Surgery
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
both ovaries and fallopian tubes (salpingo-oophorectomy)
the uterus (hysterectomy)
the omentum (the thin, fatty pad of tissue that covers the intestines)
nearby lymph nodes
samples of tissue from the pelvis and abdomen
If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.
You may be uncomfortable for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
The time it takes to heal after surgery is different for each woman. You will spend several days in the hospital. It may be several weeks before you return to normal activities.
If you haven't gone through menopause yet, surgery may cause hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time
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Showing posts with label for. Show all posts
risk factors for ovarian cancer
Risk factors
Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, we do know that women with certain risk factors may be more likely than others to develop ovarian cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for ovarian cancer:
Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer
Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, we do know that women with certain risk factors may be more likely than others to develop ovarian cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for ovarian cancer:
Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer
staging for ovarian cancer
Staging
To plan the best treatment, your doctor needs to know the grade of the tumor (see Diagnosis) and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.
Your doctor may order tests to find out whether the cancer has spread:
CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
Chest x-ray: X-rays of the chest can show tumors or fluid.
Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer:
Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs
To plan the best treatment, your doctor needs to know the grade of the tumor (see Diagnosis) and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.
Your doctor may order tests to find out whether the cancer has spread:
CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
Chest x-ray: X-rays of the chest can show tumors or fluid.
Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer:
Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs
Why Not Try Some Natural Treatments for Ovarian Cysts
Natural Treatment for Ovarian Cysts and PCOS
Natural Ovarian CystNatural Ovarian Cyst Relief Secrets is a step-by-step guide to eliminating ovarian cyst within weeks.
The author of the book, Laura Jenkins, suffered from a severe case of ovarian cyst. When none of the conventional treatments worked, she decided to do some research on her own.
She soon discovered why the usual medications don't work. The reason for this is simple - they treat only the symptoms, but do nothing about the root cause of the problem.
But that is not all; birth control pills that are most often prescribed for this condition can even make the cysts larger, eventually leading to surgery.
Laura Jenkins managed to cure her cysts by applying all-natural methods and techniques that she described in her book, the Natural Ovarian Cyst Relief Secrets. Yes, she did it!
In Laura's guide you will learn:
- Step-by-step method that can help you start shrinking your cysts within days,
- One critical factor that can cause the development of ovarian cysts,
- How to regain and maintain your hormonal balance,
- 5 critical mistakes that can worsen your condition,
- How to reverse your ovarian cysts by eating the right food,
- Which common household objects increase your chances of developing cysts,
- The main reason why women have ovarian cysts and what you can do about it,
- And more
Natural Ovarian Cyst Relief Secrets also contain guidelines that help you adjust the principles in the book to your specific situations.
Relief Secrets
Natural Ovarian CystNatural Ovarian Cyst Relief Secrets is a step-by-step guide to eliminating ovarian cyst within weeks.
The author of the book, Laura Jenkins, suffered from a severe case of ovarian cyst. When none of the conventional treatments worked, she decided to do some research on her own.
She soon discovered why the usual medications don't work. The reason for this is simple - they treat only the symptoms, but do nothing about the root cause of the problem.
But that is not all; birth control pills that are most often prescribed for this condition can even make the cysts larger, eventually leading to surgery.
Laura Jenkins managed to cure her cysts by applying all-natural methods and techniques that she described in her book, the Natural Ovarian Cyst Relief Secrets. Yes, she did it!
In Laura's guide you will learn:
- Step-by-step method that can help you start shrinking your cysts within days,
- One critical factor that can cause the development of ovarian cysts,
- How to regain and maintain your hormonal balance,
- 5 critical mistakes that can worsen your condition,
- How to reverse your ovarian cysts by eating the right food,
- Which common household objects increase your chances of developing cysts,
- The main reason why women have ovarian cysts and what you can do about it,
- And more
Natural Ovarian Cyst Relief Secrets also contain guidelines that help you adjust the principles in the book to your specific situations.
Relief Secrets
For Healthy People Daily Aspirin May Do More Harm Than Good
A UK study presented at a conference last weekend found no evidence to support the idea that a daily dose of aspirin protects people who do not have artery or heart disease from developing it in the future any better than a placebo, and experts suggest given the higher risk of internal bleeding from taking aspirin routinely, for healthy people such a precaution may do more harm than good
The study reported results from the Aspirin for Asymptomatic Atherosclerosis (AAA) study, whose joint first author Professor Gerry Fowkes from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh, presented the findings at the European Society of Cardiology (ESC) Congress 2009 in Barcelona, Spain on Sunday.
Fowkes said the study was the first placebo-controlled randomised trial to test the protective effect of aspirin in people who did not show signs of atherosclerosis as measured by a low ankle brachial index (ABI) at the start of the study, and that the results found:
"No statistically significant difference in primary endpoint events between those subjects allocated to aspirin or placebo."
ABI compares the blood pressure in the lower legs to the blood pressure in the arms and is a measure of whether peripheral artery disease might be present.
Studies have already shown that antiplatelet drugs like aspirin are effective in secondary prevention, where people who already have arterial disease, or have suffered a stroke or heart attack, use them to prevent a further event.
But as Fowkes explained, there was little evidence about how effective routine use of these drugs might be in primary prevention, that is protecting people who have not yet developed arterial or heart disease from getting it in the future, so that any benefits in this direction might be weighed up against the already known risk of bleeding.
The trial recruited 28,980 men and women who were living in central Scotlan and were aged from 50 to 75 years. Al the participants were free of clinically evident cardiovascular disease and went through ABI screening.
3,350 participants with low ABI (under or equal to 0.95) were then randomized to taking a once daily 100 mg dose of aspirin or equivalent placebo.
The researchers then followed them for an average of 8.2 years, using a mix of annual contact, looking at GP records, discharge reports from Scottish hospitals, and death notifications.
They looked for two kinds of information in the follow up, which they grouped according to whether they were primary or secondary endpoints of interest to the study.
The primary endpoints they looked for in the follow up records were: initial fatal or non-fatal coronary event or stroke, or revascularisation. They used this as a composite figure in the analysis.
They looked for two secondary endpoints: (1) all initial vascular events defined as a composite of a primary endpoint event or angina, intermittent claudication or transient ischaemic attack, or (2) death from all causes.
The results showed that:
"Although the AAA trial was not of screening per se, the results would suggest that using the ABI as a tool to screen individuals free of cardiovascular disease in the community is unlikely to be beneficial if aspirin is the intervention to be used in those found to be at higher risk."
"Other more potent antiplatelets might be considered, but only if increased effectiveness in avoiding ischaemic events is not matched by increased bleeding," he added.
The study was part funded by the British Heart Foundation, whose Medical Director, Professor Peter Weissberg said:
"We know that patients with symptoms of artery disease, such as angina, heart attack or stroke, can reduce their risk of further problems by taking a small dose of aspirin each day."
"The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits," he added.
However, other experts might suggest that the study's findings are too bound up with the issue of using ABI as the screening tool, and the question of whether these results would be different with another screening tool remains unanswered.
As Fowkes himself pointed out:
"It is possible that in the general population, aspirin could produce a smaller reduction in vascular events than this trial was designed to detect, but it is questionable whether such an effect, together with aspirin related morbidity, would justify the additional resources and health care requirements of an ABI [ankle brachial index] screening programme."
Speaking at another session the day before, Gilles Montalescot from the University Hospital of Pitié-Salpètrière in Paris, emphasized the difference between using aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) in primary and secondary prevention of strokes.
"If the net cerebrovascular benefit is in favour of aspirin in secondary prevention, it is a different story in primary prevention where the protection against ischemic stroke is offset by the risk of intracranial bleeding," said Montalescot.
Speaking at the same session, Carlo Patrono of the Catholic University School of Medicine in Rome, Italy, who worked on the AAA trial with Fowkes, said aspirin should be trialled further, as it may offer potential benefits in treating other diseases:
"Additional benefits of long-term aspirin therapy in preventing other serious outcomes, such as colorectal cancer, are not yet established by randomised clinical trials."
"However, the demonstrated efficacy of low-dose aspirin in reducing the risk of recurrence of sporadic colorectal adenomas is promising in this respect," added Patrono.
The study reported results from the Aspirin for Asymptomatic Atherosclerosis (AAA) study, whose joint first author Professor Gerry Fowkes from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh, presented the findings at the European Society of Cardiology (ESC) Congress 2009 in Barcelona, Spain on Sunday.
Fowkes said the study was the first placebo-controlled randomised trial to test the protective effect of aspirin in people who did not show signs of atherosclerosis as measured by a low ankle brachial index (ABI) at the start of the study, and that the results found:
"No statistically significant difference in primary endpoint events between those subjects allocated to aspirin or placebo."
ABI compares the blood pressure in the lower legs to the blood pressure in the arms and is a measure of whether peripheral artery disease might be present.
Studies have already shown that antiplatelet drugs like aspirin are effective in secondary prevention, where people who already have arterial disease, or have suffered a stroke or heart attack, use them to prevent a further event.
But as Fowkes explained, there was little evidence about how effective routine use of these drugs might be in primary prevention, that is protecting people who have not yet developed arterial or heart disease from getting it in the future, so that any benefits in this direction might be weighed up against the already known risk of bleeding.
The trial recruited 28,980 men and women who were living in central Scotlan and were aged from 50 to 75 years. Al the participants were free of clinically evident cardiovascular disease and went through ABI screening.
3,350 participants with low ABI (under or equal to 0.95) were then randomized to taking a once daily 100 mg dose of aspirin or equivalent placebo.
The researchers then followed them for an average of 8.2 years, using a mix of annual contact, looking at GP records, discharge reports from Scottish hospitals, and death notifications.
They looked for two kinds of information in the follow up, which they grouped according to whether they were primary or secondary endpoints of interest to the study.
The primary endpoints they looked for in the follow up records were: initial fatal or non-fatal coronary event or stroke, or revascularisation. They used this as a composite figure in the analysis.
They looked for two secondary endpoints: (1) all initial vascular events defined as a composite of a primary endpoint event or angina, intermittent claudication or transient ischaemic attack, or (2) death from all causes.
The results showed that:
- 357 participants had a primary endpoint event (reflecting a rate of 13.5 primary events per 1,000 person years).
- 181 of these were in the aspirin group and 176 were in the placebo group, with no statistically significant difference between them.
- 578 participants had a secondary endpoint vascular event, 288 in the aspirin and 290 in the placebo group, also with no statistically significant difference between them.
- Death from all causes was also similar in both groups (176 people died in the aspirin group and 186 in the placebo group).
- 34 (2 per cent) of the aspirin group participants had an initial event of major bleeding that required hospital admission, compared to 20 (1.2 per cent) in the placebo group.
"Although the AAA trial was not of screening per se, the results would suggest that using the ABI as a tool to screen individuals free of cardiovascular disease in the community is unlikely to be beneficial if aspirin is the intervention to be used in those found to be at higher risk."
"Other more potent antiplatelets might be considered, but only if increased effectiveness in avoiding ischaemic events is not matched by increased bleeding," he added.
The study was part funded by the British Heart Foundation, whose Medical Director, Professor Peter Weissberg said:
"We know that patients with symptoms of artery disease, such as angina, heart attack or stroke, can reduce their risk of further problems by taking a small dose of aspirin each day."
"The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits," he added.
However, other experts might suggest that the study's findings are too bound up with the issue of using ABI as the screening tool, and the question of whether these results would be different with another screening tool remains unanswered.
As Fowkes himself pointed out:
"It is possible that in the general population, aspirin could produce a smaller reduction in vascular events than this trial was designed to detect, but it is questionable whether such an effect, together with aspirin related morbidity, would justify the additional resources and health care requirements of an ABI [ankle brachial index] screening programme."
Speaking at another session the day before, Gilles Montalescot from the University Hospital of Pitié-Salpètrière in Paris, emphasized the difference between using aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) in primary and secondary prevention of strokes.
"If the net cerebrovascular benefit is in favour of aspirin in secondary prevention, it is a different story in primary prevention where the protection against ischemic stroke is offset by the risk of intracranial bleeding," said Montalescot.
Speaking at the same session, Carlo Patrono of the Catholic University School of Medicine in Rome, Italy, who worked on the AAA trial with Fowkes, said aspirin should be trialled further, as it may offer potential benefits in treating other diseases:
"Additional benefits of long-term aspirin therapy in preventing other serious outcomes, such as colorectal cancer, are not yet established by randomised clinical trials."
"However, the demonstrated efficacy of low-dose aspirin in reducing the risk of recurrence of sporadic colorectal adenomas is promising in this respect," added Patrono.
Treatment Options for Ruptured Ovarian Cysts:
The treatment you receive for a ruptured ovarian cyst will depend on the severity of your condition when you presented to hospital, the extent of damage caused by the rupture and upon whether or not there were any complications associated with the cystic rupture.
Primary treatment of your condition will be to stabilize your condition, if you have presented in an emergency situation. Doctors will need to assess your airway, breathing and circulation, and may need to start you on intravenous treatment. For very unstable patients, your first diagnostic treatment will include a culdocentesis, to determine the type and extent of fluid in your abdominal cavity.
In most cases of ovarian cyst rupture, whether there have been complications or not, you will be started on antibiotics. In the short term, you may be treated with stronger antibiotics such as Gentamycin or its variants. This drug has a narrow therapeutic window and treatment with this drug will not be extended. You will likely also receive a broad-spectrum penicillin variant as well as a drug such as Metronidazole, which acts against anaerobic bacteria and protozoa. Treatment may also include a cephalosporin drug, such as Cefotetan, which targets gram-positive cocci bacteria and gram-negative rod bacteria.
In pre-menopausal women, your doctor is likely to want to induce an anovulatory state - that is, to prevent ovulation. This will be achieved using oral contraceptive medication. It is important to use this medication to reduce stimulation of the ovaries, which also reduces the risk of further cysts. Treatment with oral contraceptives is not likely to be permanent, and you can discuss your options for falling pregnant with your doctor.
Of course, since ruptured ovarian cysts are often quite painful, your doctor will want to help you manage your pain. The type of analgesic medication you are given will depend on the other medications you are being given. Acutely, preventing infection is the primary concern, so doctors may change your pain medication as your antibiotic load changes. Typically, you may be started on a higher dose analgesic such as Fentanyl or a barbiturate such as Vicodin. A lower dose codeine derivative, such as Tylenol, will be recommended for mild to moderate pain. Newer analgesics, such as Ketorolac may also be useful therapeutic agents in certain situations.
Once your condition has been stabilized, your doctor may want to continue running tests to understand your condition more fully. You are likely to have regular abdominal examinations, both manual and by ultrasound. Your doctor may need to undertake a laparoscopic or surgical exploration to either diagnose or treat your ruptured ovarian cyst. Surgical management of a hemorrhagic cyst will probably be necessary.
If your treatment has included a surgery, your doctor will speak to you about your post-operative care. There will be things that you will need to do, such as regular foot and leg exercises to prevent blood clots if you are bed bound. You will also be advised not to undertake certain activities, such as use of tampons and sexual intercourse, until your medical team is satisfied with the way that your body has healed following surgery.
After you leave hospital, it is likely that your condition will continue to be monitored over a series of outpatient appointments. These consultations may involve further ultrasonography. You may also need to consult your gynecologist to rule out any underlying malignancy or to talk about how your condition may have impacted on your fertility.
Primary treatment of your condition will be to stabilize your condition, if you have presented in an emergency situation. Doctors will need to assess your airway, breathing and circulation, and may need to start you on intravenous treatment. For very unstable patients, your first diagnostic treatment will include a culdocentesis, to determine the type and extent of fluid in your abdominal cavity.
In most cases of ovarian cyst rupture, whether there have been complications or not, you will be started on antibiotics. In the short term, you may be treated with stronger antibiotics such as Gentamycin or its variants. This drug has a narrow therapeutic window and treatment with this drug will not be extended. You will likely also receive a broad-spectrum penicillin variant as well as a drug such as Metronidazole, which acts against anaerobic bacteria and protozoa. Treatment may also include a cephalosporin drug, such as Cefotetan, which targets gram-positive cocci bacteria and gram-negative rod bacteria.
In pre-menopausal women, your doctor is likely to want to induce an anovulatory state - that is, to prevent ovulation. This will be achieved using oral contraceptive medication. It is important to use this medication to reduce stimulation of the ovaries, which also reduces the risk of further cysts. Treatment with oral contraceptives is not likely to be permanent, and you can discuss your options for falling pregnant with your doctor.
Of course, since ruptured ovarian cysts are often quite painful, your doctor will want to help you manage your pain. The type of analgesic medication you are given will depend on the other medications you are being given. Acutely, preventing infection is the primary concern, so doctors may change your pain medication as your antibiotic load changes. Typically, you may be started on a higher dose analgesic such as Fentanyl or a barbiturate such as Vicodin. A lower dose codeine derivative, such as Tylenol, will be recommended for mild to moderate pain. Newer analgesics, such as Ketorolac may also be useful therapeutic agents in certain situations.
Once your condition has been stabilized, your doctor may want to continue running tests to understand your condition more fully. You are likely to have regular abdominal examinations, both manual and by ultrasound. Your doctor may need to undertake a laparoscopic or surgical exploration to either diagnose or treat your ruptured ovarian cyst. Surgical management of a hemorrhagic cyst will probably be necessary.
If your treatment has included a surgery, your doctor will speak to you about your post-operative care. There will be things that you will need to do, such as regular foot and leg exercises to prevent blood clots if you are bed bound. You will also be advised not to undertake certain activities, such as use of tampons and sexual intercourse, until your medical team is satisfied with the way that your body has healed following surgery.
After you leave hospital, it is likely that your condition will continue to be monitored over a series of outpatient appointments. These consultations may involve further ultrasonography. You may also need to consult your gynecologist to rule out any underlying malignancy or to talk about how your condition may have impacted on your fertility.
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