Ovarian cancer: Year of the Zebra

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Ovarian cancer is a malignant cell growth that begins in the ovaries. It often occurs bilaterally, or on both sides, and spreads quickly to nearby organs through direct extension; to abdominal organs through a process known as abdominal seeding; and to distant organs through the blood and lymphatic systems.
The exact cause is unknown, but can involve a genetic mutation in the BRCA 1 or BRCA 2 genes. Initially, individuals with ovarian cancer can be asymptomatic or experience subtle, nonspecific symptoms.
Common early symptoms can include abdominal distension, bloating, abdominal or pelvic pain, and urinary frequency and urgency.
Later, ovarian cancer can cause unintentional weight loss, abdominal enlargement, bowel obstruction, menstrual changes, and dyspareunia, or pain during sexual intercourse.
A classic finding is a “Sister Mary Joseph nodule”, which happens when the cancer metastasizes, or spreads, to the umbilicus.
Alright, so diagnosis of ovarian cancer starts with a history and physical examination, which includes a bimanual pelvic examination, and may show signs of enlarged ovaries.
Additional diagnostic tests like a transvaginal ultrasound to visualize the cancer or a CT, MRI, or PET scan may also be done to assess for metastases.
Laboratory test results may also be ordered and may include CA 125, inhibin, alpha-fetoprotein, or AFP, and beta-human chorionic gonadotropin, or hCG, for short.
Finally, diagnosis is confirmed with a biopsy of affected tissue, which is usually performed after the tumor is removed or during exploratory laparotomy.Now, the treatment of ovarian cancer includes a total abdominal hysterectomy with bilateral salpingo-oophorectomy, a surgical procedure that involves the complete removal of the uterus, in addition to both fallopian tubes and ovaries.
Lymph nodes may also be involved, and may need to be removed. Surgery is usually followed by chemotherapy and radiation therapy to kill any remaining cancer cells.In addition, individuals may also be prescribed targeted therapy with medications called poly (ADP-ribose) polymerase or PARP inhibitors, which block the PARP enzyme that has a role in DNA repair.
As a result, PARP inhibitors can prevent cancerous cells from repairing their DNA, ultimately causing these cells to die.Alright, as a quick recap… Ovarian cancer is a malignancy of the ovaries typically caused by a genetic mutation in the BRCA 1 or BRCA 2 genes.
Early symptoms are usually subtle and nonspecific with late stage symptoms including unintentional weight loss, abdominal enlargement, bowel obstruction, menstrual changes, and dyspareunia.
Diagnosis involves a history, physical examination, and laboratory and diagnostic imaging tests. Treatment may include a combination of total abdominal hysterectomy with bilateral salpingo-oophorectomy, chemotherapy, radiation therapy, and PARP inhibitors.