Ovarian Cancer-Defined

According to the text, Understanding Pathophysiology 3^rd edition, cancer is an overgrowth of useless tissue that is not affected by normal human body physiology and is one of the leading adult diseases of the western world with risk factors that increase dramatically with age. The disease is very complicated and research geared toward its understanding is ongoing.

The Research

Researchers have that cancer is actually not a single disease bur a collection of many different diseases that all begin and spread due to an alteration of mutation in genetic factors and is influenced by the modifiable risk factors of environment and lifestyle. Carcinogenesis is caused oncogenes, which are mutant genes that aid in the spread by causing abnormal acceleration in proliferation (multiplication of cells) and tumor suppressor genes that are proteins that fail to slow or stop proliferation as they are designed to do. Cancer cells are typed according to their place of origin. Terato cells arise from germ cells or cells that form reproductive organs. Adenocarcinoma arises from glandular or ductal epithelium, sarcoma stems from connective tissue and carcinomas begin in endothelial and epithelial tissue.

Ovarian cancer accounts for 5% of all female cancer deaths and is the cause of more deaths than any other of the reproductive system. This cancer is linked with increased age, family history of breast cancer, infertility, prolonged use of fertility drugs without becoming pregnant, early start or late end of menstral cycle, no interruptions in ovulation before the age of thirty and genetic predisposition. Risk is decreased by events that interrupt ovulation such a pregnancy, breast-feeding and use of birth control pills (Huether, McCane, 2004).

Ovarian cancer comes three forms. 90% of cases come in the form of epithelial tumors with the rest being germ cell and stromal tumors. As with other cancers, metastasis usually is accomplished by extension, seeding, or traveling through the blood and lymph system. Another avenue for metastasis of ovarian cancer is through the diaphragm into the chest wall, which can result in pleural effusion (fluid build up in the area between the lungs and chest). In contrast with other cancers, a palpable mass is usually not present and localized pain is not an associated symptom unless the disease has extensive progression (Understanding Pathophysiology 3^rd ed).

How it develops

Pathology of this disease is described to be 90% of cases resulting from changes in ovarian surface epithelial cells of woman 45 years or older with the other 10% arising from theca or germ cells of the ovarian stroma of younger women. The pattern and progression of this type of cancer starts from a single normal cell that changes to one that has genetic malformations to include amplification or deletion of several chromosomes. The loss of tumor suppressor genes and activation of oncogenes also occur as part of this progression, which eventually leads to a spread of cancer to the intra-abdominal region into the surface of the peritoneum (abdominal area lining). Most cases of ovarian cancer do not appear to be inherited and occur sporadically. Facts show that only 5-10% of cases are genetically imposed and most of these cases are linked to mutations of BRCA1, which is the breast cancer susceptibility gene (Huether, McCance, 2004).

The breast cancer susceptibility gene, BRCA1, is a dominant gene located on chromosome 17 and its mutations have been associated with 50% of all inherited breast cancer cases, especially when a family history of both breast and ovarian cancer is present. Women 40 years of age that have this gene have a risk for developing breast cancer that is 20 times greater in comparison to the general population and will have an increased risk over their lifetime of 60 to 85%. The risk of possessing this gene is not limited to breast cancer alone but includes a higher risk for ovarian cancer because BRCA1 is a tumor suppressor gene and with its mutation, can be inhibited. This process will allow cell proliferation to accelerate uncontrolled until metastasis develops. Due to the precences of this gene, cancer can form in either the breast or ovaries or may even develop in both area at the same time even in symptoms do not exist in both areas (Huether, McCance, 2004).

Symptoms

Symptoms of ovarian cancer are general and are not localized to a specific point of origin until the disease has spread from the original site. In progressed stages, the major symptoms of pain and swelling in the abdominal region start in the are of the primary ovary mass. Other symptoms include sensations of pelvic and leg pain as well as dyspepsia, vomiting and change in bowel habits due to the obstruction of the cancer mass. If the cancer tumor is one that secretes hormones such as estrogen or if ulcerations occur due to tumor location, postmenopausal bleeding can occur. Tumors can also secrete ADH (Antidiuretic Hormone), which can result in another vague symptom of ovarian cancer known as ascites (fluid accumulation in the abdominal cavity). Even if the tumor has not metastasized, systemic manifestations can still occur and include cellular damage due to tissue inflammation of the stress response, and wasting of brain tissue due to elevation of certain hormones (Mayer, Kowalak, 2002 p.1335).

Diagnosis

Diagnosis is difficult due to the fact that no specific symptoms are present until the disease has greatly progressed causing the individual not to seek medical treatment. CT scan, ultrasound and MRI are used to locate tumors, which then leads to a diagnosis. Upper GI series (x-rays), mammography, lymphography, intravenous pylogram and barium enema are all tests used to determine extent of progression. Staging goes from I to IV and also includes a recurrence stage. Stage I depicts cancer that is limited to the ovaries, stage II involves one or both ovaries and goes into the pelvic region, stage III involves one or both ovaries and one or both of the following: spread beyond pelvis into the abdominal lining or spread into the lymph nodes and stage IV involves one or both ovaries and distant metastasis. Recurrence is the stage that refers to presence of cancer after treatment has been completed (Huether, McCance, 2004).

Treatments

The most used and effective type of treatment for this form of cancer is surgery to remove as much of the affected tissue as possible. Radiation is administered for remaining affected tissue after surgery for tumors less than 2cmin size, which have not metastasized to the liver or kidneys. Chemotherapy may also be used depending on the extent of the disease (Huether, McCance, 2004).

In my research I have found that the diagnostic tests and therapies for ovarian cancer are consistent with that of other cancers with improvements in both being accomplished through continued extensive research. This extensive research includes investigation of the elements that aid in the disease progression as well as aspects that can halt the advancement or even prevent occurrence by better pinpointing genetic predisposition along with modifiable risk factors. More knowledge in these areas as well as better understanding of the physiological changes that occur in the body to allow cancer to develop, grow and metastasize will greatly advance the fight against ovarian cancer.

References

Huether, Sue E., McCance, Katheryn L. (2004). Understanding Pathophysiology 3^rd ed.

Missouri: Mosby

Mayer, B. & Kowalak, J. P., (Eds.) (2002)

Illustrated Manual of Nursing Practice 3^rd ed. Pennsylvania: Lippencott Williams & Wilkins

Marijuana

                         

There has been a lot of debate over the last few years whether the legalization of marijuana would be a wise thing or not. Some say no under any circumstances claiming it is a “gateway drug”. Others say it has no more potential for harm than alcohol or cigarettes. Still, others take a somewhat middle of the road approach saying that it's only acceptable if used for medical purposes. What does the research say? There have been several studies that have yielded very interesting results that shed some light on what this controversial herb can do.

What is it?

Marijuana comes from the blooms of the Cannabis plant. Specifically, it’s the cannabinoids of the bloom (one of which is called THC) that hold the medicinal properties. In northern China evidence of its cultivation and consumption dates back to 7,000 B.C. and was used for it’s medicinal and mood altering effects even then. Also, the burial site of an Asian shaman dating back 2,700 years contained over 2 pounds of the herb and due to tests conducted to attest to it’s potency it was affirmed that the most probable use was for treating the physical, emotional and spiritual being.

The Government

The United States government prohibits the consumption of this plant despite the studies that show it’s benefits, with a law enacted in 1937. Lawmakers stated that the reasoning for this was that it had no positive benefit, was a gateway drug, possessed a high potential for abuse and in fact was as dangerous as heroin, which is what it was compared to when it was classified as a schedule I substance.

My Experience

I, myself, grew up as many did being taught that this “street drug” was bad, destructive, highly addictive, a gateway drug and even caused severe memory loss and damage to the brain. Since becoming an adult and reading for myself the study results as well as becoming a nurse and seeing first hand how Marinol (a DEA approved synthetic form of marijuana) has helped many of my patients with chronic nausea and loss of appetite associated with chemotherapy and chemo type drugs, I have changed my view. When I saw how much suffering there was from pain, nausea, loss of appetite, weight loss and malnutrition from cancer and autoimmune disease and so few options to effectively treat such symptoms I began to reconsider my opposition. I knew then, that I needed to search for the facts for myself.

McGill University Health Centre and University in Montreal reviewed 23 clinical studies on the drug between the years 1966-2007 and noticed that there was not a higher rate of serious side effects than the non-user control group. This is not to say that the substance is totally harmless and suitable for everyone. Those that are more sensitive to psychological effects of medication (adolescents, pregnant or nursing mothers or those with a history of mental illness, hepatitis C, CIOPD, heart disease or stroke) should take caution or avoid.

The Research

As more scientific evidence is found to confirm the therapeutic effects of marijuana there are nearly 1 million patients reported to be using it, under medical supervision, to combat nausea, loss of appetite, pain and sometimes the spread or worsening of disease for conditions such as Cancer, Diabetes, Fibromyalgia, Multiple Sclerosis, Rheumatoid Arthritis, Huntington’s Disease, ALS, GI disorders, Alzheimer’s disease, Neuropathy and HIV/AIDS just to name a few.

Research has proven that the body produces it’s own endocannabinoid system with it’s own receptors that helps to regulate body responses to stimuli initiated by certain disease processes. The problem is that this effect is short lived. Cannabinoids bind to these receptors providing a more lasting effect.

There are several advocacy groups such as the ACLU that consistently protest and present lawsuits to reverse the governments stand on the use of this drug for medical purposes. Slowly, some states are starting to recognize and authorize its use medically to relieve the suffering of those with chronic disease.