Ovarian cancer

The term cancer refers to ovarian cancers (malignant tumors) originating from the ovarian structure responsible for production of ova in women.
It happens more often after the eighth decade of life, being relatively rare at earlier ages.
Risk factors for its development include family history of prior disease, nulliparity (no previous pregnancies), early menarche, late menopause and old age. Patients are considered risk women carrying mutations in the genes BRCA1 and BRCA2, whose chance of developing cancer can reach over 50%, so it is recommended the removal of the ovaries and fallopian tubes when they are aged between 35 and 40 years.
In general cause nonspecific symptoms, which contributes to the delay in diagnosis, resulting in a worse prognosis.
Until very recently the only known risk factor was the number of ovulations, the higher, the higher the risk of ovarian cancer, it prompted one preventative measure: a decrease in the number of ovulations, with the use of birth control pills. But there is strong evidence that only tumors actually originate in the ovaries are germ cell tumors, epithelial tumors have mostly are tumors arising in other sites and deployed early in the ovaries.
Treatments
The doctor can describe treatment options and possible outcomes. Most women are subjected to surgery and chemotherapy. Radiotherapy is rarely used.
The cancer treatment may affect cancer cells in the pelvis, abdomen, or across the body;
Local treatment: surgery and radiation therapy are local treatments that remove or destroy ovarian cancer in the pelvis. When cancer affects other zones of the organism, the treatment site can be used to control the disease in these specific areas.
Intraperitoneal Chemotherapy: Chemotherapy may be administered directly into the abdomen and pelvis through a thin tube. The drugs destroy or control the cancer in the abdomen and pelvis.
Systemic chemotherapy: this treatment is referred to as systemic, since the drugs enter the bloodstream and may affect all cells.
You can learn how treatment alters their normal activities. Physician and patient together can develop a treatment plan tailored to the medical needs of the patient and personal.
Taking into account that the cancer treatments damage healthy cells and tissues is common side effects that arise depend mainly on the type and extent of treatment. Side effects may not be the same for all women and can vary between treatment sessions. Before starting treatment, the medical team will explain what the possible side effects and suggest useful ways of dealing with them.
You can talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.
Before starting treatment, you can ask the doctor some questions:
• What is the stage of evolution of my disease? The cancer has spread outside the ovaries? If so, where?
• What are my treatment options? We recommend intraperitoneal chemotherapy for my case? Why?
• Is it appropriate to participate in a clinical trial?
• I will require more than one type of treatment?
• What are the expected benefits to each type of treatment?
• What are the risks and possible side effects of the treatments? What you can do to control the side effects? These problems will disappear after treatment ends?
• What can I do to prepare for treatment?
• Will I need to stay in hospital? If so, for how long?
• What is the estimated cost of the treatment? My insurance will cover this treatment?
• How will the treatment affect my normal activities?
• The treatment will cause an early menopause?
• Will I be able to get pregnant and have children after treatment ends?
• How often should I conduct thorough medical examinations after treatment?
Surgery
During surgery is performed along a cut in the abdomen wall. This type of surgery is designated by laparotomy. If identified ovarian cancer, the surgeon removes:
• both ovaries and fallopian tubes (salpingo-oophorectomy);
• the uterus (hysterectomy);
• the omentum (a thin layer of fat which covers the bowels);
• nearby lymph nodes;
• tissue samples of the pelvis and abdomen to analysis.
If the cancer has spread, is removed as much as possible of the tumor, this procedure gives the name of surgery "cytoreductive".
If you have an early ovarian cancer in stage I, the extent of surgery may depend on whether they want to become pregnant and have children. Some women with ovarian cancer at a very early stage may decide, together with the doctor, removing only one ovary, a fallopian tube and omentum.
You may feel uncomfortable during the first few days after surgery. There are some medications to control pain. Before surgery, you should discuss the plan for pain relief with the doctor or nurse. If necessary, the doctor can adjust the plan after surgery.
Time to healing and recovery period varies from woman to woman. Will be hospitalized a few days in the hospital and can go up several weeks until able to resume normal activities.
If not yet reached menopause, surgery may cause him hot flashes, vaginal dryness and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk to your doctor or nurse about your symptoms so that you develop a treatment plan. There pharmaceuticals and lifestyle changes that may be useful; most symptoms disappears or decreases with time.
For the surgery, you may want to put some questions to the doctor:
• What kind of surgery I recommend? Will be removed lymph nodes and other tissues? Why?
• When will I know the results of the pathology? Who will explain them?
• How will I feel after surgery?
• If you have pain, how will they be controlled?
• How long will I be in hospital?
• I will have some long term effects caused by this operation?
• The surgery will affect my sex life?
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. After surgery, the majority of women undergoes chemotherapy for ovarian cancer, and some are undergoing chemotherapy before surgery.
It is usually administered more than one drug. Drugs for the treatment of ovarian cancer may be administered by different routes:
• By a vein (IV): drugs can be administered through a narrow tube inserted into a vein.
• By a vein and directly into the abdomen: some women undergo chemotherapy IV along with chemotherapy intraperitoneal (IP), IP chemotherapy drugs are administered through a narrow tube inserted into the abdomen.
• the mouth: some drugs for the treatment of ovarian cancer may be administered by oral route (by mouth).
Chemotherapy is administered in cycles of treatment, each treatment period followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
The treatment can be performed in a clinic, a doctor's office or at home. Some women may need to be hospitalized during the treatment.
The side effects of chemotherapy depend mainly on the drugs used and the amount administered. The drug may damage normal cells that divide rapidly:
• blood cells from blood: blood cells are cells which "fight" against infection, help the blood to clot, and carry oxygen to all parts of the body. When drugs affect blood cells, the patient is more likely to get infections, have bruise or bleed easily, and may also feel weak and tired. The medical team will assess whether the level of blood cells is low. If so, may suggest drugs which promote the production of new blood cells.
• Cells in hair roots: Some drugs can cause hair loss. The hair is reborn, but its color and texture may be slightly different.
• Cells that line the digestive tract: Some drugs can cause poor appetite, nausea and vomiting, diarrhea, or mouth sores and lips. Ask the medical staff councils to control these symptoms.
The drugs used in the treatment of ovarian cancer may also cause rashes, hard of hearing, loss of balance, arthropathies or swelling of the legs and feet, most of these side effects tend to disappear after the end of treatment.
Regarding chemotherapy may want to ask some questions to the doctor:
• When treatment begins? When does it end? How often do I have to do the treatments?
• What kind of drug / s vai me / will be administered / s?
• Because these drugs act?
• Recommends the chemotherapy IP (intraperitoneal) chemotherapy and IV for my case? Why?
• What are the expected benefits of treatment?
• What are the risks of treatment? What side effects will I have?
• Can I prevent or treat any of these side effects? How?
Radiotherapy
Radiotherapy, also called radiation therapy, uses high energy rays to kill cancer cells. This radiation is emitted by a large machine.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, although it can be use to alleviate pain and other problems caused by the disease. Treatment is administered in a hospital or clinic. Each session only takes a few minutes.
Side effects depend mainly on the radiation dose administered and the treated region. The radiation therapy to the abdomen and pelvis may cause nausea, vomiting, diarrhea or bloody stools. Moreover, the skin of treated area may become red, dry and sensitive. The doctor can treat or control the side effects. Generally, these effects disappear gradually after treatment is over.
Therapeutic targeting
Some of the most promising and exciting advances in treating cancer in the last decade are directed therapies. These therapies are developed with the aim of blocking the growth and spread of cancer by blocking specific molecular targets responsible for proliferation and tumor progression. Treatments are focused on specific cellular and molecular changes of various cancers, and therefore could enhance the effect of chemotherapy and less harming normal cells.
Therapies directed interfere with cell division and tumor dissemination in several ways:
• Interacting with molecules that are involved in the complex system of communication that governs the functions and cellular activities such as division, cell movement, external responses to specific stimuli and cell death. By blocking the signals that tell the tumor cells to grow and multiply in an uncontrolled way, therapies directed may halt the progression of cancer and to induce cell death (apoptosis).
• Other causes cell death inducing apoptosis directly or indirectly stimulating the immune system (defense) to recognize and destroy tumor cells or producing toxic substances directly against cancer cells.
Most treatments are directed, or small molecules or monoclonal antibodies. Small molecules are able to enter into the cells and act on targets located therein. Monoclonal antibodies do not penetrate through the membrane of cells and target molecules on cell surfaces (receivers) or outside the cell.
There are so many targeted therapies that interfere with several cellular processes. One can block certain enzymes and growth factors involved in proliferation of cancer cells. Other block blood vessel growth (angiogenesis). Cancer cells require a constant supply of blood through the blood vessels to provide oxygen and nutrients to ensure its survival. Treatments interfering with angiogenesis may prevent tumor growth by blocking the growth of blood vessels that supply oxygen and nutrients to tumor cells block the growth of cancer. In the treatment of ovarian cancer may be used a monoclonal anti-angiogenic which is used in combination with chemotherapy.
Prevention
There is no known way to prevent ovarian cancer. But these things can reduce the likelihood of developing ovarian cancer:
• Having used birth control pills for more than five years.
• Having had a tubal ligation (getting your tubes tied), both ovaries removed, or hysterectomy (operation in which the uterus and sometimes the cervix, is removed).
• Have given birth.