Symptoms of ovarian cancer and methods of treating cancer pathology

Ovarian cancer in the first two stages occurs with a minimal set of symptoms (nausea, flatulence, weight loss), which makes early detection and treatment of the pathology problematic. At later stages (III-IV), when cancer cells gradually grow, covering nearby organs, treatment requires radical, complex, long-term treatment. The chances of recovery decrease with each new stage, but still the probability of a favorable outcome exists even at the last stage (10%).  

Main methods of treatment for ovarian cancer - features, indications and contraindications

When selecting a particular treatment method for ovarian cancer, the doctor takes into account several factors:

Often the transition of pathology from stage I to stage II takes a year. In the future, the rate of development of the disease will depend on the protective reactions of the patient’s body and other factors.

Some tumors have an aggressive course (they are most common in ovarian cancer), in other cases the symptoms are not so painful/less dangerous.

• Presence/absence of metastases

For high-quality treatment of this pathology, it is better to use an integrated approach, which will include several methods.

When is surgery for ovarian cancer the only option?

Surgical treatment occupies the main position in the treatment of the disease in question.

Most doctors are of the opinion that regardless of the stage of the pathology, the nature of the tumor, the patient must be operated on. This need is explained by possible errors in determining the stage of cancer. If ovarian cancer has begun to metastasize, then chemotherapy/radiation therapy alone will not be enough. Metastatic organs do not respond to the effects of any drugs.

There are several types of operations that are used for this pathology:

It involves removing the uterus, appendages, ovaries, and greater omentum. If there are no signs of cervical cancer, it is left. The ovaries and appendages are almost always removed (although there are exceptions), since the risk of cancer cells spreading to both organs is quite high. The omentum should be removed due to the probable occurrence of metastases here in ovarian cancer.

In some cases (due to the health of the patient, due to insufficient qualifications of the operator, in other cases), the operator may decide to perform supravaginal removal of the uterus.

It consists of total removal of the uterus and its organs (ovaries, appendages, omentum, cervix). Extirpation is indicated in the presence of pathological changes in the cervix.

• Cytoreductive manipulations

Used when it is impossible to eliminate the entire tumor. This procedure is aimed at reducing the parameters of a malignant tumor, which will later be susceptible to chemotherapy. If the tumor is gigantic, these procedures are not fruitful.

For ovarian cancer, cytoreductive operations are performed in 3 stages:

• Primary operation. Relevant in the presence of large low-quality formations. The goal of the manipulation is to minimize the parameters of the tumor and its metastases.
• Intermediate. After the primary cytoreductive surgery, the patient undergoes a short course of chemotherapy (2 sessions). If there are positive results, the doctor decides to perform an intermediate operation, which consists of reducing the volume of the tumor - this makes it possible to increase the effectiveness of chemotherapy procedures in the future.
• Secondary. If, after the entire course of treatment, a patient is diagnosed with a tumor whose dimensions exceed 5 cm, he is prescribed a secondary cytoreductive operation.

It is carried out under unforeseen circumstances that are associated with the disintegration of a tumor, which provokes intestinal obstruction, intra-abdominal bleeding, and other exacerbations. The purpose of the manipulation is to remove the tumor and stop the bleeding.

It has a diagnostic purpose: it is performed on patients who have successfully completed treatment ; other examinations have not revealed any signs of pathology. The purpose of the procedure is to confirm the absence/presence of malignant formation, metastasis. This manipulation is often used to take a sample of an organ that is susceptible to defective changes.

Laparotomy can be performed at any stage of the disease if the patient has no contraindications to surgical intervention (inflammatory phenomena in the genitourinary system, poor blood clotting, heart failure, etc.).

Chemotherapy for ovarian cancer: when is chemotherapy the best solution?

This procedure is fruitful when combined with surgical methods of treating the tumor. Among the medications used in chemotherapy, it is worth highlighting the drugs platinum + cyclophosphamide, or platinum + taxol. In the absence of any positive shift, the drugs are replaced with others: methotrexate, fluorouracil, lofenal, etc.

There are several ways to administer drugs: intramuscularly, intravenously. If the patient has ascites, after pumping out the fluid, medications are also administered into the abdominal cavity.

After prescribing a course of treatment, blood is drawn from the patient weekly, which is necessary to study the condition of the internal organs and blood composition.

Indications for chemotherapy when diagnosing ovarian cancer:

• After surgery: Chemotherapy is a means of preventing the appearance of metastases/new tumors in the future.
• Before surgical procedures, it helps to control the growth of cancer cells.
• Stabilization of cancer cell growth. Prescribed only after laparoscopy.
• Elimination of residual malignant tumors after surgery on the patient.
• In order to increase the patient's life expectancy. Helps temporarily stabilize health.

For each patient, medications are selected individually, taking into account several points:

• Weights.
• General condition.
• Functioning of the hematopoietic system.
• The nature of malignant formation.
• Tumor susceptibility to certain drugs.
• Absence/presence of ascites.

When using chemotherapy, drugs that have a positive effect on the hematopoietic system are prescribed in parallel.

Radiation therapy for ovarian cancer

This treatment method is based on the use of radioactive rays to irradiate the abdominal cavity.

, several methods can be used :

• The principle of moving stripes. Irradiation does not occur evenly, which can provoke the transfer of cancer cells to healthy areas in the future.
• The principle of open fields. More popular in the treatment of ovarian cancer: radioactive rays affect a wide area of ​​the abdominal/pelvic organs.

Radiation therapy is rarely used in the treatment of the disease in question; it is combined with other treatment methods.

Indications for this procedure:

• In order to relieve the patient’s pain, to improve the general condition. The duration of the 1st session is limited to a few minutes per day. The number of procedures will vary from 1 to 10.
• Lack of results after a course of chemotherapy + surgery.
• A recurrence of ovarian cancer is diagnosed. In this case, a complex treatment of chemotherapy + radiation therapy is prescribed.
• Elimination of residual formations after surgical treatment.

This type of treatment is contraindicated for patients who have serious disorders in the functioning of internal organs/systems.

Drug treatment for ovarian cancer

The entire range of existing medications that are used in the fight against ovarian cancer can be divided into 6 groups:

They provoke a failure in the DNA synthesis of the cancer cell, which favors its destruction. Representatives of this group of drugs are methotrexate, 6-mercaptopurine, ftorafur.

• Chlorethylamines, ethyleneamines

When these drugs enter the body, they react with tumor cells, disrupting their normal functioning, which causes cell death. Popular drugs in this group are cyclophosphamide, sarcolysine, and benzo-TEF.

• Hormones.
• Antibiotics (antitumor)

Today, the exact mechanism of their action is being studied. The purpose of using drugs is to destroy the structure of cancer cells. Bruneomycin and Adriamycin receive positive responses.

• Herbal medicines

They cannot be prescribed to patients with a low hemoglobin content in the blood or in case of malfunctions of the hematopoietic system. The principle of their action is to block the division of cancer cells. Colchamine, vincristine, and vinblastine are often used in the treatment of ovarian cancer.

• Other antitumor drugs

Inhibits the growth of cancer cells. These medications (L-asparaginase, myelosan) are representatives of different chemical groups.

Patient recovery after treatment for ovarian cancer

After/during treatment of the disease in question, the patient experiences a number of exacerbations that can be eliminated or alleviate their manifestation. A set of necessary and useful measures will be prescribed by the doctor.

When to start looking for cancer?

There are several options for dealing with the side effects of ovarian cancer treatment, the main ones are the following:

Drug therapy

Depending on the negative phenomena that occurred during the course of chemotherapy and radiation therapy, the patient may be prescribed maintenance medications:

Often prescribed simultaneously with a course of chemotherapy. However, if nausea and vomiting are present after the end of treatment, Ativan, Zofran, Compazine can be prescribed to avoid dehydration. There can be several variations of taking such medications: orally, rectally (suppositories), intravenously (dropper).

Prescribed if an adequate diet has not given a positive effect.

When both ovaries are removed, the doctor selects medications that will need to be taken regularly. Otherwise, disrupted hormonal levels can provoke negative consequences (hot flashes, early menopause, dry skin/vagina, etc.)

• Drugs that help maintain protective reactions in the body (interleukin-2, activated lymphocytes, etc.).

Psychological assistance to the patient

For moral support, patients can turn not only to relatives, friends, and partners:

He will be able to talk about possible exacerbations caused by treatment, preventive measures, and features of home treatment (diet, exercise). Financial questions and details of doctor visits can be clarified with the doctor/nurse.

They will be able to advise an organization where you can apply for financial support, where to find housekeepers/caregivers.

• Priest, psychotherapist.
• Support group for women who have suffered a similar disease

Today, there are many women volunteers who disseminate information about the nuances of cancer treatment they have undergone and provide moral assistance

Physiotherapy

Physical activity after treatment of the disease in question will be very useful. Physical activity helps improve blood circulation and promotes renewal of the body at the cellular level. Sports will help cope with nausea and improve appetite.

The best sports during the rehabilitation period are swimming and therapeutic exercises. For these purposes, there are special centers where people who have suffered serious illnesses can study.

Physiotherapeutic procedures can be carried out in healthcare institutions.

Prognosis and prevention - what is the survival rate after treatment?

After completion of treatment, a favorable prognosis (from 5 years of life) will be determined by the stage at which the cancer was detected, the effectiveness of treatment, and the histotype of the tumor:

• Stage 1 - 78-86%.
• Stage 2 – 58-66%.
• Stage 3 – 22-40%.
• Stage 4 – 5-10%.

• Due to the fact that the nature of the disease in question is not fully understood, a set of preventive measures against ovarian cancer does not exist.
• However, by following several rules, it is possible to reduce the risk of this pathology:

1. Regular visits to the gynecologist - every 6 months.
2. Infertility treatment. Ovarian cancer occurs more often in nulliparous women.
3. Taking hormonal contraceptives (before menopause).
4. Timely treatment of inflammatory processes of the genitourinary system.

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Modern methods of treating ovarian cancer

Types and symptoms of ovarian cancer

The disease can be primary or secondary. In the first case, we are talking about the development of a malignant tumor consisting of many cells, each of which has its own name. A secondary form of pathology is spoken of when a benign neoplasm smoothly develops into a malignant one.

There are four stages of ovarian cancer. At the initial stage of the disease, the tumor progresses very slowly, without causing the appearance of unpleasant symptoms. The first signs of the disease appear after the tumor grows. At a time when the tumor is benign, it is impossible to diagnose oncological pathology.

At a late stage of ovarian cancer, a woman is concerned about the following symptoms:

• frequent dull pain in the lower abdomen, possibly of low intensity;
• weakness throughout the body and constant fatigue;
• apathy, loss of appetite, depression;
• urinary disturbance;
• disruptions in bowel function;
• menstrual irregularities (usually rare and scanty discharge);
• increase in abdominal size.

Patients suffering from ovarian cancer sometimes note an increase in body temperature up to 37 degrees in the evenings and for no apparent reason. The results of a clinical blood test show an increase in the erythrocyte sedimentation rate with a normal white blood cell count.

Diagnosis of ovarian cancer

A gynecologist may suspect a pathology through examination, revealing the rapid growth of a tumor in the patient. Typically, malignant, rather than benign, tumors rapidly increase in size. A clear sign of the disease is the accumulation of fluid in the abdominal cavity in the presence of a tumor in the ovary. Sometimes pathology is discovered accidentally during biopsy or histology.

Diagnosing advanced ovarian cancer is not difficult. The tumor is noticeable or palpable through the anterior wall of the abdominal cavity. Also noteworthy is the patient’s large belly, the shape of which does not change depending on the position of the body. If cancer cells penetrate the navel, it becomes purple-blue in color.

For optimal diagnosis of the disease, it is necessary to perform an ultrasound examination of the abdominal cavity and pelvis. We can talk about a tumor if the neoplasm fits tightly to the ovary or is so large that it is located between the uterus and the rectum.

Ultrasound is not a universal diagnostic method, because it cannot detect very small tumors. Sometimes it is impossible to see the affected tissue in this way due to the presence of fluid in the abdomen. In this case, doctors recommend their patients to resort to the paracentesis procedure.

Most malignant neoplasms can metastasize to other organs, for example, to the mammary glands. That is why, having discovered an ovarian tumor, the doctor may prescribe additional examinations for the patient. With pathology, the lymph nodes located in the pelvic cavity often become inflamed.

Ovarian cancer treatment

There are several ways to combat pathology, the most common of which are chemotherapy and surgery.

The treatment tactics are determined by the doctor after a thorough examination and examination of the patient. Most often, surgery is performed and then chemotherapy courses are prescribed. If the disease has reached the last stage, then chemotherapy is practiced.

In special cases, chemotherapy is the only possible treatment.

Surgery is one of the most reliable ways to combat ovarian tumors.

With stage 3 or 4 ovarian cancer, it is not always possible to completely get rid of the affected tissue, so chemotherapy is additionally used.

In addition to surgery, treatment for ovarian cancer is carried out using one of the methods listed below.

1. Chemotherapy. It is carried out after the maximum possible removal of the tumor in order to prevent the growth of metastases and relapse of oncological pathology. If the damaged tissue was not completely removed, then this manipulation is necessary to stop the growth of the tumor or its final destruction. This procedure is the only option after palliative surgery (when it is impossible to completely remove the tumor) to prolong the patient’s life.
2. Treatment with hormonal drugs is used as an addition to chemotherapy. Usually prescribed: Sustanon, Testosterone and Methyltestosterone.
3. Radiosurgery is a popular method of combating malignant tumors, which uses a gamma knife. When the device is focused over the affected tissue, a focus of high intensity appears. As a result, cancer cells die without harming healthy ones. The procedure is effective, absolutely safe and does not require anesthesia, but is only suitable for combating small tumors. After radiosurgery, the patient does not need much time to recover.

Ovarian cancer: prevention and prognosis

To prevent the development of cancer, it is recommended to follow the following rules:

• stop drinking alcohol, drugs, and smoking;
• promptly treat infectious diseases of the genital organs;
• eat a full and balanced diet;
• refuse to work in hazardous industries, minimize the effects on the body of aggressive and radioactive substances (this especially applies to women whose relatives suffered from cancer of the reproductive organs);
• If a genetic predisposition to pathology is detected, undergo an ultrasound examination of the ovaries every six months and donate blood for the oncological marker CA-125.

Relapses are possible 1.5-2 years after tumor removal. Typically, neoplasms are found in the lumen between the uterus and rectum. Further therapeutic tactics are determined based on the medical history. The doctor may recommend that the patient undergo additional examinations, for example, laparoscopy, radiography, magnetic resonance imaging.

Breast cancer and spay removal

As already mentioned, the cause of ovarian cancer cannot always be determined. It has been proven that women predisposed to developing cancer have a special genetic marker. To avoid breast cancer, they may be recommended surgery. This is especially true for patients who have entered menopause.

Removal of the ovaries (oophorectomy) is practiced as a procedure that helps prevent the development of ovarian and breast cancer if a woman has a gene abnormality (BRCA1 or BRCA2). During the procedure, the reproductive organs are either surgically removed or their functions are disabled using drugs or radiation. After medical intervention, the likelihood of developing breast cancer is halved.

Why can removing the ovaries prevent or stop cancer? It turns out that these organs produce hormones that can stimulate the growth of breast cancer cells.

Sometimes after surgery, a malignant tumor not only stops growing, but also begins to shrink.

Disabling the functions of the reproductive organs is practiced at the third or fourth stage of the pathology, and surgical intervention is only used in advanced cases.

Surgical removal of the ovaries is the most reliable way to prevent or cure breast cancer. However, after such manipulation, the woman will no longer be able to have children. Drug disabling the functions of the reproductive organs is a reversible method, and their irradiation is practiced very rarely, because during the treatment process healthy tissue can be affected.

There is no consensus among doctors about removing the ovaries as a way to prevent breast cancer. After such manipulation, side effects rarely occur, but sometimes infectious pathologies, bleeding or damage to internal organs develop. The delayed effect of removal of reproductive organs is artificial menopause, which occurs regardless of the patient’s age and is manifested by the following symptoms:

• vaginal dryness;
• noticeable decrease in libido;
• tides;
• heavy sweating;
• increased nervous excitability;
• periodic swelling;
• weight gain;
• depression;
• decreased bone density, threatening osteoporosis.

In addition, if the ovaries are removed for breast cancer before menopause, infertility occurs due to the inability of the reproductive system to produce eggs.

The operation helps to cope with cancer not only of the reproductive organs, but also of the breast. Women who have a specific cancer marker often turn to surgeons. Unfortunately, this manipulation leads to changes in hormonal levels, the onset of early menopause and further infertility.

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Ovarian cancer treatment

The ovaries are paired organs of the female reproductive system, located on both sides of the uterus. They form and mature eggs, and also produce female sex hormones - estrogen and progesterone. The success of treatment for ovarian cancer depends on the stage and type of disease. Timely diagnosis is of great importance.

Most often, the disease begins in the cells of the outer lining of the organ: epithelial cancer accounts for about 90% of the total number of tumors. Less commonly, malignant tumors grow from tissue that produces eggs (germ tumors), and very rarely from cells that produce hormones (stromal tumors).

Ovarian cancer tumors tend to grow rapidly and do not manifest themselves in any way in the early stages of the disease (with the exception of stromal ones).

The main risk factors include:

• old age - as a rule, the disease develops in women after menopause, aged 50 to 60 years (8 out of 10 cases);
• women with early onset of menstruation (before 12 years) and late menopause (after 52 years);
• smoking;
• obesity;
• taking fertility drugs and hormone replacement therapy;
• polycystic disease;
• endometriosis (abnormal growth of the inner lining of the uterus);
• hereditary factor (genetic predisposition) – the presence of ovarian, breast or colorectal cancer in close relatives.

Women who do not have children and have never breastfed are also at risk.

Stages and types of ovarian cancer

There are 4 stages:

• At stage 1, the lesion is found in one or both ovaries. The prognosis for cure is positive; most patients go into stable remission without return of the disease.
• At stage 2, the tumor spreads to other parts of the pelvic cavity. In general, at this stage the prognosis is positive; according to statistics, in a five-year range, 70% do not experience a relapse (return of the disease).
• Stage 3 ovarian cancer is diagnosed when the tumor grows into the abdominal cavity and pelvic lymph nodes. The prognosis is made individually based on the patient’s condition and the extent of the tumor. The treatment uses an integrated approach, with the active use of chemotherapy. Chemotherapy for stage 3 ovarian cancer is aimed at both combating the primary tumor and destroying regional metastases.
• At stage 4, metastases are detected outside the abdominal cavity (in the liver, spleen, lungs). In this case, cancer is difficult to treat.

There is also a classification according to the degree of malignancy:

• class A (low degree of malignancy) - slowly growing tumor, cells with minor abnormalities (highly differentiated);
• class B (moderate degree of malignancy) – more pronounced morphological changes in tumor cells compared to highly differentiated ones;
• class C (high degree of malignancy) – fast-growing tumor, poorly differentiated cells.

Treatment methods for ovarian cancer

• Complex therapy usually includes a combination of surgery (surgery) and chemotherapy.
• Surgery
• Typically, during surgery for ovarian cancer, both paired organs, the fallopian tubes and uterus, nearby lymph nodes and folds of fatty tissue in the abdominal cavity to which the cancer has spread are removed.

If the disease can be detected in a young woman at the very beginning (at stage 1), in some cases a gentle surgical intervention is performed with removal of the ovary and fallopian tube on one side. In addition to the fact that the prognosis for treatment in this case is positive, this allows us to maintain hope for pregnancy.

To reduce trauma and the likelihood of complications, as well as for cosmetic purposes, surgery for ovarian cancer can be performed using the da Vinci Robot intelligent robotic system.

Chemotherapy

Chemotherapy for ovarian cancer is usually prescribed after surgery as part of complex therapy. The drugs are usually injected into a vein or directly into the abdominal cavity, or a combination of these methods is also used.

1. In later stages, chemotherapy may be chosen as the main treatment method.
2. Radiation therapy
3. In rare cases (with severe pain, bleeding from the tumor), treatment regimens for ovarian cancer include external beam radiation therapy or brachytherapy (contact radiation).

Consequences of treatment

After the operation, complications characteristic of any surgical intervention (bleeding, infection) are possible.

While taking chemotherapy, a woman may experience nausea, vomiting, and hair loss. After completing the course, these effects usually disappear.

Recovery after treatment

With a normal rehabilitation period, complete recovery after treatment for ovarian cancer takes up to 6 weeks for women. If the uterus has been removed, you must stop having sex for 3-4 weeks. In some cases, your doctor may prescribe hormonal medications and vitamin D.

If you need a second opinion to clarify your diagnosis or treatment plan, send us an application and documents for consultation, or schedule an in-person consultation by phone.

+7 499 490-24-13

Expert opinion

• Scientific degree: Candidate of Medical Sciences
• Specialization: oncologist, hematologist, chemotherapy
• Position: chief physician

Place of work: “Outpatient Oncology and Hematology Clinic”

Moscow city

Worked in leading cancer centers in the USA and UK. Trained in medical management in Canada, Germany, Singapore. Author of a number of publications, participates in scientific programs as a principal investigator.

Invited expert on thematic radio and television broadcasts on TV channels “Dozhd”, “Mir”, “RBC”, etc., Radio Liberty, “Echo of Moscow”, “Mayak”, etc.

Publishes articles and gives interviews to journalists from popular publications “AIF”, “Women’s Health”, etc.

Source: https://rakanet.ru/rak-yaichnikov/lechenie-raka-yaichnikov/

Ovarian cancer: first signs and symptoms in women, ovarian oncology in women, treatment of ovarian cancer

The etiology of the development of ovarian tumors, as for most human tumors, is completely unknown. But there are certain risk factors for developing this disease in women:

• Up to 10% of ovarian cancer cases are familial. The risk of ovarian cancer is increased if you have a relative with breast or ovarian cancer, especially if diagnosed during childbearing years. Genetic predisposition in women who carry BRCA1 or BRCA2 gene mutations. Therefore, if a genetic predisposition to the development of breast or ovarian tumors is suspected, a genetic examination is performed to determine the presence/absence of mutations in the BRCA1 or BRCA2 genes.
• Early onset of menarche and late onset of menopause are also thought to increase the risk of developing ovarian cancer.

Factors that are associated with a low risk of developing ovarian cancer

• Use of oral contraceptives,
• Lactation,
• Bilateral tubal ligation.

Symptoms of ovarian cancer

The insidiousness of ovarian cancer is that in the early stages it is asymptomatic, or the symptoms are minor and patients do not pay attention to them. Most often, the first signs of ovarian cancer are detected when the process is already at stages 3-4.

The most common symptoms are:

• Pain in the lower abdomen. Usually this is a mild or nagging pain, often one-sided, which goes away on its own for quite a long time.
• Feeling of heaviness in the lower abdomen.
• An increase in the volume of the abdomen, the appearance of areas of “hardening” in it.
• Impaired urination and difficulty in bowel movements. This is due to the pressure of tumor masses on the wall of the bladder or rectum. Because of this, there is a frequent urge to urinate, constipation, a feeling of incomplete emptying of the bladder or intestines, and bloating.
• Metastasis of the tumor through the peritoneum leads to the development of ascites (accumulation of fluid in the abdominal cavity), which is accompanied by an increase in abdominal volume, general deterioration of health, shortness of breath, inability to eat or a feeling of fullness from a small amount of food.
• In the last stages, general symptoms characteristic of a malignant process appear - weight loss, even cachexia (exhaustion), deterioration of general condition, severe weakness, etc.

Diagnosis of ovarian cancer

Transvaginal ultrasound (trusound) and determination of the CA 125 marker in blood serum are used as diagnostic methods. The combination of these two methods has high specificity for diagnosing ovarian cancer.

Additional research methods such as magnetic resonance imaging (MRI) or positron emission tomography (PET) can provide additional information, but are not necessary studies in routine practice during preoperative preparation.

If the results of TRUS are questionable, the use of MRI can help us in correctly diagnosing ovarian tumors (malignant/benign tumor).

The final diagnosis of ovarian cancer is made only after a morphological (examination of cellular/tissue composition) examination.

CA 125 (carbohydrate antigen 125) is the main marker of ovarian cancer. Normal levels in blood serum are up to 35 IU/ml. In most cases of ovarian cancer, its concentration increases 5 times or more.

The concentration of CA 125 in the blood serum can also increase in various non-tumor diseases: inflammatory changes in the abdominal cavity, pelvis, menstruation, benign tumors of the female reproductive system (ovarian cysts).

However, in most of these cases, the concentration of CA 125 in the blood serum does not exceed 100 IU/ml.

Ovarian cancer treatment

The extent of surgical intervention and the need for neoadjuvant (preoperative) / adjuvant (postoperative) chemotherapy depend on the stage of the disease, as well as other factors.

Surgical treatment of ovarian cancer

The goal of surgical treatment is to remove as much of the primary tumor and its metastases as possible. The operation that is preferred for ovarian cancer is extirpation of the uterus with appendages and resection of the greater omentum (i.e.

complete removal of the uterus, fallopian tubes and ovaries on both sides). For patients who want to preserve reproductive function, it is possible to perform unilateral removal of the appendages with adequate staging and no changes in the preserved structures.

For ovarian cancer, there is such a thing as cytoreductive surgery, an operation that is performed to reduce the volume of the tumor.

For patients who did not undergo maximum cytoreduction at the first stage, it is possible to perform an intermediate cytoreductive operation if there are positive dynamics or stabilization during chemotherapy.

Make an appointment with an oncologist-gynecologist

Systemic drug treatment (chemotherapy) for ovarian cancer

For ovarian cancer, different chemotherapy options can be used depending on the stage of the disease.

Neoadjuvant chemotherapy is preoperative chemotherapy for patients who cannot undergo surgical treatment at the first stage. When the desired effect is achieved, the patient subsequently undergoes surgical treatment.

Adjuvant chemotherapy is postoperative chemotherapy, carried out in the postoperative period in patients depending on the stage of the disease; in the early stages it is carried out in patients with intermediate and high risk (determined by the attending oncologist depending on certain characteristics).

Curative chemotherapy is carried out in the case of initially widespread disease or the presence of relapse of the disease.

When the disease relapses after previously administered platinum-based chemotherapy, attention is paid to the time from the end of treatment until the relapse occurs.

If less than 6 months have passed since the end of chemotherapy or a relapse occurred during chemotherapy, the tumor is considered not sensitive to platinum drugs (platinum-resistant), and these drugs are not used in further treatment.

Chemotherapy for patients with platinum-resistant disease is usually characterized by low antitumor effect and short life expectancy.

As 1st line therapy (i.e.

 what is used first) in the absence of contraindications, combinations based on platinum drugs are used, for example, paclitaxel at a dose of 175 mg/m2 with carboplatin AUC6 every 3 weeks for 6 courses of treatment.

Carboplatin can also be combined with gemcitabine, docetaxel, liposomal doxorubicin, but in accordance with European recommendations, the combination of carboplatin with paclitaxel is in first place in terms of evidence.

Monitoring of patients with ovarian cancer

Dynamic observation after treatment should include:

• anamnesis collection,
• examination and examination (ultrasound of the pelvic organs, abdominal cavity,
• taking blood tests to determine the concentration of CA 125 in the serum.

Frequency - once every 3 months during the first two years, then once every 4 months during the third year, once every 6 months during the 4th and 5th years or until the disease progresses.

Prices at the European Oncology Clinic for treatment of ovarian cancer

• Ovarian resection - RUB 49,700.

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Ovarian cancer: symptoms in women, first signs, treatment, prognosis

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%.

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.

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.

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).

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.

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.

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 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.

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.

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.

Source: https://bezboleznej.ru/rak-yaichnikov-u-zhenshin