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How to recognize ovarian cancer, known as the 'silent killer'

Ovarian cancer is a disease in which malignant cells develop in the ovaries -- two small hormone-producing organs on both sides of the uterus. The American Cancer Society estimated that there will be about 22,280 new cases of ovarian cancer and 15,500 deaths from ovarian cancer in 2012.

It has been called the silent killer because of its nearly asymptomatic early stages, but given these statistics, it's more important than ever to spread awareness and increase early detection. In fact, David Fishman, director of the National Ovarian Cancer Detection program, said, "if you diagnose ovarian cancer in the earliest stage, it's over 90 percent curable."

Causes
The exact cause of ovarian cancer currently evades scientists. Healthy cells multiply at a steady rate, with new cells replacing old, dying cells, and so on. Cancer cells, on the other hand, do not die. They continue multiplying until they amass into a tumor. These cancer cells then metastasize, which means they beyond the initial ovarian tumor to corrupt other areas in the body.

The Mayo Clinic reported that cancer that begins on the outside of the ovaries forms an epithelial tumor. When the cancer starts in the egg-producing cells is forms a germ cell tumor. When it beings in the hormone-producing cells, it forms stromal tumors. More Caucasian women develop ovarian cancer than African-American women.

Symptoms
Since the ovaries are deep within the abdominal cavity, symptoms during the early stages are difficult to detect, according to the National Ovarian Cancer Coalition(NOCC). Stephen J. Iacoboni, medical director of hematology/oncology at Kennewick General Hospital, said that ovarian cancer often presents itself in the later stages (III-IV) "because this illness is asymptomatic in the early stages and because there is no effective screening method."

Common symptoms include bloating, pelvic or abdominal pain, trouble eating, feeling full quickly and frequent need to urinate. The NOCC added that fatigue, upset stomach, back pain, pain during intercourse and constipation can also be warning signs, especially if they persist for longer than two weeks.

Diagnosis
Doctors may monitor women who are at high risk or demonstrate warning signs with various early detection tests: blood tests, transvaginal ultrasounds and pelvic exams. The Ovarian Cancer National Alliance (OCNA) explained that a high concentration of protein CA-125 exists in cancerous cells. Blood tests can evaluate the prevalence of this protein in women. Transvaginal ultrasounds, which are administered by inserting a probe into a woman's vagina, can provide computer images of her reproductive organs and bladder. A doctor can assess the size and shape of a woman's ovaries and uterus by inserting a finger or two into her vagina and placing his other hand over her abdomen, during a pelvic exam.

If these tests reveal a possibility of ovarian cancer, the doctor can proceed to PT or CT scans. The only definitive diagnosis procedure, however, is surgery and biopsy, according to the OCNA.

Beth Karlan, a gynecologic oncologist at Cedars-Sinai Medical Center, recommended seeking treatment from a gynecologic oncologist because they are trained as surgeons and as oncologists. This specialty has the privilege of caring for patients from diagnosis through to follow-up after treatment. She also said there is also data suggesting that ovarian cancer patients have a better chance of survival when treated by gynecologic oncologists.

Treatment
According to the department of pathology at John Hopkins, there are three basic forms of ovarian cancer treatment: surgery, chemotherapy and radiation. Robin Cohen, an oncology nurse and co-founder of the Sandy Rollman Ovarian Cancer Foundation, said, "The treatment depends on the staging. For advanced cancer (which is most common), a total hysterectomy and debulking (removal of as much cancer as possible) are performed."

The goal of surgery is to remove the cancer from the ovaries and surrounding infected areas. This could necessitate removal of the ovaries, fallopian tubes, uterus, omentum and lymph nodes, depending on how far the cancer has spread.

Chemotherapy drugs kill cancer cells and can be given intravenously or directly into the abdominal cavity. These can be administered alone or in combination with other approaches. Smith added, "Chemotherapy is used to shrink ovarian cancer and slow cancer growth. But of course, it comes with potential side effects - the most common are nausea and vomiting."

In certain circumstances, patients benefit from radiation treatment, which destroys cancer cells with high energy X-rays.