OVERVIEW OF THE DISEASE

A. Definition of the disease

Cancer begins in cells, the building blocks that make up tissues. Tissues make up
the organs of the body. Normally, cells grow and divide to form new cells as the body
needs them. When cells grow old, they die, and new cells take their place. Sometimes,
this orderly process goes wrong. New cells form when the body does not need them, and
old cells do not die when they should. These extra cells can form a mass of tissue called a
growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer. Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed and they usually do not grow back. Benign
tumors do not invade the tissues around them. Cells from benign tumors do not spread to
other parts of the body.

Malignant tumors are cancer. Malignant tumors are generally more serious than
benign tumors and they may be life-threatening. Malignant tumors often can be removed,
but sometimes they grow back. Malignant tumors can invade and damage nearby tissues
and organs. Cells from malignant tumors can spread to other parts of the body. Cancer
cells spread by breaking away from the original (primary) tumor and entering the
lymphatic system or bloodstream. The cells invade other organs and form new tumors
that damage these organs. The spread of cancer is called metastasis.

Benign and malignant cysts

 An ovarian cyst may be found on the surface of an ovary or inside it. A cyst
contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not
cancer).

Most ovarian cysts go away with time. Sometimes, a doctor will find a cyst that
does not go away or that gets larger. The doctor may order tests to make sure that the cyst
is not cancer.

Ovarian cancer

Ovarian cancer can invade, shed, or spread to other organs:

Invade; A malignant ovarian tumor can grow and invade organs next to the
ovaries, such as the fallopian tubes and uterus.
Shed; Cancer cells can shed (break off) from the main ovarian tumor. Shedding
into the abdomen may lead to new tumors forming on the surface of nearby organs and
tissues. The doctor may call these seeds or implants.
Spread; Cancer cells can spread through the lymphatic system to lymph nodes in
the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to
organs such as the liver and lungs. When cancer spreads from its original place to another
part of the body, the new tumor has the same kind of abnormal cells and the same name
as the original tumor. For example, if ovarian cancer spreads to the liver, the cancer cells
in the liver are actually ovarian cancer cells. The disease is metastatic ovarian cancer, not
liver cancer. For that reason, it is treated as ovarian cancer, not liver cancer. Doctors call
the new tumor "distant" or metastatic disease.

B. Modifiable Factors

Medications - Some studies show that women who have taken fertility drugs, or
hormone therapy after menopause, may have a slightly increased risk of developing
ovarian cancer. The use of oral contraceptive pills, on the other hand, seems to decrease a
women's chance of getting the disease.
 Obesity in early adulthood - Studies has suggested that women who are obese at age
18 are at increased risk of developing ovarian cancer before menopause. Obesity may
also be linked to more aggressive ovarian cancers, which can result in a shorter time to
disease relapse and a decrease in the overall survival rate.
Hormone replacement therapy (HRT) - Findings about the possible link between
postmenopausal use of the hormones estrogen and progestin and risk of ovarian cancer
have been inconsistent. Some studies indicate a slightly increased risk of ovarian cancer
in women taking estrogen after menopause.
Unhealthy diet - Up to 30% of cancers in developed countries may be related to poor
nutrition. Diets high in saturated fats and low in fruits and vegetables increase the risk of
having ovarian cancer.
Occupational exposures - Certain substance encounter at work are carcinogens,
including asbestos, arsenic, benzene, silica and second-hand tobacco smoke.
Unsafe intercourse - there is risk of direct infection because there is no protection to
protect the client from acquiring such disease
Multiple sex partners - a woman whose partner has more than one sex partner is at
greater risk of developing PID, because of the potential for more exposure to infectious
agents.

C. Non-modifiable Factors

Family history of ovarian cancer or Heredity - Women who have one or more
close relatives with the disease have an increased risk of developing ovarian cancer.
Certain genes, such as the BRCA 1 and 2 genes are inherited and result in a high risk for
development of ovarian cancer.
A family history of breast or colon cancer - Also confers an increased risk for the
development of ovarian cancer.
Age Women who are in advanced age are more likely than younger women to get
ovarian cancer, and the risk is even greater after age 60. About 50% of ovarian cancers
occur in women over 63 years of age.
 Infertility - If you've had trouble conceiving, you may be at increased risk. Although
the link is poorly understood, studies indicate that infertility increases the risk of ovarian
cancer, even without use of fertility drugs. The risk appears to be highest for women with
unexplained infertility and for women with infertility who never conceive. Research in
this area is ongoing.
Ovarian cysts - Cyst formation is a normal part of ovulation in premenopausal
women. However, cysts that form after menopause have a greater chance of being
cancerous. The likelihood of cancer increases with the size of the growth and with age.

D. Signs and symptoms with rationale

In the early stages of ovarian cancer, you may not experience any obvious or
painful symptoms. Unfortunately, due to a lack of definitive symptoms, the majority of
women with ovarian cancer are not diagnosed until their cancer has reached an advanced
stage.
However, some recent studies have indicated that the majority of women with
ovarian cancer actually do experience symptoms before their diagnosis. Since symptoms
may be subtle, and vary from person to person, they may not be associated with the
symptoms of ovarian cancer. For example, back pain is the most common early symptom
of the disease, according to the American Cancer Society.

Abdominal Pain- because of an increase uterine muscle contractility there is an

increase lactic acid formation which irritates the nerves causing the abdominal pain
Excessive amount of bleeding- uterine Fibroids is one of the causes of bleeding
Anemia- this is because of severe bleeding so the patient may manifest pallor,
weakness or cold clammy skin
Nausea and Vomiting- this is due to abdominal distention because of an increase
pressure of the pelvic area
DOB- due to increased abdominal pressure
Hyperthyroidism- due to increase HCG level and structural similarities of the HCG
alpha chain with alpha chains of FSH and TSH
 Constipation- the large intestine is being compromised by the increasing size of the
peritoneum which may cause narrowing of the rectum and decrease peristalsis resulting
to constipation.
 E. Diagnosis

Transvaginal ultrasound is the preferred imaging modality for assessment of a

suspected pelvic mass. The definitive diagnosis of all ovarian cysts is made based on
histologic analysis. Each cyst type has characteristic findings. Laboratory tests, although
not diagnostic for ovarian cysts, may aid in the differential diagnosis of cysts and in the
diagnosis of cyst-related complications. Studies include the following, Urinary pregnancy
test, Complete blood count (CBC), Urinalysis, Endocervical swabs if infectious etiology
is suspected, Serum biomarker testing, Cancer antigen 125 (CA125) - The finding of an
elevated CA125 level is most useful when combined with an ultrasonographic
investigation while assessing a postmenopausal woman with an ovarian cyst, hCG, L-
lactated dehydrogenase, alpha-fetoprotein, and inhibin may be helpful if a less common
histology is suspected.

F. Prevention

Although there's no definite way to prevent the growth of ovarian cysts, regular
pelvic examinations are a way to help ensure that changes in your ovaries are diagnosed
as early as possible. In addition, be alert to changes in your monthly cycle, including
symptoms that may accompany menstruation that aren't typical for you or that persist
over more than a few cycles.

G. Treatment

Treatment depends on age, the type and size of cyst, and symptoms. In many cases
waiting and be re-examined to see if the cyst goes away on its own within a few months
can be done. This is typically an option regardless of age if there is no symptom
and an ultrasound shows a small, fluid-filled cyst. It will be likely recommended to get
follow-up pelvic ultrasounds at periodic intervals to see if the cyst has changed in size.
Birth control pills also help to reduce the chance of new cysts developing in future
menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing
risk of ovarian cancer the risk decreases the longer you take birth control pills.
 Surgery can also be done if it is large, doesn't look like a functional cyst, is growing,
or persists through two or three menstrual cycles. Cysts that cause pain or other
symptoms may be removed.
Some cysts can be removed without removing the ovary in a procedure known as an
ovarian cystectomy. In some circumstances, removing the affected ovary and leaving the
other intact in a procedure known as oophorectomy.
If a cystic mass is cancerous, however, it will likely be advised a total abdominal
hysterectomy bilateral salpingo-oophorectomy or the removal of entire uterus, the
ovaries, and the fallopian tubes.

H. Complications

Infrequent complications associated with ovarian cysts include ovarian torsion; A

cysts that become large may cause the ovary to move out of its usual position in the
pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion;
Rupture. A cyst that ruptures may cause severe pain and lead to internal bleeding.