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Ovarian Cancer; Diagnosis.



Who gets ovarian cancer? A woman can inherit an increased risk for this disease, particularly if a "first degree" relative (a mother, sister or daughter) has or had ovarian, breast or colon cancer. In fact, if a woman has a strong family history of ovarian cancer, she is more likely to develop the disease at an early age (younger than 50). Other risk factors include:

Being of Eastern European Jewish ethnicity (Askhenazi) if the condition has already affected one or more family members

Having a mutation in the BRCA BRCA  

One of two genes (designated BRCA1 and BRCA2) that help repair damage to DNA, but when inherited in a defective state increase the risk of breast and ovarian cancer.
1 or BRCA2 gene. A mutation in the BRCA1 or BRCA2 gene increases your risk by an estimated 40 to 50 percent.

Having a personal history of breast, endometrial endometrial /en·do·me·tri·al/ (en?do-me´tre-il) pertaining to the endometrium.
endometrial,
n relating to the end-ometrium or cavity of the uterus.
 or colon cancer

Never having been pregnant or having your first child after age 30.

A high-fat diet

Obesity

Starting your periods at a young age, or going through menopause at an older than average age

Of all risk factors, the most significant is a family history of breast and/or ovarian cancer. However, it's important to keep risk factors in perspective. Most women with risk factors for ovarian cancer will never actually get ovarian cancer. And most women with ovarian cancer do not have any strong risk factors for the disease.

Even with significant risk factors such as family history, the overall chances of getting ovarian cancer are still small. Nonetheless, you should talk to your health care professional if you know you have any risk factors.

To date, only about nine percent of ovarian cancer cases are caused by inherited defects in the BRCA1 and BRCA2 genes. Genes, the pieces of the chemical DNA DNA: see nucleic acid.
DNA
 or deoxyribonucleic acid

One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes.
 within your cells that are inherited from your parents, determine many aspects of your body's make up. Scientists have known for years that genes determine the risk for developing a disease like cancer.

The BRCA1 and BRCA2 genes normally help prevent cancer by making a protein that keeps cells from growing too much. But if you have a defect in either of these genes--inherited from either parent--they don't make that protein, and there's nothing to slow down or stop rapidly multiplying cells from becoming cancerous.

There are many questions around genetic testing for a genetic risk for ovarian cancer, both scientific and ethical.

If you want to have genetic testing, you should see a specially trained genetic counselor who can accurately and appropriately counsel you about your risk and options.

The genetic counselor, in concert with your physician, can recommend prevention and screening strategies, discuss your options for risk reduction and counsel you about the psychosocial issues around this topic, regardless of family history or inherited susceptibility. Your health care professional can refer you to a certified genetic counselor.

Diagnostic Tests

If you or your doctor suspects you may have ovarian cancer, or you have a very high risk of developing it, you will undergo certain diagnostic tests. Unfortunately, there are no screening tests for ovarian cancer (as there are for other cancers, like breast cancer or colon cancer). The following imaging tests can show whether a mass is present, but cannot tell whether or not the mass is cancerous. The CA-125 blood test is usually used in women who have already been diagnosed with ovarian cancer. Diagnostic tests include:

Abdominal or transvaginal ultrasound. This test uses sound waves to distinguish fluid-filled cysts from solid ones. It is often used to rule out or identify a possible cancer.

CT scan. This test produces x-ray images of cross sections of body tissues. It is used to show the size of the tumor or mass, whether lymph nodes are involved and whether the tumor has spread to other organs. They are also used to guide a biopsy needle into a tumor to obtain a tissue sample.

lower GI series (barium dye enema enema /en·e·ma/ (en´e-mah) [Gr.] a solution introduced into the rectum to promote evacuation of feces or as a means of introducing nutrients, medicinal substances, or opaque material for radiologic examination of the lower intestinal ). During a barium dye enema, barium sulfate, a chalky substance, is placed into the colon and rectum. The barium outlines the colon and rectum so they are more visible on x-rays. This test enables your health professional to see the bowel on x-ray to detect abnormalities related to ovarian cancer.

CA-125 blood test. This is most commonly used in women who have already been diagnosed with ovarian cancer and treated to determine if the cancer has recurred. It measures levels of a tumor marker, or protein, called CA-125.

It is not used for screening or diagnosis because it results in too many false positives or negatives. For example, studies find that CA-125 levels are normal when ovarian cancer is confined to the ovaries in half of postmenopausal post·men·o·paus·al
adj.
Of or occurring in the time following menopause.


postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr
 women, while some ovarian cancers do not produce enough CA-125 to cause a positive result. Other benign conditions may increase CA-125 levels, such as endometriosis endometriosis (ĕn'dəmē'trē-ō`sĭs), a condition in which small pieces of the endometrium (the lining of the uterus) migrate to other places in the pelvic area. , benign ovarian cysts, pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. , the first trimester of pregnancy and cirrhosis of the liver Cirrhosis of the liver
A type of liver disease, most often caused by chronic alcohol abuse. It is characterized by scarring of the liver, which leads to an increase in the blood pressure in the portal veins.

Mentioned in: Bleeding Varices
.

Future screening tests

Researchers are evaluating new methods that use the fledgling science of proteomics (the study of the proteins that govern every biological process in the body) to identify ovarian cancer in its earliest stages. Once perfected, proteomics could use protein fingerprinting to identify Stage 1 ovarian cancer from just a few drops of blood in a 30-minute test.

A paper published in June 2004 found the method correctly identified 68 cancer specimens with no false-positives (identifying a non-cancer sample as cancerous). Results from other small clinical trials are also encouraging; however, clinical trials using larger numbers of patients are underway to verify the results obtained in the early investigations.

If your health care professional suspects ovarian cancer, you will likely undergo an exploratory laparotomy. During a laparotomy laparotomy /lap·a·rot·o·my/ (-rot´ah-me) incision through the flank or, more generally, through any part of the abdominal wall.

lap·a·rot·o·my
n.
1.
, the surgeon makes an incision in your stomach and removes the tumor. The surgeon then performs a biopsy to see if the tumor is cancerous. If the tissue is indeed cancerous, the surgeon will remove as much of the tumor and affected tissue/organs as possible.

References

Lacey JV Jr, Mink PJ, Lubin JH, et al. Menopausal hormone replacement therapy Hormone Replacement Therapy Definition

Hormone replacement therapy (HRT) is the use of synthetic or natural female hormones to make up for the decline or lack of natural hormones produced in a woman's body.
 and risk of ovarian cancer. JAMA. 2002 Jul 17;288(3):334-41. Erratum [Latin, Error.] The term used in the Latin formula for the assignment of mistakes made in a case.

After reviewing a case, if a judge decides that there was no error, he or she indicates so by replying, "In nollo est erratum
 in: JAMA 2002 Nov 27;288(20):2544.

Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M, Liu J, McNeeley SG, Lopez AM; Women's Health Initiative Women's Health Initiative A 15-yr, $628 million project involving 1. An observational study of the health habits and medical Hx of ±100,000 ♀ 2.  Investigators. Effects of estrogen plus progestin progestin /pro·ges·tin/ (-jes´tin) progestational agent.

pro·ges·tin
n.
1. A natural or synthetic progestational substance that mimics some or all of the actions of progesterone.
 on gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology.  cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA. 2003 Oct 1;290(13):1739-48.

"Ovarian Risk Tied to Body Size" American Cancer Society. Nov. 9, 2001. http://www.cancer.org. Accessed Sept. 2004.

"Breakthrough Helps Ovarian Cancer Patients Beat Odds" National Ovarian Cancer Coalition. http://www.ovarian.org. Accessed Sept. 2004.

"Ovarian Cancer." CancerNet. National Cancer Institute. National Institutes of Health. http://www.cancer.gov. Accessed Sept. 2004.

"What Every Woman Should Know About Cancer." National Ovarian Cancer Coalition, http://www.ovarian.org. Accessed Dec. 2001.

"Ovarian, Uterine & Colon Cancers: Be Aware." National Women's Health Resource Center Health Report. Vol. 21, No. 1. February 1999.

Petricoin EF, Ardekani AM, Hitt BA, Levine PJ, Fusaro VA, Steinberg SM, Mills GB, Simone C, Fishman DA, Kohn EC, Liotta LA. Use of proteomic patterns in serum to identify ovarian cancer. Lancet. 2002 Feb 16;359(9306):572-7.

American Cancer Society. Cancer Facts and Figures, 2004..Available at: http://www.cancer.org. Accessed September 9, 2004.

Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004 Jun 9;291(22):2705-12

Questions and Answers: OvaCheckT and NCI/FDA Ovarian Cancer Clinical Trials Using Proteomics Technology. National Cancer Institute. [Press release]. Available at http://www.cancer.gov. Accessed July 20, 2004.

Conrads TP, Fusaro VA, Ross S, et.al., High-resolution serum proteomic features for ovarian cancer detection. Endocr Relat Cancer. 2004 Jun;11(2):163-78.

"Questions and answers about the CA-125 test." Johns Hopkins Pathology. August 2003. http://ovariancancer.jhmi.edu. Accessed April 2006.

"How is ovarian cancer found?" The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"How is ovarian cancer treated?" The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"What's new in ovarian cancer treatment and research?" The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"Can ovarian cancer be prevented?" The American Cancer Society. March 2006. http://www.cancer.org Accessed April 2006.

"What are the key statistics about ovarian cancer?" The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"Do we know what causes ovarian cancer?" The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"Questions and answers about Doxil." Doxil.com. http://72.14.203.104. Accessed April 2006.

"Treatment for Epithelial Ovarian Cancers by Stage." The American Cancer Society. March 2006. http://www.cancer.org. Accessed April 2006.

"Docetaxel With or Without Phenoxodiol in Treating Patients With Recurrent Advanced Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cavity Cancer." Clinicaltrials.gov. March 2006. http://www.clinicaltrials.gov. Accessed April 2006.

Keywords: Endometrium endometrium /en·do·me·tri·um/ (-me´tre-um) pl. endome´tria   the mucous membrane lining the uterus.

en·do·me·tri·um
n. pl.
,Keloids,Malignant,Nicotine,Anti-La,Breast implant
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Publication:NWHRC Health Center - Ovarian Cancer
Date:May 30, 2006
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