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

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

Three main types of ovarian cancer exist:

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

reason of ovarian cancer

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

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

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

Signs & symptoms

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

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

Diagnosis of mastitis & breast engorgement

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

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

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

Treatment of mastitis & breast engorgement

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

Conservative treatment

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

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

Aggressive treatment

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

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

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

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

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

Other treatments

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

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

Special considerations If the patient has mastitis:

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

Before surgery:

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

After surgery:

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

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

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

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