INTRODUCTIONThe disease we have decided to write our report is on ovarian cancer. It is cancer that begins in the ovaries, which are important organs in the human female reproductive system. The normal functions of the ovaries are to produce most of the human sex steroid hormones, which will be Estrogen, Progesterone and Androgens. These substances control the start of puberty and sexual development and regulate the menstrual cycle. Ovaries are also the source of eggs or oocytes, which are released monthly during the process of ovulation in women of reproductive age. The ovaries of newborn female babies already contain all the eggs they will ever have, as the girl matures, the hormones produced by her body causes the eggs to mature and to be released then the ovary must repair itself and undergo the process of regeneration, ready for fertilization and growth into a fetus. WHAT IS OVARIAN CANCER?It has been known scientifically for over 150 years. 5% – 10% are associated with ovarian cancer are associated with hereditary risks and can be inherited from either parents. A family history of Prostate Cancer may be linked to Ovarian Cancer. The ovary is composed of three different cell types. They are: Epithelial Tissue, Germ cells, which produce eggs, and Stromal tissue, a mesh that supports the ovary. All three of these cell types can give rise to ovarian cancer, but not all cancers are treated the same. Other types of cancer are much more and these include mixed mesodermal tumours or carcinomas and small cell cancer. Ovarian cancer is a serious and under recognized threat to women’s health. It is the deadliest of all gynecologic cancers and is the fifth leading cause of cancer death among women. It is also the sixth most common type of cancer to affect women.Epithelial Ovarian Cancer is the most common type, occurs in the surface, related to the frequency of ovulation. The fallopian tubes may be where most ovarian cancers arise from and the most commonly diagnosed will be from the age 60 and older.Germ Cell Tumour usually occur inside the gonads, if originated outside of the gonads there may be birth defects resulting from errors during development of the embryo. It is often diagnosed in young women, and make up 20% of all ovarian tumours and 3% are malignant. Stromal Carcinoma develops in connective tissue of cells that holds the ovary together and the one that produces female hormones Estrogen and Progesterone. The two most common types are the Granulosa cell tumours and the Sertoli’s and Leydig’s.SYMPTOMS• Bloating is normal due to the fluid accumulating in the abnormal cavity. This is because of the cancer spreading• Feeling full or loss of appetite can be because of the fluid as well and can potentially affect breathing once reaches the lung areas• The chances of pregnancy after diagnosis are uncertain because treatments can affect the woman’s reproductive system• The intestines can be affected because they are relatively close which causes swelling and painOther Symptoms:• Abdominal, pressure• Bloating or discomfort• Constipation/Diarrhea• Fatigue• Nausea• Indigestion/Gas• Shortness of breath• Unexplained weight gain or loss• Urinary frequencyDIAGNOSISOne reason ovarian cancer can be a difficult disease to cure is that it often has spread extensively by the time it is diagnosed and another reason is that the treatments do not work completely for everyone. There are no unique symptoms or findings that can lead a health care professional to make a definite diagnosis very early. Almost one-third of women who are eventually diagnosed with ovarian cancer experienced their symptoms for more than six months before the diagnosis was made. When a woman visits a health care provider because she is experiencing symptoms, the health care provider will probably recommend a series of diagnostic tests to determine the cause of the symptoms. When a patient describes symptoms that could signal a number of different problems, the health care provider will create a mental list of possible diagnoses. Tests are performed to rule out or confirm diagnoses on the list then as the test results become known, one of the potential diagnoses become most likely, and then further testing can focus intently on ruling out or confirming the specific diagnosis. To confirm diagnosis physicians will perform a Laparotomy. It is an exploratory surgical procedure that is required to confirm an ovarian cancer diagnosis. Surgery is nearly always performed to assess the nature of the cancer and treat the disease. Staging the disease is the process of determining the stage of the tumour, which is determined by the location of the cancer, whether other parts of the body are affected and the prognosis. The doctor can prescribe appropriate treatment once she or he knows the stage of tumour.STAGING OF OVARIAN CANCERThe staging of ovarian cancer is performed in order to determine the extent and spread of the disease. Majority of women are found to have advanced diseases at the time of diagnosis. The staging is based on the International Federation of Gynecology and Obstetrics. (FIGO)Stage I: The cancer spread is limited to one or both ovariesIA: Disease is confined to one ovaryIB: Disease is confined to both ovariesIC: Stage IA or IB with cancer cells in the peritoneal washing or ascites or rupture of the ovarian tumour.Stage II: The cancer is confined to the pelvisIIA: Disease has spread to the fallopian tubes and/or uterusIIB: Disease involves other pelvic organs including the bladder, pelvic colon or peritoneum IIC: Stage IIA or IIB with cancer cells on the ovarian surface, pelvic washings or ascites or rupture of the ovarian tumourStage III: The cancer has spread to the abdomenIIIA: Microscopic disease in the abdominal activityIIIB: Abdominal diseases that is 2 cm or less in diameterIIIC: Abdominal disease that is greater than 2 cm or spread to the retroperitoneal lymph nodes (pelvic, para-aortic, or inguinal)Stage IV: Spread of disease outside of the abdomen such as a positive pleural effusion; the cancer cells in the fluid surrounding the lung or involvement of the liver parenchyma (Tumour) in the internal portion of the liver. The diagram shown on page 5 shows how the disease spreads throughout the body. Here are the stages:Before Ovarian Cancer: Healthy OvariesStage 1: Cancer is confined to one or both ovariesStage II: Cancer spreads within the pelvic regionStage III: Average stage of Diagnosis: Stage IIIC – Cancer spreads to other body parts within the abdomenStage IV: Cancer spreads beyond the abdomen to other body partsPREVENTIONHere are some examples of reducing risk of ovarian cancer:• Birth control pills are oral contraceptives that can cut risk of ovarian cancer in half if taken for at least five years because of the higher progestin levels• Pregnancy and breastfeeding may significantly lower the risk of ovarian cancer• Tubal ligation/Hysterectomy may help prevent when you carry BRCA1 or BRCA2 gene mutation and moderately disrupts blood flow in ovariesCURES AND TREATMENTSMany women experience anxiety about the surgical removal of the ovaries because these are the organs that secrete the female hormones. After menopause, the ovaries secrete little to no hormonal products. Even prior to menopause, removing the ovaries does not result in a loss of femininity. It is important to talk to family members and your physician about your concerns. The surgery is often referred to as primary cytoreductive or debulking surgery. The goal of this surgery is to remove as much of the tumour that is present as possible while keeping your safety in mind. There are multiple goals of the surgery. First, surgery will confirm the diagnosis, if not done already. Secondly, when the tumour is large, removing it may provide relief from pain and pressure caused by the disease. Lastly, it has been well established that reducing the largest remaining tumour to one centimeter or less in diameter will result in an improved survival for the patient; this is referred to as optimal cytoreduction. Furthermore, the ability to remove all visible disease, referred to as complete cytoreduction. These procedures are one of the most critical choices you will make for your treatment and one you should research thoroughly.Surgery is the first step of a lifelong process. You are encouraged to ask questions about which you have concerns. After the date is set for the surgery, you will feel a sense of relief. Focus on the surgery and the recovery process. Take things step by step. At your postoperative visit, when you are ready, you will be given details regarding the next steps.A patient without a health insurance is charged within the range of $20, 000 or more for surgery up to $200, 000. A hysterectomy typically costs $10, 000 to $20, 000 or more but can reach more than $40, 000 depending on the extent of the surgery.AFTER SURGERY One of the more common side effects is infection, which may occur in one of many places such as the bladder, the surgical incision site, the IV sites, in the abdominal cavity, or in the blood stream. Treatment varies based on the site but may include antibiotic treatment or drainage of the infection. Another would be bowel dysfunction, which may result in nausea and vomiting. Muscle weakness and fatigue are also common side effects following the surgery and often improve with time and mild activity such as physical activity when you are able since you will become more comfortable with the incision and allows your muscles to regain strength as well as preventing one of the major causes of death after surgery.After your surgery, the pathologist will study the surgical tissue and report the degree of spread of the disease. If the disease has spread beyond the ovaries, you will need additional therapy that is given in the form of chemotherapy. The goal is to give the most effective amount of chemotherapy while preventing or minimizing side effects on the drugs. Chemotherapy works by targeting these differences in the cancer cells. This process will be administered over planned time intervals referred to as the chemotherapy schedule.CONCLUSION The three of us have heard of this devastating disease but we had little to no knowledge of this concept. Doing this research gave us a chance to really understand what it is like to have one of the hardest diseases there is to human history and learning about individuals who have this made us realize how strong one’s human body is and we are thankful that there may not be official cures but there are many different ways of treatments or preventions to help idle them before they get worse. We now give much higher praises to people who continue to live or survive with this disease for it takes such strength and motivation to continue to fight their battles to continue living as much as they can.