Staging is the process of discovering how far the cancer has spread. Most ovarian cancers spread is not obvious which are classified at the time of surgery. One of the goals of surgery for ovarian cancer is to obtain tissue samples for diagnosis and stage of cancer. In order to classify the stage of cancer, tissue samples taken from different parts of the pelvis and abdomen for examination under a microscope.
Staging is very important because ovarian cancer has different prognostic stages and treated differently. The precision of this classification could determine whether the patient is cured or not. If the disease is not properly classified by stage, then the cancer has spread outside the ovary might be overlooked and untreated. Once the classification has been assigned by stage, it will not change, even if the cancer recurs or spreads to other parts of the body.
Ask your cancer care team treating him to explain the classification procedure based on the stage. Also ask if you conduct a comprehensive classification procedure. After surgery, ask at what stage your cancer. In this way, you have the information necessary to participate in making decisions about their treatment.
Ovarian cancer is classified according to the “AJCC / TNM. This describes the extent of tumor (T) parent, the absence or presence of metastasis or lymph nodes (N) nodes near and the absence or presence of metastasis (M) at a distance. This system is much like the system currently used by most gynecologic oncologists, called the FIGO system. Both systems use the results of surgery to establish the actual stages.
(The higher the grade, the more likely it is that the cancer has spread).
Grade 1: well differentiated (looks like the normal ovarian tissue).
Grade 2: not as well differentiated (looks less ovarian tissue).
Grade 3: poorly differentiated (looks very little ovarian tissue).
Once you have determined the categories T, N and M of a patient, this information is combined with a process called stage grouping to determine the stage, expressed in Roman numerals from stage I (the least advanced stage) to Stage IV (advanced stage). The following table illustrates how TNM categories are grouped in stages.
Symptoms and signs of ovarian cancer
Ovarian cancer can cause many different signs and symptoms. Women are more likely to have symptoms if the disease has spread beyond the ovaries. However, even ovarian cancer early can cause symptoms. The most common symptoms include:
Pain in the pelvis or abdomen.
Difficulty eating or feeling of fullness when eating fast.
Urinary symptoms such as urgency (constant feeling of having to urinate) and frequency (having to urinate often).
These symptoms may be caused by benign (not cancerous) and cancer of other organs. When caused by ovarian cancer, these symptoms tend to be persistent and represent a change from what is normal. For example, symptoms may be more severe or occur more frequently. If a woman has these symptoms almost daily for more than several weeks should consult their doctor, preferably a gynecologist.
Other symptoms of ovarian cancer may include:
Pain during sexual intercourse.
Changes in menstruation.
However, it is more likely that these symptoms are caused by other conditions, and occur almost as frequently in women without ovarian cancer
If there is any reason to suspect you might have ovarian cancer, your doctor will use one or more procedures to be absolutely sure that this is the disease and to determine the stage of cancer.
Ultrasonography (ultrasound) uses sound waves to create an image on a video screen. A small probe placed in the vagina or on the abdomen of a woman emits sound waves. These sound waves create echoes as they enter the ovaries and other organs. The same probe detects the echoes that bounce, and a computer translates the pattern of echoes and converts it into an image. Because ovarian tumors and normal ovarian tissue often reflect sound waves in different ways, this test may be useful for finding tumors and determine whether a lump is solid or fluid-filled cyst.
CT is an X-ray procedure that produces detailed cross-sectional images of the body. Instead of taking a photograph, as does conventional radiography, a CT scanner takes many pictures as it rotates around you. A computer then combines these images and forms the image of a section of the body. The machine takes pictures of multiple sections of the body area being studied.
This test can help determine if cancer has spread to the liver or other organs. This study is useful because it shows how big the tumor, what other organs may be affected, whether lymph nodes are enlarged and if the kidneys or bladder have been affected by cancer.
You may be asked to take one or two pints of a liquid called oral contrast “before the CT. This helps outline the intestine so that is not going to miss tumors. It is also possible that you apply an intravenous line through which is injected a different kind of contrast dye. This helps better outline structures in your body.
Barium enema X-ray
This test aims to determine whether the cancer has invaded the colon (large intestine) or rectum (also used to detect colorectal cancer). After taking laxatives the day before the test, the radiology technician introduces barium sulfate, a substance limestone in the rectum and colon. Because barium is impermeable to X-rays, details the structures of the colon and rectum on the x-ray of the abdomen. This test is rarely used in women with ovarian cancer. Instead of this test, you can do a colonoscopy.
Magnetic resonance imaging
MRI scans use radio waves and strong magnets instead of x-ray The energy of radio waves is absorbed and then released, forming a pattern that depends on the type of tissue and by certain diseases. A computer translates the pattern of radio waves received by the tissues into a very detailed image of parts of the body. Magnetic resonance imaging not only produce cross-sectional images of body as well as computed tomography, but also occur along sections of its body. Vein can be injected contrast material (as in CT). It is not often used to detect ovarian cancer.
MRI tests are particularly useful in examining the brain and spinal cord. MRI exams last longer than CT scans, often up to 30 minutes or more. In addition, you will be placed inside a tube that restricted and can be annoying for people who feel anguish at being in closed places (claustrophobia). The machine also makes a thumping noise that might cause discomfort. Some centers provide headphones with music to block this noise
You may have a chest radiograph to determine whether ovarian cancer has spread (it has metastasized) to the lungs. This spread may cause one or more tumors in the lungs and often leads to the accumulation of fluid around the lungs. This fluid, called pleural effusion, can be seen on chest radiograph.
Positron emission tomography
In this test (PET, for its acronym in English) were given glucose (sugar) radiation to determine whether cancer. Because cancers use glucose (sugar) at a higher rate than normal tissues, the radioactivity will tend to concentrate in cancer. A reading device (scanner) can detect the radioactive deposits. This study may be helpful in locating small groups of cancer cells. In some cases, this test has proved useful in detecting ovarian cancer that has spread. It is even more valuable when combined with CT (PET / CT scan). Although PET can help find cancer that has spread, this test is expensive and many insurance companies will not cover the cost.
Your doctor will order blood tests to make sure you have enough red blood cells, white cells and platelets (cells that help stop bleeding). Also performed tests to measure kidney function and liver, as well as general health status. Finally, the doctor will order a CA-125 test. If the level is high, we recommend consultation with a gynecologic oncologist.
During a pelvic exam, your health professional feels the ovaries and uterus to examine the size, shape and consistency. Although a pelvic examination is recommended because it means he can find some early cancers of the reproductive system for even the most skilled examiner is difficult or even impossible to palpate the majority of ovarian tumors in their early stages. However, pelvic exams can help identify cancers or other gynecological conditions. Women should consult their physicians about the need for these tests.
Although the Pap test is effective in detecting early cervical cancer, not a test to find ovarian cancer. Rarely ovarian cancers are detected through Pap tests, but usually these cases are already advanced.
Screening for ovarian cancer
The tests and screenings are intended to find a disease such as cancer, in people who have no symptoms. Perhaps the best example of this is the mammogram, which can often detect breast cancer at its earliest stage, even before the doctor can feel the tumor. Although there has been much research on the development of screening tests for ovarian cancer, studies to date have not yielded much success. There are two tests used most often to detect ovarian cancer. These tests, transvaginal ultrasound and CA-125, are often offered to women who are at high risk of epithelial ovarian cancer as those with a very strong family history.
Transvaginal ultrasound is an ultrasound examination that places a small instrument into the vagina. This test can help find bodies in the ovary, but can not indicate precisely which masses are cancers and which not.
In studies of women who are at average risk of ovarian cancer, these tests are not affected in the least amount of deaths from ovarian cancer. Thus, transvaginal ultrasound and blood test CA-125 are not recommended as screening tests for ovarian cancer in women without known strong risk factors. These studies often do in women at high risk, but it is unclear how useful they are. Additional research is underway to improve screening for ovarian cancer. It is expected that after improvements, these tests can be effective enough to reduce mortality from ovarian cancer.
Researchers from various U.S. institutions have made significant progress towards the obtaining of a blood test that detects breast cancer. This is possible under a simple analysis can recognize the DNA of breast cells lost or killed in this process.
Early studies showed an effectiveness of 100% to rule out cancer in healthy women. And in the case of female patients as detected in 70% of cases.
This achievement was the result of advances in DNA sequencing. If a cell is damaged breast will surely highlight the genes that characterize it that way. This will facilitate the screening apparently healthy and asymptomatic women, making it possible to start a treatment in a first stage of the disease which increases exponentially the chances of cure.
It also constitutes an invaluable tool for women already diagnosed under that genetic sequencing could help selecting the best treatment for each woman. So accurate diagnosis of patients with tumor biopsies could be avoided that would be replaced by a blood draw, which would provide the same information as that.
Unfortunately we are still far from this stage as to offer this test commercially must further develop research and lower costs now are very high and would make it impossible to mass consumption.
Changes in brain tissue can occur in people with breast cancer who are treated with chemotherapy, according to a U.S. study published in the journal Breast Cancer Research and Treatment.
The study provides information on the anatomical basis of already known effects of chemotherapy on cognitive function. Memory and executive functions (including a decreased ability to multitask and a decrease in the rate of information processing) are the functions most affected.
Brenna McDonald and Andrew Saykin, University of Indiana, with their colleagues, conducted the study with 17 women with breast cancer treated with chemotherapy after surgery, 12 women with the disease who have not received chemotherapy after surgery and 18 women free of the disease.
Magnetic resonance images of brain were taken after surgery but before radiotherapy and chemotherapy. The scans were repeated one month and one year after completion of chemotherapy.
Decreased gray matter density was most evident in brain areas associated with cognitive dysfunction experienced by women during and immediately after chemotherapy. For most women, the density of gray matter was improved one year after completion of chemotherapy.
For many women, the effects are subtle, said Dr. Saykin. For some, however, changes in gray matter may be more important. For example, for a relatively small proportion of patients treated with chemotherapy, generally middle-aged women, the brain changes are so important that they are unable to return to work. Most, however, remain able to work and do multitasking, but they may find it difficult to do.