In the ovaries, which are located in the pelvic area, female germ cells develop and mature, hormones are produced. Various negative factors can lead to the occurrence of such a pathology as ovarian dysgerminoma. Young women of reproductive age are most susceptible to the disease, a neoplasm also occurs in adolescents and even children.
What is pathology?
Ovary dysgerminoma is a rare pathology that develops in young women with an infantile physique. Usually the neoplasm is unilateral, characterized by rapid growth. The tumor is round on a stalk, has a tuberous capsule, can reach a significant size (up to 15 cm), completely replacing he althy tissues.
In the section, the neoplasm is compact, pink in color, there are areas of softening. Perhaps the presence of foci of necrosis with zones of disintegration of a dark color. If the area of necrosis is significant, the tumor becomes flabby, the capsule loses its integrity, the dysgerminoma becomes dark purple.
Malignant tumor,gives early metastases, has no hormonal activity. If a dysgerminoma of the left ovary is diagnosed, then the right paired organ is the first to be affected by metastases, then the retroperitoneal lymph nodes. If the disease progresses, then the spine, liver, and lungs are involved in the pathological process. At a later stage, the supraclavicular lymph nodes suffer.
Why ovarian dysgerminoma develops
The causes of the development of pathology are under study. But according to experts, a disease can occur as a result of:
- genetic disorders;
- pathologies of the female genital area of an inflammatory nature;
- infantilism;
- late or early onset of menses;
- violations of the monthly cycle;
- infertility.
If several unfavorable factors are present at once, cells can begin to regenerate, their anatomical structure changes, they grow intensively, destroying he althy tissues.
Symptoms
Ovary dysgerminoma has non-specific symptoms, this is precisely its danger. Only indirect signs can indicate the presence of a pathological process:
- a woman suffers from pulling, dull pains in the lower abdomen. When twisting the legs of the neoplasm, they can become sharp;
- menstrual cycle is disturbed;
- patient complains of weakness;
- temperature keeps within 37, 1-38, 0 °C for a long time;
- impaired urination.
If the process has spread to otherorgans, then signs indicating their defeat are added. For example, the patient may have digestive disorders. The patient feels nausea, sometimes vomiting occurs. Patients often have no appetite, their working capacity is reduced, against which a woman can rapidly lose weight. With further development of the neoplasm, signs of ovarian damage may join. When the tumor collapses, the patient's ESR rises, symptoms appear that indicate intoxication of the body.
Diagnosis
Often, a tumor is detected already when its pedicle is twisted, the capsule is ruptured. But even during a routine examination, a diagnosis of ovarian dysgerminoma can be made.
Diagnosis before surgery will allow to assess its volume and the possibility of preserving reproductive function. During a gynecological examination, a painless rounded neoplasm is palpated, which is located in the area of the appendages, is mobile and has a dense texture. Having found a tumor, the doctor will refer you for an additional examination.
Ultrasound
Carried out with a transabdominal or transvaginal probe. On the echogram, a specialist will detect an echo-positive formation that has uneven contours and an irregular shape, heterogeneous in structure. If the tumor has metastasized, damage to the second ovary, the presence of fluid in the retrouterine space, an increase in regional lymph nodes can be determined.
Tumor marker analysis
Used to determine if a process is malignant. Such a study is carried out in dynamics during the entire course of treatment. If the indicators decrease, then the therapy is effective.
Additional investigations and differential diagnosis
Additionally, computed tomography, lung x-ray, ovarian biopsy are recommended. Blood tests in the presence of pathology will not show changes. After confirming the diagnosis, the specialist will determine the stage of the disease, which depends on the size of the formation, the presence of metastases.
Also conduct differential diagnosis with uterine fibroids and other tumors. Fibromyoma can most often be found in the fairer sex in the elderly or middle age. And ovarian dysgerminoma usually affects patients at a young age and adolescence. Fibromyoma is manifested by polymenorrhea (frequent menstruation) or hypermenorrhea (abundant prolonged menstruation), dysgerminoma is characterized by scanty periods or their absence. Regardless of the results of the differential diagnosis, all detected tumors of the female genital organs are removed.
Therapy Methods
When diagnosed with "dysgerminoma of the right ovary" or "dysgerminoma of the left ovary", the treatment will be only surgical, after which chemotherapy or radiation therapy is recommended.
The choice of the method of surgical intervention depends on the age of the patient, whether she has children, the stage of the pathological process.
At stage IA in the absence of childrenpatients remove the appendages on only one side, after which careful lifelong monitoring is indicated. In case of recurrence, chemotherapy is given. If a woman has already realized her reproductive function or is in menopause, the uterus and ovaries are removed.
The second stage is treated by removing the appendages on the affected side, followed by four cycles of chemotherapy. Elderly women are advised to undergo radical surgery and three courses of chemotherapy.
In the third stage, older women undergo complete removal of the uterus with appendages and all metastatic foci, after which three courses of chemotherapy are recommended. For women of reproductive age, in some cases only one side of the appendages can be removed, followed by four rounds of chemotherapy.
In the case of the fourth stage, four courses of chemotherapy are recommended for patients of all categories.
Radiation therapy is carried out after radical surgery, if the process has spread beyond the small pelvis. The radiation program is compiled by a radiologist.
Post-operative care of patients
To prevent the spread of the pathological process after the course of treatment, dispensary observation is recommended:
- in the first year after therapy - once a month;
- in the second year - every 2 months;
- for the third - once a quarter;
- on the fourth and fifth year - every 6 months;
- from the sixth year until the end of life - once a year.
Compulsory testing recommended during examination:
- gynecological examination;
- PAP test;
- ultrasound examination;
- analysis for tumor markers;
- chest x-ray;
- Computer tomography (once a quarter for 2 years).
Forecast
Negative factors that affect a favorable outlook are:
- age of the patient (the older the patient, the less favorable prognosis);
- remnants of the neoplasm, to which there is no access during surgery;
- large tumor size;
- two-way process;
- metastases to various organs.
Chemotherapy has a positive effect on the healing process. With unilateral removal of the appendages and chemotherapy, 80% of patients noted that their menstrual cycle was restored. Many were able to conceive and give birth to a he althy child.
Adequate therapy can ensure a complete recovery, at the first stage, 90% of patients survive for five years.
Ovary dysgerminoma has an unfavorable prognosis with bilateral lesions, spread beyond the ovaries with metastasis. There is no consensus among specialists in this case regarding the survival of the patient. Some believe that combination therapy will allow 80% of patients to survive. Others point to variability in malignancy of the neoplasm.
Ovary dysgerminoma is a formidable pathology that affects mainly young women. Butdo not despair. Even if the diagnosis is disappointing, properly selected therapy will save not only life, but also reproductive functions. And in order to prevent the development of pathology, it is necessary to undergo medical examinations in a timely manner and follow all the doctor's prescriptions.
