Ovarian carcinoma is a malignant tumor that affects the ovaries . It can be both primary in nature, when the main focus is located in the tissues of the ovary, and secondary (metastatic), with the primary focus in almost any part of the body [2] . Primary lesions include carcinoma (70% of all malignant ovarian tumors), germinogenic and stromal tumors of the sex cord, as well as rarer variants. Metastatic lesions of the ovary are quite common: with tumors of the endometrium, breast, colon, stomach and cervix. [2] [3]
| Ovarian cancer | |
|---|---|
 Mucinous tumor of the ovary of low malignancy potential. Medium increase, hematoxylin-eosin staining. | |
| ICD-10 | C 56. |
| ICD-10-KM | |
| ICD-9 | 183 |
| ICD-9-KM | |
| ICD-O | different |
| Omim | and |
| Diseasesdb | 9418 |
| Medlineplus | 000889 |
| eMedicine | med / 1698 |
Each year, more than 225 thousand new cases of ovarian carcinoma are recorded in the world, of which about 140 thousand end in death [4] . Despite the successes achieved in the diagnosis of ovarian carcinoma, about 75% of it is detected in the later stages. Five-year survival in the third stage is about 24%, in the 4th stage - 4.6%.
In 2018, in terms of the incidence of ovarian cancer, Serbia was in first place, Brunei was second and Belarus was third. [3]
Content
Epidemiology
Ovarian carcinoma is the fifth most frequent cause of death from various epithelial tumors in women , the leading cause of death from gynecological malignant tumors, and the second most frequently diagnosed tumor in gynecology [5] . According to the American Cancer Society, ovarian cancer is the fifth leading cause of cancer death among women in the United States. [6]
Reasons
For many malignant tumors, the causes of the occurrence are poorly understood, this disease is no exception. However, there are allegations that ovarian carcinoma is more common among nulliparous women. It is also believed that the prevention of ovarian carcinoma is the use of oral contraceptives [7] .
Of course, as for other oncological diseases, heredity is of significant importance, in other words, the increased likelihood of developing ovarian carcinoma can be transmitted from any parent, father or mother, to his daughter [8] . In addition, in patients with breast carcinoma, the risk of ovarian carcinoma is doubled [7] .
There is also an opinion that the spread of the disease is associated with an increase in the amount of animal fat consumed during food intake [7] .
Risk factors for the development of ovarian carcinoma include chronic gonadotropic hyperstimulation, uterine fibroids, chronic sensitized inflammatory processes, early and late menopause, uterine bleeding in postmenopausal women [9] .
Stages of the disease
The International Federation of Obstetricians and Gynecologists (FIGO) classifies the stages of the disease as follows [10] :
- I - only the ovaries are affected;
- IA - one ovary is affected, ascites is not;
- IB - both ovaries are affected, ascites is not;
- IC - the appearance of a tumor on the surface of the ovary (s), ascites;
- II - the disease spreads along the pelvis ;
- IIA - damage to the uterus or fallopian tubes ;
- IIB - damage to other tissues of the pelvis;
- IIC - a tumor on the surface of the ovary (s), ascites.
- III - spreads to the peritoneum , metastases appear in the liver and other organs within the abdominal cavity , damage to the inguinal lymph nodes .
- IIIA - distribution within the pelvis, with contamination of the peritoneum.
- IIIB - metastases with a diameter of up to 2 cm.
- IIIC - metastases with a diameter of more than 2 cm involving retroperitoneal and inguinal nodes.
- IV - distant metastases.
Symptoms
Basically, in the early stages, ovarian carcinoma proceeds without any symptoms . In addition, the first symptoms (an enlarged stomach) are often perceived by a woman as a manifestation of adnexitis ( inflammation of the ovaries ). The tumor gradually spreads through the abdominal cavity, affecting the omentum and causing fluid accumulation ( ascites ) [7] .
Also, one of the first symptoms may be pain in the lower abdomen with a pulling character, and is usually difficult to distinguish from those pains that occur with inflammation of the ovary [7] .
Diagnostics
Ovarian carcinoma can be suspected during examination of the patient’s abdomen and gynecological examination. If carcinoma is suspected, puncture is performed to obtain fluid from the abdominal cavity and identify tumor cells in it [7] .
A biopsy for ovarian carcinoma in developed European countries is not recommended, as this can lead to tumor sieving. Therefore, the final diagnosis can only be made during surgery during the operative analysis of the samples taken and the postoperative pathology of the excised tissues [11] .
Ultrasound examination of the abdominal cavity and pelvis, computed tomography (CT) of the chest organs, as well as CT or MRI of the abdominal cavity organs are used to diagnose carcinoma and assess the prevalence of metastatic lesions [7] .
The most informative diagnostic method is a histological examination of an ovarian biopsy specimen [10] . This study allows you to determine the nature and structure of the tumor. Based on the data obtained, the oncologist makes treatment tactics and makes a prognosis.
Treatment
The main methods of treating cancer are surgery and chemotherapy . During surgery at an early stage of the disease, only the affected ovary can be removed; in more complex cases, depending on the lesion, they can remove the uterus and omentum [7] .
Chemotherapy is usually based on a combination of several drugs, for example, Cisplatin (or Carboplatin ), Cyclophosphamide , Taxol , etc.
Due to the aggressive biology of the tumor, only a small number of patients (about 25%) are detected in the early stages. [12] The remaining patients are admitted for treatment at the III-IV stages of the disease, which is why the number of relapses even after complex treatment is quite high - about 80%.
Treatment for relapse of ovarian cancer can be either surgical or medication. Studies have shown that relapse-free and overall survival is better in patients who underwent optimal volume cytoreductive surgery (CC-0) and chemotherapy, compared to chemotherapy alone.
Ovarian Transplant
Since many women develop ovarian carcinoma at a reproductive age, some of them want to have children after treatment. A successful pregnancy after removal of the ovaries and cure of a carcinoma is possible provided that healthy tissue was cryopreserved during the operation and then transplanted back.
A study in this area was conducted by Danish scientists led by Annette Jensen, Rigshospitalet, Copenhagen. The work of the Danish Cryopreservation Program and the Ovarian Transplantation Program, which started in 2000, was monitored. Since [ when? ] tissue taken from almost 800 women underwent cryopreservation, 41 of them were selected for participation. According to the results of the study, 30% of women managed to get pregnant, both naturally and with IVF. The average age of women during transplantation was 33 years. In total, during the observations they had 14 children. [13] [14]
Forecast
The National Cancer Society (USA), citing the National Cancer Institute and the SEER Data Base, published survival statistics based on a study of patients from 2004 to 2010 [15]
| Stage | 5 year survival | |
| I | 90% | |
| IA | 94% | |
| IB | 92% | |
| IC | 85% | |
| II | 70% | |
| IIA | 78% | |
| IIB | 73% | |
| III | 39% | |
| IIIA | 59% | |
| IIIB | 52% | |
| IIIC | 39% | |
| IV | 17% |
The cause of death is usually the development of ascites, metastases in the bones, lungs, liver and brain, as well as impaired intestinal patency or exhaustion [7] .
Notes
- ↑ Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- ↑ 1 2 Andrew E Green. Ovarian Cancer Medscape. Date of treatment October 9, 2015.
- ↑ 1 2 Ovarian cancer statistics . World Cancer Research Fund (August 22, 2018). Date of treatment March 26, 2019.
- ↑ Nikoghosyan S.O., Kuznetsov V.V. Modern diagnosis of ovarian cancer // Russian Oncological Journal. - 2013. - No. 5.
- ↑ Ovarian Cancer - Gynecology and Obstetrics (English ) ? . Merck Manuals Professional Edition. Date of appeal March 25, 2019.
- ↑ Ovarian cancer is hard to detect (neopr.) . medicalxpress.com. Date of appeal March 25, 2019.
- ↑ 1 2 3 4 5 6 7 8 9 Leningrad Regional Oncology Center . www.lood.ru. Date of appeal March 25, 2019.
- ↑ Viviana Rivera-Varas. Breast Cancer Genes and Inheritance (English) (1998). Date of treatment November 24, 2013.
- ↑ Ovarian cancer. Per. from English N. D. Firsova (2017).
- ↑ 1 2 Ovarian cancer on the Oncology website
- ↑ Eierstockkrebs - Früherkennung, Diagnose und Krankheitsverlauf //onkologie.hexal.de
- ↑ FY Ahmed, E Wiltshaw, RP A'Hern, B Nicol, J Shepherd. Natural history and prognosis of untreated stage I epithelial ovarian carcinoma. // Journal of Clinical Oncology. - 1996-11. - T. 14 , no. 11 . - S. 2968–2975 . - ISSN 1527-7755 0732-183X, 1527-7755 . - DOI : 10.1200 / jco.1996.14.11.2968 .
- ↑ Ovarian transplantation is effective and safe for cancer patients . Euroonco. Date of treatment October 9, 2015.
- ↑ Ovarian transplants prove safe and effective for cancer patients . Medicalnewstoday (October 7, 2015). Date of treatment October 9, 2015.
- ↑ American Cancer Society. Survival rates for ovarian cancer, by stage . American Cancer Society (August 5, 2014).
[1] On the survival of patients with ovarian cancer at different stages of the disease.
Literature
- Marie E. Wood, Paul A. Bann. "The secrets of hematology and oncology." Moscow, Binom, 1997
- Malignant neoplasms in Russia in 1997 (morbidity and mortality). Edited by Academician of RAMS V. I. Chissov, prof. V.V. Starinsky, Ph.D. honey. Sciences L.V. Remennik. Moscow, 1999.
Links (in English)
- The site of Willie O'Hagan, an artist seeking to draw attention to cancer patients
- Ovarian Cancer Information at Johns Hopkins Hospital Website
- American National Association of Ovarian Cancer Patients :
- Ovarian Cancer Information from the US Ministry of Health :
- Newsletter for patients with ovarian cancer :
- Ovarian Cancer in Canada
- Diary of a patient with ovarian cancer
- Canadian Cancer Society
- British Society for the Support of Ovarian Cancer Patients
- Register of patients with ovarian cancer
- Ovarian Cancer Research Fund
- Diary of a patient with ovarian cancer
- A place for communication between patients with ovarian cancer and mutual support
- Chicago Society of Ovarian Cancer Patients
- Cancer Center Sloan-Catering
- ↑ Larisa Verdun. About the prognosis of ovarian cancer survival at different stages - a site about ovarian disease . Site about ovarian disease . okiste.ru (06/10/2017). Date accessed June 10, 2017. (unavailable link)