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Ovarian cancer

Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). more...

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Causes

Ovarian cancer is the fourth leading cause of cancer death in women, the leading cause of death from gynecologic malignancies and the second most commonly diagnosed gynecologic malignancy . It is idiopathic, meaning that the exact cause is unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4 % to 2.5 % (1 out of 40-60 women) lifelong chance of developing ovarian cancer.

Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older ages of final pregnancy, and the use of some oral contraceptive pills have also been shown to have a protective effect. Ovarian cancer is reduced in women after tubal ligation.

The link to the use of fertility medication has been controversial. An analysis in 1991 raised the possibility that use of drugs tation may increase the risk for ovarian cancer. Several cohort studies and case-control studies have been conducted since then without providing conclusive evidence for such a link with the possible exception that prolonged use (> 1 year) of clomiphene citrate should be avoided.1 It will remain a complex topic to study as the infertile population differs in parity from the "normal" population.

There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1 or the BRCA2 gene (especially Ashkenazi Jewish women) are at a higher risk of both breast cancer and ovarian cancer, often at an earlier age than the general population. Patients with a personal history of breast cancer, or a family history of breast and/or ovarian cancer, may have an elevated risk. A strong family history of uterine cancer, colon cancer, or other gastrointestinal cancers may indicate the presence of a syndrome known as hereditary non-polyposis colon cancer (HNPCC), which confers a higher risk for developing ovarian cancer. Patients with strong genetic risk for ovarian cancer may consider the use of prophylactic oophorectomy after completion of child-bearing.

Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial and have not been definitively proven.

A study funded by American Cancer Society conducted at the H. Lee Moffitt Cancer Center of the University of South Florida has found a correlation between high levels of lysophospholipids (a type of fatty acid) with ovarian cancer patients and low levels of lysophospholipids with healthy women. This potential biomarker can be detected by a simple blood test. The blood test was 93 % accurate as predictor of ovarian cancer with less than 4 % false positives of the 117 women studied. Other indicators of ovarian cancer could be used to increase accuracy to 100 %. 2

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Proteins' promise: new test could reveal early ovarian cancer
From Science News, 5/14/05 by N. Seppa

A test that measures protein concentrations in the blood can signal the presence of ovarian cancer, a new study shows. The finding brings scientists a step closer to a diagnostic tool for catching this stealthy cancer early enough for effective treatment. The researchers caution, however, that they haven't yet perfected the procedure.

There is currently no routine screening for ovarian cancer in the general population, even though more than 22,000 women are diagnosed with the disease each year in the United States. Doctors typically test for ovarian cancer when a woman experiences a combination of symptoms, such as abdominal pain, bloating, and abnormal vaginal bleeding, or if she has a family history of this cancer. Doctors use ultrasound or touch to examine the abdomen and can use a blood sample to look for a high concentration of the protein called CA125, which sometimes indicates ovarian cancer.

Unfortunately, these tests miss many early-stage ovarian cancers, a shortcoming that has tragic consequences. Most women found to have ovarian cancer don't survive 5 years beyond the day of diagnosis, primarily because the cancer has spread unnoticed by the time it's discovered. However, early-stage cancer that's confined to the ovaries is highly treatable.

To devise an early-warning test, David C. Ward of the Nevada Cancer Institute in Las Vegas and his colleagues measured the relative concentrations of 169 proteins in the blood of ovarian cancer patients and healthy women. The amounts of 35 of the proteins varied significantly between the groups.

The researchers chose four of those proteins that are relatively simple to detect as the basis for a new ovarian cancer test. Two of the proteins, prolactin and osteopontin, showed up more abundantly in the cancer patients. The two others, leptin and insulin-like growth factor-II, were scarcer in the patients.

The researchers tried out the test on 246 blood samples, about half from cancer patients and half from healthy women. The four-protein analysis enabled the scientists, who didn't know beforehand the source of a sample, to correctly identify the cancer status of the blood-sample donor 95 percent of the time. Notably, the test correctly spotted 26 of 27 early-stage ovarian cancers, the team reports in an upcoming Proceedings of the National Academy of Sciences.

By testing their approach on blood samples from unidentified women, the researchers "make a powerful argument for the potential of this type of strategy," says John O. Schorge of the University of Texas-Southwestern Medical Center in Dallas.

Doctors at the Yale University School of Medicine are using the new analysis to test women who have a close relative with ovarian cancer or who harbor a mutation in one of the cancer-suppressing genes known as BRCA1 or BRCA2, Ward says. Such women are likely to be the first to benefit from a test for ovarian cancer, Schorge says.

Ward's team is attempting to improve the test's accuracy by adding other proteins to the array tested. "We absolutely have to increase the sensitivity of this test," Ward says. Before such a test can make it to the clinic, it would also have to prove itself in evaluations involving blood samples from thousands of women.

COPYRIGHT 2005 Science Service, Inc.
COPYRIGHT 2005 Gale Group

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