Ovarian cancer - Causes, symptoms and treatment. MF.
Ovarian cancer is one of the most frequent oncological diseases that occur in women. The peak incidence falls on 60 years. Before the age of 45, ovarian cancer is rare. To date, the incidence ranges from 9 to 17 women per 100,000 women per year. For ovarian cancer, family predisposition is very important. For example, if the ovarian cancer was in two first-degree relatives( mother, sister, daughter), then the risk of the disease is 50%.With a burdened family history, ovarian cancer develops 10 years earlier.
Causes of ovarian cancer
There are many theories that seek to explain the cause of ovarian cancer. For example, the theory of "continuous evolution" explains the occurrence of ovarian cancer by an increase in the number of ovulations, leading to an increase in the damage to the epithelium of the ovary surface. Following this theory, nulliparous women are more at risk of ovarian cancer than those who have repeatedly become pregnant, breastfed and gave birth. However, it should be recognized that the comparison of a woman giving birth and not giving birth is conducted with respect to all oncogynecologic diseases and where no exact answer is given - whether the factor of absence of birth affects the increase in the incidence of cancer. Proceeding from this, this theory is unprovable for ovarian cancer. I must admit that there is no reliable cause of occurrence at the moment.
Types of ovarian tumors
The following ovarian tumors are distinguished by a histological structure: serous tumors( 75%), mucinous tumors( 20%), endometrioid tumors( 2%), clear cell tumors( 1%), Brenner tumors( less than 1%), mixed tumors(1%), undifferentiated cancer( less than 1%), unclassifiable tumors( 1%).Each of the listed forms can be: benign, borderline and malignant.
Bordered tumors are tumors of a low degree of malignancy. For a long time they do not go beyond the ovaries. In most cases, occur in 30-50 years, have a favorable prognosis.
The most common serous ovarian tumors. As a rule, they are formed as a result of immersion of the superficial epithelium deep into the ovary. Among all serous tumors borderline 10%, and are observed mainly up to 40 years. Malignant form - serous ovarian cancer - is the most common form of ovarian cancer. Among them, three degrees of differentiation are distinguished: high, moderate and low.
Mucinous tumors account for up to 15-20% of all epithelial ovarian tumors. They can reach a gigantic size, occupy the entire abdominal cavity. In 8-10% of cases they are bilateral, most often they go beyond the ovaries. In 5-10% of cases malignancy of benign mucinous tumors is observed. Papillary growths in mucinous tumors are less common than in serous, but when they occur they allow us to talk about high mitotic activity in the tumor tissue.
Other epithelial ovarian tumors are less common.
Symptoms of ovarian cancer
The clinical picture is asymptomatic in most cases. The most common symptoms are:
1. Disorder of the menstrual cycle
2. Difficult urination and constipation - with an increase in the tumor in size, and compression of surrounding organs.
3. Sensation of raspiraniya or pressure and pain in the lower abdomen.
4. Dyspareunia - painful sex.
5. There may be emergencies, such as a torsion of the foot of the tumor or a rupture of the tumor. This condition requires immediate surgical intervention.
6. An increase and bloating, constipation, nausea, loss of appetite or rapid satiety is a symptom typical of late stages of the disease.
7. Bloody discharge is a fairly rare complaint, characteristic mainly for patients in postmenopausal women.
8. The appearance of fluid in the abdomen and small pelvis
Examination for suspected ovarian cancer
The main objective evidence of ovarian cancer is the presence of voluminous formation in a small pelvis, dense, usually immobile, rough or hilly. With the appearance of ascites and the presence of volumetric education in the small pelvis, it is possible to speak almost precisely about the tumor of the ovaries.
It is important to remember that with the onset of menopause in a woman, the ovaries decrease in size and are not palpable. Therefore, the well-palpable appendages during normal gynecological examination should be alarming.
The main diagnostic methods are:
1. Bimanual examination of - allows the formation of a small pelvis to be palpated at a sufficiently large size of the formation, to determine its approximate size, correlation with the surrounding organs( soldered or not), to estimate the mobility of the formation, its shape and the nature of the surface.
2. Clinical and biochemical blood tests, urine - as a rule, no specific changes are characteristic of ovarian cancer. Possible leukocytosis, anemia, increased ESR.With metastases in the liver, hepatic markers will be changed - ALT, AST, bilirubin.
3. Determining the level of CA-125 .The CA-125 antigen is a high molecular weight glycoprotein that is produced by tumor cells of the ovarian epithelium, as well as by other pathological and normal cells. The norm of 10-13 U / ml for a woman, the upper limit of the norm according to different data can reach 35 units / ml. At a level of more than 95 units / ml in combination with volumetric education originating from the uterine appendages, the accuracy of this method reaches 95%.However, this is typical for postmenopausal women, and for women of reproductive age, the level of CA-125 can be elevated in many physiological states( for example, with menstruation can be increased to 35 U / ml - the upper limit of the norm) and, accordingly, can not be considered absolute. In addition, the CA-125 level in ovarian cancer may increase along with the progression of the tumor, hence it can be used to elucidate the dynamics of the tumor process.
4. The ultrasound is an important research method.being sufficiently reliable at the same time is harmless and is available in almost any hospital, which makes it possible not only to detect tumor formation in the small pelvis, but also to observe it in dynamics, and also to give an approximate prognostic assessment of malignancy or good quality of the process( estimate approximate!).With the help of ultrasound, you can identify the nature of education, the presence or absence of fluid, the presence or absence of chambers and cavities, overgrowth and papillae.
5. Excretory urography - can be used according to the prescription of specialist
6. Recto-manoscopy, irrigoscopy - according to indications.
7. MRI and CT is a highly specific diagnostic method in which it is also possible to determine the presence or absence of distant metastases in the liver and other organs. Minus - high cost.
8. Finally, it is possible to speak about the nature and structure of the tumor only after taking the material, which is possible only in the course of surgical intervention. It is possible to start the operation laparoscopically, taking a biopsy material for express biopsies, the answer is given on average within twenty minutes.
For a differential diagnosis with functional ovarian cysts, in the absence of many of the above methods of examination, it is possible to prescribe the patient oral contraceptives for a period of two months. If during this time there is no improvement in dynamics, one must think about a malignant process.
Ovarian cancer metastases
Dissemination( spread) in ovarian cancer occurs in three ways: contact, lymph and hematogenous. The contact path is the most frequent and the earliest variant of distribution. Most often localized along the lateral canals, on the liver capsule, in the right sub-diaphragmatic space, on the mesentery and intestinal loops, as well as in the large omentum.
Lymphogenous metastasis is typical as a rule in later states. In this case, the pelvic and lumbar lymph nodes are affected.
Hematogenous path of spreading - extremely rarely, no more than 2-3% of cases, metastases in the liver and lungs are characteristic. When spreading above the diaphragm, pleural effusion is observed, mainly on the right.
An international TNM classification is used to estimate the prevalence of malignant diseases, in addition to leukemias. T - degree of local spread of the tumor, N - absence or presence of regional metastases, M - absence or presence of distant metastases.
Stages of ovarian cancer according to TNM 7 classification
Stage Tx - Primary tumor evaluation not possible
Stage T0 - It is not possible to detect the primary tumor
Stage I( T1) - Ovarian cancer( carcinoma) is within one or both of the ovaries.
Stage IA( T1a) - Tumor within the borders of one ovary.
Stage IB( T1b) - The tumor is confined within both ovaries.
Stage IC( T1c) - The tumor is confined within one or both ovaries with the presence of rupture of the ovary capsule, tumor on the surface of the ovary, tumor cells in the ascites fluid and abrasive washings.
Stage II( T2) - The tumor is confined to the small pelvis.
Stage IIA( T2a) - Spreading onto and / or metastases into the uterus and / or fallopian tubes. In ascitic fluid and washings from the abdominal cavity, there are no malignant cells.
Stage IIB( T2b) - Spreading and / or metastasis to other pelvic tissues without organ germination. In ascitic fluid and washings from the abdominal cavity, there are no malignant cells.
Stage IIC( T2c) - Combining the signs of T2a or T2b with the detection of tumor cells in the ascitic fluid and the washings of their abdominal cavity.
Stage III - There are metastases on the peritoneum outside the small pelvis.
Stage IIIA( T3a) - There are microscopic metastases in the peritoneum outside the small pelvis
Stage IIIB( T3b) - There are macroscopic metastases in the peritoneum outside the pelvis, measuring 2 cm or less in the largest dimension.
Stage IIIC( T3cN0M0) or TlubayaN1M0 - There are macroscopic metastases on the peritoneum beyond the pelvic area, measuring more than 2 cm in the largest dimension.
Stage IV( Tlaya Nelybaya M1) - There are distant metastases.
Treatment of ovarian cancer
The main method of treatment of ovarian cancer is the combination therapy - a combination of surgery and chemotherapy. The volume of the operation is finally determined intraoperatively, depending on the prevalence of the tumor. In the early stages, the affected ovary is removed. When the process goes to the uterus, supravaginal removal of the uterus with the ovaries is performed( the cervix uterus is not removed).When the tumor spreads into the omentum, the organ is resected.
Chemotherapy is used almost always, usually supplementing surgical treatment. Currently, for the purpose of chemotherapy treatment of ovarian cancer, combinations of such drugs as Cisplatin and Carboplatin, Cyclophosphane, Taxol, and many others are used.
It is imperative to monitor treatment, which is possible with ultrasound and the study of the level of tumor markers( CA125), as well as other methods used to eliminate tumor spread.
For radiotherapy, intraperitoneal administration of radioactive colloids or irradiation of the stomach and pelvis is used.
Prognosis for ovarian cancer
According to different data, the five-year survival rate is 95% at the first stage of the disease.
The prognosis is determined by histological, biological and clinical factors. An important prognostic factor is also the degree of differentiation of the tumor. Even with an I grade ovarian tumor, the prognosis may be unfavorable if the tumor has a low differentiation. Five-year survival of patients with ovarian cancer younger than 50 years is 40%, over 50 years - 15%.With borderline ovarian tumors, the 10-year survival rate is 95%, the 20-year survival rate is 90%.
Prevention of ovarian cancer
Specific prevention does not exist, systematic preventive gynecological examinations are recommended so that in case of disease it is possible to identify it as early as possible and begin treatment.
Doctor gynecologist Kupatadze D.D.