Cancer
"For it is through the power of words that God delivers us from our suffering and pain." -Eleanor Roosevelt
Cancer is one of the most difficult forms of medical conditions to understand, treat or manage. Cancer can affect anyone and causes a person’s life to be cut short in an instant. Early diagnosis enables patients to receive the best possible treatment from world-class physicians. As cancer spreads throughout the body, treatment options range from surgery to radiation therapy to chemotherapy and targeted therapies.
There are many types of cancers; only two of them, skin cancer and ovarian cancer, are easily identifiable. Skin cancers account for less than 2% of all cancers diagnosed in the U.S. (Rupp, 2014). Ovarian cancer accounts for 40,000 new diagnoses per year in the U.S. Cancer treatment is costly to health systems worldwide. When treated correctly, ovarian cancer has no physical, psychological or financial complications. It rarely leads to death; however, patients spend months or even years undergoing treatment. The main concern for ovarian cancer is not the success of treatments, but rather the high cost of care.
Ovarian cancer affects women in almost every country on Earth but is particularly common in African American women where around 50 percent of all women have been diagnosed with ovarian cancer. In recent decades, the rate of ovarian cancer occurrence in this group has increased significantly, resulting in more deaths.
Ovarian cancer may affect both men and women but the disease tends to be more aggressive in women. Approximately one in seven people are diagnosed with ovarian cancer during their lifetime, and there are more cases among women aged 55 and older than among all other groups. According to Statista research, ovarian cancer is the second leading cause of cancer death in the U.S. in women (Rupp, 2014). About 60 % of ovarian cancers are malignant and the rest are benign.
Ovarian cancers usually arise in the fallopian tubes, the lining inside the uterus that protects, supports and protects a woman’s womb. Most ovarian cancers are squamous cell carcinomas (Rupp, 2014). Other types of ovarian cancer include endometrial carcinomas, choriocarcinomas and sarcomas. Some ovarian cancers are rarer and occur more frequently in specific parts of the body such as the ovary, fallopian tubes, the womb, the uterus and the breasts (Rupp, 2014). Ovarian cancer also occurs more often in women who are not currently planning on having children versus in those who do plan on having children and for these reasons ovarian cancer is considered a fertility disorder. However, infertility rates are uncommon in ovarian cancers (Rupp, 2014). Ovarian cancers occur less commonly than breast cancers and more commonly in older people. The average age at onset for ovarian cancer ranges between 45 and 65 years old. The risk factor associated with ovarian cancer is the presence of hereditary genes and ovarian hormonal receptor alterations, which are found in approximately 1 in 6 women.
Ovarian cancers are more treatable than other cancers. The three types of ovarian cancers available — primary ovarian carcinoma, metastatic ovarian carcinoma, and secondary ovarian carcinomas — can be treated with radiotherapy, medication and hormones. Radiation therapy has been shown to prolong survival for ovarian cancer patients by up to 4 months and also reduces side effects (Rupp, 2014). Metastatic ovarian cancers that have spread to other parts of the body are less treatable; however they are also less likely to recur than those who only spread cancer to other parts of the body. For ovarian cancers, surgery is recommended as the only long-term treatment option or when medically appropriate (Rupp, 2014). The long-term survival of patients with ovarian cancers in non-operationalized stage does not improve significantly using surgical methods.
Metastatic ovarian cancers, which require surgery, are usually treatable by hormone medications and surgery. Surgery may be accompanied by a series of postoperative procedures that ensure the safety of the patient’s body, including blood transfusions, removal of tissue, and permanent removal of some reproductive organs or structures (Rupp, 2014). Other treatments offered for ovarian cancers include chemotherapy for ovarian tumors based on the type of ovarian cancer, radiation therapy to increase tumor control, cryotherapy and immunotherapy. Hormone therapy also can reduce the risk of tumour growth, delay progression and length of time to progression of ovarian cancers (Rupp, 2014).
Ovarian cancers are generally fatal within 3–5 months of appearance (Rupp, 2014). Treatment options vary among ovarian cancers of different stages. Primary ovarian carcinoma is a hard-to-treat cancer that occurs because it is so rare in women and its etiology is still poorly understood. Chemotherapy and radiotherapy are the standard treatments, however some women may refuse radiation therapy or chemotherapy due to personal considerations. Patients most at risk for ovarian cancer are usually diagnosed with ovarian cancers while being at high risk for a family history of ovarian cancer. These women are sometimes given hormonal therapy that is used to maintain ovulation, as well as other supportive measures such as nutrition and counseling. Secondary ovarian cancers, for instance, occur as ovarian cancers occur first and then re-emerge after a period of remission and need additional interventions. Both chemo and hormonal therapy are used to treat ovarian cancers that develop resistance to systemic treatment (Rupp, 2014).
Different types of ovarian cancer have different characteristics and prognosis. Prognosis is better for malignant ovarian cancers than for benign ovarian cancers. Malignant ovarian cancers are generally treated by biologic agents known by their stage of development. Biologic treatment used to treat primary ovarian cancers includes alonzoal-tubulin inhibitors (ATIs) and retinoid therapies (retinoids) (Rupp, 2014). ATIs, which prevent the binding of the oestrogen receptor to the estrogen receptor-β receptor complex, decrease levels of estrogen receptor, inhibiting ovulation. Retinoid agents (retinones), which bind to estrogen receptor, target estrogen receptor and inhibit it, decreasing ovulation and ovulation cycles. Adjuvant use of oral contraceptives has shown to improve clinical outcomes in patients with ovarian cancers that have developed resistance to the hormone therapy (Rupp, 2014).
Some ovarian cancers occur in the fallopian tubes, other in the womb, certain tumours present in the cervix and others can even occur in the lungs. Clinically significant differences in ovarian cancers exist between different subtypes. Ovarian cancers with features of mucinous subtype (including adenomyosis) and serous subtype (including serous cytotrophosone syndrome) are harder to treat than those with the granulosa subtype.
The main cause of ovarian cancers is the dysfunction of ovarian hormones or receptors associated with ovarian hormones and its receptors. Multiple types of ovarian cancers involve multiple entities, making it exceedingly difficult to diagnose and treat. Many ovarian cancers have a strong genetic component, which makes it very challenging to identify hereditary ovarian cancers. Another key challenge in ovarian cancers is their highly unpredictable nature and poor response to therapies. Oligodendrocytic ovarian cancers can be treated with chemotherapy, hormonal therapy and surgery, however most of these cancers are very rare (Rupp, 2014).
Patents and drugs for ovarian cancers have been extensive. A large number of patents for ovarian cancers have received emergency approval in the US, Europe and Japan. Several major classes of drug candidates are currently being explored by various companies and companies like Merck, Novartis and Bristol Myers Squibb have committed funds. Among the current active pharmaceutical research companies developing products related to ovarian cancers, several of them show promise: imatinib (Ipsilopidine), teriflunomide (Tetra-hydrofolate) and bevacizumab (Bevacizumab). While ibuprolines, cyclophosphamide and vorinostat (Bevacizumab) are among the most promising drug candidates, several others are also actively being evaluated by major players in the healthcare industry.
Ovarian cancers are the third leading cause of cancer-related death (Rupp, 2014). Globally, it represents about 9% of all cancers diagnosed, and the incidence and mortality rates have increased over the past decade. Despite widespread screening programs and availability of effective treatments, there are still many factors responsible for the increasing prevalence of ovarian cancers. Women with ovarian cancers are mostly younger and have higher chances to become pregnant and to bear children. Because of their greater likelihood to get ovarian cancers, ovarian cancers are twice as common in females from reproductive-age compared to males ages 35–44 (Rupp, 2014). Due to the growing body of scientific evidence, ovarian cancers can be successfully diagnosed and treated early enough to offer long-term protection to patients.
Ovarian cancers rank highest in mortality rates among all types of cancers. Approximately 27,000 new occurrences of ovarian cancers annually were reported in the United States alone, accounting for an annualized mortality rate of 528, 250 fatalities each month and 730 deaths each day, and with high incidence rates amongst African American women. Although ovarian cancers account for less than 2% of all cancers diagnosed worldwide, it contributes more deaths to all of the top five cancers that are causing the greatest burden of illness and mortality (Rupp, 2014). The combination of a longer incubation period, high number of false initial diagnoses and lack of knowledge surrounding ovarian cancers makes ovarian cancers very difficult to diagnose. To prevent ovarian cancers, physicians recommend that women undergo routine screening of their ovaries or undergo surgery if ovarian cancers are detected during regular checkups or surgeries.
References
Rupp, W. E. (2014). Overview of the biological and behavioral risk factors and early detection of ovarian cancer. International Journal of Oncology in Clinical Immunology, 5(6), 298–305. doi:10.
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