Ovarian carcinoma: tumor types, treatment and prognosis. Serous ovarian carcinoma Serous ovarian cancer Survival Serous ovarian cancer

Ovarian carcinoma is a serious health problem for women

Ovarian carcinoma - what is it? This is a malignant formation that develops from the integumentary epithelial tissue of the ovaries: as a result of a mutation, atypical cell division begins. Carcinoma is primary, secondary and metastatic.

Primary carcinoma initially develops as a malignant tumor; the secondary arises as a result of the degeneration of a benign neoplasm. Metastatic cancer occurs as a result of the drift of tumor cells (with blood or lymph flow) from a focus located in another organ.

Attention! The most dangerous type of cancer is metastatic. It is characterized by more aggressive and rapid development of the tumor, the spread of cancer cells throughout the body, the emergence of secondary cancer foci.

Carcinoma is called the "silent killer" because in the early stages the tumor does not make itself felt. Even a blood test and ultrasound may not show the onset of a malignant tumor. And at the last stage, treatment is difficult and does not always give positive results.

On a histological preparation, different forms of carcinoma differ significantly. With metastatic carcinoma, two ovaries are affected at once; on ultrasound, the tumor looks like dense tuberous ulcers.

Histological forms of the disease

Ovarian cancer according to the modern classification has the following histological forms:

1. Epithelial carcinoma - develops from the surface tissues of the body. Most often, only one of the ovaries is affected, without spreading to the other side. It is found at the last stage, as it develops asymptomatically. Due to late diagnosis, it has a poor prognosis.
2. Adenocarcinoma of the ovary - the tumor develops from the glandular tissue of the organ. On ultrasound, the neoplasm looks like a multi-chamber node, in which there are necrotic foci and small cavities. Rapidly begins to metastasize.
3. Serous ovarian carcinoma has many varieties. It makes up about half of all malignant tumors of this organ. It is characterized by germination through the capsule into the deep tissues of the ovary.
4. Mucinous (mucus-forming) ovarian carcinoma - is diagnosed only in a small number of cases, but is characterized by aggressiveness and a tendency to form metastases. Does not grow into a capsule. Accompanied by concomitant gynecological diseases (ectopic pregnancy, fibroids, inflammation of the uterine appendages).

These are the most common types of malignant tumors. Mixed, clear cell and endometrial cancer are much less common.

Risk group

Ovarian carcinoma can be found in any woman and at any age. The disease develops under the influence of certain factors, but specific causes have not yet been identified.

Provoking factors include:

• gynecological diseases;
• early puberty and late menopause;
• lack of pregnancy and infertility;
• long-term use of hormonal drugs;
• unfavorable ecology, toxic and carcinogenic effects on the body;
• bad habits (alcoholism, smoking, malnutrition);
• the presence of excess weight;
• age - over 45 years;
• burdened heredity.

If there is a family or personal history of cancer of the genital organs, mammary glands or large intestine, a woman needs to be attentive to her health. In this case, the likelihood of developing ovarian carcinoma increases significantly, so regular examinations and preventive examinations by a gynecologist are necessary.

Important! Pregnancy and long-term breastfeeding help prevent the appearance of tumors, so doctors often recommend women at risk to think about having a baby.

Signs of carcinoma

The initial stage of the disease has no specific symptoms. A characteristic clinical picture appears at stages 3-4 of the development of a malignant tumor. The woman has:

• irregular menstruation;
• pain during sexual contact;
• uterine bleeding;
• problems with urination and bowel movements, which are caused by the pressure of the tumor on the organs located near the ovaries;
• heaviness and pain in the lower abdomen;
• an increase in the volume of the abdomen as a result of filling the abdominal cavity with pathological fluid.

If the pedicle is twisted or the neoplasm ruptures, the patient has a surgical emergency.

Important! If the patient is not provided with medical care in time, then the pathology can lead to serious complications and even death.

Carcinoma treatment

Treatment of ovarian carcinoma is carried out in the following ways:

1. Chemo- and radiation therapy.
2. Surgical intervention.
3. Maintenance therapy (used when the tumor is not treatable and there is no way to remove it).

The choice of treatment method depends on the shape and size of the tumor, its localization, the general condition of the patient, as well as the presence of concomitant pathologies, especially gynecological ones.

Surgical removal is the main treatment for malignant tumors. Based on the results of the examinations, doctors conclude that it is necessary to remove one of the ovaries or two ovaries along with the uterus and tubes. Part of the omentum is also removed if metastases are found on it.

Important! Serous papillary adenocarcinoma of the ovary is treated with chemotherapy and x-rays. Surgical intervention is possible only at an early stage of tumor development.

Most often, palliative treatment (radiation and chemotherapy) is used for papillary ovarian carcinoma. This is due to the rapid growth and metastasis of the tumor, its penetration into the deep tissues of the organ and seeding of the peritoneum.

Maintenance therapy is aimed only at eliminating the symptoms of the tumor, slowing down its growth and, accordingly, prolonging the life of the patient.

According to the histological structure of the tumor, there can be several types: serous tumors, endometrioid tumors, mucinous tumors, mixed tumors, etc. Each of these forms can be:

• benign
• malignant
• borderline - a low-grade tumor that does not extend beyond the ovary for a long time, has a favorable prognosis

The most common is serous ovarian cancer. Among all cases of morbidity, the borderline type is 10%; it affects mainly women under 40 years of age. The malignant form is the most common, however, it is also differentiated into a low, moderate and high degree. This disease is characterized by a very aggressive course and in half of the cases affects both ovaries. However, the bilateral lesion does not depend on the stage of the disease. The presence of widespread metastases, ascites, may be the result of the prevalence of a small primary tumor, so insignificant that it is sometimes difficult to detect on microscopic examination. But large formations in both ovaries do not always go beyond the boundaries of the organ. These tumors look different, but the most typical is a tumor that resembles a cauliflower. In almost all cases, by the time of surgical intervention, the formation completely fills the organ. Serous ovarian cancer may spread to the peritoneum, leading to ascites.

In the initial stages, the disease is asymptomatic. Stage I-II disease is often discovered by chance during any surgical intervention. At later stages, patients are concerned about an increase in the abdomen, dysfunction of the bladder and intestines, shortness of breath, weight loss, unreasonable persistent fever, swollen lymph nodes. In some cases, a volumetric neoplasm can be detected in the abdominal cavity.

Diagnosis of the disease is not difficult. Bimanual rectovaginal examination in most patients can detect a tumor located in the pelvis. In addition, dimensions, consistency, mobility, localization, surface character, etc. can be determined. However, such a study is ineffective with small tumor sizes or an atypical location, as well as in obese women or in patients with adhesions after laparotomy.

Verification of the diagnosis allows a cytological analysis of ascitic fluid or pleural exudate.

• Ultrasound is a highly informative diagnostic method
• Determination of the level of oncomarker - antigen CA-125
• X-ray examinations can determine the prevalence of a malignant tumor
• If necessary, radioisotope renography, computed tomography, excretory urography, laparoscopy are performed.

In women of childbearing age, malignancy should be differentiated from cysts, endometriosis, inflammatory pseudotumors, and fibroids. The final diagnosis is possible with a diagnostic laparotomy and mandatory histological examination. Surgical treatment consists in removing the malignant formation along with the ovaries.

Forecast

the prognosis of survival depends on the form of the degree of the disease. The prognosis of a five-year survival rate of 80-95% in the initial stages of the disease of a localized form. For stages III and IV, the survival rate is 25-30%. Borderline serous ovarian disease recurs after about 16 years in 15% of cases, and many of them are at least stage II. The most common causes of death are ascites, exhaustion of the body, intestinal obstruction, as well as distant metastases to vital organs: the brain, liver, and lungs.

Questions

Q: What is serous ovarian cancer?

What is serous ovarian cancer?

Serous ovarian cancer is a type of a large group of epithelial neoplasms. This means that serous cancer is formed from degenerated and malignant epithelial cells. Unfortunately, where exactly the malignant epithelial cells come from in the ovary is not fully understood at the moment. Oncologists have put forward three main hypotheses that explain the origin and development of serous ovarian tumors:

• adenocarcinoma;

Determination of the histological type of the tumor is important only for the choice of a drug for chemotherapy, as well as the selection of optimal doses of radiation therapy.

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ovarian cancer

Malignant neoplasms of the ovaries develop mainly from the epithelial tissue of the female reproductive organs and are among the most frequently diagnosed female cancers.

Like all cancers, ovarian cancer can be treated radically only in the initial stages, characterized by the absence of metastasis (the spread of cancer cells throughout the body). A significant part of ovarian tumors after treatment recurs, that is, it occurs again.

Causes

The true etiology of the development of malignant ovarian tumors (as well as most other cancers) is unknown to medicine. But there are certain factors that increase the risk of developing this disease.

One tenth of all ovarian cancer cases are genetically transmitted through direct relatives. The chance of ovarian cancer increases if there is a family history of breast cancer.

There are certain genetic mutations that contribute to the atypical behavior of cells and their degeneration. For women who have a family history of ovarian and breast cancer, doctors are advised to regularly screen for the presence (or absence) of mutations in the BRCA1 and BRCA2 genes.

Other risk factors include:

• early onset of the first menstruation (menarche) and late onset of menopause;
• no pregnancy (it is believed that pregnancy increases protection against ovarian tumors - at the same time, the more pregnancies a woman had, the lower the risk of cancer);
• age over 50 years (ovarian cancer is extremely rare in patients under 40 years of age);
• obesity - according to medical research, the risk of developing ovarian cancer in overweight women is much higher (at the same time, patients with obesity are 50% more likely to have deaths);
• taking medications for the treatment of infertility (especially if a woman has not become pregnant as a result of the use of drugs);
• hormone replacement therapy (long-term use of estrogen after menopause);
• the influence of toxic and carcinogenic substances (in particular, asbestos);
• irrational nutrition (eating too much protein food and insufficient presence of fresh plant products in the diet);
• diseases of the reproductive organs;
• smoking and alcohol abuse.

Symptoms

Ovarian cancer in the early stages does not have severe symptoms.

In the future, the following signs of pathology are observed:

• pain in the pelvic area and lower back;
• ascites (accumulation of fluid in the abdominal cavity);
• discharge of a bloody nature, not related to menstruation;
• constipation and other intestinal disorders;
• increased urination;
• weakness, fatigue, drowsiness;
• weight loss (against the background of an increase in the abdomen);
• disruption of the menstrual cycle.

The initial symptoms of ovarian cancer may resemble inflammatory diseases of the reproductive organs, so women do not always go to the clinic after the onset of the first symptoms. Some of them begin to self-medicate - take anti-inflammatory and analgesic drugs, which aggravates the course of the disease.

Video: All about ovarian cancer

Diagnostics

• blood test for cancer markers;
• ultrasonography;
• computed tomography (together with positron emission tomography);
• radiography (including contrast);
• diagnostic laparoscopy: using a small incision, doctors insert a tube with a video camera into the cavity, which allows you to visually assess the condition of the internal organs;
• rectovaginal examination;

In rare cases, a biopsy is used - taking a tissue sample for examination in the laboratory. The method (although it allows almost 100% accuracy to detect the presence of cancer) can lead to the spread of cancer cells throughout the abdominal cavity.

Ovarian cancer is classified according to the histological composition of tumors and their localization in the ovary:

• Epithelial ovarian cancer occurs in cells located on the surface of the main female reproductive organs. This form of ovarian cancer is the most common. Malignant epithelial tumors extend to the peritoneal surface and almost never affect the opposite ovary. Almost 2/3 of tumors are diagnosed at the stage of spread, which worsens the prognosis;
• glandular ovarian cancer is one of the histological varieties of epithelial cancer. Such cancer originates from the glandular epithelium and occurs quite often (in 40% of cases);
• serous ovarian cancer is also among the most common and occurs in 50-60% of cases. This histological variety is characterized by the penetration of the surface epithelium of the ovary into the organ;
• Mucinous ovarian cancer is another form of epithelial cancer, but it is much less common (only 10% of cases). This form is characterized by the presence of such concomitant diseases as fibroids and inflammation of the appendages. Often, mucinous cancer develops in women who have had an ectopic pregnancy.

Less common are other histological varieties - endometrioid tumors, clear cell, mixed, and Brenner tumors. All these forms of ovarian cancer occur in only 1 out of 100 cases.

Stages of ovarian cancer

Like all cancers, ovarian cancer develops in stages. The prognosis of treatment depends on the stage at which the disease is diagnosed. Stage 1 ovarian tumors are characterized by the absence of symptoms and the small size of the neoplasm. At stage 2, the tumor spreads over the entire surface of the organ and begins to penetrate into nearby tissues. At the same time, the lymph nodes remain intact. Treatment of ovarian cancer in the first two stages can have a favorable outcome with lifelong remission.

At stage 3, metastases appear in the lymphatic system and nearby organs. Ascites appears - due to rupture of the ovary and damage to the lymphatic vessels. The first metastases occur in the peritoneum and other nearby organs. At stage 4, multiple metastases occur - in the lungs, liver, bone tissue.

Treatment

The main treatments for ovarian cancer are surgical removal and chemotherapy.

Radical operations involve the removal of the uterus, appendages and the ovary itself. Sometimes the second ovary is also removed if the tumor has spread to it. After the operation, chemotherapy is prescribed, sometimes radiation therapy. These treatments are designed to destroy remaining cancer cells and prevent recurrence - the recurrence of the disease.

Forecast

If the disease is diagnosed at stage 1 and the doctors perform an operation to remove the tumor on time, a successful cure is possible in 90% of cases. For stage 2, the survival rate is 60%.

With the development of cancer up to stage 3, the prognosis of survival decreases to 30%. At stage 4, when metastases penetrate into distant organs, the prognosis is almost always unfavorable - only 5% of patients live longer than 5 years.

All about the treatment of ovarian cancer at stage 4 in this article.

Prevention

Studies show that long-term use of combined contraceptives reduces the risk of ovarian cancer. The therapeutic effect continues for several years after stopping the drugs. Pregnancy (as mentioned above) and breastfeeding also reduce the likelihood of developing ovarian cancer, so childbearing can also be considered a kind of preventive measure for oncology of the female reproductive organs.

Bilateral tubal ligation is also a preventive measure - this gynecological procedure is indicated for women who do not plan to have children in the future.

Some experts recommend that women with BRCA gene mutations have their uterus, fallopian tubes, and ovaries removed before the first signs of cancer appear. Of course, such an operation is practiced only in cases where women no longer plan to have a child.

Video: All about ovarian cancer prevention

Nutrition (diet)

Proper nutrition is a very important part of the therapeutic process. During the treatment period, the body needs good nutrition more than ever, since the fight against cancer requires additional strength. Diet therapy is also one of the therapeutic methods at the stage of body recovery after chemotherapy and radiation.

Patients with ovarian cancer may find it helpful to include the following foods in their diet:

During chemotherapy, patients often have no appetite or an aversion to the smell of cooked food. In this case, patients are advised to eat cold dishes - cheeses, yogurts, salads, including those with the addition of meat and fish, eggs. All products must be fresh, special attention should be paid to the purity of vegetables and fruits - during illness and treatment, the immune system weakens, and the body becomes vulnerable to any infections.

This article describes the treatments for ovarian cancer in more detail.

Prices for ovarian cancer treatment in Israel are covered in this section.

• red meat and animal fats;
• fried, salty and spicy foods;
• semi-finished products;
• soups in meat broth;
• mushrooms;
• preservatives;
• vinegar;
• sugar and sweets;
• premium bread;
• alcohol;
• coffee and strong tea.

Doctors advise drinking enough fluids and not loading the body with large amounts of food at one time. It is better to switch to crushed food - eat 5-6 times a day in small portions.

Ovarian cancer is an aggressive and dangerous disease that occurs most often in women of mature age. Radical surgery and chemotherapy can cure ovarian cancer only in cases where cancerous tumor cells have not yet spread through the lymphatic and circulatory systems throughout the body. Let's take a look at the photo.

Ovarian cancer is an oncological disease that provokes serious destructive processes in the tissues of the organ. The disease has 4 stages. The likelihood of successful treatment and recovery depends on the degree of development of the disease. When a woman is diagnosed with stage 1 ovarian cancer, the survival rate and chances of

Ovarian cancer is the leading cause of death from cancer of the female genital organs. In the third stage in a neglected state for most women, the disease ends in death. Even with minimal (2 cm) residual tumors after primary laparotomy, survival lasts only 40 months. Z stage.

Treatment of ovarian cancer should take place in a clinical setting under the guidance of qualified doctors. The main types of treatment for this serious and dangerous disease are surgery and chemotherapy. It should always be remembered that the use of any folk remedies in the treatment of cancer.

Ovarian cancer is a serious disease that is not always completely curable. Long-term remission without relapse is possible only if the disease is diagnosed at the earliest stages, when there are no metastases in the lymph nodes and internal organs. But even the removal of the ovaries, uterus and its appendages by 1.

Ovarian cancer is often diagnosed at a late stage, making treatment difficult and increasing the chance of recurrence. Recurrence of ovarian cancer is the recurrence of a malignant focus after remission - a period during which cancer cells were not found in the body in the body. Most often relapse.

Ovarian cancer develops relatively slowly and at an early stage almost does not give severe symptoms. This is the main therapeutic problem in ovarian cancer: the detection of a tumor often occurs when the neoplasm has spread to neighboring tissues or even metastasized to distant organs. That's why.

Stage 4 ovarian cancer is characterized by a high level of carcinogenicity, exacerbation of symptoms and a dangerous spread of metastases to other organs. The pessimistic prognosis of survival forces us to take early diagnosis and prevention seriously, especially in the case of a hereditary predisposition. Oncology.

Abnormal and excessive accumulation of fluid in the abdominal cavity is called ascites. This symptom can be a sign of many types of cancer, but most often accompanies ovarian cancer. The development of ascites is promoted by long-term disturbances in the natural circulation of fluid in the abdominal cavity. Ascites is a rather dangerous condition.

Israel is a country with one of the highest levels of medicine in the world. Thanks to the introduction of innovative diagnostic and treatment technologies into practice, as well as due to the high level of training of medical personnel, the most serious illnesses are successfully treated in Israel - even those that are incurable in other countries. More.

Ovarian cancer is a malignant tumor that develops from epithelial tissue. The disease most often develops in adulthood (the average age of ovarian cancer patients worldwide is 63 years). The most common cause of poor treatment outcomes is late diagnosis of the disease. It is found that the probability

Ovarian cancer arises from the epithelial tissue of the female reproductive organs. This is one of the most dangerous gynecological diseases. Every woman needs to know what are the symptoms and manifestations of this pathology and how to identify the disease in the early stages. It should be remembered that at the slightest suspicion of malignant.

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Do not self-medicate. Consult with your physician.

Ovarian cancer - metastases

Oncological diseases in women most often occur at an older age. Their cause has not been clearly proven. A provoking factor may be a hereditary predisposition, infertility, the use of hormonal drugs, a disease of the mammary glands.

Metastasis in ovarian cancer is when cancer cells separate from the main tumor and invade the tissues of nearby healthy organs, forming new tumors (a kind of seeding). They spread through the abdominal cavity, with the flow of blood, lymph. Organs are affected in approximate order: abdominal cavity, greater omentum, lymph nodes, liver, pleura, diaphragm, lesser omentum, intestines, fallopian tube. Metastasis in ovarian cancer is important. The treatment and prognosis of recovery depend on where the detached tumor migrated.

An important role is played by the histological significance of ovarian neoplasms, its origin. Initially, the tumor may be malignant - primary. If it develops from benign (cystoma), secondary. The tumor, depending on the different types of cells, can be:

• stromal (appears in the tissues that form the basis of the ovary);
• germinogenic (formed from the embryonic cells of the egg);
• epithelial (outer tissues of the ovary).

All these types of tumors are life threatening and form metastases in the later stages. The most common malignant epithelial neoplasm, which can be of various types:

• serous (adenocarcinoma, adenofibroma, cystadenofibroma);
• mucinous;
• endometriotic.

If you differentiate the type of ovarian cancer in the early stages and prescribe the necessary treatment, then there is a chance for recovery.

To determine the exact diagnosis, I use different types of techniques, taking into account the spread of the tumor to other organs:

• Ultrasound (classic, transrectal, transvaginal);
• lymphography (examination of lymph nodes);
• laparoscopy (using an endoscope to study the abdominal cavity);
• blood test for oncomarkers CA-125;
• irrigoscopy (the large intestine is studied in the same way);
• fibrogastroscopy (examine the gastric mucosa);
• fibrocolonoscopy (with the help of a certain apparatus, rectal tissues are taken for diagnosis);
• cystoscopy (using an endoscope to examine the bladder);
• sigmoidoscopy (with the help of a rectoscope, sigmoidoscope, colonoscope, a tissue sample is taken in the lower part of the intestine);

Serous ovarian cancer

The most common type of neoplasm is malignant, it progresses very quickly, forming metastases. Serous ovarian cancer is often bilateral. Under the microscope, you can see a multi-chamber cystic structure, a kind of "cauliflower". The serous tumor itself is small in size, its metastases reach impressive volumes. Most often, it spreads through the abdominal cavity and does not inseminate the internal organs, forming ascites. But, damaging the pleura, it forms an accumulation of fluid in its area. Characteristic for her is the defeat of the retroperitoneal lymph nodes, less often the inguinal and iliac.

This type of cancer appears in the later stages. The temperature rises, the lymph nodes, the stomach increase, the activity of the gastrointestinal tract, urinary system is disrupted, shortness of breath occurs. In younger women, it is important to accurately differentiate the disease and not confuse it with myoma, pseudotumors of inflammatory genesis, endometriosis. Serous cancer is treated by surgery, a malignant tumor is excised along with the ovary.

Epithelial ovarian cancer

This type of tumor accounts for almost 80% of oncological diseases. Epithelial ovarian cancer is malignant, benign, borderline.

In its treatment, surgical intervention is used:

• wedge-shaped resection of the ovaries (the damaged part of the organ is cut off, then it is reconstructed by applying nodal and subcortical sutures);
• excision of an ovarian cyst (in case of a benign tumor, the cortical substance and the ovarian stroma are separated from the cyst wall with a scalpel, restored in the above way);
• oophorectomy (removal of the ovary along with the fallopian tubes);
• surgical removal of the main focus of the tumor and its metastasis.

I use chemotherapy, which helps to reduce the growth of the tumor and slow its spread. Various drugs are used: cisplatin, taxol, cyclophosphamide, docitaxel.

Radiation exposure in the treatment of ovarian cancer is negative in that it destroys not only cancer cells, but also healthy ones, worsening the patient's condition. Effective treatment is complex.

Prevention

In the early stages, the prognosis for recovery is 79-87%, in the later stages 5-21%. Ovarian cancer is not a verdict, an optimistic attitude, early diagnosis and timely prevention are important. It is necessary to undergo a medical examination in a timely manner, especially if there is a hereditary predisposition (from mother to daughter).

Do not start the treatment of viral and infectious diseases. When using hormonal drugs, consult a doctor. Lead a healthy lifestyle and watch your diet. At the first manifestations of pain in the pelvic area, consult a doctor.

Signs of ovarian cancer, diagnosis, effectiveness of treatment at different stages of the disease

Ovarian cancer is a malignant neoplasm that accounts for up to 90% of all tumors of this organ. The incidence in Russia is up to 12 thousand new cases during the year. Out of 100 thousand women, the pathology is diagnosed in patients, and in many cases already in a severe degree. This is largely determined by a long, asymptomatic course.

This disease is the fifth in the list of the most dangerous malignant tumors. It occurs mainly in middle-aged and elderly women, most often in the group over 55 years of age. About 8% of cases of ovarian cancer are detected in young women, in which case the disease is hereditary.

Etiology

The causes of oncopathology are completely unknown. It is more often observed in developed countries, except for Japan. Scientists suggest that dietary habits, in particular, excessive consumption of animal fats, play a role in this.

The main factors that provoke ovarian cancer are hormonal imbalance and genetic predisposition.

90% of ovarian tumors occur by chance, while the risk of getting sick is about 1%. If the patient in the family had similar cases of the disease, then the probability of pathology increases to 50%. The risk is especially high if the mother or sisters of the patient are diagnosed with ovarian or breast cancer with a mutation in the BRCA1 or BRCA2 genes. In women with breast cancer, the frequency of ovarian tumors is increased by 2 times.

The main factor leading to the failure of the cell division and growth program is constant ovulatory cycles without interruptions for bearing a child. Chronic hormonal stimulation leads to tissue damage and increased protective repair mechanisms. Under these conditions, the likelihood of malignant transformation increases.

A long period of ovulation is typical for patients with early onset and late completion of the menstrual cycle, with a small number of pregnancies, late first births and lack of lactation. The risk of pathology increases significantly with infertility, as well as with drug stimulation of ovulation for 12 cycles or more. Pregnancy, as well as long-term use of oral contraceptives, reduce the likelihood of the disease.

There is evidence of a harmful effect on the ovaries of infectious parotitis ("mumps"), contact with talc and asbestos, lactase deficiency.

Classification of pathology

9 out of 10 cases of malignant tumors of this organ are epithelial ovarian cancer. It is formed from cells located on the surface of the capsule - the outer layer of the organ. This explains the rapid formation of metastases in the abdominal cavity.

Depending on the microscopic structure, according to the WHO classification, the following types of epithelial ovarian cancer are distinguished:

• serous;
• endometrioid;
• mucinous ovarian cancer;
• clear cell;
• Brenner's tumor;
• mixed;
• unclassified.

Any of these tumors develop from endothelial, mesenchymal, or granulomatous cells. All of them are formed in the embryonic period from the middle germ layer - the mesoderm. Other types of cells, such as squamous epithelium, are not found in the ovaries. Therefore, for example, squamous keratinizing ovarian cancer is impossible. The definition of a morphological variant is important for the formation of a treatment program.

The spread of malignant cells is carried out mainly along the peritoneum, metastases can grow into the wall of the intestine or bladder. In addition, metastasis is possible through the lymphatic vessels with damage to the pelvic, inguinal and peri-aortic lymph nodes. The entry of cancer cells into the blood can cause the formation of distant foci in the brain, spleen, liver, skin and lungs, as well as lymph nodes above the collarbone and in the neck. Quite often, the tumor metastasizes to the navel with the formation of the so-called knot of Sister Mary Joseph.

In some patients, the ovarian neoplasm has a metastatic character, that is, its primary focus is located in another organ (mammary gland, intestines, uterine endometrium). This lesion is called a Krukenberg tumor.

To assess the clinical course of the disease, 2 classifications are used: TNM and FIGO (International Association of Obstetricians and Gynecologists). The principles of both systems are similar:

• Stage 1 (T1 or I according to FIGO) - the neoplasm develops in one or both ovaries;
• Stage 2 (T2, II) - the tumor spreads to the uterus, tubes or pelvic organs;
• stage 3 (T3, III) - the spread of metastases to the peritoneum;
• Stage 4 (M1) - there are malignant foci in distant organs.

N0: lymph nodes are not affected, N1 - malignant cells are found in them. To clarify this indicator, a biopsy of several of these formations is necessary.

One of the important characteristics of cancer is the degree of its differentiation. The more differentiated cells are, the less prone they are to malignant growth. On this basis, they distinguish:

• G1 - highly differentiated cancer;
• G2 - average degree;
• G3 is a poorly differentiated tumor, usually highly malignant.

The division of tumors according to the degree of differentiation is rather arbitrary. In one neoplasm, there may be cells with different malignancy. Differentiation changes with the progression of the disease, as well as under the influence of treatment. Metastases and recurrences are often significantly different in this respect from the primary focus.

Distinguish between primary, secondary and metastatic cancer. In the primary lesion, the tumor initially affects the ovaries. Most often, it is dense, round or oval in shape, with a bumpy surface, characterized by the rapid spread of cells along the peritoneum.

The basis of secondary cancer is a papillary cystoma, which is often mistaken for an ovarian cyst.

Clinical picture

Symptoms of ovarian cancer appear with a common process. In addition, serous ovarian cancer spreads very quickly through the abdominal cavity. This explains the late diagnosis of the disease.

The first signs of ovarian cancer are nonspecific. Patients complain of periodic moderate pain in the abdomen, a feeling of heaviness and fullness. Due to compression of the neoplasm of the intestine, constipation occurs. Sometimes the pain is sudden, acute and is associated with a rupture of the ovarian capsule or the development of inflammation around it.

In the later stages, join:

• weakness;
• loss of appetite;
• an increase in the abdomen with the accumulation of fluid in the abdominal cavity (ascites);
• shortness of breath with the accumulation of effusion in the pleural cavity;
• nausea and vomiting;
• bloating;
• frequent urination.

Due to the pressure of the ascitic fluid, the protrusion of the abdominal wall occurs with the formation of a hernia. Pathological discharge from the genital tract for ovarian cancer is uncharacteristic. They arise only when the process spreads to the uterus.

The progression of the disease is accompanied by significant damage to the intestine, leading to narrowing of its lumen and disruption of normal operation. Gradually, the absorption capacity of the intestinal villi decreases, and the supply of nutrients to the blood decreases. Exhaustion develops, which is often the cause of death of patients.

How fast does ovarian cancer develop? Often the tumor is asymptomatic for a long time. After the appearance of its clinical signs, the progression of the disease generally occurs very quickly, within a few months.

Features of individual forms of cancer

Epithelial cancer

Epithelial tumors are more likely to develop in older women. The most common variant is serous ovarian cancer. They grow from cells lying on the surface of the organ. The neoplasm slowly grows outward, penetrates through the capsule, its cells spread throughout the abdominal cavity. Epithelial can be unilateral or bilateral. It is detected already at a late stage, when complications appear, for example, ascites. Therefore, the prognosis for this form is unfavorable.

In most patients, an increase in the level of CA-125 is determined in the blood. Treatment includes surgery followed by chemotherapy. Monitoring the effectiveness of the intervention is carried out by repeated determinations of CA-125. Epithelial tumors often recur.

Germ tumor

A rare variant of a malignant neoplasm is a germinal tumor formed from germ cells, which are normally capable of transforming into tissues of the placenta, yolk sac and fetus. The main variants of such a disease are teratoma and dysgerminoma. Less common are embryonic carcinoma, nongestational choriocarcinoma, yolk sac tumor, and mixed variants.

A feature of germ cell tumors is their production of a variety of tumor markers. In particular, dysgerminoma secretes lactate dehydrogenase, embryonic carcinoma and yolk sac tumor - alpha-fetoprotein, and choriocarcinoma - human chorionic gonadotropin. This phenomenon is used to diagnose neoplasms.

Malignant germinal tumors are a rare disease. They mainly affect children and young women. These formations lead to the appearance of pain in the abdomen quite early. They grow rapidly, and therefore are recognized earlier.

Treatment of germ cell tumors is to remove the affected ovary. Often, an organ-preserving operation is performed with the obligatory determination of the stage of the disease. After the operation, chemotherapy drugs are prescribed. Dysgerminoma is highly sensitive to radiation therapy. These tumors have a better prognosis than epithelial ones. Survival of patients after 5 years reaches 70-85%.

Stromal cell pathologies

Stromal cell volumetric formations arise from the germ cells of the sex cord. Of these, granulosa-theca cell tumor is the most common. It has a fairly low grade of malignancy. The features of the pathologies of this group is their hormonal activity - the production of testosterone or estrogen.

Such neoplasms are more often observed after the onset of menopause. Depending on the secreted hormones, they can be manifested by bleeding or virilization (“masculinity”) phenomena - facial hair growth, voice change, acne. Treatment consists of complete removal of the uterus and appendages and radiation therapy. Chemotherapy drugs are ineffective. A feature of sex cord cancer is its ability to recur after many years. Survival in the early stages reaches 90%.

Diagnostics

Suspicion of ovarian cancer appears during the general and gynecological examination of the patient. The doctor determines an increase in the abdomen, signs of pleural effusion, shortness of breath. With a two-handed examination in the area of ​​​​the appendages, a rounded immovable formation is determined. In the early stages of the disease, these signs are not detected.

Diagnosis of ovarian cancer is supplemented by data from additional research methods.

The first step is ultrasound - transvaginal using a vaginal probe and transabdominal - through the surface of the abdominal wall.

If cancer is suspected, computed tomography of the pelvic organs and abdominal cavity is performed. The method makes it possible to assess the size of the neoplasm, the degree of its germination in other organs, the change in the lymph nodes.

MRI in ovarian cancer is also a highly informative diagnostic method.

Given the high probability of the spread of the malignant process in the peritoneum, the study of ascitic fluid by paracentesis (puncture of the abdominal wall) is not carried out. Also avoid puncture of ovarian cysts. To obtain an effusion, a puncture of the posterior fornix of the vagina is often done.

How to diagnose distant metastases?

For this purpose, patients undergo the following studies:

• radiography of the lungs - mandatory;
• fibrogastroduodenoscopy and colonoscopy (endoscopic examination of the stomach and colon) - if necessary;
• cystoscopy - if you suspect a lesion of the bladder;
• separate diagnostic curettage.

To assess the effectiveness of treatment, a tumor marker of ovarian cancer, the tumor-associated antigen CA-125, is determined in the blood. In the initial diagnosis of the disease, it is not essential. Changes in its concentration during therapy are important. Some formations secrete alpha-fetoprotein, human chorionic gonadotropin, or lactate dehydrogenase. The level of these substances can also be used as a diagnostic indicator.

To clarify the function of the hematopoietic system, liver and kidneys, a blood test is performed.

If metastases are suspected, the fluid removed from the abdominal and pleural cavities is examined directly during the operation, and a biopsy of the alleged distant foci of the disease, including on the diaphragm, is performed.

To find out if the pelvic lymph nodes are affected, diagnostic laparoscopy is often used - an examination of the abdominal cavity using a flexible optical device - an endoscope inserted through a small incision in the abdominal wall. There are more than 100 lymph nodes in the pelvic area, each of which can only be affected at a microscopic level. This explains the objective difficulties in recognizing the stage of the tumor.

Differential diagnosis is carried out with such diseases as:

Treatment

Treatment for ovarian cancer is based on surgery and chemotherapy. The therapy program is individual and depends on the age, general condition of the patient and the stage of the neoplasm.

I stage

In stage I cancer, when there is no damage to the peritoneum and other organs, the uterus, appendages and omentum are removed. Be sure to search for malignant cells in swabs from the peritoneum. If during the operation foci resembling metastases are found, an urgent biopsy of such areas is performed.

If the tumor is diagnosed in a young woman in the early stages, then with the patient's persistent desire to maintain the ability to bear children, only the affected ovary is removed and biopsy material is taken from the second.

If well-differentiated cancer is found only on one side without germination of the ovarian capsule, chemotherapy drugs after surgery may not be prescribed. If the tumor has an average or low degree of differentiation, in any case, chemotherapy, including platinum preparations, is used in the postoperative period. It is necessary to pass from 3 to 6 courses.

The survival rate for ovarian cancer detected and operated on at an early stage is over 90%.

II and subsequent stages

At II and subsequent stages of cancer, cytoreductive interventions are performed. Cytoreduction is the removal of as much of the neoplasm as possible, including metastatic foci. The better the operation, the better the prognosis. At III-IV stages, chemotherapy is often prescribed to reduce the size of the neoplasm before surgery.

Cytoreductive intervention can be performed in more than half of patients with advanced tumors. This treatment helps reduce symptoms, improve quality of life, and prepare the patient for chemotherapy.

If recurrence of ovarian cancer is diagnosed after surgery, reoperation is rarely performed because it does not improve patient survival. Indications for re-surgical treatment:

• single tumor focus;
• young age;
• the occurrence of a relapse a year or more after the completion of chemotherapy.

At stage IV of the disease, surgery is often refused. Treatment consists in the appointment of anticancer drugs. In such cases, palliative surgery is used, for example, with the appearance of intestinal obstruction.

Conducting chemotherapy

Systemic drug use should be started 10 days after surgery. Chemotherapy for ovarian cancer consists of 6 courses of combined treatment with Carboplatin and Paclitaxel or Cyclophosphamide. They are administered within one day, a second course is prescribed after 3 weeks. Treatment allows to achieve a relapse-free period of up to 18 months. The life expectancy of patients increases to 36 months.

Anticancer drug "Carboplatin"

The previously used drug Cisplatin is poorly tolerated: nausea and vomiting appear, kidneys and the nervous system are affected. Carboplatin has less pronounced toxic effects, but against the background of its use, suppression of the immune function (myelosuppression) is noted. The combination of carboplatin and cyclophosphamide helps to reduce the dosage of the toxic drug.

Before each repeat course of chemotherapy, a blood test is performed. If the number of neutrophilic leukocytes is less than 1.5x109 / l and / or the number of platelets is less than 100x109 / l, the administration of chemotherapy drugs is postponed to a later date. A correctly chosen treatment regimen can achieve remission lasting more than a year in 70% of patients.

Treatment for relapse

When the primary treatment (surgery and chemotherapy) is completed, the patient should visit the gynecologist every 3 months. The level of CA-125 is regularly monitored. An increase in its content in the blood is the first sign of a relapse. If this happens, repeated courses of chemotherapy are prescribed. Recurrence is confirmed by ultrasound, and if necessary - computed tomography.

In the event of a relapse later than a year after completion of treatment, the same scheme is applied as for the first time. If the disease returned earlier, a second line of chemotherapy drugs is used: Paclitaxel, Topotecans, Etoposide, anthracycline antibiotics, and others. The effectiveness of chemotherapy in relapse is low: it is up to 40% and provides a life expectancy of up to 9-12 months.

• in the first 2 years: examination by a gynecologist, ultrasound and determination of CA-125 every 3 months;
• during the 3rd year: the same studies with an interval of 4 months;
• then the survey is carried out twice a year.

IP and targeted therapy for ovarian cancer

A modern method of treatment is the introduction of chemotherapy drugs directly into the abdominal cavity (IP-therapy). This allows the drug to come into direct contact with the tumor, reducing the severity of side effects. For intraperitoneal therapy, Paclitaxel is used, a herbal preparation obtained from a yew tree. Its molecule is large, so the drug is poorly absorbed into the blood, accumulating in the abdominal cavity. It is administered weekly for a month. A more modern remedy from this group is Docetaxel.

Targeted (targeted) therapy is also being introduced into the clinic - the use of agents that act only on tumor cells without affecting healthy tissues (Bevacizumab).

Nutrition

Nutrition after chemotherapy should include more animal proteins and complex carbohydrates. It is better if the dishes will spare the digestive organs. To do this, the products should be steamed, baked or wiped. The less animal fat the patient consumes, the better. You need to eat in small portions, but often - up to 6 times a day.

The ovarian cancer diet includes the following foods:

• protein: nuts, eggs, sea fish, lean meat (veal, poultry);
• dairy: kefir, curdled milk, cottage cheese, low-fat and mild cheese, butter;
• vegetable: apples, citrus fruits, cabbage, bell peppers, zucchini, eggplant, greens;
• cereals: whole grain bread, oatmeal and buckwheat porridge;
• carbohydrates: honey.

It is necessary to abandon salty, canned, spicy, spicy foods and seasonings, as well as alcohol.

Treatment with folk remedies will not help get rid of ovarian cancer, but will only lead to the loss of precious time for the patient. Medicinal herbs can temporarily mask the manifestations of the disease, but will not stop the growth of the tumor.

Forecast and prevention

In general, ovarian cancer is characterized by an unfavorable course. However, the prognosis largely depends on the stage of the tumor.

How long do patients live after confirmation of the diagnosis?

On average, 40% of patients live for 5 years or more. At an early stage, this figure increases to 90%. In stage III tumors of distant organs, it is not higher than 20%.

A high risk of cancer recurrence is associated with the following factors:

• low degree of differentiation;
• involvement of the ovarian capsule;
• the presence of a focus on the outer surface of the organ;
• detection of malignant cells in washings and biopsy material of the peritoneum;
• ascites

Due to the unclear causes of the disease and the mechanisms of its development, the primary prevention of cancer is nonspecific. It is based on the prevention of constant ovulation. Pregnancy has a positive effect. It is necessary to treat gynecological diseases associated with hormonal imbalance, as well as infertility, in time.

Screening studies (determination of tumor markers, ultrasound) have low efficiency and high cost, so they have been abandoned all over the world.

Scientists conducted a study on the role of nutrition in the prevention of this tumor. 30 thousand women within 4 years have reduced the share of animal fats to 20% of daily calories, and also increased the consumption of vegetables and fruits. During this period, their incidence did not change, but in subsequent years it decreased by 40%. These data were not considered reliable. However, the overall trend towards reduced tumor risk with dietary changes is undeniable.

Criteria for referral of a woman for genetic counseling to determine the risk of familial ovarian cancer:

• at least 2 close relatives (mother or sisters) suffer from breast, endometrial or ovarian cancer;
• more than a third of women over 35 in the family have the listed diseases;
• the presence of relatives who fell ill at the age of 20 - 49 years;
• the presence in the family of primary multiple tumors, including damage to the reproductive system.

These criteria allow you to identify a risk group and carefully diagnose. This allows you to recognize a malignant tumor at an early stage, when the effectiveness of treatment is very high.

Among the many pathological processes, theorists and clinicians at all times were most interested in those that most often led to the death or disability of patients. Without exaggeration, we can say that the most severe and insidious disease of malignant genesis in women is ovarian cancer (OC). The problem of this pathology has been and remains one of the most urgent and difficult sections of oncology, and therefore is widely discussed in various fields of medicine.

Ovarian cancer (OC), along with malignant tumors of the cervix and uterine body, is one of the most common diseases of oncological nature and ranks third in world statistics. According to the literature, ovarian carcinoma accounts for 6-8% of all oncological diseases and 20-25% of malignant tumors of the female genital organs, and ovarian cancer accounts for about 80% of all adnexal tumors.

According to the International Agency for Research on Cancer (IARC), most countries are characterized by an increase in the incidence of malignant ovarian tumors (OMT). Meanwhile, mortality rates do not tend to decrease.
Of all oncogynecological pathologies, mortality from OC in terms of mortality is in first place, and in almost half of cases (47%), mortality from genital cancer is due to OC. Moreover, 2/3 of malignant ovarian tumors are detected in the late stages, when the pathological process passes beyond the affected organ, although in 60% of patients the time from the onset of the first symptoms to the correct diagnosis is about 6 months, in 80% of them already detected metastases to various organs. Late diagnosis is due to the absence of specific clinical manifestations in the early stages of the development of the tumor process, the tendency of the ovarian tumor to early metastasis, the difficulty in detecting the tumor during physical, radiological and ultrasound examination due to the anatomical and topographic features of the ovaries, the absence of strictly determined risk groups requiring regular in-depth examination. The overall 5-year survival rate for this category of patients in leading cancer centers does not exceed 20-35%.

Analysis of trends in morbidity and mortality and their geographical features allows us to get closer to understanding some aspects of the etiology and pathogenesis of this disease (Makarov O.V., 1996).
At present, a significant amount of experimental, epidemiological and clinical facts have been accumulated, which make it possible to identify many aspects of the etiopathogenesis of OC, despite this, the causes of most ovarian tumors remain unknown. Reviews of numerous studies indicate a high incidence of ovarian cancer in industrialized countries, with the exception of Japan. This may be due to dietary factors, namely, a high intake of animal fats, although recent studies do not confirm the association of the development of OC with either high-calorie foods or the use of alcohol, caffeine and nicotine. There is also no convincing evidence of a possible carcinogenic effect of radiation used for diagnostic and therapeutic purposes in the development of OC, although experimental models of ovarian tumors were created by irradiating rodents with X-rays or by transplanting ovarian tissue into the spleen or other organs of the portal system. Several studies have linked the development of ovarian carcinomas with the use of talc for hygiene purposes.

The greatest role in the development of OC is currently assigned to hormonal and genetic factors.
Genetic predisposition was found in 1/3 of patients with OC. It is assumed that this disease is inherited according to the recessive type of constitutional and endocrine-metabolic features characteristic of OC. Hereditary forms of OC tend to run in families - hence their working name "familial cancer". Family analysis indicates the association of OC with endometrial and breast carcinoma on the maternal side, and on the paternal side, colon cancer is the most dangerous. According to the world literature, familial forms of OC can be 10%.

L.V. Akulenko et al. (1998) proposed criteria for identifying hereditary forms of OC. These are:

• the presence in the family of 2 or more relatives of the 1st degree of kinship (mother and daughter, sister and sister) affected by OC and / or endometrial cancer, and / or breast cancer;
• the proportion of affected and unaffected family members (women aged 35 and over) should be 33-50%;
• the presence in the family of patients with cancer at the age of 20-49 years (the average age of those affected is 43.0+-2.3 years;
• the presence in the family of one or more patients with primary multiple tumors of different anatomical localizations, including cancer of the organs of the reproductive system;
• the presence in the family of one or more patients with bilateral breast cancer.

There are three types of familial cancer syndrome. In the first type of syndrome, OC can be traced in several generations. Women in these families have an increased risk of disease and other malignant neoplasms (equal to the population average). In the second type of syndrome, a symptom complex is observed: ovary - mammary gland. Women suffer from OC and breast cancer 1.5 times more often than in the general population. Family cancer syndrome of the third type - common cancer syndrome (Lynch syndrome -II). Women and men have a sharply increased risk of colon cancer and, to a lesser extent, adenocarcinomas of other localizations.
One of the important modern achievements is the proof of genetic damage in the etiology of OC at the level of oncogenes and suppressor genes and the introduction of this knowledge into clinical practice. Among the most studied gene factors of carcinogenesis is the activation of the K-ras oncogene, the detection of mutations in which can serve for the differential diagnosis of mucinous ovarian cancer. Amplification of c-erbB2\HER2, occurring in OC in 10-50%, indicates an unfavorable prognosis of the disease. Studies of the p53 suppressor gene responsible for apoptosis of damaged cells and participating in the cell division cycle, as well as other apoptosis genes that are inactivated in about half of cases of borderline malignant ovarian tumors, can serve as a prognostic factor for OC. Significant advances in molecular genetics have been made in identifying the role of hereditary mutations in the BRCA1, BRCA2, as well as MSH2, MLH1 genes. In carriers of oncogenes BRCA1, BRCA2, by the age of 60, the incidence of OC can reach 70%. Such women are strictly shown ophorectomy after the completion of the reproductive period.

Studies on the creation of experimental ovarian tumors by irradiating rodents with X-rays and by transplanting ovarian tissue into the spleen and other organs of the portal system have become classics, which made it possible to formulate a theory of pathogenesis from the point of view of hormonal imbalance towards the predominance of gonadotropic hormones. Numerous epidemiological studies have noted that pregnancy reduces the risk of OC, and a large number of pregnancies have a significant protective effect. Infertility also increases the risk of developing ovarian cancer, and drugs that stimulate ovulation for more than 12 cycles increase the risk by 2-3 times. At the same time, the use of oral contraceptives reduces the risk of developing this type of cancer. In a large WHO-sponsored study, the relative risk of developing OC in women who have ever taken oral contraceptives was 0.75. Explanations for hormonal factors can be found in the "ovulatory" hypothesis, postulating that the risk of developing ovarian cancer is directly dependent on the number of ovulatory cycles throughout a woman's life. The integumentary epithelium of the ovary, from which most ovarian tumors develop, undergoes proliferation and repair after each ovulatory cycle. The greater the number of ovulations, the higher the potential risk of deviations in reparative processes, which leads to malignant transformation.
Other pathogenetic hypotheses for the development of OC reveal immunological, biochemical, and histochemical mechanisms.
Thus, in matters of etiology and pathogenesis, researchers do not always come to a consensus, and therefore the problem of further epidemiological research remains relevant. The search for etiological agents of OC, which contribute to the identification of correct risk factors for the formation of risk groups and revealing the mechanisms of pathogenesis, is still promising.

90% of ovarian tumors originate from the coelomic epithelium or mesothelium as a result of mesodermal cell metaplasia. 75% of epithelial ovarian tumors are serous cancer, 20% are mucinous and 2-3% are endometrioid cancer. All other forms of malignant epithelial ovarian tumors account for 3%. The peak incidence of ovarian cancer falls on the age period of 55-65 years. The average age of patients with endometrioid ovarian cancer is approximately 10 years lower than that of patients with mucinous ovarian cancer. Serous ovarian cancer occupies an intermediate age niche.

Serous ovarian cancer is a tumor that has a multi-chamber cystic or cystic-solid structure. Tumor cells form a serous fluid similar to that secreted by the epithelium of the fallopian tubes. In the early stages of development, the surface of the cystic tumor is smooth, whitish in color. Serous ovarian cancer is characterized by an aggressive course. In 50% of cases, serous cancer affects both ovaries. The size of the tumor is large or even gigantic. Serous ovarian cancer can be highly, moderately or poorly differentiated. The tumor quickly grows into the capsule, invades adjacent organs and forms many implantation metastases of various sizes in the parietal and visceral peritoneum, massively affects the greater omentum. Ascites is formed in most patients.

Mucinous ovarian cancer macroscopically is a multi-chamber cystic or cystic-solid tumor, the inner capsule of which is lined with mucus-forming epithelium. In 10-30% of cases, both ovaries are affected by the tumor. The tumor can reach a gigantic size and develop against the background of a benign or borderline mucinous cyst. Often the tumor has a fairly long stalk that can twist. In such cases, a clinic of an acute abdomen develops. Papillary growths in mucinous tumors are less common than in serous cancer. In the vast majority of patients with mucinous cancer, the tumor does not grow into the ovarian capsule and adjacent organs, but forms implantation metastases in the peritoneum and greater omentum. Massive carcinomatosis is more characteristic of serous cancer. The degree of differentiation of the cells that make up the tumor can be different. If the contents of a mucinous tumor enter the abdominal cavity, pseudomyxoma of the peritoneum may develop. In this case, the abdominal cavity may contain a huge amount of mucous content with the formation of many areas of compressed mucin, which compresses the abdominal organs.

Endometrioid ovarian cancer can be either cystic or solid. In about half of the cases, the tumor affects both ovaries. The tumor contains papillary growths, which are more than in mucinous cancer, but less than in serous malignant tumors. Endometrioid malignant tumors of the ovaries practically do not reach large sizes. Histologically, endometrioid ovarian cancer is similar to endometrial adenocarcinoma. The degree of differentiation of endometrioid cancer cells can be different. Foci of benign squamous metaplasia indicate a good prognosis, while mixed squamous cell tumors have a very aggressive clinical course and a poor prognosis. Carcinomatosis is rare. Implantation metastases are observed in the pelvic organs and the greater omentum. Often, endometriotic cancer develops against the background of endometriosis of the ovaries. Endometrioid ovarian cancer can be combined with endometrial adenocarcinoma, and if the histological structure of these tumors is different, we can talk about primary multiple endometrioid cancer.
The leading clinical symptoms of common forms of ovarian cancer are due to the size of primary tumors, invasive growth in adjacent organs, and massive implantation of tumor cells in various anatomical structures of the abdominal cavity. The second most clinically significant way of spreading ovarian cancer is lymphogenous tumor metastasis. First of all, lymphogenous metastases affect the lumbar lymph nodes, then the iliac and obturator ones. Often, with III-IV stages of ovarian cancer, tumor metastases can be observed in the lymph nodes of the supraclavicular region, neck and inguinal zone. Already at the I clinical stage of ovarian cancer, lymphogenous metastases in the lumbar groups of lymph nodes account for 18%, at II - 20%, III - 42%, stage IV - 67% of cases. Hematogenous metastasis of the tumor usually occurs after implantation and lymphogenous, when there is a significant spread of the tumor. The most common distant metastases are in the liver and lungs. Ovarian cancer is characterized by metastatic pleurisy.
In the early stages of development, ovarian cancer is asymptomatic. Ovarian cancer of I and even II clinical stages in most cases is an accidental finding during various surgical interventions on the abdominal organs and examinations performed for gynecological or extragenital pathology. Complaints of patients reflect the already significant spread of the process: an increase in the abdomen, pain, menstrual dysfunction or the function of adjacent organs of the small pelvis, shortness of breath. Sometimes patients find a volumetric formation in the abdominal cavity, note weight loss, fever, decreased appetite, and an increase in peripheral lymph nodes.
Diagnosing common forms of ovarian cancer is not difficult. Bimanual rectovaginal examination allows the vast majority of patients to reveal a volumetric formation in the small pelvis. The upper pole of the tumor can be palpated in the hypo- or mesogastric region, the lower one - in the Douglas space. Often, a single tumor conglomerate is determined in the small pelvis, including the internal genitalia, part of the large intestine, and loops of the small intestine. With a small amount of ascitic fluid, a metastatically altered greater omentum can be palpated. Cytological examination of ascitic fluid or exudate from the pleural cavity allows you to verify the diagnosis. Highly informative methods for diagnosing malignant epithelial tumors of the ovaries are ultrasound and determination of the level of the tumor marker - antigen CA-125 in the blood serum. To establish the prevalence of the malignant process, X-ray examination of the organs of the chest cavity, colonoscopy, gastroscopy, irrigoscopy, cysto- and sigmoidoscopy allow. If necessary, radioisotope renography, excretory urography, computed tomography, laparoscopy are performed.
Diagnosis of ovarian cancer in the initial phase of its development is difficult. A gynecological examination reveals unilateral, less often bilateral formations, which in women of the reproductive period of life should be differentiated, first of all, with functional cysts, inflammatory pseudotumors, endometriosis, and fibroids.
In women of premenopausal and postmenopausal periods of life, the detection of an adnexal mass of 8 cm or more almost always requires surgical intervention. Differential diagnosis is carried out with benign tumors of the ovaries, uterine fibroids and metastatic lesions of the ovaries in cancer of the stomach, colon and breast. The final diagnosis is established during a diagnostic laparotomy with a mandatory intraoperative histological examination.

Early diagnosis of OC remains the main unresolved problem in gynecological oncology. Clinical recto-vaginal examination of the small pelvis often allows the identification of an ovarian neoplasm. Since the 1970s, thanks to the introduction of ultrasound technology, a new era has begun in the diagnosis of ovarian tumors. Ultrasound examination of the small pelvis has become a routine method in the examination of a patient with a suspected ovarian tumor. With small neoplasms in the small pelvis, transvaginal echography is the most informative; with formations larger than 6-7 cm, the role of transabdominal echography increases. Ovarian cancer in the early stages is echographically a cystic formation with single papillary formations with fuzzy contours, while at stages 1C and II, extensive papillary growths are already visualized with a violation of the integrity of the cyst capsule and a small amount of fluid is determined in the retrouterine space. For generalized stages of OC, echographically, the presence of an irregularly shaped tumor conglomerate of a cystic-solid structure with blurred boundaries and growths along the outer contour is characteristic. Ascites is detected in 70-80% of cases. When identifying echographic signs of malignancy of the tumor process in the ovaries and beyond, it is necessary to differentiate the primary and secondary lesions of the ovaries.
Sonographic criteria for the differential diagnosis of primary and metastatic ovarian cancer

Criteria: primary cancer, metastatic cancer
Side of the lesion: more often bilateral always bilateral
The structure is cystic-solid: predominantly cystic Solid, less often with necrosis in the center
Tumor size: over 10 cm Up to 10 cm
Contours of the tumor: indistinct, uneven Clear, bumpy
Communication with the uterus: in the conglomerate with the uterus, there is no connection with the uterus

The advantages of the ultrasound method in the diagnosis of ovarian tumors are its high information content, simplicity, speed, harmlessness, painlessness, the possibility of objective documentation and repeated testing.
As the next step in the in-depth diagnosis of OC, X-ray computed tomography can be called in cases where echography does not give a clear idea of ​​the degree of tumor lesion.
Of great importance in the diagnosis of OC is the search for tumor markers - specific biological substances produced by the tumor, which could be determined by biochemical or immunological methods. Two groups of tumor markers are currently best known: oncofetal antigens (alpha-fetoprotein and human chorionic gonadotropin) and tumor-associated antigens (CA-125, CA-19-9 and CA-72-4).
The determination of oncofetal antigens in the blood of young patients with tumor formations of a solid structure in the ovaries indicates the presence of a germ cell tumor. Determining the level of oncofetal antigens during treatment and after its completion makes it possible to judge the effectiveness of therapy. Of the tumor-associated antigens, CA-125 has been the most studied. This tumor marker is a glycoprotein antigen produced by cells of serous malignant ovarian tumors and is determined using monoclonal antibodies. CA-125 is not strictly specific for OC, its level can be increased in liver cirrhosis, acute pancreatitis, endometriosis, uterine myoma and pregnancy. In young women, its concentration during the menstrual cycle can also fluctuate. However, the content of CA-125 over 35 U/ml is determined in almost 80% of patients with OC: in 90% with advanced OC and in 50% with early stages. This is much more common than in non-tumor pathological conditions (in 5-10%) or in healthy women (up to 1%). Therefore, CA-125 is the standard in the examination of women in the detection of tumor masses in the pelvis, suspicious according to the clinical and echographic studies of cancer. At the same time, the possibility of obtaining false positive results among a healthy contingent of the examined does not allow the use of CA-125 as a tumor marker for screening programs for the early detection of ovarian cancer. The determination of the level of CA-125 in the dynamics of cancer treatment and further monitoring of patients to detect relapses of the disease is of the greatest importance.

The search for more sensitive and specific tumor markers of OC continues. Macrophage colony-stimulating factor (M-CSF), which is determined in 70% of patients with OC, may be an addition to CA-125. At present, in connection with the development of proteomics, new methods for the search for highly specific markers for various tumors are being developed and mastered, which is a promising direction in oncology.
Unfortunately, the proposed screening programs for the detection of ovarian cancer do not meet most of the requirements formulated by WHO experts for routine screening in oncology. Firstly, the issues of the pathogenesis of the disease have not been resolved so far, namely, the question of the progression of a benign ovarian cyst into a borderline one, and that, in turn, into an invasive carcinoma, remains unclear. Secondly, the proposed diagnostic tests are not strictly specific for the detection of ovarian cancer, especially in the early stages, because they give a high percentage of false positive results. Thirdly, therapeutic tactics have not been finally determined for various degrees of the spread of the tumor process, and the results of the treatment of ovarian cancer remain unsatisfactory.
One of the most important points influencing treatment planning is setting the stage of the disease.
Until the mid-1960s, there was no unified system for the clinical classification of ovarian tumors. There were a number of classifications based on operational findings. Latour I. P., Davis V. A. (1957), Holme G. M. (1957), Henderson D. N (1957) attributed to stage I OC a unilateral lesion of the ovary, without germination of the capsule and adhesive process, in which complete tumor removal. To stages II and III, these authors attributed cases with rupture or germination of the capsule, various variants of spread within the small pelvis, and to stage IV they unanimously attributed cases with tumor metastases within the abdominal cavity. Cases with distant metastases were classified by some authors into a separate group - IV L, VI, etc. The classifications proposed by Bean Z. L. (1957), Muller (1959), Hoffmann V. D. (1962) were based on tumor mobility and the possibility of surgery. They did not reflect the degree of spread of the tumor (Nechaeva ID, 1972), but laid the foundation for the principles of postoperative staging and evaluation of the results of cytoreductive operations.

In the USSR until 1985, along with the constantly improving FIGO (1964, 1970, 1976, 1985) and TNM (1954, 1967, 1970, 1981, 1987, 1992) classifications, the USSR Ministry of Health classification of 1956 was used, according to which Stage I included damage to only one ovary, stage II - transition to other genitalia, stage III - dissemination of the parietal peritoneum of the small pelvis, involvement of regional lymph nodes and the greater omentum in the tumor process. Stage IV, along with the germination of neighboring organs, distant metastases, included all ascitic forms and cases with lesions of the peritoneum outside the small pelvis. Only the widespread development of chemotherapy, which can significantly affect the state of intraperitoneal metastases, made it possible to abandon the previous staging of OC and move on to
modern FIGO and TNM classifications. However, until now, all clinical classifications of OC remain rather conditional. It is possible to single out a truly localized stage, in which the focus is limited to one ovary, without damage to the capsule, and the five-year survival rate of patients in this group reaches 90%, which all modern authors agree with, and the second, when the process has gone beyond the ovary, thereby has become systemic. Even with diagnosed "early" stages of OC according to modern classifications, latent metastases in the peritoneum or in the lymph nodes reduce five-year rates to 70-40%. Five-year results in SS and IV stages, according to the literature, do not exceed 10% despite progress in treatment.
The scientific development of knowledge about ovarian tumors begins in the middle of the 19th century. At this time, the immediate results of the treatment of OC were not very comforting due to the high postoperative mortality, and the long-term results of 6-15% were completely unsatisfactory. With the advent of radiation therapy at the beginning of the 20th century, attempts were made to supplement surgical intervention with radiation, but the percentage of cures among all patients with OC was at the level of 20-27%. A new round in the development of medical care for patients with OC in the USSR dates back to the mid-50s, when one of the first domestic chemotherapy drugs, sarcolysin, was discovered. There have been reports of a small number of objective remissions with this drug.
Until the mid-70s, countless studies were carried out to optimize the surgical treatment of OC from bilateral adnexectomy to superradical operations on the pelvic and abdominal organs (Bohman Ya. V., 1993, etc.).
A new stage in the development of curative care for ovarian cancer began in the 80s
years with the introduction into clinical practice of polychemotherapy based on the drug
goods of platinum. This stage was reflected in the results of population statistics.
US research. So for the period from 1974 to 1986-91, the relative five-year survival rate has undergone a statistically significant increase for the white population from 36% to 44%. The next step in the development of chemotherapy
Since the first half of the 1990s, OCs have been clinical trials and practical introduction of taxanes and a wide range of second-line drugs. The first publications about taxol concern its use in platinum-resistant cases of OC, and now taxol and its analogues have firmly established themselves as first-line drugs in the USA and other developed countries.

The current standards for the treatment of ovarian cancer were formed by the International Group for the Study of Ovarian Cancer at the 7th International Conference on Gynecological Oncology, held in Rome in 1999.
There are five types of surgery for ovarian cancer:

• Primary cytoreductive surgery consists in removing as much of the primary tumor as possible and its metastases. The optimal extent of this operation is the absence of visual signs of tumor or minimal residual tumor.
• Intermediate cytoreductive operation. It is performed for advanced ovarian cancer after 2 courses of chemotherapy in order to reduce the size of the primary tumor and its metastases. The goal of surgical intervention is to remove the tumor masses as much as possible in order to create the most favorable conditions for subsequent chemotherapy.
• Secondary cytoreductive operation. The operation is performed in patients with ovarian cancer who have undergone combined treatment, but have a residual tumor or a localized recurrent tumor larger than 5 cm.
• Second look operation. Diagnostic laparotomy, which is performed on a clinically cured ovarian cancer patient with normal CA-125 levels and no ultrasound or radiological signs of the disease. The semantic significance of this operation is the morphological confirmation of the patient's cure and the determination of further management tactics.
• Palliative reoperation. Produced for emergency or urgent indications in patients with disease progression due to intra-abdominal bleeding, intestinal obstruction, peritonitis. The purpose of the operation is to eliminate the cause of an acute abdomen (removal of a decaying tumor, stopping bleeding, resection of a part of the intestine blocked or perforated by a tumor)

In the early stages of OC, which include la, Ib and Pa, as a surgical stage of treatment, it is necessary to perform panhysterectomy with extirpation of the greater omentum at the level of the transverse colon. To substantiate the early stage, a cytological examination of the peritoneal fluid, if any, washes from the peritoneum of the small pelvis, side pockets of the abdominal cavity, liver and diaphragm is mandatory. Poorly differentiated tumors require a biopsy of the pelvic and para-aortic lymph nodes. In young women with highly differentiated ovarian cancer or tumors of borderline malignancy, if the patient wishes to maintain childbearing function, an organ-preserving operation is possible: unilateral adnexectomy with mandatory resection of the second ovary, omentectomy and cytological control. In such observations, which are extremely rare, after childbirth, the uterus is extirpated with the remaining appendages. It should be remembered that organ-preserving surgery for ovarian cancer is the exception, not the rule.
Laparoscopy for suspected OC is performed only for diagnostic purposes. A number of authors recommend this method for biopsy of pelvic and para-aortic lymph nodes as a standard. Inadequate laparoscopic interventions for the surgical treatment of ovarian cancer should be avoided.
If early-stage OC is confirmed, adjuvant chemotherapy may not be performed in cases of borderline malignancy and well-differentiated cancer. In other cases, combined chemotherapy is recommended in the amount of 4-6 cycles of platinum preparations with alkylating agents. The use of taxanes and anthracyclines in induction chemotherapy in the early stages of OC remains debatable. The effectiveness of methods such as radiation therapy and hormonal treatment in the early stages of OC has not been proven.
In a locally advanced and disseminated process, to which a number of authors include stage 1c, due to the presence of tumor cells in the peritoneum, surgical intervention should always be a stage of complex treatment and be of a cytoreductive nature. The optimal cytoreductive operation is subtotal hysteradnexectomy or panhysterectomy with extirpation of the greater omentum, with a decrease in residual tumor masses, according to different authors, from 0.5 to 2 cm3. Only optimal cytoreduction can be the basis for staging the III stage, in which the long-term results are noticeably better compared to the III stage, in which, unfortunately, there are more than half of the patients who received complex treatment. In everyday clinical practice, there are situations when complete removal of the tumor is impossible. Massive carcinomatosis, the “armored” greater omentum completely replaced by a tumor, tumor invasion into the diaphragm, the porta of the liver and its parenchyma, the lesser omentum, the mesentery of the small intestine, and the retroperitoneal spaces often force the surgeon to minimize the amount of surgical intervention. At the same time, one should always strive to remove the primary tumor, most of the omentum and large tumor nodes on the parietal peritoneum.

At stage III, the volume of intervention can be reduced only because of the impossibility of removing tumor masses without damaging vital organs. Removal of the lymph nodes of the retroperitoneal space in OC, according to many surgeons, is diagnostic. Supplementing the operation with appendectomy, splenectomy, removal of the affected parts of the intestine, can only be carried out in order to achieve a conditional radical operation. Palliative interventions with an increase in intestinal obstruction are performed in order to improve the quality of life of patients. With massive distant metastases to the liver and lungs, cytoreductive intervention is not indicated. In turn, it is not possible to operate on about 10% of patients with ovarian cancer during the initial visit. The main reasons for such clinical situations are the germination of the primary tumor in adjacent organs and soft tissues of the small pelvis, total carcinomatosis and multiple metastases in the abdominal organs, ascites, pleurisy, aggravated somatic condition, elderly and senile age, and a sharply weakened condition of patients. Treatment of this category of patients begins with systemic polychemotherapy. As a result of a short course of induction chemotherapy (2-4 cycles), it is possible to perform intermediate cytoreductive surgery in approximately 30% of patients. The operation is undertaken in order to reduce the mass of the primary tumor and its metastases and, thus, increase the effectiveness of subsequent chemotherapy, as well as improve the quality of life of patients. It has been proven that intermediate cytoreductive surgery increases the survival rate of patients with ovarian cancer.

Systemic chemotherapy for locally advanced and metastatic forms of OC is an obligatory component of treatment, in the amount of at least 6 courses. With the ineffectiveness of first-line chemotherapy, a transition to other groups of drugs is possible. The choice of chemotherapy options is not the task of population studies in OC.
It was expected that the widespread introduction of the latest chemotherapeutic drugs, such as taxol, gemzar, etc., should increase the median survival of patients with OC by 12 months. However, the question of the effectiveness of taxanes as first-line chemotherapy still remains open, since international clinical studies of the Gynecological Oncology Group - GOG-111, GOG-132, ICON-3 - give conflicting results about their advantage over platinum-containing combination chemotherapy.
The question of indications for radiation therapy in common forms of OC
remains open.
Despite the developed standards, questions are still being raised to optimize the treatment of OC, such as: 1. The role of organ-preserving operations and adjuvant chemotherapy in proven early stages of OC. 2. Place of lymphadenectomy in the treatment of OC. 3. The role of neoadjuvant chemotherapy and the rational number of cycles of chemotherapy before attempting cytoreductive surgery. 4. Significance of excessive radicalism during the surgical stage of treatment. 5. The role of repeated surgical interventions after the end of the first line of chemotherapy.

The prognosis of patients with ovarian cancer depends primarily on the stage of the disease (the prevalence of the process), the histological structure of the tumor and the ploidy of tumor cells. This is followed by: the degree of differentiation of tumor cells, the expression of the HER-2/neu oncogene, the rate of tumor reproduction, the size of the residual tumor after surgery, the severity of ascites and the age of the patient. The most unfavorable prognosis is observed in patients with massive disseminated forms of malignant epithelial ovarian tumors. Polyserositis and distant metastases in elderly and senile patients who have verified clear cell or poorly differentiated serous cancer with aneuploidy of tumor cells reduce the chances of curing the patient to almost zero. While highly differentiated malignant ovarian tumors of any histological structure of stages IA and IB are cured in 95-100% of cases. The given prognostic factors in patients with advanced forms of ovarian cancer due to the massive spread and large total volume of the tumor have no significant prognostic value, and any treatment methods are only palliative.

Properly performed diagnosis allows you to determine the most appropriate type of treatment and prolong the life of the patient. The prognosis of life with a malignant formation depends on the results of treatment and on the stage of the disease.

Treatment of adenocarcinoma

The treatment of ovarian adenocarcinoma is mainly surgical. During the operation, an ovary or two can be cut out, as well as the uterus and fallopian tubes, if they are affected. But, whenever possible, surgeons try to remove the neoplasm itself. This allows the woman to keep the opportunity to have children.
Sometimes patients are given chemotherapy before surgery to shrink the tumor. Also, this method is used after surgical treatment, if there are residual cancer cells.

The essence of chemotherapy is the use of poisons and toxins that have a detrimental effect on malignant cells and destroy them. Of course, along with the tumor, the whole body suffers.

If surgery is contraindicated, chemotherapy for ovarian adenocarcinoma is used as the main treatment. In some cases, it is not even needed, and only helps with the operation. For example, in well-differentiated adenocarcinoma, the prognosis for survival is 95% after surgical treatment.

How and with what drugs the treatment of ovarian adenocarcinoma will be carried out depends on many factors: the age and condition of the patient, the stage of cancer and the size of the tumor, the presence of metastases.

After treatment, constant monitoring of the patient is required. To prevent recurrence of the disease, ultrasound and tests for tumor markers are performed.

Informative video

Disease prevention

To prevent any type of cancer, it is necessary to exclude the influence of factors that can provoke its formation. That is, you need to fight bad habits and excess weight, eat right and avoid stress. Radiation should be avoided whenever possible. It is important to monitor your health, fully treat infectious and inflammatory diseases that can trigger the development of cancer.

If you notice any symptoms of an ovarian tumor in yourself, contact your doctor immediately, and do not postpone it for later. Timely detection of the disease will help you save your life.

No less important is the choice of a good specialist who has experience in dealing with similar cases and who can perform the operation with a positive result.

Informative video

Ovarian carcinoma is a common malignant neoplasm that affects women in late reproductive and early postmenopausal age.

Ovarian carcinoma is a genital cancer and accounts for up to 25% of all oncological processes in a woman's reproductive system in the structure of morbidity.

Ovarian carcinoma is a malignant tumor localized in the stromal or parenchymal tissue of a woman's ovaries and has a primary or secondary origin. The defeat of the ovaries takes up to a quarter of all forms of genital carcinoma. In 70% of cases, ovarian cancer is primary, i.e. develops directly from the cells of the body.

The most common histological form of ovarian carcinoma is the serous variant of the tumor, which is detected in 50% of cases. In second place in terms of frequency of occurrence is the endometrioid form, and in third place is the mucinous form of cancer.

In general, ovarian carcinoma is ranked second in frequency among tumors of the female reproductive system, second only to malignant neoplasms of the uterus. In the structure of mortality, ovarian tumors occupy the fifth place, which characterizes them as one of the leading causes of female mortality in oncology.

Causes

There are non-specific reasons for the development of the oncological process, as well as specific ones, i.e. specific to each specific type of tumor. Nonspecific causes include all external environmental factors that reduce the body's resistance to pathogens and weaken the immune status.

In the case of ovarian carcinoma, there are a number of characteristic causes that directly affect the development of a malignant neoplasm:

• No history of childbirth is one of the most actively researched causes. Despite the lack of data on the pathogenetic mechanism, there is a certain correlation between the incidence of carcinoma and the absence of pregnancies in history.
• Another addiction has long been noticed, use of combined oral contraceptives significantly increases the risk of developing malignant neoplasms in the ovaries, as well as vice versa - not taking oral contraceptives is a factor in the formation of carcinoma.
• hereditary predisposition- despite the fact that in almost all cancers the hereditary factor plays a large role - in the case of ovarian carcinoma, there is a clear relationship between the detection of the disease and the severity of the family history.

Also, significant risk factors for the formation of carcinoma include systematic gonadotropic stimulation, the concomitant presence of myomatous nodes in the uterus, chronic inflammatory processes occurring in the internal genital organs and the late onset of menopause.

Process staging

The International Association of Obstetricians and Gynecologists FIGO has developed its own classification of the staging of the oncological process in ovarian cancer, which is fully compatible with the international universal classification TNM, but has a number of divisions in the classification that are valuable in the practice of oncogynecologists:

I stage– The tumor is localized directly in one or both ovaries.

I A - Oncological process on the one hand.

I B - Both organs are involved in the oncological process.

I C - The tumor is determined on the outer surface, the presence of exudative effusion in the abdominal cavity.

II stage– The spread of the malignant process to the peritoneum and pelvic organs.

II A - The tumor affects the uterus or fallopian tubes.

II B - Invasion or infiltration of the bladder or various parts of the large intestine.

II C - Involvement in the process of the peritoneum, pronounced ascites.

III stage- Metastatic lesions of the abdominal organs. Spread of metastases to the liver tissue, abdominal and inguinal lymph nodes.

III A - Damage to the iliac, para-aortic groups of lymph nodes, colonization of the peritoneum without going beyond the small pelvis.

III B - Determination of metastases with dimensions not exceeding 2 cm.

III C - Metastases larger than 2 cm and lesions of the retroperitoneal lymph nodes.

• IV stage- The presence of distant metastases.

Kinds

Ovarian carcinoma has several types of histological structure, which depends on a combination of pathogenetic factors. Oncogynecologists distinguish the following types of malignant neoplasms of the ovaries:

• Tumor from serous tissue;
• endometrioid tumor;
• Mucinous tumor;
• Endometrioid stromal sarcoma;
• Brenner's tumor;
• Unclassified low-grade epithelial tumors.

The frequency of occurrence of all of the above tumors is in descending order.

Classification by localization

Local lesion with ovarian carcinoma, it corresponds to stage I of the oncological process. With sufficiently highly differentiated malignant tumors, the progression of tumor growth can take a rather long time period, which is typical for tumors of serous origin. With a local lesion, the prognosis remains favorable.

The spread of the tumor process to the small pelvis, and more precisely to its peritoneum, corresponds to stage II and is accompanied by a pronounced exudation of fluid into the abdominal cavity, which is called ascites. Ascitic fluid can accumulate in large volumes, which can lead to distension of the anterior abdominal wall due to increased intra-abdominal pressure.

Metastases to distant organs- corresponds to stage IV and is the terminal stage of the progression of tumor growth. Damage to various organs and systems, as well as cancer intoxication and cachexia, leads to multiple organ failure and decompensation of all pathological processes in the body. Mortality in stage IV is more than 95%.

Classification by structural and functional properties

Serous tumor- begins its development from the stromal connective tissue elements of the ovary. This form occurs most often and, despite the malignancy of the process, has a slow rate of tumor progression.

Most often, a stromal tumor is diagnosed at stage I, and with radical combined surgical and radiation treatment, it is possible to achieve a high five-year survival rate for patients.

1. endometrioid form- is in second place in terms of occurrence. The tumor develops from the endometrial tissue. It may be primary, but is most often diagnosed along with a malignant lesion of the endometrium of the uterus and is secondary. Macroscopic examination of the tumor often reveals cystic cavities.
2. Mucinous tumor- is relatively rare and almost always affects only one of the ovaries. The tumor is low invasive but rapidly growing. Such tumors often have a homogeneous solid structure.
3. clear cell carcinoma- is very rare and is detected in less than 1% of cases of genital cancer. Clear cell carcinoma is a poorly differentiated form with rapid invasive growth. The prognosis for this form is unfavorable.

Symptoms

Symptoms of ovarian carcinoma can be either general, characteristic of all malignant neoplasms, or typical - occurring only in certain cases.

• Irregularities in the menstrual cycle- arise as a result of the formation of a hormonal imbalance of female sex hormones.
• Pain syndrome- the manifestation of discomfort and pain occurs already by the end of stage I, when the tumor begins to grow and stretch the connective tissue capsule of the organ. The pain syndrome is directly proportional to the progression of tumor growth. Pain can also occur during intercourse, which is called dyspareunia.
• Increasing the volume of the abdomen- occurs when a tumor of the peritoneum is affected, which leads to the development of ascites. In the later stages, the tumor itself acquires an impressive size and can even be contoured through the anterior abdominal wall.

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Photo: ascites in severe ovarian cancer

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Diagnostics

To prescribe the most effective treatment for ovarian carcinoma, a thorough diagnosis of the patient is carried out with the determination of tumor markers and such instrumental studies as ultrasound diagnostics, computed tomography and magnetic resonance imaging.

• Definition of tumor markers- an increase in the concentration of alpha-fetoprotein and beta-chorionic gonadotropin in peripheral blood plasma is detected, which makes it possible to suspect an oncological process with high reliability.
• ultrasound- is carried out to establish the localization of the tumor and determine its structure.
• CT and MRI- the necessary studies for a more accurate study of the localization of the tumor and the formation of treatment tactics.

For more information about performing an MRI and reading the results, in the video from the medical conference:

Therapy

Radical treatment of ovarian carcinoma is possible at stages I and II, until the tumor has become widespread. An obligatory component of treatment is the resection of the affected ovaries - oophorectomy.

• Chemotherapy- is effective in hormone-dependent forms of ovarian carcinoma. Can be performed in neoadjuvant mode with possible regression of tumor growth. After a course of polychemotherapy, a mandatory surgical intervention is performed, and after removal of the tumor, control courses of chemotherapy are prescribed.
• Surgical intervention- a radical component of treatment. Depending on the histological picture of the tumor and the stage, both an organ-preserving operation with the removal of only the affected ovary, and an extended operation with extirpation of the uterus and removal of the pelvic parametrium can be performed.

Forecast

The prognosis is ambiguous in ovarian carcinoma and largely depends on the histological form, the stage of the tumor process and the individual parameters of the cancer patient.

Serous tumors in stages I and II have a favorable prognosis, the five-year survival rate is more than 80%.

A conditionally favorable prognosis is made for endometrial and mucinous tumors at stages I and II.

All the remaining forms have an unfavorable prognosis, given the dependence, the lower the differentiation of tumor tissues, the worse the prognosis. Already in the early stages, the five-year survival rate does not reach 60%, and in the later stages it is no more than 5%.

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