Ovarian cancer – primary, secondary or metastatic tumoral damage of female gormonoprodutsiruyushchy gonads – ovaries. At early stages ovarian cancer ; patognomonichny manifestations are absent. Common forms are shown by weakness, an indisposition, decrease and a perversion of appetite, dysfunction of a GIT, dizurichesky frustration, ascites. Diagnosis of ovarian cancer includes carrying out fizikalny and vaginal inspection, ultrasonography, YaMRT or KT of a small pelvis, a laparoscopy, a research of an onkomarker of CA 125. In cancer therapy of ovaries surgical approach (pan-hysterectomy), polychemotherapy, radiotheraphy is applied.
Ovarian cancer costs on the seventh place in structure of the general oncopathology (4-6%) and takes the third place (after cancer of a body of a uterus and cancer of a neck of a uterus) among malignant tumors in gynecology. More often ovarian cancer affects women of the preclimacteric and climacteric period though is not an exception and among women 40 years are younger.
Classification of ovarian cancer
In the place of emergence of the initial center of cancer the gynecology distinguishes primary, secondary and metastatic damages of ovaries. Primary cancer of an ovary develops in iron at once. On the gistotip primary tumors are epitelialny formations of a papillary or ferruterous structure, develop from cages of an integumentary epithelium less often. Primary cancer of an ovary carries bilateral localization more often; has a dense consistence and a hilly surface; occurs mainly at women up to 30 years.
About 80% of clinical cases fall to the share of secondary ovarian cancer in gynecology. Development of this form of cancer happens from serous, teratoidny or psevdomutsinozny to cysts of ovaries. Serous tsistadenokartsinoma develop at the age of 50-60 years, mutsinozny - after 55-60 years. Secondary endometrioidny tsistadenokartsinoma occur at the young women who usually have infertility.
Metastatic damage of ovaries develops as a result of distribution of tumor cells hematogenic, implantation, limfogenny in the ways from primary centers at cancer of a stomach, mammary gland, uterus, thyroid gland. Metastatic tumors of ovaries possess rapid growth and an adverse current, usually affect both ovaries, early disseminirut on a peritoneum of a small pelvis. Macroscopically metastatic form of ovarian cancer has whitish color, a hilly surface, a dense or pasty consistence.
More rare types of ovarian cancer are presented papillary tsistadenomy, granulezokletochny, light-cellular (mezonefroidny) cancer, adenoblastomy, by Brenner's tumor, stromalny tumors, disgerminomy, teratokartsinomy, etc. In clinical practice ovarian cancer is estimated according to criteria of FIGO (a stage of I-IV) and TNM (prevalence of primary tumor, regionarny and remote metastasises).
I (T1) – prevalence of a tumor is limited to ovaries
- IA (T1a) – cancer of one ovary without germination of its capsule and growth of tumor cells on the surface of gland
- IB (T1b) – cancer of both ovaries without germination of their capsules and growth of tumor cells on the surface of glands
- IC (T1c) – cancer of one or two ovaries with germination and/or a rupture of the capsule, tumoral growths on the surface of gland, existence of atypical cages in astsitichesky or flushing waters
II (T2) – damage of one or both ovaries with spread of a tumor on structures of a small pelvis
- IIA (T2a) - ovarian cancer extends or spreads in uterine tubes or a uterus
- IIB (T2b) - ovarian cancer extends to other structures of a basin
- IIC (T2c) – tumoral process is limited to damage of a small pelvis, existence of atypical cages in astsitichesky or flushing waters is defined
III (T3/N1) - damage of one or both ovaries with ovarian cancer metastasis on a peritoneum or in regionarny lymph nodes
- IIIA (T3a) – existence of microscopically confirmed vnutribryushinny metastasises
- IIIB (T3b) – macroscopically defined vnutribryushinny metastasises with a diameter up to 2 cm
- IIIC (T3c/N1) - macroscopically defined vnutribryushinny metastasises with a diameter more than 2 cm or metastasises in regionarny lymph nodes
IV (M1) – ovarian cancer metastasis in the remote bodies.
Ovarian cancer reasons
The problem of development of ovarian cancer is considered from positions of three hypotheses. It is considered that as well as other ovarialny tumors, ovarian cancer develops in the conditions of a long giperestrogeniya that increases probability of tumoral transformation in estrogenchuvstvitelny fabric of glands.
Other view of genesis of ovarian cancer is based on ideas of a constant ovulation at early approach menarche, a late menopause, the small number of pregnancies, shortening of a lactation. Continuous ovulations promote change of an epithelium of a stroma of an ovary, thereby creating conditions for aberrantny damage of DNA and activation of an expression of oncogenes.
The genetic hypothesis distinguishes from group of potential risk of women with family forms of breast cancer and ovaries. On observations, the increased risk of development of ovarian cancer is associated with existence of infertility, dysfunction of ovaries, giperplaziya of endometrium, frequent ooforit and adneksit, myomas of a uterus, benign tumors and cysts of ovaries. Application of hormonal contraception is longer than 5 years, on the contrary, reduces probability of developing of ovarian cancer practically twice.
Ovarian cancer symptoms
Displays of ovarian cancer are variable that is explained by variety of morphological forms of a disease. At the localized ovarian cancer forms the symptomatology, as a rule, is absent. At young women ovarian cancer can clinically demonstrate from the sudden pain syndrome caused reabrupt legs of a tumor or perforation of its capsule.
Activization of displays of ovarian cancer develops in process of distribution of tumoral process. There is an increase of an indisposition, weakness, fatigue, a subfebrilitet; deterioration in appetite, GIT function (meteorizm, nausea, locks); emergence of the dizurichesky phenomena.
At defeat of a peritoneum ascites develops; in case of metastasises in lungs – tumoral pleurisy. In late stages cardiovascular and respiratory insufficiency increases, hypostases of the lower extremities, thromboses develop. Metastasises at ovarian cancer, as a rule, come to light in a liver, lungs, bones.
Hormonal and active epitelialny educations occur among malignant tumors of ovaries. Granulezokletochny ovarian cancer – the feminizing tumor promoting premature puberty of girls and renewal of uterine bleedings at patients in a menopause. The Maskuliniziruyushchy tumor – an adenoblastoma, on the contrary, leads to a girsutizm, change of a figure, reduction of a breast, the termination of periods.
Diagnosis of ovarian cancer
The complex of methods of diagnosis of ovarian cancer includes carrying out fizikalny, gynecologic, tool inspection. Recognition of ascites and tumor can be made already during a stomach palpation. The gynecologic research though allows to reveal existence one - or bilateral ovarialny education, but does not give a clear idea of degree of its high quality. By means of a rektovaginalny research the ovarian cancer invasion in parametriya and pararectal cellulose is defined.
By means of a transvaginal ekhografiya (ultrasonography), MPT and KT of a small pelvis volume formation of irregular shape without accurate capsule with hilly contours and unequal internal structure comes to light; its sizes and degree of prevalence are estimated. The diagnostic laparoscopy at ovarian cancer is necessary for carrying out a biopsy and definition of a gistotip of a tumor, a fence of a peritonealny exudate or washouts for a cytologic research. In some cases receiving astsitichesky liquid is possible by means of a puncture of the back arch of a vagina.
At suspicion of ovarian cancer the research of the tumoral associated markers in serum is shown (SA-19.9, SA-125, etc.). Mammography, a X-ray analysis of a stomach and lungs, an irrigoskopiya is made for an exception of primary center or metastasises of ovarian cancer in the remote bodies; Ultrasonography of an abdominal cavity, ultrasonography of a pleural cavity, ultrasonography of a thyroid gland; FGDS, rektoromanoskopiya, tsistoskopiya, hromotsistoskopiya.
Cancer therapy of ovaries
The issue of the choice of medical tactics at ovarian cancer is resolved taking into account a stage of process, morphological structure of a tumor, potential sensitivity of this gistiotip to chemotherapeutic and beam influence, the burdening somatic and age factors. In cancer therapy of ovaries surgical approach (pan-hysterectomy) is combined with carrying out polychemotherapy and radiotheraphy.
Surgical treatment of the localized ovarian cancer form (the I-II Art.) consists in carrying out removal of a uterus with an adneksektomiya and a resection of a big epiploon. At the weakened or elderly patients performance of nadvlagalishchny amputation of a uterus with appendages and a subtotal resection of a big epiploon is possible. In the course of operation intraoperative audit of paraaortal lymph nodes with their urgent intraoperative histologic research is obligatory. At the III-IV Art. of ovarian cancer the cytoreductive intervention directed on maximum removals of tumoral masses before chemotherapy is made. At inoperable processes are limited to a biopsy of tumoral fabric.
The polychemotherapy at ovarian cancer can be carried out on preoperative, postoperative a stage or be independent treatment at widespread malignant process. The polychemotherapy (platinum medicines, chlorethylamines, taxons) allows to achieve suppression of a mitosis and proliferation of tumor cells. As side effects of tsitostatik nausea, vomiting, neuro and a nefrotoksichnost, oppression of the haematogenic function act. Radiation therapy at ovarian cancer has insignificant efficiency.
Forecast and prevention of ovarian cancer
The remote survival at ovarian cancer is caused by a disease stage, morphological structure of a tumor and its differentiation. Depending on a gistotip of a tumor the five-year threshold of survival overcomes 60-90% of patients with the I Art. of ovarian cancer, 40-50% - from the II Art., 11% - with the III Art.; 5% - with the IV St. Are more favorable concerning the forecast serous and mutsinozny ovarian cancer; less – mezonefroidny, undifferentiated, etc.
In the post-operational period after a radical hysterectomy (pan-hysterectomy) patients need systematic observation of an onkoginekolog, the prevention of development of a postkastratsionny syndrome. In prevention of ovarian cancer the essential part is assigned to timely detection of benign tumors of glands, onkoprofilaktichesky surveys, decrease in influence of adverse factors.