Ovarian Cancer Treatment Information

OVARIAN CANCER TREATMENT INFORMATION

Description of the Normal Ovaries

The ovaries are the two "egg shaped" ("ovoid") structures which are suspended in the female pelvis. They are normally of a pinkish-grey color, and are land 1/2 inches in length, 3/4 of an inch in width, 1/3 of an inch thick, and weigh 1/4 of an ounce apiece. They are smooth in a youngster, but tend to be puckered and pockmarked in older women. The outer coat of the ovary is a tough glisteny membrane called the "tunica albuginea". There is one ovary on either side of the uterus (womb), and they connect to the uterus via the fallopian tubes. Along with the lower cervix, vagina and vulva, these "organs" make up the female reproductive system. A "system" is made up of several organs, an "organ" is made up up various tissues, and a "tissue" is made up of many individual "cells", which are the smallest unit of human life. A network of "ligaments" of connective tissue suspends the ovaries in the pelvis. Specifically, each "broad ligament" helps connect the ovaries to the uterus; the fallopian tubes are embedded in the upper portion of the broad ligament. The "ligament of the ovary" connects the lower portion of the ovaries to the uterus, while the "round ligament" tethers the uterus itself inside the pelvis. Thus the actual position of the ovaries in the female pelvis will vary with the position of the uterus, but normally the ovaries are very close to the inner muscular "pelvic wall". The upper portions of the ovaries are free of attatchments. The "ampulla" of the fallopian tubes curves around each ovary to receive its contents, but it also can miss allowing an egg, germ or cancer cell to get onto the "peritoneal" membrane lining that surrounds the inner pelvis and abdomen. This is an important "route of spread" for ovarian disease.

The blood supply to the ovaries and fallopian tubes are from a tributary of the great descending "aorta" which emanates from the heart and supplies the entire body below the heart with fresh blood. Specifically, the paired "gonadal" or "ovarian" arteries from the aorta conduct blood to the ovaries to nourish them. The importance of the ovaries is highlighted by the fact that they have their own blood vessels supplying them, in contrast to other pelvic organs which share sub-branches of the aorta. Used blood drains from the ovaries into a network ("plexus") of veins, called the "pampiniform plexus", ultimately this collected blood drains back to the heart by way of the large "inferior vena cava" which collects used blood from the lower body. This venous drainage system can act as a route of spread for infection or cancer. When blood goes into the smallest vessels, called "capillaries", the fluid portion of the blood ("serum") seeps out to bathe the individual cells with oxygen and nutrients. This fluid is then called "lymph", and it is recollected by "lymph channels". The lymph channels conduct the lymph fluid to local "lymph nodes" which abnormally pea-sized glands stuffed with white blood cells. Lymph nodes "filter" the lymph fluid, and the nodes interconnect to send the purified lymph back toward to heart to rejoin the bloodstream. Regarding the ovaries, the lymph drainage occurs along the ligaments and the fluid is processed in "groups" of "regional lymph nodes". These are named according to the major blood vessels they are near. For the ovary, the regional lymph node groups in the pelvis include the the "iliac', "hypogastric", "sacral", and "obturator" nodes. These are all subgroups of "pelvic" lymph nodes. Drainage of lymph fluid to further regional nodes, including the "inguinal" in the groin and the "Para-aortic" in abdomen can occur. When lymph nodes trap germs or cancer cells, they swell ("lymphadenopathy"). Lymph nodes are considered "enlarged" when they are larger than 1 cm (-1/2 inch) across. The lymph system can act as a conduit for spread of infections or cancer, but conversely it may help limit these processes by trapping and destroying germs or cancer cells.

The ovaries are the female paired reproductive organs ("gonads") which produce store, and release eggs ("ova") in anticipation of child-bearing. Each part of the reproductive system has its "counterpart" in the opposite sex-- that is what it would have been had the sex been different. The counterpart to the ovaries are the male testicles, to the clitoris is the penis, and to the vulva is the scrotal sac. While in the womb, "hormonal influences" (messenger chemicals) under the control of "genes" within each living "cell" guide the early gonad cells to develop ("differentiate") into either female or male gonads and genitals. The presence of the male hormone "testosterone" is coded for by the "Y" sex chromosome, and if it is present, testicles, a penis, and a scrotum will form. Conversely, in incipient females only the "X" sex chromosomes are present, meaning ovaries, fallopian tubes, a uterus, cervix, vagina and vulva will develop in the early fetal period. From birth, the ovary contains all of the "eggs" that a female will ever have, usually about 100,000. This is different than the male, who continues to produce new sperm through adult life. The ovary produces hormones (estrogen and progesterone) which are critical in female maturation and fertility. The ovary is composed of several types of cells, each of which can give rise to specific cancers. These cells include the primordial eggs themselves ("oocytes"), the supporting cells which contain them ("epithilial cells") and hormone-producing cells ("Granulosa" and "Theca" cells). Young women first start their monthly "periods" at "menarche", which normally occurs around 11 years of age. With each monthly "menstrual cycle" one (or occasionally more) egg(s) are released in anticipation of fertilization. The lining of the uterus ("endometrium") is built up prior to the egg's release to form a nourishing surface for combining egg and sperm, and sustaining the resultant "embryo". If successful fertilization occurs, then the embryo will become a "fetus" after 8 weeks of gestation in the womb, by which time its sex becomes apparent. If no fertilization occurs, then the egg dies, and the inner lining of the uterus sloughs off as a bloody emission called I'menses". As the ovary ages, it gives up its egg cells during each month's period or for a pregnancy. By age 50 or so, the ovary runs out of eggs, loses it's ability to produce hormones, and shrinks ("atrophies"). This process is called "menopause". Most ovarian cancers occur after the age of menopause.

What is Ovarian Cancer?

The ovary is composed of individual cells, including the eggs (oocytes), supporting cells of the organ (epithelial cells), and hormone-producing cells (granuloma and theca cells). These cells divide to produce new ones, and grow very rapidly during womb life, early childhood and puberty. In adulthood, new cells are produced only to replace those that die of old age, injury or disease. As mentioned, no more egg cells are ever produced after womb life, however other ovarian cells are. Normally, division of cells is under very tight control. This control is exerted by the "genes" inside each cell, which are housed in long clumps forming "chromosomes", which are visible under a light microscope. The genes themselves are made up of DNA, the master genetic code material. If the genes are damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Ovarian cancer starts in a single cell. That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so the cancer can continue to grow. Quickly growing cells can clump up to form a "tumor". A tumor simply means a swelling, it can be caused by inflammation or infection. A "benign" tumor only grows in it's local area (although it may get quite large)-- it cannot spread and is not cancer. By contrast, a tumor which can spread to other body areas is called "malignant" and this is cancer. The process of cancer spread to other areas is called "metastasis", so only malignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any area of the body, and it often grows better in it's area of spread than in It's area of origin ("primary site"). It is this capacity for spread that makes cancer so dangerous. Cancer commonly kills by causing anemia (low red blood cell counts), infection (from poor immune function and low white blood cells counts) and debility (from general malnutrition, dehydration and weakness). With ovarian cancer, a common reason for death is by the tumor pressing on the nearby kidney drainage system leading to kidney failure, called "uremia". In younger women, most ovarian tumors are benign cysts and are not dangerous. Unfortunately, most ovarian tumors in post-menopausal women are cancerous, and lethal if their growth is not arrested.

How Common Is Ovarian Cancer?

Each year in the U.S.A. there are 23,000 new cases of ovarian cancer causing 13,000 deaths. It is the 4th most common lethal cancer in women. The annual number of cases has increased 10% over the past 25 years. Some of this increase is due to better detection and recognition of ovarian cancer. About 1 woman in 70 will develop ovarian cancer, and the average patient is 60 years old. It is more common in industrialized countries, and very rare in children.

What Causes or Increases the Risk for Ovarian Cancer?

Like any cancer, the exact reason why one woman gets ovarian cancer and another does not remains unknown. However, several "risk factors" have been noted.

While most ovarian cancers are aggressive, and historically were very lethal, new research provides better hope than ever before for ovarian cancer patients. Commonly, patients first get diagnosed with advanced disease, since early disease rarely produces symptoms.

It is crucial to understand your treatment options for ovarian cancer, selecting the proper treatment can literally make the difference between life and death. It is important to have the peace-of-mind of knowing you have done everything possible to fight this cancer successfully.

CancerAnswers's materials explains the definition, types, frequency, symptoms, evaluation, historic and latest effective treatment for ovarian cancer. We describe surgery, radiation, chemotherapy, and hormones. We tell you everything you must know to help you make the right choices today for an ovarian cancer problem.

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