OVARIAN CANCER- RISK FACTORS, CURRENT AND FUTURE TREATMENT OPTIONS

A cancer that can arise from any part in the ovary is called ovarian cancer. The main site of ovarian cancer is the outer lining or the epithelium [1].

Various symptoms that can be observed and felt are problems in consuming food, urinating very often, pain in the pelvic region & bloating [2].

STATISTICS CONCERNING OVARIAN CANCER:

1. The worldwide headcount of women who suffer from ovarian cancer and succumb to it annually is 1, 40,000.

2. In the UK and US, ovarian cancer has a grip over 5,500 and 21,000 females per year [3].

3. White women are more prone to succumb to ovarian cancer than women from other ethnicities such as Blacks, Hispanics, American Indians and Asian [4].

RISK FACTORS:

1. Presence of cancer through generations - The dangers of ovarian cancer are enhanced by faulty genes such as BRCA 1 and BRCA 2. The probability of a woman suffering from ovarian cancer might increase if any person in the immediate family is also undergoing the same suffering.

2. Those who have already undergone the trauma of breast cancer - The chances of females being inflicted with ovarian cancer is much more when the same population has also withstood the pain & sufferings of breast cancer- since, the same “mischievous” genes are responsible for both the types of cancers.

3. Infertility as a cause - Studies are being carried out to verify claims that if a woman’s infertility is itself the cause of ovarian cancer.

4. More time and effort has to be invested to find out if Intra-Uterine devices influence the occurrence of ovarian cancer.

5. It has been established that if women undergo Combined Sequential HRT (constant intake of oestrogen with progesterone for a period of 15 days of the menstrual cycle) for a period of more than 5 years, then their chances of being inflicted with ovarian cancer is also more.

6. Studies have shown that it is a disadvantage to be tall and obese- these factors contribute in the increased occurrence of ovarian cancer.

7. A woman’s chances of suffering from ovarian cancer are more when her ovaries are removed for treating ovarian cysts than in cases of endometriosis.

8. Smoking caused the highest incidence of mucinous ovarian tumors when compared to the other types of tumors in the ovaries [5].

CURRENT TREATMENT OPTIONS:

1. Traditional Surgical procedures: The extent and the kind of surgery needed will rely on the stage and type of ovarian cancer that a woman is suffering.

a) Ovarian cancer in the very early stages (Stage 1a or 1b) is of low grade or in the borderline condition. The immediate requirement is to remove the affected ovary along with the fallopian tube.

b) In the early stages (Stage 1) of ovarian cancer, it is necessary to take out the two ovaries, womb and the omentum (the abdomen’s fatty tissue) - the cancer can spread to all these organs. Chemotherapy may be administered to prevent the relapse of cancer.

c) The more advanced stages (2, 3 or 4) need more medical assistance. Set standards advice women to get the entire cancer taken out from the body, at suitable time intervals. This is termed complete resection. Chemotherapy will be given to destroy the other cancerous cells, as the medical team completes the surgery (adjuvant chemotherapy). In some cases when total resection is not possible, chemotherapy is administered before surgery gets started- neoadjuvant therapy.

When half the treatment process is complete, a scan is performed. This is to know whether or not the cancer has shrunk or not; if yes, surgery is resumed and again chemotherapy is administered. This period of surgery is called debulking and is carried out to remove the remaining cancerous cells [6].

2. Even immunologic and hormonal therapies are made use of in treating ovarian cancer. Patients who are in the advanced stages of the disease may be treated by using radiation; this is done to reduce their pain and is called palliative care [7].

3. Robotic surgery: Another therapeutic option that can be utilized in the early stages of ovarian cancer is robotic surgery. One can opt for this treatment when the cancer is restricted only to the ovaries. All most all the patients opt for a robotic simple hysterectomy (taking out the uterus along with the cervix) plus a bilateral salpingo-oophorectomy (taking out the ovaries plus the fallopian tubes surgically) followed by staging methods at frequent intervals (tissues are studied to know the spread of cancer). Those patients who want to maintain their fertility choose unilateral salpingo-oophorectomy along with dilation and curettage- scraping of the uterine lining is done surgically and the uterus plus the unaffected ovary are preserved.

To carry out the staging methods, the da Vinci Si robotic unit is utilized for its accuracy [8].



INTERESTING TREATMENT OPTIONS FOR THE FUTURE:

1. Treating ovarian cancer with Frankincense: It is an aromatic plant resin that can be derived from a tree Boswellia sacra. The main constituent of Frankincense is acetyl-11-keto-beta-boswellic acid (AKBA) which acted against chemotherapy resistant ovarian cancer cell lines (in the advanced stages). Indications are in favour of incorporating Frankincense into the clinical trials which can remove the resistance shown by the drugs otherwise and increase the number of patients who survived after undergoing this treatment [9].

2. Pazopanib in the maintenance treatment of ovarian cancer: Pazopanib, an FDA-approved medicine that has been used as a therapy for kidney cancer and soft tissue sarcoma, is now being incorporated in late-stage ovarian cancer treatment. Phase III trials have been carried out and the aim is to keep the success of the study constant as soon as the initial therapy is completed. If the FDA gives its permission for Pazopanib to be used, that would be the one and only medicine that can be used in the maintenance treatment in the US.

Stand-alone Pazopanib therapy gives fatal adverse events; hence, it has to be taken along with other targeted medicines. Researchers have to now find out as to how to sequence Pazopanib and chemotherapy at their highest levels [10].

3. Reishi, a medicinal mushroom, in supplementary ovarian cancer treatment: In vitro studies involving Reishi (Ganoderma lucidum), a medicinal mushroom, have yielded promising results. Polysaccharides and triterpenes are the constituent compounds of this mushroom; these antioxidants exhibited anti-cancer properties. They showed their effects on a protein, cyclin D1, present in the cancerous cells of the ovary. Cancerous cell growth was also restricted by these extracts [11].




REFERENCES:

1. http://www.medicalnewstoday.com/articles/159675.php

2. http://en.wikipedia.org/wiki/Ovarian_cancer

3. http://www.medicalnewstoday.com/articles/159675.php

4. http://www.cdc.gov/cancer/ovarian/statistics/race.htm

5. http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/ovarian-cancer-risks-and-causes

6. http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/treatment/which-treatment-for-ovarian-cancer

7. http://www.stopovariancancer.com/treatment.shtml

8. http://robotic-surgery.med.nyu.edu/for-patients/our-departments/gynecology/conditions/early-stage-ovarian-cancer

9. http://www.medicalnewstoday.com/articles/270505.php

10. http://www.onclive.com/conference-coverage/asco-2013/Maintenance-Therapy-With-Pazopanib-Delays-Relapse-of-Advanced-Ovarian-Cancer

11. http://medicinalmushroominfo.com/reishi-ovarian-cancer-possible-future-supplementary-treatment/

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