Ovarian cancer ranks seventh among all cancer diseases and third among malignant tumors in gynecology. It affects the fairer sex during premenopause and menopause, but it also occurs in women under 40 years of age. Early diagnosis of ovarian cancer is a key objective of cancer screening. Timely detection makes it possible to begin treatment at the initial stages and increases the chances of the effectiveness of 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 to be primary:
- Carcinoma is a malignant tumor formed from skin cells and mucous membranes.
- Dysgerminoma is a cancer that develops from the primary cells of the gonads. The neoplasm is one of the most common and makes up about 20% of all malignant ovarian tumors.
- Teratoma comes from the germ layer.
- Chorioncarcinoma - one of the worst forms of ovarian cancer, is a modification of the epithelium of the chorion.
- Ovarian stroma is a tumor of non-epithelial origin.
Metastatic cancer of paired gonads is a malignant tumor of the ovary, which appeared as a result of blood, 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 along the peritoneum. Secondary ovarian tumor occurs in women 45-60 years old.
Despite advances in diagnosing ovarian cancer in women, approximately 75% of the diseases are found in the later stages. The reason for this is the long asymptomatic course of the pathology.
Classification
Malignant ovarian tumors are systematized according to the place of occurrence, stages and prevalence.
There are 4 degrees of tumor growth:
- I (T1) - characterized by unilateral ovarian damage. Mortality at this stage is about 9%. But detecting cancer at this stage is very rare.
- II (T2) - characterized by the spread of the tumor to both ovaries and pelvic organs.
- III (T3 / N1) - damage to the gonads with metastasis to the lymph nodes or along the peritoneum.
- IV (M1) - the formation of secondary foci in other organs. Survival at this stage is 17%. The main cause of death is the accumulation of fluid in the abdominal cavity, the depletion of metastatic organs.
In the diagnosis of ovarian cancer in the initial stages, the risk of tumor metastasis and serious complications, leading in most cases to death, is reduced.
Reasons for the development 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 forms during prolonged production of estrogen by the body. This statement is based on observations of women who have used hormonal contraception for more than 5 years. The main pharmacological property of the drugs is the suppression of the production of gonadotropic hormones, which increase the risk of the tumor moving into estrogen-sensitive tissues.
Genetic studies in combination with late and early diagnosis of ovarian cancer in women show that a hereditary factor affects the development of the disease. In this regard, the closest relatives of cancer patients are strongly recommended to undergo a preventive examination.
Other factors that affect the occurrence of malignant cells in the ovaries are also distinguished:
- Polyps of the body and cervix.
- Ovarian dysfunction.
- Violation of the thyroid gland and adrenal glands.
- Excessive growth of the endometrium.
- Frequent unilateral and bilateral oophoritis.
- Infertility.
- Often occurring simultaneous inflammation of the ovaries and fallopian tubes (adnexitis or salpingoophoritis).
- Benign, hormone-dependent neoplasms from smooth muscle tissue of the uterus (fibroids).
- Tumor-like formations from the connective tissue of the uterus (fibromyomas).
- Ovarian cyst.
- Early puberty and the onset of sexual activity.
- Repeated abortions cause hormonal disorders and malfunctions of the ovaries.
Also, overweight, bad habits can affect the dysfunction of a woman’s paired sex glands and the appearance of malignant cells in them.
Clinical signs
Early diagnosis of ovarian cancer helps to start timely treatment, the outcome of which in most cases is favorable. Therefore, it is so important to pay attention to the slightest changes in the body and internal well-being. Symptoms of ovarian cancer are variable. They grow with the spread of the tumor:
- General malaise.
- Impotence.
- Fast fatiguability.
- Continuous steady increase in temperature.
- Decreased appetite.
- Flatulence.
- Constipation
- Dysuric manifestations.
Diagnostic methods for ovarian cancer
Recognizing the 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 disease are applied comprehensive. They include examination, medical history, laboratory, gynecological examinations using various instruments and apparatuses.
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:
- Inspection of the gynecologist.
- Transvaginal ultrasound scanning.
- Axial computed tomography.
- Radiological method for the study of the pelvic cavity.
- Diagnostic laparoscopy.
- Specific laboratory tests.
This set of examinations is a standard kit for detecting ovarian tumors.
Laboratory research
Analyzes in oncology are prescribed in parallel with the clinical and instrumental examination. They allow the interpretation of biopsy data and have important prognostic significance. The most valuable are histological and cytological studies:
- Histology of a biopsy of a woman's genitals - examination under a microscope of tissue samples taken from reproductive organs in order to determine its nature. The material for analysis is a scraping of the endometrium lining the uterus. Testing is planned and urgent. Emergency histology is done within half an hour and is usually performed during surgery.
- Cytology of cervical scraping, or Pap smear, is done to detect cancerous conditions of the organ from which the smear was taken. The material for the study 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 - imprints from the intrauterine device or aspiration of the contents of the organ with a catheter.
Diagnosis of ovarian cancer is also carried out by examining blood or urine tumor markers. Tumor-associated markers are proteins, ribozymes, tumor decay products produced by healthy tissues upon 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 antigen (SCC) - Squamous cell carcinoma protein determination.
- Oncoprotein E7 - the marker determines the likelihood of cervical cancer in women with papillomavirus type 16 and 18.
- The tumor marker CA 72-4 is a test for determining the content of glycoprotein produced by malignant glandular cells.
- HE4 is a protein secreted by the cells of the reproductive system.
Clinical and biochemical analyzes 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 ultrasound. It allows you to evaluate the volume, shape, structure, degree of spread of tumors.
The most commonly used diagnosis of ovarian cancer is by ultrasound. Ultrasound scans 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 genitals of a woman. Ultrasound can be performed at any age, and with gynecological diseases in any phase of the menstrual cycle.
MRI of the pelvic organs is a non-invasive method of investigation by fixing the radio waves emitted by hydrogen atoms under the influence of a magnetic field.
CT of the pelvic organs - a study of the organs of the pelvic cavity using a tomograph. The diagnostic method can be carried out with or without X-ray contrast agents. The method allows to identify a tumor with asymptomatic cancer.
Ovarian laparoscopy is a minimally invasive method that allows you to give a visual assessment of the pelvic organs and, if necessary, make biomaterial sampling for histological and cytological studies.
Differential diagnosis - what is the point?
Currently, there is no multi-purpose highly informative non-invasive early differential method. Diagnosis of ovarian cancer. Clinicians use a comprehensive approach that includes a whole range of research procedures.
One of the key factors in the neglect of ovarian tumor damage is its late detection due to the complexity of diagnosis in the initial stages. At the initial treatment, the doctor often makes other diagnoses: ovarian cystoma, inflammation of the appendages, uterine fibroids. Before surgery, it is difficult to distinguish a cyst from a malignant tumor, especially if it is mobile and one-sided. But there are a number of signs, in the presence of which the initial diagnosis is questioned:
- Intensive growth of the neoplasm.
- The roughness of the consistency.
- The tumor is almost motionless.
- Reduced ESR in a clear inflammatory process.
- Samples for Mantoux and Koch are negative.
- The presence of hypoproteinemia.
- Decreased albumin levels.
- Hyperproduction of estrogen.
- Elevated blood levels of ketosteroids, serotonin.
If it is not possible to distinguish a malignant tumor from another tumor, resort to gluttony.
Differential diagnosis of ovarian cancer makes it possible to distinguish the disease from any other in the early stages. The detection of a tumor in the initial stages contributes to the timely adoption of the correct measures to combat it.
Early Cancer Diagnosis
Based on statistical data, the first and second stage of ovarian cancer is detected only in 37.3% of patients. Despite certain achievements, the oncology mortality of paired gonads is about 40%.
Diagnosis of ovarian cancer at an early stage is practically not carried out due to the absence of signs that accurately describe the pathology, the specificity of the research methods, as well as the biological properties of the tumor. To identify asymptomatic oncology, screening tests and examinations are used:
- Gynecological examination with a visual assessment of the reproductive organs of a woman.
- Definition of onomarker SA-125
- Pap smear.
- HPV analysis.
- Transvaginal ultrasound.
Screening does not always help to recognize cancer. In some cases, tests for tumor markers give a false positive result. Assign an additional examination. Diagnostic methods are not included in the list of free compulsory medical insurance and are usually quite expensive.
In the early stages of the disease, the likelihood of false negative results is also high. Meanwhile, the tumor does not disappear anywhere, but rather, metastasizes to other organs. Symptoms begin to appear, which often indicates a severe stage of the pathology.
Features of the diagnosis of oncology in postmenopausal women
According to statistics, 80% of malignant tumors are formed in women older than 50 years. In most cases, carcinomas have a cystic structure. In contrast to the diagnosis of ovarian cancer, a dopplerometric study is sufficient for examining a cyst, provided that the blood levels of CA-125 are within normal limits. With prolonged follow-up of patients in the last phase of the menopause, it turned out that in 53% of cases, the resulting cyst resolves spontaneously.
There are a number of clinical signs that help identify the tumor in the early stages, but for the most part they remain unattended. Still, the primary diagnosis of ovarian cancer in postmenopausal women is based on the presence of just such symptoms.
One manifestation is spotting. The occurrence of menstruation is due to the function of the ovaries, the reproductive properties of which die out during menopause. In the postmenopausal period, vaginal bleeding is a serious reason for contacting 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 the release of estrogen hormones. Increased rates of steroidal female hormones after the last independent menstruation may indicate the presence of malignant cells in the body.
In menopause, an annual mammography is mandatory. Statistics show that ovarian metastasis quite often has a primary focus in the mammary glands. In women older than 50 years, when examining the breast, it is necessary to focus on the neoplasms that have arisen in it, since they can be an early stage of cancer.