Ovarian cancer is a significant health concern for healthcare providers and scientific medical world. Severe mutations in the genes, cellular impairments, and hormonal imbalance are associated with active and abnormal proliferation of malignant cells in the ovaries specific to ovarian cancer. Various genetic and environmental factors facilitate its progression. It considerably compromises vital reproductive functions of the females. The variety of clinical manifestations reveals cancerous alterations in the ovaries primarily at the advanced stage whereas they are vague on the onset of the disease. Gynecologists approach multiple traditional and newly-designed diagnostic techniques for detecting ovarian malignancy. They involve various therapeutic interventions such as targeted medication, chemotherapy, radiation therapy, surgery, and hormonal therapy for combatting the affliction under discussion. The given disease has deleterious effects on the affected individual and their family, and entails significant financial costs. However, further research is crucial for improving diagnostic and therapeutic techniques that can be beneficial for preserving females health.
Keywords: female, cancer, ovaries, disease
Ovarian cancer is a serious, life-threatening malignant condition that considerably deteriorates a females health. It increases a risk of losing fertility abilities due to the penetration of cancerous cells into the reproductive organs. The stated disease can progress asymptomatically that, consequently, aggravates and reduces further treatment perspectives. Sufficient theoretical background regarding the pathophysiology of ovarian cancer, available diagnostic methods, and treatment options can be beneficial to successfully address the disease. The information related to the social and economic effects associated with ovarian cancer will assist in developing appropriate preventive care strategies.
Definition and Epidemiology
Ovarian cancer is a severe malignant lesion of the reproductive organs called ovaries. It is characterized by excessive and uncontrollable infiltration of cancer cells in the ovaries that can potentially transform into a malignant tumor (U.S. National Library of Medicine, 2017). In view of the site of malignancy, practitioners differentiate epithelial and non-epithelial types of ovarian cancer. Epithelial ovarian cancer progresses in case cancer attacks epithelial ones whereas non-epithelial ovarian cancer occurs when the malignancy affects other tissues of the ovaries. It is estimated that approximately 90% of primary ovarian tumors pertain to epithelial type. This condition is prevalent in menopausal and old women (European Society for Medical Oncology, 2014). Furthermore, sex cord stromal tumors and germ cell tumors are the major types of the non-epithelial ovarian cancer.
Duly-done diagnosis is crucial for preserving vital reproductive functions of females and, consequently, childbearing status. Family history associated with ovarian cancer, young age, and sufficient health condition does not increase the chances of complete recovery. However, ovarian cancer can considerably reduce life span due to the insidious nature of malignant cells and locations of the ovaries that complicate early diagnosis and treatment.
The discussed disorder is the seventh primary cause of cancer-related deaths of females in the world. Thus, in 2013, the incidence of ovarian cancer comprised 22,240 clinical cases registered in the United States (McCance & Huether, 2014, p. 831). The given affliction can affect a woman of any age, though the females aged 50 to 60 and older are more susceptible to acquiring symptoms of ovarian cancer. It is estimated that around 88% of ovarian cancer accrue to the women aged 45 years and older (Algeciras-Schimnich, 2013). Asymptomatic progression peculiar to this malignancy aggravates early diagnosis that, consequently, causes more fatalities compared to any other cancer of the females reproductive organs. Furthermore, detection of cancerous abnormalities in the ovaries in the late stages is associated with poor survival rate. According to Center for Disease Control and Prevention reports (2017), there were 21,161 diagnosed ovarian cancer cases in 2014 and 14,195 deaths related to the given disease. Various credible organizations assert that the number of similar clinical cases and the number of fatalities will remain within approximately the same range that can negatively affect demographic situation in the countries with problematic population growth. Subsequently, it comprises an extra socioeconomic burden for any state budget. Furthermore, statistics report that ovarian cancer particularly prevails in white females compared to those of African or Hispanic race.
Physiology and Pathophysiology
The ovaries are the almond-shaped gonads that are located on both sides of female uterus. They are responsible for estrogen and progesterone production as well as for other female hormone secretion. In addition, the given reproductive organs produce vital but small amounts of androgen (McCance & Huether, 2014, p. 776). Sufficient production of female sex hormone is critical for proper functioning of the reproductive organs and the entire reproductive system. Simultaneously, the ovaries participate in the female ova formation and its release.
The discussed disease primarily develops either in the ovarian epithelial cells or in the abdominal linings epithelial cells from where the cancer starts spreading to the ovaries. Certain types of ovarian cancer originate from the surrounding tissues that join the ovaries or in the cells that act as ova precursors. Uncontrollable and abnormal proliferation of malignant cells triggers severe physiological impairments and cellular alterations that can be frequently revealed at the advanced stages of ovarian cancer progression. Progressive ovarian cancer can damage neighboring organs or affect lymph nodes. In addition, mutated cells can infiltrate the bloodstream and start spreading to other organs.
The pathophysiology of ovarian cancer remains a controversial issue since there is no certainty in exact pathways of the disease under review. However, researchers concur that breast cancer genes BRCA1 and BRCA2 or discordant repair genes initiate the development of ovarian cancer (U.S. National Library of Medicine, 2017). The aforementioned genes being specific tumor suppressor genes produce proteins that makes it possible to preserve genetic information, providing cellular stability and repairing DNA damage. However, any mutations that occur in the stated genes can interfere with DNA fixing that, consequently, disturb cellular balance and entail multiplication and growth of the abnormal cells. Furthermore, one researcher identified that mutations in the MLN1 or MLN2 genes and somatic mutations in the TP53 gene can ultimately facilitate tumor progression (U.S. National Library of Medicine, 2017). Additionally, mutations in the TP53 gene decrease or eradicate tumor suppressive capacities that accelerate the cancerous tumor formation (U.S. National Library of Medicine, 2017). Therefore, significant cellular impairments and mutations in the tumor suppressor genes are strongly associated with ovarian cancer.
Researchers have specified certain risk factors that increase the chances of having ovarian cancer, despite the precise etiology of ovarian cancer remaining unidentified. Females of any age are prone to acquiring the malady under scrutiny. However, it is mostly common for the women in premenopausal and menopausal age. Individuals with genetic predisposition and family history of breast or ovarian cancers are at a greater risk of having symptoms of the reviewed disease due to the presence of mutated BRCA1 and BRCA2 genes in the body. Furthermore, women with such genetic abnormalities as Peutz-Jeghers syndrome, Lynch syndrome, and confirmed polycystic ovary syndrome are predisposed to ovarian cancer (Cancer Treatment Centers of America, 2017). The preterm menarche and menopause can also be responsible for experiencing ovarian cancer symptoms. The long-term estrogen hormone replacement therapy, the presence of breast, colorectal and endometrial cancers, the application of intrauterine devices, and long-term fertility medication administration can potentially imply the development of ovarian cancer (Mayo Clinic Staff, 2014a). Furthermore, endometriosis, no history of pregnancy, hormone imbalance, excessive weight and abnormal smoking can ultimately facilitate the spread of the disease under discussion.
Symptoms and Signs
Asymptomatic development is inherent for ovarian cancer until it reaches the advanced stage. Its similarity with digestive or intestinal dysfunctions frequently prevents the correct and early diagnosing and consequent medical management. The onset of the disease primarily manifests in persistent abdominal distention, decreased appetite, and pelvic pain, frequent and urgent urination, and indigestion (McCance & Huether, 2014, p. 832). The first symptoms of the disease are vague and frequently ignored. Females with ovarian cancer can experience abnormal bowel movements, vaginal bleedings and abnormal menstruation. They complain about rapid satiety, vomiting, nausea, fatigue and dyspnea. The progressed ovarian cancer can occur in dyspepsia, venous or arterial thrombosis as well. Finally, ovarian cancer is associated with clot formation and pleural effusion.
Proper diagnostic evaluation is critical for ovarian cancer detection and the development of appropriate treatment regimen. Diagnosticians involve various available diagnostic methods and tools for revealing alterations characteristic of ovarian cancer. Preliminary evaluation commonly includes thorough physical examination, medical history study, scrutiny of the prescribed laboratory and imaging tests. The vaginal assessment can disclose certain visible abnormalities in the uterus or in the ovaries (Nordqvist, 2016). However, it is difficult to properly assess impairments on routine gynecologic examination due to ovaries being located deep in the abdomen. Patients interview and medical history study can be helpful in identifying genetic and other risk factors present in the affected individual.
Blood smear, laparoscopy, colonoscopy, and ultrasound of the abdomen largely assist in revealing internal impairments and alterations associated with ovarian cancer. The abnormalities in blood smear demonstrate inflammation in the body that requires further investigation. Health care providers start screening with a blood test CA-125 that measures cancer antigen 125 (McCance & Huether, 2014, p. 833). High CA-125 level and abdominal swelling increase the contingency of having cancer in the ovaries. Furthermore, HE4 blood test is critical for controlling treated patients diagnosed with ovarian cancer due to high likelihood of recurrent cases (Chyke, Doubeni, Doubeni, & Myers, 2016, p. 940).
In certain instances, the involvement of laparoscopy and colonoscopy is beneficial for detecting internal abnormalities. Laparoscopy assists in examining and evaluating the lower abdomen whereas colonoscopy is useful for uncovering impairments in the intestines. It is particularly recommended for those who complain about rectum bleeding or severe constipation. In fact, such test as abdominal fluid aspiration can detect abnormalities in the abdomen. A high level of abdominal fluid primarily reveals the malignancy spreading in the ovaries.
Such imaging techniques as abdominal and pelvic computed tomography, transvaginal ultrasound, and magnetic-resonance scanning are presently practiced for diagnosing cancer of this type. The reason is that they essentially assist in disclosing masses in the abdomen and pelvis, the abdominal cavity fluid, bowel obstruction (Green, St?ppler, & Davis, 2016). Moreover, these imaging tests can uncover kidney abnormalities and tumors in the reproductive organs. The aforementioned methods are vain in detecting the type of tumor, except for biopsy that can finally confirm the presence of ovarian malignancy. Therefore, all diagnostic tests and tools are critical for identification of the disease and determining its extent. In addition, they are ultimately helpful during treatment and after-therapy monitoring.
Gynecologists approach a variety of treatment modalities that can be highly efficient in managing ovarian cancer. Clinicians actively prescribe chemotherapy sessions, radiation therapy, surgery, targeted medication, and hormone therapy. Surgical interventions are primarily involved for removing the tumor or conducting ovariectomy. With regard to extensive surgery, it includes the excision of the ovaries, the fallopian tubes, and the uterus from the area of ovarian cancer lesion (Mayo Clinic, 2014b). Surgeons frequently remove nearby lymph nodes and fatty abdominal tissues to minimize the risk of metastatic spreading. A partial surgery implicates the resection of one ovary that can preserve the fertility ability.
Targeted medication is beneficial for suppressing cancer cells multiplication and growth, and their gradual elimination. Chemotherapy is also an efficient alternative for treating advanced forms of ovarian cancer. It is designed for destroying malignant cells and ceasing their proliferation. Chemotherapy generally precedes surgery for preventing metastasis development and spreading inside the body. In certain cases, it is recommended to conduct postsurgical adjuvant chemotherapy to minimize further spread of the disease (Chyke, Doubeni, Doubeni, & Myers, 2016). Much like chemotherapy, radiation therapy is used for liquidating malignant cells and shrinking tumors. Appropriate supportive care and psychological support is crucial for the females affected by ovarian cancer.
Researchers keep developing medication and enhancing treatment options that can be effective for ovarian cancer management. Such newly-designed therapies as small-molecular-weight inhibitors, monoclonal antibodies, epidermal growth factor receptors, gene therapy, and PARB inhibitors are under clinical trials that can confirm their appropriateness and applicability for treating ovarian cancer (McCance & Huether, 2014, p. 834).
Ovarian cancer becomes a serious psychological, financial and physical challenge for the affected person and her close environment, particularly for the family, considering the urgent need to arrange immediate treatment and regular care. The given disease is a severe psychological factor that negatively affects the patients mental health considering the adverse effects of the aggressive therapy and the increased risk of losing childbearing status due to surgical interventions. The affected person frequently experiences anxiety, depression, emotional instability and solitude. It can drastically disturb social interactions, as well as private relationship of the couple due to serious health decline of the sufferer. Therapy expensiveness is ultimately a factor that distresses everyone. Severe forms of the stated cancer can result in further unemployment or decreased working hours. Additionally, ovarian cancer can compromise reproductive health of the affected woman and her childbearing status. Furthermore, family and relatives that are supposed to provide nursing care to the sick family member can suffer from deficient social communication and interaction. It can, consequently, worsen their physical and psychological health status. Thus, supportive care and psychological assistance are critical for minimization of the negative events associated with the disease. It is a crucial factor that can contribute to recovery.
Multiple researchers and investigators continue developing novel drugs and modes of treatment that can be effective in treating ovarian cancer with minimal negative consequences. Additionally, they actively work on designing diagnostic devices that can reveal the disease at the earliest stages and, consequently, reduce ovarian cancer mortality rate. The financial expenses incurred due to provision of medical and nursing care to the patients with this kind of cancer and continuous research for treatment alternatives is associated with significant economic burden for the American tax-payers.
Ovarian cancer is a serious malignant disease that considerably deteriorates female health. It is characterized by abnormal multiplication and growth of mutated cells on the epithelial surfaces or tissues of the ovaries. Family history, the presence of abnormal genetic syndromes and other cancerous conditions are the biggest risk factors that predispose a female to acquiring ovarian cancer. The onset of ovarian cancer is specified by asymptomatic progression or vague clinical manifestations such as abdominal swelling, pelvic pain, decreased appetite, and fatigue. Further development of the disease can be revealed by vaginal bleedings, abnormal bowel movements, urgent urinations, and abdominal distension. Blood tests, colonoscopy, laparoscopy, and various imaging scans significantly assist in reveling malignancy in the ovaries. Such treatment modalities as chemotherapy, surgical interventions, targeted medication, hormone and radiation therapies can be efficient for ovarian cancer management.