Ovarian cancer ranks seventh among all cancers and third among malignant tumors in gynecology. It affects the fairer sex during premenopause and menopause, but also occurs in women under 40 years of age. Early diagnosis of ovarian cancer is a key task of preventive oncological examinations. Timely detection makes it possible to start treatment at the initial stages and increases the chances of effective therapy.
Description of the disease. Origin
Carcinoma of the paired gonads of a woman is a tumor consisting of malignant (malignant) cells that affects the ovaries. Cancer can be primary (its main source is in the tissues of the ovary) and metastatic (the primary focus is located in any other part of the body). The following are considered primary:
- Carcinoma is a malignant tumor that develops from cells of the skin, mucous membranes.
- Dysgerminoma is a cancer that develops from the primary cells of the gonads. Neoplasm isone of the most common and accounts for about 20% of all malignant ovarian tumors.
- Teratoma comes from the germ layer.
- Chorioncarcinoma - one of the most terrible forms of ovarian cancer, is a modification of the chorion epithelium.
- Ovarian stroma is a tumor of non-epithelial origin.
Metastatic cancer of the paired gonads is a malignant tumor of the ovary that appeared as a result of hematopoietic, lymphogenous, implantation movement of malignant cells from another organ.
Most often the ovary is affected by cancer of the colon, cervix, breast. Metastases reach large sizes - up to 20 cm - and quickly spread through the peritoneum. Secondary ovarian tumor occurs in women aged 45-60.
Despite advances in the diagnosis of ovarian cancer in women, approximately 75% of diseases are detected in the later stages. The reason for this is the long asymptomatic course of the pathology.
Classification
Malignant tumors of the ovaries are classified according to the place of occurrence, stages and prevalence.
There are 4 degrees of tumor growth:
- I (T1) - characterized by unilateral ovarian lesion. Mortality at this stage is about 9%. But finding cancer at this stage is rare.
- II (T2) - characterized by the spread of the tumor to both ovaries and pelvic organs.
- III (T3/N1) – gonadal lesion with metastasis to lymph nodes or peritoneum.
- IV (M1) - the formation of secondary foci in otherorgans. The survival rate at this stage is 17%. The main cause of death is the accumulation of fluid in the abdominal cavity, depletion of metastasized organs.
Diagnosis of ovarian cancer at the initial stages reduces the risk of tumor metastasis and the occurrence of serious complications, leading in most cases to death.
Causes of oncology
Factors affecting the occurrence of ovarian malignant tumors have not yet been thoroughly studied, there are only assumptions.
The main hypothesis is that ovarian cancer is formed when the body produces estrogen for a long time. This statement is based on observations of women who have used hormonal contraception for more than 5 years. The main pharmacological property of drugs is the suppression of the production of gonadotropic hormones, which increase the risk of tumor displacement into estrogen-sensitive tissues.
Genetic studies in combination with late and early diagnosis of ovarian cancer in women show that the development of the disease is influenced by a hereditary factor. In this regard, the closest relatives of cancer patients are strongly recommended to undergo a preventive examination.
Also, there are other reasons that affect the occurrence of malignant cells in the ovaries:
- Polyps of the body and cervix.
- Ovarian dysfunction.
- Disruption of the thyroid and adrenal glands.
- Excessive growth of the endometrium.
- Frequent unilateral and bilateraloophorites.
- Infertility.
- Often simultaneous inflammation of the ovaries and fallopian tubes (adnexitis or salpingo-oophoritis).
- Benign, hormonally dependent neoplasms of the smooth muscle tissue of the uterus (fibroids).
- Tumor-like formations from the connective tissue of the uterus (fibroids).
- Ovarian cyst.
- Early puberty and onset of sexual activity.
- Repeated abortions cause hormonal imbalances and ovarian failure.
Also, overweight and bad habits can affect the dysfunction of a woman's paired gonads and the emergence of malignant cells in them.
Clinical signs
Early diagnosis of ovarian cancer helps to start timely treatment, the outcome of which is favorable in most cases. Therefore, it is so important to pay attention to the slightest changes in the body and internal well-being. The symptoms of ovarian cancer are variable. They grow as the tumor spreads:
- General malaise.
- Powerlessness.
- Fatigue.
- Prolonged steady rise in temperature.
- Decreased appetite.
- Meteorism.
- Constipation.
- Dysuric manifestations.
Methods for diagnosing ovarian cancer
Recognition of a tumor in the early stages allows you to start timely therapy and prolong remission. Depending on the classification and clinic of ovarian cancer, diagnosis and treatment are carried out in different ways. Methods and means of assessing the diseaseapply complex. They include examination, anamnesis, laboratory, gynecological examinations using various instruments and apparatus.
Depending on the clinic, the diagnosis of ovarian cancer will have some differences. But to assess the overall picture for preventive and therapeutic purposes, a similar set of studies is used:
- Gynecological examination.
- Transvaginal ultrasound scan.
- Axial computed tomography.
- Radiological examination of the pelvic cavity.
- Diagnostic laparoscopy.
- Specific laboratory tests.
This set of examinations is a standard set for the detection of ovarian tumors.
Laboratory studies
Tests in oncology are prescribed in parallel with the clinical and instrumental examination. They allow interpretation of biopsy data and have important prognostic significance. Histological and cytological studies are of the greatest value:
- Histology of a woman's genital biopsy is the study under a microscope of tissue samples taken from the reproductive organs in order to determine its nature. The material for analysis is a scraping of the endometrium lining the uterus. Testing is scheduled and urgent. An emergency histology is done within half an hour and is usually done during surgery.
- Cervical cytology scraping, or Pap smear, is done to detect cancerous conditions of the organ from which the smear was taken. material forresearch is a biopsy from ecto- and endocervix. The analysis allows you to evaluate the size, external boundaries, number and nature of cells.
- Analysis of aspirates from the uterine cavity is carried out in order to detect diseases of the uterine body. Material for research - prints from the intrauterine device or aspiration of the contents of the organ with a catheter.
Also, the diagnosis of ovarian cancer is carried out by examining tumor markers in blood or urine. Tumor-associated markers are proteins, ribozymes, tumor decay products produced by he althy tissues for the penetration of cancer cells:
- CA-125 is a test that quantifies ovarian cancer markers.
- Cancer-embryonic antigen - detection of the amount of tissue marker of cancer in the blood.
- Squamous cell carcinoma (SCC) antigen - detection of squamous cell carcinoma protein.
- Oncoprotein E7 - a marker that determines the likelihood of cervical cancer formation in women with papillomavirus types 16 and 18.
- Oncomarker CA 72-4 - a test for determining the content of glycoprotein produced by malignant cells of glandular tissue.
- HE4 is a protein secreted by the cells of the reproductive system.
Clinical and biochemical tests are less specific, but without them there will be no complete picture of the disease.
Instrumental methods
Diagnosis of ovarian cancer in women is carried out using various equipment. One of the first examinations is an ultrasound. It allows you to evaluate the volume, shape, structure, degree of spread of neoplasms.
The most commonly used diagnostics of ovarian cancer by ultrasound. An ultrasound scan can be performed transvaginally or transabdominally. The latter method involves placing the transducer on the surface of the abdomen. Such manipulation, as a rule, precedes transvaginal. With this method, the transducer is inserted into the vagina, which allows a more detailed study of the woman's genitals. Ultrasound can be performed at any age, and for gynecological diseases in any phase of the menstrual cycle.
MRI of the pelvic organs is a non-invasive method of examination by fixing radio waves emitted by hydrogen atoms under the influence of a magnetic field.
CT scan of the pelvic organs - examination of the pelvic organs using a tomograph. The diagnostic method can be carried out with the use of X-ray contrast agents or without them. The method allows to detect a tumor in asymptomatic cancer.
Laparoscopy of the ovaries is a minimally invasive method that allows you to give a visual assessment of the pelvic organs and, if necessary, take biomaterial for histological and cytological studies.
Differential diagnosis - what is the point?
Currently, there is no multi-purpose highly informative non-invasive method for early dif. diagnosis of ovarian cancer. Clinicians use a holistic approach that accommodates a range of research procedures.
One of the key factors in the neglect of tumor lesions of the ovaries is itslate detection due to the complexity of diagnosis in the initial stages. During the initial visit, the doctor often makes other diagnoses: ovarian cystoma, inflammation of the appendages, uterine fibromyoma. Before surgery, it is difficult to distinguish a cystoma from a malignant tumor, especially if it is mobile and unilateral. But there are a number of signs, in the presence of which the initial diagnosis is questioned:
- Intensive neoplasm growth.
- Burriness of consistency.
- The tumor is practically immobile.
- Decreased ESR in overt inflammation.
- Mantoux and Koch tests are negative.
- Presence of hypoproteinemia.
- Decreased albumin levels.
- Estrogen overproduction.
- Increased blood levels of ketosteroids, serotonin.
If it is not possible to distinguish a malignant tumor from another neoplasm, they resort to abdominal surgery.
Differential diagnosis of ovarian cancer allows you to distinguish the disease from any other in the early stages. Detection of a tumor at the initial stages contributes to the timely adoption of the right measures to combat it.
Early Cancer Diagnosis
Based on statistical data, the first and second stages of ovarian cancer are detected only in 37.3% of patients. Despite certain achievements, the mortality rate from oncology of the paired gonads is about 40%.
Diagnosis of ovarian cancer at an early stage is practically not carried out due to the lack of signs that accurately describe the pathology,specificity of research methods, as well as the biological properties of the tumor. Screening tests and examinations are used to detect asymptomatic oncology:
- Gynecological examination with visual assessment of the woman's reproductive organs.
- Determination of the CA-125 onomarker
- Pap smear.
- HPV test.
- Transvaginal ultrasound.
Screening does not always help to recognize cancer. In some cases, tests for tumor markers give a false positive result. An additional examination is ordered. Diagnostic methods are not included in the list of free CHI and are usually quite expensive.
False-negative results are also high in the early stages of the disease. Meanwhile, the tumor does not disappear anywhere, but on the contrary, it metastasizes to other organs. Symptoms begin to appear, which often indicate a severe stage of the pathology.
Peculiarities of diagnosing oncology in postmenopause
According to statistics, 80% of malignant tumors are formed in women over 50 years old. In most cases, carcinomas have a cystic structure. In contrast to the diagnosis of ovarian cancer, a Doppler study is sufficient to examine the cyst, provided that the CA-125 blood levels are within the normal range. Long-term follow-up of patients in the last phase of the menopause showed that in 53% of cases the resulting cyst resolves spontaneously.
There are a number of clinical signs that help to identify the tumor in the early stages, but inmost of them go unnoticed. And yet, the primary diagnosis of ovarian cancer in postmenopausal women is based on the presence of just such symptoms.
One of the manifestations is spotting. The occurrence of menstruation is due to the function of the ovaries, the reproductive properties of which fade in menopause. In the postmenopausal period, bleeding from the vagina is a serious reason to visit a gynecologist. Bloody discharge between the regulators during the initial stage of the extinction of the reproductive function is also considered abnormal.
During menopause, the ovaries stop releasing estrogenic hormones. Increased levels of female steroid hormones after the last independent menstruation may indicate the presence of malignant cells in the body.
In menopause, an annual mammogram is mandatory. Statistics show that ovarian metastasis quite often has a main focus in the mammary glands. In women over 50 years of age, when examining the breast, it is necessary to focus on neoplasms that have arisen in it, as they can be an early stage of cancer.
