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Singapore Cancer Society

Definition

Ovarian cancer is a disease in which the cells in the ovaries become abnormal, start to grow uncontrollably, and form tumors. Ninety percent of all ovarian cancers develop in the cells that line the surface of the ovaries and are called epithelial cell tumors.

Description

The ovaries are a pair of almond-shaped organs that lie in the pelvis on either side of the uterus. The fallopian tubes connect the ovaries to the uterus. The ovaries produce and release usually one egg each month during the menstrual cycle. Along with the adrenal gland, the ovaries also produce the female hormones estrogen and progesterone, which regulate and maintain the secondary female sexual characteristics.

Ovarian cancer is the fifth most common cancer among women in the United States. It accounts for 4% of all cancers in women. However, the death rate due to this cancer is higher than that of any other cancer among women. The American Cancer Society estimates that in 1998, at least 26,000 new cases will be diagnosed in the United States, and there will be at least 14,500 deaths due to ovarian cancer. Ovarian cancer can develop at any age, but more than half the cases are among women who are 65 years old or older. The incidence of the disease is higher among white women. Only 50% of the women who are diagnosed with ovarian cancer will survive five years after initial diagnosis. This is because at the time of initial diagnosis, the cancer is usually in an advanced stage. It is difficult to diagnose ovarian cancer early because often there are no warning symptoms and the disease grows relatively quickly. In addition, the ovaries are situated deep in the pelvis and small tumors can't be detected easily during a routine physical examination.

Causes & symptoms

The actual cause of ovarian cancer is not known, but several factors are known to increase a woman's chances of developing the disease. These are called risk factors. The major risk factors for cancer in general are tobacco, alcohol, diet, sexual and reproductive behavior, infectious agents, family history, occupation, environment, and pollution. There are several risk factors particularly associated with ovarian cancer.

• Age. The incidence of the disease increases with age. Half of all cases are diagnosed after age 65.
• Race. The incidence of the disease is highest among white women and lowest among blacks.
• High-fat diet. When Asian women move to the more affluent Western countries and adopt a diet that is rich in fat, the incidence of ovarian cancer among them rises. Furthermore, ovarian cancer is highest in those countries with the highest consumption of dairy foods (Switzerland, Denmark, and Sweden) and lowest in those countries with the lowest dairy intake (Japan, Hong Kong, Singapore). Ovarian cancer is also linked to high socioeconomic status in women.
• Family history. Women who have even one close relative with the disease increase their risk threefold. In addition, if a woman has had breast cancer , she is at an increased risk for ovarian cancer.
• Early menstruation/late menopause. Menstruating early (before age 12) and experiencing menopause late seem to put women at a higher risk for ovarian cancer. It is believed that the longer a woman ovulates, the higher her risk of ovarian cancer (some researchers think exposure to estrogen during the monthly cycles is the cause). Since ovulation occurs only during the childbearing years, the longer she menstruates, the greater her risk. Pregnancy gives a break from ovulation and exposure to estrogen for nine months. Hence, multiple pregnancies actually appear to reduce the risk of ovarian cancer. Similarly, since oral contraceptives suppress ovulation and reduce exposure to estrogen, women who take birth control pills have a lower incidence of the disease.
• Fertility drugs. One study has shown that prolonged use of certain fertility drugs, such as clomiphene citrate, may increase a woman's risk of developing ovarian tumors.
• Talcum powder. Some studies have suggested that the use of talcum powder in the genital area may double a woman's risk of getting the cancer. The incidence of ovarian cancer is higher than normal among female workers exposed to asbestos. Since talc contains particles of asbestos, some researchers believe that is what accounts for the increased risk.

Ovarian cancer has no specific signs or symptoms in the early stages of the disease. There may be some vague, nonspecific symptoms that are often ignored. However, if any of the symptoms persist, it is essential to have them evaluated by a doctor immediately. Only a doctor can determine whether the symptoms are an indication of early ovarian cancer. The patient may experience the following symptoms:

• pain or swelling in the abdomen
• bloating, and a general feeling of abdominal discomfort
• constipation, nausea, or vomiting
• loss of appetite, fatigue
• unexplained weight gain (generally due to an accumulation of fluid in the abdomen)
• vaginal bleeding in postmenopausal women.

Diagnosis

If ovarian cancer is suspected, the doctor typically begins the diagnosis by taking a complete medical history to assess all the risk factors. A thorough pelvic examination is conducted. Blood tests to determine the level of a particular blood protein, CA125, may be ordered. This protein is usually elevated when a woman has ovarian cancer. However, it is not a definitive test because the levels may also rise in other gynecologic conditions, such as endometriosis and ectopic pregnancy. Ultrasound is almost always used to check the size of the ovaries. Standard imaging techniques such as computed tomography scans (CT scans) and magnetic resonance imaging (MRI) may be used to determine the condition of the ovaries and if the disease has spread to other parts of the body.

In order to determine if the tumor is benign or cancerous, surgery is necessary. If the tumor appears to be small from the imaging tests, then a procedure known as laparoscopy may be used. A tiny incision is made in the abdomen and a slender, hollow, lighted instrument is inserted through it. This lets the doctor view the ovary more closely and to obtain a piece of tissue for microscopic examination. If the tumor appears large, a laparotomy is performed under general anesthesia. This procedure combines both diagnosis and treatment for ovarian cancer because the tumor is often completely removed at this time. A piece of the tissue that is removed will be examined under a microscope to determine whether the tumor was benign or malignant.

Surgery confirms the diagnosis, but ovarian cancer is often strongly suspected before surgery based on symptoms and ultrasound. The goal of surgery is to completely remove the cancer, but often this is not possible.

Diagnosis in alternative treatment uses mainstream diagnostic techniques and supplements them with thorough physical and psychological examinations. Considerations such as lifestyle, relationships, and emotional and psychological histories are used to complete an overall portrait of a patient's health in order to develop holistic strategies for healing.

Treatment

There are many alternative treatments available to help with ovarian cancer. Alternative treatments can be used in conjunction with, or separate from, surgery, chemotherapy, and radiation therapy. When used with conventional treatment, alternative treatments have been shown to decrease pain and side effects, aid in the recovery process, and improve the quality of life of cancer patients.

Alternative treatment of cancer is complicated, and there are many choices in therapies and alternative practitioners. Consumers should consult as many trained healthcare practitioners as possible when choosing alternative therapies. If consumers are willing to ask questions and thoroughly research their options, they can increase their chances of getting the best possible alternative support for the difficult task of treating cancer.

Alternative medicine generally views cancer as a holistic problem. That is, cancer represents a problem with the body's overall health and immunity. As such, treatment is holistic as well, striving to strengthen and heal the physical, mental, and emotional aspects of patients. Alternative cancer treatments may emphasize different basic approaches, which include traditional medicines, mind/body approaches, physical approaches, nutritional and dietary approaches, integrated approaches, and experimental programs.

Traditional medicines

Traditional Chinese medicine uses acupuncture, acupressure massage, herbal remedies, and movement therapies like t'ai chi and qigong to treat cancer. Traditional Chinese herbal remedies have already contributed a significant number of anticancer drugs, and studies have shown their anticancer properties. Acupuncture has been shown to reduce some tumors, significantly reduce pain, and support and improve immune system activity.

Ayurvedic medicine uses detoxification, herbal remedies, massage, exercise, yoga, breathing techniques, and meditation as part of its cancer treatment. Panchakarma is an extensive detoxification and strengthening program that is recommended for cancer patients and those undergoing chemotherapy and radiation. Panchakarma uses fasting, special vegetarian diets, enemas, massage, herbal medicines, and other techniques to rid the body of excess toxins (believed to contribute to chronic diseases like cancer) and to strengthen the immune system. Some ayurvedic herbs may also have significant anticancer properties.

Naturopathy and homeopathy are traditional Western healing systems using herbal medicines and other techniques to strengthen the immune system and reduce the pain of cancer treatment. Western herbalism is also beginning to compile studies of many herbs that have potential anticancer and immune strengthening properties (like mistletoe).

Mind/body approaches

Mind/body treatments seek to help patients with the mental and spiritual challenges posed by cancer and try to mobilize the body's own defenses and immune system. Some of these therapies include psychotherapy, support groups, guided imagery , visualization techniques, meditation, biofeedback, hypnosis, breathing techniques, and yoga. Mind/body approaches work with the idea that the mind and emotions can profoundly influence the health of the body. These techniques help patients manage the stress and anxiety that accompany cancer. Mind/body techniques have also been shown to stimulate the immune system and to reduce the pain of symptoms and conventional treatments.

Physical approaches

Physical approaches to cancer include exercise; massage therapies; movement therapies including yoga, t'ai chi, and qigong; breathing techniques; and relaxation techniques. These therapies strive to increase immune system response, promote relaxation and stress reduction, and reduce side effects (like pain, nausea, weakness, and physical immobility) of conventional treatments.

Nutritional and dietary approaches

Cancer patients have heightened needs for diets free of toxic chemicals and full of cancer­fighting nutrients. Diet and nutrition may improve both a cancer patient's chances for recovery and the patient's quality of life during treatment. In laboratory studies, vitamins such as A, C and E, as well as compounds such as isothiocyanates and dithiolthiones found in broccoli, cauliflower, and cabbage, and beta-carotene found in carrots, tomatoes, and salad greens, have been shown to protect against cancer. The minerals selenium and zinc are also important nutrients in the ovarian cancer diet. Omega-3 essential fatty acids such as flaxseed oil or evening primrose oil are recommended as well.

Dietary approaches for ovarian cancer include vegetarianism, the raw food diet, and macrobiotics. Cancer diets generally emphasize raw and fresh fruits, vegetables, whole grains, beans, and peas. These diets also restrict or eliminate intake of fat, meat, dairy products, sugar, hydrogenated oils, processed foods, and foods with additives and artificial ingredients. Caffeine and alcohol are generally prohibited, and overeating is strongly discouraged.

Many herbs have been shown to have anticancer, immune enhancing, and symptom reducing properties. Some of the herbs used for ovarian problems include burdock, mullein, yarrow, vitex, dandelion, black cohosh , St. John's wort , red raspberry, nettles, and Siberian ginseng. Chinese herbs include astragalus, ginger, dong quai , cinnamon, rehmannia root, and scrophularia root. Patients should consult a competent herbalist or naturopathic doctor for individualized herbal support for ovarian cancer.

Integrated approaches

Keith Block, M.D., is a conventional doctor and oncologist (cancer specialist) who is integrating many alternative practices into his cancer treatment center affiliated with the Chicago Medical School. His program seeks to provide individualized cancer treatment using both conventional therapies while integrating alternative healing techniques. Block advocates a special diet (based on vegetarianism and macrobiotics), exercise, psychological support, and herbal and nutritional supplements. Block's program has received acclaim for both treatment success and satisfaction of patients.

Experimental programs

Antineoplaston therapy was developed by Stanislaw Burzynski, a Polish doctor, who began practicing in Houston, Texas. Burzynski has isolated a chemical, deficient in those with cancer, that he believes stops cancer growth, and his treatment has shown some promise.

Dr. Joseph Gold, the director of the Syracuse Cancer Research Institute, discovered that the chemical hydrazine sulfate has many positive effects in cancer patients, including stopping weight loss, shrinking tumors, and increasing survival rates.

The Livingston therapy was developed by the late Virginia Livingston, an American doctor. She asserted that cancer is caused by certain bacteria that she claimed are present in all tumors. She advocated a detoxification program and special diet that emphasized raw or lightly cooked, primarily vegetarian foods, with special vitamin and nutritional supplements.

The Gerson therapy has been the best known nutritional therapy for cancer. It is available in two clinics in California and Mexico. It consists of a basic vegetarian diet low in salt and fat, with high dosages of particular nutrients using raw fruit and vegetable juices. The Gerson therapy also requires patients to drink raw calf's liver juice, believed to aid the liver, and advocates frequent coffee enemas (thought to help the body evacuate toxins).

Allopathic treatment

The cornerstone of allopathic treatment for ovarian cancer is surgery. The goal is to remove as much of the cancer as possible. Chemotherapy, which involves the use of anticancer drugs to kill the cancer cells, is usually administered after the surgery to destroy any remaining cancer. Radiation therapy is not routinely used for ovarian cancer.

The type of surgery depends on the extent of the disease. In most procedures, the ovaries, uterus, and fallopian tubes are completely removed. In rare cases, if the cancer is not very aggressive and the woman is young and has not had children, a more conservative approach may be adopted. Only one ovary may be removed, and, if possible, the fallopian tubes and the uterus may be left intact. Occasionally, in addition to the female reproductive organs, the appendix may also be removed. The liver and the intestine will be examined for signs of cancer and may be biopsied. Ovarian cancer spreads contiguously, which means that it moves to the organs that are next to it. In some cases, extensive surgery may be needed to remove as much of the cancer as possible.

Expected results

Most often ovarian cancer is not diagnosed until it is in an advanced stage, making it the most deadly of the female reproductive cancers. More than 50% of the women who are diagnosed with the disease die within five years. If ovarian cancer is diagnosed while it is still localized to the ovary, more than 90% of the patients will survive five years or more. However, only 24% of all cancers are found at this early stage.

Alternative medicine rarely claims to be able to cure cancer on a regular basis, but many treatments have been shown to help improve symptoms, control the pain and side effects of conventional treatments, speed healing, and increase the quality of life for cancer patients. Alternative therapies have also shown some unexpected results and cures. Some alternative therapies may be strongest as preventative measures, before major problems like cancer occur in the body, and as supportive measures, used with allopathic medicine.

Prevention

There are ways to reduce one's risks of developing ovarian cancer. Currently, genetic tests are available that can help to determine whether a woman who has a family history of breast, endometrial, or ovarian cancer has inherited the mutated gene that predisposes her to these cancers. (However, this mutation affects only a few women.) If the woman tests positive for the mutation, then she may opt to have her ovaries removed (a procedure called an oophorectomy). Allopathic medicine often recommends removing the ovaries as prevention even when a clear genetic component is not found, and this procedure is called a prophylactic oophorectomy.

Having one or more children, preferably having the first before age 30, and breast-feeding may decrease a woman's risk of developing the disease. High-risk women are advised to undergo periodic screening with transvaginal ultrasound or a blood test for CA125 protein. The American Cancer Society recommends annual pelvic examinations for all women after age 40, in order to increase the chances of early detection of ovarian cancer.

Alternative medicine stresses preventative measures that avoid removing the ovaries, unless a clear genetic risk has been established. Some studies have shown that removal of the ovaries does not necessarily reduce the risk of cancer, and does not necessarily increase longevity rates in women.

Having sound physical and mental health can significantly reduce the chances of getting cancer of any type. The following guidelines are generally recommended by doctors, nutritionists, and alternative practitioners for cancer prevention and recovery.

• Do not smoke.
• Do not drink alcohol excessively.
• Exercise regularly, at least 20 minutes per day. It is better to exercise outdoors in the fresh air. In a 1987 study at Harvard, Dr. Rose Frisch surveyed more than 5,398 women of all age groups. Those women in all groups who performed regular exercise had less risk for uterine, breast, cervical, ovarian, and vaginal cancers. For breast cancer, the risk was cut in half.
• Avoid exposure to radiation. This includes avoiding unnecessary x rays, not residing near sources of natural or man-made radiation, and avoiding occupational exposure to radiation.
• Avoid exposure to harmful chemicals, in food, the home, and the workplace.
• Maintain proper body weight and avoid obesity.
• Practice safe sex.
• Protect the skin from overexposure to sunlight. The midday sun between 11 a.m. and 3 p.m. should be avoided and the skin should never be allowed to burned.
• Eat a healthy diet. People should become educated on and practice dietary principles that reduce the risk of cancer. These principles include eating plenty of raw and fresh fruits, vegetables, beans, and whole grains. People should consume organically grown foods when possible, minimize overeating, reduced the intake of meat and dairy products, increase fiber, avoid processed and artificial foods. They should also avoid canned foods including soft drinks, avoid sugar and refined starch products such as white flour, reduce the intake of fat, avoid hydrogenated vegetable oils such as margarine and shortening, and drink filtered or spring water.
• Strive to maintain sound mental and emotional health. It is helpful to learn a technique like yoga, t'ai chi, or meditation to reduce stress and promote relaxation. People should maintain healthy relationships and social support systems.

Key Terms

Computed tomography (CT) scan

A series of x rays that are put together by a computer in order to form detailed pictures of areas inside the body.

Ectopic pregnancy

A pregnancy that results when the fertilized egg implants itself in the fallopian tubes (or other places in the body) instead of the womb.

Endometriosis

A condition that causes an inflammation of the inner lining of the uterus and sometimes results in heavy vaginal bleeding.

Magnetic resonance imaging (MRI)

A medical procedure used for diagnostic purposes; pictures of areas inside the body can be created using a magnet linked to a computer.

Transvaginal ultrasound

A procedure in which a device is inserted through the vagina and sound waves are bounced off the ovary walls. The echoes created by the reflected sound waves can be used to image the ovaries.

Further Reading

For Your Information

Books

• Lerner, Michael. Choices in Healing: Integrating the Best of the Conventional and Complementary Approaches to Cancer. Cambridge, MA: MIT Press, 1994.
• Northrup, Christiane, M.D. Women's Bodies, Women's Wisdom. New York: Bantam, 1994.
• Walters, Richard. Options: The Alternative Cancer Therapy Book. New York: Avery Publishing Group, 1993.
• Weil, Andrew, M.D. Natural Health, Natural Medicine. New York: Houghton Mifflin, 1995.
• Yance, Donald R. Herbal Medicine, Healing and Cancer. Chicago: Keats Publishing, 1999.

Periodicals

• Alternative Therapies Magazine. PO Box 17969, Durham, NC 27715. (919) 668-8825. www.alternative-therapies.com.
• Health Wisdom for Women. Phillips Publishing, 7811 Montrose Road, Potomac, MD 20854. (800) 804-0935.

Organizations

• The Alliance for Alternative Medicine. PO Box 59, Liberty Lake, WA 99019.
• American Cancer Society (National Headquarters).1599 Clifton Rd., N.E., Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org.
• The Health Resource. 209 Katherine Dr., Conway, AR 72032. (501) 329-5272.
• Women's Cancer Resource Center. 3023 Shattuck Ave., Berkeley, CA 94705. (510) 548-9272.

Other

• Cancer Nutrition Center. http://www.cancernutrition.com.
• Cancer Prevention Coalition. http://www.preventcancer.com.
• Cancer Support and Education Center. http://www.cs-ec.org.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.