Ovarian Cancer: Diagnostic Imaging - Essay Example

? Ovarian Cancer and Diagnostic Imaging By (Module and number) OVARIAN CANCER AND DIAGNOSTIC IMAGING The female reproductive system serves as the vessel of carrying a fetus in it for the period of 9 full months. One of the vital organs included in the system is the ovary. It is defined as “one of the typically paired essential female reproductive organs that produce eggs and in vertebrates female sex hormones (Merriam-Webster, 2008).” It is a very important female reproductive organ for the continuous survival and existence of mankind. However in past years or decades, cancer has attacked this very vital organ. People have known cancer as a life-threatening disease. But what really is cancer? How can ovarian cancer be detected? Are there any precautions that women can make to avoid ovarian cancer? A person’s body is made of millions of cells. There are different types of cells present in a single body and each type has its own distinct function. Cancer is also a cell formed internally. According to the National Cancer Institute (2012): “Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.” As further discussed by Ruddon (2007, 4): “Cancer is a group of diseases of higher multicellular organisms. It is characterized by alterations in the expression of multiple genes, leading to dysregulation of the normal cellular program for cell division and cell differentiation.” There are many types of cancer that may be acquired by different people of different age and gender regardless of social stature. Nobody is excused from being diagnosed with cancer. There are cancer patients who are diagnosed with malignant cancer while there are a number of somewhat lucky individuals who are diagnosed with benign tumours. How can the characterization be made? How can cancer, especially ovarian cancer be detected (Ruddon, 2007, 4)? What is ovarian cancer? Annual statistics have shown the increasing number of women diagnosed with ovarian cancer. Yearly, there are approximately 190,000 new cases and the death toll has reached to an estimated 114,000. It also has been noted that the increasing number of ovarian cancer cases can be found in Canada, Scandinavia, the United States and Eastern Europe. In the United Kingdom, ovarian cancer is considered as the second most widespread gynaecological cancer as the number of newly diagnosed women reaches an estimated 6,700 annually (Ruddon, 2007, 71; National Collaborating Centre for Cancer, 2011, 14). Just like the other kinds of cancer, ovarian cancer roots from being a tumour which will eventually be examined and be classified as either benign or malignant. If the mass that undergone examination is found to be malignant, cancer is then considered and is presented as the main diagnostic result. This process of examining the mass or tissue to be able to study the presence of a particular disease is noted as histopathology (Bancroft and Gamble, 2008, 1-2). However, histopath comes on the latter stage of diagnosis. On the initial stages, the usual step that the doctors refer its patients to is termed as a diagnostic imaging. There are specific types of imaging which can be done to aid accurate diagnosis and staging of cancer. These diagnostic imaging includes: 1) Radionuclide Imaging (RNI), 2) Ultrasound (US), 3) Computerised Tomography (CT), and 4) Magnetic Resonance Imaging (MRI). Radionuclide Imaging (RNI) One kind of imaging that an ovarian cancer patient can be referred to undergo is the Radionuclide Imaging or RNI. According to Berger and Gambhir (2001, 29): “A key advantage of the radionuclide imaging technologies over other imaging approaches is the ability to label almost any chemical species with an isotope of choice. This has allowed the development of hundreds of radioactive imaging probes capable of imaging a variety of molecular events.” There are 2 major technologies that utilize radioactive isotopes for imaging molecular events. Namely, these are the Single Photon Emission Computed Tomography or SPECT and Positron Emission Tomography or PET. SPECT is being carried out by using a gamma camera. Here, when an isotope is being utilised, a single high photon is directly released. On the other hand, in PET, a positron is released from the radioactive isotope (Berger and Gambhir, 2001, 28). The techniques of the RNI propose the probability of the meticulous observance on a very timely manner of what is happening within a human’s body. It would be a very reliable source as to the present condition and location of the tumour and whether it might cause other troubles besides what it is already instigating. Ultrasound (US) During pregnancy, ultrasound is done to detect the present stage of the baby inside the mother’s womb. It is also the instrument to detect the baby’s heartbeat and check on its gender. This is just the most common use of an ultrasound that any person would know. There are also several types of ultrasound that are conducted upon requests of physicians. Ultrasound imaging is another technique for the detection of biological events in human tissues. According to Ruddon (2007, 461), ultrasound imaging uses: “An ultrasound contrast microbubbles targeted to tumour microvascular by linkage to the arginine-arginine-leucine (RRL) … Targeted microbubbles may therefore provide a noninvasive imaging technique for imaging of tumour vasculature and for determining response to anti-angiogenesis drugs.” It is unlike RNI where radioactive isotopes are used in the process. RNI does not utilize any contrast to see what is going on inside the targeted area. Another difference is that usually ultrasound is black and white and as the name goes depends on the sound waves which are being transmitted. RNI, on the other hand, shows the tumour and targeted area in vivid colours to compare and contrast which is the tumour and which are the regular body tissues. So far in comparing the 2 diagnostic imaging which have been tackled, it is more advisable to use RNI as it is more specific towards the location and the condition of the tumour present in a person’s body. It may not immediately conclude that a specific tumour is malignant however it gives more depth as to how much damage and danger the tumour can bring to the patient. However, ultrasound is still the initial step that physicians would request their patients to undergo in detecting tumours. Computed Tomography Scan (CT-Scan) Once a patient has been suspected of having an ovarian tumour or cancer, a physician would initially request for an ultrasound to either confirm initial physical findings. The next step towards the detection of tumour or cancer is the Computed Tomography Scan or CT-Scan. It is used to thoroughly examine a patient’s abdomen area up to the pelvis. By this, physicians will be given the desired information as to a pre-operation preparation. This will give sufficient recommendation if a patient does need to undergo surgery or not (Bardos, 2004, 7). What is a CT scan? As defined by Dizon and Abu-Rustum (2006, 6) “CT scan is a highly sensitive radiology exam used to help diagnose and follow patients with cancer.” It is more precised than an ultrasound yet can be as efficient and effective like the RNI. CT scan gives physician a better view on the location and status of the tumour present in the body. However, there are also instances that the scan could not completely give a better picture what is happening on a real-time basis. There is a slight delay in producing the slides that contains the scanned body area. It does not give the result on a timely manner compared to the RNI and Ultrasound. Yet the scan is the one being depended on by physicians to make a decision whether a patient needs to go under the knife or not. Though there is a slight unreliability of the scan since it does not produce an instant image of the stature of the tumour, the scan is more precise, advanced and reliable that it is given such importance that patients do undergo a scan. CT scans are performed even if an ultrasound has already been performed in a patient. The whole procedure does not give any discomfort to the patient just like the other procedures. Magnetic Resonance Imaging (MRI) More often than not, a patient before being diagnosed with a tumour undergoes Magnetic Resonance Imaging or MRI. Even if the patient has already undergone CT scan, an MRI is still needed before making a diagnosis. MRIs give the physician a clearer view of where and how big the tumour is. Though the scan can also give the same information to the physicians, MRI gives more angular views of the tumour. CT scan is more used by physicians to their patients. Usually, those patients who get a positive result in the scan are the ones who are requested to undergo MRI (Dizon & Abu-Rustum, 2009, 34). As further elaborated by Dizon and Abu-Rustum (2009, 34): “The accuracy of MRI also is greatly affected by tumour size and location of disease. The reported sensitiveness, specificities, and positive and negative predictive values of MRI to detect recurrent ovarian cancer vary and range from 62% to 84%, 37% to 95%, 64% to 93%, and 15% to 83% respectively.” Not all patients need to undergo MRI. As it has been previously stated, the initial test that a patient with suspected ovarian cancer needs to undergo to is ultrasound. If the ultrasound gives a negative result, the patient does not need to undergo and further tests. Most probably the physician will give medication to the patient for prevention of what ailment the patient might acquire in the future. If a patient gets a positive result in the ultrasound, the second step of the process is the CT scan. In this stage, physicians can give opinions towards what process would be next for the patient. Most of the times, when the scan shows a disturbing image either in terms of the size or the location of the tumour, patients are then required by their physicians to have an MRI (Dizon & Abu-Rustum, 2009, 34; Schwab, 2001, 655). MRI is not a cheap procedure. It is quite expensive yet truly it can provide the information needed not just by the physicians to diagnose a patient but also of a patient to know what is happening within their system. When compared to other imaging, MRI is still the most reliable among the 4 that have been discussed. PET imaging is just like a conventional CT scan however it cannot provide the information that an MRI can. PET and CT scan can only provide limited information regarding the size and location of the tumour (Dizon & Abu-Rustum, 2009, 34; Schwab, 2001, 655). Even if the scan will give the physicians whether they would advise an operation for the patient or not, it is the MRI who will guide the whole procedure as to how the operation will be carried through. Before a patient is diagnosed with ovarian cancer, there are numerous steps and tests that the patient need to undergo to. There is no shortcut in diagnosing a patient. Cancer is a very serious and life-threatening disease. A physician should give an accurate diagnosis as a slight miscalculation will may cause a patient’s life. These diagnostic imaging are used by physicians as to accurately know whether a mass is a tumour or just a regular mass of tissue (Dizon & Abu-Rustum, 2009, 34; Schwab, 2001, 655). Unlike other cancers, cancers that are formed within the female reproductive system are considered as silent killers. Symptoms of cancer will not show up until the 2nd or 3rd stage which is already considered as dangerous or fatal for the patient. As it is known, the female reproductive system is very crucial in procreating the human life form. If more and more females will acquire this ailment, what will happen to the future of mankind? Or will there still be mankind? Survival rates of ovarian cancer patients is deemed really low compared to other types of cancer. It has been estimated that patients diagnosed with stages III and IV ovarian cancer has only a 5-30% of survival. There have been conclusions that “early detection represents an intervention of choice in reducing morbidity (Schwab, 2001, 655).” Once the tumour or mass has been extracted, it will go through histopathology. If the test will show that the tumour is benign, there are still precautionary medications and processes that a patient might be required to take. There might be oral pills that will be given by doctors or a patient will need to undergo several radiation therapies to ensure that there will not be any build-up of cancer cells within the area or nearby area where the tumour or mass was extracted. When the tumour is diagnosed to be malignant, there are several procedures that the patient need s to undergo however it is not a guarantee that cancer will be cured or if cured will not recur. There are instances however that conducting of chemotherapy is being based on the physical condition of a patient. It would be based either on whether the body will accept the initial chemotherapy dosage that will be introduced to the body or whether the patient will be able to endure the procedure as a whole (Dizon & Abu-Rustum, 2006, 48). Rieber et al. (2001, 123) recommended that: “Transvaginal sonography is the diagnostic method of choice as a screening technique for ovarian processes. Suspicious findings on transvaginal sonography should be confirmed on MR imaging. If MR imaging confirms a dermoid or endometrial cyst, further diagnostic procedures may be unnecessary. In all other cases, a surgical evaluation must be considered.” Though there are imaging being discovered through various technological advancements to detect and verify ovarian cancer, there is still not enough education being disseminated to women regardless of age towards the awareness of the silent killer. Unlike the other type of cancers, an ovarian cancer patient does not feel any pain or see any symptoms during the early stages. Regular check-ups are needed to detect any kind of cancer. Imaging has been proven to detect any malicious lump present in the female reproductive system. Whether the tumour detected through the various imaging is malignant or not, imaging has been a helpful tool with regards to locating and examining the unwanted tissue prior to any operation. Imaging aids physicians to decide whether or not major surgery is required in removing the lump (Rieber et al. 2001, 123). As far as the available technology is concern, it has proven to be more effective for women to have routine imaging procedures conducted. This is not to scare anybody towards the possibility of cancer. Such action will just ensure the safety of the health of female’s since they are the targeted subject of a very delicate type of cancer. There is still a portion of the society that does not acknowledge the importance of women for the humanity. It is the women who have the capacity to carry a foetus in the womb. They are playing a very important role in the propagation of the human race yet their health is not being considered. These women’s health is not properly taken care of. Cancer is a very deadly disease if not attended to during its earlier stages. Ovarian cancer does not have any symptoms and because of this, it is only being detected during its latter stage which can already be very crucial. A woman should undergo imaging especially of its reproductive system either yearly or bi-yearly. The earlier the tumour is detected; cancer and even deaths can be prevented. Detection and prevention is always better than medication. References American Cancer Society (2012) How is Ovarian Cancer Diagnosed? Available from: [accessed 01 April 2012]. Bancroft, J. D. and Gamble, M. 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