Malignant neoplasm of the ovary, fallopian tube and primary peritoneal carcinoma. Malignant neoplasm of the ovaries Ovarian disease ICD 10

Every year, about 170,000 new cases of ovarian cancer are registered worldwide and about 100,000 women die from the progression of the disease. The problem of early diagnosis of malignant ovarian tumors is one of the most difficult and unresolved. Its relevance is due to the undoubted increase in morbidity and mortality from this pathology, noted over the past decades in many countries of the world.

ICD-10: C56

general information

The majority (75-87%) of patients with malignant ovarian tumors are admitted for treatment in an advanced stage of the disease. At the same time, it is known that if in the early stages of the disease the five-year survival rate is 60-100%, then in the third and fourth stages its value does not exceed 10%.

Late diagnosis of malignant ovarian tumors is due to both the limitations of clinical research methods and the asymptomatic course of the disease and, consequently, the late presentation of patients for medical help.

Etiology

Hormonal, genetic factors, as well as environmental conditions play an important role in the development of ovarian cancer. There are predisposing factors:

• in unmarried women over 25 years of age;
• in nulliparous women;
• in persons with a history of spontaneous or induced abortions;
• in patients with chronic infections, allergic diseases, thyroid diseases;
• in women with a sedentary lifestyle;
• in women suffering from infertility;
• in those operated for gynecological diseases (uterine leiomyoma, tubo-ovarian formation, ectopic pregnancy);
• in patients with tumors of the breast and digestive tract;
• in persons with menopause and metrorrhagia, amenorrhea, monophasic MC, early signs of menopause;
• with a family history;
• in persons taking medications that stimulate ovulation (such as clomiphene), they increase the risk by two to three times when taken for more than 12 MC;

Epidemiological studies have established that there is a connection between the development of ovarian tumors, marital status and reproductive function. In families of patients with ovarian cancer, a similar form of cancer occurs 4-6 times more often than in the population. These families also had a 4-fold increased incidence of breast cancer compared to the general population. The risk of developing ovarian cancer for first-degree relatives in such families is 9-10 times higher than the maximum value of the accumulated general population risk.

Analysis of studies of patients with malignant ovarian tumors, based on the use of this approach, made it possible to consider this disease as multifactorial. Thus, genetic factors in the development of ovarian cancer account for 54%, and environmental factors, respectively, account for 46%, which, on the one hand, corresponds to the idea of ​​​​the complex interaction of hereditary and environmental factors in the development of the disease, and on the other hand, indicates the genetic heterogeneity of this disease.

Factors that reduce the risk of developing ovarian malignancies:

• pregnancy – the risk value is inversely related to the number of pregnancies;
• Application OK. According to WHO, there is a relationship between the duration of taking OCs and the incidence of ovarian cancer: five years of taking drugs in this group reduces the risk of the disease by 25%;
• tubal ligation and hysterectomy.

Pathogenesis

It has been established that the development of ovarian tumors largely depends on the increased secretion of FSH from the pituitary gland. Evidence of the latter is an age-related increase in the concentration of gonadotropins in the blood, which correlates with an age-related increase in the incidence of ovarian tumors. Under conditions of prolonged increase in FSH secretion in the ovaries, first diffuse, then cellular hyperplasia and proliferation of cellular elements occur, which can result in the formation of a tumor.

The tumor, which is observed during inflammatory processes of the uterine appendages, infectious diseases, can be caused by both prolonged hyperestrogenism and a temporary decrease in the estrogenic function of the ovaries.

The mechanism of tumor occurrence can be schematically represented as follows: a primary weakening of ovarian function and a decrease in the level of ovarian estrogens, and then a compensatory increase in the level of pituitary gonadotropin, primarily FSH.

Changes in the sensitivity of tissues to the action of normal hormone concentrations play a role in the occurrence of tumors.

Clinical observations show that patients operated on for benign ovarian tumors have various extragenital diseases: obesity, hypertension, diabetes, gastrointestinal and liver diseases. This can be explained by the commonality of etiopathogenetic factors that are associated with disruption of metabolic and energy processes.

The morphology of ovarian tumors is very diverse. This is due to the fact that the ovaries consist of many elements of different histogenesis. The ovaries occupy one of the first places in terms of the diversity and structure of tumors. In their origin, a significant role belongs to rudimentary remains and dystopia, which were preserved during embryogenesis. Many tumors develop from postnatal areas of the epithelium, growths, in particular from the epithelium of the fallopian tubes and uterus, which can implant on the surface of the ovary, especially during inflammatory processes in the ovaries and fallopian tubes.

Due to the influence of the histological type of tumors on the clinical picture and treatment results, great importance is attached to the classification of ovarian tumors.

Benign ovarian tumors, to one degree or another, should be considered precancerous, since most ovarian cancer diseases develop against the background of preexisting (mainly cilioepithelial) ovarian cysts.

Clinical picture

Late diagnosis of malignant ovarian tumors is due to both the limitations of clinical research methods and the absence or insufficiency of subjective sensations in patients, and, consequently, late seeking medical help.

The progression of ovarian cancer occurs primarily through dissemination through the peritoneum. This explains the asymptomatic course of the disease in the early stages. The absence of pathognomonic symptoms in this pathology, oncological alertness among doctors of the general medical network leads to the fact that in 70% of patients the disease is diagnosed in late stages, when damage to the peritoneum outside the pelvis with the involvement of abdominal organs, ascites, tumor pleurisy, hematogenous metastases in the liver, lungs and bones.

Early and relatively permanent symptoms of ovarian tumors (benign and malignant) include pain, sometimes very mild, referred to by patients only as “straining” in the lower abdomen, mostly unilateral. Sometimes there is a feeling of heaviness in the lower abdomen, constant or periodic pain in the abdomen without a specific localization, at times in the epigastric region or in the hypochondrium. The pain sometimes stops for more or less long periods of time. For the first time, the disease may manifest as sudden acute pain as a result of torsion of the tumor stalk or rupture of its capsule.

Relatively early but rare symptoms of the disease include difficulty urinating or bowel function as a result of pressure from even a small ovarian tumor located in front or behind the uterus. The first sign may be an enlargement of the abdomen or the appearance of hardening in it.

With malignant ovarian tumors, as well as with the malignancy of benign tumors, at first there are usually no pronounced features of a malignant nature. The most noticeable symptoms, but already in the later stages of the disease, are: deterioration in general condition, fatigue, weight loss. Painful sensations are more pronounced, intestinal bloating is more often noted, especially in the upper section, and satiety from small portions of food, which is due to the large volume of the tumor, the appearance of metastases in the omentum and in the visceral peritoneum, creating difficulties in the passage of gases, and the accumulation of ascites. As the tumor grows or ascites increases, the abdomen enlarges and shortness of breath develops. Tumor progression is sometimes accompanied by an increase in body temperature. Thus, the analysis of subjective and objective symptoms of the disease in both early and advanced stages of malignant ovarian tumors showed that focusing on these symptoms cannot serve the purposes of early diagnosis, since symptoms characteristic only of the early stages of the disease have not been identified.

Diagnostics

Early diagnosis of ovarian cancer is difficult, and the role of preventive examinations and screening is negligible, since to date there are no specific diagnostic tests that can detect a tumor at the initial stages of its development.

Physical research methods

• Survey - first menarche at a later age, more frequent infertility, a small number of pregnancies and early or late onset of menopause in various nosological forms of tumors. Of particular importance are information about previous surgery for a benign ovarian tumor, as well as information about tumor diseases in the family.
• General examination - signs of intoxication.
• Deep palpation of the abdomen - palpation of the tumor, the presence of metastases.
• Examination of the external genitalia.
• Inspection in mirrors.
• Bimanual gynecological examination – detailed description of the tumor.
• Rectovaginal examination.

Laboratory research methods

Required:

• determination of blood group and Rh factor;
• general blood analysis;
• general urine analysis;
• biochemical blood parameters;
• tumor marker CA-125 (its increase is observed in almost 90% of primary patients).

If indicated:

• cytological - examination of fluid obtained during puncture of the abdominal and pleural cavities for atypical cells, as well as examination of washings from the pelvic cavity obtained during puncture of the abdominal cavity through the posterior vaginal fornix;
• liver function tests.

Instrumental research methods

Required:

• Ultrasound scanning of the pelvic organs;
• chest x-ray;
• intravenous pyelography;
• irrigography;
• cystoscopy;
• sigmoidoscopy;

If indicated:

• diagnostic laparoscopy;
• CT scan;
• lymphangiography;

Specialist consultations

Required:

• oncologist.

If indicated:

• gastroenterologist;
• urologist;
• surgeon

Differential diagnosis

• metastatic lesions, including choriocarcinoma.

Treatment

Patients diagnosed with or suspected of having a malignant ovarian tumor should be referred to gynecological oncologists. Treatment of this category of patients should be carried out only in specialized hospitals.

The fairly high sensitivity of most epithelial neoplasias to a wide range of antitumor drugs during initial chemotherapy creates the prerequisites for long-term treatment of ovarian cancer as a chronic process that requires replacing one type of therapy with another.

The drugs that are currently classified as second-line chemotherapy for ovarian cancer are: topotecan, gemcitabine, oxaliplatin, irinotecan, epirubicin.

Surgery

Surgical treatment is currently given paramount importance, both as an independent method and as an important stage in a complex of treatment measures at any stage of treatment and at any stage of the disease.

If possible, treatment of patients with ovarian cancer should begin with surgery, which is the final stage of diagnosis. Laparotomy allows for a thorough examination of the pelvic organs, abdominal cavity and retroperitoneal space, thereby helping to verify the histological diagnosis and clarify the extent of the process, and also allows you to remove the tumor completely or a significant part of it.

Staging is based on knowledge of the stages of spread of ovarian cancer metastases. As noted earlier, the main route of dissemination for malignant epithelial ovarian tumors is implantation in the parietal and visceral peritoneum and, somewhat less frequently, in the retroperitoneal lymph nodes (para-aortic and pelvic). During surgical staging, all possible sites of metastasis must be taken into account. Only a midline laparotomy can provide a fairly complete view of the abdominal cavity. After opening the abdominal cavity in the presence of ascitic fluid, the latter is sent for cytological examination. In the absence of free fluid, it is necessary to make swabs with saline solution from the peritoneum of the pouch of Douglas or take impression smears from the parietal peritoneum. In addition, a biopsy of the peritoneum of the pouch of Douglas and the lateral canals of the abdominal cavity, the diaphragm is performed, even in the absence of macroscopic signs of peritoneal carcinomatosis. Lack of information about the condition of the parietal peritoneum can lead to incorrect staging and, therefore, to inadequate treatment. Thus, when a tumor of one or two ovaries is detected without changes in the parietal peritoneum, we can talk about the presence of stage I a or I in the patient of the disease, however, when damage to the pelvic peritoneum is detected, the process is characterized as stage II, and in the presence of micrometastases in the parietal peritoneum of the abdominal cavities - as stage III a. If enlarged para-aortic or pelvic lymph nodes are detected, it is necessary to perform a puncture or biopsy.

Tactics of surgical treatment and chemotherapy depending on the stage of ovarian cancer

I a, b stages. With a low risk of recurrence (subject to adequate staging), only surgical treatment is possible. The standard scope of the operation is extirpation of the uterus with appendages and omentectomy at the level of the transverse colon. With accurate surgical staging, patients after surgery do not require additional treatment, since the five-year survival rate in these patients exceeds 90%.

For young women wishing to preserve fertility, the scope of the operation can be limited to unilateral removal of the uterine adnexa, biopsy of the second ovary and omentectomy. An operation of this scope is possible only for borderline ovarian tumors and well-differentiated stage I adenocarcinoma with a low risk of recurrence.

At high risk of recurrence After a standard operation, four courses of chemotherapy are indicated.

I b-II a stage. After completing the standard volume of surgery, six courses of monochemotherapy or combined chemotherapy are indicated.

IIb-III stages. At the first stage, it is advisable to perform surgical treatment, which in these situations is always cytoreductive in nature and is a stage of combined treatment. Primary cytoreductive surgery is the removal of tumor masses before starting chemotherapy. With primary cytoreductive surgery, the tumor mass decreases, which creates favorable conditions for subsequent chemotherapy. After surgery, 6-8 courses of first-line combination chemotherapy are indicated.

In cases where it is impossible to perform primary cytoreductive surgery at the first stage of treatment, 2-3 courses of combination chemotherapy followed by surgery are indicated.

Stage IV. The operation is performed on patients in whom distant metastases are manifested by specific pleurisy, damage to the supraclavicular lymph nodes and a single skin lesion. In the presence of hematogenous metastases (in the liver, lungs), palliative surgery is indicated only for vital indications (intestinal obstruction).

Malignant ovarian tumor is the fifth most common cancer in women. It is a formation that affects nearby tissues. At the moment, doctors cannot name the exact causes of the disease, but they identify several risk factors.

Some women have a genetic predisposition to cancer. If the patient's mother had malignant tumors during her childbearing years, a chromosomal mutation may occur that will result in her daughter developing a tumor in the future. Thanks to modern technologies, everyone has the opportunity to get tested for a genetic predisposition to an ovarian tumor.

The risk of the disease increases in women who live in megacities. The growth of malignant cells is influenced by poor ecology, constant stress and a frantic pace of life.

The age factor plays a big role. After menopause, an ovarian tumor arises in women from the sex cord cells, and in young girls it forms from the cells of the fetus.

Hormonal imbalances are one of the factors that provoke the occurrence of cancer. The risk is significantly reduced during pregnancy and taking oral contraceptives. This is due to the fact that pregnancy and hormonal drugs reduce the number of menstrual cycles and slow down the process of egg maturation.

Important! Two out of three women diagnosed with ovarian cancer die. This can be prevented through timely diagnosis and treatment. The earlier the tumor is detected, the higher the chances of successful recovery.

Women need to pay attention to the symptoms of ovarian cancer in order to consult a doctor in time. At the initial stage, the disease is asymptomatic. A cause for concern may be rapid weight loss, which causes the stomach to increase in size. When the ovarian tumor begins to grow, the patient may experience weakness. This happens because education draws strength from the resources of the female body and slows down metabolism. Gastrointestinal disorders, constipation or diarrhea indicate that metastases begin to spread into the fatty layer of the abdomen and intestines. In this case, the woman shows signs of exhaustion, and her stomach remains round.

Important! When metastases reach the peritoneum or penetrate the brain, the patient suffers from disorders of the nervous and digestive systems.

It should be noted that at first the signs of the disease coincide with the manifestation of digestive disorders and inflammation of the ovary. Do not forget that the formation makes itself felt in the form of various symptoms when metastases have spread to the body. If treated on time at this stage, in 70% of cases the patient can count on a favorable outcome.

Classification

In the international classification of diseases, malignant ovarian tumors are coded C56. They can be classified as follows.

Tumors of the surface epithelium. Their histological structure is similar to derivatives of the Müllerian duct. They can be clear cell or transitional cell.

Serous formations of the ovary consist of cubic and columnar epithelium. The secretion of the epithelium is protein. Benign serous tumors are called adenocistomas (code 9014/0) and cystic adenocarcinomas (code 8441/3). If adenocarcinoma practically does not affect the stroma, it has a borderline degree of malignancy. In cystic adenocarcinoma, the cells are highly malignant. Papillae may form on the surface of the tumor and spread into the cyst cavity. These formations metastasize and spread throughout the abdominal cavity. In some cases, they lead to ascites.

Mucinous ovarian cysts have a lining of the cavity made of epithelium with a mucous consistency. The cells in the tissues are identical and secrete mucus. Endometrioid cysts are large in size and have little secretory activity. They form glands of irregular shape. Adenofibromas have a fibrous stroma and are a malignant type of formation.

Diagnosis and treatment

Diagnosis of ovarian cancer ICD 10 is carried out using palpation or gynecological examination. In order to confirm the diagnosis, doctors perform a puncture. This procedure helps determine the presence of tumor cells in fluid taken from the peritoneal area.

Doctors try to avoid a method such as a biopsy, as this can cause the tumor to spread. Gynecologists can announce the final diagnosis after analyzing the affected tissues.

In order to determine the presence of metastases, you will have to undergo an ultrasound examination of the peritoneum and pelvis, computed tomography and magnetic resonance therapy.

Note: Recently, the most accurate method for determining a malignant cyst is histological analysis of an ovarian biopsy. With this examination, doctors are able to determine the type and structure of the tumor. The data obtained allows gynecologists to determine treatment tactics and make your prognosis.

Over the past decade, doctors have adhered to proven tactics: they perform surgery and consolidate the result with chemotherapy. If the surgery was performed early, your affected ovary will be removed. When the tumor has metastasized, in addition to the ovary, your uterus and omentum will be removed. The operation is performed as follows: the uterus is dissected, the ovary affected by the tumor and the fallopian tubes, which connect the uterus and ovaries, are removed. The surgeon then examines the peritoneal area for cancerous tissue. If the doctor finds evidence of a tumor in your intestine, he will remove the lesion and then join the two ends together. Chemotherapy consists of alternating or combining several proven drugs. Such combinations make it possible to consolidate the postoperative effect, as well as completely eliminate the tumor.

Video: Diagnosis and treatment of ovarian cancer

ICD-10 CODE
C56. Malignant neoplasm of the ovary.

EPIDEMIOLOGY

Malignant tumors of the reproductive system are observed more often (35%) than other cancers in women. Ovarian cancer accounts for 4–6% of malignant tumors in women and is the seventh most common cancer. According to

According to the International Agency for Research on Cancer, every year more than 165,000 new cases of ovarian cancer are registered worldwide, and more than 100,000 women die from malignant ovarian tumors. Europe, especially the Nordic countries, and the United Kingdom, as well as North America, have the highest standardized incidence rates (12.5 or more per 100,000). In Russia, more than 11,000 women are diagnosed with ovarian cancer annually (10.17 per 100,000). This pathology ranks seventh in the structure of overall cancer incidence (5%) and third among gynecological tumors (after cancer of the body and cervix). Over the past 10 years, the country has seen a noticeable increase in the disease (by 8.5%).

The survival rate of patients with this pathology is low. Only in the first year after diagnosis, every third patient dies. According to summary data from population-based cancer registries in European countries, the one-year survival rate of patients with ovarian cancer is 63%, three-year - 41%, five-year - 35%.

PREVENTION OF OVARIAN CANCER

Prevention of ovarian cancer does not exist due to the lack of a full understanding of the etiology and pathogenesis of this pathology. Unfortunately, the only thing that oncologists can currently offer is regular observation by a gynecologist for the purpose of early detection of ovarian formations, prevention and treatment of inflammatory diseases leading to infertility. The latter increases the risk of the disease, while a large number of pregnancies and births has a significant protective effect.

SCREENING

The main reasons for the low survival rate of patients with malignant ovarian tumors lie in the asymptomatic course of the disease in the early stages, the lack of full diagnosis, and ineffective treatment, especially in case of relapses of the disease. It must be emphasized that a significant percentage of patients with ovarian tumors initially end up in non-specialized institutions, where they receive inadequate treatment. All this leads to a fatal deterioration in the results of subsequent treatment.

WHO experts suggest screening that must meet the following requirements:

• test systems that record the preclinical phase of the disease;
• examination methods acceptable to the population (available, sensitive, specific, do not cause complications);
• determination of the morphological identity of the tumor.

Population screenings carried out in some European countries with an emphasis on identifying tumor markers and using transvaginal ultrasound examination showed their low effectiveness and significant financial costs.

CLASSIFICATION OF OVARIAN CANCER

The multicomponent structure of the gonads and the combination of structures of various functional areas determine the widest range of histological forms of neoplasms of this organ. If we also take into account transitional forms, as well as tumors that combine two or more histological types, then the number of variants of ovarian tumors will increase exponentially. The unusual nature of ovarian tumors is confirmed by cases of multicentric growth, when primary tumor foci are found in the retroperitoneal space, but with absolutely unchanged ovaries.

There have been numerous attempts to divide ovarian tumors according to the degree of malignancy, but it is considered arbitrary.

This is due to the fact that in large tumors, along with highly differentiated ones, moderately differentiated and poorly differentiated cells can be found, and this causes significant difficulties in interpreting the histological form of the tumor. In addition, differentiation can change during the progression of the disease, as well as under the influence of chemotherapy, and be completely different in the primary tumor and its metastases. The vast majority of patients (85%) suffer from epithelial forms of ovarian tumors.

Currently, two classifications of ovarian cancer are used: FIGO and TNM (Table 29-6).

Table 29-6. Classification of ovarian cancer by stages (TNM and FIGO)

Note. Metastases to the liver capsule are classified as T3/stage III; liver parenchymal metastases are classified as M1/stage IV; positive cytological findings in pleural fluid are considered M1/stage IV.

ETIOLOGY (CAUSES) OF OVARIAN CANCER

The etiology of ovarian cancer is unknown.

PATHOGENESIS OF OVARIAN CANCER

Epithelial ovarian malignancies (cancer) account for about 80% of all ovarian tumors and originate from the ovarian epithelium. The remaining tumors arise from germinal and stromal cells. The source of almost all epithelial ovarian tumors is considered to be cysts that arise as a result of the detachment of invaginated integumentary mesothelium. Cells in these cysts can differentiate into either tubal or endocervical epithelium. Cells of germ cell tumors develop from germ cells, and stromal cell tumors of the ovaries develop from mesenchymal cells. Many authors involved in this section of oncomorphology have shown that in a significant number of observations it is impossible to establish the onset of invasive growth.

The rapid development of biological sciences in the last decade and especially intensive research in experimental theoretical oncology have made it possible to achieve significant progress in understanding the genetic factors involved in the occurrence of neoplasia in humans. At present, there is no longer any doubt that the basis of malignant neoplasms (including ovarian cancer) is damage to the genetic apparatus in germ and somatic cells, making these cells sensitive to the effects of carcinogenic environmental factors that can trigger the process of malignancy. Depending on in which cell the initial mutation occurred - sexual or somatic - cancer can be hereditary or sporadic.

Recently, issues of etiology, pathogenesis and early diagnosis are largely associated with medical genetic research aimed at studying the role of hereditary predisposition to the development of ovarian cancer, their genetic heterogeneity and identifying individuals among relatives with a potentially high risk of developing this form of cancer. In families of patients with ovarian cancer, a similar form of cancer is noted 4–6 times more often than in the general population. These families also experience a fourfold increase in the incidence of breast cancer compared to the general population. The risk of developing ovarian cancer for first-degree relatives in such families is 9–10 times higher than the maximum value of the accumulated general population risk. Clinical genealogical analysis of pedigrees of patients with tumors of the female reproductive system made it possible to develop criteria used to identify hereditary forms of these diseases:

• the presence of two or more first-degree relatives (mother-daughter, sister-sister) with ovarian and/or breast (and/or endometrial) cancer;
• the number of patients from the total number of family members (women) aged 35 years and older is 33–50%;
• presence in the family of people with cancer aged 20–49 years (average age of patients - (43.0+2.3) years;
• presence in the family of patients with ovarian cancer and primary multiple tumors of different anatomical locations, including cancer of the reproductive system.

Each of these criteria serves as an indication for mandatory referral of the family to specialized genetic consultation. The first level of etiological and genetic heterogeneity of ovarian cancer was established depending on the nature of its accumulation and other tumors in families, which made it possible to distinguish three groups.

• Families with accumulation of only ovarian cancer (organ-specific).
• Families with an accumulation of ovarian cancer associated with other tumors of the female reproductive system (breast cancer, endometrial cancer).
• Families where ovarian cancer is a component of familial cancer syndrome (Lynch syndrome II).

Of particular interest are families with the accumulation of various tumors of the female reproductive system. Carrying out genetic analysis of such pedigrees, a high genetic determinacy of familial accumulation of ovarian and breast cancer was shown. This feature is reflected in the presence of a high genetic correlation coefficient between ovarian cancer and breast cancer (72% of common genes that form a predisposition to these two different forms of tumors). There is reason to believe that these associations are based on common genetic susceptibility factors or close linkage of genes responsible for the development of these pathologies. One of the significant achievements in the field of studying hereditary forms of ovarian cancer (breast cancer) was the discovery of the BRCA1 and BRCA2 genes. The BRCA1 gene has been mapped to the long arm of chromosome 17 (mutation of this gene has been shown to occur in germ cells, leading to the development of hereditary forms of ovarian and breast cancer). In sporadic ovarian tumors, a high percentage of p53 gene mutations (29–79%), increased expression of the epidermal growth factor receptor (9–17%), expression of the Her2/neu oncogene (16–32%) and activation of the Kiras gene were found. Thus, hereditary forms of ovarian cancer (and breast cancer) attract special attention from oncologists from the point of view of forming “risk groups” in relatives for the purpose of early diagnosis of pre-tumor and tumor pathology in them. It should be noted that all diagnosed malignant tumors were of early stages, which significantly affected the survival of patients.

CLINICAL PICTURE (SYMPTOMS) OF OVARIAN CANCER

The degree of spread, and accordingly the stage of the disease, is determined according to clinical examination, the results of surgical intervention and histological examination of biopsies taken during surgery from various parts of the abdominal cavity. Correct determination of the stage of the disease allows you to choose the optimal tactics and improve treatment results.

It is necessary to note the significant difficulties that arise in determining the prevalence of the malignant process, especially in the so-called early stages. According to the literature, even in patients with stages I–II ovarian cancer (“early stages”), with targeted research, metastases to the retroperitoneal lymph nodes of various locations are diagnosed in more than 30% of cases. Based on this, the developed and repeatedly modified FIGO and TNM classifications do not fully satisfy oncologists, since even despite numerous amendments, they remain quite conditional.

Thus, we can conclude that there are probably at least two stages in ovarian cancer:

• true stage I (the process is limited to the ovary);
• Stage II (the process has already acquired a systemic character).

However, it is currently almost impossible to clinically determine this line. The difficulty of palpation and visual diagnosis of metastases in the retroperitoneal lymph nodes is explained by the fact that even tumor-affected lymph nodes are not enlarged, have a dense elastic consistency, and are freely or relatively displaceable. In addition, retroperitoneally, in the para-aortic zone alone, there are from 80 to 120 lymph nodes, and almost each of them can be affected by metastases.

Most researchers note a fairly high percentage of relapses - from 23% in patients with the so-called early stages of the disease; The operation was performed on these patients in full. In addition, in patients with malignant ovarian tumors, micrometastatic bone marrow lesions are detected in 30% of cases. It must be emphasized that patients with micrometastases in the bone marrow more often (70%) experience relapses of the disease compared to patients in whom no bone marrow lesions were detected (40%).

Unfortunately, the few prognostic parameters currently used do not provide full information by which one can objectively judge the course of the disease. Evidence can be provided by patients with borderline ovarian tumors - a condition in which both the morphological structure and the degree of differentiation are optimal from a prognostic point of view, but relapses and metastases in this pathology are well known.

The flow cytometry method, considered the most objective at present, can also give completely different results when studying tissues from different poles of the same tumor.

DIAGNOSIS OF OVARIAN CANCER

Early diagnosis of ovarian cancer is difficult, since to date there are no specific diagnostic tests that can detect a tumor at the initial stages of its development.

The progression of ovarian cancer occurs primarily due to dissemination through the peritoneum. This explains the asymptomatic course of the disease in the early stages, therefore, in almost 80% of patients, ovarian cancer is diagnosed in the later stages, when there is already damage to the peritoneum outside the pelvis involving the organs of the peritoneal cavity, ascites, as well as lymphogenous and hematogenous metastases in the liver and lungs ( tumor pleurisy), bones.

LABORATORY RESEARCH

One of the most interesting and promising areas in the diagnosis of malignant tumors is the determination of tumor markers. Despite the apparent abundance of tumor markers, the only reliable test for ovarian cancer, mainly in its serous form, is the determination of CA 125. An increase in its concentration was noted in 88.8% of primary patients. However, when studying the blood sera of patients with stage I of the disease, the content of the marker is practically no different from that in the control. At stages II, III and IV of the disease, the concentration of CA 125 increases, which is used to monitor the disease.

The observed increase in the concentration of CA 125 during relapses of the disease indicates the need to monitor all patients (during the period of remission), since in only 1 out of 10 patients the test result is false negative. Moreover, even if during the initial examination in primary patients the CA 125 values ​​did not exceed the norm, then during remission an analysis for the content of markers in the blood is necessary (this is due to a possible increase in the concentration of markers during relapse). The latter once again confirms the potential of ovarian cancer cells to undergo changes that manifest themselves morphologically and at the biochemical level.

An increase in the concentration of CA 125 from zero (or from the basal level) to 35 units/ml, i.e. within normal limits, may be a preclinical manifestation of relapse. Data analysis showed that all patients with a CA 125 level less than 1/2 of the discriminatory concentration of 35 units/ml and a monthly increase of less than 20% from the previous marker value do not experience relapse in the next 6 months. In complete remission in the absence of a tumor, the CA 125 level should be close to zero. An increase in marker concentration during remission should become the basis for a comprehensive, in-depth examination of the patient in order to detect a relapse of the disease.

The discovery of tumor-associated Ags, followed by monoclonal Abs, made it possible to use these proteins for the diagnosis and treatment of cancer. This method allows you to determine the extent of the process and the histological shape of the tumor. In the future, the radioimmunovisualization method can also be used in the treatment of ovarian cancer, since almost any therapeutic agent conjugated with a monoclonal antibody will be delivered to the site of Ag synthesis, i.e. directly to malignant tissues.

INSTRUMENTAL RESEARCH

The advantages of the ultrasound method in the diagnosis of ovarian tumors are considered to be its high information content (sensitivity, specificity and accuracy reach 80–90%), simplicity, speed, harmlessness, painlessness, and the possibility of repeated use. Pelvic ultrasound has become a routine method in examining a woman with suspected ovarian tumor. For more in-depth diagnosis in the presence of ovarian tumors, highly informative methods such as CT and MRI are currently used.

Chest X-ray is a mandatory component of the examination if an ovarian tumor is suspected, as it allows one to diagnose possible metastasis to the lungs and pleurisy. This gives grounds, with a greater or lesser degree of probability, to suspect an ovarian tumor. However, only histological verification of the diagnosis can give an accurate and final answer.

Sometimes, to make a diagnosis, it is necessary to perform laparoscopy or laparotomy and obtain material for histological examination.

DIFFERENTIAL DIAGNOSTICS

If a mass formation is detected in the pelvic area, it is necessary to exclude diseases such as diverticulitis, ectopic pregnancy, cysts and benign ovarian tumors, MM and endometriosis. It should be remembered that some malignant neoplasms, such as gastrointestinal or breast cancer, can metastasize to the ovaries.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

If a malignant ovarian tumor is suspected, consultation with an oncologist is required.

TREATMENT OF OVARIAN CANCER

SURGICAL TREATMENT OF OVARIAN CANCER

Surgical intervention is currently given paramount importance as an independent method and as the most important stage in a complex of treatment measures. For almost all ovarian tumors, a median laparotomy should be performed. Only this access allows for a thorough examination of the abdominal organs and retroperitoneal space, facilitates morphological verification of the diagnosis, determines the degree of differentiation and ploidy of the tumor and, most importantly, allows the removal of tumor tissue in whole or in part.

For malignant ovarian tumors, the operation of choice is extirpation of the uterus and appendages, removal of the greater omentum. Some clinics call for additional appendectomy, splenectomy, resection of the affected parts of the intestine, as well as retroperitoneal lymphadenectomy.

Theoretically, total retroperitoneal lymphadenectomy can lead to better treatment results, however, a few authors with sufficient experience in performing such operations note almost the same survival rate of patients who underwent standard surgery and patients after additional lymphadenectomy.

It must be emphasized that even the initial forms of the disease are a big problem for oncologists. At present, and probably in the future, treatment should begin only with surgery, because only after laparotomy can maximum information about the condition of the disease be obtained. In this case, one should strive for the maximum volume, taking into account the frequency of relapses and metastases. However, not all patients are candidates for radical surgery. In some cases, at obvious risk, surgeons are forced to meet the wishes of young women who, for one reason or another, do not agree to radical surgical treatment. In such cases, a strict individual approach is required. Organ-preserving operations are possible, but only with the most thorough morphological examination of the contralateral ovary, appendages, peritoneum, greater omentum, with determination of the degree of differentiation, proliferative potential and other biological parameters of the tumor.

For highly differentiated tumors of stages IA and IB, extirpation of the uterus and appendages, removal of the greater omentum, peritoneal biopsy (at least 10 samples, especially from the pelvic area and subdiaphragmatic surface), and washings from the abdominal cavity are usually performed. If stage IA of serous well-differentiated cancer is confirmed in women who wish to preserve reproductive function, unilateral adnexectomy, biopsy of the contralateral ovary, resection of the greater omentum, and revision of the retroperitoneal lymph nodes can be performed. The sparing volume of the operation places great responsibility on the surgeon, since the frequency of diagnostic errors at all stages of monitoring the patient is quite high. In this regard, it is necessary to ensure constant strict monitoring of the patient.

All patients with moderately differentiated and poorly differentiated tumors of stages IA, IB, IC and II are indicated for surgery (extirpation of the uterus with appendages, removal of the greater omentum).

Adjuvant chemotherapy for well-differentiated tumors of stages IA and IB is usually not performed in most clinics, although postoperative drug treatment, even in monotherapy, increases five-year survival by 7%.

For other histological forms of stage IA and IB ovarian cancer, radical surgery is preferable. After radical surgery, adjuvant monochemotherapy with melphalan, cisplatin or combinations of CAP, CP (at least 6 courses) is recommended.

For stage II tumors, polychemotherapy with combinations of CAP, CP, TP (at least 6 courses) is indicated.

COMBINATION THERAPY FOR OVARIAN CANCER

Significantly more problems arise when treating patients with advanced stages of the disease. Currently, there is no doubt about the need for combined or complex measures in the primary treatment of these patients.

Studying the importance of the sequence of therapeutic interventions in stages III–IV of ovarian cancer, we came to the conclusion that the “surgery + chemotherapy” option improves patient survival when compared with the option when drug treatment was carried out at the first stage. This statement can be justified purely theoretically:

• the ineffectiveness of pharmacological drugs is eliminated by removing the bulk of the tumor with weak blood flow;
• the effectiveness of chemotherapy is associated with the high mitotic activity of small tumors;
• the smallest residual tumors require fewer courses of chemotherapy, while larger tumors increase the likelihood of the emergence of resistant forms;
• removal of the main tumor masses leads to relative normalization of the patient’s immune system;
• If possible, phenotypically resistant tumor cells are removed.

Solid tumors are characterized by relatively poor blood flow, which reduces the concentration of the pharmacological drug in tumor tissues and, accordingly, the effectiveness of the treatment. This is especially pronounced in the central areas of the tumor, where extensive necrosis often occurs due to impaired tissue trophism. Adjacent to the necrotic areas are numerous, especially viable, areas of malignant tissue supplied with blood from small vessels. This idea is confirmed, however, indirectly, by the low content of free glucose and high level of lactic acid in the interstitial fluid of solid tumors.

All this leads to a temporary decrease in the mitotic activity of malignant cells and, as a result, to a decrease in the effectiveness of chemotherapy, which is tropic to the DNA of the cell only in a certain phase. For the maximum effect of most pharmacological agents, a fraction of cells with rapid growth is required, therefore, when the bulk of cells that are insensitive to chemotherapy are removed, more sensitive small foci (disseminates) with high mitotic activity remain. In addition, removal of a large tumor mass leads to the restoration of the relative immunocompetence of the tumor-bearing organism, primarily due to a decrease in tumor-induced immunosuppression. As is known, the goal of surgical treatment is to remove the maximum possible volume of the primary tumor and its metastases. If complete removal of the tumor is not possible, most of it is removed. It has been shown that patient survival significantly correlates with the size of metastases remaining after surgery. Thus, with a residual tumor size not exceeding 5 mm, the average life expectancy corresponds to 40 months, with sizes up to 1.5 cm - 18 months, and in the group of patients with metastases more than 1.5 cm - 6 months.

Primary cytoreductive surgery involves removing as much of the tumor and metastases as possible before starting drug therapy. Primary cytoreductive surgery is considered the standard for advanced ovarian cancer, especially at stage III of the disease. The goal of cytoreductive surgery should be complete or maximum tumor removal. The role of cytoreductive surgery in FIGO stage IV is controversial, but patients with only pleural effusion, supraclavicular lymph node metastases, or single skin metastases can be treated as in stage III disease. This volume of surgery is not indicated for patients with metastases to the liver and lungs. On the other hand, neoadjuvant chemotherapy is considered an acceptable alternative to cytoreductive surgery in stage IV disease or when surgical treatment is technically difficult.

Interim cytoreductive surgery is performed after a short course of induction chemotherapy (usually 2–3 courses). Performing an operation at this stage is an acceptable approach in the treatment of patients in whom the first operation was either trial or unsuccessful.

Operation “Second look” is a diagnostic laparotomy, which is performed to evaluate residual tumor in patients without clinical manifestations of the disease after courses of chemotherapy. However, this tactic is not currently widely used because it does not result in improved survival.

Secondary cytoreductive surgery. Most secondary cytoreductive surgeries are performed for localized relapses that occur after combined treatment. Preliminary analysis showed that candidates for performing such operations can be identified taking into account prognosis factors. Most often, these are tumors that recur a year or more after completion of primary treatment and respond adequately to previous chemotherapy.

Palliative operations are mainly performed to alleviate the patient’s condition, for example, in case of intestinal obstruction due to adhesions or progression of the disease.

To date, surgical treatment methods for ovarian cancer have remained virtually unchanged, with a few exceptions, while drug treatment has become more effective and continues to improve.

New promising methods of conservative therapy at the intersection of genetics, immunology, chemotherapy and radiation treatment are being widely developed. It should be recognized that, probably, in the near future, the treatment of malignant ovarian tumors will be the prerogative of conservative medicine.

DRUG TREATMENT OF OVARIAN CANCER

Systemic chemotherapy is considered the standard treatment for patients with advanced ovarian cancer. Taking into account the fact that in stages II–IV of ovarian cancer, cytoreductive surgery is not considered radical, chemotherapy should be started as soon as possible after surgery (within the next 2–4 weeks).

Currently, about two dozen drugs are known that have activity in ovarian cancer. Cisplatin is considered one of the most effective antitumor drugs, which today forms the basis of drug treatment for patients with ovarian cancer. Its effectiveness is approximately 30% in previously treated patients and 60–70% in patients who have not received chemotherapy; Moreover, in 15–20% of them it is possible to achieve complete regressions, and the five-year survival rate in this group is 16%.

As adjuvant chemotherapy for stages IA and IB with signs of a high risk of relapse, monotherapy with cisplatin (50 mg/m2 once every 4 weeks, 6 injections) can be performed, which significantly increases five-year relapse-free survival for poorly differentiated early-stage tumors. Elderly patients can be given melphalan monotherapy as adjuvant chemotherapy (0.2 mg/kg on days 1–5 every 28 days, 6 courses).

Platinum derivatives and combinations based on them are also currently considered the standard of first-line induction chemotherapy for stages II–IV, which have significantly improved immediate and long-term treatment results compared to regimens without platinum drugs, especially in patients with small residual tumors. The most popular combinations based on platinum derivatives are considered to be PC (cisplatin + cyclophosphamide in a ratio of 75/750 mg/m2) and CC (carboplatin + cyclophosphamide in a ratio of 5/750 mg/m2).

Considering that platinum derivatives play a leading role in the drug treatment of ovarian cancer, the third generation platinum derivative, oxaliplatin, is extremely interesting and promising. The drug has already shown its activity both in monotherapy and in combinations, demonstrating limited cross-resistance with cisplatin and carboplatin. The results of a comparative multicenter study examining the effectiveness of oxaliplatin in combination with cyclophosphamide (OC) compared with the PC regimen showed that the effectiveness of the regimens did not differ significantly. Meanwhile, a significant advantage of the combination with the inclusion of oxaliplatin in terms of toxicity was noted: grade III–IV anemia and the need for blood transfusions, as well as grade III–IV leukopenia and grade III–IV nausea were observed much less frequently in the group of patients receiving the OS combination. Thus, the new platinum derivative appears undeniably promising in the treatment of ovarian cancer.

Speaking about the drug treatment of ovarian cancer, one cannot help but dwell on some new drugs, among which taxanes (paclitaxel) are the most studied and widely used. The drug demonstrated high antitumor activity both in patients with relapses and in previously untreated patients. According to the study results, replacing cyclophosphamide with paclitaxel in combination with cisplatin leads to an increase in the frequency of objective effects, prolongation of disease-free and overall survival. Currently, the combination of “cisplatin + paclitaxel” (75/175 mg/m2), along with PC, PAC and CC regimens, is considered standard for induction chemotherapy for ovarian cancer, but its use in Russia is limited due to the high cost of treatment.

The second taxane derivative, docetaxel, also has high activity in ovarian cancer. In particular, its effectiveness in combination with platinum derivatives during induction therapy is 74–84%.

It has been noted that combinations containing docetaxel have less neurotoxicity. However, there are no results of comparative studies assessing the effectiveness and toxicity of docetaxel in comparison with paclitaxel in ovarian cancer. In this regard, paclitaxel remains the drug of choice in official recommendations.

The arsenal of antitumor drugs used for second-line chemotherapy is large. However, this is rather evidence that one of them does not allow achieving long-term remissions in the majority of patients.

The effectiveness of these drugs ranges from 12 to 40% with an average life expectancy of 9–12 months. Topotecan is a drug from the group of topoisomerase-1 enzyme inhibitors, also widely used for second-line chemotherapy. When topotecan was prescribed at a dose of 1 mg/m2 for 5 days, the frequency of the antitumor effect in patients with platinum-sensitive ovarian tumors was 20%, and in patients with cisplatin-resistant tumors - 14%. Etoposide (orally at a dose of 50 mg/m2 for 14 days) is effective in 27% of patients with resistance to platinum derivatives and in 34% with preserved sensitivity.

Gemcitabine is considered another promising drug for second-line chemotherapy. The effectiveness of the drug as first line chemotherapy is 24%, in combination with cisplatin - 53–71%. When treating with a combination of topotecan and paclitaxel, it is possible to achieve an overall effect of 29 to 46%. Gemcitabine is prescribed at a dose of 1000 mg/m2 on days 1, 8 and 15 every 4 weeks.

Expression of estrogen receptors by epithelial ovarian cancer tumor cells has stimulated studies of the effectiveness of tamoxifen. The objective effect rate of tamoxifen when prescribed at a dose of 20–40 mg daily is 13% with an average duration of effect of 4.4 months. The minimal toxicity of the drug makes it justified to prescribe it to patients with an increase in the concentration of CA 125 as the only sign of the disease or to weakened patients with a widespread tumor process.

Unsatisfactory results of treatment of patients with progression of ovarian cancer stimulate the search for new approaches. Currently, the possibility of vaccine therapy, gene therapy (especially replacement of the mutated p53 gene, monoclonal antibodies), in particular the possibility of prescribing trastuzumab, inhibitors of angiogenesis and intracellular signaling alone or as an addition to second-line chemotherapy, is being studied.

FORECAST

According to summary data, the five-year survival rate for stage I mesonephroid cancer is 69%, for serous - 85%, for mucinous - 83%, for endometrioid - 78%, and for the undifferentiated form - 55%.

According to statistics, every woman has a risk of developing ovarian cancer. The percentage here is 1:71, and the lifetime mortality rate from this disease has a percentage of 1:95. As mentioned above, malignant tumors of this type often affect older patients. Typically, patients are between 60 and 70 years old when cancer is diagnosed. An interesting fact is that white-skinned women suffer from ovarian cancer many times more often than patients with dark skin. Recently, there has been a noticeable positive trend in this disease: over 20 years, it has been diagnosed in fewer women. In addition, out of four patients, one is sure to be cured within a year.

Within five years, among patients diagnosed with ovarian cancer, 45% remain alive. Also interesting is the fact that older patients (over 65 years of age) respond better to treatment. Unfortunately, today this malignant tumor is detected in only 20% of cases.

Causes of ovarian cancer

To date, doctors cannot name the exact reason why ovarian cancer occurs. But there are special factors that make women susceptible to malignancy in this organ. There are also many theories used, which, unfortunately, have not yet received full medical confirmation. For example, women who have become pregnant frequently or taken oral contraceptives have a lower risk of developing ovarian cancer. Some doctors believe that carcinogenic substances can enter the ovaries through the vagina, so they recommend tubal ligation. There is also a theory that a malignant tumor forms if too many male hormones, in particular androgens, are released in the female body. It is believed that ovarian cancer can develop due to a genetic predisposition.

Risk factors

The risks of developing ovarian cancer are as follows:

• Age-related changes in the body - older people are more often diagnosed with a malignant tumor. This disease is greatly affected by menopause.
• Some studies have shown a relationship between obesity and ovarian cancer.
• Women who have not had children may develop this type of cancer, while those who have been pregnant frequently are generally considered more protected.
• To reduce the risk of developing ovarian cancer, tubal ligation or hysterectomy (removal of the uterus while preserving the ovaries) is performed.
• Some studies have shown that taking the fertility drug Clomid for more than a year can lead to the appearance of a tumor.
• A large amount of androgens (male hormones) in the female body.
• If you take estrogen after menopause, you may develop ovarian cancer.
• If a woman is already more likely to have breast cancer.
• Poor nutrition – eating low-fat foods for more than 4 years.
• Those who drink alcohol and smoke increase their risk of developing cancer.
• Taking paracetamol and aspirin may, on the contrary, reduce this risk.

Ovarian Cancer Risk Calculation

Since in the initial stage of development of this disease there are no symptoms or are so subtle that few women decide to go to see a doctor, diagnosing ovarian cancer is quite difficult. There is a special calculation of the risk of this disease. At the same time, today there are several types of it:

1. Calculation of PI (or prognostic index).
2. ROMA calculation.

Typically, during diagnosis, a serum marker is studied, which is called Ca 125. Studies have shown that its amount was increased in 80% of all patients who were sick with ovarian cancer. It is worth noting that in the first two stages of the disease, its index practically does not change. Therefore, a different marker (NOT 4) is used for the first stage. For a more accurate diagnosis, these two markers are usually combined.

ROMA Index

The ROMA index is considered the best option for diagnosing stage 1 ovarian cancer. Thanks to it, it is possible to assess how likely it is for a woman to develop a malignant tumor in the pelvic organs. The ROMA index consists of the following tests:

1. Number 143 Ca 125.
2. Number 1281 NOT 4.
3. Calculated indices ROMA1 – for women before menopause and ROMA2 – for women after menopause.

This index allows you to see how much two main markers are present in a woman’s body.

Hereditary ovarian cancer

According to statistics, in 5-10% of cases, ovarian cancer is hereditary. The main feature of this type of disease is the fact that the patient may be at a younger age (before menopause). It was also common for her parents or immediate family to have had this disease or other types of cancer. Today, special programs have been opened for the prevention of hereditary ovarian cancer. They have a very important negative side. In some cases, during such a program it is necessary to delay pregnancy (by taking oral contraceptives) or to completely abandon the possibility of becoming pregnant (then a hysterectomy or tubal ligation is performed). That is why it is very important to diagnose a genetic predisposition to this type of malignant tumor in advance, so that young couples can think about the possibility of having children before starting the program.

Pathogenesis

According to the latest statistics, in 80% of cases, ovarian cancer develops in the form of malignant tumors that form from the epithelial tissues of the organ itself. All other tumors develop from germinal or stromal cells.

It is believed that cysts are the source of all such epithelial formations. Cysts usually appear after the invaginated integumentary mesothelium begins to shed. Cells in cysts can transform into tubal or endocervical epithelium. Most doctors are confident that it is almost impossible to determine exactly when cancer began to appear.

Symptoms of ovarian cancer

Symptoms of ovarian cancer are quite varied and a woman may not always be able to determine that she needs to be examined. Among the most common are:

• Indigestion.
• Increased frequency of urination, which becomes quite painful.
• Nausea and vomiting.
• Discharge in the form of blood from the vagina.
• Constipation.
• The waist increases in diameter.
• Frequent pain in the lower back and lower abdomen.
• Disturbed menstrual cycle.
• Frequent feeling of bloating or overeating.
• Appetite worsens.
• Sexual contact is painful.
• Weight changes quickly.

The most important symptom is bleeding on non-menstrual days. Typically, a malignant tumor is quite difficult to see. Since it is located inside the ovary, at stages 1 or 2, it is practically invisible.

First signs

Almost all patients diagnosed with ovarian cancer experienced the following first signs of this disease:

1. Pain syndrome in the abdominal area.
2. Bloating, involuntary passing of gas.
3. Feeling full too quickly while eating.
4. Dyspepsia.
5. Pain in the lumbar region.

Low-grade fever with ovarian cancer is a fairly common symptom. Typically, patients with this disease have a constantly elevated body temperature (37-38 degrees). But often abnormal temperature jumps are also noticeable, which can be explained by the fact that the products of tumor decay are absorbed by the body. Usually, despite the fact that the body temperature rises, the woman’s general well-being remains at a satisfactory level.

Severe pain in ovarian cancer occurs when the pedicle of a moving tumor becomes twisted. The so-called “acute abdomen” is accompanied not only by severe pain, but also by frequent vomiting, nausea, and rapid pulse. In addition, pain can occur in the last stages of the disease, when the tumor is already so large that it puts pressure on neighboring organs.

Bloody vaginal discharge is an alarming signal that requires a mandatory examination by a doctor. Typically, this type of discharge is considered rare for ovarian cancer, appearing in only 20% of cases. In addition, it is necessary to pay attention that this symptom appears only in women of sufficiently old age (after 65 years). Discharge from ovarian cancer can be either bloody or brown in color. The amount of discharge is small and lasts from several days to a week.

You can read more about the symptoms of ovarian cancer.

Right ovarian cancer

A malignant tumor in the right ovary is called cancer. Usually the tumor affects only the right side of this female organ. Often, cancer of the right ovary is formed from epithelial tissue. Often the cause is cysts (benign tumors). Patients with cancer of the right ovary notice a slight nagging pain on the right side of the lower abdomen.

Left ovarian cancer

Typically, the tumor grows from a cyst (a benign growth filled with fluid or mucus). It can also develop from epithelial cells. It affects only the left ovary, which is why it got its name. Usually, patients quickly feel full and may experience mild nagging pain on the left side of the lower abdomen.

Stages

The stages of ovarian cancer are as follows:

Stage 1: The malignant tumor is located in one or two ovaries, without extending beyond them.

Stage 1A: Cancer begins in one of the ovaries (right or left), without spreading beyond it. The tumor only grows internally. There are no cancer cells in the abdominal cavity or pelvic organs.

Stage 1B: The tumor is widespread in both ovaries, but only inside them. Cancer cells in the pelvic and abdominal organs have not been diagnosed.

Stage 1C: The tumor is in two ovaries. Also:

• There may be a rupture of its wall if there is a cystic type tumor.
• Analysis of the abdominal fluid showed the presence of cancer cells.
• The cells came out of at least one ovary.

Stage 2: The tumor is diagnosed in one or both ovaries, and it has also grown into the pelvic organs, but has not spread to the abdominal cavity, lymph nodes or other organs.

Stage 2A: If the cancer has started to spread into the fallopian tubes or uterus. There are still no cancer cells in the abdominal cavity.

Stage 2B: The tumor has spread to other organs located in the pelvis. There are no cancer cells in the abdominal cavity.

Stage 2C: Cancer cells are found in the abdomen and the tumor has spread to other organs in the pelvis.

Stage 3: One or two ovaries are affected by tumor. Besides:

• Spread of the tumor to the lymph nodes.
• The spread of cancer cells to the abdominal cavity, especially its lining.

Stage 3A: During surgery, it is discovered that the tumor has spread to both ovaries. No metastases to the abdominal cavity are visible. There is no tumor in the lymph nodes.

Stage 3B: The naked eye can see that the metastases have spread to the abdominal cavity. The affected area is both ovaries. There are no cancer cells in the lymph nodes.

Stage 3C: In addition to the cancer affecting both ovaries, there is also:

• Spread of cancer cells to lymph nodes.
• Metastases larger than 2 cm are visible in the abdominal region.

Stage 4: Very common degree. Cancer cells travel through the bloodstream to other, even distant, organs.

Read more about the stages of ovarian cancer in this article.

Remission of ovarian cancer

Remission of ovarian cancer is a long period of time when the disease did not develop, remaining at the same level. Recently, German doctors have noted that patients who took the drug Pazopanib, even in the last stages of the disease, were able to extend remission to six months. The approval of such a drug would be a huge step forward, as patients would be able to go much longer between chemotherapy treatments. According to statistics, in advanced stages, ovarian cancer is considered a complex disease that often leads to death. The survival rate here is only 20-25%.

Complications and consequences

The most effective way to overcome ovarian cancer is surgery. But if we talk about what consequences such a disease has, then we must first of all pay attention to its stage, size and type. Of course, no doctor can give a 100% result, because much depends on the patient himself.

It is worth understanding that surgical operations do not leave their mark on the human body. If you have had your ovaries or another organ, such as your uterus, removed to fight cancer, you should be prepared for changes to occur in your body.

Firstly, if at least one ovary is removed, this sharply reduces the amount of hormones produced. When both organs are removed, the hormonal levels change very seriously. You can at least somehow stabilize your condition with the help of special courses. But remember that after the operation the patient will be forced to constantly artificially maintain hormonal levels. If this is not done, the disease may return again.

Secondly, sometimes during the operation the doctor also removes the uterus. This leads to the formation of a void. It, of course, affects the general condition negatively. After such an operation, it is prohibited to lift any weights, play sports or have an active sex life.

Do not forget to constantly undergo examinations, which will allow you to detect a relapse of the disease in time.

Diagnosis of ovarian cancer

Differential diagnosis

Differential diagnosis for ovarian cancer includes testing for basic tumor markers. Thanks to this technique, in 80% of cases it is possible to determine the development of a tumor and prescribe the correct treatment.

Ovarian cancer treatment

The main role in this process is given to surgical intervention. But treatment for ovarian cancer may differ for different stages. What are the most common treatments for ovarian cancer today?

In the final stages of the disease, when surgical methods can no longer help, chemotherapy is used. Thanks to the use of various chemicals, it is possible not only to stop the development of the tumor, but also to reduce its size.

Medicines

Cisplatin. Available in the form of a yellowish powder. Due to its composition, the drug takes part in cell death. As a rule, it is used for cancer of the ovaries and other pelvic organs. Among the main contraindications for use are: severe renal impairment, high sensitivity, bone marrow hypoplasia. Cannot be used during pregnancy. Should only be used under the supervision of an experienced oncologist.

Adriablastin. This drug is an antibiotic that belongs to the anthracycline group. Its main activity is antitumor. Usually used in combination with other drugs. Actively used for ovarian cancer. The drug is contraindicated in patients with acute liver disorders, myocarditis, tuberculosis. It is also prohibited to use during pregnancy.

Vincristine. It is of plant origin. It is used for various tumors, especially ovarian cancer. Available in the form of a snow-white or slightly yellowish powder. Do not take during pregnancy, with jaundice, or for elderly people.

Paclitaxel. The drug is based on alkaloids that are secreted by yew bark. It comes in the form of a white powder. It has a cytotoxic antimitotic effect. The drug should not be taken by patients with Kaposi's sarcoma, neutropenia, or during pregnancy.

Traditional treatment

Traditional medicine offers its own methods of treating ovarian cancer. But remember that they have not been tested, so they do not always give 100% results. In addition, traditional treatment is usually quite individual, so it can help some, but harm others. For example, many patients try to treat a tumor in the ovaries with a decoction of pine needles. In order to prepare it, you need to take about three tablespoons of needles and place them in a liter of boiling water. This infusion is drunk in one day. On the second, the whole process is repeated. The course of treatment consists of one month.

Herbal treatment

Some believe that ovarian cancer can be fought with the help of poisonous herbs, in particular, celandine, aconite, and hemlock. Many people try to recover by taking fly agarics. Herbs must be properly infused so that they are no longer so toxic to the human body. It is also worth taking just a few drops of these tinctures.

According to statistics, about 51% of all patients began taking various herbs after receiving a terrible diagnosis. Many people have paid attention to the fact that a substance called trifolyrizine works well against the growth and development of tumors. It can be found in the root of Sophora yellowensis. Curcumin also showed some activity in this area. Thanks to the flavonoids found in hops, the development of ovarian cancer can be blocked. One of the popular recipes for herbal treatment is this: take two teaspoons of hop cones, pour one glass of boiling water and leave for about two to three hours. After this, strain the drink well and take it before meals three times a day.

Homeopathy

Homeopathy is also widely used by patients who have been diagnosed with ovarian cancer. Popular drugs include:

1. Argentum metallicum. Used to improve the general condition of the body. In some cases, inhibition of cancer progression and reduction in tumor size were noticeable.
2. Asafoetida. The medicine is indispensable if the patient exhibits the main symptoms of ovarian cancer.

Surgical treatment

Surgical treatment of ovarian cancer usually has two main goals. First, during surgery, the doctor can find out in more detail how far the tumor has spread. Secondly, the organs are cleansed so that a more effective result can be obtained. During surgery, the surgeon usually removes both ovaries, and sometimes the uterus and fallopian tubes are also removed. Sometimes the surgeon may also decide to remove part or all of the omentum. If cancer cells have spread to the lymph nodes, some of them are excised. Parts of tissue, as well as a small amount of fluid, are removed during surgery and then sent for research.

Life after ovarian cancer

First of all, you should be prepared for the fact that in some cases the cancer never goes away. Therefore, such patients attend chemotherapy courses for many years. But, if you manage to recover, then the patient begins a life full of worries about the future. It is very difficult to be 100% sure that the cancer will not come back. After all, relapses are common.

After treatment is completed, your doctor will need to monitor you regularly. It is very important not to miss a single meeting with him. During such meetings, an examination is carried out and new tests are taken. It is also worth understanding that antitumor treatment often leads to side effects. Moreover, some of them will stay with you for life. Many people are starting to exercise and trying to eat healthier.

Disability

For ovarian cancer, the following types of work are contraindicated:

1. Work in an unfavorable microclimate.
2. Work that involves harmful substances and factors.

With effective treatment of stage 1 and 2 ovarian cancer, patients are given moderate restrictions on their ability to live. Therefore, the patient can return to work without any problems if it is not on the list of contraindications. At stages 1, 2, 3, if treatment of the tumor is impossible, a pronounced limitation of life activity is imposed (second disability group). The first disability group is assigned to those patients who have been diagnosed with stage 4 ovarian cancer.