Ovarian cancer

Ovarian cancer is a malignant tumor of the ovary are often found in women aged 50-70 years. Ovarian cancer can spread to other parts, pelvis and abdomen through the lymphatic system and spread through the vascular system to the liver and lungs.

Etiology
The cause of ovarian cancer is not known with certainty. However, many theories that explain the etiology of ovarian cancer, including:
1. Incessant ovulation hypothesis
The theory states that there is damage to ovarian epithelial cells for wound healing at the time of ovulation. The healing process of epithelial cells are disrupted can lead to the process of transformation into tumor cells.
2. Hypothesis androgen
Androgens have an important role in the formation of ovarian cancer. It is based on the experiment results that contain epithelial ovarian androgen receptor. In experiments in vitro, androgens can stimulate the growth of normal ovarian epithelium and ovarian cancer cells.

Pathophysiology
Every day, normal ovary will form several small cysts called follicles de Graff. In mid-cycle, dominant follicle with a diameter of more than $ 2.8 cm will release the mature oocyte. Follicle rupture would be the corpus luteum, which when cooked has a structure of 1.5 to 2 cm with cysts in the middle. If fertilization does not occur in the oocyte, the corpus luteum will experience a progressive fibrosis and shrinkage. However, when fertilization occurs, the corpus luteum will first swell and then gradually decreases during pregnancy.
Ovarian cysts originating from the normal ovulation process called functional cysts and are always benign. Cysts can be either follicular and luteal sometimes called Theca-lutein cysts. Cysts can be stimulated by gonadotropins, including FSH and HCG. Multiple functional cysts can be formed due to gonadotropin stimulation or excessive sensitivity to gonadotropins.
In tropoblastik gestational neoplasia (hydatidiform mole and choriocarcinoma) and sometimes in multiple pregnancies with diabetes, causing a condition called HCG hiperreactif lutein. Patients in the treatment of infertility, ovulation induction using gonadotropins (FSH and LH) or sometimes clomiphene citrate, ovarian hyperstimulation syndrome can cause, especially when accompanied with HCG administration.
Neoplasia cyst can grow from excessive cell proliferation and uncontrolled in the ovaries and can be malignant or benign. Malignant neoplasia which can be derived from all types of cells and ovarian tissue. So far, the most common malignancy originating from the surface epithelium (mesothelium) and most of the partial cystic lesions. Similar type of benign cyst with malignancy is serous and mucinous cistadenoma. Other malignant ovarian tumors that can be composed of cystic areas, including this type granulosa cell tumor of sex cord cells and germ cell tumors from primordial germ cells. Teratomas derived from germ cell tumor that contains elements from the three embryonic germ layers; ektodermal, endodermal, and mesodermal.
Endometrioma is a cyst containing blood from ectopic endometrium.

Risk Factors

• High-fat diet
• Smoke
• Alcohol
• Perineal use of talc powder
• History of breast cancer, colon, or endometrial
• Family history of breast or ovarian cancer
• Nulliparous
• Infertility
• Early menstruation
• Never given birth

Signs & Symptoms

Common symptoms are varied and not specific. At an early stage in the form:

• Irregular menstruation
• Menstrual tension continues to rise
• Menorrhagia
• Tenderness in the breast
• Early menopause
• Discomfort in the abdomen
• Dyspepsia
• Pressure in the pelvis
• Frequent urination
• Flatulenes
• Feeling of fullness after eating small meals
• Increasing abdominal girth

Staging
Primary ovarian cancer staging according to FIGO (Federation InternationalofGinecologies and Obstetricians) in 1987, is:

STAGE I -> growth limited to ovaries

1. Stage 1A: growth limited to one ovary, no ascites containing malignant cells, no growth on the outer surface, capsule intact.
2. Stage 1B: growth limited to both ovaries, no ascites, contain malignant cells, no tumor on external surface, capsule intact.
3. Stage 1C: tumors with stage 1a and 1b, but there is a tumor or a second outer surface of the ovary or capsule rupture or by ascites containing malignant cells or with positive peritoneal washings.

STAGE II -> Growth in one or two ovaries with extension to the pelvis

1. Stage 2A: expansion or metastasis to the uterus, or fallopian
2. Stage 2B: expansion of other pelvic tissues
3. Stage 2C: 2a and 2b tumor stage but on the surface of the tumor with one or both ovaries, capsule ruptured, or with ascites containing malignant cells with positive peritoneal washings.

STAGE III -> tomor on one or both ovaries with peritoneal implants outside the pelvis or positive retroperitoneal. Tumor confined within the small pelvis but cell histology proved to extend to the bowel or omentum.

1. Stage 3A: tumor confined in the small pelvis with negative nodes but histologically and microscopically confirmed there is a growth (seeding) surface of the abdominal peritoneum.
2. Stage 3B: a tumor on one or both ovaries with peritoneal implants surface and proved microscopically, the diameter exceeds 2 cm, and lymph nodes negative.
3. Stage 3C: implants in abdoment with a diameter> 2 cm or lymph node positive retroperitoneal or inguinal.

STAGE IV -> growth on one or both ovaries with distant metastases. When the pleural effusion and positive sitologinya results in stage 4, as well as metastasis to the liver surface.

Enforcement of Medical Diagnosis

The majority of ovarian cancer stems from a cyst. Therefore, if a woman found an ovarian cyst have to do further tests to determine whether the cyst is benign or malignant (ovarian cancer).

The characteristics cysts that are malignant are the circumstances:

• Rapidly enlarging cyst
• Cysts in adolescence or postmenopausal
• Cysts with thick walls and are not sequential
• Cyst with solid parts
• Tumors of the ovary

Strengthens the case for further investigation towards ovarian cancer such as:

• Ultrasound with Doppler to determine blood flow
• If necessary, a CT-Scan / MRI
• Examination of tumor markers such as Ca-125 and Ca-724, beta - HCG and alfafetoprotein

All of the above checks have not been able to confirm the diagnosis of ovarian cancer, but only as a handle to perform surgery.