The American Cancer Society
reports that ovarian cancer is the eighth most common cancer among
women today. About 3% of all cancers in women are some type of
ovarian cancer. Unfortunately, ovarian cancer ranks among fifth in
cancer deaths, primarily due to the fact that it is hard to detect
until it has advanced beyond the ovaries into other areas of the
body. Estimates are that 1 in every 57 women will develop ovarian
cancer in the United States.
In the female reproductive
system, the ovaries house the eggs needed for reproduction. There
are two ovaries, one on each side of the uterus where fertilized
eggs are implanted during pregnancy. Another reason for the ovaries
importance: they are the main source of female hormones estrogen and
progesterone.
There are three different types
of tissues in the ovaries, each able to produce a different type of
ovarian cancer. By far, the most prevalent type of cancer is found
in the epithelial tissue of the ovaries. Epithelial tissue lines the
outside of the ovaries and is found in about 85 – 90% of all ovarian
cancer cases. It can grow undetected and spread rather quickly to
the abdomen and into other parts of the body.Germ cells actually
produce the eggs that are formed inside the ovaries. Germ cell
tumors accounts for about 5% of ovarian cancer cases today. Stromal
cells produce the estrogen and progesterone and account for the
remaining 5 – 10% of cancer-causing tumors.
Survival rates for ovarian
cancer vary widely largely depending on the stage of the cancer at
the time of diagnosis. Stage 1 and 2 cancers have much better
survival rates than do stage 3 and 4. The American Cancer Society
notes that about 76% of women survive one year after diagnosis and
the survival rate drops to 45% at five years. If doctors can
diagnose and treat the cancer while it is still in the ovaries, the
overall survival rate climbs to 94%, yet fewer than 20% of ovarian
cancers are diagnosed at this early stage.
Risk
Factors and Testing:
Despite the facts and figures,
it is hard to detect ovarian cancer since most of the time it starts
without detectable symptoms. Women who have a family history of
breast cancer or ovarian cancer should discuss it with their
physician so that early testing can be done before ovarian cancer
has a chance to grow undetected. Generally the cancer strikes women
over the age of 50, with women 65 and older most at risk. It has
been found in younger women, however. Women who are overweight or
who have used fertility drugs also have an increased risk of
developing the cancer. Hormone replacement therapy (HRT) has also
been shown to increase the risk for developing ovarian cancer.
Testing for the cancer isn’t
that easy either. While regular pap tests can help screen for
certain types of cancer, it isn’t a reliable indicator of ovarian
cancer. Usually by the time a doctor can detect ovarian cancer with
a pap smear, the cancer is already in advanced stages. Regular
health exams, however, can help physicians determine if there are
changes in the size of the ovaries or uterus. Tumors in the ovaries
that are still in the early stages may not be detected early,
though.
Women with several risk factors
or a personal history of breast cancer could be screened with a
vaginal ultrasound and possibly blood tests that screen for “tumor
markers.” Tumor markers can include testing for increased amounts of
CA-125 or a protein in the blood that is generally higher in women
who have ovarian cancer. There are still many clinical trials to
develop further lines of research along blood tests so that quicker
methods of detection can be brought to light.
Treatment:
Surgery is usually one of the
first lines of defense when fighting ovarian cancer. Surgical
options depend heavily on how far the cancer has spread and the type
of ovarian cancer that is present. Some of these options can include
removal of one or both ovaries, a total hysterectomy – which
includes removal of the uterus as well as the ovaries – or cutting
away the tumors in the tissues, leaving as much of the reproductive
system intact as possible.
One thing to remember is that
once a surgeon starts to remove tissue, he needs to have approval to
remove as much as he feels necessary in order to prevent the cancer
cells from spreading. Cancer that is not removed can quickly spread
as a result of the surgery. Discuss how much surgery needs to be
performed, especially if the woman is still old enough and wants to
continue bearing children after treating the cancer. Bear in mind
that once the procedure starts the surgeon may need to do more
tissue removal than first anticipated and discuss the possibility
that the surgery will be more extensive than first anticipated.
Depending on the stage of the
cancer and the success of the surgery, chemotherapy and radiation
treatment may or may not be necessary. Chemotherapy uses
high-powered medications to destroy cancer-causing cells in the
body. Unfortunately, chemotherapy does not discriminate between
cancer cells and non-cancer cells, so normal cells are often killed
during treatment as well. There are a number of side effects of
chemotherapy that include nausea, vomiting, anemia (low red blood
cell count), hair loss, and decreased white blood cell and platelet
counts. Medications are available to combat these side effects, with
the exception of hair loss. Generally hair will begin to grow back
after chemotherapy is completed.
Chemotherapy is used in the
event that doctors were not able to determine if all cancer was
removed during surgery. The higher the staging of the cancer, the
more likely it is that chemotherapy will be needed. Some tumors, for
example, may not be removed completely by surgery and chemotherapy,
in conjunction with radiation therapy, can shrink the tumors.
Most, but not all chemotherapy
treatments are given intravenously, either through an IV that is
inserted at each treatment or through an IV port that stays in the
vein and accessed each time a treatment is needed. The port can be
removed when chemotherapy is completed. Some chemotherapy treatments
are given orally, while others may be given directly into the
abdominal cavity or into a muscle (intramuscular). The type of
chemotherapy used depends on the type of ovarian cancer being
treated. In addition, the number of doses and the frequency also
depend on the stage; these factors also take into consideration how
quickly a patient can recover from a dose of chemotherapy treatment.
Some patients can endure chemotherapy once every three weeks, while
others may need slightly longer to recover. Normal cells need the
chance to “bounce back” while not allowing cancer cells the same
opportunity to recover. The doctor will discuss each of these
factors when prescribing a treatment plan for chemotherapy.
Radiation therapy is generally
only helpful in treatment if the cancer is still confined to a
relatively small area, like the ovaries. Once the cancer begins to
spread to other organs, radiation therapy loses its effectiveness
since it cannot be sufficiently targeted to help kill the cancer
cells.
Role of
Clinical Trials in Follow-up Care:
Because of the relatively small
window for effective detection and treatment of ovarian cancer,
doctors regularly recommend that women enroll in a clinical trial
for follow-up care. Women can help advance the science of treating
ovarian cancer at any stage of the disease. Even when the disease
advances into the third and fourth stages where traditional
treatment methods fail, it is still possible to learn from women in
these categories so that further clinical advancements can be made.
Dr. Don Dizon, FACP, Assistance
Professor, OB/GYN & Medicine at Brown Medical School notes, “Many of
the advances in the treatment of ovarian cancer would not be
possible if not for the women who participate in clinical trials.
Whether they joined the trials before cancer was detected and taught
physicians what to search for or after their cancer was in the
treatment stages, doctors could still learn a great deal from them.”
Dizon leads several clinical
trials, each in different areas since there are many fruitful
avenues for medical exploration in ovarian cancer. Some of these
areas include immunotherapy or ways to use the immune system to
combat and treat ovarian cancer; quality of life studies for women
who are completing treatment; and novel therapeutics for early
detection of ovarian cancer. Dizon says, “When ovarian cancer
reaches the abdomen, something about the environment there allows it
to spread quickly to other parts of the body. Research studies are
looking at the effectiveness of applying chemotherapy directly to
the abdomen as a method of treatment.” These are only some of the
reasons that Dizon recommends that even healthy women get involved
in clinical trials.
As far as prevention and early
treatment, Dizon notes that there are several trials out there aimed
at blood profiling that will hopefully give doctors useful tools for
finding ovarian cancer at even earlier stages. Dizon also notes with
irony that one of the best methods for preventing ovarian cancer
could put women at increased risk for developing breast cancer
later. “Without removing the ovaries – one of the only ways known to
almost fully prevent ovarian cancer – birth control pills remain one
of the best ways to reduce a woman’s risk of developing ovarian
cancer. Still, women must weigh the increased risk of breast cancer
if they choose this mechanism of prevention.”
Ovarian cancer can and does
recur. For this reason, five year survival rates are lower than
researchers like when managing a deadly disease. The cancer may not
all be removed during the first treatment and could have spread
undetected to other areas of the body. Another reason many doctors
advocate participation in clinical trials is the possibility of
recurrence. Women and caregivers need to be prepared for this
possibility when first beginning to look at treatment options and
follow-up care.
Caregiver Role:
Caregivers play an important
role in the treatment of ovarian cancer. While it may be difficult
to discuss, it is important to maintain open lines of communication
with family, friends, and others who may be supportive during this
time. In addition, caregivers can help relay information to
physicians that may seem insignificant to the patient, yet could
give important details about what is happening at home as a result
of treatment.
Caregivers can help fill the
following roles in the treatment “team:”
-
Someone to drive the patient
to and from doctor appointments or treatment (chemotherapy
and/or radiation)
-
An extra helping hand in
the kitchen to prepare and/or freeze meals for the family
-
A listening ear when the
patient needs time to “vent” about the struggles of the cancer
and its treatment
-
Filling in at school
functions for children when the patient is not feeling well
enough to attend
These are only a few of the many
activities with which caregivers can help during the treatment of
ovarian cancer. Perhaps the most important role is one of advocate
both at home and in the physician’s office. Advocacy can be a tiring
activity and one that patients may not have the strength to perform
while they are being treated.
While the outlook for women who
develop ovarian cancer is not always discouraging, it is an area
that deserves increased attention in the research field today. Since
the cancer can grow silently for far too long before it is detected,
women need to be vigilant about comprehensive annual exams and
reporting even small changes in their health to their family
physician. Caregivers can play a role in this process as well by
helping place symptoms in perspective and giving new importance to
even the smallest of changes in a woman’s health. Learning more
about ovarian cancer and being unafraid to objectively balance the
information can aid doctors when trying to determine if the symptoms
represent normal functions of the body or if it could be a more
serious sign.
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