Ovarian cancer | Vital Health Endometriosis Center

The Endometriosis – Ovarian Cancer Connection (Part 5)

Dr. Cook — Fri, 16 Mar 2012 04:36:34 +0000

As you can see below there are many different types of ovarian tumors and cancers. We will use this official classification system to show which of these are associated with endometriosis.

World Health Organization Histological Classification of Ovarian Tumors^1,2 (1999):

I. Surface epithelial-stromal tumors
1. Serous tumors
(1) Benign
1. Cystadenoma and papillary cystadenoma
2. Surface papilloma
3. Adenofibroma and cystadenofibroma
(2) Of borderline malignancy (of low malignant potential)
1. Cystic tumor and papillary cystic tumor
2. Surface papillary tumor
3. Adenofibroma and cystadenofibroma
(3) Malignant
1. Adenocarcinoma, papillary adenocarcinoma, and papillary cystadenocarcinoma
2. Surface papillary adenocarcinoma
3. Adenocarcinofibroma and cystadenocarcinofibroma
(malignant adenofibroma and cystadenofibroma)
2. Mucinous tumors, endocervical-like and intestinal types
(1) Benign
1. Cystadenoma
2. Adenofibroma and cystadenofibroma
(2) Of borderline malignancy (of low malignant potential)
1. Cystic tumor
2. Adenofibroma and cystadenofibroma
(3) Malignant
1. Adenocarcinoma and cystadenocarcinoma
2. Adenocarcinofibroma and cystadenocarcinofibroma
(malignant adenofibroma and cystadenofibroma)
3. Endometrioid tumors
(1) Benign
1. Cystadenoma
2. Cystadenoma with squamous differentiation
3. Adenofibroma and cystadenofibroma
4. Adenofibroma and cystadenofibroma with squamous differentiation
(2) Of borderline malignancy (of low malignant potential)
1. Cystic tumor
2. Cystic tumor with with squamous differentiation
3. Adenofibroma and cystadenofibroma
4. Adenofibroma and cystadenofibroma with squamous differentiation
(3) Malignant
1. Adenocarcinoma and cystadenocarcinoma
2. Adenocarcinoma and cystadenocarcinoma with squamous differentiation
3. Adenocarcinofibroma and cystadenocarcinofibroma
(malignant adenofibroma and cystadenofibroma)
4. Adenocarcinofibroma and cystadenocarcinofibroma with squamous differentiation
(malignant adenofibroma and cystadenofibroma with squamous differentiation)
(4) Epithelial-stromal and stromal
1. Adenosarcoma, homologous and heterologous
2. Mesodermal (mullerian) mixed tumor (carcinosarcoma),
homologous and heterologous
3. Stromal sarcoma
4. Clear cell tumors
(1) Benign
1. Cystadenoma
2. Adenofibroma and cystadenofibroma
(2) Of borderline malignancy (of low malignant potential)
1. Cystic tumor
2. Adenofibroma and cystadenofibroma
(3) Malignant
1. Adenocarcinoma
2. Adenocarcinofibroma and cystadenocarcinofibroma
(malignant adenofibroma and cystadenofibroma)
5. Transitional cell tumors
(1) Brenner tumor
(2) Brenner tumor of borderline malignancy (proliferating)
(3) Malignant Brenner tumor
(4) Transitional cell carcinoma (non-Brenner type)
6. Squamous cell tumors
7. Mixed epithelial tumors (specific types)
(1) Benign
(2) Of borderline malignancy (of low malignant potential)
(3) Malignancy
8. Undifferentiated carcinoma

II. Sex cord-stromal tumors
1. Granulosa-stromal cell tumors
(1) granulosa cell tumors
(2) thecoma-fibroma group
2. Sertoli-stromal cell tumors androblastomas
(1) well-differentiated
(2) Sertoli-Leydig cell tumor of intermediate differentiation
(3) Sertoli-Leydig cell tumor poorly differentiated (sarcomatoid)
(4) retiform
3. Sex cord tumor with annular tubules
4. Gynandroblastoma
5. Unclassified
6. Steroid (lipid) cell tumors
(1) stromal luteoma
(2) Leydig cell tumor
(3) unclassified

III. Germ cell tumors
1. Dysgerminoma: variant-with syncytiotrophoblast cells
2. Yolk sac tumors (endodermal sinus tumors)
(1) polyvesicular vitelline tumor
(2) hepatoid
(3) glandular
3. Embryonal carcinoma
4. Polyembryoma
5. Choriocarcinoma
6. Teratomas
(1) immature
(2) mature
(3) monodermal
(4) mixed germ cell

IV. Gonadoblastoma

V. Germ cell sex cord-stromal tumor of nongonadoblastoma type

VI. Tumors of rete ovarii

VII. Mesothelial tumors

VIII. Tumors of uncertain origin and miscellaneous tumors

IX. Gestational trophoblastic diseases

X. Soft tissue tumors not specific to ovary

XI. Malignant lymphomas, leukemias, and plasmacytomas

XII. Unclassified tumors

XIII. Secondary (metastatic) tumors

XIV. Tumorlike lesions

References
1. Kaku, T, Ogawa S, Kawano Y, Ohishi Y, Kobayashi H, Hirakawa T, Nakano H; Histological classification of ovarian cancer; Med Electron Microsc (2003) 36:9–17

2. Chen V, Ruiz B, Killeen J, Cote´ T, Wu X, Correa C; Pathology and Classification of Ovarian Tumors; CANCER Supplement (2003) 97(10): 2631-42

The post The Endometriosis – Ovarian Cancer Connection (Part 5) appeared first on Vital Health Endometriosis Center.

The Endometriosis – Ovarian Cancer Connection (Part 4)

Dr. Cook — Fri, 16 Mar 2012 03:14:18 +0000

The basic types of benign and malignant ovarian tumors are described in this blog. Tumors can be solid or cystic and they are also classified as benign (not cancer) and malignant (cancer)

There are 6 basic types and a total of 23 different kinds of benign ovarian tumors including:

Simple Cysts
Functional cysts
Graafian Follicle Cyst
Corpus Luteum Cyst
Hemorrhagic Cyst
Polycystic ovaries (PCOS)
Endometrioma – Endometriosis chocolate cyst
Benign epithelial tumors
Serous tumors
- Cystadenoma and papillary cystadenoma
- Surface papilloma
- Adenofibroma and cystadenofibroma
Mucinous tumors
- Cystadenoma
- Adenofibroma and cystadenofibroma
Endometrioid
- Adenoma and cystadenoma
- Adenofibroma and cystadenofibroma
Clear cell adenofibromas – 12 reported cases
Benign Brenner Tumors
Benign Mixed Epithelial Tumors
Benign germ cell tumors
Mature cystic teratomas
Monodermal teratoma (can be benign or malignant)

Types of carcinomas of low malignant potential (borderline tumors)

There is a total of 15 potential types of borderline tumors, all of which are the epithelial tumors. These tumors are all of the epithelial type ovarian tumor and while not completely benign they are not as aggressive as most ovarian cancers, are not as invasive and have a much better prognosis than typical ovarian cancers.

Types of malignant ovarian tumors

The 3 basic types of malignant ovarian tumors include:

Epithelial – 90% of all ovarian cancers
Germ cell tumors
Sex Cord-stromal cell tumors

The World Health Organization classification system (see next post) describes 14 different types of ovarian tumors with well over 30 different types of ovarian cancer.

I know some of this can get a bit boring, but stick with me as we are laying the framework to understand the difference between a news sound bite and what having endometriosis really means in regards to any increased risk of ovarian cancer.

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The Endometriosis – Ovarian Cancer Connection (Part 3)

Dr. Cook — Fri, 09 Mar 2012 18:47:51 +0000

In this blog, I will start to discuss the different types of diseases of the ovary and will go over some of the more common types of cysts of the ovary that can be part of the normal menstrual cycle. A diseased ovary will have an abnormal growth either, liquid (a cyst), solid (tumor), or a growth comprised of a mixture of solid and liquid (complex mass). These conditions can also be divided into cancerous (malignant), non-cancerous (benign) or borderline tumors. When reading about these conditions you may see the word “adnexa” used, which refers to the fallopian tube and the ovary, thus the right adnexa is the right tube and ovary.

A functional or follicular cyst of the ovary forms during the first two weeks of the menstrual cycle every month as the egg matures prior to ovulation. Normally the fluid in this cyst drains out with ovulation (when the egg is released from the ovary). The two weeks after ovulation prior to the first day of the next period, a corpus luteum cyst forms. Normally it is really not much of a cyst but does produce progesterone until the period starts. Occasionally when the egg is released a small vessel is ruptured and bleeds back into the cyst and is known as “Hemorrhagic Corpus Luteum” (HCL) cysts. In essence, it is a blood clot in the ovary, which can be moderately large (several centimeters in diameter) and sometimes can look similar to an ovarian endometrioma on an ultrasound (sonogram). Your physician may have you come back in 1 to 2 months to recheck the size of the cyst with the ultrasound. The HCL will go away (kind of like healing a bruise) but an endometrioma will not shrink in size.

A “simple cyst” means it is a single, smooth round fluid cyst. A simple cyst can be a follicular cyst. If a simple cyst does not go away with the period, it can be a follicular cyst that did not rupture (ovulate) or got “stuck” which can happen once in awhile in an otherwise normal ovary. Often these will resolve with some time. Occasionally it will need to be drained, which in this case often resolves the problem. A simple cyst on sonogram can also be a cyst on the fallopian tube. It is fairly common to have “para-ovarian cysts”. Usually, these are not very large, but occasionally may be confused with an ovarian cyst. Sometimes it is difficult to tell if the cyst is actually on the ovary or fallopian tube with an ultrasound.

In the next blog, I will go over the different types of benign ovarian tumors (not cancer) and the different types and subtypes of ovarian cancer. Ovarian cancer is not one disease but actually represents over 30 different types of cancer. After we have gone through some of the basics about the more common forms of ovarian cancer, we can start to talk about the relationship between endometriosis and the different types of ovarian cancer.

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The Endometriosis – Ovarian Cancer Connection (part 2)

Dr. Cook — Fri, 02 Mar 2012 01:35:01 +0000

To really understand the issue of endometriosis and ovarian cancer we need to keep several things in perspective, including the following:

does the information in a scientific study apply to you as an individual
how good is the data and what are the shortcomings
what is actual risk of the situation affecting you
what is the actual change in the risk for any given factor
what can you do to change or reduce the risk in question

In the following paragraphs I use the example of what scientific studies tell us about how consuming dairy products affects the risk of developing ovarian cancer.

For example, a journalist could correctly state that scientists have shown dairy consumption increases by 100% the risk of a woman developing ovarian cancer. Relative risk (RR) is a statistical term used to quantify the amount of increased (or decreased) risk in comparison to the baseline level. Twice as many people will develop the disease with a relative risk of 2.0. A 2004 study found that high consumption of whole cows milk did have an RR of 2.0 and thus this statement is correct.

The article also stated that lower consumption of whole milk did not show the same risk. So based this information a woman who only uses milk on her cereal in the morning is not increasing her risk of ovarian cancer. But if she stopped eating her morning cereal with milk basing her decision on this news report, she would be changing her life on information that did not apply to her.

In addition, another larger study in 2005 reviewed over 20 articles evaluating the risk of ovarian cancer as it related to dairy consumption (including the 2004 article). It does seem that high whole milk consumption increases the risk of developing ovarian cancer but only by 25% (average relative risk = 1.25)

The risk of ovarian cancer as it related to overall dairy consumption was slightly increased (RR = 1.17), with yogurt consumption slightly increased (RR =1.13) but skim/ low-fat milk did not show an increased risk (RR = 0.94) nor did the consumption of cheese have an increased risk (RR = 0.95).

From these studies, the accurate message is low/fat skim milk and cheese do not seem to increase the risk of developing ovarian cancer, while whole milk and yogurt demonstrate a small increase in risk. In other words a news piece on dairy increasing doubling the risk of ovarian cancer would falsely create worry and concern in the woman who has a bowl of cereal in the morning and perhaps eliminated something from her life that she not need to (endo does that enough on its own, we don’t need to unnecessarily add to it). Next time I will get into the discussion of what we know about ovarian cancer and how it is not one disease but in reality many different diseases, with different causes, prognosis, and outcomes.

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The Endometriosis – Ovarian Cancer Connection

Dr. Cook — Thu, 01 Mar 2012 01:13:01 +0000

An increasing number of scientific articles are coming out showing a correlation between endometriosis and ovarian cancer. An increased risk of developing cancer is always a concern in general and the possibility of ovarian cancer in particular since it is so hard to detect early with vague, common symptoms and thus is usually in an advanced stage when diagnosed with a resulting poor prognosis for survival. Common symptoms of ovarian cancer include bloating, fatigue, constipation, pelvic or abdominal pain, vaginal bleeding, back pain, pain with intercourse, difficulty eating or feeling full without eating much and urinary frequency. These symptoms describe in a large part those experienced by patients with endometriosis and thus are not very helpful in alerting us to the possibility of ovarian cancer. The PAP smear is a great screening tool for cervical cancer. Unfortunately, we do not have anything like this for ovarian cancer.

Ovarian cancer is the sixth most common cancer for women in the U.S., second most common gynecological cancer and the most deadly gynecological cancer. Approximately 70% of women have advanced disease at the time of diagnosis and 65% die within the first 5 years. Approximate survival rates at 5 years based upon stage are; Stage I – 89%, Stage II – 66%, Stage III – 34% and Stage IV – 18%. A woman’s lifetime risk of developing ovarian cancer is about 1.4% or 1 in 70 women.

For those with a first-degree relative with ovarian cancer, the risk increases to about 3.3% or a 1 in 30 chance. A family history of ovarian cancer is the most significant risk factor while not having children also increases the risk as well as early age of onset of menses, late menopause, infertility and use of talc in the genital area. Several factors seem to decrease the risk including use of birth control pills, pregnancy, breastfeeding, tubal ligation, and hysterectomy.

Before I can talk about how endometriosis affects your chance of getting ovarian cancer, we need to gain a better understanding of ovarian cancer and how the information from scientific studies may or may not apply to individual patients. I will go over this in the next couple of blogs.

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