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Final Project – Repackaging PortfolioMatt HammesLI819 XIAugust 1, 2009Research Report NarrativeI started off this project by interviewing my client. I have a friend who was getting ready to undergo surgery, so I thought she would be a good person to turn to. She had an ovarian cyst, and she really didn’t know too much about them. So, it became my job to put together a packet of information for her. She wanted something fairly simple that explained what the cysts were, along with a couple of pictures (nothing too graphic or scary). She wanted it to be a document in packet format, so she could just sit down and look at it. She also specified that it shouldn’t be more than 10 pages long, since she didn’t want it to be too long. She was afraid that after awhile, the technical information would just start to run together. This sounded straightforward enough.When I began my research, I immediately discovered that there was a ton of information available on library databases (I primarily used those found on my local library’s website, ). However, I was able to narrow my search criteria and come up with some really good information. One problem I ran into was that there seemed to be a lot of very short articles with extremely technical information, which appeared to be expert clinical statements designed to be read and considered by other experts in the field. Once I recognized these, my search became easier and I was able to locate the information she needed using library databases. At first I intended to supplement that information with info I found during a quick Google search, however, I found everything I needed using the library databases. For most of these articles, I used the General Reference Center Gold, Credo Reference, and Research Library databases.BibliographyBourne, T.H., Campbell, S., Collins, W.P., Crayford, T.J.B., Rawson, H.J. (200). Benign ovarian cysts and ovarian cancer: A cohort study with implications for screening. The Lancet. 355(9209), 1060.Cyst, Ovarian. (2003). Webster's New World? Medical Dictionary. Hoboken, NJ: Wiley. Graham, Janis. (2002).?Ovarian cysts: when to worry. (red alert ob/gyn).?Redbook.??198.6,?29(1).Information from your family doctor: Ovarian Cyst. (2003) American Family Physician. 67(11), 2375.Lok, Cori.?(2002). Cyst risks.?U.S. News & World Report.?41.Ovarian Cysts. (2004). In New Harvard Guide to Women's Health, The. Cambridge, MA: Harvard University Press. Walling, Anne D. (2004). Managing Ovarian Cysts in Postmenopausal Women. American Family Physician. 69(7), 1753Information PackageSimple definition – An ovarian cyst is a fluid-filled sac in the ovary.From U.S. News & World Report - Twenty percent of women of childbearing age have small, benign cysts in their ovaries, and this gynecological problem may signal a heightened risk of heart disease. A study in this week's issue of Circulation showed that women with these cysts, compared with other women, tend to have stiffer arteries--a condition linked to plaque buildup, which can cause heart attacks and strokes. Young women don't tend to think of themselves as heart attack candidates, so these cysts should be an incentive to visit a cardiologist, particularly since women with cysts also tend to have high blood pressure and cholesterol levels.Basic information from Redbook - The most common symptoms (if you have any at all) are a dull ache on one side of your abdomen or groin, constipation, and bloating. If your ovary feels slightly enlarged to your doctor during a pelvic exam, it's a tip-off that you may have a cyst, says Raymond Kaufman, professor of ob/gyn at Baylor College of Medicine in Houston. Because most cysts disappear within two menstrual cycles, many doctors recommend you return for another pelvic exam in two months. Most cysts are harmless, hormone-related fluid-filled growths that occur as a normal consequence of ovulation and affect virtually every woman at some point. If a cyst remains for longer than two months and/or causes severe discomfort, a simple, painless, in-office transvaginal ultrasound by your ob/gyn can rule out other types of ovarian cysts that are unrelated to your menstrual cycle, as well as the unlikely possibility of cancer or an ovarian tumor.Detailed information directly from The New Harvard Guide to Women’s Health:A cyst is an abnormal tissue sac filled with fluid or a semifluid gel. Cysts can develop on one or both ovaries in women of any age, and they can grow to astounding proportions—sometimes reaching the size of an orange or larger. Although many ovarian cysts are harmless, they occasionally cause severe pelvic pain, particularly if they become very large or if they twist or rupture (the bigger the cyst, the greater the chance of rupture). And in older women in particular, it is vital that an ovarian cyst be distinguished from ovarian cancer.In women of reproductive age. evarian cysts often result from events that take place during the normal menstrual cycle; thus, they are called functional cysts. In the course of a normal cycle, a single cystlike follicle in the ovary (the Graafian follicle; see illustration) matures and ruptures to release an egg into the fallopian tube. What remains of the follicle is a yellow structure called the corpus luteum, which—unless pregnancy occurs—soon disintegrates on its own. Occasionally, however, the Graafian follicle does not rupture but instead continues to grow. This results in a type of functional cyst known as a follicle cyst. Another type of functional cyst called a corpus luteum cyst can develop if the corpus luteum keeps growing after the egg is released. Functional cysts of both types usually disappear on their own in the course of one or two menstrual cycles.Occasionally a woman develops many tiny follicle cysts on the ovaries. This is called polycystic ovary syndrome, and it is generally associated with hormonal abnormalities and a number of other symptoms.The ovaries are prone to a variety of other cysts and abnormal growths, many of which are noncancerous. Common in young women, for example, are dermoid cysts (teratomas). Often containing fatty cells, hair, bone, and even teeth, these are believed to result not from a pregnancy but from the woman's own cells, which for unknown reasons are stimulated to grow and become differentiated into these organs. Also fairly common are ovarian cystadenomas, benign tumors which contain fluid-filled cysts as well as some tissue. In rare cases, cystadenomas appear to become cancerous, although just how often this occurs remains unclear. Among the most common solid (noncystlike) growths on the ovaries are endometriomas, which are composed of tissue from the uterine lining—as can occur in endometriosis.In a postmenopausal woman an ovarian growth is more likely to be due to ovarian cancer than to a benign cyst. The increasing use of ultrasound has made it clear, however, that postmenopausal women can also develop noncancerous cysts much more frequently than was previously believed. Cysts in postmenopausal women are sometimes called postmenopausal enlarged ovary.Who is most likely to develop an ovarian cyst?Functional ovarian cysts can—by definition—occur only in premenopausal women. Other than that, there are no known risk factors for them. Using oral contraceptives is known to be a reverse risk factor, in that women who are using birth control pills almost never develop functional ovarian cysts. Other benign ovarian cysts and tumors are common in all age groups, Cystadenomas are more common in women with a family history of ovarian cancer.What are the symptoms?Ovarian cysts often produce no symptoms and are discovered only during the course of a routine pelvic examination. Occasionally, however, there may be pelvic or abdominal pain, especially if a cyst is pressing on nearby organs or is growing rapidly, or if it has ruptured or twisted. Some women may also experience pain during sexual intercourse. If the cyst has ruptured, there may be nausea, vomiting, or pain in the shoulder. Delayed, irregular, or painful periods may be yet another symptom of ovarian cysts. Symptoms generally reflect the size of the cyst or growth rather than its specific tissue type.How is the condition evaluated?The symptoms of ovarian cysts can suggest many other conditions—including ovarian cancer, pelvic inflammatory disease (PID), and ectopic pregnancy. The likelihood of having these and other conditions depends on a number of factors, including the woman's age, reproductive history, risk factors for ovarian cancer, and specific symptoms. In addition to doing a thorough physical examination—including a palpation of the uterus and pelvic region—a clinician evaluating a potential ovarian cyst will ask questions about all of these issues. Any woman with pelvic pain will be asked about risk factors for pelvic inflammatory disease, including previous sexually transmitted diseases and multiple sexual partners. And premenopausal women will be asked for the dates of their last and previous menstrual periods and for their contraceptive history.An ultrasound (either transabdominal or transvaginal) may be done of the pelvic region as well. This can be extremely useful in determining the exact location of the abnormality and in differentiating ovarian cysts from ectopic pregnancies. And since malignant growths often have a characteristic appearance, the ultrasound can help the clinician assess the likelihood that a growth is cancerous.Other parts of the evaluation depend on the woman's age. If there is even a remote possibility of pregnancy in a premenopausal woman, a pregnancy test will be done. If a premenopausal woman has pain on one side of the pelvic area and abnormal vaginal bleeding, the problem could be ectopic pregnancy or a corpus luteum cyst. To differentiate between these two conditions, a clinician may take a blood sample so that levels of the pregnancy hormone human chorionic gonadotropin (hCG) can be measured. This blood test may be done even if an earlier pregnancy test of the urine was negative, since urine tests are not always accurate in diagnosing an ectopic pregnancy. If there is no hCG in the blood, ectopic pregnancy can be ruled out.Once the possibility of pregnancy has been eliminated, most premenopausal women with ovarian cysts are told to wait a month or two—unless the cyst is large or there is pelvic pain. After this waiting period the physical examination and ultrasound are repeated. If an ultrasound examination shows suspicious or equivocal results, or if the symptoms have not resolved themselves after one or two menstrual cycles, a number of other blood tests may be done as well.One of the most useful, the CA125 radioimmunoassay, measures the amount of a specific antigen (a protein capable of inducing an immune response) which is shed into the bloodstream by certain malignant cells and in other abnormal conditions. If levels of this antigen are low in a premenopausal woman, the clinician can be reasonably sure that an ovarian growth is due to a functional ovarian cyst rather than the outgrowth of endometrial tissue (an endometrioma). CA125 levels may be measured even before an ultrasound is done in a postmenopausal woman. This is because the chances of ovarian cancer are much greater after menopause, and levels of CA125 are elevated in about 80 percent of all ovarian cancers.If a cyst is larger than about 6 to 8 cm in diameter, surgical exploration—and possibly removal—of the cyst by a gynecologist is usually necessary. Using a procedure called a laparos-copy, the gynecologist can inspect the cyst directly and remove tissue for study to determine its exact nature.How are ovarian cysts treated?An ovarian cyst in a premenopausal woman often requires no immediate treatment unless the cyst is unusually large or unless there is severe pelvic pain. If the cyst remains after one or two menstrual cycles, the clinician may prescribe birth control pills to see if these help suppress the cyst.Persistent functional cysts can be left in place or removed surgically. Among the factors to be considered are the size and nature of the cyst and extent of the symptoms, as well as the woman's age and future childbearing plans. If the cyst ruptures or twists, or if pain is severe for other reasons, it can be removed surgically in a procedure called a cystectomy. This can usually be accomplished in conjunction with a laparoscopy.In postmenopausal women, the usual practice has been to remove a cyst surgically because of the higher likelihood of ovarian cancer in this age group. As ultrasound techniques have become more refined, however, some doctors feel comfortable leaving a very small, clear-cut cyst in place in a postmenopausal woman, provided that the CA125 test results are normal. In this situation, it is important for the woman to be monitored periodically to detect any change in the cyst.Because some ovarian cystadenomas appear to become cancerous, they are usually removed surgically when diagnosed during laparoscopy. But a premenopausal woman who still wishes to bear children should discuss her pregnancy plans with her gynecologist. Although it is often possible to preserve an ovary while removing a cyst, very large ovarian cysts may require the removal of the ovary (unilateral oophorectomy). So as long as the other ovary is functional, however, childbearing is still possible.Although dermoid cysts are considered harmless, they are generally removed surgically.Benign ovarian cysts and ovarian cancer. This is a study that was done to investigate the possibilities of ovarian cancer, and its implications on screening.SummeryBackgroundWhether some benign ovarian cysts can develop into cancerous cysts is not known. If a large proportion of ovarian cancers arose in this way, it might be possible to remove the benign cysts in a screening programme before they became malignant. We used follow-up data from a cohort of 5479 self-referred women without symptoms, who participated in a ultrasonographic-screening trial for early ovarian cancer between June, 1981, and August, 1987. We assessed whether the removal of persistent ovarian cysts from these women was associated with a reduction in the expected number of deaths from ovarian cancer in the cohort as a whole.MethodsThe expected number of deaths from all causes, all cancers, and ovarian, breast and colorectal cancers were calculated for the study cohort by the standard life-table method. The actual number of deaths and each cause were obtained and the proportional mortality ratio was calculated for each cause of death.Findings5135 (95%) of the participants in the original trial were traced. During the screening, five of these women were found to have stage I epithelial ovarian cancer and 88 had benign epithelial ovarian tumours. The number of reported deaths from all causes (387 [50% of expected]), all cancers (221 [71%]), and ovarian cancer (22 [90%]) was lower than expected because of the “healthy-colunteer effect”. Proportional mortality ratios were 100% (by definition) for all cancers, 141% for breast cancer, 128% for ovarian cancer (95% Cl 87.7-187.6, p=0.19), 84% for colorectal cancer, and 48% for lung cancer.InterpretationThe removal of persistent ovarian cysts was not associated with a decrease in the proportion of expected deaths from ovarian cancer relative to other cancers during follow-up. For population-based screening of healthy women without family history of ovarian cancer, a screening test is required that is specific and sensitive to early malignant disease, and inexpensive. ................
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