What is Krukenberg metastasis? This pathology is a secondary cancer. It affects only the female population, because it is found in the ovaries. It is an accumulation of atypical cells that divide and form a secondary tumor. Among malignant neoplasms of the ovaries, it ranks third after epithelial and embryonic forms of cancer. Serves as an unfavorable sign, reporting the spread of the primary malignant formation and the 3-4 degree of the process.
Reasons
Krukenberg cancer is a metastatic ovarian cancer. Metastasis circulates from the abdominal organs, most often the stomach. Rarely, the primary site may be the breast, thyroid, or uterus.
Mechanisms for the development of pathology
The primary tumor becomes an active pathological focus, which is supplied with blood and nutrients. In this case, the cells divide uncontrollably and can bud off. Often they enter the circulatory and lymphatic systems of the body. With the flow of these physiological fluids, malignant cells are carried to other organs and secondary tumors develop. Krukenberg's metastasis is more often localized in both ovaries. Tumorbegins to progress and serve as a source of new metastases.
There are 4 stages of the cancer process:
- 1 stage - one ovary is affected.
- 2 stage - one or both ovaries and surrounding pelvic tissue are involved in the process.
- 3 stage - the tumor is found in one or both ovaries, and there are also metastases in the pelvic peritoneum or retroperitoneal lymph nodes.
- 4 stage - cancer covers both ovaries and serves as a source for new metastases to other organs.
Metastases of Virchow, Krukenberg, Schnitzler and sister Joseph in stomach cancer
Virchow's metastasis - spreads with lymph flow through the thoracic lymphatic duct and is localized in the left supraclavicular region. Feels good on examination.
Krukenberg's metastasis is localized in the ovaries. Schnitzler's metastasis is located in the tissue of the small pelvis and is palpable during digital examination of the rectum. Sister Joseph's metastasis is located in the navel.
Symptoms and treatment of Krukenberg metastasis
Krukenberg's metastasis is localized in the ovaries, which are endocrine organs that produce hormones. A crash occurs. Changes in hormonal levels are manifested by a number of symptoms:
- decreased libido and inability to experience orgasm (frigidity);
- increased perspiration;
- mood swings;
- appearance of male pattern hair (appearance of antennae, hair on the abdomen, chest, back) andchanging the timbre of the voice to a lower one;
- menstrual irregularities (menstruation can be heavy or scanty, there are extraordinary bleeding from the vagina);
- often the aggression of the tumor provokes the onset of menopause.
A woman may also experience discomfort and pain in the lower abdomen, which bother at rest or during intercourse, as well as on the eve of menstruation. In some cases, there is a violation of the process of urination and a disorder manifests itself in the form of cystitis. The tumor can compress surrounding organs. The degree of manifestation of symptoms depends on the size of the tumor, age, general condition of the woman and the presence of concomitant pathology.
The listed symptoms are necessarily accompanied by manifestations of primary cancer.
With oncological pathology of the stomach, symptoms are observed:
- burping with putrid odor;
- nausea and vomiting;
- heaviness in the stomach;
- bloating;
- pain in the epigastric region;
- ascites - accumulation of fluid in the abdominal cavity.
When the process goes to the peritoneum, it begins to produce fluid, the volume of which can reach up to 10 liters. It can be found in the pleural cavity, which is manifested by respiratory and cardiovascular failure.
Any cancerous process leads to the depletion of the body, because it requires an increased fight of the immune system with it, and also requires energy supply with nutritional resources for its growth.
Symptoms of cancer cachexia (wasting)
There arethe following signs of violation:
- general weakness, fatigue;
- increase in body temperature within 37.3-37.5 degrees;
- significant weight loss in a short amount of time;
- loss of appetite or lack thereof;
- taste perversion;
- indigestion.
Krukenberg Metastasis Diagnosis
Very often, the detection of distant metastases precedes the detection of gastric cancer. In this case, the process can proceed already in the advanced stage (3-4). basic diagnostic methods:
- Identification of complaints and study of the history of the development of the disease. It is necessary to detail the symptoms, when it started, what is the reason, whether there are other symptoms from the gastrointestinal tract.
- Inspection. Gynecological examination using mirrors, bimanual examination (two hands). You can find rounded formations with a smooth surface and painless. Be sure to examine the mammary glands and regional (nearby lymph nodes). Digital examination of the rectum to detect Schnitzler's metastasis.
- Ultrasound examination of the pelvic organs with a filled bladder, so the appendages are better visualized. Allows you to quickly determine the pathological focus, its shape, size and degree of spread. There is an ultrasound method with a biopsy.
- Percutaneous biopsy and subsequent cytological examination describing Krukenberg's metastasis. Rarely used now becauseinappropriate and traumatic.
- MSCT with contrast. Allows you to study in detail the tumor and surrounding tissues, to determine the presence of metastases. Used when the ultrasound picture is unclear.
- Investigation of the primary focus: fibrogastroduodenoscopy, examination of the mammary glands, ultrasound of the abdominal cavity, examination of the thyroid gland.
- Doppler examination of the tumor is necessary to study the blood flow of the tumor. A valuable method for surgeons.
- Determination of the level of tumor markers in the blood - tumor-associated antigens. Their level increases with the progression of the oncological process. The most informative are C-125, CA-19-9, CA-72-4. They are found in 89-100% of patients.
Treatment of Krukenberg metastasis
The volume of therapeutic measures is determined by an oncologist or an oncologist-surgeon. It is necessary to take into account the age of the patient, the severity and stage of the disease. If the operation is contraindicated for the patient, then they resort to courses of chemotherapy and radiation therapy, as well as the elimination of pain with narcotic analgesics (palliative therapy).
Surgical treatment is very difficult and difficult for the patient, because it is carried out in several stages.
- Elimination of the primary focus with surrounding tissue and lymph nodes. If this is the removal of the stomach, then the final stage of such an operation will be the imposition of a gastrostomy.
- Removal of the ovaries. Childbearing age is not taken into account because it isquestions about the patient's life. If only one ovary is affected, then the second is removed for prophylaxis, because the appearance of a Krukenberg metastasis in it is only a matter of time.
Removed organs are sent for histological examination to understand the nature of the tumor, the origins of its growth.
After surgical treatment, a course of chemotherapy and radiation therapy is prescribed to prevent recurrent neoplasms and to fight the remaining malignant cells in the body.
Rehabilitation of patients after treatment is aimed at psychological assistance, immunostimulating therapy, restorative treatment, diet, sleep and rest. If there is a gastrostomy, then proper care is necessary for it. During this period, the support of loved ones is especially important.
Forecast
Unfortunately, disappointing. According to medical statistics, mortality in the first year of incidence is 95%. But cases of five-year survival are known - 1% of cases. The reason for such harsh statistics is due to the neglected state of the primary malignant focus.
Krukenberg Metastasis Prevention
In our country, the mentality of citizens does not allow them to seek medical help in a timely manner. Our medicine is mostly free, but there are medical examination rooms. Polyclinics are actively inviting the attached population to undergo medical examination. It is aimed at all segments of the population and allows you to identify signs of the initial stages of the disease and start treatment in a timely manner. Plannedexaminations by a gynecologist also reveal abnormalities in the female body. In persons suffering from diseases of the stomach, a planned fibrogastroduodenoscopy is necessary, because there is a risk of developing stomach cancer.
Prevention of secondary ovarian cancer is possible only through regular examination of your body.
