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Eating your grains in the form of bread or pasta does not count as a “whole food” and increases the likelihood for a proinflammatory state of obesity when eaten consistently in high amounts symptoms diabetes type 2 20 mg vastarel sale. In order to medications such as seasonale are designed to buy vastarel master card consume 75 grams of fiber daily treatment 4 stomach virus order vastarel no prescription, one must eat nine servings of fruit and vegetables symptoms 4 days before period buy vastarel 20mg low price, a lesser amount of cereal containing fiber, and lesser still of bread, even if it is from whole grain. Exercise Every person is drawn towards one activity they like to do for their body. It is critical to find something you truly enjoy if you are going to be able to continue your routine over the long term. With exercise, the temperature inside your muscles increases the rate of metabolism 17 percent or more. It flushes toxic wastes from your body; that’s why regular exercise reduces the risk of cancer, heart disease, and more. Even the Nurses Health Study (more than 23,000 nurses participating) found that in the more than 2,200 women in whom cardiovascular risk was being tracked, those who exercised approximately ten minutes, six days per week, had the same risk reduction compared to those who took Lipitor 10mg daily! And yet the women who exercised had other health benefits that the Lipitor patients missed out on. Reduce Sugar Consumption Consider carbohydrates in the form of vegetables, whole fruits, fresh fruit juice and whole-grained foods. The table on Natural Sweeteners for Your Health (page 38) will guide you with sugar consumption. Eliminate Hydrogenated and Trans Fats from Your Meals and Snacks this process of hydrogenation basically kills omega-3 oils. This process was introduced into North America by Procter & Gamble’s first Crisco cookbook in 1912. Alternative and Natural Interventions for Cardiovascular Disease G 37 Natural Sweeteners for Your Health the following sugars are the “next best thing” to sugar found in the whole foods fruits and vegetables. These contain some nutrients, but still have a fairly high glycemic index: I Agave nectar—from a cactus-like plant in Mexico. I Fructose (Levulose)—found in many foods in combination with glucose and galactose such as: Honey, tree fruits, berries, melons, beets, sweet potatoes, parsnips, and onions. Please limit refined fructose consumption because it has been shown to damage cellular function through a process called glycation of many age-related chronic diseases. Because it decreases infection from tooth-harming bacteria in the mouth, xylitol gums have actually been well proven to reduce dental cavities. I Turbinado—raw sugar cane juice that has been dehydrated, colored, and then crystallized. I Fruit Juice Concentrate—remaining sugar from apples, devoid of most of its fiber, enzymes, vitamins, and minerals. However, the fruit itself is always a healthier sugar than the powder from the fruit. I Unsulphured Molasses—made from the juice of sun-ripened cane, blackstrap molasses is the residue of the cane syrup after the sugar crystals have been separated. I Raw Honey—made by bees and typically only sold in health food stores, but still contains minerals and vitamins. The Healthiest Form of Sugar is from Whole Foods Better than all those sugars listed above are fruits and vegetables. These whole-food sugars also come with micronutrients known as fiber, enzymes, complete vitamins, organic minerals, antioxidants, and phytochemicals. Both scientific literature and clinical experience definitively show that diets high in fiber, fruits, vegetables, and herbal teas significantly reduce the occurrence of a host of deadly diseases listed above! You get them from red meat, processed meats, high-fat dairy products, and commercially deep-fat fried foods. So avoid these: I Organ meat including liver, kidney, brains, heart, stomach, etc. I Skin of poultry I Fried foods, including deep-fat fried fish I Fatty red meat I Processed meat of any type, including those made from turkey or chicken (surprisingly, these are often higher in fat than those made from beef) I High fat dairy products, including milk, butter, cheese, ice cream, and yogurt Healthier fats come in the form of whole foods such as avocados. Others safer fats are: I Cultured dairy products, sour cream, plain yogurt, cottage cheese, fetta cheese, blue cheese, and other fermented cheeses. Omega-3 fatty acids have recently been shown to be more effective than statin drugs according to 83 a published meta-analysis Swiss researchers reviewed 97 random controlled clinical trials, including more than 275,000 participants, and discovered that statin drugs decreased mortality by 22 percent, but omega-3 fatty acids decreased mortality by 32 percent. Even death from any cause was reduced by only 13 percent with statins but by 23 percent with omega-3 fatty acids! Why not make fish (like ocean-raised salmon, herring and mackerel), cod liver oil, olive oil, borage oil, primrose oil, and flaxseed oil a part of every meal? Keeping Blood Thin Naturally Nattokinase is a potent fibrin inhibitor, reducing blood thickness and atherosclerosis of heart disease and stroke. I have a patient that does better on nattokinase and vitamin E than he did on Coumadin and Lovenox shots for recurrent pulmonary embolisms (clots to the lungs). Alternative and Natural Interventions for Cardiovascular Disease G 39 Serrepeptase digests blood clots and possibly arterial plaque. Serrapeptase, however, has no inhibitory effects on prostaglandins so stomach acid level remains unchanged. Perfusion of blood where it was formerly insufficient is the recognized method of reversing angina pectoris and lower extremity claudication. It is also the way to keep vessels working, blood pressure down, and slow or stop the progression towards atherosclerosis. Fortunately, there are a few who know how to expose misleading study design or those studies in which researchers report negative interpretations of what are actually positive results. It reminds me of our government buying into the false report that Iraq was concealing weapons of mass destruction to be used on us—reason enough to engage in what now has become a five-year war with more than 4,000 U. In addition, we have the highest levels of military intelligence now admitting that they really did not have any evidence of weapons of mass destruction—the declared basis for going to war in the first place. In fact, you will find that most of the peer-reviewed literature available on the National Library of Medicine’s public access website ( Also, its toxic effects can cause other problems which may lead to a fatal outcome. Proper investigation and treatment may sometimes be delayed by 85 a patient’s faith in such therapy. For example, these authors, also published in peer-reviewed scientific journals, state direct opposition to R. Fish oils are now proven to help revitalize vessel wall endothelia and to partially reverse atherosclerotic damage. Being safe and having proven benefits, chelation therapy and fish oils can be integrated together with nutrients, lifestyle-dietary revision, exercise, and medications as necessary, into a cardiovascular revitalization strategy. You might be also interested to know that statistical analyses of the more carefully performed studies on chelation show that the probability that these positive results are due to random chance alone ranges from less than one in 1,000 to less than one in 10,000! You deserve to be informed of the risks and benefits of all types of valuable interventions, not just the ones that are highly profitable for doctors and pharmaceutical companies. And toxicological studies demonstrate aspirin to be more than five times 89 more dangerous in rat studies. However, that was before the effect of aspirin on a bleeding stomach was fully realized. I will venture to say that this amino acid exceeds the safety of any and every drug currently used in medicine. Did you know that even a slightly increased lead level raises your chance of death by 46 percent? Two important studies expose what many toxicologists have been saying for years about the destructive effect that metals have on brain function. In a 2002 article, the analysis of 4,292 individuals ages 30 to 74 years from 1976 through 1992, found the subjects to have a slightly elevated blood lead level—comprising 15 percent of the population! Among these people with slightly elevated blood lead levels there was a 46 percent increased death rate (all-cause mortality) compared to those with completely “normal” blood lead levels. The University of Michigan recently hosted scientists and researchers from all over the world at a conference on toxic heavy metals. Results showed a significant excretion of all six of the toxic heavy metals most commonly encountered. So please don’t be scared into thinking that oral chelation is a “health hazard” because you may lose some trace elements along with the toxic ones. That is why the simple recommendation to supplement with zinc and calcium with oral chelation has proven to more than make up for this trace mineral excretion. Essentially, the potential of trace mineral depletion of any consequence to your health is minimal according to the research by Dow Chemical and also a 91 92 2000 report published in Food Chemical Toxicology.

But its costs seem to symptoms panic attack generic 20mg vastarel free shipping be spiralling out of control symptoms genital warts buy 20mg vastarel mastercard, and it contributes greatly to symptoms diabetes type 2 20 mg vastarel sale the ‘dehumanizing’ atmosphere of medicine today treatment concussion discount vastarel online master card, of which many complain. When it was built, the Wexham Park Hospital was regarded as an excellent example of its type, but it and similar complex modern hospitals embody the paradox at the centre of the medical enterprise. Some critics argued that modern hospital medicine had contributed little except cost: it was public-health measures in the nineteenth century that had actually brought down mortality. Whether the medicine of the future can afford the modem hospital remains an unsolved problem. It is conceivable that the huge hospitals of today will soon seem medicine’s dinosaurs, and that they will be replaced by simpler and more varied institutions. There are records of grape cultivation and wine-making in groups developed their own Mesopotamia and Egypt at least 4,500 years ago but many fermented liquors must particular knowledge of local therapeutic and narcotic have been known long before then, as were other medicinal products. Bitter experience Bernardino de Sahagun and taught people which plants were toxic, and, happier events perhaps suggested, appear in the third volume of the Florentine Codex of more subtly, that some had beneficial properties. But the hiero­ («*<») glyphics are difficult to interpret, and the identity of many remedies is doubtful. Extracts of plants still sometimes used as purgatives senna, colocynth, and castor oil were recognized. Parts of animals were also applied therapeutically, especially fat, and more curious recipes include ox spleen, pig’s brain, and tortoise gall (with honey). But names of remedies must be interpreted carefully; ‘ass’s heads’ and ‘pig’s teeth’ may be no more what they seem than are buttercups ‘cups for butter’ or foxgloves ‘gloves worn by foxes’. Copies of herbals have survived, suggesting familiarity with hellebore, henbane, mandrake, and the opium poppy, all of which contain potent drugs well known today, but the exact purposes for which these remedies were applied are often uncertain or obscure. Other drugs may Historiao:las cot;as de NuevaE: have been known and mentioned in records that have not survived. As in China, simplicity was sought by inventing a small number of basic prin­ ciples, this time the four temperaments the blood, the phlegm, the yellow bile, and the black bile, giving the sanguine, the phlegmatic, the jaundiced, and the melancholic temperaments and in attributing disease to an excess or deficiency of the wet and dry, hot and cold humours responsible for these temperaments. Treatment gave more weight to diet and lifestyle than to drugs as a means of restoring a healthy balance. Surviving ancient Greek texts include references to books on drugs, and to suppliers of medicinal plants, but no great ancient Greek schedule of drugs is known to exist. In the more regulated civilization of Rome, Galen of Pergamum has become the most famous, and for many centuries was probably the most influential, medical Medicines of ancient China and India In ancient China, treatment before about In India, an empirical and rational system, 1100 bc seems to have been dominated by Ayurvedic medicine, displaced earlier philosophical ideas of disease. In the golden magico-religious practices between 600 and period that followed, treatment was more 100 bc. No medical books from the Veda empirical and based on direct observation: period have survived, but as far as is known medicines were given because they were seen the medical materials then used resembled to have worked before, not because they those of Egypt and Mesopotamia, augmented were supposed to summon a god to help. In later Then orthodoxy became unpopular, with a Brahmanical texts (ad 100-700), a basic the­ growing influence of Buddhism and Indian ory of seven elements appears chyle, blood, ideas, and increasing reliance on charms and flesh, fat, bone, marrow, and semen and per­ magic. Therapy was directed to restoring pentina, or snake-root, was introduced to harmony between the principles, and drugs, it European medicine during the 1950s as a was thought, might be supposed to act in this sedative and to treat high blood pressure. The relief depicts plants and animals encoun­ tered by the Egyptian pharoah in Asia. The ancient Egyptians attributed medici­ nal properties to many famil­ iar fruits and vegetables. Other authors sheltered under the cover of his authority, just as they had after Hippocrates, and the probably diverse medical practices of cen­ turies became consolidated in a Galenical system, which related more to the indi­ vidual patient than to the formal classification of disease. The accumulated experience of Greece and Rome became mingled in the medieval Arabic world with that of Muslims. Among the works of this period are a systematic treatise on poisons written in the eighth century by the Arabic alchemist Jabir ibn Hayyan. The noted scientist and philosopher Ibn Sina (Avi­ cenna) also included a book on medicaments in his Canon on Medicine published in the eleventh century, a text that continued to serve for 500 years. Much med­ ical knowledge was reintroduced to Europe after Muslim conquests in North Africa and Spain, especially through the medical schools established at Salerno in Italy and at Montpellier in France in the eleventh and twelfth centuries. Then came the great outburst of independence and origi­ nality in the ‘rebirth of learning’ or the Renaissance. In medicine, rejection of orthodoxy began gradually, and was made conspicuous by the flamboyant charac­ ter Philippus Aureolus Theophrastus Bombastus von Hohenheim, who was born near Zurich and adopted the name Paracelsus in recognition of the Roman med­ ical writer Celsus. Drug Treatment and the Rise of Pharmacology 249 Dioscorides the five-volume herbal produced by Pedanius Dioscorides of heal ye Apthae. And ye leaves being applied, do restrain Cilicia (southern Anatolia) in the first century ad became a ye Herpetas, a heal ye running ulcers which are in ye basic source of knowledge about plants and medicines for at head, a ye falling down of the eyes. Although written in Greek, and trans­ Forty-four drugs mentioned by Dioscorides survived into lated into a variety of languages over the years, it is best the twentieth century in offical European pharmacopoeias, known by its Latin title De Materia Medico. About 500 plants according to the historian Charles Singer, passing ‘to us are included in the treatise, many of which can be identified through the Middle Ages, some continuously and some from their descriptions. For many of the illustrations, the artist copied drawings made in the first century bc by a Greek physician called Kra teuas. This manuscript, which is now in the Austrian National Library in Vienna, was a present from the reigning Roman Emperor in the West, Flavius Anicius Olybrius, to his daughter Juliana Anica in ad 512. This manuscript remained in the Library of Magdalen College, Oxford, until 1934, when it was at last printed with an appendix by Robert W. The classification seems strange to us, but the plants described and illustrated cover an extensive range of those familiar today. The medicinal applications, written long before any mod­ ern concepts of disease had been formulated, are essentially To our eyes, this illustration of Galen (centre) in conversa­ symptomatic treatments. Most plants are claimed to cure tion with Dioscorides in the Codex Vindobonesis may show almost every ill. The bramble (‘batos’, Rubus fruticosus), the early medieval lack of a sense of history, because according to Dioscorides, Dioscorides was alive around ad 60 whereas Galen was binds and drys; it dyes ye hair. But the force of the illustration is tops of it being drank stops ye belly, a restrains ye flux of chiefly symbolic, with the greatest diagnostician of antiq­ women, & is convenient for ye biting of ye Prester. And uity shown to be on good terms with the greatest master the leaves being chewed do strengthen ye gums, and of herbal lore and pharmacy. Partly because of advances in chem­ istry and alchemy, herbal medicine flourished amongst the Arabic inheritors of Greek philosophy and science. Martin Luther had shown his defiance of authority by burning a papal bull and a copy of canon law, and Paracelsus followed his example by burning the books of Galen and Avicenna. Appointed town physician of Basel in 1527, he also taught medical students there for a year. Later, after he had lost a lawsuit against a canon of the cathedral, he became a wandering practitioner. He treated patients, but also made chemical experiments and reported novel observations, many of which have been repeatedly confirmed. Paracelsus noted that air was necessary for wood to burn and he claimed that without air all living things would die. He recommended various minerals as med­ icines, and may have introduced mercury for syphilis, as well as advising the use Opposite: In this thirteenth of antimony, arsenic, copper, iron, and lead for various purposes. His secret rem­ century manuscript, a child is edy, laudanum, probably depended mainly on opium for its benefits (see page being given a fomentation 258). He (poultice) for internal pain and a woman a herbal potion sought a small number of simplifying principles, but these belonged to several for nausea. He invented a mystical philosophy of gnomes, sylphs, nymphs, and sala tx n tn Cub n a n ft. Paracelsus’s doctrines shocked many respectable physicians of the time, who clung, sometimes with great bigotry, to Galenical doctrine in the face of Paracelsian heresy. It is so much easier to assert authority than to investigate facts, and the time was one of original ideas but not yet of their experimental evaluation. Nor was understanding of ill health sufficiently advanced to distin­ guish what now we call one ‘disease’ from another. Injuries broken bones, and wounds with accompanying sep­ sis, fevers, and tumours were obvious enough. Certain patterns of fever could be recognized, such as tertian and quartan agues in which the fever (probably malarial) recurred on the third or fourth day. But accurate diagnosis of internal disorders was non-existent, and had little basis for developing until the ele­ ments of physiology and pathology were established in the seven­ teenth and eighteenth centuries by, among others, William Harvey (see page 159). The choice of drugs for treating sick patients thus depended on a mixture of authority, tradition, and philosophy (or metaphysic, or superstition).

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These physicians assume great responsibility in helping women of all ages find pride in themselves and their bodies medicine interaction checker order 20 mg vastarel overnight delivery. You must be able to nioxin scalp treatment order vastarel us keep your cool while deal ing with many varied situations simultaneously symptoms tuberculosis purchase vastarel 20 mg mastercard. To excel in this specialty symptoms migraine buy genuine vastarel on-line, med ical students have to tolerate touching many gravid abdomens, performing un limited vaginal examinations, and getting their hands dirty (after all, any type of bodily fluid is game). During the third stage of labor, obstetricians may find them selves covered in blood, vomit, urine, and even fecal matter. Like their colleagues in emergency medicine, obstetrician-gynecologists are ready for anything when it comes to women’s health. Whether the case involves an infant failing to de liver head first, a placental abruption, or a new patient with imminent delivery of twins, obstetrician-gynecologists have to think fast and react quickly and com petently in life-threatening situations. For example, a serious Likes working with his or her antepartum obstetric complication, such hands. In the clinic or hospital ward, you also en gage in many pelvic examinations, pap smears, colposcopies, and operative deliveries with forceps or vacuum. Several aspects of primary care and emergency medicine are also very im portant in this specialty. Despite subspecialty development, the vast majority of physicians who train in this field consider themselves generalists, meaning that they assume the role of obstetrician, gynecologist, primary care doctor for women, or all three. In a single day, you may be delivering a baby, treating a sexually transmitted disease with an antibiotic, evaluating unusual vagi nal bleeding in the emergency room, or counseling a woman on the psycholog ical effects of menopause. In all cases, the obstetrician-gynecologist listens to the patient and empathizes with health issues that are unique to women. Obstetrics-gynecology is unique in being highly specialized—in the medical and surgical treatment of female health problems—while still categorized as primary care. The majority of reproductive-age women in this country consider their obstetrician-gynecologist as their primary care provider. For example, during pregnancy, employment position obstetricians promote a healthy lifestyle. They provide screening services related to blood pressure assess Source: American Medical Association ment, Papanicolaou smear, breast exami nation and review of the breast self-exam ination, and referral for mammography or other specialized services. They spend time discussing work-related health risks, smoking, seat belt use, safe sex and sexually transmitted disease prevention, and genetic screening for family planning. Fol lowing delivery, the obstetrician holds a responsibility to the mother for at least 6 weeks. The physician must continue to evaluate not only her anatomy, but also her psychological well-being. Most patients of gynecologists are either initially transferred from their obstetric clinic or referred from nurse practitioners or in ternists. Thus, patient relationships may be as short as one delivery or continue long after menopause. Because of the thrilling rush of the operating room experience, some obste trician-gynecologists like the surgical aspect of their specialty the best. Caesarean delivery has become the most common hospital-based operative procedure in the United States and now accounts for about 23. One academic physician stated “in most cases, my surgical efforts cure prob lems, usually with good outcomes. The manual dexterity required for obstetric or gynecologic surgery may not approach that of, for example, neurosurgery or otolaryngology. Despite the reduction in operating room time due to new primary care educational requirements, gradu ating residents in this specialty are still well-trained, competent surgeons of the abdomen and pelvis. In a way, obstetrician-gynecologists have much more in common with their colleagues in ophthalmology, a surgical specialty that also has significant medical and primary care components. Medical students should disregard condescending comments made by other surgical subspecialists. Some obstetrician-gynecologists take the initiative of completing a 1-year fellowship in pelvic surgery as a junior attending to gain additional surgical experience. There is little room for indecisiveness, meekness, or timidity within this specialty. Because gy necologic surgeries start quite early in the morning and deliveries or ruptured ec topic pregnancies can occur during the middle of the night, you must be able to function at all times of day or night. Your common sense and experience are calming and reassuring for an ex pectant mother about to deliver her first child, a preoperative gynecologic patient, and a woman struggling with the loss of a pregnancy. The obstetrician-gynecologist’s typical day often consists of a mix of surgery, hospital rounds, clinic, and administrative duties. Due to the erratic lifestyle, many medical students strike this specialty from their list of choices. However, there Obstetrics $230,044 is some variability depending on your Obstetrics & choice of practice. In private practice, the Gynecology $230,804 hours of patient care depend on the num Reproductive ber of group members, location, and pa Endocrinology & tient load. The number of interruptions by Infertility $221,850 patients in labor correlates with the vol Gynecologic ume of obstetrics in one’s practice. After Oncology $300,340 finishing residency, some doctors choose to practice only gynecology. After all, the Source: American Medical Group Association delivery of uncomplicated pregnancies also falls under the domain of family prac titioners and nurse midwives. In the academic setting, obstetrician-gynecologists who are full-time faculty members spend less time in surgery and in clinic. More time is devoted to teaching and mentoring residents, conducting research, and ad ministrative tasks. Yet despite the infringements on family and personal time, most obstetricians and gynecologists are extremely fulfilled by their careers. Their high level of ca reer satisfaction and desire to practice is comparable to that of other women physi cians, particularly those in surgery. To honor maternity/paternity leave and family obligations, most hospitals and group practices create contracts with defined schedules including part-time hours, minimal on-call nights, and less operating time. Despite such flexibility, a recent study found that female obstetrician gynecologists, compared to other women physicians, worked significantly more clinical hours and call nights; they slept even less when on call. Gender discrimination in obstetrics and gynecology has undergone a signif icant role reversal. Not only do male obstetrician-gynecologists feel at times that they are losing ground, but some recruiters from private practice groups have be gun discriminating against male physicians. Assuming that women prefer a fe male obstetrician-gynecologist, these practices aggressively seek female residents. They want to balance their male-dominated staff with female obstetrician-gyne cologists, creating a dramatically changed workforce. As a result, many qualified male doctors struggle to secure their preferred career. In fact, one study found that 26% of graduating male residents reported difficulty in finding a job, com pared to 17% of female residents. The idea that female patients feel more comfortable with a female obstetrician-gynecologist is completely erroneous. In a recent survey of obstetric patients during their postpartum hospital stay, the majority (58%) had no preference for the gender of their obstetrician; 34% preferred female physi cians and 7% indicated a desire for a male doctor. Men who cultivate traditionally female skills, particularly empathy and good communication, can thrive as obstetrician-gynecologists. The current medicolegal climate of our society, with its get-rich quick incentives, makes obstetrics and gynecology a high-risk specialty. In fact, most medical students considering this specialty are especially concerned about the daily potential litigation. In light of this ever-present malpractice menace, obstetrician-gynecologists must be passionate about their careers and provide outstanding patient care. In many instances, the threat of lit igation encourages the development and training of better physicians. If you look at all the statistics and numbers, obstetrician-gynecologists have the highest incidence of lawsuits throughout their careers. Since the 1950s, the number of malpractice claims filed against obstetrician-gynecologists has in creased nearly 15% every year. More than half of all claims were dismissed, settled without payment, or won by the physician. Due to unaffordable liability insurance premiums (or even the inability to obtain insurance) many physicians have curtailed their services.

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This may include the diaphragm symptoms uterine fibroids buy cheap vastarel 20 mg line, omentum symptoms 2 weeks pregnant purchase vastarel 20 mg fast delivery, peritoneum treatment keloid scars order cheap vastarel, ascites treatment in statistics purchase discount vastarel online, and nearby lymph nodes. A prognosis is the likely or staging systems for ovarian cancer: the American expected course and outcome of a disease. The outer sac (capsule) of the spread of cancer to distant sites the ovary is intact. Stage 1B the next section describes each cancer stage as Cancer is in both ovaries. Stage 1C Cancer is in one or both ovaries and one or more of the following has also happened: Stage 1C1 – the capsule of the ovary broke open (ruptured) during surgery. Stage 2A Cancer has grown into and/or spread implants on the Stage 3C uterus, fallopian tubes, ovaries, or all of these areas. Cancer has spread to the tissue lining the abdomen and it can be seen without a microscope. Cancer Cancer has grown into and/or spread implants may have spread to lymph nodes in the back of on other organs or tissues in the pelvis. It may have also spread to the outer include the bladder, sigmoid colon, rectum, or the surface of the liver or spleen. The peritoneum is the tissue that lines the inside of the abdomen and pelvis and covers most organs in this space. Stage 4 Cancer has spread to areas far from the pelvis and abdomen, such as the lungs, brain, or skin. It has spread Cancer may have also spread to lymph nodes outside the pelvis to tissues in the belly (abdomen). And, one or both of the following has happened: 1) cancer has spread to the tissue lining the inside Stage 4A of the abdomen (peritoneum); or 2) cancer may There are cancer cells in the fuid around the lungs. Stage 3A1 Stage 4B Cancer has spread outside the pelvis, but only to Cancer has spread to the inside of the liver or lymph nodes in the back part of the abdomen—called spleen, to distant lymph nodes, or to other organs retroperitoneal lymph nodes. Stage 3A2 Cancer has spread to the tissue lining the abdomen, but it is so small it can only be seen with a microscope. The cell subtype Ovarian cancer is also classifed based on what is based on the features of the cancer cells. Cancer grades the cancer grade is a rating of how much the cancer cells look like normal cells. Based on the features of the cancer cells, the pathologist will score the cancer as Grade 1, 2, or 3. Some pathologists describe the grading in only two classes: high grade or low grade. If the cancer can’t be Your treatment team controlled or cured, a care plan for the end of life can Treating ovarian cancer may consist of a team of be made. There are many benefts to advance care gynecologic oncologist and medical oncologists. Your gynecologic Making the most of your time oncologist is an expert in surgery and chemotherapy for gynecologic cancers. Sometimes, a medical Lowering the stress of caregivers oncologist who is an expert in treating cancer with Having your wishes followed chemotherapy may administer treatment. Treatment of other Advance care planning starts with an honest talk medical problems may be improved if he or she is between you and your doctors. Just having may receive care from nurses, social workers, and a general idea will help with planning. Ask to have the names and information, you can decide at what point you’d want contact information of your health care providers to stop chemotherapy or other treatments, if at all. You can also decide what treatments you’d want for symptom relief, such as surgery or medicine. Cancer treatment There is no single treatment practice that is best for Another part of the planning involves hospice care. There is often more than one treatment Hospice care doesn’t include treatment to fght the option, including clinical trials. Clinical trials study cancer but rather to reduce symptoms caused by how well a treatment works and its safety. Hospice care may be started because you aren’t interested in more cancer treatment, no other the treatment that you and your doctors agree on cancer treatment is available, or because you may should be reported in the treatment plan. All known side Hospice care allows you to have the best quality of efects should be listed and the time required to treat life possible. One study found that patients Your treatment plan may change because of new and caregivers had a better quality of life when information. Any of these An advance directive describes the treatment you’d changes may require a new treatment plan. It can also include your treatment wishes if your heart or lungs were to stop working. If you already have an the best advice that I could offer advance directive, it may need to be updated to be someone facing an illness is to stay legally valid. Ovarian cancer survivor Ovarian cancer is staged during surgery to remove the cancer—called surgical staging. The cancer grade describes how fast or slow the cancer will likely grow and spread. Gynecologic oncologists and medical oncologists often work closely together to plan the best treatment for ovarian cancer. This Surgical treatment often involves removing both information may help you understand the ovaries, both fallopian tubes, and the uterus. When the uterus and the cervix are removed, it is There are two main goals of surgical treatment for called a total hysterectomy. Most often, the uterus ovarian cancer: and cervix are removed through a surgical cut in the belly (abdomen). To do so, the tumor is removed along with other organs and tissues If cancer has spread outside the ovaries, your doctor where cancer cells have or might have spread. This is called debulking surgery or cytoreductive A number of procedures may be done during surgical surgery. This surgeon is able to remove all of the tumors that are 1 includes the tumor size, tumor location, and how far cm or larger in size, the surgery is called an optimal the cancer has spread. Removal of all disease that can be seen you want the option of becoming pregnant after with the eye is called no gross residual disease. Optimal debulking is linked with better treatment outcomes, particularly if there is no gross residual disease. This may include removing organs such as cuts in the abdomen instead of one big one. It may tools are inserted through the cuts to perform the also remove part of your stomach, liver, pancreas, surgery. The that look diferent or are larger than normal should camera lets your doctor see your ovaries and other also be removed if possible. A Laparoscopy may be used in select cases, such as laparotomy is a long surgical cut in the abdomen. Rarely, it may be is often an up-and-down (vertical) cut from the top used when cancer has spread outside the ovaries. This lets this surgery should only be done by a gynecologic your doctor see the tumor and other organs and oncologist with a lot of experience. Preparing for surgery Thus, a laparotomy is the most common and Your treatment team will give you instructions on how preferred method for ovarian cancer surgery. You may be asked to experts recommend that it should be used when stop taking some medicines for a short time. Figure 8 Debulking surgery sites Diaphragm Spleen Debulking surgery removes as Liver Stomach much cancer as possible. The Gallbladder Pancreas extent of the surgery depends on how far the cancer has Peritoneum Omentum spread. It may remove all or Large intestine Small intestine part of nearby organs such as your liver, spleen, stomach, Appendix gallbladder, pancreas, Bladder intestines, appendix, and bladder.