The body is made up of trillions of living cells

Normal body cells grow, divide, and die in an orderly fashion.

Cancer begins when cells in a part of the body start to grow out of control.

Cancer cell growth is different from normal cell growth.

1. Instead of dying, cancer cells continue to grow and form new, abnormal cells.
2. Cancer cells can also invade (grow into) other tissues, something that normal cells
cannot do.
Why the Cells become cancerous ???
Due to damage to DNA.
What is ovarian cancer?
Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female
reproductive glands in which the ova, or eggs, are formed.)
Tumors in the ovaries can be benign, which means they are not cancer, or they can be
malignant, which means they are cancer.
Cancers that start in the ovaries can spread to other parts of the body. This is called
metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is
still called ovarian cancer.
SITUATION:
World:
Ovarian cancer is the fifth most common cause of cancer deaths among women in the US,
according to the American Cancer Society. However, a new study offers hope for women
diagnosed with the disease; the 10-year survival rate is higher than previously thought.
Philippines:
The Department of Health website cites ovarian cancer as the fifth most common
cancer among Filipino women. It is considered a silent killer as it is usually detected
when the cancer cells have already spread to other organs such as the lungs and the
liver.
ANATOMY & PHYSIOLOGY
The ovaries are twin organs that produce womens eggs and the main source of the
hormones estrogen and progesterone.
size: One ovary is long, 2 cm wide and 1 cm thick
Shape: almond shape.
Location: on each side of the uterus in pelvis.
SIGN & SYMPTOMS:
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer
may cause few and nonspecific symptoms that are often mistaken for more common
benign conditions, such as constipation or irritable bowel.
Signs and symptoms of ovarian cancer may include:

Abdominal bloating or swelling - which is when the area below your stomach
swells or feels full.
Vaginal bleeding or discharge (not normal for individual)
Quickly feeling full when eating
Indigestion and acid reflux
Weight loss

Pain in the pelvic or abdominal area, abdominal distension or discomfort,

abdominal mass
Changes in bowel habits, such as constipation
A frequent need to urinate
Physical findings are uncommon in patients with early disease, but the more advanced
the disease one may present with ovarian or pelvic mass, ascites, pleural effusion, or
abdominal mass or bowel obstruction. Pay attention to your body, and know what is
normal for you. If you have vaginal bleedingand/or an abnormal menstral cycle that is
not normal for you, see a physician right away. The key is early intervention so the
earlier ovarian cancer is found and treated, the more likely treatment will be effective.

PREDISPOSING FACTORS:
What are the risk factors?
Heredity:
Women with a family history of cancer of the ovaries, breast or colon have a
greater chance of acquiring ovarian cancer. Experts believe that about 10
percent to 15 percent of cancer of the ovary and the breast are induced by the
inherited genetic changes, including BRCA 1 and BRCA 2 gene mutations. Those
with a strong family history should ask their physician whether a closer follow-up
is needed.
Gender:
All women, simply because they are women and have ovaries are at risk to a
varying degree for developing ovarian cancer. This fact alone should motivate all
females to be on guard for any signs or symptoms of this cancer.
Age:
This is the strongest risk factor for ovarian cancer. It has a higher probability
after menopause. The use of postmenopausal hormone therapy may also
increase the risk. The association appears strongest among those who take
estrogen without progesterone for at least 5 to 10 years. It is not clear if taking
the combination of the two drugs also increases the risk. The younger the
relative who developed ovarian cancer, the greater the risk is for the female to
have cancer of the ovary. The highest incidence (23.1 percent) is found between
the age 55 and 64, and second highest (19.7 percent) among those age 65 to
74; 19.1 percent for those between 45-54; 18.2 percent between 75-84; 8
percent for age 85 and older. Those who are under 20 have 1.2 percent
incidence; between 20-34, 3.5 percent; and, 35 to 44, 7.3 percent. The median
age is 63.
Obesity:
Moderately overweight or obese women are a a higher risk for ovarian cancer
than normal weight women. The heavier they are, the higher the risk is. The
death rates for this cancer is likewise greater for obese women. It behooves not
only women but men and children, to maintain a normal weight through healthy
lifestyle.
Infertility and drugs:
Women who could not get pregnant or who use fertility drugs appear to have a
higher risk for ovarian cancer, compared to women who have had children,
women who breastfed, and women who have used oral contraceptive.
Estrogen hormone replacement therapy,
especially with long-term use and in large doses.
Age when menstruation started and ended.

If you began menstruating before age 12 or underwent menopause after age 52,
or both, your risk of ovarian cancer may be higher.
Never being pregnant.
Fertility treatment.
Smoking.
Use of an intrauterine device.
Polycystic ovary syndrome.
CAUSES:
It's not clear what causes ovarian cancer.
In general, cancer begins when a genetic mutation turns normal cells into abnormal
cancer cells. Cancer cells quickly multiply, forming a mass (tumor). They can invade
nearby tissues and break off from an initial tumor to spread elsewhere in the body
(metastasize).
Types of ovarian cancer
The type of cell where the cancer begins determines the type of ovarian cancer you
have. Ovarian cancer types include:

Epithelial tumors, which begin in the thin layer of tissue that covers the
outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
Stromal tumors, which begin in the ovarian tissue that contains hormoneproducing cells. These tumors are usually diagnosed at an earlier stage than
other ovarian tumors. About 7 percent of ovarian tumors are stromal.
Germ cell tumors, which begin in the egg-producing cells. These rare ovarian
cancers tend to occur in younger women.

STAGES
Stage I - Growth of the cancer is limited to the ovary or ovaries.

Stage IA - Growth is limited to one ovary and the tumor is confined to the inside of
the ovary. There is no cancer on the outer surface of the ovary. There are no ascites
present containing malignant cells. The capsule is intact.
Stage IB - Growth is limited to both ovaries without any tumor on their outer
surfaces. There are no ascites present containing malignant cells. The capsule is
intact.
Stage IC - The tumor is classified as either Stage IA or IB and one or more of the
following are present: (1) tumor is present on the outer surface of one or both
ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant
cells or with positive peritoneal washings.

Stage II - Growth of the cancer involves one or both ovaries with pelvic extension.

Stage IIA - The cancer has extended to and/or involves the uterus or the fallopian
tubes, or both.
Stage IIB - The cancer has extended to other pelvic organs.
Stage IIC - The tumor is classified as either Stage IIA or IIB and one or more of the
following are present: (1) tumor is present on the outer surface of one or both

ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant
cells or with positive peritoneal washings.
Stage III - Growth of the cancer involves one or both ovaries, and one or both of the
following are present: (1) the cancer has spread beyond the pelvis to the lining of the
abdomen; and (2) the cancer has spread to lymph nodes. The tumor is limited to the true
pelvis but with histologically proven malignant extension to the small bowel or omentum.

Stage IIIA - During the staging operation, the practitioner can see cancer involving
one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has
not spread to lymph nodes. However, when biopsies are checked under a microscope,
very small deposits of cancer are found in the abdominal peritoneal surfaces.
Stage IIIB - The tumor is in one or both ovaries, and deposits of cancer are present
in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm
in diameter. The cancer has not spread to the lymph nodes.
Stage IIIC - The tumor is in one or both ovaries, and one or both of the following is
present: (1) the cancer has spread to lymph nodes; and/or (2) the deposits of cancer
exceed 2 cm in diameter and are found in the abdomen.

Stage IV - This is the most advanced stage of ovarian cancer. Growth of the cancer involves
one or both ovaries and distant metastases (spread of the cancer to organs located outside
of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the
cavity which surrounds the lungs) is also evidence of stage IV disease.
PATHOPHYSIOLOGY
Most theories of the pathophysiology of ovarian cancer include the concept that it
begins with the dedifferentiation of the cells overlying the ovary. During ovulation, these
cells can be incorporated into the ovary, where they then proliferate. Ovarian cancer
typically spreads to the peritoneal surfaces and omentum.
Ovarian carcinoma can spread by local extension, lymphatic invasion, intraperitoneal
implantation, hematogenous dissemination, and transdiaphragmatic passage.
Intraperitoneal dissemination is the most common and recognized characteristic of
ovarian cancer. Malignant cells can implant anywhere in the peritoneal cavity but are
more likely to implant in sites of stasis along the peritoneal fluid circulation. As
discussed later, these mechanisms of dissemination represent the rationale to conduct
surgical staging, debulking surgery, and intraperitoneal administration of chemotherapy.
In contrast, hematogenous spread is clinically unusual early on in the disease process,
although it is not infrequent in patients with advanced disease.
DIAGNOSES
The following tests are used to diagnose ovarian cancer:
Blood test
Ultrasound
Laparoscopy and possibly Endoscopy
Colonoscopy
Abdominal fluid aspiration
Chest X-ray
CT (computerized tomography) scan
MRI (magnetic resonance imaging) scan
Positron emission tomography (PET scan)
Biopsy

TREATMENT
Treatment for ovarian cancer consists of
1. surgery
2. chemotherapy
3. combination of surgery with chemotherapy
4. radiotherapy
Surgery
Chemotherapy: Patients will typically receive a combination of carboplatin
(Paraplatin) and paclitaxel (Taxol) intravenously. As it is injected into the
bloodstream it can target cancer cells in the reproductive system, as well as any
cancer cells that may have reached elsewhere in the body.
Side effects chemotherapy
Nausea, vomiting - medication
chemotherapy sessions.

for

this

may

be

given

intravenously

during

Diarrhoea.
Hair loss.
Loss of appetite.
Mouth sores.
Anaemia.

Drugs used in chemotherapy:

Topotecan (Hycamtin)
- Topotecan
-

is an antineoplastic. It works by killing certain cancer cells.

Topotecan may cause severe and sometimes fatal bone marrow suppression and blood problems. These blood problems may

increase the risk of developing a severe infection. Topotecan should not be used in patients who have low platelet levels or very low
white blood cell levels.

Liposomal doxorubicin (Doxil)

- Treating advanced ovarian cancer and AIDS-related Kaposi sarcoma in certain
patients. It is also used with another medicine to treat a type of bone marrow
cancer (multiple myeloma) in certain patients.
- Doxorubicin liposomal is an antineoplastic antibiotic. It works by killing cancer
cells.
Gemcitabine (Gemzar)
Cyclophosphamide (Cytoxan)
- Cyclophosphamide is a cancer medication that interferes with the growth and
spread of cancer cells in the body.
- Cyclophosphamide is used to treat several types of cancer. Cyclophosphamide
is also used to treat certain cases of nephrotic syndrome (kidney disease) in
children.
Vinorelbine (Navelbine)
- Vinorelbine is cancer medication that interferes with the growth of cancer cells
and slows their spread in the body.
- Vinorelbine is used to treat non-small cell lung cancer.
- Vinorelbine is sometimes used in combination with other cancer medications.
Ifosfamide (Ifex)
- Ifosfamide is a cancer medication that interferes with the growth and spread of
cancer cells in the body.
- Ifosfamide is used with other cancer medicines to treat testicular cancer.

Etoposide (VP-16)
- Etoposide is a cancer medicine that interferes with the growth and spread of
cancer cells in the body.
- Etoposide is used to treat small cell lung cancer. It is usually given in
combination with other cancer medicines.
Altretamine (Hexalen)
- Altretamine is a cancer medicine that interferes with the growth and spread of
cancer cells in the body.
- Altretamine is used to ease the symptoms of ovarian cancer. This medication
will not treat the cancer itself.
- Altretamine is usually given after other cancer medicines have been tried
without success.
Capecitabine (Xeloda)
- Capecitabine is a cancer medicine that interferes with the growth of cancer
cells and slows their spread in the body.
- Capecitabine is used to treat colon cancer, and breast or colorectal cancer that
has spread to other parts of the body.
- Capecitabine is often used in combination with other cancer medications and/or
radiation treatments.
Irinotecan (CPT-11, Camptosar)
Melphalan
- Melphalan is a cancer medication that interferes with the growth and spread of
cancer cells in the body.
- Melphalan is used to treat multiple myeloma (a type of blood cancer) and
cancer of the ovary.
- Melphalan treats only the symptoms of ovarian cancer or multiple myeloma,
but does not treat the cancer itself.
Pemetrexed (Alimta)
- Pemetrexed is a cancer medication that interferes with the growth and spread
of cancer cells in the body.
- Pemetrexed is used to treat non-small cell lung cancer after other cancer
medications have been tried without successful treatment.
- Pemetrexed is also used with another medication called cisplatin to treat
mesothelioma, a form of lung cancer associated with exposure to asbestos.
Albumin bound paclitaxel (nab-paclitaxel, Abraxane)
-

COMBINATION CHEMOTHERAPY
For Germ Cell Cancer:
The combination mainly used most often is called PEB
P - cisplatin (Platinol), E -etoposide, B - bleomycin.
Other combination includes TIP: paclitaxel (Taxol), ifosfamide, and cisplatin
VeIP: vinblastine, ifosfamide, and cisplatin
VIP: etoposide (VP-16), ifosfamide, and cisplatin
For stromal tumors:
carboplatin plus paclitaxel or PEB
Side effects: Nausea, vomiting, hair loss and low blood count.
RADIOTHERAPY
Side effects Bladder infections.

Diarrhea, Constipation.
Irritation, darkening of your skin that the radiation
beams hit.
Nausea, Frequent urination, Abdominal pain
PREVENTION:
Oral contraceptives
Gynaecologic surgery
tubal ligation
hysterectomy
EARLY DETECTION
If a woman shows ovarian cancer symptoms, doctors may monitor her with one of three
tests or a combination of them:
1. Blood Test
2. Transvaginal Ultrasound
3. Pelvic Exam
Screening test for ovarian cancer:
1. Transvaginal ultrasound
2. CA 125 blood test.
CONCLUSION:
Remember that although ovarian cancer is less common cancer it is not silent
and early diagnosis may save lives.
Ovarian cancer has always been thought of as a symptomless disease, but
research has shown this to be untrue . There are symptoms , unfortunately they
may be so subtle that they are attributed to other benign conditions.
However 81% of the respondents realize in observation that symptoms existed
before diagnosis, with these symptoms being confused with irritable bowel
syndrome, pre-menopause, stress acid-reflex, endometriosis, gall bladder issues
or other ailments.
It is the time to BREAK THE SILENCE.. educate yourself and the women you
love !!!
What is the prognosis?
This depends a lot on how early diagnosis was made, and whether the cancer is Stage I
(confined to the ovary or both ovaries), or the cancer has spread to other organs in the
abdomen (Stage III), or has spread to organs outside the abdomen (Stage IV). About 75
percent (3 out of 4) of ovarian cancer patients live for at least one year after diagnosis.
Forty-six percent are still alive at least after 5 year. If diagnosed and treated before the
cancer has spread outside the ovary, the five-year survival rate is 94 percent.
http://womenshealth.gov/publications/our-publications/fact-sheet/ovarian-cancer.html#
http://www.mayoclinic.org/diseases-conditions/ovarian-cancer/basics/risk-factors/con20028096
http://newsinfo.inquirer.net/65293/cancer-of-the-ovary
http://www.physio-pedia.com/Ovarian_Cancer#Definition.2FDescription

Medications

Common Drugs & Drug Combinations Used in Chemotherapy

Carboplatin & Paclitaxel

Cisplatin & Paclitaxel

Bevacizumab

Paclitaxel & Bevacizumab

[1]

If it is not the first time a patient has received chemotherapy, the type of drugs used are
determined by how long it has been since the last time they took a drug containing
platinum.[2] If it has been less than 6 months, the patient is termed platinum resistant. If it
has been more than 6 months since the last day of platinum-based chemotherapy, then
often a platinum-containing drug will be used again. [4]
In patients who are platinum resistant, a single drug is often used. Some of these
include:[2][1]
Pegylated liposomal doxoruicin, Docetaxel, Paclitaxel, Topotecan, Gemcitabine, Etoposide, or
Bevacizumab
Other Drugs Approved for Ovarian Cancer
Adriamycin PFS
Adriamycin RDF
Carboplatin
Clafen
Cisplatin
Cyclophosphamide
Cytoxan
Doxorubic in Hydrochloride
Dox-SL
DOXIL
Doxorubicin Hydrochloride Liposome
Evacet
Gemcitabine Hydrochloride
Gemzar
Hycamtin
LipoDox
Neosar
Paclitaxel
Paraplat
Paraplatin
Platinol
Platinol-AQ
Taxol
Topotecan Hydrochloride

[1][2][4]

Diagnostic Tests/Lab Tests/Lab Values

There are currently no reliable screening tools available to diagnose ovarian cancer. Annual
pap smears will detect cervical cancer but NOT ovarian varieties. The current
recommendations include an annual pelvic exam, transvaginal ultrasound, and CA-125 blood
test.[10] These are the best options for screening but even in combination, results have been
found to be unreliable.
Screening Tools

[2]

Pelvic Exam: Women age 18 and above should have a mandatory annual vaginal
exam. Women age 35 and above should receive an annual rectovaginal exam
(physician inserts fingers in the rectum and vagina simultaneously to feel for
abnormal swelling and to detect tenderness).
Transvaginal Ultrasound: This ultrasound, performed with a small instrument
placed in the vagina, is appropriate especially for women at high risk for ovarian
cancer or for those with an abnormal pelvic exam.
CA-125 Test: This blood test determines if the level of CA-125, a protein produced by
ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian
cancer or with an abnormal pelvic examination. Some non-cancerous diseases of the
ovaries also increase the CA-125 levels, and some ovarian cancers may not produce
enough CA-125 levels to cause a positive test.

It is also important to have a comprehensive family history taken by a physician who can
identify risk factors associated with ovarian cancer since 5-10% of cases have a familial link.
[2]
If a women is considered to be at high risk for ovarian cancer, the following tool can also
be used:

Genetic testing: This testing identifies mutations in BRCA1 and BRCA2. Mutations in
these proteins increased a womans risk of ovarian cancer greatly. About 1.4 percent
of women in the general population will develop ovarian cancer sometime during
their lives.[4] By contrast, approximately 39 percent of women who inherit a harmful
BRCA1 mutation and 11 to 17 percent of women who inherit a harmful BRCA2
mutation will develop ovarian cancer by age 70 years. [4]

Positive Tests [10]

If any of these tests are positive, a woman should consult with a gynecologic oncologist who
may conduct a CT scan and X-Rays and study the results. However, the only way to more
accurately confirm ovarian cancer is with a biopsy, a procedure in which the doctor takes a
sample of the tumor and examines it under a microscope.
Medical Management (current best evidence)

There are three main treatment types for ovarian cancer: [2]
1) Surgery - Surgery to remove the cancerous growth is the most common method of
diagnosis and therapy for ovarian cancer. It is best performed by a qualified gynecologic
oncologist.
2) Chemotherapy - Chemotherapy is the treatment of cancer using chemicals
(medications) that travel through the bloodstream to destroy cancer cells or stop them from

growing both in and outside the ovaries. Chemotherapy is used in the majority of cases as a
follow-up therapy to surgery.

Intraperitoneal - medicine is placed directly into the peritoneal area through a

surgically implanted port and catheter. New advances have combined it with
intravenous (IV) therapy, using chemotherapy agents that work best for treating
ovarian cancer. The National Cancer Institute recommends that, for select ovarian
cancer patients, chemotherapy be given by both IV and IP. This combination has been
found to increase survival for women with advanced stage ovarian cancer. [10]
Neoadjuvant - a patient may receive chemotherapy before having surgery to
remove their tumor.[10]

3) Radiation Therapy - Radiation therapy uses high-energy X-rays to kill cancer cells and
shrink tumors (only rarely used in the treatment of ovarian cancer in the United States).
Side effects of Chemotherapy:[10]

Hair loss

Nausea & Vomiting

Fatigue

Diarrhea & Constipation

Nerve Problems

Mouth Issues

Sexual & Intimacy Issues

"Chemobrain"

Physical Therapy Management (current best evidence)

Although there are no specific physical therapy protocols for ovarian cancer, evidence
supports the benefits of physical therapy in improving daily function, quality of life, and
health in patients with cancer. As part of your cancer treatment, physical therapists can help
you design an individualized exercise program. There are many reasons for being physically
active during cancer treatment, but each persons exercise program should be based on
what is safe and what works best for them. It should also be something you like doing. Your
exercise plan should take into account any exercise program you already follow, what you
can do now, and any physical problems or limits you have. [12] These therapeutic exercises
aim to reduce fatigue and optimize physical function, safety and well-being. [13]
An exercises regimen could include:

Range-of-motion training with

Light resistance exercises

Cardiovascular activity

Flexibility exercises

Strength training

[14]

[14]

[15]

[15]

[15]

Exercise, even minimal physical exertion, increases heart rate and muscle flexion while
boosting your bodys tolerance to chemotherapy and radiation treatments. Participating in
daily exercise programs will enable you to gain a sense of physical control over your

condition, and will provide an outlet for stress and anxiety. In addition, exercise will instill
you with the motivation and the drive for optimal wellness. [14]
Physical therapy also provides:

Massage Therapy, which recent studies show can decrease stress, anxiety,
depression, and pain, and increase alertness [15]
Lymphedema Therapy
Self-Care Managment to improve an individuals ability to return to their home

The American Cancer Society outlines the following for physical activity after
cancer treatment. [8]
When you are recovering from cancer treatment

Many side effects get better within a few weeks after cancer treatment ends, but
some can last much longer or even emerge later. Most people are able to slowly
increase exercise time and intensity.
What may be a low- or moderate-intensity activity for a healthy person may seem
like a high-intensity activity for some cancer survivors.

When you are living disease-free or with stable disease

During this phase, physical activity is important to your overall health and quality of
life. It may even help some people live longer. Theres some evidence that getting to
and staying at a healthy weight, eating right, and being physically active may help
reduce risk of second cancer as well as other serious chronic diseases. More research
is needed to be sure about these possible benefits.

The American Cancer Society recommends that cancer survivors take these
actions

Take part in regular physical activity.

Avoid inactivity and return to normal daily activities as soon as possible after
diagnosis.
Aim to exercise at least 150 minutes per week.

Include strength training exercises at least 2 days per week.

A growing number of studies have looked at the impact of physical activity on cancer
recurrence and long-term survival. Exercise has been shown to improve cardiovascular
fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem,
happiness, and several quality of life factors in cancer survivors. At least 20 studies of
people with breast, colorectal, prostate, and ovarian cancer have suggested that physically
active cancer survivors have a lower risk of cancer recurrence and improved survival
compared with those who are inactive. Randomized clinical trials are still needed to better
define the impact of exercise on such outcomes.
Those who are overweight or obese after treatment should limit high-calorie foods and
drinks, and increase physical activity to promote weight loss. Those who have been treated
for digestive or lung cancers may be underweight. They may need to increase their body
weight to a healthier range, but exercise and nutrition are still important. Both groups should
emphasize vegetables, fruits, and whole grains. Its well known that obesity is linked with a

higher risk of developing some cancers. Its also linked with breast cancer recurrence, and it
might be related to the recurrence of other types of cancer, too. Exercise can help you get to
and stay at a healthy weight.

Living with advanced cancer

Some level of physical activity can improve quality of life for people with certain
types of cancer, even if the disease is advanced (has spread to many places and/or is
no longer responding to treatment). But this varies by cancer type, physical ability,
health problems related to the cancer or cancer treatment, and other illnesses. The
situation can also change quickly for a person with advanced cancer, and physical
activity should be based on the persons goals, abilities, and preferences.

Differential Diagnosis
Ovarian cancer presents with few diagnostic dilemmas yet it is commonly misdiagnosed as
Extraovarian Primary Peritoneal Carcinoma (EOPPC) and adnexal masses (ovarian cysts). The
differential diagnosis for these two diagnosis are extensive, with most masses representing
benign processes. [3][5] EOPPC is an abdominal cancer without ovarian involvement. It mimics
the signs and symptoms of ovarian cancer as well as the microscopic appearance and
pattern of spread. Ovarian cysts are difficult to differentiate without histopathologic tissue
diagnosis, a definitive diagnosis is generally precluded. Physicians must evaluate the
likelihood of a pathologic process using clinical and radiologic information and balance the
risk of surgical intervention for a benign versus malignant process. [5]

In addition, ovarian carcinoma will sometimes present first with a paraneoplastic syndrome
such as polyarthritis syndrome, carpal tunnel, myopathy, plantar fasciitis, or palmar fasciitis
(swelling, digital stiffness or contractures, palmar erythema). The condition may be
misdiagnosed as chronic regional pain syndrome (CRPS), Dupuytrens contracture, or a
rheumatologic disorder. Hand and upper extremity manifestations often appear before the
tumor is clinically evident. [3]

Additional Differential Diagnosis:

Malignant gastric tumors
Anovulation
Appendiceal tumors
Appendicitis, Acute
Ascites
Benign lesions of the uterine corpus
Bladder distention/urinary retention
Borderline Ovarian Cancer
Cervicitis
Colon cancer
Embryologic remnants
Endometriosis
Gastric Cancer
Irritable Bowel Syndrome

Low-lying cecum
Metastatic gastrointestinal carcinoma
Ovarian torsion
Pancreatic Cancer
Pelvic abscess
Pelvic Inflammatory Disease
Pelvic kidney
Peritoneal Cancer
Peritoneal cyst
Rectal Cancer
Retroperitoneal mass
Urachal cyst
Urinary Tract Obstruction
Uterine Cancer
Uterine fibroids