Ovarian cancer, ovarian cancer causes,(Signs & Stages)
What is it
Women have two ovaries that are in the pelvis and communicate with the rest of the female reproductive system through the tubes . Its main function is reproduction and, subject to this, the production of female hormones. The ovaries have a coating formed by epithelial cells . From the malignant transformation of these cells arise the vast majority of ovarian cancers.
This type of tumor develops s bove all in the women between 50 and 70 years ; globally, about 1 in every 7 women develops this disease. It is the third most frequent type of cancer of the female reproductive system but, on the other hand, more women die of ovarian cancer than of any other that affects the reproductive system.
To date, it is unknown how and why ovarian cancer appears . However, several hormonal and reproductive factors are known that may favor their appearance as infertility or a small number of pregnancies . The genetic factors are decisive only 10-15 percent of cases. In these cases , breast and ovarian cancer are associated in the same family or, even, in the same person. Also, it is suspected that some environmental factors such as dietary fat, the use of talcum powder or some virus infections, may have some importance in the onset of this disease.
It is estimated that 1.5 percent of women are diagnosed with this disease throughout their lives. Although ovarian cancer can occur in youth, the vast majority of cases occur after menopause . The elderly is thus another risk factor, as are the obesity and smoking .
It is a disease that usually produces few symptoms , and can reach an advanced stage before causing them. However, there are a number of warning signs that allow an early detection of ovarian cancer and, therefore, a better prognosis. The first symptom may be a slight discomfort in the lower abdomen, similar to indigestion; Uterine hemorrhage is not frequent. The fact that a postmenopausal patient has larger ovaries may be an early sign of cancer, although their growth may also be due to cysts, non-cancerous masses and other disorders. Also, fluid may appear in the abdomenand this can swell, due to it or to the increase in size of the ovary. In this phase, the woman may have pelvic pain , anemia and weight loss . In some exceptional cases, ovarian cancer secretes hormones that produce excessive growth of the uterine lining , an increase in the size of the breasts or a greater development of the hair . Other symptoms may be lack of appetite , early satiety or fatigue .
Ovarian cancer is less common in the women who have had multiple pregnancies . It is also less common among women who have taken oral anovulatory (contraceptives) for years . However, no study has shown that this lower probability of ovarian cancer in women who have taken contraceptives is compensated by other side effects such as increased incidence of cardiovascular diseases and, possibly, other tumors. That is why its preventive use is not justifiedin the general population. A special case is women at very high risk, such as those with a hereditary syndrome of breast and ovarian cancer (BRCA), in which the protective role of anovulators is being studied and even, the patient can be proposed to remove of both ovaries from the age of 35 if you have already fulfilled your desires of descent.
The recent disclosure of prophylactic surgery to which the actress and film director Angelina Jolie submittedTo remove the ovaries and fallopian tubes due to their high genetic predisposition to ovarian and breast cancer has shown the importance of knowing the family history in the prevention of these tumors. According to the data that the organization World Ovarian Cancer Day (World Ovarian Cancer Day) manages, between 15 and 20 percent of the cases of ovarian cancer that are registered in the world have a genetic factor. This means that having a relative by blood (mother, sister, grandmother, aunt, etc.) who has had ovarian cancer at any age or breast cancer before 50 is an alert to maximize the controls that allow early detection.
The diagnosis of
ovarian cancer in its early stages is difficult to establish , because symptoms usually do not appear until the cancer has spread and because many other less serious diseases have similar symptoms. Often, the symptoms of ovarian cancer are confused with gastrointestinal problems.
The diagnosis is usually suspected when a pelvic mass is detected in a routine gynecological examination. The ultrasound , the tomography (CT), the MRI and blood test called CA-125 make firmer this suspicion that will be confirmed in the operation.
The factor that most determines the chances of success in the treatment of ovarian cancer is a surgery that completely eliminates the tumor . In most cases , the uterus and both ovaries are completely removed, regional nodes are removed or biopsied, and cytology and biopsies are taken from the entire interior of the abdomen. In young women with very early tumors and who want to have children can sometimes opt for conservative surgery that preserves fertility . Chemotherapy is always given after the operation, except in cases of non-aggressive tumors and in very early stages.
Ovarian cancer in its early stages is highly curable . In its intermediate and advanced phases the prognosis is worse, although it has improved a lot in recent years; thus, if in the 1980s the survival rate of patients with advanced ovarian cancer did not reach 20 months, it is now 45 months. In any case, it is still the gynecological tumor that causes the most deaths. According to figures from the World Ovarian Cancer Day (WOCD) organization, almost a quarter of a million women worldwide are diagnosed with ovarian cancer each year, of which 140,000 die. In addition to the advances that occur in the treatment, the decrease in deaths from this disease could come from prevention and early diagnosis.
In the absence of effective forms of prevention or early detection, therapeutic innovation plays a fundamental role in the prognosis of the disease. The latest advances in this field, such as cytoreductive surgery, intraperitoneal chemotherapy and therapies with biological agents, allow ovarian cancer to be controlled for a longer time.
Complete debulking surgery
This intervention is applied in those cases in which the tumor has spread widely through the abdomen . It consists of surgically removing as much tumor as possible, in order to reduce the tumor of the patient to a microscopic size (less than 1 centimeter).
If a patient has undergone cytoreduction surgery, this type of chemotherapy is more effective since the tumor is much more sensitive to treatment.
The incorporation of biological agents such as angiogenic therapies , and specifically bevacizumab , to the treatment of ovarian cancer contributes to the improvement of the control and prognosis of patients; as well as PARP inhibitors (pharmacological inhibitors of the poly ADP ribose polymerase enzyme), effective both when a relapse occurs and in patients who have a BRC gene mutation (according to research, this mutation is present in most patients). hereditary ovarian tumors). In the latter group of patients, which represents 20 percent of the total, it has been shown that inhibitors of PARP prevent the tumor from developing.
90 percent of women with ovarian cancer survive more than five years if the diagnosis is made early, something that currently only happens in 20 percent of cases.
The survival rate of patients has tripled today compared to the 80s, when the average did not reach 20 months.
Only in Spain a total of 3,200 new cases of ovarian cancer are registered per year , most of them in advanced stages, mainly due to the absence of specific symptoms in the initial phase of the disease and the lack of effective early detection methods. .
Between 15 and 20 percent of cases of ovarian cancer diagnosed in the world have a family history , according to the World Ovarian Cancer Day (World Ovarian Cancer Day) organization.
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