The following summarizes selected women's health-related blog entries.
~ "Looking for Common Ground on Abortion? You're Standing On It," Jodi Jacobson, RH Reality Check: "Getting beyond the political deadlock on abortion is important if for no other reason than that the political obstacles result in the denial to women of essential services," Jacobson writes in a blog post on the growing political dialogue over finding "common ground" in the abortion debate. However, she adds, "the current public discourse on 'abortion reduction' is vague, distracts us from sound policy approaches and suggests a worrisome practice of stigmatizing women who do choose abortion or trying to 'convince' them to choose otherwise." She says that "common ground" on abortion is "right under our feet, and points toward well-proven policies and interventions aimed at keeping abortion 'safe and legal'" and reducing unintended pregnancies. She goes on to explain how this approach is "different than 'abortion reduction,'" noting that abortion already has been on the decline among most groups for "some time." Jacobson continues that low-income women are the only group in which the abortion rate increased in recent years, adding that these women "rely heavily on publicly funded contraceptive services." She writes that "instead of focusing first on access to contraceptives and health services, and the contributions of poverty and violence as core determinants in the number of unintended pregnancies among women in the U.S. or even on the conditions that affect women's ability to access and use these methods, some prominent columnists have focused on 'the morality of the left' and the morality of individual behavior and choices." She also notes that "the media often portray women as irresponsible, both directly and indirectly," citing a February New York Times opinion piece by Slate commentator William Saletan. Using the abortion-reduction strategy "as the framework puts us right back in the place of stigmatizing abortion, instead of creating the conditions in which fewer unintended pregnancies occur in the first place," Jacobson writes. She continues that "common ground" on abortion is "right in front of us." Jacobson closes with a list of recommendations for the Obama administration and Congress. According to Jacobson, by "taking these steps while also increasing individual and family wellbeing, we will dramatically reduce unintended pregnancies and by extension abortions, and achieve all the gains we seek while protecting women's rights." She concludes that the rate of abortions "will continue to decline if we focus on securing women's rights, closing the gap in access to services, providing universal sexual and reproductive health education based on evidence, engaging women and men as moral actors in their choices, and removing the social and political barriers to essential services. That's not only common ground, it's solid ground and proven ground" (Jacobson, RH Reality Check, 3/18).
~ "Beyond Stem Cells and Global Warming: Media Ignore Bush Administration's Widespread Interference with Science," John Delicath, Huffington Post blogs: "During coverage of President Barack Obama's executive order on stem cell research and his presidential memorandum on scientific integrity," the media provided "only a cursory account" of former President George W. Bush's "interference with science, adopting a common refrain that critics have accused the Bush administration of putting politics before science on issues such as stem cells and global warming," according to Delicath, director of the Media Matters Action Network. Delicath writes, "[I]t is vital that the media help the public appreciate the significance of political interference in science," because "political interference with science in the policy-making process threatens our health, our environment, our prospects for economic renewal and our standing in the world." He continues, "Bush's history on this front cannot be forgotten, nor can we afford for it to be repeated," adding that the Union of Concerned Scientists has "spent years researching and documenting the political assault on science during the Bush presidency." Delicath notes the organization released reports and surveys that documented "specific instances in which Bush officials ignored, manipulated, distorted or suppressed scientific evidence" on several issues, including sex education and contraception. He writes that "many media outlets hailed Obama's break with Bush on stem cells but saw fit to simply ignore the history of the widespread abuse of science under Bush" and provided coverage of "Obama's executive order on stem cells without even mentioning his memorandum on scientific integrity." Delicath goes on to recap the coverage of Obama's executive order by several newspapers, including the Washington Post, New York Times, Los Angeles Times and others. He writes that "the problem" with newspaper coverage that "made passing reference to the use of science under Bush, of course, is that [the newspapers] failed to note that political interference was widespread and systematic and offered little sense of the breadth and scope of the problem." The papers also "failed to inform their readers that the charges of political interference with science under Bush are well-substantiated with credible evidence from a range of sources," Delicath says. He concludes, "If the media fail to take seriously political interference in science, and if columnists and pundits ignore the issue in the nation's largest opinion-making forums ... the issue will disappear from the public radar, and the public will not be engaged in ways that can help ensure scientists are afforded the opportunity to pursue research and speak openly and honestly about their work" (Delicath, Huffington Post blogs, 3/18).
~ "Do We Need a White House Council on Women and Girls? Yes, Dear, We Do," Rose O'Malley, Womenstake blogs: In a March 18 opinion piece published in the Washington Post -- which discusses the recently created White House Council on Women and Girls -- columnist Kathleen Parker "expresses her desire for more attention to be paid to the challenges facing men and boys, assumes that women have achieved total educational equality with men, and then, just for fun, denies that the wage gap exists in any meaningful way other than as an expression of women's childrearing choices," O'Malley writes in a blog entry. She continues that Parker is "correct when she states that women outnumber men in college and that women now make up half of law and medical school graduates." However, "this doesn't mean that women have it made, or that they have achieved educational parity with their peers," although women and men graduate from medical school at the same rate, male surgeons earn 40% more than their female counterparts. O'Malley says that contrary to the reasoning that the wage gap is "nothing more than women's choices," several studies have demonstrated that "the wage gap does still exist, including a Government Accountability Office study concluding that at least 20% of the wage gap was a result of discrimination. According to O'Malley, Parker's column "simply ignores" certain facts, including that "one in eight women is living in poverty, with single mothers, women of color and elderly women among the most vulnerable, or that women are now losing their jobs at faster rates than men and are less likely to qualify for unemployment, or that the individual health insurance market fails women on several levels." She continues, "These facts can't be pithily dismissed, so she simply does not bring them up." O'Malley asks, "How about we just all agree that addressing the challenges that women and girls face does not in any way diminish the challenges that men and boys confront?" She continues, "Social reform is not some sort of battle of the sexes where helping one 'side' hurts the other." According to O'Malley, the White House council "is just recognizing and responding to the many things that women have to deal with that men do not, like being a pregnant student or making less money for the same work, as well as recognizing that women have for too long been locked out of the highest echelons of the workplace where policies are made." She concludes, "And I, for one, applaud it" (O'Malley, Womenstake blogs, 3/18).
~ "Making the Link Between Dating Violence and Women's Reproductive Health," Kiersten Stewart, The Hill's Congress Blog: Recent reports about singer Rhianna's abuse by her boyfriend has "put the issue of dating violence front and center before the nation's teens," Stewart writes. However, she continues, the relationship between dating abuse and reproductive health is "one aspect of the issue that's largely absent from the conversation." Stewart writes that recent studies have shown "relationship or dating abuse can have reproductive health consequences, including unplanned pregnancy and exposure to sexually transmitted infections and HIV/AIDS transmission," all of which primarily affect young women. According to the Harvard School of Public Health, female domestic violence survivors are "four to six times more likely than non-abused girls to become pregnant," Stewart writes. In addition, one out of three adolescents tested for STIs and HIV "have experienced domestic violence," according to Stewart. She continues by describing the case of a young woman who contracted STIs and became pregnant while in an abusive relationship with a man who had multiple sexual partners. According to Stewart, this case "belies the old stereotype that attributes unplanned pregnancies and STIs to promiscuity or irresponsible behavior." She continues that "any serious attempt to reduce unplanned pregnancy and STI rates must help prevent" relationship and dating abuse. According to Stewart, the 2005 Violence Against Women Act "contained groundbreaking new initiatives including programs to train health care providers to assess patients for domestic violence and intervene to help those who are victims of abuse, encourage men to teach the next generation that violence is wrong and provide crisis services" for rape and sexual assault survivors. However, "Congress has not yet funded many of the new prevention programs," which "needs to change," the blog entry says. It continues that President Obama created the White House Council on Women and Girls with a mandate "to help prevent violence against women." The blog entry concludes that the council "won't succeed unless Congress funds these new VAWA health programs, and we all begin to recognize the link between violence and women's reproductive health" (Stewart, The Hill's Congress Blog, 3/19).
~ "When 'Choosing Life' Just Isn't Enough," Choice USA's Choice Words: The unintended pregnancy of Alaska Gov. Sarah Palin's (R) 18-year-old daughter Bristol, who gave birth in December 2008, "significantly reshaped the way Republicans were inclined to respond to teen pregnancy," a Choice USA blog entry says. It adds, "What was once a reprehensible situation became something to be praised," until news that Bristol Palin will not marry Levi Johnston, the teenage father of her child, "tossed a wrench into the gears of this perfect family values fairytale." According to the blog entry, Bristol Palin's "decision to break off the engagement adds one more challenge to her mother's brand of social conservatism" and also "sends a notably strong message to young women who may find themselves in a similar situation: Single motherhood is not only possible, but OK." The blog entry continues by describing "crisis pregnancy centers," some of which encourage unmarried pregnant women to give up their infants for adoption rather than raise their children as a single parent. According to the blog entry, the "'abortion reduction' agenda" of crisis pregnancy centers and conservatives who support these views are "a mere front for complete reproductive control." It continues, "Single motherhood is, to them, grounds for a woman to put her baby up for adoption." In addition, crisis pregnancy centers "preach that any household that doesn't fit this romanticized idea of the 'sanctity of heterosexual marriage' is unfit for children, no matter how abusive one partner may be or how little they may love one another," the blog entry says. It continues that such centers would "rather see a woman carry a fetus to term, give birth, then just let the baby go and forget it all happened, which is of course, impossible." The blog entry concludes, "I'm not sure I can take any more paternalistic 'should'ves' and 'could'ves' from these people" (Choice USA's Choice Words, 3/17).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
четверг, 29 сентября 2011 г.
четверг, 22 сентября 2011 г.
Arizona, Nevada, Rhode Island Take Actions On HPV Vaccine, Stillborn Birth Certificate-Related Legislation
The following highlights recent state actions on legislation related to human papillomavirus vaccines and birth certificates for stillborn infants.
Arizona: The Senate last week approved a budget bill that includes language that would prohibit the state from requiring HPV vaccines for middle-school age girls, the Arizona Republic reports. According to the Republic, supporters of the language have said that they do not trust state health officials to make the right decision about whether to mandate HPV vaccination and that the vaccine could cause girls to become promiscuous. State health officials have said that the language is unnecessary and that they are not considering mandating the vaccine. Health officials added that they would like the option to consider mandating the vaccine in the future and that the Senate is setting a potentially harmful precedent in approving such language. Sen. Amanda Aguirre (D) unsuccessfully attempted to remove the language from the bill. According to the Republic, the Senate and House still must agree on the budget proposal before it moves to Gov. Janet Napolitano (D), who has said she will sign the Senate measure. According to Jody Hatz of the National Conference of State Legislatures, no other state has attempted to prohibit mandating the vaccine (Crawford, Arizona Republic, 5/17).
Nevada: The Assembly Commerce and Labor Committee last week approved a bill (SB 409) that would require most insurance companies in the state to cover HPV vaccines for girls and women ages nine to 26, the Las Vegas Review-Journal reports. The measure was approved after Assembly Speaker Barbara Buckley (D) made a motion to combine it with a separate bill (SB 113) that mandates coverage for prostate screenings, according to the Review-Journal. The combined legislation restores a provision, which had been removed in the Senate after objections from local governments, that would require self-funded health plans to cover the vaccine. According to the Review-Journal, the prostate-screening bill already included a mandate that self-funded plans cover screening, and some lawmakers questioned why such plans would not also be required to cover HPV vaccination. The bill now moves to the full Assembly. Funding for HPV vaccines has been included in budgets for the state's Medicaid and SCHIP programs, the Review-Journal reports (Whaley, Las Vegas Review-Journal, 5/17).
Rhode Island: The Senate last week unanimously approved a bill (SB 174) that would allow the parents of stillborn infants at 20 weeks' gestation or more to request birth certificates, the Providence Journal reports. The House earlier this month approved the measure. According to the Journal, there were 85 stillborn infants in the state in 2005. The measure, which was sponsored by Sen. Walter Felag (D), was supported by the MISS Foundation, an organization that has worked with legislators and families in more than 12 states to pass similar legislation, according to the National Conference of State Legislatures. The foundation worked with a Rhode Island family whose infant was stillborn to gain lawmakers' support. The measure now goes to Gov. Donald Carcieri (R) for consideration, the Journal reports (Gudrais/Peoples, Providence Journal, 5/16).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Arizona: The Senate last week approved a budget bill that includes language that would prohibit the state from requiring HPV vaccines for middle-school age girls, the Arizona Republic reports. According to the Republic, supporters of the language have said that they do not trust state health officials to make the right decision about whether to mandate HPV vaccination and that the vaccine could cause girls to become promiscuous. State health officials have said that the language is unnecessary and that they are not considering mandating the vaccine. Health officials added that they would like the option to consider mandating the vaccine in the future and that the Senate is setting a potentially harmful precedent in approving such language. Sen. Amanda Aguirre (D) unsuccessfully attempted to remove the language from the bill. According to the Republic, the Senate and House still must agree on the budget proposal before it moves to Gov. Janet Napolitano (D), who has said she will sign the Senate measure. According to Jody Hatz of the National Conference of State Legislatures, no other state has attempted to prohibit mandating the vaccine (Crawford, Arizona Republic, 5/17).
Nevada: The Assembly Commerce and Labor Committee last week approved a bill (SB 409) that would require most insurance companies in the state to cover HPV vaccines for girls and women ages nine to 26, the Las Vegas Review-Journal reports. The measure was approved after Assembly Speaker Barbara Buckley (D) made a motion to combine it with a separate bill (SB 113) that mandates coverage for prostate screenings, according to the Review-Journal. The combined legislation restores a provision, which had been removed in the Senate after objections from local governments, that would require self-funded health plans to cover the vaccine. According to the Review-Journal, the prostate-screening bill already included a mandate that self-funded plans cover screening, and some lawmakers questioned why such plans would not also be required to cover HPV vaccination. The bill now moves to the full Assembly. Funding for HPV vaccines has been included in budgets for the state's Medicaid and SCHIP programs, the Review-Journal reports (Whaley, Las Vegas Review-Journal, 5/17).
Rhode Island: The Senate last week unanimously approved a bill (SB 174) that would allow the parents of stillborn infants at 20 weeks' gestation or more to request birth certificates, the Providence Journal reports. The House earlier this month approved the measure. According to the Journal, there were 85 stillborn infants in the state in 2005. The measure, which was sponsored by Sen. Walter Felag (D), was supported by the MISS Foundation, an organization that has worked with legislators and families in more than 12 states to pass similar legislation, according to the National Conference of State Legislatures. The foundation worked with a Rhode Island family whose infant was stillborn to gain lawmakers' support. The measure now goes to Gov. Donald Carcieri (R) for consideration, the Journal reports (Gudrais/Peoples, Providence Journal, 5/16).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 15 сентября 2011 г.
What Is Ovarian Cancer? What Causes Ovarian Cancer?
Ovarian cancer is any cancerous growth that may occur in different parts of the ovary. The majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. According to the American Cancer Society it is the 8th most common cancer among women in the USA (excluding non-melanoma skin cancers). In the UK ovarian cancer is the fifth most common cancer among females, after breast cancer, bowel cancer, lung cancer and uterine cancer (cancer of the uterus).
Approximately 5,500 women in the UK and 21,000 women in the USA are diagnosed with ovarian cancer each year. Worldwide, around 140,000 women die of ovarian cancer every year.
Tragically, the overall five year survival rate is only 46 per cent in most developed countries (it is lower for more advanced stages). However, according to the National Cancer Institute, if diagnosis is made early, before the tumor has spread, the five year survival rate is nearer 93 per cent. In 2009 scientists in the US said that current tests for diagnosing ovarian cancer are not good enough .
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Even modern screening tests for ovarian cancer, which include a blood test for the CA 125 marker, combined with ultrasound, often result in unnecessary surgery and "..are failing to catch early signs of the disease..", a study at the University of Alabama at Birmingham Comprehensive Cancer Center revealed.
What are the ovaries?
The ovary is the female gonad, while the testis is the male gonad. A gonad is a reproductive gland that produces germ cells (gametes). A male sperm is a gamete, and a female egg is also a gamete. Each human gamete has 23 chromosomes, half the number of chromosomes contained in most types of human body cells.
The ovary, also known as the egg sac, is one of a pair of reproductive glands in women. The ovaries are located at either side of the uterus (womb), in the pelvis. Each ovary is about the size and shape of an almond. The ovaries produce ova (eggs) and female hormones, such as estrogen and progesterone. These hormones regulate the menstrual cycle, pregnancy, and control the development of female characteristics, such as body shape, body hair, breasts, etc.
During the female menstrual cycle, which lasts about one month, one egg is released from one of the two ovaries - the egg travels through the fallopian tube and into the uterus. This is known as ovulation.
Cancer of the ovary can spread to other parts of the reproductive system as well as surrounding areas, such as the stomach, vagina and uterus. Ovarian cancer more commonly occurs in women aged 65 or over, but can affect women of any age.
What is cancer?
Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer that occur in various parts of the body - each is classified by the type of cell that is initially affected.
Usually our cells divide (multiply, form new ones) only when old and dying ones need to be replaced. However, the controls that regulate when a cell divides as well as when a cell should die sometimes become faulty. This may result in cells not dying when they should, while additional cells are still being added - an uncontrolled accumulation of cells. Eventually a mass of cells is formed - a tumor.
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Malignant and benign tumors
Tumors that stay in one place and demonstrate limited growth are usually considered to be benign. Malignant, or more dangerous tumors emerge when two things occur:
Invasion - the cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue - this process is called invasion.
Angiogenesis - the cancerous cells manage to divide and grow, making new blood vessels to feed themselves.
Metastasis
When a tumor manages to spread to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is extremely hard to treat.
Three main types of ovarian cancers (tumors)
Epithelial ovarian cancer is by far the most common form of ovarian cancer. Germ cell and stromal ovarian cancers are much less common. Ovarian cancer can also result from a cancer somewhere else in the body that has spread:
Epithelial ovarian cancer (epithelial ovarian tumors) - derived from cells on the surface of the ovary. It occurs mainly in adults.
Germ cell ovarian cancer (germ cell ovarian tumors) - derived from the egg-producing cells within the body of the ovary. This rare type of cancer more commonly affects children and teenage girls.
Stromal ovarian cancer (sex cord stromal tumors) - develops within the cells that hold the ovaries together.
Cancers from other organs in the body can spread to the ovaries - metastatic cancers - a metastatic cancer is one that spreads from where it first arose as a primary tumor to other locations in the body.
What are the symptoms of ovarian cancer?
In the early stages, ovarian cancer usually has vague symptoms which are not easy to recognize. In fact, doctors used to think that ovarian cancer had no symptoms (unfortunately, many still do). Even though healthcare professionals are much better at identifying ovarian cancer symptoms these days, patients often attribute their symptoms to other conditions, such as pre-menstrual syndrome, irritable bowel syndrome, or a temporary bladder problem.
The main difference between ovarian cancer and other possible disorders is the persistence and gradual worsening of symptoms. While most digestive disorders have fluctuating symptoms, those of ovarian cancer are more constant and steadily advancing.
The following are examples of possible early symptoms of ovarian cancer:
Pain in the pelvis
Pain on the lower side of the body
Pain in the lower stomach
Back pain
Indigestion or heartburn
Feeling full rapidly when eating
More frequent and urgent urination
Pain during sexual intercourse
Changes in bowel habits, such as constipation
As ovarian cancer progresses these symptoms are also possible:
Nausea
Weight loss
Breathlessness
Fatigue (tiredness)
Loss of appetite
Ovarian cancer is not a silent killer. A study by the National Breast and Ovarian Cancer Centre, Australia, found that 83% of women experience at least one symptom of ovarian cancer in the year prior to their diagnosis. The researchers also found that 17% of women waited more than three months after the onset of their symptoms before visiting their doctor, with 8% waiting more than six months. The most common symptoms, experienced by half of the study participants, were abdominal symptoms such as fullness and pain. Bloating, bowel or urinary symptoms were reported by approximately one third of participants.
If you experience bloating, pressure or pain in the abdomen or pelvis that persists for more than a few weeks you should see your doctor immediately. If you have already been to the doctor and ovarian cancer was not diagnosed, but treatment is not relieving symptoms, either see your doctor again or get a second opinion. It is important that the evaluation includes a pelvic examination.
People with close family members who have/had ovarian or breast cancer should see a doctor who is trained to detect ovarian cancer.
What are the causes of ovarian cancer?
Although we know that ovarian cancer, like many other cancers, is caused by cells dividing and multiplying in an unordered way, nobody completely understands why cancer of the ovary occurs. We know that the following risk factors are linked to a higher chance of developing the disease:
Family history
Most women who develop ovarian cancer do not have an inherited gene mutation. Women with close relatives who have/had ovarian cancer, as well as breast cancer, have a higher risk of developing ovarian cancer compared to other women. There are two genes - BRCA1 and BRCA2 - which significantly raise the risk. The BRCA1 and BRCA2 genes also raise the risk of breast cancer. Those genes are inherited. The BRCA1 gene is estimated to increase ovarian cancer risk by 35% to 70%, and the BRCA2 by 10% to 30%. People of Ashkenazi Jewish descent are at particularly high risk of carrying these types of gene mutations.
Women with close relatives who have/had colon cancer, prostate cancer or uterine cancer are also at higher risk of ovarian cancer.
Genetic screening can determine whether somebody carries the BRCA1 and/or BRCA2 genes. Although a test for gene mutations known to significantly increase the risk of hereditary breast or ovarian cancer has been available for more than a decade, a study by researchers from Massachusetts General Hospital found that few women with family histories of these cancers are even discussing genetic testing with their physicians or other health care providers.
After eight years of searching, an international team of scientists found that a single nucleotide polymorphisms (SNP) on chromosome 9 that is uniquely linked to ovarian cancer. The scientists estimated that women carrying that particular version of the SNP on both copies of chromosome 9 have a 40 per cent higher lifetime risk of developing ovarian cancer than women who do not carry it on either copy of chromosome 9, while women with only one copy of the variant have a 20 per cent higher lifetime risk of developing ovarian cancer than women who have none.
Age
The majority of ovarian cancers occur in women over 65 years of age. A higher percentage of post-menopausal women develop ovarian cancer compared to pre-menopausal women.
High number of total lifetime ovulations
There is a link between the total number of ovulations during a woman's life and the risk of ovarian cancer. Four principal factors influence the total:
Never having been pregnant - women who have never become pregnant have a higher risk of developing ovarian cancer compared to women who have became pregnant. The more times a woman has become pregnant the lower her risk is.
Never having taken the contraceptive pill - women who have never been on the contraceptive pill have a higher risk of developing ovarian cancer compared to women who have. Taking the Pill for 15 years halves the risk of ovarian cancer, a study by the Collaborative Group on Epidemiological Studies of Ovarian Cancer found.
Early start of menstruation (early menarche) - women who started their periods at an early age have a higher risk of developing ovarian cancer.
Late start of menopause - women whose menopause started at a later age than average have a higher risk of developing ovarian cancer.
Scientists at the Centers for Disease Control and Prevention (CDC) found that survival among women with ovarian cancer is also influenced by age of menarche (when periods start) and total number of lifetime ovulatory cycles.
Some gynecologic surgeries may reduce the risk
Women who have had their fallopian tubes tied (tubal ligation) are estimated to have a 67% lower risk of ovarian cancer. A hysterectomy is said to reduce the risk by about one third.
Infertility or fertility treatment
Some studies have found a link between infertility treatment and a higher risk of ovarian cancer. Nobody is yet sure whether the risk is linked to infertility treatment, just infertility itself, or both. A Danish study published in the peer-reviewed British Medical Journal concluded that the use of fertility drugs does not increase a woman's risk of developing ovarian cancer. The study involved 54,362 women with infertility problems referred to all Danish fertility clinics between 1963 and 1998.
Breast cancer
Women who have been diagnosed with breast cancer have a higher risk of developing ovarian cancer.
HRT (Hormone replacement therapy)
HRT slightly increases a women's risk of developing ovarian cancer. Experts say the risk grows the longer the HRT continues, and returns to normal as soon as treatment stops. Danish scientists reported that compared with women who have never taken hormone therapy, those who currently take it or who have taken it in the past are at increased risk of ovarian cancer, regardless of the duration of use.
A UK study that was published in the peer-reviewed medical journal The Lancet suggested that between 1991 and 2005, an extra 1,000 women in the UK died of ovarian cancer because they were on Hormone Replacement Therapy.
Foods high in acrylamide
A study in the Netherlands found a link between acrylamide, a carcinogenic compound found in cooked, and especially burned, carbohydrate rich foods, and increased risk of endometrial and ovarian cancer in postmenopausal women.
Obesity/overweight
Being obese or overweight increases the risk of developing many cancers. The more overweight you are, the higher the risk. Several studies have also shown that obese cancer patients are more likely to have faster advancing ones compared to cancer patients of normal weight. Obese older women who have never used hormone replacement therapy have nearly twice the risk of their normal weight peers of developing ovarian cancer, according to a study by the researchers at the National Cancer Institute.
Endometriosis
Women who develop endometriosis have an approximately 30% higher risk of developing ovarian cancer compared to other women. Endometriosis is a condition in which cells that are normally found inside the uterus (endometrial cells) are found growing outside of the uterus. Danazol, a medication used to treat endometriosis has been linked to ovarian cancer risk.
Diagnosis of ovarian cancer
There is a tragic myth among many health care professionals and patients in too many countries about early stage ovarian cancer having no symptoms. A UK study, called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general practitioners and over 1,000 women, including 132 with ovarian cancer, found that 80% of GPs in the UK were wrongly of the view that women have no symptoms in the early stages of ovarian cancer. Studies in countries with top healthcare services have come up with similar findings.
The GP (general practitioner) will carry out a vaginal examination and check for any visible abnormalities in the uterus or ovaries. The doctor will also check the patient's medical history and family history. Further tests will be ordered - these are usually done by a gynecologist - a doctor who specializes in treating diseases of the female reproductive organs.
If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer's spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop.
The following tests are used to diagnose ovarian cancer:
Blood test
There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.
Ultrasound
This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.
Laparoscopy and possibly Endoscopy
A laparoscope - a thin viewing tube with a camera at the end - is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.
Colonoscopy
If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope - a thin tube with a camera at the end - will be inserted into the rectum.
Abdominal fluid aspiration
If the patient's abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.
Chest X-ray
This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.
CT (computerized tomography) scan
X-rays are used to create a 3-dimensional picture of the target area.
MRI (magnetic resonance imaging) scan
Magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.
Combined positron emission tomography (PET) and computed tomography (CT) scanning of patients in the early stages of ovarian cancer can enable physicians to determine whether the cancer has spread to nearby lymph nodes without having to perform surgery, reported scientists at San Gerardo Hospital, Monza, Italy.
The 4 stages of ovarian cancer
Ovarian cancer is classified into four stages, with stage 4 being the most advanced.
Stage 1 - the cancer is confined to one or both ovaries. This is subdivided into three groups:
Stage 1a - the cancer is confined to just one ovary (contained inside it).
Stage 1b - the cancer is confined to both ovaries (contained inside them).
Stage 1c - either 1a or 1b, but there is come cancer on the surface of one or both ovaries, or cancer cells are found in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.
Stage 2 - the cancer has spread to the uterus, fallopian tubes or some other areas in the pelvis (tummy area). This is subdivided into 3 groups:
2a - the cancer has spread into the uterus (womb) or the fallopian tubes.
2b - the cancer has spread into other tissues in the pelvis, such as the rectum or bladder.
2c - 2a and 2b, and there is cancer on the surface of one or both ovaries, or cancer cells are identified in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.
Stage 3 - the cancer has spread into the peritoneum (the lining of the abdomen), or to the lymph nodes in the upper abdomen, groin or behind the uterus. Most ovarian cancers are diagnosed at this stage. This stage is divided into three subgroups:
3a - an examination with a microscope of tissue taken from the peritoneum (lining of the abdomen) or the omentum (fatty layer over the top of the intestines) detects cancer cells.
3b - tumor growths are identified in the peritoneum 2cm or smaller.
3c - tumor growths larger than 2cm are identified in the peritoneum. Cancer is found in the lymph nodes in the groin, behind the womb or the upper abdomen.
Stage 4 - the cancer has spread beyond the abdomen to other parts of the body, including such organs as the lungs or the liver. If cancer is just found on the surface of the liver, but not inside it, it is still stage 3.
What is the treatment for ovarian cancer?
Treatment for ovarian cancer consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and sometimes radiotherapy. The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.
Some studies have indicated that specialized hospitals tend to have better survival rates for ovarian cancer patients, compared to general hospitals. Dutch ovarian cancer patients who were treated at a semispecialized or specialized hospital survived longer than those treated at a general hospital, reported researchers at the University Medical Center Utrecht in The Netherlands.
Surgery
The surgical removal of the cancer is performed in the vast majority of ovarian cancer cases, and is often the first treatment the patient will undergo.
Unless the ovarian cancer is very low grade, the patient will require an extensive operation that includes the removal of both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and the omentum (a fold of fatty abdominal tissue). Cancer often spreads into the omentum. In most cases the operation will be carried out by a gynecologic oncologist surgeon - a specialist in surgery for women with cancer of the reproductive organs. This operation, sometimes referred to as a total hysterectomy, will mean that the woman will begin her menopause immediately. Recent research by Canadian scientists found that premature removal of the ovaries increases the risk of lung cancer.
If the cancer is confined to just one of the ovaries the surgeon may just remove the affected ovary and the adjoining fallopian tube. The woman will have a chance of being able to conceive. If both ovaries are removed it will not be possible to conceive.
Surgery for ovarian cancer will require a hospital stay of up to two weeks, plus a recovery period of at least six weeks when the patient gets back home.
Chemotherapy
Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Chemotherapy for ovarian cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove.
Patients will typically receive a combination of carboplatin (Paraplatin) and paclitaxel (Taxol) intravenously (injected into the bloodstream). As it is injected into the bloodstream it can target cancer cells in the reproductive system, as well as any cancer cells that may have reached elsewhere in the body.
Treatment usually involves 6 to 12 chemotherapy sessions which will be given three to four weeks apart so that the body has time to recover. One session usually consists of a 3-hour gradual injection of the medicine into the body; sometimes it may be extended to 24 hours. Extended injections require an overnight stay in hospital.
Compounds in cranberries may help improve the effectiveness of platinum drugs that are used in chemotherapy to fight ovarian cancer, scientists at Rutgers University found.
Monitoring response to chemotherapy
Tests will be carried out to determine how well the chemotherapy is working. This will include blood tests to see if levels of CA125 have dropped, and imaging scans to see if tumors have shrunk. Sometimes the surgeon may want to have another look inside.
The patient will be in remission if all tests are clear of cancer. In remission means the cancer is under control.
If cancer is still present after chemotherapy treatment doctors will switch to other treatments. Patients who did not respond well to a specific type of chemotherapy treatment are unlikely to respond well if the same treatment is done again. This may involve another type of chemotherapy, such as intraperitoneal chemotherapy, in which the medication is aimed at the stomach, or radiotherapy.
Researchers in the Duke Comprehensive Cancer Center reported that the addition of a chemotherapeutic drug for leukemia - dasatinib (Sprycel) - to a standard regimen of two other chemotherapy drugs appears to enhance the response of certain ovarian cancers to treatment, according to a pre-clinical study. Study leader, Deanna Teoh, M.D. said "These findings indicate that we may be able to direct the use of a targeted therapy like dasatinib based on gene expression pathways in select ovarian cancers."
Side effects of chemotherapy
Chemotherapy targets rapidly dividing cells. Unfortunately, healthy rapidly dividing cells, such as red and white blood cells and hair follicles may also be affected. The severity and types of side effects depend on the type of medication, number of treatments, and some aspects of the patient and their general health. This may result in the following side effects:
Nausea, vomiting - medication for this may be given intravenously during chemotherapy sessions.
Diarrhea.
Hair loss.
Loss of appetite.
Mouth sores.
Anemia.
Infections because the white blood cell count is low (leucopenia).
In the vast majority of cases the damaged healthy cells repair themselves rapidly after treatment is over and the side-effects will soon disappear.
Radiotherapy
Radiation is not the mainstay of ovarian cancer treatment - it is not generally considered effective for ovarian cancer. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer. External radiotherapy may be used to clear traces of cancer left after chemotherapy, while internal radiotherapy may be used for advanced cancer. Radiotherapy may cause the following symptoms; some symptoms may not appear until a long time after treatment is over:
Bladder infections
Diarrhea
Constipation
Irritation, darkening of your skin that the radiation beams hit
Nausea
Frequent urination
Abdominal pain
Diptheria toxin-enconding DNA
Scientists at Lankenau Institute for Medical Research found that nanoparticle delivery of diphtheria toxin-encoding DNA selectively expressed in ovarian cancer cells reduced the burden of ovarian tumors in mice. Lead researcher, Janet Sawicki, Ph.D said "We now have a potential new therapy for the treatment of advanced ovarian cancer that has promise for targeting tumor cells and leaving healthy cells healthy.".
View drug information on Sprycel; Taxol.
Approximately 5,500 women in the UK and 21,000 women in the USA are diagnosed with ovarian cancer each year. Worldwide, around 140,000 women die of ovarian cancer every year.
Tragically, the overall five year survival rate is only 46 per cent in most developed countries (it is lower for more advanced stages). However, according to the National Cancer Institute, if diagnosis is made early, before the tumor has spread, the five year survival rate is nearer 93 per cent. In 2009 scientists in the US said that current tests for diagnosing ovarian cancer are not good enough .
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Even modern screening tests for ovarian cancer, which include a blood test for the CA 125 marker, combined with ultrasound, often result in unnecessary surgery and "..are failing to catch early signs of the disease..", a study at the University of Alabama at Birmingham Comprehensive Cancer Center revealed.
What are the ovaries?
The ovary is the female gonad, while the testis is the male gonad. A gonad is a reproductive gland that produces germ cells (gametes). A male sperm is a gamete, and a female egg is also a gamete. Each human gamete has 23 chromosomes, half the number of chromosomes contained in most types of human body cells.
The ovary, also known as the egg sac, is one of a pair of reproductive glands in women. The ovaries are located at either side of the uterus (womb), in the pelvis. Each ovary is about the size and shape of an almond. The ovaries produce ova (eggs) and female hormones, such as estrogen and progesterone. These hormones regulate the menstrual cycle, pregnancy, and control the development of female characteristics, such as body shape, body hair, breasts, etc.
During the female menstrual cycle, which lasts about one month, one egg is released from one of the two ovaries - the egg travels through the fallopian tube and into the uterus. This is known as ovulation.
Cancer of the ovary can spread to other parts of the reproductive system as well as surrounding areas, such as the stomach, vagina and uterus. Ovarian cancer more commonly occurs in women aged 65 or over, but can affect women of any age.
What is cancer?
Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer that occur in various parts of the body - each is classified by the type of cell that is initially affected.
Usually our cells divide (multiply, form new ones) only when old and dying ones need to be replaced. However, the controls that regulate when a cell divides as well as when a cell should die sometimes become faulty. This may result in cells not dying when they should, while additional cells are still being added - an uncontrolled accumulation of cells. Eventually a mass of cells is formed - a tumor.
Other interesting articles
What is cancer? What causes cancer?
What is chemotherapy? What are the side effects of chemotherapy?
What is breast cancer?
What is function of the lymph nodes?
What is ovulation? What is the ovulation calendar?
What is menopause? What are the symptoms of menopause?
What is pain? What causes pain?
What is endometriosis? What causes endometriosis?
Malignant and benign tumors
Tumors that stay in one place and demonstrate limited growth are usually considered to be benign. Malignant, or more dangerous tumors emerge when two things occur:
Invasion - the cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue - this process is called invasion.
Angiogenesis - the cancerous cells manage to divide and grow, making new blood vessels to feed themselves.
Metastasis
When a tumor manages to spread to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is extremely hard to treat.
Three main types of ovarian cancers (tumors)
Epithelial ovarian cancer is by far the most common form of ovarian cancer. Germ cell and stromal ovarian cancers are much less common. Ovarian cancer can also result from a cancer somewhere else in the body that has spread:
Epithelial ovarian cancer (epithelial ovarian tumors) - derived from cells on the surface of the ovary. It occurs mainly in adults.
Germ cell ovarian cancer (germ cell ovarian tumors) - derived from the egg-producing cells within the body of the ovary. This rare type of cancer more commonly affects children and teenage girls.
Stromal ovarian cancer (sex cord stromal tumors) - develops within the cells that hold the ovaries together.
Cancers from other organs in the body can spread to the ovaries - metastatic cancers - a metastatic cancer is one that spreads from where it first arose as a primary tumor to other locations in the body.
What are the symptoms of ovarian cancer?
In the early stages, ovarian cancer usually has vague symptoms which are not easy to recognize. In fact, doctors used to think that ovarian cancer had no symptoms (unfortunately, many still do). Even though healthcare professionals are much better at identifying ovarian cancer symptoms these days, patients often attribute their symptoms to other conditions, such as pre-menstrual syndrome, irritable bowel syndrome, or a temporary bladder problem.
The main difference between ovarian cancer and other possible disorders is the persistence and gradual worsening of symptoms. While most digestive disorders have fluctuating symptoms, those of ovarian cancer are more constant and steadily advancing.
The following are examples of possible early symptoms of ovarian cancer:
Pain in the pelvis
Pain on the lower side of the body
Pain in the lower stomach
Back pain
Indigestion or heartburn
Feeling full rapidly when eating
More frequent and urgent urination
Pain during sexual intercourse
Changes in bowel habits, such as constipation
As ovarian cancer progresses these symptoms are also possible:
Nausea
Weight loss
Breathlessness
Fatigue (tiredness)
Loss of appetite
Ovarian cancer is not a silent killer. A study by the National Breast and Ovarian Cancer Centre, Australia, found that 83% of women experience at least one symptom of ovarian cancer in the year prior to their diagnosis. The researchers also found that 17% of women waited more than three months after the onset of their symptoms before visiting their doctor, with 8% waiting more than six months. The most common symptoms, experienced by half of the study participants, were abdominal symptoms such as fullness and pain. Bloating, bowel or urinary symptoms were reported by approximately one third of participants.
If you experience bloating, pressure or pain in the abdomen or pelvis that persists for more than a few weeks you should see your doctor immediately. If you have already been to the doctor and ovarian cancer was not diagnosed, but treatment is not relieving symptoms, either see your doctor again or get a second opinion. It is important that the evaluation includes a pelvic examination.
People with close family members who have/had ovarian or breast cancer should see a doctor who is trained to detect ovarian cancer.
What are the causes of ovarian cancer?
Although we know that ovarian cancer, like many other cancers, is caused by cells dividing and multiplying in an unordered way, nobody completely understands why cancer of the ovary occurs. We know that the following risk factors are linked to a higher chance of developing the disease:
Family history
Most women who develop ovarian cancer do not have an inherited gene mutation. Women with close relatives who have/had ovarian cancer, as well as breast cancer, have a higher risk of developing ovarian cancer compared to other women. There are two genes - BRCA1 and BRCA2 - which significantly raise the risk. The BRCA1 and BRCA2 genes also raise the risk of breast cancer. Those genes are inherited. The BRCA1 gene is estimated to increase ovarian cancer risk by 35% to 70%, and the BRCA2 by 10% to 30%. People of Ashkenazi Jewish descent are at particularly high risk of carrying these types of gene mutations.
Women with close relatives who have/had colon cancer, prostate cancer or uterine cancer are also at higher risk of ovarian cancer.
Genetic screening can determine whether somebody carries the BRCA1 and/or BRCA2 genes. Although a test for gene mutations known to significantly increase the risk of hereditary breast or ovarian cancer has been available for more than a decade, a study by researchers from Massachusetts General Hospital found that few women with family histories of these cancers are even discussing genetic testing with their physicians or other health care providers.
After eight years of searching, an international team of scientists found that a single nucleotide polymorphisms (SNP) on chromosome 9 that is uniquely linked to ovarian cancer. The scientists estimated that women carrying that particular version of the SNP on both copies of chromosome 9 have a 40 per cent higher lifetime risk of developing ovarian cancer than women who do not carry it on either copy of chromosome 9, while women with only one copy of the variant have a 20 per cent higher lifetime risk of developing ovarian cancer than women who have none.
Age
The majority of ovarian cancers occur in women over 65 years of age. A higher percentage of post-menopausal women develop ovarian cancer compared to pre-menopausal women.
High number of total lifetime ovulations
There is a link between the total number of ovulations during a woman's life and the risk of ovarian cancer. Four principal factors influence the total:
Never having been pregnant - women who have never become pregnant have a higher risk of developing ovarian cancer compared to women who have became pregnant. The more times a woman has become pregnant the lower her risk is.
Never having taken the contraceptive pill - women who have never been on the contraceptive pill have a higher risk of developing ovarian cancer compared to women who have. Taking the Pill for 15 years halves the risk of ovarian cancer, a study by the Collaborative Group on Epidemiological Studies of Ovarian Cancer found.
Early start of menstruation (early menarche) - women who started their periods at an early age have a higher risk of developing ovarian cancer.
Late start of menopause - women whose menopause started at a later age than average have a higher risk of developing ovarian cancer.
Scientists at the Centers for Disease Control and Prevention (CDC) found that survival among women with ovarian cancer is also influenced by age of menarche (when periods start) and total number of lifetime ovulatory cycles.
Some gynecologic surgeries may reduce the risk
Women who have had their fallopian tubes tied (tubal ligation) are estimated to have a 67% lower risk of ovarian cancer. A hysterectomy is said to reduce the risk by about one third.
Infertility or fertility treatment
Some studies have found a link between infertility treatment and a higher risk of ovarian cancer. Nobody is yet sure whether the risk is linked to infertility treatment, just infertility itself, or both. A Danish study published in the peer-reviewed British Medical Journal concluded that the use of fertility drugs does not increase a woman's risk of developing ovarian cancer. The study involved 54,362 women with infertility problems referred to all Danish fertility clinics between 1963 and 1998.
Breast cancer
Women who have been diagnosed with breast cancer have a higher risk of developing ovarian cancer.
HRT (Hormone replacement therapy)
HRT slightly increases a women's risk of developing ovarian cancer. Experts say the risk grows the longer the HRT continues, and returns to normal as soon as treatment stops. Danish scientists reported that compared with women who have never taken hormone therapy, those who currently take it or who have taken it in the past are at increased risk of ovarian cancer, regardless of the duration of use.
A UK study that was published in the peer-reviewed medical journal The Lancet suggested that between 1991 and 2005, an extra 1,000 women in the UK died of ovarian cancer because they were on Hormone Replacement Therapy.
Foods high in acrylamide
A study in the Netherlands found a link between acrylamide, a carcinogenic compound found in cooked, and especially burned, carbohydrate rich foods, and increased risk of endometrial and ovarian cancer in postmenopausal women.
Obesity/overweight
Being obese or overweight increases the risk of developing many cancers. The more overweight you are, the higher the risk. Several studies have also shown that obese cancer patients are more likely to have faster advancing ones compared to cancer patients of normal weight. Obese older women who have never used hormone replacement therapy have nearly twice the risk of their normal weight peers of developing ovarian cancer, according to a study by the researchers at the National Cancer Institute.
Endometriosis
Women who develop endometriosis have an approximately 30% higher risk of developing ovarian cancer compared to other women. Endometriosis is a condition in which cells that are normally found inside the uterus (endometrial cells) are found growing outside of the uterus. Danazol, a medication used to treat endometriosis has been linked to ovarian cancer risk.
Diagnosis of ovarian cancer
There is a tragic myth among many health care professionals and patients in too many countries about early stage ovarian cancer having no symptoms. A UK study, called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general practitioners and over 1,000 women, including 132 with ovarian cancer, found that 80% of GPs in the UK were wrongly of the view that women have no symptoms in the early stages of ovarian cancer. Studies in countries with top healthcare services have come up with similar findings.
The GP (general practitioner) will carry out a vaginal examination and check for any visible abnormalities in the uterus or ovaries. The doctor will also check the patient's medical history and family history. Further tests will be ordered - these are usually done by a gynecologist - a doctor who specializes in treating diseases of the female reproductive organs.
If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer's spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop.
The following tests are used to diagnose ovarian cancer:
Blood test
There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.
Ultrasound
This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.
Laparoscopy and possibly Endoscopy
A laparoscope - a thin viewing tube with a camera at the end - is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.
Colonoscopy
If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope - a thin tube with a camera at the end - will be inserted into the rectum.
Abdominal fluid aspiration
If the patient's abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.
Chest X-ray
This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.
CT (computerized tomography) scan
X-rays are used to create a 3-dimensional picture of the target area.
MRI (magnetic resonance imaging) scan
Magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.
Combined positron emission tomography (PET) and computed tomography (CT) scanning of patients in the early stages of ovarian cancer can enable physicians to determine whether the cancer has spread to nearby lymph nodes without having to perform surgery, reported scientists at San Gerardo Hospital, Monza, Italy.
The 4 stages of ovarian cancer
Ovarian cancer is classified into four stages, with stage 4 being the most advanced.
Stage 1 - the cancer is confined to one or both ovaries. This is subdivided into three groups:
Stage 1a - the cancer is confined to just one ovary (contained inside it).
Stage 1b - the cancer is confined to both ovaries (contained inside them).
Stage 1c - either 1a or 1b, but there is come cancer on the surface of one or both ovaries, or cancer cells are found in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.
Stage 2 - the cancer has spread to the uterus, fallopian tubes or some other areas in the pelvis (tummy area). This is subdivided into 3 groups:
2a - the cancer has spread into the uterus (womb) or the fallopian tubes.
2b - the cancer has spread into other tissues in the pelvis, such as the rectum or bladder.
2c - 2a and 2b, and there is cancer on the surface of one or both ovaries, or cancer cells are identified in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.
Stage 3 - the cancer has spread into the peritoneum (the lining of the abdomen), or to the lymph nodes in the upper abdomen, groin or behind the uterus. Most ovarian cancers are diagnosed at this stage. This stage is divided into three subgroups:
3a - an examination with a microscope of tissue taken from the peritoneum (lining of the abdomen) or the omentum (fatty layer over the top of the intestines) detects cancer cells.
3b - tumor growths are identified in the peritoneum 2cm or smaller.
3c - tumor growths larger than 2cm are identified in the peritoneum. Cancer is found in the lymph nodes in the groin, behind the womb or the upper abdomen.
Stage 4 - the cancer has spread beyond the abdomen to other parts of the body, including such organs as the lungs or the liver. If cancer is just found on the surface of the liver, but not inside it, it is still stage 3.
What is the treatment for ovarian cancer?
Treatment for ovarian cancer consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and sometimes radiotherapy. The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.
Some studies have indicated that specialized hospitals tend to have better survival rates for ovarian cancer patients, compared to general hospitals. Dutch ovarian cancer patients who were treated at a semispecialized or specialized hospital survived longer than those treated at a general hospital, reported researchers at the University Medical Center Utrecht in The Netherlands.
Surgery
The surgical removal of the cancer is performed in the vast majority of ovarian cancer cases, and is often the first treatment the patient will undergo.
Unless the ovarian cancer is very low grade, the patient will require an extensive operation that includes the removal of both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and the omentum (a fold of fatty abdominal tissue). Cancer often spreads into the omentum. In most cases the operation will be carried out by a gynecologic oncologist surgeon - a specialist in surgery for women with cancer of the reproductive organs. This operation, sometimes referred to as a total hysterectomy, will mean that the woman will begin her menopause immediately. Recent research by Canadian scientists found that premature removal of the ovaries increases the risk of lung cancer.
If the cancer is confined to just one of the ovaries the surgeon may just remove the affected ovary and the adjoining fallopian tube. The woman will have a chance of being able to conceive. If both ovaries are removed it will not be possible to conceive.
Surgery for ovarian cancer will require a hospital stay of up to two weeks, plus a recovery period of at least six weeks when the patient gets back home.
Chemotherapy
Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Chemotherapy for ovarian cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove.
Patients will typically receive a combination of carboplatin (Paraplatin) and paclitaxel (Taxol) intravenously (injected into the bloodstream). As it is injected into the bloodstream it can target cancer cells in the reproductive system, as well as any cancer cells that may have reached elsewhere in the body.
Treatment usually involves 6 to 12 chemotherapy sessions which will be given three to four weeks apart so that the body has time to recover. One session usually consists of a 3-hour gradual injection of the medicine into the body; sometimes it may be extended to 24 hours. Extended injections require an overnight stay in hospital.
Compounds in cranberries may help improve the effectiveness of platinum drugs that are used in chemotherapy to fight ovarian cancer, scientists at Rutgers University found.
Monitoring response to chemotherapy
Tests will be carried out to determine how well the chemotherapy is working. This will include blood tests to see if levels of CA125 have dropped, and imaging scans to see if tumors have shrunk. Sometimes the surgeon may want to have another look inside.
The patient will be in remission if all tests are clear of cancer. In remission means the cancer is under control.
If cancer is still present after chemotherapy treatment doctors will switch to other treatments. Patients who did not respond well to a specific type of chemotherapy treatment are unlikely to respond well if the same treatment is done again. This may involve another type of chemotherapy, such as intraperitoneal chemotherapy, in which the medication is aimed at the stomach, or radiotherapy.
Researchers in the Duke Comprehensive Cancer Center reported that the addition of a chemotherapeutic drug for leukemia - dasatinib (Sprycel) - to a standard regimen of two other chemotherapy drugs appears to enhance the response of certain ovarian cancers to treatment, according to a pre-clinical study. Study leader, Deanna Teoh, M.D. said "These findings indicate that we may be able to direct the use of a targeted therapy like dasatinib based on gene expression pathways in select ovarian cancers."
Side effects of chemotherapy
Chemotherapy targets rapidly dividing cells. Unfortunately, healthy rapidly dividing cells, such as red and white blood cells and hair follicles may also be affected. The severity and types of side effects depend on the type of medication, number of treatments, and some aspects of the patient and their general health. This may result in the following side effects:
Nausea, vomiting - medication for this may be given intravenously during chemotherapy sessions.
Diarrhea.
Hair loss.
Loss of appetite.
Mouth sores.
Anemia.
Infections because the white blood cell count is low (leucopenia).
In the vast majority of cases the damaged healthy cells repair themselves rapidly after treatment is over and the side-effects will soon disappear.
Radiotherapy
Radiation is not the mainstay of ovarian cancer treatment - it is not generally considered effective for ovarian cancer. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer. External radiotherapy may be used to clear traces of cancer left after chemotherapy, while internal radiotherapy may be used for advanced cancer. Radiotherapy may cause the following symptoms; some symptoms may not appear until a long time after treatment is over:
Bladder infections
Diarrhea
Constipation
Irritation, darkening of your skin that the radiation beams hit
Nausea
Frequent urination
Abdominal pain
Diptheria toxin-enconding DNA
Scientists at Lankenau Institute for Medical Research found that nanoparticle delivery of diphtheria toxin-encoding DNA selectively expressed in ovarian cancer cells reduced the burden of ovarian tumors in mice. Lead researcher, Janet Sawicki, Ph.D said "We now have a potential new therapy for the treatment of advanced ovarian cancer that has promise for targeting tumor cells and leaving healthy cells healthy.".
View drug information on Sprycel; Taxol.
четверг, 8 сентября 2011 г.
Breast Enlargement Surgery Linked To Boost In Self-Esteem And Sexuality
Women who undergo breast enlargement often see a sizable boost in self-esteem and positive feelings about their sexuality, a University of Florida nurse researcher reports.
Although plastic surgery should not be seen as a panacea for feelings of low self-worth or sexual attractiveness, it is important for health-care practitioners to understand the psychological benefits of these procedures, says Cynthia Figueroa-Haas, a clinical assistant professor at UF's College of Nursing who conducted the study. The findings - which revealed that for many women, going bigger is better - appear in the current issue of Plastic Surgical Nursing.
"Many individuals, including health-care providers, have preconceived negative ideas about those who elect to have plastic surgery, without fully understanding the benefits that may occur from these procedures," said Figueroa-Haas, who conducted the study for her doctoral thesis at Barry University in Miami Shores before joining the UF faculty. "This study provides the impetus for future studies related to self-esteem, human sexuality and cosmetic surgery."
In 2005, 2.1 million cosmetic surgical procedures were performed, according to the American Society for Aesthetic Plastic Surgery. That figure is expected to grow. Consider that the number of breast augmentation procedures alone increased a staggering 476 percent since 2000, according to the American Society of Plastic Surgeons. More than 2 million women in the United States have breast implants, and this year more than 360,000 American women will undergo breast augmentation.
Figueroa-Haas studied 84 women who were 21 to 57 years old, assessing their perceptions of self-esteem and sexuality before and after cosmetic breast augmentation. Study participants had been previously scheduled for breast augmentation and were undergoing the procedure solely for cosmetic purposes. Eligible candidates were mailed a consent form, a demographic questionnaire and pre-tests asking them to rate their self-esteem and sexuality. They were then mailed a similar post-test two to three months after the surgery.
Improvements in the women's self-esteem and sexual satisfaction were directly correlated with having undergone breast augmentation. Figueroa-Haas used two widely accepted scientific scales to measure self-esteem and sexuality, the Rosenberg Self-Esteem Scale and the Female Sexual Function Index, which assesses domains of sexual function, such as sexual arousal, satisfaction, experience and attitudes.
The participants' average self-esteem score increased from 20.7 to 24.9 on the 30-point Rosenberg scale, and their average female sexual function score increased from 27.2 to 31.4 on the 36-point index. Of note, after the procedure, there were substantial increases in ratings of sexual desire (a 78.6 percent increase from initial scores), arousal (81 percent increase) and satisfaction (57 percent increase). Figueroa-Haas did point out that a small number of participants showed no change in their levels of self-esteem or sexuality after surgery.
With a heightened interest in men's sexuality issues in recent years, the research sheds light on women's sexuality, and how plastic surgery can improve and enhance this important area of life, Figueroa-Haas said.
"So much attention is directed to men's sexuality issues; we have all seen countless commercials on drugs and therapy devoted to improving men's sexuality. Unfortunately, very little is discussed regarding women's sexuality issues," Figueroa-Haas said. "I strongly believe that my research shows that interventions such as cosmetic plastic surgery can address these sorts of issues for some women. For example, those women who may have breast changes due to nursing or from the inevitable natural aging process. These women may not feel as attractive, which could ultimately negatively impact their levels of self-esteem and sexuality."
Figueroa-Haas warned that women should not view plastic surgery as a cure-all for any self-esteem and sexuality woes. In fact, ethical plastic surgeons should screen for this type of behavior and rule out potential patients who may have more serious psychological issues, she said.
"There may be patients who will never be satisfied with their bodies no matter how much surgery they receive or feel that their life will completely change after plastic surgery," Figueroa-Haas said. "These are not ideal candidates for surgery and should seek further counseling to address their underlying psychological issues. But for women who seek improvements in certain physical areas, plastic surgery can be a very positive experience."
Further research should be conducted to assess significant psychosocial issues that may arise after plastic surgery, said Figueroa-Haas, adding that her study helps call attention to the need for health-care providers to be able to predict outcomes in this specialized population.
"Since plastic surgery is increasing dramatically, my intention for researching this topic was to evaluate nurses' attitudes toward cosmetic surgery patients and make recommendations for increasing awareness of the factors surrounding these patients," Figueroa-Haas said. "Nurses should display compassion and understand an individual's reason for seeking cosmetic surgery instead of dismissing or stereotyping these patients. This study shows that there are genuine psychological improvements that follow plastic surgery, and these issues must be understood and respected."
Contact: Tracy Brown
University of Florida
Although plastic surgery should not be seen as a panacea for feelings of low self-worth or sexual attractiveness, it is important for health-care practitioners to understand the psychological benefits of these procedures, says Cynthia Figueroa-Haas, a clinical assistant professor at UF's College of Nursing who conducted the study. The findings - which revealed that for many women, going bigger is better - appear in the current issue of Plastic Surgical Nursing.
"Many individuals, including health-care providers, have preconceived negative ideas about those who elect to have plastic surgery, without fully understanding the benefits that may occur from these procedures," said Figueroa-Haas, who conducted the study for her doctoral thesis at Barry University in Miami Shores before joining the UF faculty. "This study provides the impetus for future studies related to self-esteem, human sexuality and cosmetic surgery."
In 2005, 2.1 million cosmetic surgical procedures were performed, according to the American Society for Aesthetic Plastic Surgery. That figure is expected to grow. Consider that the number of breast augmentation procedures alone increased a staggering 476 percent since 2000, according to the American Society of Plastic Surgeons. More than 2 million women in the United States have breast implants, and this year more than 360,000 American women will undergo breast augmentation.
Figueroa-Haas studied 84 women who were 21 to 57 years old, assessing their perceptions of self-esteem and sexuality before and after cosmetic breast augmentation. Study participants had been previously scheduled for breast augmentation and were undergoing the procedure solely for cosmetic purposes. Eligible candidates were mailed a consent form, a demographic questionnaire and pre-tests asking them to rate their self-esteem and sexuality. They were then mailed a similar post-test two to three months after the surgery.
Improvements in the women's self-esteem and sexual satisfaction were directly correlated with having undergone breast augmentation. Figueroa-Haas used two widely accepted scientific scales to measure self-esteem and sexuality, the Rosenberg Self-Esteem Scale and the Female Sexual Function Index, which assesses domains of sexual function, such as sexual arousal, satisfaction, experience and attitudes.
The participants' average self-esteem score increased from 20.7 to 24.9 on the 30-point Rosenberg scale, and their average female sexual function score increased from 27.2 to 31.4 on the 36-point index. Of note, after the procedure, there were substantial increases in ratings of sexual desire (a 78.6 percent increase from initial scores), arousal (81 percent increase) and satisfaction (57 percent increase). Figueroa-Haas did point out that a small number of participants showed no change in their levels of self-esteem or sexuality after surgery.
With a heightened interest in men's sexuality issues in recent years, the research sheds light on women's sexuality, and how plastic surgery can improve and enhance this important area of life, Figueroa-Haas said.
"So much attention is directed to men's sexuality issues; we have all seen countless commercials on drugs and therapy devoted to improving men's sexuality. Unfortunately, very little is discussed regarding women's sexuality issues," Figueroa-Haas said. "I strongly believe that my research shows that interventions such as cosmetic plastic surgery can address these sorts of issues for some women. For example, those women who may have breast changes due to nursing or from the inevitable natural aging process. These women may not feel as attractive, which could ultimately negatively impact their levels of self-esteem and sexuality."
Figueroa-Haas warned that women should not view plastic surgery as a cure-all for any self-esteem and sexuality woes. In fact, ethical plastic surgeons should screen for this type of behavior and rule out potential patients who may have more serious psychological issues, she said.
"There may be patients who will never be satisfied with their bodies no matter how much surgery they receive or feel that their life will completely change after plastic surgery," Figueroa-Haas said. "These are not ideal candidates for surgery and should seek further counseling to address their underlying psychological issues. But for women who seek improvements in certain physical areas, plastic surgery can be a very positive experience."
Further research should be conducted to assess significant psychosocial issues that may arise after plastic surgery, said Figueroa-Haas, adding that her study helps call attention to the need for health-care providers to be able to predict outcomes in this specialized population.
"Since plastic surgery is increasing dramatically, my intention for researching this topic was to evaluate nurses' attitudes toward cosmetic surgery patients and make recommendations for increasing awareness of the factors surrounding these patients," Figueroa-Haas said. "Nurses should display compassion and understand an individual's reason for seeking cosmetic surgery instead of dismissing or stereotyping these patients. This study shows that there are genuine psychological improvements that follow plastic surgery, and these issues must be understood and respected."
Contact: Tracy Brown
University of Florida
четверг, 1 сентября 2011 г.
Advaxis Doses First Cervical Dysplasia Clinical Trial Patient
Advaxis, Inc., (OTCBB: ADXS), the live, attenuated Listeria monocytogenes (Lm) biotechnology company, has dosed the first patient in its US Food and Drug Administration (FDA)-approved, phase II clinical trial in cervical intraepithelial neoplasia (CIN), commonly known as cervical dysplasia.
The clinical trial is slated to be a multicenter, randomized, placebo controlled, blinded clinical trial of ADXS11-001 -Advaxis' lead immunotherapeutic candidate. The dosing was administered at the site of Dr. Keith Aqua, M.D. of the Institute for Women's Health & Body.
"Dosing the first patient is a significant milestone for our company," commented Advaxis Chairman/CEO Thomas A. Moore. "It is a highly awaited development amongst all Advaxis and immunotherapy followers, at large; following the recent Dendreon Corporation (Nasdaq: DNDN) FDA approval. We look forward to completing and reporting the first dosing leg over approximately the next fifteen (15) months."
About the Institute for Women's Health & Body
The Institute for Women's Health & Body in Wellington, Florida is Advaxis' first clinical trial site in this multicenter study. The principal investigator at the Institute for the trial is Dr. Keith Aqua, M.D. - an experienced clinical investigator in the development of new therapies for women's health. His center has two (2) Florida sites with 84,000 active patients and conducts over 2,000 Pap smears, per month.
About Advaxis' Cervical Dysplasia (CIN) Trial
Advaxis has initiated the Company's first clinical trial site in its randomized, single blind, placebo-controlled, Phase II clinical trial of ADXS11-001 for the treatment of cervical intraepithelial neoplasia (CIN). The study is designed to assess the safety and efficacy of ADXS11-001 for the treatment of CIN grade 2/3 commonly known as cervical dysplasia.
About Cervical Dysplasia (CIN)
Cervical dysplasia is the precursor condition to cervix cancer, which is diagnosed in 450,000 American women annually. Progressive CIN is currently treated with surgery to prevent cancer from occurring; however, this treatment is associated with a number of problems, which include the development of an "incompetent cervix" i.e., a condition that prevents women from carrying a baby to full term. The typical CIN patient is a woman between 25 and 45 years of age. Although surgery is a viable short-term solution for the condition, it does not address the cause of the disease, which is a human papilloma virus (HPV) infection. Women who require surgery once may need it again. Current HPV vaccination products have not demonstrated effectiveness against active HPV infections.
Source
Advaxis, Inc.
The clinical trial is slated to be a multicenter, randomized, placebo controlled, blinded clinical trial of ADXS11-001 -Advaxis' lead immunotherapeutic candidate. The dosing was administered at the site of Dr. Keith Aqua, M.D. of the Institute for Women's Health & Body.
"Dosing the first patient is a significant milestone for our company," commented Advaxis Chairman/CEO Thomas A. Moore. "It is a highly awaited development amongst all Advaxis and immunotherapy followers, at large; following the recent Dendreon Corporation (Nasdaq: DNDN) FDA approval. We look forward to completing and reporting the first dosing leg over approximately the next fifteen (15) months."
About the Institute for Women's Health & Body
The Institute for Women's Health & Body in Wellington, Florida is Advaxis' first clinical trial site in this multicenter study. The principal investigator at the Institute for the trial is Dr. Keith Aqua, M.D. - an experienced clinical investigator in the development of new therapies for women's health. His center has two (2) Florida sites with 84,000 active patients and conducts over 2,000 Pap smears, per month.
About Advaxis' Cervical Dysplasia (CIN) Trial
Advaxis has initiated the Company's first clinical trial site in its randomized, single blind, placebo-controlled, Phase II clinical trial of ADXS11-001 for the treatment of cervical intraepithelial neoplasia (CIN). The study is designed to assess the safety and efficacy of ADXS11-001 for the treatment of CIN grade 2/3 commonly known as cervical dysplasia.
About Cervical Dysplasia (CIN)
Cervical dysplasia is the precursor condition to cervix cancer, which is diagnosed in 450,000 American women annually. Progressive CIN is currently treated with surgery to prevent cancer from occurring; however, this treatment is associated with a number of problems, which include the development of an "incompetent cervix" i.e., a condition that prevents women from carrying a baby to full term. The typical CIN patient is a woman between 25 and 45 years of age. Although surgery is a viable short-term solution for the condition, it does not address the cause of the disease, which is a human papilloma virus (HPV) infection. Women who require surgery once may need it again. Current HPV vaccination products have not demonstrated effectiveness against active HPV infections.
Source
Advaxis, Inc.
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