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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Ovary


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
183.0 - Malignant Neoplasm of Ovary and Other Uterine Adnexa; Ovary
198.6 - Secondary Malignant Neoplasm of Other Specified Sites; Ovary
233.39 - Carcinoma in Situ; Other and Unspecified Female Genital Organs; Other Female Genital Organ
236.2 - Neoplasm of Uncertain Behavior of Genitourinary Organs, Ovary

Related Terms

  • Cancer of the Ovary
  • Epithelial Carcinoma of the Ovary
  • Malignant Neoplasm of the Ovary
  • Ovarian Cancer
  • Ovarian Epithelial Cancer

Overview

Image Description:
Cancer Ovary - A frontal view of a female trunk and reproductive organs shows the central position of the uterus in the lower abdomen with an ovary on each side. A closer view of the uterus and ovaries depicts a normal right ovary and a tumorous growth within the left ovary.
Click to see Image

Ovarian cancer is a life-threatening tumor that develops in one or both ovaries. It is the eighth most common cancer in women and the fifth most common cause of cancer deaths in women ("Overview"). Ovaries are paired organs, one on each side of the uterus. The ovaries produce eggs (ova) and the female hormones estrogen and progesterone. Cancer of the ovary has few or no symptoms in its early stages, which means that most women are diagnosed at more advanced stages with poor prognoses. In the US, about 15,280 women die of ovarian cancer each year (Garcia).

Ovarian tumors are classified according to the kinds of cells from which the tumor started (cell of origin) and whether the tumor is benign (non-malignant) or cancerous (malignant). The three main types of ovarian tissue are composed of epithelial cells, stromal cells, or germ cells. In ovarian cancer, one of these types of cells has divided and reproduced uncontrollably until accumulation of the cells forms a growth or tumor. Epithelial cells normally cover the ovary and are the cells of origin responsible for approximately 85% of ovarian cancers. Stromal cells found inside the ovary are the primary source of the female hormones estrogen and progesterone. Their abnormal growth accounts for 5% to 10% of ovarian cancers. Germ cells also are located within the ovary: they are the cells that make up the ova. Germ cells account for up to 15% of ovarian cancers ("Overview"). Tumors composed of germ cells are more common in teenaged girls and young women than in older women. One theory about the origin of ovarian cancer is that it is ovulation-related. This is supported by the fact that suppression of ovulation as in pregnancy or during the use of birth control pills (oral contraceptives) reduces the risk of developing the disease. Another theory is that the normal repair process that occurs during the ovulation cycle is in some way defective (Garcia).

Epithelial tumors can be further divided into benign epithelial tumors, low-malignant potential (LMP) tumors, and epithelial ovarian carcinoma, and can be differentiated under the microscope (histologically) into serous, mucinous, endometrioid, and clear cell types. Treatment depends upon the type, grade, and staging of the tumor. Epithelial tumors are graded histologically according to how closely the cells resemble normal cells, with grade 1 being nearly normal in appearance, grade 2 less normal, and grade 3 the least normal.

The International Federation of Gynecology and Obstetrics (FIGO) stages ovarian tumors on a scale of I to IV according to how well- or poorly-organized the tumors are and whether the cancer is localized or has spread (metastasized). Stage I is cancer that is localized and contained in the ovary or ovaries. Stage II is cancer that has spread to other pelvic organs such as the uterus, bladder, or rectum, but is confined to the pelvis. Stage III is cancer that has spread to the lymph nodes and/or abdominal lining and organs, with possible superficial liver metastases. Stage IV is cancer that has spread to distant organs, such as the brain, bone, lungs, or functional part of the liver (liver parenchyma). Other staging systems (e.g., tumor/node/metastasis [TNM system]) may be combined with FIGO staging to further describe tumor characteristics.

Incidence and Prevalence: The incidence of ovarian cancer increases with age from approximately 20 per 100,000 for women age 30 to 50 to 40 per 100,000 for women age 50 to 75. Although ovarian cancer occurs most commonly after menopause (average age is 63), it may develop at any age.

Ovarian cancer accounts for 3% of all cancers in women (“Overview”). It also accounts for more deaths than any other gynecologic cancer (Garcia). The American Cancer Society projected that approximately 21,880 new cases of ovarian cancer would be diagnosed in 2010 with about 13,485 deaths ("Overview"). A woman's risk of developing ovarian cancer in her lifetime is 1 in 71, and her risk of dying from the disease 1 in 95, with a higher risk for white women than black women (“Overview”).

International incidence is estimated to parallel that of the US although not all countries gather and record data.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for the development of ovarian cancer include family history of gynecologic cancer, age, obesity, frequency of ovulation, ethnic heritage, and dietary factors. Number of pregnancies (gravidity) is an important risk factor. Women with a history of pregnancy have a 50% lower risk of ovarian cancer than women who were never pregnant (nulligravidous), and a protective effect is shown in women with multiple pregnancies (Garcia). Positive family history of ovarian, breast, or uterine cancer in first-degree relatives (mother, sister, or daughter) is found in only 5% to 10% of cases. Feminine powders or deodorant sprays may be associated with increased risk. The use of oral contraceptives is associated with decreased risk of ovarian cancer (Garcia).

Women whose number of ovulations is decreased by other factors, (e.g., irregular periods, menopause earlier than age 50, breast feeding) also may be less likely to develop ovarian cancer. Tubal ligation and hysterectomy also have been associated with a reduced risk of ovarian cancer, but the evidence is less conclusive. It is unclear if short-term hormone replacement therapy (HRT) contributes to risk, but those using HRT longer than 10 years show twice the risk for ovarian cancer compared to those who do not (“Overview”).

Source: Medical Disability Advisor



Diagnosis

History: History is nonspecific in that symptoms in early-stage disease are either absent or vague and may resemble menopausal symptoms and intestinal illnesses. Individuals in later stages may report indigestion, gas, nausea, vomiting, loss of appetite, a feeling of fullness after small meals, pelvic or abdominal pain, swelling, increased frequency or urgency of urination, unexplained change in bowel habits, unexplained weight gain or loss, pain during intercourse (dyspareunia), ongoing fatigue, lower back pain, shortness of breath, and, in rare cases, postmenopausal vaginal bleeding. These symptoms usually do not become apparent until the later stages of the disease when the cancer mass is large enough to interfere with pelvic organs such as the bladder or rectum, or after the cancer has metastasized to the abdominal cavity. Obtaining a personal obstetric and gynecologic history and a family history of gynecologic disease may be important in diagnosis.

Physical exam: There is no definitive physical examination to detect ovarian cancer in its early stages. Physical findings usually are not significant. Because ovarian cancer often has no early symptoms, over 70% of women have progressed to an advanced stage by the time the disease is diagnosed (Garcia). In advanced ovarian cancer, examination and palpation of the abdomen may reveal ovarian, pelvic, or abdominal mass, or possible bowel obstruction.

Annual gynecologic exams (pelvic exams) may reveal the presence of the disease in its later stages. During the pelvic exam, the physician examines the ovaries for size, shape, and consistency, and evaluates the abdomen for fluid in the abdominal cavity (ascites).

Tests: There is no definitive screening test for detection of ovarian cancer in its early stages comparable to mammography for early detection of breast cancer. Pap smear is useless to detect ovarian cancer. The cancer antigen 125 assay (CA-125) performed on a blood sample measures a protein secreted by ovarian cancer cells that can be elevated in over 80% of individuals with ovarian cancer, however CA-125 may be normal in 50% of early-stage cancers, which can be misleading (Garcia). Exploratory abdominal surgery (laparoscopy) performed to confirm the presence of cancer suspected from physical exam is the only definitive way to diagnose ovarian cancer. Routine blood tests, including a complete blood count (CBC) and a blood chemistry profile with liver function tests, will be performed before any surgery to evaluate overall health status. During laparoscopy, the tumor is removed for laboratory evaluation, and fluid from the abdominal cavity is assessed for presence of cancer cells.

Routine imaging tests are not needed in all women who are suspected of having an ovarian tumor. Noninvasive diagnostic imaging such as ultrasound performed with a small instrument inserted into the vagina (transvaginal ultrasound), computed tomography (CT), and magnetic resonance imaging (MRI), may help distinguish between benign and cancerous tumors. X-ray procedures (i.e., barium enema, intravenous pyelogram) are used if involvement of the colon or urinary tract is suspected.

In women who have gastrointestinal symptoms, endoscopic examination of the upper and lower GI tract is indicated to help rule out GI conditions and evaluate for bowel obstruction caused by pressure from an ovarian tumor or other abdominal tumor.

Source: Medical Disability Advisor



Treatment

Treatment for ovarian cancer is based on the stage of the cancer: limited disease, as in stages I and II, or advanced disease, as in stages III and IV. The likelihood of recurrence is also an important consideration in selecting treatment options. Ovarian cancer treatment usually involves a combination of surgery to remove (excise) the tumor, chemotherapy that uses cytotoxic drugs to kill the cancer cells, and radiation (high energy x-rays) to kill cancer cells.

The initial treatment for ovarian cancer usually is surgery. Complete surgical intervention includes surgical staging and debulking. Surgical staging is the examination of tissues and organs in the pelvic cavity to accurately assess the disease. Debulking is removal of as much of the cancerous tissue as possible; the ovaries, Fallopian tubes, uterus, the fold of fatty tissue covering and padding the organs in the abdomen (omentum), and affected lymph nodes or surrounding tissues usually are removed.

After surgery, most individuals are treated with chemotherapy except when the cancer is stage I at diagnosis and risk of metastasis is reduced. Chemotherapy becomes the mainstay of the treatment process if the cancer recurs. New combinations of chemotherapy drugs administered with platinum and paclitaxel have demonstrated improved survival rates in recent years. They usually are administered intravenously on an outpatient basis within a few weeks after surgery. The treatment is repeated every 3 weeks for a total of 6 times. Each 3-week interval is referred to as a “cycle” of chemotherapy. Chemotherapy also can be given by injecting drugs directly into the peritoneal fluid inside the abdominal and pelvic cavities (intraperitoneally).

Treatment with surgery and chemotherapy is tailored to each of the four stages of the disease. For epithelial ovarian cancer, in stage I, surgery is performed for staging and removal of the ovary (oophorectomy). In stage II, both surgery and chemotherapy or radiation therapy are used. In stages III and IV, surgery, debulking, and chemotherapy are used. After treatment, blood tests are performed to determine if tumor marker levels have returned to normal. This is sometimes followed by a second operation (second-look laparoscopy) to see if more treatment is required. If both ovaries need to be removed (bilateral oophorectomy), the individual will go through a surgical menopause and will become sterile.

Radiation therapy is not administered as often as chemotherapy because of its toxicity; however, it is used when afflicted areas are painful and not responding to chemotherapy or when the disease has spread to the brain, bones, or lungs. Radiation usually is given by aiming radiation beams at the abdomen. Radioactive phosphorus also can be injected intraperitoneally.

For low-malignant potential (LMP) tumors, surgery is performed to remove the affected ovary and the Fallopian tube on the same side (salpingo-oophorectomy). If the cancer returns, chemotherapy and radiation may be used in conjunction with additional surgery.

For stromal and germ cell tumors, part or the entire affected ovary may be removed. Since this type of tumor may be benign, surgery will enable staging and assessment of the need for additional surgery or chemotherapy.

Individuals who are in the end stages of ovarian cancer may require palliative therapy, in which the primary focus is pain control.

Source: Medical Disability Advisor



Prognosis

The most significant predictor of outcome is the stage of the cancer at the time of diagnosis. Outcome is also contingent on the cell of origin type. Clear cell carcinomas are the most difficult to treat even when cancer is confined to the ovary. The remaining diseased tissue after the initial laparotomy is an important indicator of prognosis: good prognosis for recovery is found in microscopic disease found outside the pelvic area or macroscopic disease within 2 cm outside the pelvis; macroscopic disease more than 2 cm after surgery or metastatic cancer outside the peritoneal cavity carries poor prognosis (Garcia).

The best 5-year survival rates are in women whose disease has not spread beyond the ovary. The current 5-year survival rates for the four stages are stage I, 92.8%; stage II, 78.6%; stage III, 50%; and stage IV, 17.5% (“Overview”). Low survival rates are due to the fact that the disease is rarely detected early. However, survival rates have shown continued improvement since 1975, as indicated by a 5-year survival rate of 45% reported in 1995-2002 compared to a rate of 36% reported in 1975-1977 (Garcia).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Gynecologist
  • Oncologist
  • Radiology Oncologist

Source: Medical Disability Advisor



Rehabilitation

Women diagnosed with ovarian cancer may require physical and/or occupational therapy to improve strength, balance, and self-care prior to discharge from the hospital. Additional home therapy to address weakness and decreased endurance due to chemotherapy and/or radiation also may be necessary. In addition to progressive exercises, therapists address the use of any adaptive equipment that is needed and safety issues that may be present in the home or workplace.

Rehabilitation specialists and hospice workers provide palliative care services. Women with the diagnosis of cancer may find it beneficial to undergo psychological counseling either on an individual basis or in a support group setting.

Source: Medical Disability Advisor



Comorbid Conditions

  • Obesity or excessive thinness

Source: Medical Disability Advisor



Complications

Complications of ovarian cancer are primarily caused by spread of the cancer to other organs with progressive loss of function in those organs. Examples of complications include bowel obstruction, urinary obstruction, fluid collection in the thoracic cavity (pleural effusion), and accumulation of fluid in the abdomen (ascites). Bowel and urinary obstructions can result in loss of the use of the bowel and urinary tract. Pleural effusion causes shortness of breath and sometimes a mild, nonproductive cough. The symptoms of ascites increase with increasing amounts of fluid and include abdominal enlargement (distention), loss of appetite, shortness of breath, abdominal pain, low blood pressure, weakness, and fatigue.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the length of disability include age, concurrent infection, and overall health status; cell type, grade, and stage of disease at initial presentation; and presence or absence of complications from the cancer itself or from treatment. Younger women with earlier stage disease have the best chance for long-term recovery. Older women and women with poor general health or with more advanced disease may have a longer disability due to medical or surgical complications. Many women undergo a second exploratory surgery to determine if the disease has been eliminated, and this requires an additional period of disability. Chemotherapy and radiation therapy may extend the recovery period.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations include reducing the number of hours worked per day and number of days per week. Work responsibilities may need to be largely sedentary. Because of fatigue and weakness from the surgery and extended postoperative chemotherapy and, when required, radiation therapy, a woman may need a place at the work site where she can rest periodically. Women undergoing chemotherapy and/or radiation will need additional leave from work.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual complain of indigestion, gas, nausea, vomiting, loss of appetite, or a feeling of fullness after small meals?
  • Is there pelvic or abdominal pain, increased frequency or urgency of urination, unexplained change in bowel habits, unexplained weight gain or loss, pain during intercourse, ongoing fatigue, lower back pain, or shortness of breath?
  • Did physician note ovarian and abdominal enlargement and ascites during a pelvic exam?
  • Does physician believe the ovaries to be the primary site for the cancer or could the tumor be a secondary breast, lung, or other type of cancer that has metastasized to the ovaries?
  • Was exploratory laparotomy performed? Were other appropriate imaging studies done such as transvaginal ultrasound?
  • Was an assay for cancer antigen 125 performed? What was the result?
  • How was ovarian cancer confirmed?
  • What is the cell of origin? What was the stage of the cancer at diagnosis?

Regarding treatment:

  • Did surgery successfully remove the tumor, ovary or ovaries, and all cancerous tissue in the pelvic area?
  • Has individual undergone postoperative chemotherapy and/or radiation therapy appropriate for the stage of the disease?
  • Did individual tolerate and complete those therapies? If not, would individual benefit from experimental treatments?
  • Is the cancer metastatic? Which organ systems were affected and how was the metastatic cancer treated?

Regarding prognosis:

  • Have all treatment options been explored?
  • What is the likelihood of recurrence?
  • Would individual benefit from second opinion consultations?
  • Would individual benefit from counseling for psychological and emotional effects from the disease?
  • What, if any, complications have developed? How can these be treated?
  • What is expected outcome of the complication with treatment? How do these complications affect the activities of daily living for individual?
  • Has a second laparoscopic surgery been performed to evaluate the status of the cancer?

Source: Medical Disability Advisor



References

Cited

American Cancer Society. "Overview: Ovarian Cancer." American Cancer Society. 12 May. 2009. 8 Sep. 2009 <http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=33>.

Garcia, Agustin A. "Ovarian Cancer." eMedicine. Eds. Karen Loeb Lifford, et al. 13 Dec. 2007. Medscape. 25 Aug. 2009 <http://emedicine.medscape.com/article/255771-overview>.

Source: Medical Disability Advisor