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.

Colon Cancer (Colorectal Cancer)

Definition
Colon cancer is a cancer in the colon.
Colon cancer is the second leading cause of death in the United States after lung cancer (ACS 1998)
These diseases including the deadly disease because the disease is often not known until a more severe level. Surgery is the only way to change the Colon cancer.

Pathophysiology
Changes in Pathology
Tumors occur in a place which roughly follow the colon in part (Sthrock 1991 a):
• 26% in the caecum and ascending colon
• 10% in colon transfersum
• 15% in colon desending
• 20% in the sigmoid colon
• 30% in the rectum
The figure below illustrates the occurrence of cancer of the sigmoid and right colon and reduce the incidence of disease in the rectum in 30 years (Sthrock).
Colon carcinoma mostly produce adenomatus polyps. These tumors usually grow not detected until symptoms appear slowly and looked dangerous. The disease is spread in several metode.Tumor might spread in a certain spot on the inner lining of the stomach, reach the serosa and mesenteric fat. Then tumors begin to attach to the organ that is around, then extends into the lumen of the colon or spread to the spleen or the circulatory system. This circulation system directly into the primary tumor through the blood vessels of the colon by the spleen, after the tumor cells enter the circulatory system, typically cells move into the liver. The second place is a place far later metastases to the lungs. Metastases to other places including:
- Adrenal gland
- Kidney
- Leather
- Bones
- Brain
The addition to direct infection and spread through the lymphatic and circulatory system, colon tumors can also spread to parts peritonial tumor before surgery has not been done. The spread occurs when the tumor is removed and the cancer cells from tumor rupture into the cavity peritonial.

Complication
Complications occurred in connection with the increase in growth at the tumor site or through the spread of metastases which include:

•  bowel perforation caused by peritonitis
•  abscess formation
•  fistula formation in the urinary bladder or vagina

Usually the tumor and surrounding blood vessels invade the cause perdarahan.Tumor grow into the large intestine and gradually helps the large intestine and in the end not at all. Extension of tumor beyond the stomach and may be pressing on disekitanya organs (uterus, urinary bladder, and ureters) and the cause of the symptoms covered by the cancer.

Etiology
Causes of Colon cancer is unknown. Diet and reduction of the circulation time of the colon (feces forward flow) which includes the causative factor. Appropriate precautionary instructions recommended by the American Cancer Society, The National Cancer Institute, and other cancer organizations.
Foods must contain at suspected chemical substances that cause cancer of the colon. These foods also reduce the circulation time in the stomach, which accelerates colon cancer causes. Foods that are high in fat, especially animal fat from red meat, causing the secretion of acid and anaerobic bacteria, causing the incidence of cancer within the colon. The meat in frying and in baked can also contain chemicals that cause cancer. Diet with refined carbohydrates that contain fiber in large quantities can reduce the circulation time in the colon. Some groups suggested a diet that containing little animal fat and high in vegetables and fruits (eg, Mormons, Seventh Day Adventists).

Foods to avoid:

• Red meat
• Animal fats
• Fatty foods
• Meat and fish fried or grilled
• Carbohydrates are filtered (example: the filtered juice)

Food should be consumed:

• Fruits and vegetables are particularly Craciferous Vegetables from the cabbage group (such as broccoli, brussels sprouts)
• Grain rice is intact
• Liquid water is sufficient, especially

Since most tumors produce Colon adenoma, the main factor causing harm to the Colon cancer adenoma. There are three types Colon adenomas: tubular, villous and tubulo villous (will be discussed in polyps). Although most of the Colon cancers derived from adenomas, only 5% of all adenomas become manigna Colon, villous adenomas have a high potential to become manigna.
Factors leading to adenoma or benign tumor of unknown manigna clustered polyposis is a hereditary autosomal dominant gene spread. Risk of cancer in polyposis femiliar place close to 100% of persons aged 20-30 years.
People who have had ucerative colitis or Crohn's disease are also at risk of Colon cancer. The addition of risk at the beginning of a younger age and higher rates of colon involvement. Risk of Colon cancer will be 2 / 3 times greater if a family member suffering from the disease

Genesis.
Approximately 152,000 people in the United States diagnosed with Colon cancer in 1992 and 57,000 people die from this cancer in the same year (ACS 1993). Most of the clients on Colon cancer has the same frequency between men and women. Cancer in the right colon usually occurs in women and Ca in the rectum usually occurs in males.

Transcultural alternative.
Colon Ca incident on the USA seems to have a setback from all other nations except in African men and greater amerika.Kejadian happened to these cancers occur in industrial areas to the west and partly Japanese and African firlandia this is thought to relate to diet . Regions whose inhabitants have a low incidence of colon have a high dietary Ca of fruits, vegetables, fish and some meats.

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How to Prevent and Treatment Cervical Cancer

It has been described in previous articles what is cervical cancer. And how to detect cervical cancer. Then how to prevent and treatment of cervical cancer as follows:

Preventing Cervical Cancer

Although cervical cancer is scary, but we all can prevent it. You can do a lot of precautionary measures before ultimately infected with HPV and cervical cancer. Some practical ways you can do in everyday life include:

Have a healthy diet, rich in vegetables, fruit and cereal to stimulate the immune system. For example, consume a variety of carotene, vitamins A, C, and E, and folic acid can reduce the risk of cervical cancer.

• Avoid smoking. Nicotine makes all the mucous membranes of body cells react or become aroused, both the mucosal throat, lungs, and cervix.
• Avoid vitamin C deficiency
  Lifestyle of high fat foods will make people forget the other nutrients, like beta carotene, vitamin C, and folic acid.
  In fact, all three nutrient deficiencies can cause cervical cancer arise. Beta carotene, vitamin C, and folic acid can improve or strengthen diserviks mucosa.
  
• Avoid having sex too early
  Sexual intercourse should ideally be done after a woman is completely cooked. The size of maturity is not only seen it already menstruating or not. But it also depends on the maturity of the cells contained in the mucosal lining of the inner skin of the body cavity.
  Generally new mucosal cells mature after the woman is aged 20 years and over. So, a woman having sex in their teens most vulnerable when it is done under the age of 16. It deals with the maturity of mucosal cells in the cervix of the woman. At a young age, the mucosal cells of the cervix not ripe.
• Avoid having sex during menstrual period proved to be effective to prevent and inhibit the formation and development of cervical cancer.
• Avoid sex with many partners. Cervical cancer can also appear in women who have multiple sex partners. When you have sex only with their partner, and her partner did not have sex with someone else, then it will not lead to cervical cancer. When changing partners, it is associated with the possibility of contracting venereal disease, one of the Human Papilloma Virus (HPV).
• Undergo routine Pap smear tests regularly. Current Pap smear can be done even at the health center at an affordable price.
• Alternative Pap smear is a test IVA with a cheaper cost of Pap smears. The goal for the early detection of HPV infection.
• Giving the HPV vaccine or vaccination to prevent HPV infection.
• Perform cleaning of intimate organs or vagina known as a toilet. This can be done alone or can be also with the help of expert doctors. The goal is to clean the female sex organs of dirt and disease.
• Use of estrogen.
  The same risk will occur in late postmenopausal women. Because stimulation of the endometrium will be longer, so endometriumnya will more often exposed to estrogen. So it's very possible the cancer occurred.
  No wonder that women who use estrogen uncontrolled highly susceptible to cancer. Generally, the menopausal women in developed countries use estrogen to prevent osteroporosis and heart attacks.
  
  However, its use is very risky because estrogen stimulates the endometrial wall thickening and stimulate endometrial cells that turn into cancer properties

Cervical Cancer Treatment

If infected with HPV, do not worry, because the currently available range of treatments that can control HPV infection. Treatment aims to kill some cells that contain the HPV virus. Another way is to remove the damaged or infected with electric surgery, laser surgery, or cryosurgery (remove the abnormal tissue by freezing).

If cervical cancer has reached an advanced stage, it will be done chemo therapy. In some severe cases may also be performed hysterectomy is the surgical removal of the uterus or womb in total. Aim is to remove cervical cancer cells that have been developed on the body.

However, prevention is better than cure. Therefore, how to prevent HPV infection and cervical cancer? Here are some ways you can do to prevent cervical cancer.

Detection of Cervical Cancer

How do I detect that a woman at risk for cervical cancer?. The easiest way to find out by cytological examination of the cervix. This examination is currently popular is the Pap smear or Papanicolaou smear taken from the Greek name of the doctor who discovered this method of George N. Papanicolaou. In addition, there are also various other methods for early detection of cervical cancer or HPV (human papillomavirus) infection as well as follows:

1. IVA Inspection (Visual Inspection with Acetic Acid).
This examination by applying the cervix and then daubed with 5 percent acetic acid, wait for 3 minutes. Last seen with the naked eye if there is no change in color or white color does not appear, then the result is negative. This examination can be done in the clinic and the cost is relatively inexpensive at around 10 thousand to 20 thousand.

2. Pap Smear
This examination should be performed by women who have had sexual intercourse and performed regularly. You do this by taking cervical lymph then daubed on the slide and in-fixation with a certain liquid and then viewed with a microscope. Can later be seen whether they are abnormal cervical cells or not after as compared with normal cervical cells. The cost ranges from 60 thousand to 100 thousand.


3. Examination of Thin prep
This examination has an accuracy and precision is higher than the pap smear. You do this by taking the sap of the cervix and then dipped into a bottle containing a liquid fixation and centrifuged until a homogeneous, then taken a bit to daubed on the slides and performed the examination. Can diagnose pre-cancerous cells and cervical cancer cells, but the price offered is also more expensive and could reach three times the price of pap smears.

4. Colposcopy Examination
This examination using colposcopy to see abnormalities of the cervix. This tool uses a powerful beam and binocular microscope with a magnification of 5 to 40 times. Currently colposcopy has become the primary method of cervical cancer screening in several European countries. This method should be done by experts who understand. Previous medical personnel will enter the liquid to give color to the cervical canal, then perform a colposcopy and abnormal cells will appear. These areas will be sampled to find out what causes it.

There is nothing wrong with all the early examination of cervical cancer, you can perform checks anywhere and can be tailored to your financial condition. The most important thing is prevention is better and it can only be done by early detection of cervical cancer

How to prevent and treatment Cervical Cancer

Cervical Cancer

Cervical cancer is a disease caused by a malignant tumor on the cervix as a result of uncontrolled growth of tissue and surrounding normal tissue damage

Etiology
The cause of cervical cancer has not clearly known but there are some risks and predisposing factors that stand out, among others:
1. Age first had sexual intercourse
Research shows that the more young women have sexual intercourse the greater get cervical cancer. Married at the age of 20 years is considered still too young
2. The number of pregnancy and parturition
Cervical cancer most often found in women who parturition. The more often partus the more likely the risk of having cervical Cancer.
3. Number of marriages
Women who frequent sexual intercourse and multiple partners have a major risk factor of cervical kankers this.
4. Viral infections
Infection with herpes simplex virus (HSV-2) and papilloma virus or condyloma viruses acuminata suspected as factor in cervical cancer
5. Social Economy
Cervical carcinoma often found in lower socioeconomic groups may be socio-economic factors closely related to nutrition, immunity and personal hygiene. In the lower socioeconomic groups generally lack the quantity and quality of food does this affect the body's immunity.
6. Hygiene and circumcision
Presumably the influence of easy occurrence of cervical cancer in women whose partners have not been circumcised. This is because the non sircum male penile hygiene is not maintained so much a collection-a collection of smegma.
7. Smoking and the IUD (intrauterine device)
Smoking will stimulate the formation of cancer cells, while the use of an IUD will have an effect on the cervix that is originated from the erosion diserviks who later became a strep infection that is continuous, as this can trigger the formation of cervical cancer.

Classification of cervical cell growth will cancer

Microscopic
1. Dysplasia
Mild dysplasia occurred in one-third portions of the basal epidermis. Severe dysplasia occurred in two thirds epidermihampir indistinguishable from carcinoma in situ.

2. Carcinoma Stage in situ
In situ carcinoma epithelial cell changes occur in all layers of the epidermis into squamous cell carcinoma. Carcinoma in situ ectoservical growing area, transitional cell and squamous columnar endocervical reserve cells.

3. Mikroinvasif  Carcinoma Stage.
In Mikroinvasif Carcinoma, in addition to changes in the degree of increased cell growth of tumor cells also penetrate the basal membrane and invasion of the stoma so far no more than 5 mm from the basement membrane, these tumors are usually asymptomatic and only found on cancer screening.


4. Invasive Carcinoma Stage
In invasive carcinoma of the prominent changes in the degree of cell growth and cell shape varies. Growing invasive appeared in the area posterior or anterior cervical lip and extends the three departments of the posterior or anterior fornix majors, majors parametrial and corpus uteri.

5. Shape abnormalities in the growth of cervical carcinoma
Growth eksofilik, kool-shaped flowers, growing towards the vagina and can fill half of the vagina without infiltration into the vagina, growth form is easy to necrosis and hemorrhage.

Endofilik growth, usually in the form of ulcer lesions and progressive growth extends to the fornix, posterior and anterior to the corpus uteri and parametrial.
The growth of nodules, usually found in endocervical lesions which gradually transformed into ulcers.


Macroscopic
1. Preclinical stage
Indistinguishable from ordinary chronic cervicitis
2. Beginning Stage
Lesions appear most often around osteum externum
3. Half-up Stage
It has been about the most or the entire lip porsio
4. Advanced stage
Occurs destruction of cervical tissue, so it seems like ulcers with a network of fragile and bleed easily.


Clinical Symptoms


1. Bleeding
Nature can intermenstruit or contact bleeding, sometimes bleeding just happens to the next stage. On the type of bleeding occurs intraservikal slow.
2. Typically resembles water, sometimes there sebeluma onset of bleeding. In more advanced stages of hemorrhage and infection with more whitish fluid that comes out smelling so.


Diagnostic tests

1. Cytology / Pap Smear
Profits, cheap can check out the parts that are not visible.
Weakness, can not determine the precise localization.
2. Schillentest
Epithelial carcinoma of the cervix did not contain glycogen because it does not bind iodine. If porsio iodine then given a normal epithelial carcinoma will be colored brown, while the exposed carcinoma colorless.
3. Coloscopy
Check by using a tool to view the cervix with light and raised 10-40 times.
Advantages: can see clearly the areas concerned so easy to do a biopsy.
Weaknesses: only can check the area that looks just the porsio, are abnormalities in the squamous columnar junction
4. Colpomicroscopy
Seeing the vaginal smear (Pap smear) with magnification up to 200 times
5. Biopsy
With a biopsy can be found or specified types the cancer.
6. Conisation
By way of remove tissue containing mucous membranes and cervical squamous epithelium and gland. Conisation done when the results of cervical cytology in doubt and does not seem obvious abnormalities.


How to prevent and treatment Cervical Cancer

How to detect Cervical Cancer.