Ovarian Cancer

Ovarian Cancer is the second most common gynecologic cancer and is most common in women aged 40 to 65. Risk factors include early menstruation with late menopause, obesity, and a family history of ovarian, breast or colon cancer. Other risk factors may include using either the fertility drug Clomid or hormone replacement therapy. The American Cancer Society estimates 21,550 new cases of ovarian cancer and 14,600 deaths due to ovarian cancer in 2009 (ACS). Pregnancy, breastfeeding, birth control pills, ovarian removal, and tubal ligation/hysterectomy may offer some protection against ovarian cancer.

Only about 20% of ovarian cancers are found in the early stages and early detection is the best survival tool. Symptoms may include stomach or abdominal swelling/bloating, pelvic pressure, a rapid feeling of fullness after eating, urinary urgency and/or urinary frequency. Other women have complained of symptoms like persistent indigestion, a change in bowel habits, painful intercourse and lower back pain. The problem is that many of these symptoms can also be caused by such things as PMS, irritable bowel syndrome, urinary disorders or other diseases. The key is if these symptoms are persistent, last beyond a few weeks and worsen over time. If this occurs a woman should see her gynecologist for testing.

Ultrasound is usually the first modality used for the diagnosis of ovarian cancer and can determine the presence or absence of a mass with 97% accuracy (GLOWM). CT is often used to determine tumor size, location and degree of metastasis to adjacent lymph nodes or organs. Blood tests are used to determine levels of CA-125, a blood protein often found at higher levels in women with ovarian cancer. During surgery many tissue samples are taken in the abdomen and pelvis to determine cancer staging. Staging ranges from stage I (confined to ovaries) to Stage IV (spread to distant organs such as liver or lungs). Five year survival rates vary from 80% for Stage I to 18% for Stage IV. Treatment consists of surgery, chemotherapy and radiation.

This image shows a bilateral stage IB Ovarian cancer in a 47 year old. Despite the large masses (see O) the cancer is still confined to the ovaries.

Image:

http://www.glowm.com/resources/glowm/graphics/figures/v4/0540/034f.jpg Accessed February 15, 2010.

References:

ACS. American Cancer Society. Overview: What is Ovarian Cancer? Accessed February 15, 2010 at http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=33

GLOWM. The Global Library of Women’s Medicine. Ovarian Cancer. Accessed February 15, 2010 at http://www.glowm.com/?p=glowm.cml/section_view&articleid=265&SESSID=haaj72nm2tvd91b1f18m3chhk5

MayoClinic.com. Ovarian Cancer. Accessed February 15, 2010 at http://www.mayoclinic.com/health/ovarian-cancer/DS00293/DSECTION=symptoms

National Cancer Institute. Ovarian Cancer. Accessed February 15, 2010 at http://www.cancer.gov/cancertopics/types/ovarian

Gallbladder Cancer

Gallbladder cancer is the 6^th most common digestive cancer in the United States. American Cancer Society statistics estimate 6,000 new cases in 2009. Although the incidence rate is fairly low in the U.S. the death rate is high, because most new cases are not found until the cancer has spread beyond the gallbladder. Only 20% of gallbladder cancers are found in the early stages (before metastasis). This cancer is more common in females and usually occurs at age 60 or older. Obesity is also a risk factor because obese individuals are more likely to have gallstones. Native and Mexican Americans also have higher gallbladder cancer rates than other American ethnic groups. Chronic inflammation of the gallbladder and large gallstones are thought to increase cancer risk. Researchers now believe that inflammation and gallstones may cause the gallbladder to drain more slowly. This exposes the gallbladder to more bile and can irritate the gallbladder lining. It also increases the amount of time the cells are exposed to carcinogens which may be in the bile. All of these factors can result in malignant changes to the gallbladder cells.

Symptoms of gallbladder cancer can include upper right quadrant pain and tenderness (worse after eating a fatty meal), nausea, vomiting, weight loss and jaundice. These symptoms may also be seen in people with gallstones so having these symptoms is more likely to be gallstones than cancer. Lab tests may show an elevated serum bilirubin as well as cancer markers in more advanced stages.

The following imaging studies may be used for diagnosis: Ultrasound, ERCP, CT (with oral/IV contrast), and MRI. Ultrasound is usually the first modality used because of low cost. Treatment is based on the staging on the disease but is usually surgical, followed by chemotherapy and radiation therapy. Unfortunately, only 20 - 25% of gallbladder cancers are found early enough to be treated by surgery only. 5 year survival rates for stage 2 – 5 gallbladder cancers are low, from 2% to 7%. 5 year survival rates for cancer that has not spread beyond the gallbladder range from 29% to 81%.

This contrast CT image shows invasion of the liver (arrow) and a malignant gallbladder mass and gallstone (arrowhead).

References:

American Cancer Society Detailed Guide: Gallbladder Cancer. Accessed February 8, 2010 at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=68

MayoClinic.com. Gallbladder Cancer. Accessed February 8, 2010 at http://www.mayoclinic.com/health/gallbladder-cancer/ds00425

Image: RadioGraphics September 2008 vol. 28 no. 5 1307-1323. Accessed February 8, 2010 at http://radiographics.rsna.org/content/28/5/1307/F13.large.jpg