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Ovarian cancer

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Ovarian cancer (human)


Classification and external resources

Micrograph of a low malignant potential mucinous ovarian tumour. H&E stain. C56 ICD-10 183, 220 ICD-9 varied ICD-O: 9418 DiseasesDB 000889 MedlinePlus med/1698 eMedicine D010051 MeSH Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses.[1] Most (more than 90%) ovarian cancers are classified as "epithelial" and are believed to arise from the surface (epithelium) of the ovary. However, some evidence suggests that the fallopian tube could also be the source of some ovarian cancers.[2] Since the ovaries and tubes are closely related to each other, it is thought that these fallopian cancer cells can mimic ovarian cancer.[3] Other types may arise from the egg cells (germ cell tumor) or supporting cells. Ovarian cancers are included in the category gynecologic cancer.

Contents

1 Signs and symptoms 2 Cause o 2.1 Hormones o 2.2 Genetics

2.3 Other 2.4 Risk factors 3 Pathophysiology 4 Diagnosis o 4.1 Classification o 4.2 Staging 5 Prevention o 5.1 Screening 6 Management o 6.1 Surgery o 6.2 Chemotherapy 6.2.1 Intraperitoneal chemotherapy o 6.3 Radiation therapy 7 Prognosis o 7.1 Complications 8 Epidemiology 9 Society and culture 10 Other animals 11 Research o 11.1 New screening methods 12 References 13 Further reading 14 External links

o o

Signs and symptoms


Signs and symptoms of ovarian cancer are frequently absent early on and when they exist they may be subtle.[4] In most cases, the symptoms persist for several months before being recognized and diagnosed. Most typical symptoms include: bloating, abdominal or pelvic pain, difficulty eating, and possibly urinary symptoms.[5] If these symptoms recently started and occur more than 12 times per month the diagnosis should be considered.[5] Other findings include an abdominal mass, back pain, constipation, tiredness and a range of other non-specific symptoms, as well as more specific symptoms such as abnormal vaginal bleeding or involuntary weight loss.[6] There can be a build-up of fluid (ascites) in the abdominal cavity. Ovarian cancer is associated with age, family history of ovarian cancer (9.8-fold higher risk), anaemia (2.3-fold higher), abdominal pain (sevenfold higher), abdominal distension (23-fold higher), rectal bleeding (twofold higher), postmenopausal bleeding (6.6-fold higher), appetite loss (5.2-fold higher), and weight loss (twofold higher).[7]

Cause

In most cases, the exact cause of ovarian cancer remains unknown. The risk of developing ovarian cancer appears to be affected by several factors:[8]

Older women who have never given birth, and those who have a first or second degree relative with the disease, have an increased risk. Hereditary forms of ovarian cancer can be caused by mutations in specific genes (most notably BRCA1 and BRCA2, but also in genes for hereditary nonpolyposis colorectal cancer). Infertile women and those with a condition called endometriosis,[9][10] and those who use postmenopausal estrogen replacement therapy are at increased risk.

Hormones
Combined oral contraceptive pills are a protective factor.[11][12] Early age at first pregnancy, older age of final pregnancy and the use of low dose hormonal contraception have also been shown to have a protective effect.[citation needed] The risk is also lower in women who have had their fallopian tubes blocked surgically (tubal ligation).[11][12] Tentative evidence suggests that breastfeeding lowers the risk of developing ovarian cancer.[13] The relationship between use of oral contraceptives and ovarian cancer was shown in a summary of results of 45 case-control and prospective studies. Cumulatively these studies show a protective effect for ovarian cancers. Women who used oral contraceptives for 10 years had about a 60% reduction in risk of ovarian cancer. (risk ratio .42 with statistical significant confidence intervals given the large study size, not unexpected). This means that if 250 women took oral contraceptives for 10 years, 1 ovarian cancer would be prevented. This is by far the largest epidemiological study to date on this subject (45 studies, over 20,000 women with ovarian cancer and about 80,000 controls).[14] The ovaries contain eggs and secrete the hormones that control the reproductive cycle. Removing the ovaries and the fallopian tubes greatly reduces the amount of the hormones estrogen and progesterone circulating in the body. This can halt or slow breast and ovarian cancers that need these hormones to grow.[15] The link to the use of fertility medication, such as Clomiphene citrate, has been controversial. An analysis in 1991 raised the possibility that use of drugs may increase the risk of ovarian cancer. Several cohort studies and case-control studies have been conducted since then without demonstrating conclusive evidence for such a link.[16] It will remain a complex topic to study as the infertile population differs in parity from the "normal" population.

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