Although ovarian cancer is the dead...

Although ovarian cancer is the deadliest gynecological cancer, awareness among the couple women and health care professionals regarding the dangers of ovarian cancer remains inadequate. Ovarian cancer strikes 23000 American women each year, and approximately 14,000 die of the disease annually. (1) Ovarian cancer accounts for 52% of all gynecological cancer deaths. (2) The death of comedienne Gilda Radner from ovarian cancer in 1991 brought the disease to the forefront for the American public. Unfortunately, since that time there has been an absence of publicity regarding this disease. In addition, managed care organizations impose hurdle to specialty care and many times deny reimbursement when a woman dogs diagnostic screening for suspected ovarian cancer. (3)

Seventy-five percent of ovarian cancers are not diagnosed until the cancer has advanced to stage III or IV, giving a five-year survival rate of alone 20%. (4) This statistic has not changed in the last three decades primarily because an adequate screening tool still is unavailable. Clinical guidelines for the diagnostic screening of ovarian cancer have not been unraveled yet. Ten thousand pelvic examinations have to be performed, onward average, to identify one ovarian cancer. (5) The tumor marker, cancer antigen 125 (CA-125), is not specific and, therefore, is an inadequate screening tool.

Differentiating between benign and malignant ovarian masses is necessary because ovarian cancer is lethal, and there are no proven screening techniques. Clinicians must consider the patient's medical profile (ie, risk factors, size of the mass, clinical presentation) to critically evaluate the likelihood of an early ovarian cancer. Diagnostic screening must include three essential components: an accurate medical history, a careful physical examination, and the judicious use of diagnostic proceedings (eg, ultrasound, computed tomography [CT] scan, laparoscopy). (6)

EPIDEMIOLOGY

Approximately 5% to 10% of American women will go through a surgical procedure for suspected ovarian cancer an time during their lives. (7) The United States has higher surgical rates for benign ovarian tumors compared to European countries like as Britain and Wales. These differences may be attributed to health care classification screening. In Britain, cervical Papanicolaou's (Pap) smears are performed each five years and do not necessarily include bimanual examinations. The United States commends screening Pap smears and pelvic examinations annually. At least 60000 surgical excisions of benign ovarian masses meet the eye per year in the United States. (8) It is essential, therefore, to differentiate preoperatively between possible early malignancy versus a benign condition to avoid unnecessary surgery Clinicians must be aware of the incidence, risk factors, and for the use of all presenting symptoms of ovarian cancer to make a pertinent diagnosis.

Incidence. individual in 70 women will perform the operations indicated in ovarian cancer. This represents a 17% lifetime risk of developing ovarian cancer. (9) brace genes, BRCA-1 and BRCA-2, are linked with hereditary breast and ovarian cancers. progeny tests can be performed to assess DNA in white kindred cells to detect mutations in the BRCA gene These genetic markers do not predict whether the patient will lay open cancer, but rather they provide information regarding the risk of developing cancer. If a patient is BRCA positive, then her lifetime risk of developing ovarian cancer increases to between 16% and 60% versus the general population's risk of 17%

Although there is long discussion regarding BRCA-1 and BRCA-2 gene testing, sole 5% to 10% of ovarian cancers are linked to a positive familial history. (10) In general, inherited cancer accounts for 5% to 10% of all malignancies and usually befalls 10 to 15 years sooner than a sporadic cancer. Additionally, the incidence of ovarian cancer increases with age. The majority of ovarian cancer cases come to pass between the ages of 55 and 74 with the average age being 61

Risk factors. Several studies have documented a decreased risk for ovarian cancer in women who use oral contraceptive pills (OCP) The mechanism probably is related to ovulation suppression and the inhibitory force of OCP on ovarian activity. A new study of 924 women in strange York City demonstrated that use of an oral contraceptive was associated with a decreased risk of benign ovarian tumors, with the greatest reduction occurring in women who used them for more than pair years. (11) One study showed an overall 40% risk reduction of ovarian cancer in women aged 20 to 54 who used oral contraceptives. (12) After four years of oral contraceptive use, the risk of ovarian cancer decreased from 50%, and after seven years, a 60% to 80% reduction in disease was noted. (13) These studies support the recommendation that health care providers prescribe OCP for women of reproductive age seeking contraception because of the large number of surgeries generally being performed for benign ovarian disease. (14) A newly come study showed that in BRCA-1 and BRCA-2 carriers, the risk of ovarian cancer decreased through 12% with each live birth, on the other hand not with increased duration of oral contraceptive use. (15) Table 1 contains a list of risk factors.