from the ovaries, which generate eggs, estrogen and hormones. It is the fourth most women killer in the US and recorded as fifth in the UK. African-Americans are less affected compared to whites that account for a higher percentage of the problem. Commonly, ovarian cancer is epithelial in nature, and until lately, it was deliberated as a single disease, but due to further studies differences in tumor compositions have linked it to other subtitles. Stewart, Rim and Richards (2011) report that in the US, around 21,000 women are diagnosed and approximately 15,000 women succumb to the disease, which experts concur, is startling. Since the avowal of war against all cancers was instigated some three decades back in the US, it is believed that the mortality cases regarding ovarian cancer has not been put to control compared to other cancers that have significant drops due to their early detections and subsequent treatments. Dejectedly, survival rates of ovarian cancer victims are much lesser than other cancers that generally affect women. Indeed, ovarian cancer is believed to be the deadliest of all gynecologic cancers (Clarke & Bailey, 2010; Lanceley, 2011; Gostout, Pachman & Lechner, 2012).
Pathophysiology and Risk Factors
According to (Lanceley, 2011), there are numerous types and variations of ovarian cancer and serous adenocarcinoma is perceived as the most common. Specialists have also established that about ten percent of ovarian cancers are hereditary citing the known three known prototypes as ovarian-colon cancer, ovarian-breast cancer and stand-alone ovarian cancer. Accordingly, precarious dynamics related to the three brands of cancer is the history of first-degree relations from the family that has the disease. This may be the mother, sister or daughter and this danger augments among females that have more than one first-degree relative with the ovarian cancer. The BRCA-1 gene found on chromosome 17q21 has been associated with relatives suffering from breast-ovarian and ovarian cancer, whereas the BRCA-2 in chromosome 13q12 is also liable for some occurrences of hereditary breast and ovarian cancer. For cancers that lack patent familial bequest, their origins may emerge from extensive trauma of the ovaries. During monthly ovulation, the ovum breakings happen through the epithelial surface of the ovary causing provocative reaction ensuing tissue repair. From time and again, this will be repeated and the resulting risk will be ovarian cancer. Actually, the risk of acquiring ovarian cancer is relatively high among women that are over sixty years and this is due to their menopausal stage, while female below forty years are among the rare cases. Obesity has also been noted to be another risk factor contributing towards ovarian cancer. Studies have revealed that overweight women whose body BMIââ‚¬â„¢s are around thirty, risk developing ovarian cancer. The cancer society in the US has also presented their findings revealing that, overweight females had higher fatalities. It is proven that pregnancy acts as a shield that may well prevent the acquisition of ovarian cancer, whereas women who never had children are perceived to be of high risk. Accordingly, every pregnancy has been confirmed to lower the threat of getting the ovarian cancer. It is also evident that females who use estrogens after their menopause have bigger risks of acquiring ovarian cancer (Lanceley, 2011).
Histology and physical
These crop up from the faÃade of the ovary and resemble epithelial tissues found on the fallopian tube and seen as the most common. This type of cancer does not characteristically attack parenchyma in the organ space, but affixes itself on the surface.
Germ cell tumors
These comprise a quarter of the ovarian tumors and are mostly benign in mature women, and are more like embryonic tissues. Their developments are more related to testicular cancer.
These tumors start in the egg-producing ovaries and are quite dissimilar from epithelial tumors. Some tumors created by these germ cells are non-cancerous while others are malignant. Germ cell tumors mostly distress only a single ovary and often curable, even if they are detected at an advanced period.
Sex Cord Tumor
These contain at least ten percent of the tumors in the ovary is a collection heterogeneous comprising of malignant or benign tumors that widens from the cells adjacent to oocytes, together with the cells that create ovarian. These tumors are sometimes considered rare since, they comprise only 1.2 percent of all basic ovarian cancers. Accordingly, in disparity with epithelial tumors, most patients with malignant sex cord tumors are identified at early stages and this classifies it as low-grade malignant.
Signs and symptoms
Early stages of ovarian cancer have no symptoms, but when they start occurring, they are inaccurately mistaken with other ordinary diseases.
Potential indicators vary from abdominal distress, inexplicable weight-loss, irregular alterations in bowel discharge and colossal abdominal inflammation, which typically force patients to instantaneously consult a physician. In reality, these developing complications are moderately imprecise and early identification is tricky (Burges & Schmalfeldt, 2011).
Differential Diagnoses and Diagnostic methods
Prospective screening events for ovarian cancer comprise of transvaginal ultrasound, serum CA125, transabdominal ultrasound and transvaginal ultrasound with color Doppler. The largely used assessment modality, which is comparatively cheap and noninvasive, is CA125. Nonetheless, further findings have revealed that this mode of assessment has solemn limitations.
For early stages especially stage I of the infection, its sensitivity is low. And in pre-menopausal females its specificity is not efficient. On these regards, CA125 predictive value scores poorly low but still remains valuable on other advance stages of the disease (Duffy et al., 2005).
Beckmann et al., (2010) affirms that primarily, early admonition signals that a patient may present should be main springboard for a physician to commence thorough analysis.
Imaging procedures are also carried out for diagnosis of ovarian cancer and trans-vaginal ultrasound is regarded as one of the vital determinant revealing if tumors are malignant or benign.
Magnetic resonance or computed tomography can be used in specific situations more so, on differential diagnosis on primary gastrointestinal tumor or ovarian cancer.
Indeed, these methods may not be the ultimate verdict since, it is proven that they at times overlook mesenteric and peritoneal carcinomatosis regarded as frequent in advance stages of ovarian cancer. The General practitioners are required to record complete history of any female complaining about urinary and abdominal symptoms. A bimanual pelvic test should also be carried out to verify if there exists a swelling. Further questioning of the willing patient should be done to determine if any close relative has ever suffered of any type of cancer, at what age and which proven type. If there is persistence of symptoms the patient should be advised to attend surgical procedures. Precise blood tests may also be done to determine if there is high intensity of CA125 protein (Beckmann et al., 2010).
Staging is seen as the most crucial phase where medics have widely conferred and have decided on a specific procedure for commencement of treatment. Staging is founded on the locality and size of the cancer. During the analytical juncture to educe the spread and location of the cancer, staging test are done. Accordingly, auxiliary staging are also executed during surgical procedures to ascertain that macroscopic multiplication is no longer occurring. This also comprise informal peritoneal sampling, washing, visual reviewing of normal organs and node biopsies. Formally, local multidisciplinary teams discuss final issues with all relevant specialists only after staging and diagnosis stages. After compiling all required notes, the patient is also required to attend the last consultation session prior to treatment to be briefed on all the deliberated issues. Lastly assigned specialist nurse take charge in preparing the patient on all the procedures that will be addressed throughout treatment duration (Beckmann et al., 2010).
Surgery has been seen as the initial resort for women suffering from ovarian cancer. Another the determinant factor dictating the surgery is the actual stage of the disease. For those women that have FIGO stage I, surgery is suggested, while females that have not reached their menopausal stage, safeguarding fertility is greatly considered, while conducting full staging in ensuring that macroscopic extension is no longer a threat. Women with FIGO stages II and III since, this is an advance stage of the ovarian cancer, will be straightly taken to surgery. This is primarily carried out to remove the most visible parts of the disease. This process is termed as ââ‚¬Å“debulkingââ‚¬ and is done to improve the effectiveness of adjuvant chemotherapy that takes place after the surgery, to those patients that their problems show belligerent temperament at their early stages (Clarke & Bailey, 2010).
Chemotherapy is done in view of interrupting tumor development, where this method hinders the deoxyribonucleic acid cells from multiplying. Six courses of drug-combinations are also given to patients at three weekly intermissions. The intention of this treatment, where prospective relapse is high, is to exploit the disease-free phase rather than improving general survival. Accordingly, the minimization of side effects while ensuring quality life must be under consideration and this coincides with the type of chemotherapy methods being applied. Among the first-line drugs used for ovarian cancer treatment is a combination of taxane and platinum. Indeed, diverse chemotherapy drugs have specific side-effects including vomiting, hair loss and nausea. Follow-ups are done to detect any relapse after the initial treatment, where victims go into a surveillance stage. The surveillance stage involves clinical tests done to ascertain the behavior of the tumor CA125. The CA125 levels if found to be increasing, there are immediate steps taken to tame this occurrence, and while found to be responding to treatments the patient is usually given schedules for subsequent follow-ups until declared free from the disease
Experts cite that pregnancy, the use of contraceptives and other events that stifle the ovulation act as defensive measures; there is need for better screening procedures around the globe, since the majority of victims get diagnosed when they already reached the final stages of the infirmity. Indeed, there exist varied innovative medical advancements spearheaded to handle this disease while others are being processed. Speedy articulate methods must be in place to tame this deadly female enemy at the earliest time possible. Relevant bodies need to step up educational campaigns targeting all women since, diagnosis of this type of cancer shocks most women. Nevertheless, it documented that all types of cancers bring some sense of improbability, but ovarian cancer is more dreaded because of its late recognition and more antagonistic treatments sessions. Provision of detailed information would help emerging victims prepare psychologically for any eventuality.