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Query: UMLS:C1140680 (ovarian cancer)
 28,141 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a recent meta-analysis of three American case-control studies, Whittermore et al found an increased risk of ovarian cancer in women treated for infertility. We have studied the mortality due to ovarian cancer in France between 1968 and 1991 in order to verify whether the use of these treatments could have modified mortality rates during the 24 years period studied. First, we have noted that among the 3175 deaths from ovarian cancer registered in France in 1991, only 136 occurred in women under 45 years of age, and 943 occurred in women between 45 and 59 years of age. We then observed an important geographical diversity with a higher frequency of ovarian cancer in the North of France as compared to the South. Finally, we observed a 72% increase in mortality during the study period. This increase can be entirely explained by the increase in the mortality rates among women over 60 years of age. Among women under 45, the ovarian cancer rate decreased by 24% between 1968 and 1991. Among women between 45 and 59 years of age, these rates increased by only 8% (or about 0.3% per year). These results imply that a possible effect--in terms of public health--of treatment for infertility does not necessarily translate into a significant increase in mortality from ovarian cancer among women under 60 years of age. This result in no way nullifies the role that epidemiological studies have in verifying the accuracy of risks associated with treatments for infertility.
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PMID:[Pattern of mortality from ovarian cancer in France 1968-1991]. 774 98

During the period January 1984 to December 1989, we treated 128 patients with ovarian neoplasms. 82.04% patients had benign tumors while the remaining 17.96% had ovarian cancer. Epithelial tumors were the commonest histological type (67.2%) followed by teratomas (17.19%). Most patients were of low parity, with 31.70% of patients with benign tumors and 11.11% of cancer patients, presenting also with infertility. An unfortunate feature of this study, as in most others from developing countries, is that patients since survival in such cases is a function of clinical stage and histologic type. One hundred and seventeen patients were treated by surgery (91.4%). Chemotherapy was used as an adjunctive treatment in 65.22% of cancer cases.
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PMID:A clinico-pathological study of ovarian tumors in Yaounde-Cameroun. 775 82

Concerns have been raised recently about the possible association between superovulation and ovarian cancer. In order to contribute to the limited literature on this important issue, two cases of ovarian tumours in women who had undergone multiple ovulation inductions are presented. In the first case, the patient had secondary anovulatory infertility. She was treated with human menopausal gonadotrophin (HMG) alone and in combination with clomiphene citrate or buserelin for six cycles. She then underwent ovarian stimulation with buserelin/HMG in the long protocol for in-vitro fertilization (IVF) and embryo transfer. In preparation for a new IVF/embryo transfer attempt, 8 months later, the screening ultrasound revealed a cystic formation of the left ovary and an enlargement of the right. During laparotomy, both ovaries were found to bear large tumours (approximately 6 x 5 x 4 cm) which were removed. Histological examination showed that they were epithelial tumours (serous-papillary cystadenomas) of borderline malignancy. The patient conceived spontaneously 1.5 years after the operation. In the second case, the patient presented with secondary anovulatory infertility. She underwent ovulation induction with clomiphene/HMG and with buserelin/HMG in the long protocol, and intra-uterine insemination with husband's spermatozoa and conceived (singleton pregnancy). She was delivered by Caesarean section, during which a cystic tumour of the left ovary was removed. Histological examination revealed a benign mucous cystadenoma of the ovary.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Two cases of ovarian tumours in women who had undergone multiple ovarian stimulation attempts. 778 25

The distinct pathologic and biologic nature of ovarian tumors of low malignant potential (LMP) has been officially recognized by FIGO and the World Health Organization. LMP tumors may comprise 10% of ovarian neoplasms; they occur at a mean age of 40 years. Pregnancy, breast-feeding, and the use of oral contraceptives are protective against the development of tumors of LMP. A history of infertility and use of infertility drugs appear to increase the risk of these tumors. No association with hereditary ovarian cancer syndromes has been reported. The survival associated with these tumors is 99% at mean follow-up of 7 years for patients with stage I disease, and 92% for those with stage II and II disease. Retrospectively, more patients appear to have died from complications associated with adjuvant therapy than from progressive disease. The recommended treatment is surgical, consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node biopsies, peritoneal washings, and tumor debulking. In young patients with early-stage disease, conservative surgery, preserving the uterus and contralateral ovary, is acceptable. A role has not yet been established for adjuvant therapy, whether radiotherapy or chemotherapy. Laboratory investigations have not demonstrated that these tumors represent an intermediate step between benign ovarian tumors and carcinoma nor have they identified that small subset of tumors with aggressive clinical behavior. We should perhaps consider tumors of LMP in the same light as "benign" proliferative gynecologic conditions, such as endometriosis and leiomyomata.
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PMID:Management of epithelial ovarian tumors of low malignant potential. 783 12

A case-control study of reproductive factors and cancer of the ovary was conducted during 1989-1992 in metropolitan Toronto and nearby areas of Southern Ontario, Canada. In total, 450 women aged 35-79 years with histologically verified new primary epithelial ovarian cancers were interviewed concerning their reproductive histories. Over the same time period, 564 randomly selected population controls, frequency-matched to the cases according to three 15-year age groups, were also interviewed. Continuous unconditional logistic regression methods were used for analysis. It was found that childbearing and use of oral contraceptives were associated with significant decreasing trends in risk of ovarian cancer; the respective odds ratios were 0.78 for each full-term pregnancy (p < 10(-8)) and 0.92 for each year of use (p < 10(-6)). Hysterectomy was also associated with reduced risk, even after more than 20 years. Among parous women, infertility did not appear to affect risk; for nulliparous women, some evidence of increased risk was present, although fertility problems were reported by only a small fraction of nulliparae. It is suggested that the relatively lower parity of cases as compared with controls may be due to voluntary choices for having fewer children.
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PMID:Parity, contraception, infertility, and the risk of epithelial ovarian cancer. 794 59

Fecundity has been extended to the menopause by advances in assisted reproductive techniques. The incidence of ovarian cancer increases with age, and an increased risk of ovarian cancer has been associated with incessant ovulation and infertility. The increased risk of ovarian cancer in older infertility patients must be kept in mind when evaluating these patients so that this diagnosis is not overlooked or delayed.
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PMID:Advanced-stage ovarian carcinoma presenting during infertility evaluation. 797 50

Ovarian cancer is the second most common neoplasm of the female reproductive system and the leading cause of death from gynecologic cancer in the United States. The overall 5-year survival rate continues to be low. Risk factors associated with ovarian cancer are age, race, nulliparity, infertility, history of endometrial or breast cancer, and family history of ovarian cancer. The diagnosis of ovarian cancer could benefit from screening. Screening methods for ovarian cancer include pelvic examination, abdominal and transvaginal sonography, color flow Doppler, and serum CA-125 levels. Sonography and CA-125 are the most promising and most extensively studied.
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PMID:Epidemiology and screening of ovarian cancer. 801 58

Laparoscopic surgery appears now to be not just a series of simple modifications to operative techniques, but more truly a revolution. This is due to three factors: the simultaneous diagnosis of lesions, establishment of the prognosis and actual treatment: greater respect for the anatomy and physiological processes; the shift in the theatre of operations which is now represented by the pelvis itself and not the operating room we were used to. This surgical revolution has achieved a number of indisputable advances, especially where the adnexa are concerned. Tubo-peritoneal infertility, of course, for which Raoul Palmer developed laparoscopy; the approach relies on a thorough knowledge of the tubal condition. Ectopic pregnancy where laparoscopic treatment has become the standard. Ovarian cysts which raise the specific problems of discovering, and even more important, overlooking malignancy. Endometriosis for which surgical treatment has become appropriate again thanks to endoscopy. This revolutionary cycle is not yet complete for subperitoneal surgery is now being addressed. Hysterectomy, so highly symbolic for the gynecologist, is now regularly carried out in this manner. Even cancer surgery may now employ endoscopy, with second-look laparoscopy for ovarian cancer and above all lymphadenectomy techniques which were developed for a large part in France and will no doubt bring about a total change in the strategies for surgical treatment of cancer. Once the technical difficulties have been resolved radical hysterectomy has the potential to become the reference thanks to its precision and radicality. Prolapse too can draw benefit from endoscopic surgery. This is already the case for colpocervical suspension and other factors concerning prolapse are under study. We must not forget that this surgery must not only comply with the standard rules for surgery, but must also benefit from regulated and rigorous training. Collaboration with the engineers and equipment manufacturers is yet another new element with which French medicine is not yet very familiar.
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PMID:[Operative laparoscopy: genuine surgical advance or simple temptation by the feasible?]. 803 2

In the US reproduction has been increasing deferred as has marriage, and births to women aged 35-49 years are expected to increase to 8.6% in the year 2000. Decreased reproductive potential has been associated with the age and quality of the oocyte. Uterine aging can be compensated for by hormonal means, and oocyte quality can be compensated for with donations from young women. This possibility brings with it the ethical and social considerations of whether women over the age of 50 years should have children. A pregnancy rate of 30% per cycle can be achieved among women over 50 years with oocyte donors. The abortion rate increases with the age of the oocyte recipient from 14.0% among those aged 20-24 years to 44.5% among those aged 35 years and older. The risk of spontaneous abortion also was found to increase to about 75% for overall abortion and 26% for clinically recognized abortion among women over 40 years of age compared to only 12% among women aged less than 20 years. Use of fertility drugs also carries risks. In vitro fertilized pregnancy cases have provided sufficient evidence of reduced pregnancy with the advanced age of oocytes. When progesterone was given along with young oocyte donations, the achieved pregnancy rates were similar among women aged less than and more than 40 years of age. Among unassisted pregnancies, findings have shown a higher risk of obstetrical complications among older women; these outcomes could be minimized with good screening and modern obstetrical care. US vital data showed a doubling of the risk of infertility for women aged 35-44 years compared to women aged 30-34 years. Donor insemination programs have found it necessary to increase the number of cycles of treatment to 9-10 from the usual six among older women. The differences in cumulative conception rates between women aged more or less than 30 years of age was found to be statistically significant. The increased risk of ovarian cancer from superovulation was considered plausible.
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PMID:The effect of aging on fertility. 819 49

Currently, more than 50% of married women of childbearing age are using a form of contraception. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries increased from 31 to 381 million, in East Asia from 18 to 217 million, in Latin America from 4 to 44 million, in South Asia from 8 to 94 million, and in Africa from 2 to 18 million. WHO has recently estimated that over 500,000 women die each year from causes related to pregnancy and childbirth. With a worldwide estimate of 36-53 million induced abortions performed each year, between 125,000 and 170,000 women die each year because of unsafe abortions. According to data from the World Fertility Survey, short spacing between births raises the average chances of offspring dying in infancy by 60-70% and the chances of dying before the age of 5 years by about 50%. WHO's minimal estimate for yearly incidence of bacterial and viral STDs (excluding HIV infection) is 130 million. Most STDs have more serious sequelae in women than in men and lead to pelvic inflammatory disease (PID), permanent infertility, and the risk of ectopic pregnancy. African countries with high incidence of STDs have the lowest prevalences of contraceptive use. A recent examination of the WHO international data base of 22,908 IUD insertions and 51,399 woman-years of follow-up indicates that the occurrence of PID in IUD users is most strongly related to the insertion process and to background STD risk and suggests that PID is an infrequent occurrence after the insertion period. A WHO Scientific Working Group review confirmed the beneficial effects of oral contraceptives in reducing the risk of ovarian cancer, endometrial cancer, and biopsy-proven benign breast diseases. A WHO collaborative study in 5 centers in Kenya, Mexico, and Thailand provided assurance that women who used DMPA for a long time and who initiated use many years previously are not at increased risk of breast cancer.
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PMID:Contraception and women's health. 832 13


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