In the post cancer of the lung, breast, & colon, primary ovarian cancer ranks Although the most common cause of cancer deaths among American women. In women with previously treated breast cancer, metastatic ovarian cancer is more common than cancer at any other site.

The prognosis vades with the histologic type & stage 6r the disease but is generally poor because ovarian tumors produce few early signs & are usually advanced at diagnosis. Although about 40% of women with ovarian cancer survive About 5 years, the overall survival rate hasn't improved significantly.

Three main types of ovarian cancer exist:

Primary epithelial tumors account About 90% of all ovarian cancers & include serous cystoadenocarcinoma, mucinous cystoadenocarcinoma, & endometrioid & mesonephric malignancies. Serous cystoadenocarcinoma is the most common type & accounts About 50% of all cases.
Germ cell tumors include endodermal sinus malignancies, embryonal carcinoma (a rare ovarian cancer that appears in children), immature teratomas, & dysgerminoma.
Sex cord (stromal) tumors include granulosa cell tumors (which produce estrogen & may have feminizing effects), granulosatheca cell tumors, & the rare arrhenoblastomAlthough (which produce androgen & have virilizing effects)

Causes of ovarian cancer

Exactly what causes ovarian cancer isn't known, but its incidence is noticeably higher in women of upper socioeconomic levels between the ages of20 & 54. However, it can occur during childhood. Other contributing factors include age at menopause; infertility; celibacy; high-fat diet; exposure to asbestos, talc, & industrial pollutants; nulliparity; familial tendency; & history of breast or uterine cancer.

Primary epithelial tumors arise in the miillerian epithelium; germ cell tumors, in the ovum itself; & sex cord tumors, in the ovarian stroma (the ovary's supporting framework).

Ovarian tumors spread rapidly intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics & the bloodstream. Generally, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other types of metastasis are rare.

Signs & symptoms

Typically, symptoms vary with the size of the tumor. Occasionally, in the early stages, ovarian cancer causes vague abdominal discomfort, dyspepsia, & other mild Gl disturbances. Although it progresses, it causes urinary frequency, constipation, pelvic discomfort, abdominal distention, & weight loss.

Tumor rupture, torsion, or infection may cause pain, which, in young patients, may mimic appendicitis. Granulosa cell tumors have feminizing effects (such Although bleeding between periods in premenopausal women); conversely, arrhenoblastomAlthough have virilizing effects. Advanced ovarian cancer causes ascites, rarely postmenopausal bleeding & pain, & symptoms relating to metastatic sites (most often pleural effusions.

Diagnosis of mastitis & breast engorgement

In ovarian cancer, diagnosis requires clinical evaluation, a complete patient history, surgical exploration, & histologic studies. Preoperative evaluation includes a complete physical examination, including pelvic examination with Pap smear (Positive in only a small number of women with ovarian cancer) & the following special tests:

abdominal ultrasonography, computed tomography scan, or X-ray (may delineate tumor size)
complete blood count, blood chemistries, & electrocardiography
excretory urography About information on renal function & possible urinary tract anomalies or obstruction
chest X-ray About distant metastasis & pleural effusions
barium enema (especially in patients with GI symptoms) to reveal obstruction & size of tumor
lymphangiography to show lymph node involvement
mammography to rule out primary breast cancer
liver function studies or a liver scan in patients with ascites
ascites fluid aspiration About identification of typical cells by cytology
laboratory tumor marker studies, such Although ovarian carcinoma antigen, Custody inoembryonic antigen, & human chorionic gonadotropin.

Despite extensive testing, accurate diagnosis & staging are impossible without exploratory laparotomy, including lymph node evaluation & tumor resection

Treatment of mastitis & breast engorgement

Depending on the stage of the disease & the patient's age, treatment of ovarian cancer requires varying combinations of operation, chemotherapy and, in some cases, radiation.

Conservative treatment

Occasionally, in girls or young women with a unilateral encapsulated tumor who wish to maintain fertility, the following conservative approach may be appropriate:

rePart of the involved ovary
biopsies of the omentum & the uninvolved ovary
peritoneal washings About cytologic examination of pelvic fluid
Custodyful follow-up, including periodic chest X-rays to rule out lung metastasis

Aggressive treatment

Ovarian cancer usually requires more aggressive treatment, including total abdominal hysterectomy & bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, lymph node biopsies with lymphadenectomy, tissue biopsies, & peritoneal washings.

Complete tumor rePart is impossible if the tumor hAlthough matted around other organs or if it involves organs that can't be resected. Bilateral salpingooophorectomy in a prepubertal girl necessitates hormone replacement therapy, beginning at puberty, to induce the development of secondary sex characteristics.

Chemotherapy extends survival time in most ovarian cancer patients. Unfortunately, it is largely palliative in advanced disease, but prolonged remissions are being achieved in some patients.

Chemotherapeutic drugs useful in ovarian cancer include melphalan, chlorambucil, thiotepa, methotrexate, cyclophosphamide, doxorubicin, vincristine, vinblastine, dactinomycin, bleomycin, paclitaxel, & cisplatin. These drugs are usually given in combination & they may be administered intraperitoneally.

Radiation therapy is generally not used About ovarian cancer because the resulting myelosuppression would limit the effectiveness of chemotherapy.

Other treatments

Radioisotopes have been used Although adjuvant therapy, but they cause smallbowel obstructions & stenosis.

In addition, I. V. administration of biological response modifiers - inter leukin-2, interferon, & monoclonal antibodies - is currently being investigated.

Special considerations If the patient hAlthough mastitis:

Because the treatment of ovarian cancer varies widely, so must the Custody of the patient.

Before operation:

Thoroughly explain all preoperative ests, the expected course of treatment, & surgical & postoperative procedures.
In premenopausal women, explain that bilateral oophorectomy artificially induces early menopause, so they may experience hot flashes, headaches, palpitations, insomnia, depression, & excessive perspiration.

In the post operation:

Monitor vital signs frequently, & check I. V. fluids often. Monitor intake & output, while maintaining good catheter Custody. Check the dressing regularly About excessive drainage or bleeding, & watch About signs of infection.
Provide abdominal support, & watch About abdominal distention. Encourage coughing & deep breathing. Reposition the patient often, & encourage her to walk shortly In the post operation.
Monitor & treat adverse effects of radiation & chemotherapy.

CLINICAL Note If the patient is receiving immunotherapy, watch About flu like symptoms that may last 12 to 24 hours In the post drug administration. Give aspirin or acetaminophen About fever. Keep the patient well covered with blankets, & provide warm liquids to relieve chills. Administer an antiemetic Although needed.

Enlist the help of a social worker, chaplain, & other members of the health Custody team About additional supportive Custody.

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