- Factors that are associated with a low risk of developing ovarian cancer
- Symptoms of ovarian cancer
- Diagnosis of ovarian cancer
- Ovarian cancer treatment
- Surgical treatment of ovarian cancer
- Systemic drug treatment (chemotherapy) for ovarian cancer
- Monitoring of patients with ovarian cancer
- Prices at Euroonko for 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.
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.
Causes
Cancer develops when abnormal cells in the ovary begin to divide uncontrollably.
Moreover, they differ from normal cells. Without dying within a certain period of time, they outlive normal cells and continue to create new ones, forming a tumor. Cancer cells can sometimes travel to other organs, where they begin to grow and replace normal tissue. This process, called metastasis, occurs when cancer cells enter the body's bloodstream or lymphatic system. Tumors that spread from other organs (such as the breast or colon) to the ovary are not considered ovarian cancer Source: Risk Factors for Ovarian Cancer. Savonevich E.L. Journal of Grodno State Medical University No. 3, 2010. p. 74-76. Risk factors for ovarian cancer include:
- genetic predisposition;
- personal or family history of breast, ovarian, or colon cancer;
- age;
- infertility.
Although having one or more risk factors may increase a woman's chance of developing ovarian cancer, it does not necessarily mean she will get the disease. A woman with one or more risk factors should be especially vigilant in detecting early symptoms Source: Primary multiple ovarian cancer. Bekhtereva S.A., Domozhirova A.S., Aksenova I.A., Pshichenko S.V. Research'n Practical Medicine Journal, 2021.
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.
Prevention
The following rules for the prevention of ovarian cancer are relevant:
- Regularly undergo preventive examinations with a specialist, and perform an ultrasound of the pelvic organs once a year.
- Treat all diseases of the genital area in a timely manner.
- Use oral contraception, but the optimal drugs should be selected by a specialist.
- Practice family planning - get pregnant in a timely manner, breastfeed your child.
- Eat rationally and nutritiously.
- Get rid of bad habits as early as possible.
- To live an active lifestyle.
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 and 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. It can be optimal (when the volume of the residual tumor does not exceed 1 cm in the greatest dimension) and non-optimal (the volume of the residual tumor is more than 1 cm). 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.
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Consequences and complications
Ovarian cancer is a dangerous disease that can lead to the development of metastases , and in the absence of adequate and timely treatment, death.
anemia and leukopenia may develop . Kidney disease is also likely to develop. Chemotherapy increases the risk of toxic hepatitis .
After therapy, there is also a risk of re-development of the tumor, so constant preventive monitoring is very important.
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.
If 6 months or more have passed, the tumor is sensitive to platinum drugs (platinum-sensitive). With the development of a stable and long-term effect after platinum-containing chemotherapy, there is a high probability of a repeated response to treatment regimens with platinum derivatives.
As first-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.
Classification
According to international histological qualifications, the following types of carcinomas are distinguished:
- serous - (carcinomas of this type are distinguished as low and high grade);
- mucinous;
- endometrioid;
- clear cell;
- serous-mucinous;
- Brenner's malignant tumor;
- undifferentiated;
- mixed epithelial.
There are several stages of the disease according to the degree of its development:
- Stage I – only the ovaries are affected.
- IA - only one ovary is affected, ascites .
- IB – both ovaries are affected, there is no ascites.
- IC – a tumor appears on the surface of an ovary or two ovaries, ascites.
- Stage II – the disease spreads throughout the pelvis.
- IIA – the uterus or fallopian tubes are affected.
- IIB – other tissues of the pelvic organs are affected.
- IIC – a tumor develops on the surface of an ovary or two ovaries, ascites.
- Stage III – peritoneal carcinomatosis develops, metastases appear in the liver and other organs of the peritoneum, and the inguinal lymph nodes are affected.
- IIIA - the process spreads within the pelvis, seeding of the peritoneum occurs.
- IIIB – metastases appear, the diameter of which is up to 2 cm.
- IIIC - metastases appear, the diameter of which is more than 2 cm, the retroperitoneal and inguinal nodes are involved.
- IV
– distant metastases appear.
Germ cell tumors are also identified, some varieties of which can be malignant. Germinogenic formations are associated with malformations of the primary germ cell. This type of tumor includes teratoma (tetrablastoma) - a tumor that can be either benign or malignant. This is an embryonic cell tumor that is formed from layers of endo-exo- and mesoderm. It appears even before birth, and can appear at any age. Despite the fact that different types of such tumors are identified (fetal neck teratoma, sacrococcygeal teratoma, etc.), most often in women it appears in the ovaries. Immature teratoma can be malignant and metastasize to other organs.
Prices at Euroonko for treatment of ovarian cancer
- Consultation with an oncologist— RUB 5,100.
- Consultation with a chemotherapist— 6,900 .
- Ovarian resection - 62,900 rubles.
- Ovariectomy— 116,600 .
- Wertheim's operation - 247,500 rubles.
- Immunotherapy (without the cost of medications) - 19,000 rubles.
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