Discuss about the National Breast and Ovarian Cancer Centre.
Ovarian cancer is the formation of tumour in the ovary. Ovarian cancer can migrate from the ovaries to the other reproductive organs and affect its functioning. Ovaries secrete reproductive hormones in the female. These hormones are important for the reproductive and sexual development in female. (Salani, R and Bristow, R., 2010). The menstrual cycle is under control of these hormones. Every month the oocyte (egg) released by the ovary which on fertilization produce zygote is also under the supervision of these hormones. Maintenance of pregnancy and the production of the milk after the birth of baby are controlled by these hormones.
This disease is not detectable in its early phase. Formation of neoplasm clusters occurs in the ovary. (Ozols, R. F., 2003). Formation of the tumours could be in the epithelial layers, germ cells or the stroma of the ovary. Ovarian cancer is known as the “silent killer” among women due to lack of information about the disease and the late detection of the disease. (Roth, D. S., 2003). Ovarian cancer is regarded as the most dangerous and lethal gynaecologic cancer in women by the Gynaecologic cancer foundation & society of Gynaecologic Oncologists in 2010. (Jayde et al, 2012). To know about ovarian cancer it is important to understand what cancer is and what the female reproductive system is.
Cancer is the result of uncontrolled and abnormal cell division that causes severe effect on the human body. This uncontrolled growth can sometime be lethal. Cancer could be due to many reasons including both acquired or due to genetic mutation, hormonal imbalance or immune responses. The cancer which is acquired is generally the result of smoking, alcohol, bad life style and poor dietary intake or due to viral infections. Cancer is one of the deadliest diseases in the world. Tobacco intake accounts for the 70% death due to lung cancer. Every year millions of people die due to cancer. (World Health Organization, 2015).
Female reproductive system comprises of the ovaries, fallopian tube and the uterus. Ovaries are paired structure situated on both side of the uterus. They are held in suspended form by the ligament mesovarium. Ovaries secrete hormones; it is both exocrine and endocrine in nature. The sex hormones are poured into the blood by the ovary which is the function of an endocrine gland. It releases the ova every month which are an exocrine function. The epithelium of the ovary consists of cuboidal cells. Ovary comprises of the cortex which is the outer section and the medulla which form the inner section. The ovarian follicles are present in scattered form in the cortex. (Krause, W. J., 2005). The size of the ovarian follicle is different depending upon the developmental stage. The matrix comprises of mainly connective tissues, blood vessels and fibrous tissues. The size of the ovary in normal ovulating female is 3cm×2cm×1cm in dimension. (Palastanga, N and Soames, R. 2011).
The primary function of the ovary is Oogenesis i.e. formation of the gamete in female which on fusion with the male gamete forms a zygote. The ova undergo development forming all the follicular stages in the ovary. The other function of the ovary is to synthesize and release Estrogen and Progestrone hormone. (Thibodeau, G. A. and Patton, K. T., 2013). As per the growth of the female the formation of viable ova decreases and finally stops at the menopause.
Ovarian cancer is mostly observed in women above 40 years of age. It is mostly diagnosed in the advanced stages. Early symptoms are can be confusing as it can be because of other diseases also. Women generally ignore such symptoms unless it becomes really painful. The high rate of multiplication of the abnormal cells in the ovary leads to the formation of tumour in the ovary. If the tumour is malignant, it can spread in other organs of the body and can be lethal in severe cases. If the tumour is benign, it does not move to the other body parts and is not fatal. The ovarian cancer is mainly diagnosed in the three region of the ovary – in the epithelial cells, stroma or the germ cells. (Australian institute of health and welfare and the national breast and ovarian cancer centre, 2010). WHO and the International federation of gynaecology and obstetrics classified ovarian cancer into 30 types on the basis of the cells where they are formed. (Yarbo et al, 2016).
To find out and analyse
-The occurrence, number of affected women and the mortality rate related to ovarian cancer
-The various risk factors associated with the disease
-The diagnosis and prevention.
The occurrence, number of affected women and the mortality rate- out of all the cancers affecting women all across the world, ovarian cancer comes on number seven. In case of the mortality due to cancer in women, it is eighth in position. The studies conducted in U.S.A. reports that ovarian cancer accounts for the major gynaecologic malignancy related mortality. Around 23000 women are reported with ovarian cancer and around 14000 deaths are recorded due to this disease every year in U.S.A. (Epstein, C. J. and Childs, B., 1975) (Peters, J. A., 1997). While in Australia, as per the data from 2006, ovarian cancer was identified as the ninth most commonly observed cancer in women. It was second most commonly found gynaecological cancer and about 1226 women were reported to be suffering from this disease. In terms of mortality rate in women of Australia it is on the sixth position and is the leading reason for death due to gynaecological cancer. (AIHW, 2010). Across the world around 239000 women were diagnosed with ovarian cancer in the year 2012. (Ferlay, J et al., 2013). Approximately 800 women mortality was estimated in the year 2006 in Australia. There was a decline in terms of the deaths due ovarian cancer as per the age groups of 26 % from 1982 to 2006.
The Australian institute of health and welfare presented an overview statistical data for ovarian cancer in Australia. The analysis was based on approximate calculations of the various cases out of 100,000 women. The number of cases reported in 2016 of women suffering with ovarian cancer was around 1480. The mortality in case of women diagnosed with ovarian cancer was near about 1040. The age related diagnosis of the disease was around 10.4 out of 100,000 women. (Cancer Australia, 2016).
The age related study conducted shows that the ovarian cancer risk increases with the growing age. Epithelial cancer is reported the higher aged women. According to the finding in the Surveillance, Epidemiology and End Results (SEER)-It is reported maximum in the women who are around 75 to 80 years old. It is not much observed in the women below 40 years. It reported more in the women from western countries like North America and Europe and is less frequent in the African and Asian women. (Matloff, E. T, 1999). The age related diagnosis shows fluctuation from the past record considering different age groups.
The estimation by AIHW suggests that the disease can affect women more in case of women between 65- 70 years of age. The occurrence rate in women between 70- 74 will be low and will be more in women above 80. The trends recorded from 1982 to 2006 were as following for the different age groups out of 100,000 women. For the women below 50 years of age there was a decline in the disease diagnosis from 3.9 to 3.1 cases. Women falling in age group 50-69 the disease diagnosis reduced to 24.6 from 32.7 cases whereas for women above 70 years a slight increase in the number of cases was recorded from 35.8 to 40.9.
Risk factors associated with ovarian cancer- risk related to ovarian cancer include genetic, hormonal and the environmental factors. The chances of acquiring the disease are high due to the following factors.
Family history- heredity accounts as one of the strongest reasons for acquiring ovarian cancer. Women who have a history of their blood relative acquiring ovarian cancer or breast cancer are more prone to acquire this disease. Even if there is no sign of genetic mutation in these women, the chances are around 5% to get ovarian cancer.
Genetic factors- the main reason for the disease is the mutation in the gene BRCA1 or BRCA2. This mutation if inherited can lead to the formation of tumour in the ovary. The BRCA genes are the breast cancer tumour suppressor gene so the possibility of acquiring ovarian cancer increases if a woman has encountered earlier in life. This gene mutation is common in women from eastern European countries. The mutations or the excess expression of the gene cause the inheritance of the disease. The mutation in BRCA1 in a woman can lead to 85% risk of breast cancer and 60% risk of ovarian cancer whereas the mutation in BRCA2 gene has lower risk of cancer in a woman. (National breast and ovarian cancer centre, 2010). Lynch syndrome or HNPCC patient also are at high risk of developing ovarian cancer. In case also heredity has a major role for causing ovarian cancer. (Management of women at high risk of ovarian cancer, 2010).
Ageing factor- women with increasing age have more possibility of acquiring ovarian cancer. Age and family history of this cancer are regarded as important risk factor. (ACN and NBCC, 2004). Women in the age group 65- 70 are more prone to develop ovarian cancer. Age at menopause is also a factor to cause ovarian cancer. It is been reported by some scientists that if the age at menopause is more the chances are high to get ovarian cancer. (Hildreth et al, 1981).
Pregnancy and nulliparity- infertility and nulliparity pose a greater risk in women towards acquiring ovarian cancer. The studies conducted have shown that more number of abortion or incomplete pregnancy also decrease the chances of getting ovarian cancer. The unprotected sexual intercourse also can be a risk factor in case of both gravid women and those who are infertile and have unprotected intercourse. (Booth, M., Beral, V. and Smith, P., 1989). Drugs for fertility are also responsible to increase the risk. Medically induced ovulation techniques and the drugs to induce fertility have a risk of developing epithelial cancer although this has not been of much significance. (Bristow, R. E. And Karlan, B. Y., 1996).
Body mass index- body mass index also establishes a relationship with the risk of developing ovarian cancer. The high body mass index leads to higher risk of acquiring ovarian cancer. (Purdie, D. M. et al, 2001).
Lifestyle and nutritional factors- tobacco smoking, obesity all pose a threat to acquire ovarian cancer in women. Obesity in women suffering with ovarian cancer has high death rate. (Yarbo, C. H. and Wujcik, D., 2010). Low physical activity in the puberty can increase the chance of menarche and can be a risk to ovarian cancer.Other factors- ovulation also is a factor that can be responsible to cause ovarian cancer. If the ovulation duration is more the chances to acquire the disease is more. Over secretions of gonadotropins and androgens can also be a risk factor. Hormone replacement therapy is also responsible to cause tumours in the ovary. Women using talcum powder in the genital area are also prone to cancer. (Daly, M. and Obrams, G. I., 1998).
The diagnostic and prevention method- the preventive method for the disease include- a healthy life style with low fat intake and regular exercise. Pregnancy on the right time i.e. below 35 years of age and for more number of times can be effective to suppress the occurrence of the disease. Breast feeding also provide a little protection. Use of oral contraceptive pills have been reported to reduce the chance of ovarian cancer. About 50 % lower risk was observed in women who use the pill for 5 years. Hysterectomy also suppresses the development of epithelial ovarian cancer in women. (Riman, T., Persson I. Nilsson, S., 1998). The mortality rate in this disease is mainly of the late diagnosis. There are no effective screening methods to diagnose the case in women.
The diagnostic method involves a Pap test of the cervix and the ultrasound and Ct scans of the abdomen. Blood test is done to observe the level of tumour marker 125 (CA125). (Ozols, R. F., 2003). The common symptoms associated with ovarian cancer include abdominal pain, bloating, urinary symptoms, lack of appetite, fatigue, indigestion. The frequency of the symptoms determines the severity of the disease. Initially women do not notice the symptoms and often confuse it with some other diseases. In order to proceed for the surgical method it is important to diagnose the stages to identify the extent of the spread of cancer. The disease is limited to the ovaries in the initial stage I. In the stage II may spread in both ovaries and can spread to other organs of the reproductive system. Stage III is reported with the spread of cancer in the pelvic and abdominal region or nearby lymph nodes. Stage IV is the severe with the cancer spreading in the other parts of the body like lungs. Surgical method, chemotherapy, radiotherapy etc are applies to control the disease in severe cases. (Cancer Australia, 2016).
After the stage determination the surgical method are implied. In early stages a laparotomy is usually performed where small cuts are made in the abdomen and the surgery is performed. In many cases along with the surgery, chemotherapy is required as the tumour enters in the advance stages. (Salani, R. and Bristow, R., 2010). Total abdominal Hysterectomy and bilateral salpingo- oophorectomy is done to where both the ovaries and the fallopian tube are removed, along with the uterus and the cervix in severe cases. X rays are used to stop the growth of cancer cells in radiotherapy. It helps to suppress the symptom or in case it appears after the surgery. Many other techniques like target therapy, hormone therapy are used. (Nordqvist, C., 2016).
Conclusion
The studies conducted shows that the risk, occurrence and the diagnostic method related to the ovarian cancer. It is important to make awareness programmes to prevent the disease in women. Australia has a significant number of women who die every year due to ovarian cancer. To decrease the rate it important to introduce awareness programmes and should have screening to detect the disease. The factors associated are also taken into consideration.
References
Australian cancer network and national breast cancer centre. (2004). Clinical practise guidelines for the management of women with epithelial ovarian cancer. Sydney: NBCC.
Australian government. (2016). Ovarian cancer. Cancer Australia. Retrieved on 29 Sep 2016 from https://ovarian-cancer.canceraustralia.gov.au/statistics
Australian institute of health and welfare and the national breast and ovarian cancer centre. (2010). ovarian cancer in Australia: an overview. Cancer series no. 52. Cat no. CAN 48. Canberra: AIHW.
Australian institute of health and welfare. (2014). Cancer in Australia: an overview, 2014. Cancer series no. 90. Cat. No. CAN 88.
Booth, M., Beral, V. and Smith, P. (1989). Risk factors for ovarian cancer:a case- control study. Br. J. cancer. 60;592-598. UK: the macmillan press ltd.
Bristow, R. E. and Karlan, B. Y. (1996). Ovulation induction, infertility and ovarian cancer. Fertile steril. 66: 499- 507.
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Matloff, E. T. (1999). Complex decision-making for BRCAI/2 carriers. Cancer J Sci Am. 5:266-8.
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