Urine Test for Lung Cancer?

Researchers Developing Urine Test to Determine Smokers at Highest Risk for Lung Cancer

Researchers are a step closer to developing a simple urine test to identify smokers at high risk of developing lung cancer.

Although the test is still years away, the hope is to spot high-risk people earlier, when there’s still time to prevent or treat the cancer, says Jian-Min Yuan, MD, associate professor of cancer epidemiology at the University of Minnesota.

Early identification will give doctors a chance to step up smoking cessation and screening efforts, he tells WebMD.

“It might motivate smokers who are having trouble quitting” to finally kick the habit, Yuan says.

If that fails, “We can at least have them come in for lung cancer screening every six months,” he says. That way, doctors can catch cancer earlier, when there’s a higher chance it can be treated successfully with surgery, radiation, and/or chemotherapy.

The findings were presented at the annual meeting of the American Association for Cancer Research.

Smoking Causes Lung Cancer

Lung cancer is the leading cancer killer, claiming the lives of more than 160,000 Americans last year, according to the American Cancer Society. 

Smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and nearly 80% of lung cancer deaths in women are from smoking, according to the CDC. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke.

But not every smoker develops lung cancer, and there is no way to predict exactly who will develop the disease, says Peter G. Shields, MD, deputy director of the Lombardi Comprehensive Cancer Center in Washington, D.C.

“We all know that the more you smoke, the higher your risk. But only about one in 10 heavy smokers gets lung cancer,” he tells WebMD.

“It’s really remarkable that we have tests for cholesterol and so on, but we don’t have a blood or urine test for smoking,” Shields says.

Developing a Urine Test

In an effort to develop such a test, Yuan and colleagues culled data from two large studies that began about 20 years ago. One, called the Shanghai Cohort Study, involved more than 18,000 men in Shanghai, China. The other, the Singapore Chinese Health Study, included 63,257 men and women of Chinese descent.

At the time of enrollment, urine and blood samples were collected from all the participants and frozen for future use. They were also asked to answer a battery of questions, including whether they smoked, how much they smoked, and for how long they smoked.

For the new analysis, the researchers focused on 245 smokers in the studies who developed lung cancer and 245 smokers who didn’t get cancer.

Then they thawed their urine samples and measured levels of NNAL, a byproduct of one of the most potent tobacco lung carcinogens identified to date.

“When you smoke, you suck in about 60 carcinogens. One of the most potent, called NNK, breaks down and becomes NNAL in the body,” Yuan says.

NNAL has been shown to induce lung cancer in laboratory animals, but the effect in humans had not yet been studied, he says.

Then the smokers were divided into three groups based on their levels of NNAL in the urine.

Compared with those with the lowest levels, people with a mid-range level of NNAL had a 43% increased risk of lung cancer. Those with the highest levels had more than twice the risk of lung cancer.

Then the researchers measured a byproduct of nicotine, called cotinine, in the urine.

Smokers with the highest levels of both cotinine and NNAL had an 8.5-fold increase in the risk of lung cancer compared with smokers who had the lowest levels.

The findings held true even after taking into account the number of cigarettes smoked per day, the number of years of smoking, and other factors.

The next step is to measure another tobacco-carcinogen byproduct called PAH in the participants’ urine and look at whether high levels of all three chemicals even further raises risk, Yuan says.

“The idea is to build up a risk model that incorporates many of these biomarkers as well as smoking history, so we can best identify which smokers will eventually develop lung cancer,” he says.

Male Menopause

Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that their male patients are reporting some of the same symptoms that women experience in perimenopause and menopause.

The medical community is currently debating whether or not men really do go through a well-defined menopause. Doctors say that male patients receiving hormone replacement therapy (testosterone) have reported relief of some of the symptoms associated with so-called male menopause.

What Is Male Menopause?

Since men do not go through a well-defined period referred to as menopause, some physicians refer to this problem as androgen (testosterone) decline in the aging male. Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with some disease states such as diabetes. Along with the decline in testosterone, some men experience symptoms such as fatigue, weakness, depression, and sexual problems. The relationship of these symptoms to the decreased testosterone levels is still controversial.

Unlike menopause in women which represents a well-defined period in which hormone production stops completely, male hormone (testosterone) decline is a slower process. The testes, unlike the ovary, does not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his eighties or longer.

However, as a result of disease, subtle changes in the function of the testes may occur as early as 45 to 50 years of age, and more dramatically after the age of 70 in some men.

How Is Male Menopause Diagnosed?

To make the diagnosis, the doctor will perform a physical exam and ask about symptoms. He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the condition. The doctor will then order a series of blood tests which may include several hormone levels, including a blood testosterone level.

Can Male Menopause Be Treated?

If testosterone levels are low, testosterone replacement therapy may help relieve such symptoms as loss of interest in sex (decreased libido), depression, and fatigue. But, as with hormone replacement therapy in women, testosterone replacement therapy does have some potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example.

If you or a loved one is considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle changes, such as a new diet or exercise program, or other medications, such as an antidepressant, to help with some of the symptoms of male menopause.

Can A Vagina Be Too Big?

Faithful readers of this blog may remember that Masters and Johnson examined the vaginal sizes of 100 women who had never been pregnant. These women showed an un-stimulated vaginal length of 2 ¾-3 ¼ inches , with a ¾ inch width at the back of the vagina. During the sexual excitement phase the vaginal lengths increased to 3 ¾- 5 ¾ inches, with the width at the back of the vagina being 2 ¼-2 ½ inches. This correlates with our most common diaphragm sizes which are between 2 ½ -3 ½ inches in length.

"But I'm not worried about vaginal length," you might be thinking. "My problem is that I think my vagina is too loose - or too wide. Is that possible? If so what can I do?" Let's examine some of the medical data available to answer these questions.

Is my vagina too loose?
The vagina is like a collapsed, expandable tube lined with skin; the tissue below the skin is loose and contains large veins. Next are smaller circular muscles surrounded by stronger bands of muscle which run the length of the vagina. In addition, the lower third of the vagina is surrounded by a ring of muscles. This is covered by more connective tissue and blood vessels. Damage to these muscles, or if they become thin and weak, can allow the bladder ("cytocele") or rectum ("rectocele") to pouch into the vagina. Thus you can understand the importance of strong vaginal muscles. The ring of muscles around the vaginal opening contract during orgasm and may contribute to the intensity of an orgasm.

So what is too loose? This can be a matter of opinion based upon the input of a sexual partner, or one's observations of vaginal tone. Researchers have devised some ways to measure vaginal tone such as a pressure sensitive intravaginal balloon device, and ultrasound measurements of vaginal area ("pelvic floor") muscle thickness. A study of 30 women aged 20-42 found that better developed vaginal muscles were linked to having orgasms, and getting physical exercise. Conversely, increased age and having been pregnant were linked to decreased strength of vaginal muscles (McKey and Dougherty 1986).

A more recent study using ultrasound measurements (Bernstein,1997) found similar connections. Muscle thickness decreases with age, especially in women older than 60. Women with urinary incontinence had thinner pelvic floor muscles than women who were not incontinent.

Will exercising the vaginal muscles make my vagina tighter?
Two ultrasound studies of women who exercised their vaginal muscles did find that their muscles were thicker and stronger after pelvic floor muscle training. Among women with urine leakage, their thinner muscles became the thickness of healthy women's pelvic floor muscles. Additionally, they had less urine leakage - whether the problem was from stress or urge types of incontinence. The use of vaginal cones and/or Kegel exercises to increase muscle strength were both found to improve tone and decrease urine loss. While some of these studies did not measure vaginal tightness per se, when muscle bulk is increased, a woman can voluntarily contract those muscles to make the vaginal opening tighter.

Do tighter vaginal muscles really improve sexual response?
Despite the fact that most every discussion of Kegel exercises includes improved sex, there are not many scientific studies to back up this claim. One recent publication (Dean, 2008) reported on sexual function and pelvic muscle factors for some 2,800 women. Women who delivered only by Caesarean section (and their partners) perceived they had better vaginal tone leading to improved sexual satisfaction. Women who were currently doing pelvic muscle exercises scored much better on sexual satisfaction questions than women who did not. Women with incontinence (probably thinner muscles) scored the worst on the sex questions.

I've tried Kegel exercises but they don't work for me.
Assuming that the Kegel exercises have been done correctly, it may be time to move to other options. One low tech choice is weighted vaginal cones. This is a set of weights, shaped more like a tampon than a cone, where one inserts the lightest version then uses the vaginal muscles to hold it up inside. This is done twice daily. When this is easy the next heaviest cone is used - and so on. This is to be done while going about normal activities so that gravity provides an additional challenge to keeping the weight up inside.

More technology is involved in the electrical stimulator. A tampon shaped probe is inserted in the vagina and small electric shocks cause the muscles to contract then relax. This is done about 20 minutes up to several times a week. One patient of mine who used this device found it sexually pleasurable.

Less commonly used may be the "magnetic chair" ("Neocontrol"). This chair uses magnetic action to stimulate the muscles. I know this sounds very "woo, woo", but there is good data showing its effectiveness. This device is not for home use; treatments are given twice weekly by specially trained health care personnel.

Will plastic surgery make my vagina smaller?
Many genital plastic surgery techniques are based upon GYN surgical procedures used for medical problems such as reconstruction after cancer treatment, gender change, repair of cystocele/rectocele, etc. Unfortunately there are few good studies showing benefit where there is no overt medical problem.

One study of 53 women in Santiago, Chile (Pardo, 2006) was done specifically for complaints of wide vagina and decreased sexual satisfaction. The surgeons did two procedures. The first was inside the vagina where tissue along the roof was stitched tighter. This is similar to the type of repair done for a cystocele. Secondly, tissue around the vaginal opening and between the vagina and anus was stitched tighter. This is similar to the type of repair done for episiotomies after childbirth. Six months after surgery 94% claimed they experienced a tighter vagina, and had regained or improved orgasms. Yet some 4% of the women said they regretted the surgery.

The problem with this type of study is that sexual response can be very subjective. There is no easy way to measure sexual satisfaction in a group of diverse women. Every woman knew she got the surgical treatment so six months may not be a long enough time for any placebo response to wear off.

The American College of Obstetricians and Gynecologists (ACOG, 2007) has noted the lack of both safety and effectiveness data for genital plastic surgery. The possible complications for such surgery might include: infection, changes in sensation, pain with intercourse, and scar tissue. One GYN who has been performing genital plastic surgery for a number of years (Goodman, 2009) concluded that agreed upon terminology and training standards are still lacking.

What are you going to do, Jane?
As a big advocate of resistance/weight training to build muscles, I personally think exercise is a better place to start than surgery. As always, if a woman has concerns about sexual function, vaginal/genital structures, etc she should bring these up to her GYN. A GYN sees the wide range of "normal" in vaginal appearances. Yet, if one is having sexual problems due to genital changes, your GYN needs to know that is an issue.

All About Breasts

My Breasts Don't Look Normal. Is Something Wrong?

Given the breast centered focus of western civilization it's no surprise that many women are critical of the size and shape of their breasts. But what if something is truly abnormal about a young woman's breasts - would she know it? The purpose of this post is to try and address what is within the range of normal for breast appearance - and what may not be.

Age Matters
What is too early for the beginnings of breast development? Many mothers would be surprised to hear that breast development is not considered premature if it appears in African American girls by age of seven, or in other girls by age eight! Mothers then worry about the development of premature/precocious puberty (full breast development, menstrual periods, etc). Fortunately 80% of early-developing girls will not come fully into puberty. In fact, breast development may halt, only to reappear at the more usual time.

So what is the usual time to be "developed"? Lack of any breast development by age thirteen merits some monitoring. The small, firm breast buds usually appear about age eleven. By age thirteen a majority of girls have the beginnings of a mound-shape of breast tissue. Unless there is an overt reason for lack of development such as illness, radiation exposure, or hormonal problems there is evidence that breast development can continue until one's early 20's.

Size Might Matter
While most all of us have at least some difference in size between our two breasts, there are situations where the size difference is very apparent. Size differences which onset in teen years will likely equalize for about 75% of women.

Very large breasts can develop in teen women. This can occur on just one side or be bilateral. In this instance normalization of size is unlikely to happen. While a tumor can prompt a very large breast, most enlargement is related to a robust tissue response to normal hormonal influences. According to DeSilva (2006) there is no increased risk for breast cancer among young women with an extremely enlarged breast. Cosmetic surgery, if indicated, can be done. Reduction of a very large breast(s) is called reduction mammoplasty. Unlike breast augmentation (i.e. breast implants) there is usually more apparent scarring.

Conversely, there can be insufficient breast development on one or both breasts. One type that seems to cause particular distress creates a tall tube shaped breast. There is tissue growth under the nipple, but no rounded breast mound. Again, plastic surgery is the usual treatment.

Extra Nipples?
Having extra nipples has been reported in 1-2% of women. The line along which extra nipples are usually found extends from the armpit to the groin. Extra nipples do not usually have associated breast tissue so they may go unnoticed. A woman may think that the "accessory nipple" is a mole or other skin lesion. These do not have to be surgically removed unless, like a mole, they become inflamed by restrictive underwear or clothes.

Hormonal Medications
It has been noted that women using birth control pills may experience bilateral breast enlargement. This has been attributed to the hormone estrogen. A similar effect can occur in older women using post-menopausal hormonal therapy. Usually this is not a lasting effect, and size goes back down when the medication is stopped.

Previously, medications which block estrogen effects were tried as a treatment for too early or excessive breast development (Bloom 2008). This is not a standard treatment, however.

Breast Enlargement Options?
There are breast enlarging creams and herbal products advertised on the internet. As new products are touted, our Women's Health Board gets a spate of questions about the effectiveness of such products. The array of products includes pills, creams, devices, and even a chewing gum! I would concur with the review article written by Dr. A. Fugh-Berman (2003) published in the journal Obstetrics/Gynecology. She investigated many of the herbal ingredients touted to increase breast size. A few ingredients have the possibility of producing weak estrogen-like hormones. Yet most have no data to support their use for breast enlargement. Perhaps most concerning is there are no long term safety studies. In the real world, women may not use such products for very long when the promised 3-5 cup size increase does not appear.

Honestly, the most reliable way to get a larger breast size (short of weight gain or pregnancy) is breast augmentation done by surgically inserting a saline or silicone implant. The American Society of Plastic Surgeons reports an increase for cosmetic surgery from 14,000 in 1996 to 333,000 in 2005 for patients under age eighteen. At least 90% of those were females. Breast augmentation is one of the two most frequent plastic surgery procedures performed on teens (Zuckerman, 2008).

Since most health insurance will not cover breast augmentation, the costs have to be borne by the young woman, or her family. While the decision to do augmentation is a very personal decision it is worth understanding some of the risks. The FDA has not approved the use of saline implants in women under age 18, nor the use of silicone implants in women age 21 and younger. Surgeons can still do the procedure, but the benefits have not been demonstrated to out weigh the risks to the satisfaction of the FDA. Currently breast implants have a limited life expectancy. According to Zuckerman breast implants typically last about 10 years, and there is an increased of scar tissue formation the longer the implant is in place.

Interestingly, a study of women planning to get breast implants because of dissatisfaction with being too small, found that there was no difference in bra sizes compared to a group of women who were satisfied with their breast sizes (Didie, 2003).

Jane's Economy Breast Lift
Thus far we have moved from discussing medically focused breast issues through more self-concept, or cosmetic, concerns. Most women can think of a change in breast size, or firmness which they would prefer if the Fairy Godmother of Breast Structure was to grant them a wish. Would you be willing to develop a firmer breast profile without drugs, surgery, or any cost? OK, I was skeptical, too. But here it is-free to my readers:

Chest Exercises to Help Tone and More

If you do a few simple exercises, especially if combined with a balanced body work out, you will get better contours. As a bonus, saggy underarms (triceps flop) can improve. It will not increase or decrease your cup size by three to five sizes, but it will make what you have look better. And after all, isn't enhancing what we have been given what it's all about?

"Smart Choices" food label revealed as nutritional fraud

NaturalNews Insider Alert (www.NaturalNews.com) email newsletter
(Unsubscribe instructions at bottom)

---

Dear NaturalNews readers,

 

NaturalNews Tip of the day (from Mike): Want to find some truly "smart choices" for kids in the grocery store? Read the ingredients on the products you buy, remembering that the first three ingredients are mostly what that item is made of. Food manufacturers often try to bury sugars deeper in the ingredients list by using multiple forms of sugar that are listed separately: Sugar, sucrose, corn syrup, high-fructose corn syrup, etc.

Get this: A prominent dean at a nationally-recognized nutritional school with Tufts University is publicly endorsing Froot Loops for children as a "Smart Choice" for healthy food.

 

Huh? Does she know that Froot Loops is 41% sugar, with artificial colors and partially-hydrogenated oils? Read today's nutrition outrage here:

http://www.naturalnews.com/027077_nutrition_food_Tufts_University.html

 

 

Got breast cancer? Fight it with mushrooms:

http://www.naturalnews.com/027075_cancer_brst_cancer_mushrooms.html

 

... and walnuts:

http://www.naturalnews.com/027074_walnuts_cancer_tumors.html

 

 

(more below...)

---

This email newsletter is made possible by sponsorship from these quality product providers: (more info)

• Winner of NaturalNews Best Food Bar. Have a Complimentary Organic Bear Fruit Bar on us - when you sign up for our Newsletter!
• Carnivora - Cured a U.S. President! Let it work for You, Your Family & Friends - NaturalNews Readers 10% off with code NN10

• Julian Whitaker, MD: 30+ years helping people live healthier lives. Now you can get his report "7 Deadly Diabetes Lies"

---

Also today: Antioxidants and melanoma (http://www.naturalnews.com/027076_melanoma_cancer_antioxidants.html), FDA threatens thyroid supplements (http://www.naturalnews.com/027073_thyroid_the_FDA_health.html), aluminum and dementia (http://www.naturalnews.com/027072_aluminum_dementia_cleansing.html).

 

P.S. Thank you all for your support of the Health Revolution Petition! (www.HealthRevolutionPetition.org) Signatures have now exceeded 27,000. Please spread the word, as we need 100,000 signatures to take this to Washington D.C. and make an impact regarding the health care reform debate.

 

---

• Get instant alerts of new Health Ranger content on Twitter: www.Twitter.com/HealthRanger

• Follow NaturalNews on Facebook: http://www.facebook.com/pages/NaturalNewscom/35590531315

---

Today's Feature Stories:

"Smart Choices" food label is marketing fraud; Tufts University involvement questioned (opinion) (NaturalNews) The big food companies have dreamed up yet another clever con to sell processed junk foods to parents and children: A "Smart Choices" label that implies the food product is a smart choice for health and nutrition. The problem is that the...

New Study Finds Antioxidants Do Not Increase Melanoma Risk (NaturalNews) Melanoma is the most serious form of skin cancer. However, if it's recognized and treated early, it is almost 100 percent curable. On the other hand, if melanomas are ignored, they can spread to other parts the body and be fatal. According...

Study Finds Breast Cancer Fighting Properties within Mushrooms A recent study published in the International Journal of Cancer found evidence supporting that mushrooms have breast cancer-fighting properties. This study was conducted at the University of Western Australia in Perth. The study...

Walnuts Found to Prevent Breast Cancer (NaturalNews) A diet high in walnuts may significantly decrease a person's risk of breast cancer, according to a study conducted by researchers from the Marshall University School of Medicine and presented at a conference of the American Association for...

Access to Natural Desiccated Thyroid Treatments Threatened by FDA Throughout the past several months there has been a concerted effort by the Food and Drug Administration (FDA) to eliminate natural, bio-identical thyroid treatments from the market. Three companies have recently been ordered by the FDA to...

Aluminum is Potential Cause of Thirty-Five Million with Dementia Worldwide A recent report found that 35 million people around the world have Alzheimer's or other forms of dementia. The number is expected to double every 20 years "unless there is a medical breakthrough." Dementia rates have grown 10% over what was...

Scientists Use Post-Hypnotic Suggestion on the Stroop Effect The field of psychology uses various instrumental studies to examine cognitive processes. These processes are either controlled or automatic. Further, automatic processes can either be innate or learned. When a process is automatic, it is...

Leaked UN report claims swine flu could "kill millions" and cause "anarchy" in poor nations (NaturalNews) A UN report leaked to The Observer claims that swine flu could "kill millions" of people in poor nations and cause a total breakdown of society unless wealthy nations come up with US$1.5 billion to pay for pandemic vaccines and anti...

---

I've put together a detailed special report that's now posted for all NaturalNews readers. This report is entitled How to Build Your Safety Net: Twelve Ways to Achieve Prosperity During (and After) the Global Crisis. It's available right now at: http://www.naturalnews.com/Report_Financial_Safety_Net_0.html

 

* Why the bailout will sharply devalue your savings
* How to best insulate yourself from market turmoil
* Five things you should never buy in launching a business
* How to determine which activities will keep you happy while paying dividends
* The 18 "basic human drivers" that influence ALL consumer purchasing decisions
* The five absolute rules of marketing anything (without excessive spending)
* Seven key ways to generate interest on any topic
* Key questions to ask yourself that will help ensure your success
* Fifteen online resources to help with marketing, customer communications and more

Read it right now at: http://www.naturalnews.com/Report_Financial_Safety_Net_0.html

---

You've Got Great Karma, But How Are Your Finances?
Read this special report to learn how to experience abundance on many levels...

I've just posted a special report called The 7 Principles of Mindful Wealth. Read it right now at:
http://www.naturalnews.com/Report_Mindful_Wealth_0.html

... and learn how to overcome limiting beliefs and unleash a new philosophy of abundance.

Beyond "The Secret..."    More revolutionary than "The Law of Attraction..."   The 7 Principles reveals the foundational philosophy of attracting (and mindfully redistributing) enormous abundance of many kinds.

---

Truth revealed about Big Pharma and the FDA (+ remedies for 100 health conditions)

My latest book, Natural Health Solutions, reveals the truth about the FDA and Big Pharma, documenting the censorship, oppression of natural health, and the "planned diseasification" of the American public.

The book also reveals natural treatments and cures for over 100 common health conditions (and diseases) using foods, herbs and natural therapies.

"Mike Adams is leading the charge to protect your rights to have control over your body. Natural Health Solutions is a must read for anyone that wants to maintain their health and their health freedom." - Gregory Kunin, Co-Founder, Ola Loa

http://www.truthpublishing.com/NaturalHealthSolutions.html

---

Click here to unsubscribe

Not yet a subscriber? Sign up at:
http://www.NaturalNews.com/ReaderRegistration.html

Please DO NOT reply to this email. To contact NaturalNews, please use our online feedback form at: http://www.naturalnews.com/feedback.html

Privacy policy: http://www.naturalnews.com/privacypolicy.html

---

The NaturalNews Insider is published by Truth Publishing, which is solely responsible for all content. Truth Publishing International, Ltd. 12F-4, No.171, Sec. 4, Nanjing E. Rd., Songshan District, Taipei 105, Taiwan

Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.

• Surgery is done to confirm and treat cancer. Removal of all cancerous tissue and taking biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment, because the amount of cancer remaining (residual cancer) after the initial surgery may affect your outcome.
• Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Recent studies show that the addition of chemotherapy after surgery improves the outcome for some early-stage ovarian cancer.¹⁵ Chemotherapy is also recommended for all other stages of ovarian cancer. Chemotherapy that is given after a surgery is called adjuvant therapy.

Initial treatment

The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.

If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:

• Removal of your cancerous ovary and fallopian tube.
• A biopsy of your other ovary.
• Removal of fatty tissue (omentum) that is attached to some of the abdominal organs.
• Removal of lymph nodes in the pelvis and near the large blood vessel (aorta) in the belly.
• Biopsies of other tissues and peritoneal fluids (peritoneal washings) from the belly to look for cancer cells.

Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.

If you have a more advanced stage (stage II, III, or IV) of cancer or you have stage I and do not want to have children, your surgery may include:

• A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
• Collection of peritoneal fluid.
• Removal of pelvic and aortic lymph nodes (lymph node dissection).
• Removal of fatty tissue (omentum).
• Removal of as much cancerous tissue as possible.
• Biopsies of any tissue that may be cancerous.

Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.

Chemotherapy is recommended after surgery for most women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may last 4 to 6 months. Studies are looking at delivering chemotherapy directly into the belly (intraperitoneal chemotherapy). One study compared women with stage III ovarian cancer who had already had surgery. In that study, one group had treatment with paclitaxel delivered into a vein (intravenous) followed by intravenous cisplatin; the other group had treatment with intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group had more severe side effects, overall survival was better than for the intravenous group.¹⁶

Treatment Overview

continued...

Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If both of your ovaries are removed, you are likely to experience menopausal symptoms after surgery. Home treatment measures may relieve some of these symptoms. If home treatment does not help your menopausal symptoms, talk to your doctor about other ways to manage your symptoms.

If you have recently been diagnosed with ovarian cancer, you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after being diagnosed with cancer such as yours can help you accept and deal with your cancer.

What to think about during initial treatment

In about 70% of women with ovarian cancer, the cancer has already spread (metastasized) outside the pelvis by the time it is diagnosed.¹⁷ Advanced-stage cancer spreads most commonly to the lining of the abdominal cavity, the pelvic lymph nodes, and the fatty tissue around some of the abdominal organs.

Your long-term outcome depends on your age, the stage and grade of your cancer, and the amount of cancer remaining after your initial surgery.

Your quality of life becomes a critical issue when considering your treatment choices. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of ovarian cancer.

For more information about specific ovarian cancer treatments, see the topics:

Ovarian Cancer – Health Professional Information [NCI PDQ].

Ovarian Cancer – Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for ovarian cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment, depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Treatment Overview

(continued)

continued...

Your gynecologic oncologist or oncologist will schedule regular checkups, usually every 3 months for the first 2 years after treatment. Your doctor may then recommend checkups every 6 to 12 months depending on your stage of cancer. These checkups will include:

• A physical exam of your neck, lungs, and abdomen, and a pelvic exam to check for recurring cancer or swollen lymph nodes.
• A CA-125 blood test to see if the cancer has returned.
• An abdominal and pelvic CT scan or MRI to check to see if cancer has spread, especially when new symptoms, such as belly pain, are present or if CA-125 levels are high.

Second-look surgery, after 6 cycles of chemotherapy, may be done in research studies or clinical trials if no sign of cancer is found during a physical exam; in blood tests; or with X-ray, CT, or MRI. Additional biopsies are done at the time of second-look surgery to determine the need for more treatment. Second-look surgery is not recommended as standard treatment because of the chance of complications and because it does not clearly increase survival rates.

Treatment if the condition gets worse

The long-term outcome (prognosis) for ovarian cancer that has returned after treatment (is recurrent) depends on whether the cancer has spread. Even with no sign of cancer after treatment, between 30% and 50% of women who are treated for ovarian cancer have cancer return within 5 years.⁴ Women who have cancer return within 6 months after their initial treatment are less likely to respond to more treatment with the same chemotherapy medicines than women whose cancer has returned more than 6 months after their initial treatment. Other chemotherapy medicines may be recommended for further treatment.³
Palliative care
If your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life-not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.
Some treatments for recurrent ovarian cancer, such as chemotherapy and radiation, are considered palliative care. These treatments cannot cure your cancer, but they can extend your life, control your symptoms, reduce your pain, and make you feel more comfortable.
In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans concerning your health and medical care.

Treatment Overview

(continued)

continued...

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
Complementary therapies
In addition to conventional medical treatment, you may wish to try complementary therapies to help manage your symptoms. But complementary therapies are not a substitute for conventional medical treatment that is recommended for ovarian cancer. Complementary therapies include:

• Acupuncture.
• Herbs.
• Biofeedback.
• Meditation.
• Yoga.
• Visualization.
• Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

Some women with ovarian cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries, for all stages of ovarian cancer.
Most treatments for ovarian cancer cause side effects. The side effects that you have depend on the type of treatment used, your age, and your overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

• Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
• Side effects of surgery depend on how much surgery was done to treat the stage of your cancer.

Nausea and vomiting are side effects of chemotherapy for ovarian cancer. Your doctor can prescribe medicines to control nausea and vomiting.Talk to your doctor about what to expect and when you should call if you are having nausea or vomiting. Home treatment measures can also help you manage other side effects of treatment.

End-of-life issues

Some women with advanced-stage cancer may choose not to have treatment focused on prolonging life because they decide that for them the time, costs, and side effects of treatment are greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care

When To Call a Doctor

Ovarian cancer does not cause many symptoms in its early stages. And having symptoms does not always mean you have cancer. These symptoms may be caused by other problems. It is important to talk to your doctor if you have any new symptoms, such as:

• Ongoing cramps or pain in your belly.
• Ongoing pain in your pelvis or lower back.
• Abnormal bleeding from your vagina, especially after menopause if you are not using any hormonal medicines.
• Abnormal discharge from your vagina, containing mucus that may be tinged with blood.
• Pain or bleeding during sex.
• Nausea or loss of appetite or you cannot eat normally.
• Ongoing bloating or intestinal gas that is not relieved by home treatment measures.
• Bigger belly size or a lump that can be felt in your belly.
• Decreased energy level.
• A change in your bowel habits, such as constipation or diarrhea.
• A change in your bladder habits, such as urinary frequency or urgency.
• Weight loss.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your condition or symptoms without using medical treatment. Watchful waiting is not appropriate if you have symptoms that do not go away. If you are concerned about your symptoms and you have a higher risk for ovarian cancer, call and make an appointment with your doctor.

Exams and Tests

There are no reliable screening tests for ovarian cancer. Ovarian cancer is confirmed and staged by biopsies that are taken during laparotomy surgery.

Some initial exams and tests are done before surgery if ovarian cancer is suspected. These tests include:

• Your medical history, to check what symptoms you have and what your chance of developing ovarian cancer is.
• A physical exam, including a pelvic exam and Pap test. An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs.
• A complete blood count (CBC), to check for anemia and other abnormal blood values.
• A chemistry screen to check for liver and kidney problems.
• A human chorionic gonadotropin (hCG) level may be done to rule out pregnancy or an ectopic pregnancy.
• A cancer antigen 125 (CA-125) level, to measure a protein found on the surface of many ovarian cancer cells.
• A pelvic and transvaginal ultrasound to look for an ovarian lump.

Additional tests may be done before surgery to determine if other areas of the body are involved. These tests include:

• A pelvic or abdominal CT scan or MRI to check for the spread of cancer.
• A chest X-ray to check for the spread of cancer.

Early Detection

For most women, the United States Preventive Services Task Force (USPSTF) does not recommend having a CA-125 blood test or a transvaginal ultrasound to find ovarian cancer early.¹³ There is no evidence that having regular tests helps women live longer by finding ovarian cancer early. Still, experts recommend that women who have inherited a BRCA gene change and have not had their ovaries removed have a transvaginal ultrasound and a CA-125 blood test at least once a year, starting at age 35. Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want to start having these regular tests as early as age 25.¹⁴

What Increases Your Risk

Risk factors for ovarian cancer include:

• A family history. Between 10% and 20% of women with ovarian cancer have a close female relative who had ovarian or breast cancer. Women with a family history may develop ovarian cancer at an earlier age, such as in their 40s, rather than at the more typical age of postmenopausal women in their 50s. Women who have BRCA1 or BRCA2 gene mutations have between a 16% and 60% chance of developing ovarian cancer during their lifetime.
• Increasing age. Ovarian cancer most often affects postmenopausal women.
• Never having a baby.
• Starting menstrual cycles before age 12 and going through menopause at an older age. The more menstrual cycles you have, the more risk you have for ovarian cancer.
• Being unable to become pregnant (infertility). Women who do not use birth control and are sexually active but who are unable to become pregnant may have a higher chance for ovarian cancer.
• Use of estrogen or hormone replacement therapy. Some studies have shown that some women who use these hormones have a slightly increased risk of developing ovarian cancer, and other studies have shown no increased risk.In general, experts advise women considering hormone replacement therapy for symptoms of menopause to take the smallest dose possible to control symptoms, and to take the medicine for the shortest time that they can.
• Women who are of Ashkenazi Jewish ancestry (Jews whose ancestors came from Eastern Europe) may have an increased risk because of changes to the BRCA1 or BRCA2 genes. Women with this ancestry have higher rates of these gene changes.
  

  Should I have a gene test for breast and ovarian cancer?



• Polycystic ovary syndrome (PCOS). Elevated levels of male hormones (androgens) commonly found in PCOS may increase your risk for ovarian cancer.


• A history of breast cancer. Women with a personal history of breast cancer or a family history of breast cancer have a higher risk for ovarian cancer.

More research is needed to confirm if certain other factors can increase a woman's chances of getting ovarian cancer, such as:

• Exposure to asbestos.
• A history of endometriosis or ovarian cysts.
• Smoking.
• Diets high in lactose (a milk sugar), which is found in foods such as milk and ice cream.

Cause

The cause of ovarian cancer is not known. Genetics are a risk factor for some women. A family history of ovarian or breast cancer is found in 10% to 20% of women with ovarian cancer.¹ In general, fewer than 2 in 100 women (less than 2%) will get ovarian cancer in their lifetime. That risk goes up to 4 or 5 in 100 if one family member has had ovarian cancer, and 7 in 100 if two relatives have had it. But if at least two first-degree relatives (meaning mother, sister, or daughter) have had ovarian cancer, the risk is 25 to 50 in 100 (25% to 50%).²

Women who inherit changes (genetic mutations) in the BRCA1 and BRCA2 genes have a higher chance of developing ovarian cancer and breast cancer. Women who inherit the gene change in BRCA1 have a lifetime chance of 20 to 60 out of 100 of getting ovarian cancer. For women who inherit the gene change in BRCA2, the lifetime chance is 10 to 35 out of 100.³

You have a higher chance of developing ovarian cancer if you:

• Are unable to become pregnant (infertility).
• Have never had a baby.
• Have not used hormonal birth control methods. Hormonal methods change the normal cycle of the female hormones, estrogen and progesterone, so ovulation does not occur each month.

If you have a strong family history of ovarian or breast cancer, you may want to talk with your doctor or a genetic counselor about having a blood test to look for BRCA1 and BRCA2 gene changes. Women who inherit these changes in one or both of these genes have a higher chance of developing ovarian cancer, breast cancer, or both.

Ovarian Cancer Guide

What is ovarian cancer?

Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries. This topic is about epithelial ovarian cancer, the most common type.

This cancer is often cured when it is caught early. But most of the time, the cancer has already spread by the time it is found.

It is frightening to hear that you or someone you love may have ovarian cancer. It may help to talk with your doctor or join a support group to deal with your feelings.

What causes ovarian cancer?

We do not know what causes it. Some women who have it also have a family history of cancer. But most do not.

Some women are more likely than others to get this rare cancer. Women who are past menopause or who have never been pregnant are more likely to get ovarian cancer.

What are the symptoms?

Ovarian cancer does not usually cause symptoms at first. But most women do have some symptoms in the 6 to 12 months before ovarian cancer is found. The most common symptoms are gas and pain or swelling in the belly. Other symptoms are diarrhea or constipation, or an upset stomach.

But these symptoms are so general that they are more likely to be blamed on a number of other causes. Most of the time, the cancer has already spread by the time it is found.

How is ovarian cancer diagnosed?

Sometimes the doctor may feel a lump in or on an ovary during a routine pelvic exam. Often a lump may be seen during an ultrasound. Most lumps are not cancer.

The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery. The doctor makes an incision in the belly so that he or she can look inside. The doctor will remove bits of any tumors that are found and send them to a lab to confirm that they contain cancer.

There is a blood test called CA-125 (cancer antigen 125) that is sometimes done to look for cancer in women at high risk. So far, there is not enough proof to show that this test works to find ovarian cancer early in most women. Too much CA-125 in the blood can be caused by many things, like the menstrual cycle, endometriosis, and uterine fibroids, as well as many types of cancer.

How is it treated?

Surgery is the main treatment. The doctor will remove any tumors that he or she can see. This usually means taking out one or both ovaries. It may also mean taking out the fallopian tubes and uterus. After surgery, most women have several months of chemotherapy, which means taking drugs that kill cancer cells.

Topic Overview

(continued)

This cancer often comes back after treatment. So you will need regular checkups for the rest of your life. If your cancer does come back, treatment may help you feel better and live longer.
Ovarian cancer is very serious, but many women do survive it. It depends on your age and overall health, how far the cancer has spread, and how much cancer is left behind during surgery.
It may help to talk to other women who are going through the same thing. People who take part in support groups usually feel better, sleep better, and feel more like eating. Your doctor or your local branch of the American Cancer Society can help you find a support group. You can also look on the Internet to find support sites where women with this cancer can talk to each other.

What are your chances of getting ovarian cancer?

This cancer most often affects women who are past menopause. Women are more likely to get ovarian cancer if others in their family have had it. They are more likely to get it if they have had breast cancer.
You may also be more likely to get this cancer if:

• You never had a baby.
• You started your menstrual cycles before age 12 and went through menopause after age 50.
• You are unable to become pregnant.
• You have used hormone replacement therapy for menopause symptoms.

Symptoms

Ovarian cancer does not cause many symptoms in its early stages. This is why most cases are not found until the cancer has spread.⁴ Most women do have symptoms in the 6 to 12 months before ovarian cancer is found. Symptoms that occur in later stages are most likely caused by the pressure of the growing cancer. Symptoms include:

• Ongoing cramps or pain in your belly.
• Ongoing pain in your pelvis or lower back.
• Abnormal bleeding from your vagina, especially after menopause if you are not using any hormonal medicines.
• Abnormal discharge from your vagina, containing mucus that may be tinged with blood.
• Pain or bleeding during sex.
• Nausea or loss of appetite, or you cannot eat normally.
• Ongoing bloating or intestinal gas that is not relieved by home treatment measures.
• Bigger belly size or a lump that can be felt in your belly.
• Decreased energy level.
• A change in your bowel habits, such as constipation or diarrhea.
• A change in your bladder habits, such as urinary frequency or urgency.
• Weight loss.

15 Cancer Symptoms Women Ignore

WebMD uncovers common cancer warning signs women often overlook.

By Kathleen Doheny
WebMD Feature

Reviewed by Louise Chang, MD

Women tend to be more vigilant than men about getting recommended health checkups and cancer screenings, according to studies and experts.

They're generally more willing, as well, to get potentially worrisome symptoms checked out, says Mary Daly, MD, oncologist and head of the department of clinical genetics at Fox Chase Cancer Center in Philadelphia.

But not always. Younger women, for instance, tend to ignore symptoms that could point to cancer. "They have this notion that cancer is a problem of older people," Daly tells WebMD. And they're often right, but plenty of young people get cancer, too.

Of course, some women are as skilled as men are at switching to denial mode. "There are people who deliberately ignore their cancer symptoms," says Hannah Linden, MD, a medical oncologist. She is a joint associate member of the Fred Hutchinson Cancer Research Center and associate professor of medicine at the University of Washington School of Medicine, Seattle. It's usually denial, but not always, she says. "For some, there is a cultural belief that cancer is incurable, so why go there."

Talking about worrisome symptoms shouldn't make people overreact, says Ranit Mishori, MD, an assistant professor of family medicine at the Georgetown University School of Medicine in Washington, D.C. "I don't want to give people the impression they should look for every little thing," she says.

With that healthy balance between denial and hypochondria in mind, WebMD asked experts to talk about the symptoms that may not immediately make a woman worry about cancer, but that should be checked out. Read on for 15 possible cancer symptoms women often ignore.

No. 1: Unexplained Weight Loss

Many women would be delighted to lose weight without trying. But unexplained weight loss -- say 10 pounds in a month without an increase in exercise or a decrease in food intake -- should be checked out, Mishori says.

"Unexplained weight loss is cancer unless proven not," she says. It could, of course, turn out to be another condition, such as an overactive thyroid.

Expect your doctor to run tests to check the thyroid and perhaps order a CT scan of different organs. The doctor needs to "rule out the possibilities, one by one," Mishori says.

No. 2: Bloating

Bloating is so common that many women just live with it. But it could point to ovarian cancer. Other symptoms of ovarian cancer include abdominal pain or pelvic pain, feeling full quickly -- even when you haven't eaten much -- and urinary problems, such as having an urgent need to go to the bathroom.

If the bloating occurs almost every day and persists for more than a few weeks, you should consult your physician. Expect your doctor to take a careful history and order a CT scan and blood tests, among others.