Ovarian Cancer - Epithelial ovarian Cancer

Posted by Chantel Martiromo, Article By Kyle J. Norton 

The ovaries are oval shaped ovum-producing reproductive organ in part of a woman's reproductive system connected to the fallopian tubes and attached to the outer layer of the uterus via the ovarian ligament. Usually, the left and right ovary takes turn to release an egg every month.

Ovarian cancer is defined as a condition of abnormal cells growth of ovarian cells as that have become cancerous. It is one of most common cancer in US, according to the statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2010, an estimated 21,880 women in the United States will be diagnosed with ovarian cancer and 13,850 deaths.

Types
Ovarian cancer can be divided to the types below
A. Epithelial ovarian Cancer
Epithelial ovarian tumor also known as Surface epithelial-stromal tumor, as the name, it is a result of the cells on the surface of the ovary have become cancerous. Epithelial ovarian tumor is the most common form of ovarian cancer accounted for over 90% of ovarian cancer of all cases, including serous tumor, endometrioid tumor and mucinous cystadenocarcinoma.

B. Germ cell ovarian cancer

Germ cell ovarian tumor is a censer of the egg producing cells within the ovary and can be cancerous or non-cancerous tumors. It tends to occur in children and teens as a result of birth defects resulting from errors during development of the embryo.

C. Sex cord stromal ovarian cancer
Sex cord stromal ovarian tumor is a cancer of the tissue of the ovary accounted for 8% of ovarian cancers. The excess oestrogen produced by Sex cord stromal ovarian tumor can lead to certain symptoms, such as adult granulosa cell tumours and thecomas, postmenopausal bleeding, menorrhagia, amenorrhea, endometrial hyperplasia, etc. The cancer tend to develop in older age group.

D. Secondary cancer

Due to spread from other cancer to the ovaries.

E. Etc.

Epithelial ovarian Cancer
Symptoms
In early stage of the cancer, most women experience no specific symptoms or symptoms.
1. An abdominal mass

2. Bloating

3. Back pain
4. Urinary urgency
5. Constipation
6. Tiredness

7. Pelvic pain

8. Abnormal vaginal bleeding or
9. Unintentional weight loss

Unintentional weight loss of over 10% is a concerned symptom of all cancers.

10. Buildup of fluid in the abdominal cavity

11. Etc.

Causes and risk factors

1. Age
The risk of ovarian cancer increases for women between 50 to 70 years of age
2. Heredity
Women who carry certain mutation genes such as BRCA1 and BRCA2 account for 5%–13% of ovarian cancers
3. Family history
Increased risk of the disease, if one of your direct member family has history of the cancer.
4. Never pregnant
Researchers found that the risk of ovarian cancer is lower with numbers of pregnancy
5. Race
White women are associated with higher risk than other race
6. Hormone therapy
Risk of ovarian cancer increase with the use of hormone replacement therapy in post-menopausal women.
7. Chemicalsexposures
Certain chemicals such as asbestos also increases the risk of ovarian cancer
8. High fat dietary
Researchers found that women who diet high in saturated fat and trans fat are at higher risk.
9. Fertility medication
Drugs used to enhance fertility such as Clomiphene citrate may increase the risk of ovarian cancer.
10. Milk
In a report According to the BBC, researchers found that women who drank two or more glasses a day were at double the risk of those who did not consume it at all, or only in small amounts.
11. Etc.

Diagnosis and tests
After taking the family history and physical examination of the pelvic region. diagnosis in general starts with
1. Blood test
The blood is to determine the presence of the CA-125 and sometimes other markers , the higher the levels indicates more advance of the disease.

2. Gynecologic ultrasonography
Gynecologic ultrasonography is an ultrasound-based diagnostic imaging technique allowed your doctor to visualize the ovaries and around structures and to assess blood flow to the ovaries as well as looking for any abnormal cells growth mass, including cancer.

3. Ovarian biopsy
In ovarian biopsy, samples of ovaries are taken by a thin, tube-like instrument to examine under microscopy to review the stage of the cancer.

4. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. This test is helped to determine whether liver abnormality is a cyst or a tumor. Unfortunately, CT scan can only review the existence of cancer, but can not tell it is a primary or secondary cancer.

5. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the ovaries and surrounding areas.

6. Etc.

Grades

The Grades of ovarian cancer are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Ovarian cancer is classified as 5 stages
1. Stage 0,
If the cancerous cell have not penetrated in deeper tissue but in the surface of the ovarian lining.

2. Stage I

In stage I, The cancerous cells are no longer in the surface but have invaded into deep ovaries lining, but still completely inside the ovaries.

a. Stage IA1
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:
The spreading is < 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2: The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b. Stage IB:
The cancer in this stage have invaded the connective tissue, & less than 5cm (2 inch).
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:
Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (2 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the lung.

4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the lung.

5. Stage IV
In this stage, cancerous cells has spread to the tissues immediately outside of the ovaries, other distant parts of the body

Debulkability
Can all the tumor be removed surgically? Technically, it is sometime impossible but combining with chemotherapy or radiotherapy in many instants can lead to completely cure of the disease.

Prevention

A. How to prevent

1. Pregnancy
Early age at first pregnancy, older age of final pregnancy reduce the risk, while never pregnant women are at higher risk.

2. Combine oral contraceptive pill

The use of low dose hormonal contraception have shown reduced risk of ovarian cancer.

3. Breast feeding

Risk of ovarian cancer reduces with breast feeding.

4. Others
a. Prophylactic Oophorectomy
It is only considered in patients proven to carry the following inherited cancer syndromes. It is for you benefits to have a cancer risk assessed,especially if you are young and want to have children.

b. Tubal ligation

The risk is also lower in women who have had their uterine tubes blocked surgically

5. Etc.

B. With Diet
1. Soy
In laboratory studies, saponins have shown the ability to inhibit the reproduction of cancer cells and slow the growth of tumors in several different tissues.

2. Tomato
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.

3. Carrot
Carrot contains high amount of beta carotene which has shown to induce appotosis of cancer cells. In study of Cell Cycle Regulation and Induction of Apoptosis by β-carotene, researchers found that in vivo study warrants further confirmation that β-carotene acts as apoptosis agent in cancer cells particularly leukemia cells but not normal cells.

4. Brocolli and cabbage
In a study on mice , researchers found that compounds extracted from broccoli and cabbage could be a potent drug against melanoma. Also in tests on mice suggested these compounds, when combined with selenium, target tumors more safely and effectively than conventional therapy.

5. Green Tea
In a study of examination of the effects of green tea extracts, researcher found that halts growth of oral cancer cells and breaks down and kills existing oral cancer.

6. Red wine
A compound resveratrol found in red wine inhibits the abnormal cells of the skin. in the study from the Marshall University School of Medicine Researcher suggested that resveratrol causes apoptosis in human melanoma cells.
7. Etc.

C. With nutritional supplements
1. Antioxidants
Antioxidants such free radical scavengers vitamin A, C, E enhance the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth. For more information of how antioxidants help to treat cancer, click here

2. Phytochemicals
Phytochemicals are under active research for possible benefits immune system, and as anti-cancer agents. Flavonoids found abundant in berry, inhibit caner cell in vitro study.

3. Beta -carotene
In some laboratory, animal, and human studies, researchers found that vitamin A, certain retinoids may also inhibit cancer development.

4. Lycopene
Lycopene and 1,25-dihydroxyvitamin D3
In a study of Lycopene and 1,25-dihydroxyvitamin D3 cooperate in the inhibition of cell cycle progression and induction of differentiation in HL-60 leukemic cells, researchers found that The combination of low concentrations of lycopene with 1,25-dihydroxyvitamin D3 exhibited a synergistic effect on cell proliferation and differentiation and an additive effect on cell cycle progression. Such synergistic antiproliferative and differentiating effects of lycopene and other compounds found in the diet and in plasma may suggest the inclusion of the carotenoid in the diet as a cancer-preventive measure.

5. Indole-3-carbinol
Cabbage, a curciferous vegetables contains high amount of indole-3-carbinol, a chemical which boosts DNA repair in cells and appears to block the growth of cancer cells

6. Quercetin
Quercetin is a type of phytochemical, also known as a flavonoid. In cell culture or animal studies, researchers found that quercetin has activity against some types of cancer cells and suggested it may be potential benefits in treating cancer.

7. Etc.

Treatments
A. In conventional medicine
the aim of the treatment is to cure, because ovarian cancer risk of recurrence is very low but depending to the grade, stage and rebbulkability.
1. Surgery
a. In surgery, after determine the grade, stage and rebbulkability, the surgeon will try to remove as much as cancer infected area as possible.
b. Risks and side effects
Surgical and anesthesia risks

2. Chemotherapy
Chemotherapy is most use to treat with advance stage of cancer combined with radio therapy, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. Ovarian cancer is often respond well to chemotherapy. Drugs used to treat ovarian caner include platinum, taxol, cis-platinum, ondansectron, etc.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

3. Radio therapy
a. Radiation may be used for stages II, III, and IV to kill any cancer cells remaining in the body. By using high-energy x-rays or other types of radiation, radiation therapy kills the cancer cells and keep them from growing or regrowing.
c. Side effects
c.1. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.

4. Intra-peritoneal therapy
a. Intra-peritoneal therapy is a treatment of injecting drugs directly into the abdomen.
b. Risks and side effects
b.1. Infection,
b.2. Blockage
b.3. Leak
b.4. Catheter-related complications
b.5. Abdominal pain,
b.6. Etc.

5. Neooadjuvant chemotherapy
a. Neooadjuvant chemotherapy is a type of chemotherapy using drugs to reduce the size and shrink the tumor before surgery.
b. Risks and side effects during treatment
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

6. Etc.

B. Herbal medicine

1. Nettle
Nettle or stinging nettle, is a perennial plant growing in temperate and tropical wasteland areas around the world, genus Urtica, belonging to the family Urticaceae. In some studies, research found that nettle's anti-inflammatory actions are attributed to its ability to interrupt the production and actions of inflammation-producing immune cells in the body (cytokines, prostaglandins and leukotreines)

2. Fenugreek
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Vitro studies have shown that fenugreek exhibits chemopreventive properties against certain cancers.

3. Scutellaria
Scutellaria is also known as skullcaps, a genus of flowering plants, genus Scutellaria, belonging to family Lamiaceae. In a study of Inhibition of Cancer Cell Proliferation and Prostaglandin E₂ Synthesis by Scutellaria Baicalensis, researchers found that Scutellaria baicalensis selectively and effectively inhibits cancer cell growth in vitro and in vivo and can be an effective chemotherapeutic agent for HNSCC. Inhibition of PGE2 synthesis via suppression of COX-2 expression may be responsible for its anticancer activity.

4. Absinthe
Absinthe is also known as Wormwood, a distilled, highly alcoholic beverage flowers extracted from leaves of the herb Artemisia absinthium. In a study, researcher at the University of Washington found that wormwood can be used as a promising potential treatment for cancer among the ancient arts of Chinese folk medicine.

5. Turmeric
In a study conducted by S. Uddin and colleagues at the Department of Human Cancer Genomic Research at King Faisal Specialist Hospital and Research Center in Saudi Arabia, researchers found that Curcumin in turmeric may inhibit the proliferation of lymphoma cancer by modulating cell cycling and inducing apoptosis.

6. Etc.

C. Traditional Chinese medicine

1. Wu Ling Zhi
Wu Ling Zhi is also known as Trogopterus Dung. The sweet, warm and cold herb has been used in TCM to treat painful menses, pain due to absence of menses, postpartum infection and pain, angina, uterine bleeding, etc. as it moves blood, calms pain, clears blood accumulation and stops bleeding by enhancing the function of liver channels. A report from China Journal of Chinese Materia Medica 2006-07 showed that Radix ex Rhizoma Ginseng and Trogopterus Dung inhibit the proliferation and induce the apoptosis of tumor cell.

2. Rou Gui
Rou Qui is also known as Cinnamon Bark. The sweet, acrid and very warm herb has been used in TCM to treat cold limbs, cold limbs, diarrhea, muscle spasm, headache, back pain, sweating and impotent and promote urination as it tonifies fire, enhances yang, disperses cold and promotes circulation in the channels by enhancing the functions of heart, ling and gallbladder channels. In a study in 2005. researcher found that Chemical aspects of coumarin compounds in cinnamon for the prevention of hepatocellular carcinomas.

3. Qing hao
Qing hao is also known as wormwood. The bitter and cold herb has been used in TCM to
trea lupus, schistosomiasis, chronic bronchitis (essential oil) to elevate the calcium ions of leukemia white cells, etc. In a study, researcher at the University of Washington researcher found that wormwood can be used as a promising potential treatment for cancer among the ancient arts of Chinese folk medicine.

4. Gan Cao
Gan Cao is also known as Licorice root. The sweet and neutral herb has been used in TCM as an anticancer, anti-inflammatory, anti virus and bacteria, anti ulcer and anti convulsion agent and to get rid of toxins, promote secretion of insulin, protect liver from toxin, etc., as it tonifies the spleen, enhances qi, clears heat, expels phlegm and synergize other herbs by enhancing the functions of all 12 channels in the body. In-vitro, researchers found that Saponins stimulate the immune system and inhibit Epstein-Barr virus expression and possess anti-cancer activities.

5. Jiu Zi (Chinese leek)
In a study of A Pilot Study on Anticancer Activities of Chinese Leek researchers found that Chinese leek extract inhibited cancer cell growth and induced apoptosis in vitro. Oral administration of leek extract significantly reduced lung metastases in the present animal model.

8. Etc.

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