What to do if you have a malignant tumor in the ovary: symptoms and treatment of gynecological cancer

• Important aspects
• Causes
• Symptoms of ovarian cancer
• Stages
• Diagnostics
• Ovarian cancer treatment
• Forecast
• Prevention

Ovarian cancer is a malignant tumor that develops from epithelial tissue. The disease is characterized by an asymptomatic course. Ovarian cancer is often detected at a late stage and requires radical surgical treatment. Is it possible to recognize a malignant tumor in time and prevent the development of complications?

Important aspects

Cancer, or ovarian carcinoma, ranks seventh among all malignant neoplasms in women. According to the International Agency for Research on Cancer, more than 165 thousand new cases of ovarian carcinoma are registered worldwide every year. The maximum prevalence is observed in northern European countries, Canada and the USA. In recent years, an increase in incidence has been recorded (by 8% or more).

The main reason for the low survival rate of patients with ovarian cancer is late diagnosis of the disease. Many women with suspected carcinoma end up in non-specialized medical institutions, where they receive low-quality care. According to statistics, every third patient dies within a year of diagnosis. The five-year survival rate for ovarian cancer is no more than 35%.

Reviews from patients who have suffered from the disease

I want to share my experience. I read a lot of literature about the relationship between cancer and nutrition, from people who had gone through this ordeal, and immediately switched to proper nutrition. I gave up meat, sugar and dairy products. I completed 6 courses of chemistry, completed the course in August 2020 and refused surgery (I am only 27 years old). The right ovary was removed before chemotherapy. I feel great, my indicators are normal. In addition to the chemistry, I took and now continue to take the drug Fucoidan - this is an extract from seaweed that is produced in Korea. And the main thing is the power of our mind, believe 100% that everything will be fine!

Stage 3C, the tube and omentum are affected (micrometastases). During the operation, the omentum was visually clean. The marker was almost 2000. The operation was extended; another part of the peritoneum was removed. They wrote T3сN1M0. I was upset only when I received the extract. Everyone hoped that I was in the second stage. 6 courses of standard chemistry, we bought Ebeve - Austrian. The doctor said this is the best. It’s August 7th - 2 years have passed since the last chemo. The marker after the second chemo dropped to 9. It hangs between 7.3 and 10.8. Once it jumped to 14.7. I was terribly scared. Then it dropped again. And so, while I’m healthy, I took up fitness and yoga. Moreover, fitness is very cardio-intensive. Learned to ride a bike. I believe that sports will help avoid relapse. Although every examination hurts like a child, well, actually, like everyone else. So LIFE CONTINUES!

Causes

The exact cause of ovarian cancer is not known. There are many theories about the origin of carcinoma, but scientists have still not been able to come to a consensus. There are several risk factors for developing the disease:

• genetic predisposition;
• chronic hyperestrogenism (increased levels of estrogen in the blood);
• taking certain medications (oral contraceptives, etc.).

Genetic predisposition to ovarian cancer deserves special attention. It is known that the presence of carcinoma in the mother or grandmother significantly increases the risk of developing the disease. In these same families, there is an increase in the incidence of uterine and breast cancer. According to the latest data, about 70% of common genes have been identified that are responsible for the likelihood of the formation of each of these tumors. Women with a family history of ovarian, uterine or breast cancer are at high risk and should be regularly examined by a gynecologist.

Hyperestrogenism is another significant risk factor for the development of ovarian cancer. Excessive production of estrogen leads to hormonal imbalance and probably affects the appearance of atypical cells in the ovarian tissue. Hyperestrogenism also provokes the occurrence of hyperplastic processes of the endometrium and uterine fibroids. If this pathology is present, a woman should be especially attentive to her health and do not forget about regular preventive visits to the doctor.

Factors influencing the development of hyperestrogenism:

• earlier onset of menstruation (before 12 years);
• unrealized reproductive function (lack of pregnancy and childbirth);
• late first birth (after 30 years);
• late menopause (after 50 years);
• frequent abortions and miscarriages;
• refusal to breastfeed.

All these conditions contribute to increased synthesis of estrogen, which adversely affects a woman’s health and may be one of the reasons for the development of ovarian cancer.

Does taking combined oral contraceptives (COCs) and other hormonal medications affect the risk of ovarian cancer? This issue has not been fully studied. It is known that ovarian carcinoma is detected more often in women taking COCs. No data were found on the effect of medications on the likelihood of developing cancer. Many experts believe that women taking COCs are more likely to see a gynecologist and therefore early forms of ovarian cancer are detected more quickly among them.

First signs

Early diagnosis of cancer can help save a person's life. It is quite difficult to detect a malignant neoplasm in the ovary at an early stage, so doctors listen with special attention to the complaints of women when they talk about abdominal pain and cannot accurately indicate the location of this pain. Patients complain of nagging pain in the navel and groin area, discomfort during sexual intercourse. At an early stage of tumor development, the sensations are so atypical for gynecological diseases that a woman may turn to another specialist for the first time. In this case, the presence of a malignant neoplasm is detected during the examination.

Among the most characteristic symptoms of ovarian cancer in the early stages, the following are most often detected:

• slight malaise and fatigue;
• weakness and apathy;
• decreased libido;
• reluctance to lead an active lifestyle.

The woman does not experience pain as such, but she is bothered by a constant feeling of discomfort in the pelvic area. At the first stage, the neoplasm affects one ovary and is located within it. Due to the small size of the tumor, it does not cause concern to the woman and the pathological process is often discovered during a routine examination.

The clinical picture is unclear, and the presence or absence of a cancerous tumor in the ovary can only be confirmed after a detailed genetic examination. The disease develops from the epithelial cells of the appendage and does not manifest itself in any way until the organ enlarges and begins to put pressure on nearby organs. At this time, the woman notices that urination has increased significantly and the functioning of the digestive organs is disrupted. This disorder manifests itself in the form of causeless diarrhea or constipation that occurs against the background of habitual and proper nutrition.

Cancer cells have a negative impact on the organ, and it loses its functional abilities. Destructive changes begin in the ovary. At an appointment with a gynecologist, women talk about the feeling of a foreign body inside, as if it interferes with movement, especially manifesting itself at the time of defecation, causing tension, compression or distension. The sensations are similar to increased gas formation during diarrhea.

Symptoms of ovarian cancer

Ovarian cancer occurs at any age. Most often, the disease is registered during the reproductive period (18-45 years). There are known cases of carcinoma occurring in adolescents who are not sexually active. Quite often, ovarian cancer develops during menopause (after menopause).

Ovarian cancer is asymptomatic for a long time. A tumor can be detected before the first signs appear only during an ultrasound scan or during an examination by a gynecologist. Often, carcinoma becomes an incidental finding during a medical examination or examination for another disease.

In the early stages, ovarian cancer can manifest itself with the following symptoms:

• moderate nagging pain in the lower abdomen;
• menstrual irregularities;
• general weakness;
• weight loss.

All these symptoms are nonspecific and occur in a wide variety of diseases of the female genital area. Aching pain in the lower abdomen and lower back is often attributed to premenstrual syndrome, and cycle disorders are attributed to the consequences of stress. General weakness, dizziness, low performance are not taken into account at all. The nonspecific clinical picture makes ovarian cancer one of the most difficult to diagnose diseases of the reproductive system.

In later stages, ovarian cancer is accompanied by the following symptoms:

• bloody discharge from the genital tract;
• an increase in the size of the abdomen (due to ascites - accumulation of fluid in the abdominal cavity);
• frequent urination;
• constipation

Impaired urination and defecation occur when the tumor is large and there is compression of the pelvic organs (bladder and rectum).

Characteristic signs of the early stages

The first sign of the onset of a pathological process is pain in the lower abdomen. It is very different from the pain that occurs with salpingitis or salpingoophoritis. Pain at the initial stage of development of ovarian cancer is not acute, cutting, or sudden. She:

• pulling;
• dull;
• does not increase with movement;
• accompanied by slight distension.

However, even such pain can lead to a false trail and force a woman to see a doctor with suspicion of an inflammatory process or digestive disorders. At this time, you need to carefully listen to your feelings and pay attention to the presence of other symptoms:

• sudden causeless nausea;
• lower back pain (possibly on one side);
• discomfort during sexual intercourse and pain after it;
• lack of appetite and rapid satiety;
• irritability and tearfulness.

When turning to a doctor, women note that despite the lack of appetite and a reduction in the amount of food taken, noticeable fullness appears, there is a constant feeling of bloating, and flatulence increases. Changes in the organs of the urinary system deserve special attention. Urination becomes frequent, the urge occurs suddenly and immediate bowel movements are required. The patient cannot hold back and involuntary urination occurs.

Another important feature of the disease is the gradual increase in symptoms. Unlike the inflammatory process, the manifestations listed above do not go away after some time, but rather intensify. This is due to the fact that the tumor gradually grows and puts pressure on neighboring organs, causing a sensation of a foreign body in the abdomen.

The danger of ovarian cancer is also great because the growth of the tumor is often not accompanied by pain, and the patient’s condition does not bother her or cause concern. Pain occurs and does not go away only after the appearance of metastases. Often, women turn to a gynecologist only when there is an unexpected appearance of bleeding that is not related to the menstrual cycle. This symptom is especially alarming if it appears in postmenopausal women. But even in this case, diagnosing a malignant ovarian tumor is quite difficult. This is due to the fact that in the early stages the neoplasm is small in size and cannot be detected during bimanual examination.

Stages

According to the international TNM classification, there are several stages of ovarian cancer development:

• Stage 0 – no tumor.
• Stage 1 – the tumor does not extend beyond the ovary.
• Stage 2 – the tumor has spread beyond the ovary, affecting the uterus, fallopian tubes and other organs, but does not extend beyond the pelvis.
• Stage 3 – the tumor extends beyond the pelvis.
• Stage 4 – distant metastases are noted.

Metastasis is the spread of cancer cells far beyond the primary site. With ovarian cancer, metastases first occur within the pelvis (uterus, fallopian tubes and other organs). Subsequently, cancer cells are found in the retroperitoneal space, on the layers of the peritoneum, in the abdominal organs and in the bones. Metastasis to the lungs and pleural cavity is possible.

What is the disease and how can it manifest itself?

By ovarian cancer, gynecological oncologists mean a whole group of malignant tumors that differ significantly in character, origin, behavior, etc. All these malignant neoplasms are united by a common feature: they affect the ovaries - the paired organs of the female reproductive system, in which eggs mature and sex hormones are produced.

A cancerous tumor is formed from ovarian tissue

The insidiousness of ovarian cancer is that in most cases, in the early stages of development, it practically does not manifest itself at all. For this reason, approximately ¾ of patients turn to doctors with the disease in an already advanced stage, when it is much more difficult, and sometimes impossible, to help them.

According to medical statistics, after 40–45 years of age, women have a significantly increased risk of developing malignant ovarian tumors. Before the onset of menopause, in the so-called premenopause, there is a constant decrease in the activity of the ovaries, which gradually reduce the secretion of sex hormones, which leads to an imbalance in the hormonal balance in the body. This situation sometimes causes the development of ovarian cancer. After 70–75 years, hormonal “storms” in the body subside, and the incidence of the disease declines.

Diagnostics

The following methods are used to detect ovarian cancer:

Gynecological examination

During the examination, the doctor may detect a formation in the projection of the ovaries (on one or both sides). Ovarian tumors are palpated as round or oval formations. It is impossible to distinguish cancer from a benign tumor or inflammatory formation of the ovary at this stage.

Instrumental methods: ultrasound, CT, MRI, PET-CT

Ultrasound examination is a simple and safe method for identifying any ovarian formations. A more accurate picture is provided by computer and magnetic resonance imaging, as well as PET-CT. Positron emission tomography (PET-CT) is currently considered the best method for detecting ovarian malignancies.

Tumor markers

In case of ovarian cancer, a specific marker CA-125 is detected in the blood of women. An increase in its concentration is observed in 90% of patients at stage II and above of the disease. In the early stages of cancer development, CA-125 is not always detected. Determining the marker in the blood is also important for diagnosing relapse of the disease.

Biopsy

A tumor biopsy is the only method to accurately diagnose cancer and distinguish it from benign ovarian tumors. For a biopsy, a section of the organ is taken and sent to the laboratory for examination. Often, a biopsy is performed directly during surgery to remove a suspicious ovarian mass (cyst, etc.). The operation is often performed laparoscopically.

Diagnostic methods

A woman’s visit to a doctor with complaints of discomfort in the lower abdomen makes one think about the presence of an inflammatory process in the intestines, and sometimes the examination begins with the referral of a therapist. Only after discovering the absence of disturbances in the functioning of the digestive organs, the doctor gives a referral to a consultation with a gynecologist. Diagnosis of ovarian cancer includes numerous examinations and specially developed research methods:

1. Bimanual examination of the pelvic organs. Allows you to detect changes in the parameters of the ovary and identify pain when palpating. In cases where an enlargement of both organs is detected, a suspicion arises of the presence of stage 2 cancer, affecting both the right and left ovaries.
2. If the patient says that in the evenings her temperature rises to 37-37.2° and the low-grade fever persists for a long time, then the doctor gives a referral for a blood test. Based on the results of the analysis, an increased ESR is determined. This fact is one of the signs of a developing inflammatory process, but its second sign, an upward change in the number of leukocytes in the blood, is absent.
3. The detected tumor may be benign and a repeat examination will be required after some time to confirm the preliminary diagnosis. A distinctive feature of a malignant tumor is the rapid growth of the tumor. In addition, a benign tumor can affect only one ovary, while cancer cells affect both organs.
4. The diagnosis of cancer is confirmed based on the results of a biopsy and histological examination.
5. An important sign of the presence of cancer is the simultaneous presence of a neoplasm and an increase in the amount of fluid in the abdomen (ascites).

All these signs give the specialist a reason to refer the patient for further, more detailed examination. First of all, the woman undergoes an ultrasound examination, but at a very early stage the tumor is so small that it cannot always be detected. The danger of ovarian cancer lies not only in its rapid and practically asymptomatic development. The tumor is capable of metastasizing even in the early stages of development. The presence of this process can be determined after examining the lymph nodes that are affected first. To clarify the diagnosis, lipography and puncture biopsy are performed. Of course, a woman needs to undergo a blood test, computed tomography and MRI.

If necessary, the doctor performs laparoscopy. Based on the results of the analysis, it will be possible to judge with confidence the quality of the detected tumor.

The CA-125 tumor marker makes it possible to determine the presence of cancer cells at the very first stage of disease development, when the tumor is not visible on ultrasound. To do this, it is enough to donate blood from a vein, but the equipment for this study is available only in large medical centers, so doctors use other examination methods to make the correct diagnosis.

Computed tomography and MRI make it possible not only to determine the location and size of the detected tumor, but also to determine whether it is malignant.

Modern diagnostic methods make it possible to detect ovarian cancer at a very early stage; it is important that a woman listens carefully to her body and does not put off visiting a doctor until later.

Ovarian cancer treatment

Treatment for ovarian cancer is surgical only. Conservative therapy is not carried out. It is impossible to slow down tumor growth with medications. A course of chemotherapy is carried out at certain stages only to destroy metastases.

Ovarian cancer is treated by a gynecological oncologist. The choice of treatment regimen will depend on the stage of carcinoma development, the general condition of the woman and the presence of metastases. In the early stages of the disease, the woman’s desire to preserve reproductive function is also taken into account. In the later stages, we are talking about saving lives, and it is not possible to leave the pelvic organs intact.

Surgery

The operation of choice for ovarian cancer is extirpation of the uterus and appendages. During the operation, the doctor removes the uterus along with the ovaries and fallopian tubes, performs an inspection of the abdominal cavity, and excises the affected lymph nodes. According to indications, the spleen, appendix, and altered areas of the intestine are removed. Only with this approach is it possible to completely remove cancer cells and reduce the risk of relapse of the disease.

Organ-conserving surgeries for ovarian cancer are performed extremely rarely. In some cases, surgeons comply with the woman’s wishes and remove only the affected ovary, leaving the uterus in place. Such an operation is possible only if the woman wishes to preserve reproductive function, as well as with careful monitoring of the condition of a healthy ovary and other pelvic organs. Organ-conserving operations are performed only in the initial stages of cancer development.

Radiation therapy

Radiation irradiation of the affected organs allows you to get rid of cancer cells and prevent relapses of the disease. Currently, methods have been developed for targeted irradiation of only changed tissues without affecting healthy cells. This approach increases the effectiveness of radiation therapy and reduces the likelihood of complications. The radiation therapy regimen is selected individually for each patient.

Chemotherapy for ovarian cancer

The goal of chemotherapy is to remove metastases of ovarian cancer and avoid tumor recurrence. Chemotherapy uses powerful drugs that suppress the growth of cancer cells. The duration of treatment and the choice of drugs will depend on the stage of cancer and the severity of the woman’s condition. In most cases, a combination of chemotherapy and radiation is used.

After treatment, the woman should remain under the supervision of a gynecological oncologist. During the first two years, an ultrasound of the pelvic organs is performed every 3 months and the level of CA-125 in the blood is determined. Subsequently, the frequency of examinations decreases. After 5 years, if there are no relapses, it is recommended to visit a gynecologist once a year.

Basic diagnostic methods

The main task of diagnosis is to differentiate malignant ovarian tumors from various types of cysts, uterine fibroids, adnexitis, and tuberculosis of the appendages. It should be noted that in the early stages of the disease it can be quite difficult to determine the malignant nature of the neoplasms and the final diagnosis is made only by analyzing the material removed during the operation.

To establish a diagnosis, the following methods are used:

1. Examination by a gynecologist. The tumor and the degree of its mobility are determined by palpating the appendages.
2. Lab tests. A clinical blood test allows you to detect deviations in basic blood parameters relative to reference values ​​- increased leukocytosis, decreased platelet count, the presence of lymphoblasts and myeloblasts, decreased hemoglobin levels and accelerated ESR. In addition, an analysis of the level of sex hormones is carried out to detect hormonally active tumors. A blood test for the CA-125 tumor marker suggests the presence of a malignant process, although a slight increase in the level of this ovarian cancer antigen does not always indicate the presence of a tumor.
3. Ultrasound. Ultrasound location of the ovaries provides information about the presence of a tumor and its size. This type of examination also allows you to determine the fluid contents of cysts, the viscous or dense structure of the tumor.
4. PET-CT. This examination combines positron emission and computed tomography and allows you to obtain detailed information about the nature and location of the tumor, the presence of metastases, and the condition of surrounding tissues. The simultaneous use of PET and CT technologies makes it possible to reduce the time required for examination.
5. MRI (magnetic resonance imaging). Examination using radio waves, used instead of X-rays, is used not so much to diagnose ovarian tumors, but to detect distant metastases, especially in the bones and brain.
6. Laparoscopy. Examination of the abdominal cavity using fiber optics and taking material for biopsy is used in special cases when difficulties arise in establishing a diagnosis. For example, when papillary growths are detected in a cyst using this method, in some cases a histological examination is performed. In addition, laparoscopy can provide information about the extent of tumor growth into neighboring organs - bladder, intestines, etc. In this case, in addition to the gynecologist, the relevant specialists are involved in the operation to remove the tumor: urologist, proctologist and others.

Laparoscopic examination is an examination of the ovaries through small incisions in the abdominal wall using special equipment.

Forecast

According to summary data, the average survival rate for 1 year is 65%, 3 years - 40% and 5 years - about 35%. The percentage of favorable outcome increases with early diagnosis of cancer, as well as in the case of using modern methods of chemotherapy and radiation therapy.

The prognosis for ovarian cancer will also depend on the stage of the disease. When carcinoma is detected in stage I and treated in a timely manner, the survival rate is about 90%. In stage IV disease, the 5-year survival rate among patients is only 17%. The cause of death is ascites, intestinal obstruction, as well as the appearance of metastases in the bones, lungs and brain.

Is a relapse possible?

Recurrence of ovarian cancer is possible, as with any type of cancer in the body. The likelihood of the disease returning depends on many factors, the main ones being:

• level of tumor malignancy;
• stage of the disease, reflecting the extent of the cancer process;
• the effectiveness of the chosen therapy, taking into account the tumor response to the effects of cytostatic drugs.

Of considerable importance is the ability of the immune system to suppress micrometastases spread throughout the body by the lymph and bloodstream.

As a result of vascular metastasis, malignant neoplasms can appear in any organ of the body

To prevent a possible recurrence of cancer on the second ovary, the probability of which is very high, the patient is usually recommended to remove the affected organ simultaneously with the healthy one, and sometimes the uterus - panhysterectomy. If the second ovary was preserved, the re-development of a malignant tumor will have the same symptomatic picture as in the first case.

Recurrence of ovarian cancer can also occur through the development of metastatic tumors in other organs - lungs, liver, brain and bone marrow, bones. Depending on the location of the secondary tumor, symptoms can be quite varied:

• headache;
• visual and hearing disorders;
• nausea, vomiting;
• bone pain (especially at night);
• obsessive dry or wet cough;
• increased body temperature;
• loss of strength, poor appetite;
• weight loss.

Prevention

Prevention of ovarian cancer has not been developed. Currently, the exact cause of the development of this pathology is not known, so it is not possible to find effective methods for preventing cancer. The following recommendations will help reduce the risk of ovarian carcinoma:

• Regular preventive examinations with a gynecologist (at least once a year).
• Timely implementation of reproductive function.
• Long-term breastfeeding (at least 1 year).
• Take hormonal medications only as prescribed by a doctor.
• Timely treatment of any diseases of the female genital area.

At the slightest suspicion of ovarian cancer, you must definitely contact a gynecologist and undergo examination by a specialist.