How long do patients with ovarian cancer at different stages live? Ovarian cancer - causes, diagnosis, treatment.

Ovarian cancer includes a group of diseases that combine several pathological processes that occur in ovarian tissues. This concept can be differentiated depending on the clinical picture, origin and inherent properties. If ovarian cancer is detected and fixed, the first signs and symptoms in women allow the doctor to quickly develop a treatment regimen. This increases the chances of avoiding serious complications by curing the disease at its initial stage.

How to identify a disease before it develops? Ovarian cancer is one of the most hidden types in oncology. If there are gene mutations responsible for the functioning of special cells, this should be a reason to urgently consult a doctor. This mutation indicates a very high risk of cancer. Today, medicine easily determines this deviation. It is necessary to visit a specialist and undergo an ovarian examination. The complexity of this disease lies in the fact that it can only be detected at an early stage after a complex genetic examination.

An ovary affected by cancer is radically different from its healthy counterpart. The stage and malignancy of ovarian cancer are of great importance. Unfortunately, with ovarian cancer there are no obvious symptoms signaling pathology. Developing from the epithelial cells of the ovaries, the disease occurs in a latent form, without giving itself away. A blurred clinical picture hinders successful diagnosis, wasting valuable time. Only when the tumor acquires an impressive size can one suspect that something is wrong.

Being in the pelvic area, at a certain time the tumor becomes larger and begins to compress the surrounding tissues. Meanwhile, serious and irreversible consequences occur in the ovary itself. Under the negative influence of cancer cells, destructive changes occur, causing the organ to lose its functional abilities. If you know how to listen to yourself and your ailments, you can notice the feeling of a foreign body inside the pelvis. It seems to be bursting from the inside, and the symptoms are similar to diarrhea.

In rare cases, when the cancer process is reactive in nature, the earliest sign reveals itself in the first months of the pathology. It is necessary to immediately be alarmed, because otherwise metastasis and complications to internal organs will not have to wait long.

The nature of pain in ovarian cancer

What is important to pay attention to first and identify stage 1 ovarian cancer? Pain in the lower abdomen is the first symptom. It is of an exclusively pulling nature; there is no sharp pain with ovarian cancer. An exception may be the ovary, which is accompanied by sharp pain, as if from a knife blow. Such cases are rare; usually the tumor gradually increases without giving away anything.

The feeling of discomfort can occur spontaneously, radiate to the lower back and be localized in the pelvic area. If the tumor has reached a large size, it takes up a lot of space in the pelvis, which leads to displacement of the internal organs. At the slightest movement the body responds with pain. You cannot ignore and let what is happening happen to chance, because cancer cells tend to grow quickly. A pathological process is launched, the outcome of which is difficult to predict.

It is noteworthy that the longer the disease lasts, the more noticeable and aggressive the pain becomes. They may not exist at all, and the disease becomes known only after metastases occur. Carrying through the bloodstream, tumor decay products poison the entire body. At the same time, internal organs are affected by cancer cells, after which the disease moves to a more complex stage.

Nagging pain in the lower abdomen is one of the first signs of ovarian cancer

Other first manifestations of the disease

You should not expect any obvious manifestations from this type of cancer, even if it is malignant. It is important to pay attention to any changes in well-being, track them and record them. Immediately after sexual intercourse, a woman is diagnosed with dyspareunia - an atypical, normal abdominal pain of a pulling nature. This is explained by the mechanical effect on the genital organs located in close proximity to the ovaries.

The first symptoms of ovarian cancer most often appear in the later stages of development.

List of other symptoms:

• ascites: accumulation of a certain amount of fluid in the abdominal cavity;
• irregular periods, menstrual irregularities, characterized by the appearance of spotting in the middle of the menstrual cycle;
• due to the growth of the tumor, the shape and size of the abdomen changes;
• unexplained, sometimes significant weight loss;
• frequent urination;
• quick feeling of fullness;
• unreasonable nausea, refusal to eat;
• anemia, pale skin;
• weakness, excessive fatigue and changes in emotional background.

The more signs there are in total, the more pronounced the clinical picture will be. Ascites is manifested by bloating, so you should be careful about such changes in body proportions. Miscarriages and repeated difficulties with pregnancy also indicate an existing pathology. It is safe to say that cancer can be present in the body only after a thorough diagnosis and pelvic ultrasound.

It is important to know that ovarian cancer can masquerade as other diseases and conditions. In this case, the pathology is generally asymptomatic, or the patient does not pay attention to the feeling of discomfort. The results of the analysis may reveal an increase in ESR, which is associated with a reaction to the inflammatory process within the body.

Unilateral ovarian cancer and its symptoms

In gynecology there is such a concept - “an organ that is inaccessible for external examination.” The ovary is located inside the pelvis and cannot be visually identified. During a vaginal examination performed by a specialist, this is also difficult to do. The disease may already be present even if the ovaries are of normal size and configuration. Only a special examination can diagnose ovarian cancer.

If the right ovary is affected, the clinical picture of the disease resembles. An aching, nagging pain is detected in the lower abdomen. All manifestations are localized on the right side. The outflow of urine is disrupted, pressure increases, and the abdomen enlarges with asymmetry to the right side.

Other symptoms are the same as for bilateral ovarian cancer:

• flatulence, problems with bowel movements;
• excessive fatigue;
• occasionally bloody discharge from the vagina appears;
• palpitations and discomfort increase as the disease progresses.

Due to tubal obstruction, mechanically caused infertility develops. The impossibility of conception is also explained by the fact that the functions of the ovaries are sharply reduced.

If the left ovary is involved in the cancer process, the symptoms differ only in the location of manifestation. Pain and other characteristic symptoms of ovarian cancer should alert a woman and pay attention to changes in the body.

How does cancer manifest in its final stages?

As soon as metastases occur, the signs of ovarian cancer change in nature, signaling a worsening of the pathology. Sometimes this process develops in a short period of time, especially if the body is weakened and no treatment has been carried out. This is explained by the fact that the ovaries are supplied with many blood vessels through which cancer cells can easily spread to any organs and tissues.

At the beginning of the disease, being limited only to the tissues of the ovaries, cancer cells are not capable of causing harm to the entire body as a whole. Developing in stages, the cancer tumor spreads to nearby organs, changing and destroying their structure. During the process of metastasis, lymph nodes located on the periphery of the ovaries are affected.

Soon the infection reaches a large scale, and the following complications arise in the body:

1. Enlarged lymph nodes (internal iliac, sacral and, in rare cases, lumbar lymph nodes).
2. Impaired urination occurs due to the involvement of the tissues of the urethra and other organs of the urinary system in the pathological process. The bladder may also become compressed, causing the urge to urinate more frequently.
3. Destructive changes in the external genitalia.
4. Intestinal damage can be suspected by the occurrence of constipation, diarrhea and pain in the rectum.
5. In the later stages of ovarian cancer, a woman loses vitality and develops exhaustion of the body. In medical terms, cachexia occurs. It is characterized by extensive weight loss, with vital organs severely affected. Their functional ability is gradually and irrevocably lost, the organs decrease in size and literally shrink.

To summarize, we can draw an unambiguous conclusion about the symptoms and first signs of ovarian cancer. Having natural intuition and flair, a woman can recognize ovarian cancer and its first signs and symptoms on her own. At risk are older women and those who have 3 or more of the above symptoms.

Even minor deviations from the norm can be a reason to perform an ultrasound diagnosis of the pelvis. You also need to visit a gynecological oncologist twice a year and have tumor markers determined. There are special markers that allow verification in the early stages of the disease.

Ovarian cancer in women can certainly be included in the category of intractable pathologies. The explanation is the fact that until the appearance of metastases, the neoplasm may in no way make itself felt. And the initial clinical manifestations have long been perceived as symptoms of overwork or the course of inflammatory processes in the pelvis. The prognosis of survival for ovarian cancer directly depends on the stage at which the disease was diagnosed, as well as on its size and the presence of secondary foci of atypia in distant organs.

First stage of ovarian cancer

At the very early stage of its appearance, a malignant neoplasm in the ovarian structures in women may not manifest itself in any way. They continue to lead their usual lives, work, and be sexually active.

In some cases, however, warning signs may be observed:

• increased fatigue;
• decreased ability to work;
• periodic discomfort during sexual intercourse;
• changes in appetite parameters.

In this case, the menstrual cycle does not suffer, intercyclic discharge is not observed. With timely diagnosis of the focus of atypia and adequate treatment procedures, the prognosis at this stage is favorable. Women can live more than 10 - 15 years, and some even become mothers.

Great importance is attached to the cancer patient’s attitude towards recovery and her compliance with treatment recommendations. Otherwise, the disease continues to progress and passes through successive stages, when even the use of the most modern and effective treatment methods does not allow the cancer to be quickly dealt with.

Second stage of ovarian cancer

After the oncological process leaves the organ, involvement of neighboring tissues is observed. Symptoms become more characteristic of cancer, and women’s well-being deteriorates much more.

Ovarian neoplasm at stage 2 manifests itself:

• frequent pain impulses in the lower abdomen;
• discomfort during sexual intercourse;
• discomfort in the lower extremities caused by compression of vascular structures and stagnation of lymph;
• possible increase in temperature in the evening;
• increased urge to urinate;
• increasing weakness and fatigue.

The prognosis at this stage largely depends on the complexity of the treatment – ​​surgery and chemotherapy. Thus, with initially high parameters of a woman’s health, a relatively young age and careful implementation of all recommendations, 45–55% of them live from 7 to 10 years.

Whereas, in the absence of proper treatment or ignoring the recommendations given by the oncologist, a cancer patient rarely lives to see the 3rd anniversary of the cancer diagnosis. The support of family and relatives is of great importance.

Stage three ovarian cancer

No specialist can judge how long the life of a patient with stage 3 ovarian cancer will be. It is necessary to take into account a huge number of factors - from the woman’s age and health condition, to the treatment capabilities of the institution where she sought medical help.

As a rule, the prognosis is relatively favorable if all possible efforts have been made - surgical intervention, with excision of not only the ovaries themselves, but also the uterus, appendages, and greater omentum, as well as complex chemotherapy and radiation therapy.

Of course, the most exciting question for cancer patients is how long they live with ovarian cancer and whether recovery is possible - in each case the specialist answers in his own way. All people are individual and everyone's health status is different.

However, medical statistics convincingly show that if all recommendations are followed to the maximum and women are determined to recover, more than half of them successfully cross the threshold of five-year survival.

The situation is not so favorable if the patient does not want or does not have the opportunity to undergo complex antitumor treatment - the formation of complications is observed already 1–2 years from the moment the diagnosis is confirmed. Increasingly deteriorating health subsequently no longer allows for appropriate anti-cancer procedures. Efforts are directed towards maintaining the highest possible standard of living.

Stage four cancer

Of course, an extremely negative prognosis for survival is given by specialists when an oncological process is detected in the ovaries at the 4th stage of its formation. At this moment, atypical elements affect not only the pelvic organs, but also, through metastasis, affect the activity of the rest of the body.

The woman’s well-being suffers significantly. She complains of constant severe weakness and the inability to do even light housework. Painful impulses haunt her throughout the day. They are localized not only in the abdomen, but also move to the spine, lower limbs, and chest. Appetite is almost completely absent, weight is steadily decreasing.

Even the full treatment carried out - a combination of polychemotherapy with radiation therapy - does not allow us to talk about high chances of recovery. The efforts of specialists, as a rule, are aimed at maintaining the optimal functioning of vital organs.

Many cancer patients die from various complications by the end of the first year from the moment of cancer diagnosis. And only 5–7% cross the five-year survival threshold. This is why it is so important to undergo preventive gynecological examinations in a timely manner with the mandatory collection of biomaterial for atypical cells.

Ovarian malignancy throughout the world occupies one of the leading positions in the total volume of detected tumor foci. To cope with it, you will need to make every effort, both by the woman herself and her doctor. Timely treatment is a huge step towards recovery.

Ovarian cancer is a malignant tumor, the source of which is the epithelium. This is a fairly common pathology: in the structure of general cancer incidence it ranks 7th, among malignant diseases of the female genital organs - 3rd, in addition, this cancer accounts for about 4-6% of malignant neoplasms in women in general. Thus, in Russia, 15 women out of every 100,000 fall ill with it annually (this is an average; in some regions the incidence is minimal, while in others, on the contrary, it is significantly higher than the indicated value). Unfortunately, in every 4th woman a malignant neoplasm is diagnosed not at the initial stage, but already at the III-IV stage.

You will learn about why ovarian cancer occurs, what symptoms it manifests, as well as the principles of diagnosis and modern methods of treating this pathology from our article.

Causes and mechanism of development

The leading causes of ovarian cancer today are considered to be hormonal disorders in a woman’s body and a genetic predisposition to this disease. Thus, it has been proven that women who have had one or more pregnancies and give birth suffer from it much less often than those who have been diagnosed with infertility. The development of this pathology is also influenced by:

• early menarche (first menstruation before 12 years);
• late ;
• the use of hormonal drugs that stimulate ovulation, more often than 2-3 times a year;
• benign ovarian tumors and;
• in the anamnesis;
• hereditary predisposition.

Three syndromes of hereditary predisposition to this disease have been described:

• familial ovarian cancer (the likelihood of getting sick directly depends on how many close relatives have contracted this pathology previously: if 2 first-degree relatives suffer from it, the risk is 50%; if ovarian cancer is detected in one first-degree relative and one second-degree relative, the risk is 7%; if it is diagnosed in only one first-degree relative, the risk is 4-5%));
• familial breast/ovarian cancer (women suffer from both diseases at once; the degree of risk of their development is also determined by the number of close relatives suffering from them; if any one of these pathologies develops, the likelihood that the second will appear increases by 2-4 times);
• Lynch syndrome II (in families of close relatives there is a high incidence of adenocarcinomas of various localizations - endometrial, breast, ovarian, colon and rectal cancer; the likelihood of developing cancer, again, depends on the number of sick relatives, but in any case it is 2 times higher, than in individuals without Lynch syndrome).

Cancer accounts for 80-90% of all malignant ovarian tumors. Based on the form of growth and development, it is divided into primary and secondary.

• Primary cancer develops on its own, without previous cystic changes in the organ. Such tumors, as a rule, are poorly differentiated, small in size, pink-gray in color, and outwardly similar to a mulberry or a lump of caviar. Difficult to diagnose.
• Secondary forms of ovarian cancer develop from a previous benign cyst. The cells of its inner layer become malignant and then spread to other layers. They can be single- or multi-chambered, grow to large sizes, and are heterogeneous in density.

Ovarian cancer often metastasizes. As a rule, this occurs by desquamation (otherwise known as exfoliation) of malignantly degenerated cells from the surface of the affected ovarian tissue and spreading them with a flow of intra-abdominal fluid to nearby organs - the peritoneum, diaphragm, liver capsule, omentum.

Another way of metastasis is with the lymph flow, but it is involved in the process, as a rule, later, when metastases are already present in the abdominal cavity. With lymph, cancer cells enter the retroperitoneal, para-aortic, pelvic, and inguinal lymph nodes.

In 2-3 out of 100 patients, malignant cells enter the bloodstream and spread to the liver, bones and brain.

The tumor can also grow into nearby organs - the bladder and rectum.

Classification of the disease

According to the TNM classification, the following stages of ovarian cancer are distinguished:

• T x – there is not enough information to assess the tumor process;
• T 0 – primary tumor not detected;
• T 1 – the tumor is located in the ovarian region;
• T 1a – the neoplasm is limited to one ovary, does not grow into the capsule;
• T 1b – the neoplasm is limited to two ovaries, does not grow into the capsule;
• T 1c – the tumor is limited to one or two ovaries, grows into the capsule, or malignant cells are found in the ascitic fluid or washing from the abdominal cavity;
• T 2 – one or two ovaries plus organs or pelvic walls are affected;
• T 2a - the pathological process is widespread in the tissue of the uterus or fallopian tube;
• T 2b – the pathological process has spread to other pelvic organs, there is no ascites;
• T 2c – the spread of cancer is the same, but malignant cells are found in the ascitic fluid;
• T 3 – the neoplasm spreads beyond the pelvis or there are metastases in regional lymph nodes;
• T 3a – microscopic metastases are detected outside the pelvis;
• T 3b – metastases located outside the pelvis are no more than 2 cm in size;
• T 3c and/or N 1 – large metastases outside the pelvis – more than 2 cm in diameter, or metastases in regional lymph nodes;
• M 1 – extra-abdominal metastases and/or metastases were found in the liver tissue, cancer cells were found in the pleural fluid.

Since ovarian cancer can have different degrees of differentiation of tumor cells, and the treatment tactics and prognosis of the disease directly depend on this, one more type of gradation is added to the TNM classification - G:

• G 1 – borderline or high degree of differentiation;
• G 2 – average degree of differentiation;
• G 3 – poorly differentiated tumor.

Classifying ovarian cancer by stage is also extremely important. There are 4 stages, and I, II and III, in turn, are divided into A, B and C. Stage IV corresponds to the TxN x M 1 stage, and I-III completely coincide with the similar stage according to TNM (that is, stage 1A corresponds to T 1a, stage 1B – T 1c and so on). The larger the stage, the more severe the pathological process and the worse the woman’s prognosis for recovery and even life.

Clinical manifestations

The initial stages of ovarian cancer are not accompanied by any specific manifestations. However, this does not mean that the disease during this period is asymptomatic. In particular, the cystic formation from which secondary cancer originates gradually increases in size and puts pressure on nearby organs - the intestines, bladder, and uterus. This is manifested by heaviness in the lower abdomen, a tendency to urination, urination disorders, and discomfort in the lumbar region. General weakness and fatigue also arise and gradually increase. There are violations. The pain syndrome is usually not expressed.

In some cases, the disease manifests itself suddenly - an attack of acute abdominal pain associated with torsion of the tumor's leg, a resulting disruption of its blood supply, or rupture of the capsule.

If the tumor is hormonally active, there are signs of hyperestrogenemia (increased levels of estrogen in the blood) or (when the concentration of androgens - male sex hormones) is increased.

In later stages, with metastasis, the disease may be accompanied by ascites (as free fluid in the abdominal cavity is called) or. Also, in the later stages of the disease, women's appetite decreases, and they noticeably lose weight, up to cachexia (exhaustion).

Diagnostic principles

The doctor may suspect that the patient has an ovarian tumor due to her complaints in combination with medical history (indication of this disease in close relatives). An objective examination, in particular, palpation of the pelvic area, will probably partially confirm this assumption - a tumor-like formation may be palpable in the left, right, or both iliac regions. With primary ovarian cancer, it will be single, immobile, small in size, indefinite in shape (reminiscent of a mulberry), dense in consistency, and granular-lumpy surface. In secondary cancer, the size of the neoplasm can vary widely, its shape can also be different, the structure is heterogeneous, cystic, the surface is from smooth to lumpy, and there is no mobility.

A general gynecological examination, which is indicated for all women with suspected tumors of the reproductive organs, may reveal, for example, an overhang of the posterior vaginal vault or any other signs of a tumor process.

Ultrasonography (ultrasound) of the pelvic organs will help confirm the presence of a neoplasm. In this situation, it is carried out not only abdominally (through the anterior abdominal wall), but also using a vaginal sensor (it is inserted into the vagina and thus the study is carried out).

X-ray computed tomography will show a clearer picture than ultrasound and will help clarify the size and location of the tumor. This method is used in cases where ultrasonography for some reason did not provide accurate information about the extent of the pathological process.

Magnetic resonance imaging is an even more advanced diagnostic method than computer scanning. Its advantage is the ability to obtain images in different projections, and therefore to detect the growth of a tumor into organs adjacent to the ovaries. In addition, there is no radiation exposure during MRI.

A method that allows you to reliably establish a diagnosis of cancer, that is, to find out the nature of the tumor (its cellular structure) and the extent of the pathological process, is laparoscopy with targeted biopsy (in this case, a piece is cut off from the altered tissue for subsequent examination under a microscope).

A cytological examination of punctate pouch of Douglas or the contents of the abdominal (for ascites) and pleural (for pleurisy) cavities can provide certain information to the doctor. To do this, soft tissue of a given area is pierced with a thin needle and pathological fluid is drawn into a syringe for subsequent examination. In case of ovarian cancer, malignant cells characteristic of a particular type of tumor will be found in this fluid.

If, after all the studies described above, the diagnosis cannot be determined, a diagnostic laparotomy is performed - under sterile operating room conditions, the abdominal cavity is opened in a certain area and the condition of the organs, including the ovaries, is visually assessed. With cancer, of course, a tumor is discovered there, a piece of which is examined under a microscope and it is determined whether it is cancer and what kind.

In order to identify metastases, the patient may be prescribed x-rays of the chest or digestive tract, ultrasound of the liver and other diagnostic methods.

As for laboratory tests, a blood test for tumor markers may be informative: alpha-fetoprotein, human chorionic gonadotropin, CA-125 and HE-4. However, an increase in the level of these substances does not always indicate exactly the pathology we are describing, but may also occur in some other clinical situations.

Principles of treatment

A set of therapeutic measures is selected for each patient individually depending on the cancer histotype, stage of the tumor process, woman’s age, concomitant diseases and a number of other factors. Typically, treatment includes surgery, chemotherapy, radiation therapy, and/or hormone therapy.

The operation is usually performed (even at an early stage of ovarian cancer) to remove the uterus, appendages (fallopian tube and ovary) on both sides and the greater omentum.

Only in isolated cases, if the tumor process affects only 1 ovary, young women undergo only unilateral adnexectomy (in other words, the appendages on the affected side are removed) and omentectomy (resection of the omentum) followed by chemotherapy. This allows you to preserve a woman’s reproductive function - giving her a chance that in the future she will be able to conceive, bear and give birth to a child.

Also, during the operation, the maximum possible number of metastases is removed and a revision of regional lymph nodes is carried out with urgent histological examination.

Chemotherapy is carried out before surgery, after it, or as an independent method of treatment (for example, with a common process, when surgery does not make sense). Cytostatic drugs are used:

• cisplatin,
• melphalan,
• platinum derivatives.

One of the new chemotherapy drugs is paclitaxel. It has high antitumor activity, reduces the risk of relapse and is better tolerated by patients than its counterparts. Usually, not one drug is used, but a combination of two or three of them.

In some cases, chemotherapy can stop tumor cells from multiplying. It is difficult for patients to tolerate; side effects include nausea, vomiting, hair loss, suppression of hematopoiesis, and toxic effects on the liver and kidneys.

The effectiveness of chemotherapy is influenced by the general condition of the patient, the cellular composition and size of the residual tumor, the duration of the interval without treatment (in case of relapse), and the number of metastases.

Radiation therapy is not as widely used as cytostatic therapy for the treatment of ovarian cancer, since it is often not effective. However, in the case of certain histological types of tumor, such treatment is fully justified.

What's next?

A woman who has been treated for ovarian cancer must be monitored by an oncologist for 5 years. The doctor periodically conducts examinations and prescribes examinations that will help to see if new foci of tumor have arisen, and if they have appeared, to detect them as early as possible. During the first three years, examinations are carried out once every 3 months, then once every six months for another two years. If a relapse does not develop during this period, the examinations do not show anything that could alert the doctor, the woman is considered recovered.

– primary, secondary or metastatic tumor lesion of the female hormone-producing gonads – the ovaries. In the early stages, ovarian cancer has few symptoms; There are no pathognomonic manifestations. Common forms are manifested by weakness, malaise, decreased and perverted appetite, gastrointestinal dysfunction, dysuric disorders, and ascites. Diagnosis of ovarian cancer includes physical and vaginal examination, ultrasound, nuclear MRI or CT scan of the pelvis, laparoscopy, study of the CA 125 tumor marker. In the treatment of ovarian cancer, a surgical approach (panhysterectomy), polychemotherapy, and radiotherapy is used.

General information

Ovarian cancer ranks seventh in the structure of general cancer pathology (4-6%) and ranks third (after uterine cancer and cervical cancer) among malignant tumors in gynecology. Most often, ovarian cancer affects premenopausal and menopausal women, although it is not an exception among women under 40 years of age.

Classification of ovarian cancer

Based on the location of the initial focus of cancer, gynecology distinguishes between primary, secondary and metastatic lesions of the ovaries. Primary ovarian cancer develops immediately in the gland. According to their histotype, primary tumors are epithelial formations of papillary or glandular structure; less often they develop from cells of the integumentary epithelium. Primary ovarian cancer is often bilateral; has a dense consistency and lumpy surface; occurs predominantly in women under 30 years of age.

Secondary ovarian cancer in gynecology accounts for up to 80% of clinical cases. The development of this form of cancer occurs from serous, teratoid or pseudomucinous ovarian cysts. Serous cystadenocarcinomas develop at the age of 50-60 years, mucinous - after 55-60 years. Secondary endometrioid cystadenocarcinomas occur in young women, usually with infertility.

Metastatic damage to the ovaries develops as a result of the spread of tumor cells by hematogenous, implantation, and lymphogenous routes from primary foci in cancer of the stomach, breast, uterus, and thyroid gland. Metastatic ovarian tumors grow rapidly and have an unfavorable course; they usually affect both ovaries and disseminate early throughout the pelvic peritoneum. Macroscopically, the metastatic form of ovarian cancer has a whitish color, a lumpy surface, and a dense or doughy consistency.

Rarer types of ovarian cancer are represented by papillary cystadenoma, granulosa cell, clear cell (mesonephroid) cancer, adenoblastoma, Brenner tumor, stromal tumors, dysgerminoma, teratocarcinoma, etc. In clinical practice, ovarian cancer is assessed according to FIGO criteria (stages I-IV) and TNM (prevalence of the primary tumor, regional and distant metastases).

I (T1)– the spread of the tumor is limited to the ovaries:

• IA (T1a) – cancer of one ovary without germination of its capsule and proliferation of tumor cells on the surface of the gland
• IB (T1b) – cancer of both ovaries without germination of their capsules and proliferation of tumor cells on the surface of the glands
• IC (T1c) – cancer of one or two ovaries with germination and/or rupture of the capsule, tumor growths on the surface of the gland, the presence of atypical cells in ascitic or lavage waters

II (T2)– damage to one or both ovaries with tumor spread to the pelvic structures:

• IIA (T2a) - ovarian cancer has spread or metastasized to the fallopian tubes or uterus
• IIB (T2b) - ovarian cancer has spread to other structures of the pelvis
• IIC (T2c) – the tumor process is limited to the pelvis, the presence of atypical cells in ascitic or lavage water is determined

III (T3/N1)- damage to one or both ovaries with metastasis of ovarian cancer to the peritoneum or regional lymph nodes:

• IIIA (T3a) – presence of microscopically confirmed intraperitoneal metastases
• IIIB (T3b) – macroscopically defined intraperitoneal metastases with a diameter of up to 2 cm
• IIIC (T3c/N1) - macroscopically determined intraperitoneal metastases with a diameter of more than 2 cm or metastases to regional lymph nodes

IV (M1)– metastasis of ovarian cancer to distant organs.

Causes of ovarian cancer

The problem of ovarian cancer development is considered from the perspective of three hypotheses. It is believed that, like other ovarian tumors, ovarian cancer develops under conditions of prolonged hyperestrogenism, which increases the likelihood of tumor transformation in estrogen-sensitive gland tissue.

Another view on the genesis of ovarian cancer is based on the idea of ​​constant ovulation with early menarche, late menopause, a small number of pregnancies, and shortened lactation. Continuous ovulation promotes changes in the epithelium of the ovarian stroma, thereby creating conditions for aberrant DNA damage and activation of oncogene expression.

The genetic hypothesis identifies women with familial forms of breast and ovarian cancer among the potential risk group. According to observations, an increased risk of developing ovarian cancer is associated with the presence of infertility, ovarian dysfunction, endometrial hyperplasia, frequent oophoritis and adnexitis, uterine fibroids, benign tumors and ovarian cysts. The use of hormonal contraception for more than 5 years, on the contrary, reduces the likelihood of ovarian cancer by almost half.

Symptoms of ovarian cancer

The manifestations of ovarian cancer are variable, which is explained by the variety of morphological forms of the disease. With localized forms of ovarian cancer, there are usually no symptoms. In young women, ovarian cancer can clinically manifest with a sudden pain syndrome caused by torsion of the tumor stalk or perforation of its capsule.

Activation of manifestations of ovarian cancer develops as the tumor process spreads. There is an increase in malaise, weakness, fatigue, low-grade fever; deterioration of appetite, gastrointestinal function (flatulence, nausea, constipation); the appearance of dysuric phenomena.

When the peritoneum is damaged, ascites develops; in the case of metastases to the lungs - tumor pleurisy. In the later stages, cardiovascular and respiratory failure increases, edema of the lower extremities and thrombosis develop. Metastases in ovarian cancer are usually detected in the liver, lungs, and bones.

Among malignant ovarian tumors there are hormonally active epithelial formations. Granulosa cell carcinoma of the ovaries is a feminizing tumor that promotes premature puberty in girls and the resumption of uterine bleeding in menopausal patients. A masculinizing tumor, adenoblastoma, on the contrary, leads to hirsutism, changes in figure, breast reduction, and cessation of menstruation.

Diagnostics

A set of methods for diagnosing ovarian cancer includes physical, gynecological, and instrumental examinations. Recognition of ascites and tumor can be made already during palpation of the abdomen. Although a gynecological examination can reveal the presence of a unilateral or bilateral ovarian formation, it does not give a clear idea of ​​the degree of its benignity. Using a rectovaginal examination, the invasion of ovarian cancer into the parametrium and perirectal tissue is determined.

If ovarian cancer is suspected, a study of tumor-associated markers in serum (CA-19.9, CA-125, etc.) is indicated. To exclude the primary focus or metastases of ovarian cancer in distant organs, mammography, radiography of the stomach and lungs, irrigoscopy are performed; Ultrasound of the abdominal cavity, ultrasound of the pleural cavity, ultrasound of the thyroid gland; FGDS, sigmoidoscopy, with appendages and subtotal resection of the greater omentum. During the operation, intraoperative revision of the para-aortic lymph nodes with their urgent intraoperative histological examination is mandatory. At III-IV stage. For ovarian cancer, cytoreductive intervention is performed, aimed at maximizing the removal of tumor masses before chemotherapy. In case of inoperable processes, they are limited to a biopsy of tumor tissue.

Polychemotherapy for ovarian cancer can be carried out at the preoperative, postoperative stage, or as an independent treatment for a common malignant process. Polychemotherapy (platinum drugs, chlorethylamines, taxanes) allows suppression of mitosis and proliferation of tumor cells. Side effects of cytostatics include nausea, vomiting, neurotoxicity, nephrotoxicity, and inhibition of hematopoietic function. Radiation therapy for ovarian cancer has little effectiveness.

Prognosis for ovarian cancer

Long-term survival in ovarian cancer is determined by the stage of the disease, the morphological structure of the tumor and its differentiation. Depending on the tumor histotype, the five-year survival threshold is exceeded by 60-90% of patients with stage I. ovarian cancer, 40-50% - from stage II, 11% - from stage III; 5% - from IV Art. Serous and mucinous ovarian cancer have a more favorable prognosis; less – mesonephroid, undifferentiated, etc.

In the postoperative period after radical hysterectomy (panhysterectomy), patients require systematic monitoring by a gynecological oncologist to prevent the development of post-castration syndrome. In the prevention of ovarian cancer, a significant role is given to the timely detection of benign glandular tumors, oncological examinations, and reducing the impact of adverse factors.

Ovarian cancer occupies a leading place among malignant tumors in women. The disease can occur even at a young age and is diagnosed in girls. Most often, pathology occurs in the preclimatic and climatic periods.

Ovarian cancer is one of the most common types of cancer in women, and it most often occurs during premenopausal and climatic conditions

Stages of the disease

In medicine, there are 4 stages of ovarian cancer:

1. Stage 1 ovarian cancer – the tumor spreads to one or two organs. It is possible for cancer cells to reach the surface of the ovary and accumulation of excess fluid in the abdominal cavity.
2. Stage 2 ovarian cancer – malignant cells metastasize to the pelvic organs, intestines, and fallopian tubes.
3. Ovarian cancer stage 3 – characterized by the appearance of a tumor on one or two organs at once, metastases in the abdominal region and outside the pelvis. In pathology, the lymphatic and retroperitoneal nodes are also affected.
4. Stage 4 ovarian cancer is diagnosed in the presence of distant metastases. This does not take into account the size of the tumor itself.

Classification of the disease

Ovarian cancer in women occurs due to primary or secondary metastatic factors. The primary form of pathology develops as a result of the formation of malignant cells, the secondary form - due to the degeneration of benign tumors into cancerous ones.

You should know! According to the international classification ICD-10, the disease in question is classified as a malignant neoplasm and is designated by code C56.

Malignant ovarian tumors can be:

• serous;
• glandular;
• epithelial;
• mucinous;
• mixed.

Each of these tumors occurs in ovarian cancer; using photos on Internet resources, you can examine in more detail the external characteristics of the formations.

Symptoms of pathology

The disease is diagnosed in the later stages of development - at the third or fourth stage. This causes high mortality among women. The first symptoms of the problem are similar to other pathologies and do not differ in specificity.

You should know! Malignant neoplasms are not capable of producing hormones, so the disease does not cause disruption of the menstrual cycle.

Symptoms of ovarian cancer include:

• pain;
• feeling of compression of other organs;
• signs of intoxication;

Pain with ovarian cancer is the first sign of a problem in the body. Discomfort is felt in the lower abdomen and back. Pain with ovarian cancer is similar in symptoms and signs to chronic cancer.

As the tumor grows, it affects neighboring organs and tissues, which is manifested by problems with stool and frequent urge to urinate. When the pelvic organs are compressed, the veins become pinched, which ultimately leads to swelling of the lower extremities and.

In ovarian cancer, it is one of the most characteristic signs of pathology. The severity does not depend on the stage of the disease. The sign can be observed in benign tumors and in the initial stages of oncology development. The patient can independently determine the excess fluid in the abdominal cavity by the disproportionate increase in the abdominal area. When the pathological process moves to the chest area, signs of ovarian cancer are supplemented by shortness of breath and pleural effusion.

In the later stages of development, ovarian cancer symptoms resemble poisoning of the body. The disease occurs with symptoms:

• general deterioration of health;
• sudden weight loss;
• dysfunction of the gastrointestinal tract;
• loss of appetite;
• damage to the respiratory system and heart.

You should know! In rare cases, malignant cells produce their own hormones in ovarian cancer; symptoms in women in this case may be supplemented by: facial and body hair growth, cessation of the menstrual cycle, and premature puberty.

Diagnostic measures

Diagnosis of the disease includes the following activities:

You should know! Sometimes follicular cysts form on a woman’s reproductive organ, which are visually similar to tumor formations. Cysts usually go away on their own without treatment.

1. Dopplerography. Ovarian cancer cannot always be diagnosed by ultrasound, so the method is supplemented with the Doppler effect. The method allows you to identify blood flow abnormalities in the affected area. New vessels appear around the tumor and blood supply increases.
2. . It is prescribed to clarify the size of the abnormal formation, determine the extent of spread of uterine and ovarian cancer and identify metastases.
3. . Allows you to identify distant metastases in several projections.
4. PET or positron emission tomography. Thanks to the technique, it is possible to detect even minor distant metastases. During the examination, a search is made for cancer cells labeled with isotopes.
5. Detection of cancer markers. Abnormal formations produce special substances that can be found in the female body. For example, a diagnosed tumor in combination with an increased level of AFP (alpha-fetoprotein) and hCG (chorionic gonadotropin) indicates the presence of a germ cell formation.

You should know! CA-125, a tumor marker for ovarian cancer, significantly exceeds normal values ​​during the disease. This condition also occurs during exacerbation, so it is impossible to use the method of identifying cancer markers as the main one.

Therapeutic methods

The leading role in the treatment of ovarian cancer in women is given to surgery. The second most effective method of treating the disease is chemotherapy. For successful recovery, techniques are often combined.

Chemotherapy is carried out for all patients who have had their ovaries removed for cancer. This method of treatment allows you to achieve the following results:

• prevent the growth of cancer cells;
• avoid the possibility of relapse of the disease;
• slow down tumor growth at stages 3 and 4 of cancer;
• destroy the remains of oncological formation in the early stages of ovarian cancer;
• improve patient survival rates.

Radiosurgery is a commonly prescribed operation for ovarian cancer. The method is used not only for the disease in question, but also for cervical cancer and other malignant pathologies. The procedure uses a gamma knife. The installation generates low-power radioactive rays, which allows the preservation of healthy tissue. When the beam of rays is focused in the area of ​​cancer, the cancer cells disintegrate. The main condition for a successful operation is high precision, so that with the chosen focusing the rays converge in the area where the tumor is located. On Internet forums there are many positive reviews about the effectiveness of radiosurgical treatment in the fight against ovarian cancer. The main disadvantage of the technique is the inability to eliminate tumors of significant size.

Hormone-containing drugs can be prescribed as a comprehensive treatment for pathology. On forums, women write about the low effectiveness of this method of therapy. In order to suppress the growth of cancer cells, the following remedies are prescribed to women:

• Testosterone;
• Sustanon;
• Methyltestosterone.

Prediction of survival in early stages

At stage 1 ovarian cancer, the prognosis is the most favorable, since at this stage the abnormal cells do not spread beyond the organ. The five-year survival rate for the disease is about 92%.

It is also necessary to predict survival taking into account the type of tumor. Many women (8 out of 10 cases) are diagnosed with an epithelial type of formation or carcinoma. With this type of tumor, the prognosis for survival after surgery ranges from 60-80%. With stromal neoplasia, the probability of successful treatment increases to 95%; with germ cell ovarian cancer, the rate increases to 96-98%.

Stage 2 disease – ovarian cancer with metastases. For this reason, the survival prognosis is much worse than at stage 1. According to average statistics, the number of patients surviving after surgery for 5 years is 55-70%. How long a woman can live after surgery depends on the effectiveness of the drugs used and the completeness of the removal of cancer cells.

Prognosis for advanced stages of cancer

The prognosis in the last stages of the disease is unfavorable because cancer cells spread to the peritoneum and regional lymph nodes. Life expectancy is on average 57%, with stage 3 ovarian cancer. How long people live with the disease also depends on the type of tumor:

• with the epithelial form, five-year survival rate is 25-40%;
• with stromal form – 63%;
• with the germinogenic form – 84%.

Important! Stage 3 ovarian cancer with ascites has a poor prognosis, since abnormal cells attack not only the genitals, but the entire body. The probability of a favorable outcome for 3-5 years is reduced to 10%.

The worst prognosis for survival is observed with stage 4 ovarian cancer; how long patients with this disease live largely depends on the chosen treatment tactics. According to average statistical data, the five-year survival rate for this pathology does not exceed 5%, since cancer relapse is often observed after a course of therapy.

Ovarian cancer is a dangerous and difficult to diagnose disease. The first signs of pathology may not appear or may resemble other problems, for example, chronic inflammation of the ovaries. Whether the tumor can be completely removed depends on the stage of the oncological process and the treatment methods used. After tumor removal in the final stages, the survival prognosis decreases due to metastasis of cancer cells to other organs and tissues.