Ovarian Cancer - Causes, Symptoms and Treatment .MF .
ovarian cancer - one of the most common cancer occurring in women.The peak incidence occurs in the 60 years.Up to 45 years of ovarian cancer is quite rare.To date, the incidence ranges from 9 to 17 women per 100 000 women per year.It is of great importance to family history of ovarian cancer.For example, if ovarian cancer was two first-degree relatives (mother, sister, daughter), the risk of the disease is 50%.With a family history of ovarian cancer developed 10 years earlier.
Causes Ovarian Cancer
There are many theories seeking to explain the cause of ovarian cancer.For example, the theory of "continuous evolution" explains the occurrence of ovarian cancer increased number of ovulations, leading to an increase in damage to the epithelial surface of the ovary.Following this theory, nulliparous women are more at risk of ovarian cancer than those who repeatedly became pregnant, and gave birth to breastfeed.However, it should be recognized that the comparison does not bear and laboring women are held w
Types of ovarian tumors
By gistologiskomu structure identifies the following ovarian tumors: serous tumors (75%) mucinous tumors (20%), endometrial cancer (2%), clear cell tumors (1%), Brenner tumors (less than 1%),mixed tumors (1%), undifferentiated carcinoma (less than 1%) unclassified tumor (1%).Each of these forms may be: benign, borderline and malignant.
Border tumor - a tumor of low-grade.For a long time they did not go beyond the ovaries.In many common uses of the cases occur in the 30-50 years old, have a favorable prognosis.
most common serous ovarian tumors.Typically, they are formed by dipping depth ovarian surface epithelium.Among all serous borderline tumors account for 10%, and there are mostly up to 40 years.Malignant form - serous ovarian cancer - the most common form of ovarian cancer.Among them are three degrees of differentiation: high, moderate and low.
mucinous tumors account for up to 15 - 20% of all epithelial ovarian tumors.Can reach gigantic proportions, occupy the entire abdominal cavity.In 10.8% of cases are bilateral, often beyond the ovaries.In 5-10% of cases of benign mucinous tumor malignancy.Papillary growths with mucinous tumors are less common than in the serous, but they allow the meeting to talk about the high mitotic activity in the tumor tissue.
remaining epithelial ovarian tumors are less common.
Symptoms of ovarian cancer
clinical picture in most cases are asymptomatic.The most characteristic symptoms are:
1. Violation of the menstrual cycle
2. Difficulty urinating and constipation - with an increase in tumor size, and compression of the surrounding organs.
3. Tearing or pressure and pain in the abdomen.
4. Dyspareunia - painful sex.
5. Perhaps the occurrence of emergency conditions, such as tumor torsion stem tumor or gap.This condition requires immediate surgical intervention.
6. Increase and bloating, constipation, nausea, loss of appetite or rapid saturation - a characteristic symptom of advanced disease.
7. Spotting - a rare complaint, characteristic mainly for postmenopausal patients.
8. The appearance of fluid in the abdomen and pelvis
Survey for suspected ovarian cancer
main objective sign yaichinikov cancer - the presence of the bulk formation in the pelvis, dense, usually stationary, rough or rough.When the ascites, and the presence of the bulk formation in the pelvis, you can almost certainly talking about ovarian cancer.
important to remember that with the onset of menopause, a woman's ovaries decrease in size and are not palpable.Therefore, well palpable appendages in normal gynecological examination should be cause for concern.
The main methods of diagnosis include:
1. bimanual examination - allows for large amounts of education palpated education in the pelvis, to determine its approximate dimensions, the relationship with the surrounding organs (soldered or not), to evaluate the mobility of education,its form and nature of the surface.
2. Clinical and biochemical blood tests, urine - usually specific changes characteristic is not observed for ovarian cancer.Chance of leukocytosis, anemia, increased erythrocyte sedimentation rate.Metastases in the liver are altered liver function markers - ALT, AST, bilirubin.
3. Definition CA-125 level .Antigen CA-125 - a high molecular weight glycoprotein that is produced by the epithelial ovarian tumor cells and other abnormal and normal cells.The rate of 10-13 U / ml for women, the upper limit of normal, according to various sources can reach 35 units / ml.At a level greater than 95 IU / ml in combination with bulk form, originating from the uterus, the accuracy of this method is 95%.However, this is typical for postmenopausal women and for women of reproductive age of CA-125 levels may be elevated in many physiological conditions (for example during menstruation may increase up to 35 U / ml - the upper limit of normal), and therefore can not be considered absolute.Furthermore, CA-125 levels in ovarian cancer can be increased along with the progression of the tumor, therefore it can be used to determine the dynamics of cancer.
4. US - an important method of research, becausebeing sufficiently reliable at the same time is safe and available in almost any hospital, which makes it possible not only to identify tumor mass in the pelvis, but also to observe its dynamics, as well as give a rough estimate of the predictive zlokachetsvennosti or benign process (estimated approximate!).With the help of ultrasound can reveal the nature of education, the presence or absence of a liquid, the presence or absence of cells and cavities razrostany and papillae.
5. excretory urography - can be applied to destination specialist
6. sigmoidoscopy, barium enema - indicated.
7. MRI and CT - highly specific diagnostic technique in which you can also determine the presence or absence of distant metastases in the liver and other organs.Minus - the high cost.
8. Finally, the nature and structure of the tumor can only talk after taking the material, which is only possible during surgery.Maybe start the operation laparoscopically, fence bioptatnogo material ekspressbiopsii, the answer on which is given for an average of twenty minutes.
For the differential diagnosis of functional ovarian cysts, in the absence of many of the above methods of inspection vozmodno assign patient oral contraceptives for two months.If during this time to improve the dynamics is not observed - to think about the malignant process.
Metastasis of Ovarian Cancer
Dissemination (spreading) in ovarian cancer occurs in three ways: Contact, lymphatic and hematogenous.Contact the path most common and the earliest version of the spread.Most often lokalizuyutya along lateral channels on the capsule of the liver in the right subdiaphragmatic space on the mesentery and intestinal loops as well as in the greater omentum.
lymphatic metastasis is characterized as a rule at a later state.This affects the pelvic and lumbar lymph nodes.
Hematogenous spread of the way - very rare, not more than 2-3% of cases, characterized by metastases to the liver and lungs.In the propagation above the diaphragm there is pleural effusion, especially on the right.
To assess the prevalence of malignant disease, except leukemia, using the international TNM classification.T - the degree of local tumor spread, of N - the absence or presence of regional metastases, M - the absence or presence of distant metastases.
classification Stage Ovarian Cancer TNM 7 edition
Stage of the Tx - primary tumor can not be
Evaluation Stage of T0 - is not possible to detect the primary tumor
Stage I (T1) - Ovarian cancer (carcinoma) is in the range of one or both ovaries.
Stage IA (T1a) - Swelling in the confines of a single ovary.
Stage IB (T1b) - The tumor is limited to the range of both ovaries.
Stage IC (T1s) - The tumor is limited to within one or both ovaries with the presence of ruptured ovarian capsule, a tumor on the surface of the ovary, the tumor cells in astsiticheskkoy fluid and washings of the abdominal cavity.
Stage II (T2) - The tumor is limited to the pelvis.
Stage IIA (T2a) - Extension to and / or metastases to the uterus and / or fallopian tubes.The washings and ascitic fluid from the peritoneal cavity are no cancerous cells.
Stage IIB (T2b) - Extension to and / or metastasis to other tissues pelvic organs without germination.The washings and ascitic fluid from the peritoneal cavity are no cancerous cells.
Stage IIC (T2s) - The combination of T2a or T2b signs with the detection of tumor cells in the ascites fluid and washings of the abdominal cavity.
Stage III - There peritoneal metastasis outside the pelvis.
Stage IIIA (T3a) - There are microscopic peritoneal metastasis outside the pelvic
Stage IIIB (T3b) - There are macroscopic peritoneal metastasis outside the pelvic dimensions and less than 2 cm in greatest dimension.
Stage IIIC (T3cN0M0) or TlyubayaN1M0 - There macroscopic peritoneal metastasis outside the pelvic larger than 2 cm in greatest dimension.
Stage IV (Tlyubaya Nlyubaya M1) - There are distant metastases.
Ovarian Cancer Treatment
main treatment for ovarian cancer is a combination therapy - a combination of surgery and chemotherapy.The volume of transactions ultimately turns out intraoperatively, depending on the extent of the tumor.In the early stages of the affected ovary is removed.In the transition process in the womb performed supravaginal removal of the uterus to the ovaries (the cervix is not removed).In the propagation of the tumor in the gland organ resection is performed.
Chemotherapy is used almost always, usually complementing surgery.Currently, with the aim of treating ovarian cancer chemotherapeutic combinations of such drugs are used as the Cisplatin and Carboplatin, Cyclophosphamide, Taxol, as well as many others.
It is imperative to carry out the treatment of the control that is possible with the help of ultrasound and study the level of tumor markers (CA125), as well as other methods used in order to avoid the spread of the tumor.
for radiation therapy is used intra-administration of radioactive colloids or irradiation of the abdomen and pelvis.
prognosis of ovarian cancer
According to various sources the five-year survival rate is 95% at the first stage of the disease.
forecast is determined by histological, biological and clinical factors.An important prognostic factor is the degree of differentiation of the tumor.Even when I degree ovary tumor prognosis may be unfavorable, if the tumor has low differentiation.The five-year survival rate of ovarian cancer patients younger than 50 years is 40%, over 50 years - 15%.When borderline ovarian tumors, 10 year survival rate is 95%, a 20 year old 90%.
prevention of ovarian cancer
Specific prevention does not exist, recommended systematic preventive gynecological examinations, so that in case of occurrence of the disease to identify it early and begin treatment.
Gynecologist Kupatadze DD