Cancer Association of South Africa (CANSA) Fact Sheet On Ovarian Cancer

Transcription

1 Cancer Assciatin f Suth Africa (CANSA) Fact Sheet On Ovarian Cancer Intrductin The varies frm part f the female reprductive rgans that huse the va and are als respnsible fr the prductin f sex hrmnes. The varies are paired rgans lcated n either side f the uterus within the brad ligament belw the uterine (fallpian) tubes. Each vary is within the varian fssa, a space that is bund by the external iliac vessels, bliterated umbilical artery, and the ureter. The varies are respnsible fr husing and releasing va, r eggs, necessary fr reprductin. At birth, a female has apprximately 1-2 millin va, but nly abut 300 f these eggs will ever becme mature and be released fr the purpse f fertilisatin. [Picture Credit Ovarian Anatmy] Ovarian Cancer Ovarian cancer is cancer f the cells f ne r bth varies. Incidence f Ovarian Cancer in Suth Africa Accrding t the Natinal Cancer Registry (2009) the fllwing number f varian cancer cases were histlgically diagnsed in Suth Africa during 2009: Grup - Females N f Cases Lifetime Risk 2009 All females 425 1:460 Asian females 27 1:222 Black females 219 1:676 Clured females 41 1:508 White females 138 1:213 Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 1

2 The frequency f histlgically diagnsed cases f varian cancer in Suth Africa fr 2009 were as fllws (Natinal Cancer Registry, 2009): Grup - Females Years Years Years Years Years Years Years 80+ Years All females Asian females Black females Clured females White females N.B. In the event that the ttals in any f the abve tables d nt tally, this may be the result f uncertainties as t the age, race r sex f the individual. The ttals fr all males and all females, hwever, always reflect the crrect ttals. Causes f Ovarian Cancer It is nt clear what causes varian cancer. In general, cancer begins when healthy cells acquire a genetic mutatin that turns nrmal cells int abnrmal cells. Healthy cells grw and multiply at a set rate, eventually dying at a set time. Cancer cells grw and multiply ut f cntrl, and they d nt die. The accumulating abnrmal cells frm a mass (tumur). Cancer cells invade nearby tissues and can break ff frm an initial tumur t spread elsewhere in the bdy (metastasise). Generally, it s nt pssible t say what causes varian cancer in an individual wman. Hwever, sme features are mre cmmn amng wmen wh have develped varian cancer. These features are called risk factrs. Having certain risk factrs increases a wman's chance f develping varian cancer. Having ne r mre risk factrs fr varian cancer desn t mean a wman will definitely develp varian cancer. In fact, many wmen with varian cancer have n bvius risk factrs. (May Clinic). Risk Factrs fr Ovarian Cancer The risk fr develping varian cancer appears t be affected by several factrs: The mre children a wman has and the earlier in life she gives birth, the lwer her risk fr varian cancer Certain genes defects (BRCA1 and BRCA2) are respnsible fr a small number f varian cancer cases. Wmen with a persnal histry f breast cancer r a family histry f breast r varian cancer have an increased risk fr varian cancer Wmen wh take estrgen replacement nly (nt with prgesterne) fr 5 years r mre seem t have a higher risk f varian cancer Birth cntrl pills decrease the risk f varian cancer. Being infertile r having fertility treatment Using a cil (intra-uterine device (IUD) Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 2

3 Using talcum pwder Older wmen are at highest risk fr develping varian cancer. Mst deaths frm varian cancer ccur in wmen age 55 and lder Research suggests that the risk f varian cancer is slightly higher fr wmen wh: have medical cnditins such as endmetrisis smke tbacc prducts are bese are tall (Cancer Research UK; Australian Gvernment, Cancer Australia; PubMed Health) Prtective Factrs fr Ovarian Cancer There s currently nthing that can be dne t prevent varian cancer. Hwever, there are sme things that are thught t prtect against varian cancer. These are called prtective factrs. Wmen with prtective factrs may still develp varian cancer. Yu may be able t reduce yur risk f develping varian cancer by making changes t yur lifestyle, such as stpping smking and eating a healthy, balanced diet. (BUPA, UK). Getting enugh vitamin D may reduce yur risk f develping a number f cancers, including varian cancer althugh mre research needs t be dne t be certain (ibid). Research has shwn that the fllwing are assciated with a reduced risk f certain types f varian cancer: remval f the uterus (wmb) remval f the varies having the fallpian tubes tied having the fallpian tubes remved having been pregnant using ral cntraceptives (Australian Gvernment, Cancer Australia). Prphylactic Ophrectmy Prphylactic phrectmy significantly reduces ne s dds f develping breast cancer and varian cancer if ne is at high risk. Weigh the prs and cns f this cancer-preventin ptin in cllabratin with an nclgy geneticist and a medical practitiner. Wmen with BRCA1 r BRCA2 gene mutatins have a significantly increased risk f develping breast cancer and varian cancer. Several ptins are available fr reducing the risk f cancer in these wmen. One ptin is preventive (prphylactic) bilateral phrectmy - the surgical remval f the varies. Althugh remving ne s varies is usually perfrmed t reduce the risk f varian cancer, phrectmy can als reduce the risk f breast cancer. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 3

4 What is an phrectmy? In an phrectmy, a surgen remves bth the varies the almnd-shaped rgans n each side f the uterus. The varies cntain eggs and secrete the hrmnes that cntrl ne s reprductive cycle. Remving the varies greatly reduces the amunt f the hrmnes estrgen and prgesterne circulating in the bdy. This surgery can halt r slw breast cancers that need these hrmnes t grw. Wmen with BRCA gene mutatins usually als have their fallpian tubes remved at the same time (salping-phrectmy) since they have an increased risk f fallpian tube cancer as well. Wh can cnsider prphylactic phrectmy? Prphylactic phrectmy is usually reserved fr wmen with a significantly increased risk f breast cancer and varian cancer due t an inherited mutatin in the BRCA1 r BRCA2 gene - tw genes linked t breast cancer, varian cancer and ther cancers. Wmen wh have inherited mutatins and have cmpleted childbearing are the best candidates fr this surgery. Prphylactic phrectmy may als be recmmended if ne has a strng family histry f breast cancer and varian cancer but n knwn genetic alteratin. It might als be recmmended if ne has a strng likelihd f carrying the gene mutatin based n ne s family histry but chse nt t prceed with genetic testing. Wmen wh are at risk, culd cnsider this prcedure as fllws: Having a BRCA1 gene mutatin: age 35 t 40 Having a BRCA2 gene mutatin: age 45 and lder Hw much can phrectmy reduce the risk f cancer? If ne has a BRCA mutatin, a prphylactic phrectmy can reduce the: Breast cancer risk by up t 50 percent in premenpausal wmen. As an example, if a wman with a high risk f breast cancer had a 60 percent chance f being diagnsed with breast cancer at sme pint in her lifetime, bilateral phrectmy culd reduce her risk t 30 percent. Put anther way, fr every 100 wmen just like her, 60 culd be expected t be diagnsed with breast cancer withut phrectmy. And 30 wuld be expected t be diagnsed with breast cancer after phrectmy. Ovarian cancer risk by 80 t 90 percent. As an example, if a wman with a high risk f varian cancer had a 30 percent chance f being diagnsed with varian cancer at sme pint in her lifetime, phrectmy culd reduce her risk t 6 percent, assuming an 80 percent risk reductin. Put anther way, fr every 100 wmen just like her, 30 culd be expected t be diagnsed with varian cancer withut phrectmy. And six wuld be expected t be diagnsed with varian cancer after phrectmy. (May Clinic; Medscape). Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 4

5 Types f Ovarian Cancer The type f cell where the cancer begins determines the type f varian cancer yu have. Ovarian cancer types include: Cancer that begins in the cells n the utside f the varies. Called epithelial tumurs, these cancers begin in the thin layer f tissue that cvers the utside f the varies. Mst varian cancers are epithelial tumurs Cancer that begins in the egg-prducing cells. Called germ cell tumurs, these varian cancers tend t ccur in yunger wmen Cancer that begins in the hrmne-prducing cells. These cancers, called strmal tumurs, begin in the varian tissue that prduces the hrmnes estrgen, prgesterne and teststerne The type f varian cancer yu have helps determine yur prgnsis and treatment ptins (May Clinic). Symptms f Ovarian Cancer Many varian cancer symptms mimic thse f less life-threatening cnditins such as irritable bwel syndrme. These symptms include: Blating Pelvic r abdminal pain Urinary urgency r frequency Difficulty eating r feeling full quickly (Ovarian Cancer Natinal Alliance). Further Late Stage Symptms f Ovarian Cancer Spread f the cancer t ther rgans Lss f rgan functin Fluid in the abdmen (ascites) Blckage f the intestines Early Detectin f Ovarian Cancer Early detectin f varian cancer saves wmen s lives. N screening test exists that can test all wmen fr varian cancer. The Pap test des nt test fr varian cancer; it screens fr cervical cancer. Nt nly d researchers need t develp an early detectin test fr varian cancer, like mammgrams fr breast cancer and Pap tests fr cervical cancer, but als wmen and medical prfessinals need t becme mre aware f varian cancer symptms. While n early detectin tl exists fr all wmen, several tests exist fr wmen wh are at a high risk. If a wman has varian cancer symptms, a strng family histry, r a genetic Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 5

6 predispsitin such as a BRCA mutatin, dctrs may mnitr her with ne f the fllwing tests r a cmbinatin f them: The prtein CA-125 Bld Test The prtein CA-225 exists in greater cncentratin in cancerus cells. Thugh a high cunt f this prtein may help dctrs identify varian cancer, premenpausal wmen may have an elevated CA-125 due t benign cnditins unrelated t varian cancer. Uterine fibrids, liver disease, inflammatin f the fallpian tubes and ther types f cancer can raise a wman s CA-125 level, ften causing a false psitive test fr varian cancer. Althugh the CA-125 bld test is mre accurate in pstmenpausal wmen, it is nt a reliable early detectin test fr varian cancer. In abut 20 percent f advanced stage varian cancer cases and 50 percent f early stage cases, the CA-125 is nt elevated even thugh varian cancer is present. As a result, dctrs generally use the CA-125 bld test in cmbinatin with a trans-vaginal ultrasund. The CA-125 bld test can be an imprtant tl fr evaluating the disease s prgress and tumurs respnse t treatment. Additinally, this test can mnitr a wman s CA-125 level fr evidence f recurrence. The CA125+HE4 Bld Test - has been apprved by the Fd and Drug Administratin (FDA) fr risk stratificatin. A wman wh presents with a knwn tumur may have this test t determine if her surgery shuld be dne by a gynaeclgist r a gynaeclgic nclgist dctrs wh are specially trained t treat wmen with gyneclgic cancers. Ovarian cancer is nt the silent killer it was nce thught t be. Studies have shwn that there are symptms that appear in the early stages f the disease. Recgnitin f these symptms in the early stages is critical. A new bimarker, HE4, has shwn an increased sensitivity and specificity fr detectin f varian cancer ver that f CA125 alne. HE4 was als fund t increase the sensitivity f CA125 fr the detectin f varian cancer in patients presenting with a pelvic mass. The new CA125 + HE4 risk stratificatin tl is a new differential diagnstic fr wmen presenting with pelvic mass t help determine the mst apprpriate curse f care. It is designed t measure levels f the CA125 and HE4 prteins in the bld t aid in the risk stratificatin f wmen wh present with pelvic mass. It may help determine the best curse f care fr wmen presenting with a pelvic mass (HE4.cm). The OVA1 Bld Test - The FDA apprved a new varian cancer bld test, called OVA1, that can help detect varian cancer in a pelvic mass that is already knwn t require surgery. In a news release, the FDA says the test helps patients and health care prfessinals decide what type f surgery shuld be dne and by whm - but nt t screen fr varian cancer and nt fr a definitive diagnsis f varian cancer. "The OVA1 test identifies sme wmen wh will benefit frm referral t a gyneclgical nclgist fr their surgery, despite negative results frm ther clinical and radilgical tests fr varian cancer. If ther test results suggest cancer, referral t an nclgist is apprpriate even with a negative OVA1 result," the FDA states. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 6

7 The FDA says the OVA1 test shuld be used by primary care physicians r gynaeclgists t cmplement, but nt replace, ther diagnstic and clinical prcedures. OVA1 uses a bld sample t test fr levels f five prteins that change because f varian cancer. The test cmbines the five separate results int a single numerical scre between 0 and 10 t indicate the likelihd that the pelvic mass is benign r malignant. OVA1 is nly intended fr wmen aged 18 and lder wh are already selected fr surgery because f their pelvic mass. Interpreting test results requires knwing whether the wman has gne thrugh menpause (WebMD). Trans-vaginal Ultrasund - A trans-vaginal ultrasund is a test used t examine a wman s reprductive rgans and bladder. T administer the test, the dctr inserts a prbe int the wman s vagina. The prbe sends ff sund waves which reflect ff bdy structures. The waves are then received by a cmputer that turns them int a picture. (Ovarian Cancer Natinal Alliance) Diagnsis f Ovarian Cancer In smene shwing the symptms mentined abve, the dctr may rder ne r mre f the fllwing tests: Ultrasund - Ultrasund (ultrasngraphy) is the use f sund waves t create an image n a vide screen. Sund waves are released frm a small prbe placed in the wman's vagina r n the surface f her abdmen. The sund waves create eches as they enter the varies and ther rgans. The same prbe detects the eches that bunce back, and a cmputer translates the pattern f eches int a picture. This is ften the first test dne t if a prblem with the varies is suspected. Ultrasund can be useful t find an varian tumur and see if it is a slid mass (tumur) r a fluid-filled cyst. It can als be used t lk better at the vary t see hw big it is and hw it lks inside (the internal appearance r cmplexity). These factrs help the dctr decide which masses r cysts are mre wrrisme. Cmputed Tmgraphy - The CT scan is an x-ray prcedure that prduces detailed crsssectinal images f yur bdy. Instead f taking ne picture, like a cnventinal x-ray, a CT scanner takes many pictures as it rtates arund yu. A cmputer then cmbines these pictures int an image f a slice f yur bdy. The machine will take pictures f multiple slices f the part f yur bdy that is being studied. CT scans d nt shw small varian tumurs well, but they can see larger tumurs, and may be able t see if the tumur is grwing int nearby structures. A CT scan may als find enlarged lymph ndes, signs f cancer spread t liver r ther rgans, r signs that an varian tumur is affecting yur kidneys r bladder. Yu may be asked t drink 1 t 2 litres f a liquid befre the CT scan called "ral cntrast." This helps utline the intestine s that certain areas are nt mistaken fr tumurs. Yu may als receive an IV (intravenus) line thrugh which a different kind f cntrast dye is injected. This helps better utline structures in yur bdy. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 7

8 The injectin can cause sme flushing (redness and warm feeling that may last hurs t days). A few peple are allergic t the dye and get hives. Rarely, mre serius reactins like truble breathing and lw bld pressure can ccur. Medicine can be given t prevent and treat allergic reactins. Be sure t tell the dctr if yu have ever had a reactin t any cntrast material used fr imaging tests. CT scans are nt usually used t bipsy (see bipsy in the sectin Other tests ) an varian tumur, but they can be used t bipsy a suspected metastasis. Fr this prcedure, called a CT-guided needle bipsy, the patient stays n the CT scanning table, while a radilgist mves a bipsy needle tward the lcatin f the mass. CT scans are repeated until the dctrs are cnfident that the needle is within the mass. A fine needle bipsy sample (tiny fragment f tissue) r a cre needle bipsy sample (a thin cylinder f tissue abut 1½cm lng and less than 3mm in diameter) is remved and examined under a micrscpe. CT scans take lnger than regular x-rays and yu need t lie still n a table while they are being dne. But just like ther cmputerized devices, they are getting faster and the mst mdern nes take nly a shrt time. Barium Enema X-ray - This is a test t see whether the cancer has invaded the cln (large intestine) r rectum (it is als used t lk fr clrectal cancer). After taking laxatives the day befre, the radilgy technician puts barium sulfate, a chalky substance, int the rectum and cln. Because barium is impermeable t x-rays (impssible fr x-rays t g thrugh), it utlines the cln and rectum n x-rays f the abdmen. Magnetic Resnance Imaging - MRI scans use radi waves and strng magnets instead f X-rays. The energy frm the radi waves is absrbed and then released in a pattern frmed by the type f tissue and by certain diseases. A cmputer translates the pattern f radi waves given ff by the tissues int a very detailed image f parts f the bdy. Nt nly des this prduce crss sectinal slices f the bdy like a CT scanner, it can als prduce slices that are parallel with the length f the bdy. A cntrast material might be injected int a vein (same as with a CT scan). MRI scans are nt used ften t lk fr varian cancer. MRI scans are particularly helpful t examine the brain and spinal crd. MRI scans take lnger than CT scans, -- ften up t 30 minutes r mre. Als, yu have t be placed inside a tube, which is cnfining and can upset peple with claustrphbia (fear f enclsed spaces). The machine als makes a thumping nise that yu may find disturbing. Sme places will prvide headphnes with music t blck the sund. Chest X-ray - This prcedure may be dne t determine whether varian cancer has spread (metastasized) t the lungs. This spread may cause ne r mre tumrs in the lungs and mre ften causes fluid t cllect arund the lungs. This fluid, called a pleural effusin, can be seen with chest x-rays as well as ther types f scans. Psitrn Emissin Tmgraphy (PET scan) - In this test, radiactive glucse (sugar) is given t lk fr the cancer. Because cancers use glucse (sugar) at a higher rate than nrmal tissues, the radiactivity will tend t cncentrate in the cancer. A scanner can spt the radiactive depsits. This test has can be helpful fr sptting small cllectins f cancer cells. In sme instances this test has prved useful in finding varian cancer that has spread. It is even mre valuable when cmbined with a CT scan (PET/CT scan). PET scans Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 8

9 can help find cancer when it has spread, but they are expensive and nt all insurance cmpanies will cver the cst when they are used t lk fr varian cancer. (American Cancer Sciety). Staging f Ovarian Cancer Ovarian cancer is classified int the fllwing categries (stages): T-categries fr varian cancer Tx: N descriptin f the tumur's extent is pssible because f incmplete infrmatin T1: The cancer is cnfined t the varies -- ne r bth T1a: The cancer is nly inside ne vary - it isn t n the utside f the vary, it desn t penetrate the tissue cvering the vary (called the capsule) and isn t in fluid taken frm the pelvis T1b: The cancer is inside bth varies but desn't penetrate t the utside and isn t in fluid taken frm the pelvis (like T1a except the cancer is in bth varies) T1c: The cancer is in ne r bth varies and is either n the utside f an vary, grwn thrugh the capsule f an vary, r is in fluid taken frm the pelvis T2: The cancer is in ne r bth varies and is extending int pelvic tissues T2a: The cancer has spread (metastasized) t the uterus and/r the fallpian tubes but isn t in fluid taken frm the pelvis T2b: The cancer has spread t pelvic tissues besides the uterus and fallpian tubes but it isn t in fluid taken frm the pelvis T2c: The cancer has spread t the uterus and/r fallpian tubes and/r ther pelvic tissues (like T2a r T2b) and is als in fluid taken frm the pelvis T3: The cancer is in ne r bth varies and has spread t the abdminal lining utside the pelvis. This lining is called the peritneum T3a: The cancer metastases are s small that they cannt be seen except under a micrscpe T3b: The cancer metastases can be seen but n tumur is bigger than 2 centimetres T3c: The cancer metastases are larger than 2 centimetres ) T categries fr fallpian tube cancer Tx: N descriptin f the tumur's extent is pssible because f incmplete infrmatin Tis: Cancer cells are nly in the inner lining f the fallpian tube. They haven t grwn int deeper layers. Als called carcinma in situ T1: The cancer is in the fallpian tube(s), but has nt grwn utside f them T1a: The cancer is nly inside ne fallpian tube -- it has nt grwn thrugh t the utside f the tube. It hasn't grwn thrugh the tissue cvering the tumur (called the capsule) and isn t in fluid taken frm the pelvis T1b: The cancer is grwing in bth fallpian tubes -- it has nt grwn thrugh t the utside f the tube. It hasn't grwn thrugh the tissue cvering the tumur Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 9

10 T1c: (called the capsule) and isn t in fluid taken frm the pelvis (like T1a but with tumur in bth tubes) The tumur is in ne r bth fallpian tubes and has either grwn thrugh the uter wall f the tube r cancer cells are fund in fluid taken frm the pelvis T2: The tumur has grwn frm ne r bth fallpian tubes int the pelvis T2a: The cancer is grwing int the uterus and/r the varies T2b: The cancer is grwing int ther parts f the pelvis T2c: The cancer has spread frm the fallpian tubes int ther parts f the pelvis and cancer cells are fund in fluid taken frm the pelvis (either frm ascites r frm washings btained at surgery T3: The tumur has spread utside the pelvis t the lining f the abdmen T3a: The areas f cancer spread utside the pelvis can nly be fund when the area is bipsied and lked at under the micrscpe T3b: The areas f spread can be seen with the naked eye, but are 2 cm r less in size (less than an inch) T3c: The areas f spread are greater than 2 cm in size N categries N categries indicate whether r nt the cancer has spread t reginal (nearby) lymph ndes Nx: N descriptin f lymph nde invlvement is pssible because f incmplete infrmatin N0: N lymph nde invlvement N1: Cancer cells are fund in the lymph ndes clse t tumur M categries M categries indicate whether r nt the cancer has spread t distant rgans, such as the liver, lungs, r nn-reginal lymph ndes M0: N distant spread M1: Cancer has spread t the inside f the liver, t the lungs, r ther rgans Stage Gruping Once a patient's T, N, and M categries have been determined, this infrmatin is cmbined in a prcess called stage gruping t determine the stage, expressed in Rman numerals frm stage I (the least advanced stage) t stage IV (the mst advanced stage). The fllwing table illustrates hw TNM categries are gruped tgether int stages. This stage gruping als applies t fallpian tube carcinma. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 10

11 Stage T N M I T1 N0 M0 IA T1a N0 M0 IB T1b N0 M0 IC T1c N0 M0 II T2 N0 M0 IIA T2a N0 M0 IIB T2b N0 M0 IIC T2c N0 M0 III T3 N0 M0 IIIA T3a N0 M0 IIIB T3b N0 M0 IIIC T3c N0 M0 Any T N1 M0 IV Any T Any N M1 (American Cancer Sciety) Where Ovarian Cancer May Spread t in the Bdy Shuld varian cancer spread (metastasise) in the bdy, it wuld mst prbably spread as indicated belw: Cancer Type: Bladder Breast Cln Clrectal Kidney Lung Melanma Ovary Pancreas Prstate Stmach Thyrid Uterus Nn-melanma skin cancer (Natinal Cancer Institute) Main Sites f Metastasis (Spread) Bne, liver, lung Bne, brain, liver, lung Liver, lung Liver, lung, peritneum (lining f abdmen) Adrenal gland, bne, brain, liver, lung Adrenal gland, bne, brain, liver, ther lung Bne, brain, liver, lung, skin, muscle Liver, lung, peritneum (lining f abdmen) Liver lung, peritneum (lining f abdmen) Adrenal gland, bne, liver, lung Liver, lung, peritneum (lining f abdmen), varies Bne, liver, lung Bner, liver, lung, peritneum (lining f abdmen), vagina Very rare: lymph ndes, lung, bne (if in head/neck regin) Treatment f Ovarian Cancer Treatment fr varian cancer usually invlves a cmbinatin f surgery and chemtherapy. Less ften, treatment may include raditherapy. The type f treatment wmen receive depends n the type and stage f their varian cancer and their general health. Treatment is best managed by a gynaeclgical nclgist. A gynaeclgical nclgist specialises in treating cancers f the reprductive tract and has very specialised surgical skills. (Ovarian Cancer Australia). Surgery Nearly all wmen wh have varian cancer will require surgery. Smetimes, it is nt pssible t cnfirm the stage f the cancer until the surgery. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 11

12 The dctr will discuss what will happen during the surgery. The surgery will prbably invlve remving: bth varies and the fallpian tubes (called a bilateral salping-phrectmy) the uterus (called a ttal abdminal hysterectmy) the mentum, a fatty layer f tissue within the abdmen (called an menectmy) The surgen may als remve the lymph ndes frm the pelvis and abdmen. They may als take samples f nearby tissue and send it t the labratry t see if the cancer has spread. If the cancer has spread, the surgen will try t remve as much f it as pssible. This is knwn as debulking surgery. If the cancer is cnfined t ne r bth varies, nly the vary r varies may need t be remved, leaving yur uterus (wmb) intact. This means the wman may still be able t carry a pregnancy. Fr mst wmen, hwever, pregnancy is nt an issue and the nrmal prcedure is t remve bth varies and the uterus. The patient will prbably be ready t g hme three t seven days after the peratin, but it can take many weeks t fully recver. After the peratin the patient will be encuraged t start mving abut as sn as pssible. This is very imprtant. Even if it means having t stay in bed, it is imprtant t keep ding regular leg mvements t help the circulatin and prevent bld clts. A physitherapist will prvide exercises t help prevent cmplicatins. When ging hme, the patient will need t exercise gently t build up strength and fitness. Walking and swimming are gd exercises that are suitable fr mst peple after treatment fr varian cancer. A discussin with a dctr r physitherapist shuld be had abut which types f exercise wuld be suitable. Chemtherapy Chemtherapy invlves using anti-cancer (cyttxic) drugs t kill cancer cells. It is ften given after surgery fr varian cancer. In sme cases, it can be given befre surgery as it may help t shrink the tumur and make it easier t remve. This is called ne-adjuvant chemtherapy. Several different drugs can be used in chemtherapy. Often, a cmbinatin is given. The chice f drug and hw and when it is given depends n the stage f the cancer and hw much it has spread. The mst cmmn treatment fr varian cancer is a platinum-cntaining drug (carbplatin), which is used alne r in cmbinatin with anther drug, paclitaxel. Chemtherapy is usually given as an injectin int the vein, but is smetimes given as tablets. Sme studies have lked at giving chemtherapy directly int the abdmen, called intra-peritneal chemtherapy. Mst ften, chemtherapy is given n an utpatient basis but smetimes a shrt stay in hspital may be required. It is usually given in cycles, with a perid f treatment fllwed by a perid f rest t allw the bdy t recver. Mst wmen have six cycles f chemtherapy. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 12

13 Raditherapy Raditherapy uses high energy X-rays. Like chemtherapy, it wrks by targeting rapidly grwing cancer cells. Raditherapy is nt ften used t treat varian cancer. But ccasinally, the multidisciplinary team may recmmend it fr varian cancer treatment under very specific circumstances, such as treating pain and bleeding frm a lcalised tumur mass. Expectatins (Prgnsis) fr Ovarian Cancer Ovarian cancer is rarely diagnsed in its early stages. It is usually quite advanced by the time diagnsis is made Abut 3 ut f 4 wmen with varian cancer survive 1 year after diagnsis Nearly half f wmen live lnger than 5 years after diagnsis If diagnsis is made early in the disease and treatment is received befre the cancer spreads utside the vary, the 5-year survival rate is very high Clinical Trials A great deal f prgress has been made in varian cancer treatment. Mre wmen are living lnger and having fewer side effects. These advances were discvered thrugh clinical trials in which new drugs and cmbinatins are cmpared with standard treatment. All cancer trials in this cuntry are subject t careful versight t ensure that the trial is wrthwhile and safely cnducted. Indeed, participants in clinical trials ften d better verall than in rutine care. If apprached t take part in a trial, the patient will be ffered an infrmatin sheet. In the event f agreeing t participate the signing f infrmed cnsent will be required. A patient is always free t refuse r withdraw frm a clinical trial withut it affecting his/her care. (NHS Chices). Clinical trials are research studies that invlve peple. They are the final step in a lng prcess that begins with research in a lab. Mst treatments used tday are the results f past clinical trials. Cancer clinical trials are designed t test new ways t: Treat cancer Find and diagnse cancer Prevent cancer Manage symptms f cancer r side effects frm its treatment Every trial has a persn in charge, usually a dctr, wh is called the principal investigatr. The principal investigatr prepares a plan fr the trial, called a prtcl. The prtcl explains what will be dne during the trial. It als cntains infrmatin that helps the dctr decide if this treatment is right fr a particular patient. The prtcl includes infrmatin abut: Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 13

14 The reasn fr ding the trial Wh can jin the trial (called eligibility requirements ) Hw many peple are needed fr the trial Any drugs that will be given, hw they will be given, the dse, and hw ften What medical tests will be dne and hw ften What types f infrmatin will be cllected abut the peple taking part Fr sme patients, taking part in a clinical trial may be the best treatment chice. Clinical trials are part f the cancer research prcess. Many f tday's standard treatments fr cancer are based n earlier clinical trials. Patients wh take part in a clinical trial may receive the standard treatment r be amng the first t receive a new treatment. Patients wh take part in clinical trials als help imprve the way cancer will be treated in the future. Even when clinical trials d nt lead t effective new treatments, they ften answer imprtant questins and help mve research frward. Patients can enter clinical trials befre, during, r after starting their cancer treatment. Sme clinical trials nly include patients wh have nt yet received treatment. Other trials test treatments fr patients whse cancer has nt gtten better. There are als clinical trials that test new ways t stp cancer frm recurring (cming back) r reduce the side effects f cancer treatment. (Natinal Cancer Institute). Medical Disclaimer This Fact Sheet is intended t prvide general infrmatin nly and, as such, shuld nt be cnsidered as a substitute fr advice, medically r therwise, cvering any specific situatin. Users shuld seek apprpriate advice befre taking r refraining frm taking any actin in reliance n any infrmatin cntained in this Fact Sheet. S far as permissible by law, the Cancer Assciatin f Suth Africa (CANSA) des nt accept any liability t any persn (r his/her dependants/estate/heirs) relating t the use f any infrmatin cntained in this Fact Sheet. Whilst the Cancer Assciatin f Suth Africa (CANSA) has taken every precautin in cmpiling this Fact Sheet, neither it, nr any cntributr(s) t this Fact Sheet can be held respnsible fr any actin (r the lack theref) taken by any persn r rganisatin wherever they shall be based, as a result, direct r therwise, f infrmatin cntained in, r accessed thrugh, this Fact Sheet. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 14

15 References and Surces American Cancer Sciety Australian Gvernment, Cancer Australia BUPA UK Cancer Research UK HE4.cm g May Clinic Medscape Natinal Cancer Institute NHS Chices Ovarian Anatmy h=613&tbm=isch&prmd=imvns&tbnid=2k63idtlkbj8dm:&imgrefurl= edu/cancerinf/nci/cdr62963.html&dcid=ais5iukbejr_m&imgurl= mn.edu/cancerinf/nci/media/cdr jpg&w=425&h=425&ei=qshwupuxbpswh Qfm44CBQ&zm=1&iact=hc&vpx=758&vpy=276&dur=1562&hvh=225&hvw=225&tx=1 40&ty=166&sig= &page=1&tbnh=122&tbnw=122&start=0&ndsp=1 9&ved=1t:429,r:16,s:0,i:122 Ovarian Cancer Australia Ovarian Cancer Natinal Alliance PubMed Health. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 15

16 SA Natinal Cancer Registry, 2004 Department f Health, Natinal Health Labratry Service. WebMD Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO April 2015 Page 16