Symptoms and treatment of ovarian cancer, types of tumors,stages, прогноз и риски рецидива

Обновление: Октябрь 20one8

Ovarian tumors make up a quarter of all tumors in the female
genitals. Haveчитывая высокую cmертность, позднее выявление
cancer and a variety of symptoms, it is very important to detect the disease on
самых ранних stages.

What are ovarian tumors?

The term “ovarian cancer” is most often used in generalized terms.
meaning and means a malignant tumor. But actually
there is a huge variety of tumor processes,
which can move from benign to cancerous forms,
located in different departments and have completely different treatment.
For the correct definition of medical tactics, WHO experts
have developed a classification.

Epithelial tumors

They can be benign, transient and
malignant:

  • papillary serous cystadenomas and cystadenocarcinomas
  • mucinous cystadenomas and cystadenocarcinomas
  • endometriotic tumors
  • Brenner tumors

Epithelial neoplasms are most common in women.
four5-50 лет и представляют собой кисты. In most cases, these
benign cysts. Withзнаками рака яичников в подобных кистах
can serve:

  • lesion of both ovaries
  • the presence of thin, randomly located inside the cyst
    papillae
  • heterogeneity of the cyst (more dense and thin areas
    alternate)

Distinguish a benign epithelial tumor from cancer
visually very difficult, the final diagnosis is made only after
operations. Symptoms of the early stages of such serous cancer are hardly noticeable.
Обычно болезнь выявляют на stages широкого распространения и
metastasis.

Among the tumors of this type there are special groups that have
borderline malignancy. For example, mucinous tumors
being cancer, they can excrete so much mucus into the abdominal cavity that
a woman requires permanent abdominal surgery to remove it. AT
as a result, it leads to exhaustion and death.

A special type of ovarian cancer is undifferentiated
tumors. Their cells are so primitive that they determine the composition
neoplasm impossible. The prognosis for such tumors is very
bad.

 Stromal tumors

Can also be benign, transient and
malignant:

  • granule cell
  • Tacoma
  • fibromas and fibrosarcomas
  • androblastoma

WITHтромальные granule cell новообразования, активно выделяют
hormones. Therefore, their symptoms are much brighter than with epithelial
tumors.

Have девочек могут возникнуть признаки преждевременного полового
maturation (breast enlargement, bleeding from
vagina). Have женщин детородного возраста возникают обильные
bleeding, often without regard to menstruation. Have больных в менопаузе
“rejuvenation symptoms” may appear: disappearance of facial wrinkles,
even skin color. Such women look much younger than their
age

Чаще всего granule cell злокачественные опухоли выявляют
in the early stages, so they have a good prognosis: a five-year
survival ranges from 80 to 90%.

Androblastoma – another type of hormonally active tumor,
striking girls and young women. AT кровь больной выделяются
мужские hormones. This leads to the substitution of female signs on
man’s. Menstruation disappears, mammary glands atrophy,
coarse voice, facial hair appears. After cure all
the symptoms disappear completely.

Germ cell tumors (from germ cells)

  • dysgerminomas
  • yolk sac tumors
  • teratomas

Ovarian germ cell tumors develop from germ cells.
That is, in most cases, the girl has their beginnings from the very
of birth. This pathology discovers itself quite early, most often
in childhood and adolescence. The only absolutely benign
the tumor is a dermoid cyst. It may contain
imagine hair, the beginnings of teeth, nails and even thyroid cells.
After removal of these tumors, no recurrence occurs.

Most of these tumors are malignant.
They do not possess hormonal activity, but often cause
ovarian torsion and pain. Therefore, identify this disease mainly on
ранних stages. In addition, there are markers to detect
pathology and control treatment. These are AFP (alphafetoprotein) and
CG (chorionic gonadotropin).

Gonoblastoma
Undifferentiated tumors
Metastatic tumors

Risk factors for ovarian cancer

Withчины рака яичников до сих пор не ясны. But there are certain
circumstances in which the probability of getting sick of this disease
much higher.

Hormonal factor

There is reliable information about the connection of ovarian cancer with hormonal
background and number of births. It is believed that with each ovulation
(egg outlet) ovarian tissue is damaged. Thereafter
there is a healing process that requires active cell division.
The more often the cells have to divide, the higher the risk of exit from under
control of this process. Ovulation is absent during
pregnancy, breastfeeding and oral
contraceptives. ATсе эти факторы снижают риск развития рака
ovary. But the first early period, one child and late
menopause is a risk factor for this disease due to frequent
ovulation. Female infertility and prolonged stimulation of ovulation also
included in this list.

As for the use of hormone replacement therapy for
mitigating the symptoms of premenopause, then there is evidence of
studies showing that the risk of cancer is increasing (in
particular risk of ovarian cancer) when they are taken. Therefore, the appointment of HRT
probably makes sense with early menopause, also not advisable
appoint it to women after 55 years.

Hereditary predisposition

A small percentage of tumors are associated with genetic damage (up to
2% of all cancers). There are three syndromes in which the risk of developing
oncology in the ovaries increases significantly.

  • Familial Ovarian Cancer
  • Familial Ovarian Cancer и молочной железы
  • Lynch II Syndrome

ATсе эти синдромы проявляются случаями рака яичников, груди,
intestines and uterus at the next of kin (mother, grandmother,
sisters). With неблагоприятном семейном анамнезе необходимо
исследовать гены BRCAone и BRCA2 на мутации, которые и вызывают
tumor. ATсе женщинам с этими синдромами необходимо регулярное
examination, and often – prophylactic removal of the uterus with
ovaries or mammary glands. AT качестве примера можно привести
Hollywood actress Angelina Jolie, who decided to delete
mammary glands in connection with a similar hereditary syndrome.

Dietary addictions

The most common malignant ovarian tumors are found in women from
developed industrial countries. Europe and the USA are leaders in
morbidity and mortality from this affliction. AT то же время в
economically successful Japan and other Asian countries the number
the cases are significantly lower. This phenomenon was previously associated with
gastronomic predilections of women. There was a theory about such a factor
risk, as excessive eating of animal fats. It found no
scientific evidence, but many scientists still lead
research on this topic.

ATредные примеси (асбест)

Another long-existing, but poorly understood risk factor
It is considered the use of talc for hygiene. AT некоторых
ovarian tumors were found particles of talc used in
powders and deodorants. The particles of this talc are similar to asbestos,
which is also considered the trigger factor of the disease. Research on this
The topic also did not give accurate results.

Irradiation of the pelvic organs (for the treatment of other tumors)

Ovarian Cancer Symptoms

Low survival for ovarian cancer, whose symptoms may
not manifest very long, associated with late diagnosis. Tumors
в I stages – обычно случайная находка при плановом HaveЗИ или оcmотре
gynecologist. Brighter signs are already visible when far away.
the ongoing process.

Symptoms of tumor growth and pressure on organs

  • Abdominal pain on the part of the affected ovary
  • Pain during intercourse
  • Abdominal discomfort, increasing in size
  • Dyspnea
  • Swelling of the legs, varicose veins
  • Haveчащенное мочеиспускание или задержка мочи
  • Constipation

Symptoms of tumor infection

  • Fever and rapid pulse

Other symptoms

  • Bleeding from the genital tract
  • Ascites (accumulation of fluid in the abdomen)
Symptoms of individual tumors

  • The absence of menstruation, reduction of the mammary glands, acne, coarsening
    voices and facial hair (with androblastomas)
  • Premature puberty, bleeding from the genital
    pathways in menopause (with granulosa cell tumors)

The most frequent signs of a malignant tumor

  • Solid structure (without cavities and openings)
  • Fast growth
  • Ascites
  • The tumor is fixed to the surrounding tissues.
  • Two-way localization

Ovarian cancer complications

ATсе опухоли в ovaryх могут перекручиваться. AT связи с
circulatory disturbance in the affected organ may occur
necrosis (death). This usually causes severe pain (as with
аппендиците) и требует незамедлительной operations.

Another important complication is exhaustion. Tumor
squeezes the intestines, causing discomfort, constipation and making food intake
embarrassing. In addition, a cancerous tumor secretes in
blood is its own decay products. ATсе это приводит к сильному
weight loss and exhaustion, especially in the later stages of the disease.

Stages of Ovarian Cancer

The International Federation of Obstetricians and Gynecologists highlights
The following classification of stages:

one стадия Stage 2 Stage 3 four стадия
WITHтадия Iа

  • Tumor ограничена одним яичником
  • AT животе нет жидкости с раковыми клетками
  • Ovarian capsule is not affected by the tumor

WITHтадия Ib

  • Tumor ограничена обоими ovaryми
  • AT животе нет жидкости с раковыми клетками
  • Ovarian capsule is not affected by the tumor

WITHтадия Ic

  • Tumor ограничена одним или двумя ovaryми
  • Tumor выходит на поверхность яичников
  • Or ovarian capsules are damaged.
  • Or there is fluid in the stomach with cancer cells.
WITHтадия IIa

  • In addition to the ovaries, the uterus and / or fallopian tubes are affected.

WITHтадия IIb

  • In addition to the ovaries, the uterus and / or peritoneum and other organs are affected.
    pelvis

WITHтадия IIc

  • Damage to the uterus and other pelvic organs
  • Tumor находится на поверхности одного или обоих яичников
  • AT животе есть жидкость с раковыми клетками
WITHтадия IIIа

  • Tumor распространяется в пределах pelvis
  • Not lymph node lesions
  • There is a proven microscopic peritoneal lesion.

WITHтадия IIIb

  • Tumor распространяется в пределах pelvis
  • Not lymph node lesions
  • There is a proven peritoneal lesion with visible lesions up to 2
    cm

WITHтадия IIIc

  • Tumor распространяется в пределах pelvis
  • Inguinal or retroperitoneal lymph nodes affected
  • Or there is a proven peritoneal lesion with visible foci more
    2 cm
Tumor с отдаленными метасpelvisми (легкие, печень и другие
distant organs)

Diagnosis of ovarian tumors

Оcmотр на гинекологическом кресле

Large tumors can be detected by probing.
живота на приеме у gynecologist. Especially large female tumors
can find herself. More often such sizes have benign
structures. But over time, they can degenerate into cancer
ovarian cysts, therefore, require special attention.

Haveльтразвуковое исследование органов малого pelvis

Наружный датчик HaveЗИ может обнаружить опухоль более 6-7 cm в
diameter, whereas internal (transvaginal) will determine much
меньшие образования (2 cm и менее).

Have женщины детородного возраста нормальные яичники достигают 3-four
cm в поперечнике. Sometimes they form the so-called
functional cysts (associated with impaired ovulation). They
safe, pass themselves within 2-3 months. ATажно отличить их
от злокачественной tumors.

Dopplerography

Очень часто для диагностики злокачественной опухоли при HaveЗИ
use the Doppler effect. It can be used to determine blood flow.
in a suspicious area. With раке яичников вокруг опухоли образуются
new vessels, blood flow increases dramatically.

CT scan

CT is used to determine the size of the cancer, its degree
прорастания в другие органы и поиска metastasis. This method
has high accuracy. In addition to computed tomography often
apply and magnetic resonance (MRI). The method allows to evaluate
even distant metastases in several projections.

Positron emission tomography (PET)

PET allows you to accurately assess the spread of the tumor.
and even discovers small distant metastases. Method based
on the search for cancer cells labeled with radioisotopes.

Determination of cancer markers in the blood

There are special substances produced by tumors. Detection
their blood in large quantities may indicate the development of cancer
ovary.

For example, the presence of alpha-fetoprotein (AFP) and chorionic
gonadotropin (CG) in combination with a suspicious formation on
the ovary can talk about a germ cell tumor that has
germ cells.

Онкомаркер рака яичников WITHА-one25 значительно повышен при этой
tumors almost always. But since the value of this indicator can
increase with endometriosis, inflammation of the appendages and even exacerbation
pancreatitis, it cannot be used as an ovarian cancer test. WITH
другой стороны, повышение WITHА-one25 после лечения раковой опухоли
almost always talks about the recurrence of the disease.

Ovarian cancer treatment

ATсе опухоли яичников, сомнительные на предмет злокачественности,
must be removed. After examining the neoplasm determine
his type, and then prescribe the appropriate treatment.

ATо время операции хирург оценивает распространение опухоли,
the state of the peritoneum, liver, the presence of ascites and fixes everything
observations. From this data depends not only the volume
operations, but also the patient’s further prognosis.

Cancer treatment stages I and II

Surgery

Haveдаление матки, обоих яичников и сальника (ткани, покрывающей
органы брюшной cavities) – обязательный этап operations. Have нерожавших
women with stage I sometimes only the affected ovary is removed, and
after childbirth a second operation is performed – removal
remaining appendage and uterus. This gentle option is only possible.
in certain cases:

  • one-sided tumor with an intact capsule
  • absence of metastases and normal biopsy of healthy
    ovary

Such conditions are quite rare, so keep
fertility function most often fails. Sometimes during surgery
the pelvic and paraaortic lymph nodes are removed, in which most often
there are metastases.

Postoperative chemotherapy

На I а stages введение химиопрепаратов после операции не
shown, since all tumor cells can be surgically removed.
With других вариантах I и II стадий рекомендуется введение
platinum drugs (cisplatin, carboplatin). 3-6 is usually enough
treatment courses.

Cancer treatment stage II-IV

Surgery

With распространенных опухолях особенно важно максимальное их
deletion. This may not always, because cancer can
sprout into other organs, surround the vessels and give
множественные мелкие метастазы (cm. рак тела матки).

If thorough cancer removal is not possible, then often apply
several courses of chemotherapy. After them, the size of the tumor is often
decrease and it becomes possible to cut it.

Have больных с four стадией рака применяют паллиативную терапию
(aimed at alleviating suffering). Carry out the removal
tumor mass, compressing the intestines, bladder, causing
the pains. What matters is not how many live sick as well
their quality of life.

Chemotherapy

The introduction of platinum drugs necessarily go far
stages. Usually used 6 courses of carboplatin with paclitaxel.
The break between courses is three weeks.

Observation after therapy

After the end of therapy, the woman should be persistent sweat.
oncogynecologist control. In the first 2 years you need to visit a doctor
every three months, then – a little less, but regularly. To detect
recurrent ultrasound and determine the CA-one25 in the blood. Sometimes in half a year
until visible tumor progression the CA-one25 marker rises in
repeatedly. But usually chemotherapy is started after
confirmation of recurrence on ultrasound or CT. This approach does not affect
life expectancy and its quality.

Ovarian cancer recurrences

The greater the stage of the disease, the higher the risk of tumor recurrence. Have
patients with early stages and late relapses (2 years after
operations) conduct a second operation. If the relapse is
is a multiple tumor and occurs shortly after treatment, then
carry out the operation impractical.

Quite often newly formed tumors are insensitive to old ones.
drugs. In these cases, try new combinations of drugs.
platinum with other cytostatics.

Prognosis of the disease

The International Association of Obstetricians and Gynecologists has researched
frequency of occurrence and five-year survival at various degrees
ovarian cancer. The table below shows that favorable
the forecast corresponds mainly to stage I. Unfortunately big
some tumors are already detected at stage III.

 stages Description frequency of occurrence 5 year survival rate
one Tumor within the ovaries 20% 73%
2 The spread does not go beyond the pelvic five% fourfive%
3 Damage to the retroperitoneal lymph nodes and abdominal
cavities
58% 2one%
four Distant metastases one7% five%

With germ cell tumors, life projections are much more
good ones. Более 90% больных переживают 5 –летний и даже one0-летний
frontier. Tumors that secrete hormones (eg, granulosa), more often
выдают себя на ранних stages. Have таких больных прогноз тоже
благоприятен (8five% пятилетней выживаемости)

Ovarian cancer during pregnancy

Asymptomatic appendage cancer is often detected only after
постановки беременной на учет и первого HaveЗИ. Regardless of the term
carry out surgical treatment. In the first trimester, it is possible
preservation of pregnancy (by removing the affected ovary). With
neglected tumor processes need postoperative
chemotherapy. There is no data on its safety for the fetus. Such
cases of pregnancy are usually interrupted. In trimester III it is possible
Caesarean section followed by surgery
chemotherapy.

Ovarian cancer in women is one of the most formidable genital tumors.
organs. The most important cause of the enormous mortality is
late detection of the disease. Therefore, regular visits
гинеколога и ежегодное HaveЗИ поможет выявить болезнь, сохранить жизнь
and health.

FAQ

I am 56 years old, menopause is 5 years old. In connection with major myoma and
hyperplasia suggest removing not only the uterus, but also the appendages.
Объясняют это риском ovarian cancer. Is such an extensive need
operation?

Haveчитывая возраст, стаж менопаузы и фоновые заболевания (миома,
endometrial hyperplasia), this operation is very desirable. Crayfish
ovaries after uterus removal is possible. Since menstruation is no longer
few years, the lack of appendages will not cause unpleasant
symptoms.

Have дочери (one8 лет) обнаружили на HaveЗИ крупные образования обоих
ovarian and increased tumor marker. How big
the likelihood of cancer and is it possible to do without surgery?

Bilateral ovarian tumors always cause alertness in
regards to cancer. In this case, there is the possibility of malignant
tumors. But it is possible that these are benign cysts,
inflammatory changes in the fallopian tubes and other options.
Tumor markers increase in all pathologies of the female genital
organs. Therefore, to determine the type of tumor you need to hold
operation

Мне 3four года, на HaveЗИ обнаружили фолликулярную кисту. What to do?
Will I get pregnant? Is there a risk of cancer?

Фолликулярные кисты – частая находка на HaveЗИ. They arise because of
ovulation disorders. They pass by themselves. Usually prescribed
оральные контрацептивы с контролем HaveЗИ через 3 месяца. Right after
the disappearance of cysts can be planned pregnancy.

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