EtiologyThe exact cause of ovarian cancer is unknown, but con-tributing factors include infertility, familial tendency,HRT with estrogen only, obesity, and use of the malehormone androgen to treat endometriosis. Some re-searchers believe the monthly tissue-repair process thatfollows the release of the ovum may establish a situa-tion in which genetic errors can occur. There is an in-creased risk for ovarian cancer in women who carrytheBRCA1andBRCA2breast cancer genes. A newgenetic variation identified as basonuclin-2 (BNC2) ismore common thanBRCA1andBRCA2but also ap-pears to raise a woman’s risk of ovarian cancer. Anothergenetic link comes from an inherited syndrome calledhereditary nonpolyposis colorectal cancer (HNPCC)that also puts these women at greater risk for ovariancancer.Signs and SymptomsClients who consistently experienced urinary urgency;pelvic pain; abdominal pressure, fullness, and bloating;persistent indigestion or nausea; unexplained bowelhabits; loss of appetite; increased abdominal girth; dys-pareunia; lack of energy; low back pain; and changes inmenstruation should report their symptoms to theirPCP. An ovarian tumor can grow to considerable size(about the size of an onion) before producing any symp-toms. Tumor rupture, infection, or torsion (twisting)may cause pain.Diagnostic ProceduresClinical evaluation, complete history, and physicalexamination are necessary. Transvaginal sonography,abdominal ultrasound, or CT scan may be used. CBCand blood chemistries may be ordered. Surgical explo-ration is the only way to grade and stage a tumor.Histological studies are done.An early test for the diagnosis of ovarian cancer usesthe HE4 biomarker, which is secreted into the bloodby ovarian cancer cells. Another test used to detectovarian cancer detects the protein CA125 and often isunreliable, so the hope is that the HE4 test will bemore reliable in the earlier stages of the disease.Reproductive System Diseases and Disorders419Weighing the Risks and Benefits ofHormone Replacement TherapyHRT was first prescribed in the 1940s for postmenopausalwomen to treat their symptoms and to prevent post-menopausal conditions such as osteoporosis. However, tworecent studies questioned whether the benefit of HRT out-weighs its risks. The first study, conducted by the NationalInstitutes of Health, looked at the effect of HRT taken ascombination therapy versus a placebo. The study was haltedbecause it found that the overall risks of HRT therapyexceeded the benefits. The risks included more coronaryheart disease events, more strokes, serious blood clots, andinvasive breast cancers. The benefits the study found werefewer colorectal cancers and fewer hip fractures.A second study, completed in Britain, suggested that HRTcan increase the risk of dying from breast cancer in additionto raising the risk of getting the disease. The researchers alsodetermined that stopping HRT seemed to reduce the riskfairly quickly. It has been found that treatment for osteoporo-
