Food is the most important factor in shaping one’s attitudes and health,both physical and mental.
Right food, cooked correctly,eaten at the proper time ensures good physical,mental and spiritual health.
Attitudes determine your mental states.If you observe closely, when you eat food that is spicy,too hot,too cold,remnant foods, reheated foods(including that which is kept in Refrigerator),stale food shall make you fidgety, anxious,tense,low in spirits and make you depressed.
Every human being has three Attitudonal Categories., which is the result of Nature.
1.Contented , peacefull,and Knowledgeable.Under this category are people who are cheerful,not too aggressive, sober, not anxious, not irritated, patient,problem solvers without being tense and not too much worried about things they can not control.They shall do their best without bothering to know whether they have done their best and also are not unduly worried about the out come of their actions,once they complete the action.They are moderate in habits, in food and behavior.
2.Aggressive, ambitious and restless.These people are restless, self driven to the extent of being obsessed with what they do;continuously self evaluating,seeking other’s approval;they set themselves goals without evaluating their aptitude,learn the specific skills and keep on working hard;once they realise their goals they remain dissatisfied ,set other goals and go after it and continue thus throughout their life; they are fidgety,nervous, anxious,arrogant,and always try to bull doze their way in what ever they do.They are of the conviction that the world or a specific task can be done only by them and constantly find faults with others.
Their habits will be extreme whether food or hobbies or relation ships.
3.Indolent and sluggish.These people are defeatist, do not aspire to do or become any thing in lfe;they just drift along;their hunger for knowledge will be nil;they follow things of which they are not sure.
They are indifferent and and eat or do whatever they like.
These three tendencies are present in each individual at the same time.They keep on changing minute by minute.Depending on the preponderence of one tendency actions will be performed by the individual and one’s mental state also shall change.
These tendenceis can be balanced and the self satisfied, contented peaceful tendency that shall beat depression can be made permanent by food habits.
So what food one should take?
Food that-
-ensures longevity,health,strength
-contains the essence the food we eat
-that which stays in the body, after digetion ,that is ingested properly and that which ensures health
-that which we like naturally. Food to avoid-
That which is excessively sweet,bitter,spicy,salty,tangy
-that which causes anxiety and dullness(onion,chillies,fast foods of any kind,sour curd,cheese,butter)
-that which is half cooked,not fully cooked
-that which is not cooked directly by fire-gas,oven, -you can directly use a barbecue)
-that which is a left over, even if it be ours/family
-that which is not clean
-that which emanates bad smell/-that which is rancid
-that which is recooked
-that which is very hot or very cold
-thatt which is bought from unclean place.
Generally, avoid excess oil or too dry.
Minimise onion,garlic,cheese,butter,ghee,butter.
Wash the vegetables wholly, not after cutting or chopping.
Do not cut the vegetables in too small pieces
Boil vegetables withwith out water;if you have to use water ,drink that water(for vegetables only)
Drink minimum one liter water in the morning, after washing teeth, in empty stomach
Take a full breakfast, not later than 9 am.
Take leafy vegetables more
Minimise Potatoes or any other roots
Do nor drink water while eating Drink water only after finishing breakfast/lunch /dinner
Take three meals a day-breakfast,lunch(between 1 and 2 pm) and Dinner,not later than 10 pm
Take maximum two cups of coffee or tea per day
Eschew Alcohol,cigarettes non vegetarian foods.
Eat half somach full,drink one fourth stomach watetr leave balance stomach empty.
Based on these parameters, you can choose your food and beat not only Stress but develop a Healthy Mind and body.
(Source.The Bhagavad Gita-Chapter 17. and Smritis)>
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Story. The Golden Arches: the ultimate American icon. Super Size Me taught us that fast food culture brings obesity, heart disease, hypertension and a whole slew of other problems. How bad do you really want that Big Mac? Here are 15 reasons you’ll never let anyone you love get near those Golden Arches.
1. Real food is perishable. With time, it begins to decay. It’s a natural process, it just happens. Beef will rot, bread will mold. But what about a McDonald’s burger? Karen Hanrahan saved a McDonald’s burger from 1996 and, oddly enough, it looks just as “appetizing” and “fresh” as a burger you might buy today. Is this real food?
2. You would have to walk 7 hours straight to burn off a Super Sized Coke, fries and Big Mac. Even indulging in fast food as an occasional treat is a recipe for weight gain…unless you’re planning to hit each treadmill in the treadmill bay afterwards.
3. Containing less fat, salt and sugar, your pet’s food may be healthier than what they serve at McDonald’s.
4. In 2007, the employees of an Orlando-area McDonald’s were caught on camera pouring milk into the milkshake machine out of a bucket labeled “Soiled Towels Only.” That particular restaurant had already been cited for 12 different sanitary violations. Though McDonald’s proudly stands by its safety standards, and not every restaurant has such notorious incidents, the setting of a fast food restaurant staffed with low-paid employees at a high turnover rate arguably encourages bending the rules. (McDonald’s isn’t alone in this, of course – Burger King is actually ranked as the dirtiest of all the fast food chains.)
5. McDonald’s supports the destruction of the Amazon rainforest. Much of the soy-based animal feed used to fatten fast-food chickens is grown in the Amazon. Are those chicken nuggets really worth acres of irreplaceable trees? (Especially considering how important carbon sinks like the rainforest are to halt global warming!) Fast food supports a completely unsustainable system of agriculture. It’s cruel to animals, unhealthy for humans, and bad for the planet.
6. Even Prince Charles, while touring a diabetes center in the United Arab Emirates, commented that banning McDonald’s is key to health and nutrition. Don’t let the salads and chicken breasts fool you. The “chicken” at McDonald’s, by the way, comes with a whole lot more than chicken.
7. As if feeding children high-fat, high-sodium, low-nutrition “food” weren’t bad enough, some Happy Meals in 2006 contained toy Hummers. It’s as if McDonald’s was encouraging a whole generation of kids not only to guzzle food, but to guzzle gas as well. Would you like a few barrels of petroleum with that?
8. The processed fat in McDonald’s food (and other fast food) promotes endothelial dysfunction for up to 5 hours after eating the meal. Endothelial tissue is what lines the inside of blood vessels.
9. For those who enjoy sex, take note: erectile dysfunction is connected to endothelial dysfunction. Morgan Spurlock of Super Size Me commented that his normally healthy sexual function deteriorated in just one month when he ate only food from McDonald’s. Even his girlfriend commented on camera that “he’s having a hard time, you know, getting it up.”
10. How many cows does it take to keep the world loaded with Big Macs? I had to do a some research and a little math, but according to a brief video inside one of McDonald’s 6 meat processing plants, about 500,000 pounds of beef is processed per day, per plant. If an average beef cow weighs 1,150 pounds, that means 2609 cows a day are turned into burgers. That’s 952,285 cows per year. And that’s just in the United States. Eating a hamburger may not be worse than driving a Hummer, but it’s bad. One hamburger patty does not necessarily come from one cow. Think about that. You’re eating bits of hundreds of cows.
11. Maybe you just pop in for an inexpensive latte. Watch out for the caramel syrup (Sugar, water, fructose, natural (plant source) and artificial flavor, salt, caramel color (with sulfites), potassium sorbate (preservative), citric acid, malic acid) or the chocolate drizzle (Corn syrup, water, hydrogenated coconut oil, high fructose corn syrup, glycerin, nonfat milk, cocoa, cocoa (processed with alkali), food starch-modified, disodium phosphate, potassium sorbate (preservative), xanthan gum, artificial flavor (vanillin), salt, soy lecithin). Please don’t put that stuff into your body. Eat healthy cheap food instead – you can be well and still save cash.
12. Are you a vegetarian with a French fry craving? You better skip McDonald’s because their fries actually contain milk (and wheat) and though they’re fried in vegetable oil, the oil is flavored with beef extract. (McDonald’s famously misled customers for years.)
13. Do you want high blood pressure? Hit the drive-through. Eating a McDonald’s chicken sandwich (any of “˜em, take your pick) will give you about 2/3 of the recommended daily amount of sodium. And if you actually do have high blood pressure, that’s way more than you really need.
14. Finally unveiled: the secret of the Big Mac’s “secret sauce.”
Yum. Cheap oil and cheap syrup. Many people depend upon cheap food such as the sort offered at McDonald’s, whether due to the economic conditions we currently face or low incomes. So shouldn’t we be examining regulations that subsidize corn syrup but consider fruits and vegetables – the building blocks of a healthy body and green planet – to be “speciality” crops? Shouldn’t we be promoting urban gardening, community gardens and spreading information about low-cost farmers’ markets and CSAs? And focusing on the abundant choices of cheap food that are tasty and green?
They may be lean and green, but they pack quite a salty punch.
When you think of high sodium foods, what do you see? I envision salt bombs like the Big Mac (1040 mg per serving) and Campbell’s Creamy Chicken Noodle Soup (890 mg per serving). But the shocking fact is that many “healthy,” organic and vegetarian foods are high in sodium, too.
The USDA estimates that 77% of the sodium in an average American’s diet comes from packaged and processed foods (while only 5-6% of sodium is added while cooking or eating), so if you’re into convenience – even the organic, natural kind – you might want to look a little closer at the label.
How do your favorite green convenience foods add up?
1. Amy’s Curried Lentil Soup sounds like a quick and tasty treat, but packs 680 mg sodium per serving.
2. Annie’s Organic Alfredo Shells and Cheddar is one of my all-time comfort foods, but with 670 mg sodium per serving I should reconsider my definition of comfort!
3. GardenBurger’s Flame Grilled Soy Burger, though vegan, contains 500 mg sodium per serving.
4. Yves Classic Veggie Brats pack a whopping 840 mg per weiner! And ask yourself, will you honestly eat just one?
5. Quorn Garlic & Herb Chik’n Cutlets may be meatless, high in fiber and made from pretty natural ingredients but they still contain 570 mg of sodium per serving.
6. Boca Meatless Italian Sausage has significantly less fat than its meaty cousin, but it is definitely not low on sodium: 650 mg per serving.
7. Annie’s Naturals Goddess Dressing is such a delicious, creamy delight on garden fresh greens, but with 390 mg of sodiumper serving, it makes for a pretty salty salad.
8. The profits from Newman’s Own Organic Marinana Sauce might go to help good a cause, but consider what it might do to your own body’s cause with 550 mg of sodium per serving.
The Recommended Dietary Allowance (RDA) for sodium is 2400 mg, but for optimum health you should not exceed 1500-2000 mg per day, and the USDA standard for “healthy” food is that it must not contain more than 480 mg of sodium per serving.
What’s the real lesson here? Processed foods, even organic and vegetarian ones, don’t provide the optimal health for our bodies. Sure, you may grab “˜em once in awhile when you don’t have time to cook a meal from scratch. While these organic and vegetarian meals are better than stopping at the drive-thru, nothing beats creating your own meals from whole foods, which will always be the cornerstone of a truly healthy diet.
No.
Chocolate consumptiom may be reduced only by an awareness programme on the effects of consumpttion of chocolates.
There is no product whose consumption has come down because of Tax,for instance Smoking ,Drinking.
In India Cigarette sales has come down marginally because of the awareness campaign and a ban on smoking in public places.
Micrograph of a low malignant potential mucinous ovarian tumour. H&E stain.
Please read this & share with your families..
An Eye Opener on Ovarian Cancer-This has been sent to me by my friend Sri.Srinivasan, renowned cardiologist.I thought I should share with you all.
I hope you all take the time to read this and pass it on to all you can. Send this to the women in your life that you care about.
A few years ago, Gilda Radner died of ovarian cancer. Her symptoms were inconclusive, and she was treated for everything under the sun until it was too late. This blood test finally identified her illness but alas, too late. She wrote a book to heighten awareness. Gene Wilder is her widower.
KATHY’S STORY: this is the story of Kathy West
As all of you know, I have Primary Peritoneal Cancer. This cancer has only recently been identified as its OWN type of cancer, but it is essentially Ovarian Cancer.
Both types of cancer are diagnosed in the same way, with the “tumor marker” CA-125 BLOOD TEST, and they are treated in the same way – surgery to remove the primary tumor and then chemotherapy with Taxol and Carboplatin.
Having gone through this ordeal, I want to save others from the same fate. That is why I am sending this message to you and hope you will print it and give it or send it via E-mail to everybody you know.
One thing I have learned is that each of us must take TOTAL responsibility for our own health care. I thought I had done that because I always had an annual physical and PAP smear, did a monthly Self-Breast Exam, went to the dentist at least twice a year, etc. I even insisted on a sigmoidoscopy and a bone density test last year. When I had a total hysterectomy in 1993, I thought that I did not have to worry about getting any of the female reproductive organ cancers.
LITTLE DID I KNOW. I don’t have ovaries (and they were HEALTHY when they were removed), but I have what is essentially ovarian cancer. Strange, isn’t it?
These are just SOME of the things our Doctors never tell us: ONE out of every 55 women will get OVARIAN or PRIMARY PERITONEAL CANCER.
The “CLASSIC” symptoms are an ABDOMEN that rather SUDDENLY ENLARGES and CONSTIPATION and/or DIARRHEA.
I had these classic symptoms and went to the doctor. Because these symptoms seemed to be “abdominal”, I went to a gastroenterologist. He ran tests that were designed to determine whether there was a bacteria infection; these tests were negative, and I was diagnosed with “Irritable Bowel Syndrome“. I guess I would have accepted this diagnosis had it not been for my enlarged abdomen. I swear to you, it looked like I was 4-5 months pregnant! I therefore insisted on more tests.
They took an X-ray of my abdomen; it was negative. I was again assured that I had Irritable Bowel Syndrome and was encouraged to go on my scheduled month-long trip to Europe. I couldn’t wear any of my slacks or shorts because I couldn’t get them buttoned, and I KNEW something was radically wrong. I INSISTED on more tests, and they reluctantly) scheduled me for a CT-Scan (just to shut me up, I think).
This is what I mean by “taking charge of our own health care.”
The CT-Scan showed a lot of fluid in my abdomen (NOT normal). Needless to say, I had to cancel my trip and have FIVE POUNDS of fluid drawn off at the hospital (not a pleasant experience I assure you), but NOTHING compared to what was ahead of me.
Tests revealed cancer cells in the fluid. Finally, finally, finally, the doctor ran a CA-125 blood test, and I was properly diagnosed.
I HAD THE CLASSIC SYMPTOMS FOR OVARIAN CANCER, AND YET THIS SIMPLE CA-125 BLOOD TEST HAD NEVER BEEN RUN ON ME, not as part of my annual physical exam and not when I was symptomatic. This is an inexpensive and simple blood test!
PLEASE, PLEASE TELL ALL YOUR FEMALE FRIENDS AND RELATIVES TO INSIST ON A CA-125 BLOOD TEST EVERY YEAR AS PART OF THEIR ANNUAL PHYSICAL EXAMS.
Be forewarned that their doctors might try to talk them out of it, saying, “IT ISN’T NECESSARY.” Believe me, had I known then what I know now, we would have caught my cancer much earlier (before it was a stage 3 cancer). Insist on the CA-125 BLOOD TEST; DO NOT take “NO” for an answer!
The normal range for a CA-125 BLOOD TEST is between zero and 35. MINE WAS 754. (That’s right, 754!). If the number is slightly above 35, you can have another done in three or six months and keep a close eye on it, just as women do when they have fibroid tumors or when men have a slightly elevated PSA test (Prostatic Specific Antigens) that helps diagnose prostate cancer.
Having the CA-125 test done annually can alert you early, and that’s the goal in diagnosing any type of cancer – catching it early..
Do you know 55 women? If so, at least one of them will have this VERY AGGRESSIVE cancer. Please, go to your doctor and insist on a CA-125 test and have one EVERY YEAR for the rest of your life..
And forward this message to every woman you know, and tell all of your female family members and friends. Though the median age for this cancer is 56, (and, guess what, I’m exactly 56), women as young as 22 have it. Age is no factor.
A NOTE FROM AN RN:
Well, after reading this, I made some calls. I found that the CA-125 test is an ovarian screening test equivalent to a man’s PSA test prostate screen (which my husband’s doctor automatically gives him in his physical each year and insurance pays for it). I called the general practitioner’s office about having the test done. The nurse had never heard of it. She told me that she doubted that insurance would pay for it. So I called Prudential Insurance Co, and got the same response. Never heard of it – it won’t be covered.
I explained that it was the same as the PSA test they had paid for my husband for years. After conferring with whomever they confer with, she told me that the CA-125 would be covered.
It is $75 in a GP’s office and $125 at the GYN’s. This is a screening test that should be required just like a PAP smear
(a PAP smear cannot detect problems with your ovaries).
And you must insist that your insurance company pay for it.
Gene Wilder and Pierce Brosnan (his wife had it, too) are lobbying for women’s health issues, saying that this test
should be required in our physicals, just like the PAP and the mammogram. PLEASE TAKE A MOMENT TO SEND THIS OUT TO ALL THOSE YOU CAN. BE IT MALE OR FEMALE, IT SHOULD NOT MATTER, AS THEY CAN FORWARD IT ALSO TO THOSE LOVED ONES THEY KNOW.
IF YOU HAVE A PROBLEM WITH FORWARDING SOMETHING
AS IMPORTANT AS THIS, HERE’S A LITTLE HINT THAT MAY ASSIST YOU WITH YOUR DECISION ~ JUST PRETEND THAT THIS IS A JOKE, WHICH IT CERTAINLY IS NOT, AND SEND IT OUT TO ALL THE FOLKS YOU WOULD IF IT WAS.
Ovarian cancer can be deadly, is often caught in an advanced stage, and strikes many women every year.
“Ovarian cancer is the second most common gynecologic malignancy — approximately 21,650 new cases each year, with an estimated 15,500 deaths each year,” says William Edward Richards, MD, associate professor and director of women’s cancer at the University of Cincinnati’s Barrett Cancer Center. “It’s the fifth most common cause of cancer death and the most common cause of gynecologic cancer death.”
With these frightening statistics, more women should be asking questions about ovarian cancer.
Ovarian Cancer Awareness: Who’s Working on It?
“Most women are not aware of the threat of ovarian cancer,” says Robin Cohen, co-founder of the Sandy Rollman Ovarian Cancer Foundation, which is an umbrella organization of the Ovarian Cancer National Alliance. “Many of the umbrella organizations are working at the local level to educate both women and physicians about the risks and symptoms of ovarian cancer,” says Cohen.
Most (>90%) ovarian cancers are classified as “epithelial” and were believed to arise from the surface (epithelium) of the ovary.[1][2] However, recent evidence suggests that the Fallopian tube could also be the source of some ovarian cancers.[3] Since the ovaries and tubes are closely related to each other, it is hypothesized that these cells can mimic ovarian cancer.[4] Other types arise from the egg cells (germ cell tumor) or supporting cells (sex cord/stromal).
In 2004, in the United States, 25,580 new cases were diagnosed and 16,090 women died of ovarian cancer. The risk increases with age and decreases with pregnancy. Lifetime risk is about 1.6%, but women with affected first-degree relatives have a 5% risk. Women with a mutated BRCA1 or BRCA2 gene carry a risk between 25% and 60% depending on the specific mutation.[5] Ovarian cancer is the fifth leading cause of death from cancer in women and the leading cause of death from gynecological cancer.[6]
The signs and symptoms of ovarian cancer are most of the times absent, but when they exist they are nonspecific. In most cases, the symptoms persist for several months until the patient is diagnosed.
A prospective case-control study of 1,709 women visiting primary care clinics found that the combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of those with ovarian cancer but in only 8% of those presenting to primary care clinics.[18]
Accuracy of symptoms
Two case-control studies, both subject to results being inflated by spectrum bias, have been reported. The first found that women with ovarian cancer had symptoms of increased abdominal size, bloating, urge to pass urine and pelvic pain.[12] The smaller, second study found that women with ovarian cancer had pelvic/abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full.[19] The latter study created a symptom index that was considered positive if any of the six (6) symptoms “occurred >12 times per month but were present for <1 year”. For early-stage disease, they reported a 57% sensitivity and 87% to 90% specificity.
Consensus statement
In 2007, the Gynecologic Cancer Foundation, Society of Gynecologic Oncologists and American Cancer Society originated the following consensus statement regarding the symptoms of ovarian cancer.[20]
Ovarian cancer is called a “silent killer” because symptoms were not thought to develop until the disease had advanced and the chance of cure or remission poor. However, the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:
Bloating
Pelvic or abdominal pain
Pain in the back or legs
Diarrhea, gas, nausea, constipation, indigestion
Difficulty eating or feeling full quickly
Urinary symptoms (urgency or frequency)
Pain during sex
Abnormal vaginal bleeding
Trouble breathing
Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms. Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.
Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.[citation needed]
Cause
The exact cause is usually unknown. The risk of developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older age of final pregnancy and the use of low dose hormonal contraception have also been shown to have a protective effect. Ovarian cancer is reduced in women after tubal ligation.[citation needed]
Hormones
The relationship between use of oral contraceptives and ovarian cancer was shown in a summary of results of 45 case-control and prospective studies. Cumulatively these studies show a protective effect for ovarian cancers. Women who used oral contraceptives for 10 years had about a 60% reduction in risk of ovarian cancer. (risk ratio .42 with statistical significant confidence intervals given the large study size, not unexpected). This means that if 250 women took oral contraceptives for 10 years, 1 ovarian cancer would be prevented. This is by far the largest epidemiological study to date on this subject (45 studies, over 20,000 women with ovarian cancer and about 80,000 controls).[21]
The link to the use of fertility medication, such as Clomiphene citrate, has been controversial. An analysis in 1991 raised the possibility that use of drugs may increase the risk of ovarian cancer. Several cohort studies and case-control studies have been conducted since then without demonstrating conclusive evidence for such a link.[22] It will remain a complex topic to study as the infertile population differs in parityfrom the “normal” population.
Genetics
There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1 or the BRCA2gene are notably at risk. The BRCA1 and BRCA2 genes account for 5%-13% of ovarian cancers[23] and certain populations (e.g. Ashkenazi Jewishwomen) are at a higher risk of both breast cancer and ovarian cancer, often at an earlier age than the general population.[citation needed]Patients with a personal history of breast cancer or a family history of breast and/or ovarian cancer, especially if diagnosed at a young age, may have an elevated risk.
A pooled analysis of ten (10) prospective cohort studies conducted in a number of countries and including 529,638 women found that neither total alcohol consumption nor alcohol from drinking beer, wine or spirits was associated with ovarian cancer risk.”[24] The results of a case-control study in the region of Milan, Italy, “suggests that relatively elevated alcohol intake (of the order of 40 g per day or more) may cause a modest increase of epithelial ovarian cancer risk”.[25] “Associations were also found between alcohol consumption and cancers of the ovary and prostate, but only for 50 g and 100 g a day.”[26] “Statistically significant increases in risk also existed for cancers of the stomach, colon, rectum, liver, female breast, and ovaries.”[27]
Other
A Swedish study, which followed more than 61,000 women for 13 years, has found a significant link between milk consumption and ovarian cancer. According to the BBC, “[Researchers] found that milk had the strongest link with ovarian cancer—those women who drank two or more glasses a day were at double the risk of those who did not consume it at all, or only in small amounts.”[28] Recent studies have shown that women in sunnier countries have a lower rate of ovarian cancer, which may have some kind of connection with exposure to Vitamin D.[29]
Other factors that have been investigated, such as talc use,[30]asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial[citation needed] and have not been definitively proven; moreover, such risk factors may in some cases be more likely to be correlated with cancer in individuals with specific genetic makeups.[31]
Screening
Routine screening of the general population is not recommended by any professional society. This includes the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network.[36]
No trial has shown improved survival for women undergoing screening.[36]
Screening tests include the CA-125 marker, transvaginal ultrasound, and possibly a proprietary marker test combination such as OvaSure (LabCorp). A definitive diagnosis implies strong consideration of surgical excision of the ovaries and fallopian tubes. But all lab tests have a statistical false positive rate (“false alarm” rate). So a positive screening test must not represent a demand that the patient be followed up by surgery.[36]
The purpose of screening is to discover ovarian cancer in early stages, when it is more curable, on the hypothesis that early-stage cancer develops into later-stage cancer. However, it is not known whether early stage ovarian cancer evolves to later stage cancer, or whether stage III (peritoneal cavity involvement) arises as a diffuse process.[36]
The goal of ovarian cancer screening is to detect ovarian cancer at stage I.[37] Several large studies are ongoing, but none have recommended screening.[38] In 2009, however, Menon et al. reported from the UKCTOCS that utilizing mutimodal screening, in essence first performing annual CA-125 testing, followed by ultrasound imaging on the secondary level, the positive predictive value was 35.1% for primary invasive epithelial ovarian and tubal carcinoma, making such screening feasible.[39] However, it remains to be seen if such screening is effective to reduce mortality.
Management
Surgical treatment may be sufficient for malignant tumors that are well-differentiated and confined to the ovary. Addition of chemotherapy may be required for more aggressive tumors that are confined to the ovary. For patients with advanced disease a combination of surgical reduction with a combination chemotherapy regimen is standard. Borderline tumors, even following spread outside of the ovary, are managed well with surgery, and chemotherapy is not seen as useful.
Surgery is the preferred treatment and is frequently necessary to obtain a tissue specimen for differential diagnosis via its histology. Surgery performed by a specialist in gynecologic oncology usually results in an improved result.[40] Improved survival is attributed to more accurate staging of the disease and a higher rate of aggressive surgical excision of tumor in the abdomen by gynecologic oncologists as opposed to general gynecologists and general surgeons.
The type of surgery depends upon how widespread the cancer is when diagnosed (the cancer stage), as well as the presumed type and grade of cancer. The surgeon may remove one (unilateral oophorectomy) or both ovaries (bilateral oophorectomy), the fallopian tubes (salpingectomy), and the uterus (hysterectomy). For some very early tumors (stage 1, low grade or low-risk disease), only the involved ovary and fallopian tube will be removed (called a “unilateral salpingo-oophorectomy,” USO), especially in young females who wish to preserve their fertility.
In advanced malignancy, where complete resection is not feasible, as much tumor as possible is removed (debulking surgery). In cases where this type of surgery is successful (i.e. < 1 cm in diameter of tumor is left behind [“optimal debulking”]), the prognosis is improved compared to patients where large tumor masses (> 1 cm in diameter) are left behind. Minimally invasive surgical techniques may facilitate the safe removal of very large (greater than 10 cm) tumors with fewer complications of surgery.[41]
Chemotherapy has been a general standard of care for ovarian cancer for decades, although with highly variable protocols.[42] Chemotherapy is used after surgery to treat any residual disease, if appropriate. This depends on the histology of the tumor; some kinds of tumor (particularly teratoma) are not sensitive to chemotherapy. In some cases, there may be reason to perform chemotherapy first, followed by surgery.
For patients with stage IIIC epithelial ovarian adenocarcinomas who have undergone successful optimal debulking, a recent clinical trial demonstrated that median survival time is significantly longer for patient receiving intraperitoneal (IP) chemotherapy.[43] Patients in this clinical trial reported less compliance with IP chemotherapy and fewer than half of the patients received all six cycles of IP chemotherapy. Despite this high “drop-out” rate, the group as a whole (including the patients that didn’t complete IP chemotherapy treatment) survived longer on average than patients who received intravenous chemotherapy alone.
Some specialists believe the toxicities and other complications of IP chemotherapy will be unnecessary with improved IV chemotherapy drugs currently being developed.
Although IP chemotherapy has been recommended as a standard of care for the first-line treatment of ovarian cancer, the basis for this recommendation has been challenged.[44]
Radiation therapy is not effective for advanced stages because when vital organs are in the radiation field, a high dose cannot be safely delivered. Radiation therapy is then commonly avoided in such stages as the vital organs may not be able to withstand the problems associated with these ovarian cancer treatments.[45]
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