Ovarian dysgerminoma - A malignant tumor, presumably developing from the primary indifferent gonad cells. Usually diagnosed at a young age. Often occurs on the background of genital hypoplasia and general infantilism. In the early stages, it can be accompanied by pain, weakness and dysuria. In the later stages, germination of nearby organs, infection of the neoplasm, hyperthermia, and general intoxication are observed. Diagnosis expose taking into account complaints, data of general and gynecological examination and the results of additional research. Treatment - surgical removal followed by radiotherapy.
Causes and pathology of ovarian dysgerminoma
Ovarian dysgerminoma develops from primary germ cells. Normal, all germ cells at the time of birth should form primordial follicles. When the process of follicle formation is impaired, such cells remain unchanged in the tissue of the organ, begin to proliferate uncontrollably over time and are transformed into a malignant neoplasm. Patients with ovarian dysgerminoma often suffer from general and genital infantilism. Often there are anomalies of the female genital organs. A history of amenorrhea or later menarche may be detected.
Ovarian dysgerminoma is a round or oval, dense, nodular neoplasm. In the initial stages, it is covered with a smooth capsule, subsequently the capsule and the surrounding tissues germinate. More often one-sided. As a rule, ovarian dysgerminoma is localized in the gate area of the organ. Located in Douglas space (cavity behind the uterus, limited peritoneum). Size may vary significantly. In advanced cases, the tumor completely replaces the ovarian tissue. Local aggressive growth and lymphogenous metastasis are characteristic of ovarian dysgerminoma. As the tumor progresses, the fallopian tube, uterus, and other nearby organs may grow. Usually metastasizes in the lymph nodes of the abdominal aorta and the common iliac artery. In advanced cases, distant metastasis is possible, more often - to the lungs, liver and bones.
On the ovarian dysgerminoma cut brownish, gray or yellowish with a pink tinge. Diffuse hemorrhages are determined. Microscopy reveals large cells with fairly clear boundaries, bright nuclei and light foamy cytoplasm. The number of mitoses can vary. Often giant multinucleated cells are detected. Ovarian dysgerminoma cells are combined into fields without a stroma or into cells located in a hyalinized or fibrous stroma. In the stroma revealed lymphoid cell infiltrates.
Symptoms of ovarian dysgerminoma
The clinical picture is not specific. The first sign is often pain. In almost half of the patients, the pain is dull, pulling or aching. In 15% of cases, the pain is acute, resembling the clinical picture of an acute abdomen. In addition, patients with ovarian dysgerminoma may complain of dysuria, disorders of the gastrointestinal tract and menstrual disorders. Observed weakness and fatigue. In the later stages, infection and disintegration of the ovary dysgerminoma are possible, accompanied by hyperthermia, increased ESR and symptoms of general intoxication.
During an external examination, many patients show signs of infantilism. In some patients with ovarian dysgerminoma symptoms of masculinization are detected. On palpation of the abdomen is determined tumor formation. In the process of gynecological examination, a dense tumor with a diameter of 5 to 15 or more centimeters is located, located deep in the vesicular-uterine or rectus-uterine cavity. At the initial stages of ovarian dysherminoma may be mobile, as the process progresses, the mobility of the neoplasm decreases. When spreading, several nodes can be palpated or a conglomerate of tissues in the pelvic area.
Diagnosis of ovarian dysgerminoma
The diagnosis of ovarian dysgerminoma is made on the basis of complaints, data of general and gynecological examination and results of instrumental examinations. The presence of a large, lumpy, dense tumor in the pelvic area in a young patient, especially in combination with signs of infantilism or masculinization, amenorrhea or late menarche, is a reason to suspect ovarian dysgermia. Patients are sent to the pelvic ultrasound with central Doppler mapping. According to the data of the echogram, the echo positive formation of irregular shape with uneven contours is determined. According to the results of Doppler, multiple foci of vascularization are detected. The diagnosis is confirmed in the process of histological examination of a remote tumor.
Differential diagnosis of ovarian dysgerminoma is performed with uterine fibroids and other ovarian neoplasms. Fibromyoma is usually detected in patients of middle and old age, dysgerminoma in young patients and adolescent girls. In case of fibromyoma, as a rule, polymenorrhea or hypermenorrhea are observed, in dysherminomas - amenorrhea or oligomenorrhea. Differential diagnosis with other neoplasms is not of great practical value, since any ovarian tumors must be removed.
Treatment and prognosis of ovarian dysgermina
Treatment is prompt. The volume of surgical intervention is determined taking into account the prevalence of the process, the age of the patient and her desire to have children. For small ovarian dysgerminomas in women of reproductive age, who are planning childbearing, perform one-sided adnexectomy. Patients of preclimacteric age and patients who do not want to have children are hysterectomy with appendages (panhysterectomy) and removal of the omentum (omentectomy).
With bilateral ovarian dysgerminoma, capsule germination and involvement of nearby organs in the process, the uterus with appendages is combined with the removal of the omentum and subsequent radiotherapy. Ovarian dysgerminoma is highly sensitive to radiation. Radiotherapy is successfully used in the postoperative period, in the event of a relapse and in the detection of metastases. Chemotherapy is possible with disseminated ovarian dysgerminomas. Typically, patients are prescribed melphalan, cisplatin, etoposide, and bleomycin.
The forecast is relatively favorable. Five-year survival of patients with unilateral local ovarian dysherminoma after removal of the appendage is about 90%. Described cases of safe pregnancy and childbirth. Prognostically unfavorable are bilateral dysherminomas, the spread of the tumor beyond the ovary, the presence of lymphogenous and hematogenous metastases. Opinions regarding survival with disseminated ovarian dysgerminos differ. Some experts indicate that when using combination therapy, the five-year survival rate reaches 85 percent or more. Others note that the degree of malignancy of ovarian dysherminomas can vary, so the prognosis should be determined with great care, especially when a tumor is detected in adolescent girls.
Factors contributing to the disease
The definition of ovarian dysgerminoma is: it is a malignant tumor that develops over a long period of time. Such formations are formed from germ cells of embryonic gonads, as well as their derivatives.
Interesting! Of the total number of malignant lesions, 20% are dysherminomas. Most often, the tumor affects girls aged 10-30 years. Sometimes there are symptoms of infantilism.
The level of education malignancy can be different, a similar condition is characterized by a predisposition to metastasis through lymph. Secondary foci are detected in the terminal stage.
In the normal state, germ cells form primordial follicles. But under the condition of pathology, they remain in the tissues of the organ in their original state. After a time, uncontrolled proliferation occurs, and the formation acquires malignant properties. In most cases, girls with ovarian dysgerminoma suffer from general and genital immaturity. In the history of the disease can be traced menstrual function.
A malignant tumor has the form of an oval-rounded bumpy neoplasm. In the early stages of its development, it is enclosed in a smooth-walled capsule. But over time, the tumor violates all boundaries and grows into the surrounding tissue. As practice shows, dysgerminoma is in most cases one-sided and is located at the “entrance gate” of the sexual organ.
The histological form of the tumor is represented by elements of the structure with a large core of moderate hyperchromicity. Content is regarded as abundant and slightly frothy, light color. Under the microscope, it is clear that all cells are arranged in the form of cells, sometimes they are strands with a fibrous, hyalinized base. But sometimes the components form solid rows devoid of stroma. One of the structural features of the tumor capsule is the infiltration of the lymphocytic type.
How is the oncological process manifested, and how is it diagnosed?
Symptoms of an abnormal state of the ovaries can not be called specific. This is due to the fact that for a given state of hormonal activity is unusual. Most often, girls complain of pulling discomfort in the lower abdomen. They are overcome by general malaise, weakness, a constant desire to sleep, and increased fatigue. Violation of the processes of urination and the menstrual cycle is also characteristic.
Considering that a malignant tumor is prone to rapid growth and metastasis, signs of complications appear as the pathology develops. For example, an increase in the erythrocyte sedimentation rate, hyperthermia, indicates that the organism is infected with the decay products of a tumor. Common symptoms of intoxication are also present.
In order to establish the correct diagnosis, the doctor analyzes all the complaints of the patient, conduct a general gynecological examination. Mandatory is conducting instrumental studies. Serious reasons to suspect pathology are:
- the presence of bumpy education in the pelvic region,
- accompanying signs of infantilism,
The next stage of diagnosis is the direction of the patient on ultrasound, including central Doppler mapping. By means of special equipment, it is possible to detect echo-positive formation having irregular shape and uneven contours. At the same time, multiple foci of abnormal blood vessel formation can be detected. The diagnosis is finally confirmed by histological analysis. A tissue sample is taken after removal of the tumor. The main task of the doctor is to distinguish the ovarian dysgermine from uterine fibroids.
The principle of treatment and its prognosis
At whatever stage of development a tumor is discovered, the main way to get rid of it is surgery. Its scale is determined by the following factors:
- the extent of the spread of the malignant process
- the age of the patient
- her desire or unwillingness to have children.
You can call the prognosis of ovarian dysgerminoma favorable. Five-year survival rate is 90% of the total number of cases. But it largely depends on the chosen tactics of treatment.
If a bilateral lesion of the ovaries is diagnosed, then the body and the connecting canal of the uterus are completely removed, and this, together with the appendages and the omentum. The same applies to situations where the tumor grows beyond the limits of the ovary. After that, the patient undergoes radiation therapy. As a rule, a tumor of this type is very sensitive to radiation.
The organs of the lymphatic system must also be removed. It has long been established that the primary tumor, along with secondary foci, lends itself well to radiotherapy. Under the condition of a disseminated form of a tumor, the use of medicinal preparations of chemical action is allowed for therapeutic purposes.
Life expectancy after effective therapy depends on the degree of organ damage. It can be noted as unilateral lesion of the body, and bilateral. Opinions of specialists in this field about the survival rate are somewhat different. Some call the exact percentage of five-year survival of patients, others argue that this figure varies widely. Moreover, the last experts insist that it is necessary to determine the forecast with great care, especially in relation to teenage girls.
This type of tumor is quite common. In some cases, the tumor can affect both ovaries. Lymphatic and hematogenous metastasis is characteristic of this tumor, so secondary tumors can be detected too late.
This type of tumor can vary greatly in different patients by the degree of their aggressiveness. In a normal development in a newborn girl, all germ cells become primordial follicles. But in some cases this does not happen and the germ cells remain unchanged. Over time, they can begin uncontrolled division and form a malignant tumor.
The tumor may have an uneven round or oval shape. Its surface is hidden by a smooth capsule, but only in the initial stages of growth. Further, the tumor grows in the capsule itself, and in the surrounding tissue. The dysgermia is most often found near the gates of the ovary.
There are neoplasms of various sizes. With a fully neglected disease, the tumor can occupy the entire inner space of the ovary, completely replacing the organ. A distinctive feature of ovarian dysgerminoma is rapid local growth and active metastasis.
The organs in which the tumor grows in the first place are the fallopian tube and uterus. The rapid spread of cancer cells throughout the body is due to the fact that metastases grow into lymph nodes related to the abdominal aorta and the common iliac artery. So after a while, secondary tumors can be found in the lungs, liver and bones, which are far from the ovaries.
If the dysgermic ovary is cut, the tissues at the site of the incision will have a brown, gray or yellowish color with a slight pink tinge. If you study the tumor tissue under a microscope, you can see quite large cells, the boundaries of which are clearly visible. They have very light nuclei and differ from other cells in foamy cytoplasm, which also has a light shade. The number of divisions in each such cell is different. Tumor cells are combined into cells.
This type of tumor is often confused with uterine fibroids and other types of tumors in the ovary. First of all, when making a diagnosis, it is necessary to take into account the age of the patient. Fibromas usually occur in old age, while ovarian dysgerminomas can be detected in young women, and in some cases in adolescence.
When fibroma observed monthly with full cycle, but a small interval between bleeding. Usually, in the presence of fibroma, the interval between periods does not exceed twenty-one days.
When fibroma can be observed during menstruation profuse blood loss. In the case of ovarian dysgerminoma, a completely different picture is observed. Either there are no periods at all, or the gap between them reaches three months. But even leaning in favor of a diagnosis, the doctor prescribes an examination, followed by the removal of any type of tumor.
Treatment of this pathology is carried out only by surgery. In this case, the volume of surgery is determined based on the size of the tumor formation. If in the future a woman does not plan to give birth, then both ovaries and appendages are removed. The gland is also completely removed. If the tumor was formed on one side only, then only one ovary should be removed, and the possibility of having children remains.
If both ovaries are affected by a tumor, and even more so the dysgerminoma has sprouted into a capsule, we are no longer talking about preserving the ovaries. In this case, together with the ovaries, the uterus, appendages, and the omentum are removed. Next is a course of radiation therapy. The cells that make up the tumor are very sensitive to radiation, so this therapy gives good results. In the same way, the treatment of metastases.
In general, if the disease was detected at an early stage and the treatment was carried out promptly and efficiently, then the survival rate of the patients is quite high. When one ovary and appendages are removed, it is 90 percent. В медицинской литературе упоминаются случаи, когда после подобного оперативного вмешательства, женщины смогли зачать ребёнка, выносить и благополучно родить.
Менее благоприятный прогноз даётся врачами при двустороннем поражении яичников. Ещё сложнее вылечить заболевание, если опухоль вышла за пределы яичников и проросла в окружающие ткани. Самым тяжёлой считается положение, когда в других органах обнаружены вторичные опухоли.
Opinions of doctors on survival in this case differ considerably. In some cases, doctors give a favorable prognosis, but this is on condition that a fully comprehensive treatment has been carried out combining surgery, radiation therapy and a recovery period. In this case, 85 percent of the favorable outcome is assumed.
At the same time, some experts remind that the degree of tumor aggressiveness varies. Thus, it is impossible to predict the outcome of the disease. It is especially difficult to make predictions if the tumor was detected in adolescence.
What is a neoplasm
The tumor has an oval or rounded shape. It is characterized by aggressive growth, the capsule and nearby tissues quickly germinate. The tumor is located near the gate of the ovary. Its size ranges from 3 to 43 cm. Sometimes it completely replaces ovarian tissue.
Ovarian dysgerminoma. Photo taken from honey. meduniver.com site
Why pathology develops
Lymphogenous spread of metastasis is characteristic of dysgerminomas. They affect the lymph nodes of the abdominal aorta. Sometimes there is a distant metastasis to the bone, liver, lungs.
The factors provoking the development of pathology include:
- The presence of somatic diseases.
- The course of inflammatory processes.
- Penetration of viruses.
At first, the appearance of specific symptoms is not observed. A characteristic sign of the progression of dysgerminoma is pain syndrome. In 50% of women, he has a nagging, pulling or dull character. A quarter of patients complain of excruciating acute pain. Symptoms such as:
- cycle violation
- Gastrointestinal dysfunction,
- increased fatigue
Patients complain about the absence of menstruation. Often, several cycles are skipped, then bleeding from the uterus appears. The intensity of discharge is different. Abundant periods alternate with scarce. Between critical days there is bloody discharge ("daub").
Against the background of the development of the disease, the appearance of digestive disorders is observed. A woman gets sick, sometimes vomits. Appetite deteriorates, decreases performance. The patient often wants to sleep. Against this background, the patient is rapidly losing weight.
When dysgerminoma develops, there are specific signs of damage to the ovary.
As the malignant neoplasm develops, symptoms of complications appear. When the tumor disintegrates, ESR rises, there are signs of general intoxication.
Making a diagnosis
The gynecologist diagnoses the dysgermine based on the examination and complaints of the patient. The results of instrumental examinations are also taken into account. The woman is scheduled for an ultrasound examination of the small pelvis with central Doppler mapping.
This allows you to detect multiple foci of vasculation. We study the size of the tumor, its shape, structure, determined by echo. The most important stage of diagnosis is the differentiation of the tumor from fibroids.
To determine the level of ESR laboratory tests are conducted. With this pathology, the parameters increase to 50 mm / h.
How can I help the patient
Treatment of ovarian dysgerminoma involves:
- The operation.
- Radiation therapy.
The main therapeutic method is surgery. The physician must determine the morphological stage. Approximately 10% of patients within 24 months. affected second ovary. Also, the specialist should take into account the age of the patient, the degree of prevalence of the pathological process and the desire to become a mother.
Radiation therapy and chemotherapy
If a woman plans to become a mother, she is recommended to undergo radiation therapy. Ovarian dysgerminoma is highly radiosensitive. Such treatment is prescribed to affect the neoplasm itself and its metastases. Radiation therapy is indicated not only after surgery, but also as a preventive measure.
The doctor may prescribe chemotherapy for the patient. This is true when diagnosing disseminated dysgerminomas. The combination of the following drugs is prescribed:
The tumor is most sensitive to sarcolysin. A single dose of this drug varies from 30 to 50 mg. The drug is injected into a vein, 1 time / 7 days. Perhaps the appearance of platelet or leukocytopenia.
Survival prognosis for ovarian dysgerminoma
According to many gynecologists with timely combined treatment, the five-year survival rate with this diagnosis reaches 85%. But the degree of malignancy of the tumor often varies. Therefore, the forecast is determined with great care. This is especially true of girls and girls aged 10-15 years.
Medicine has known cases of successful resolution of the burden. The most unfavorable are bilateral tumors.
Dysgerminoma is considered the most common tumor of the germ type. Its size varies from 3 to 45 cm. It develops from primary germ cells. This occurs in violation of the process of formation of primordial follicles. Appear cells with a broken structure, which begin to actively multiply and degenerate into a malignant formation.
The course of the disease is often accompanied by abnormalities of the structure of the female genital organs.
Pathology itself is a round or oval formation. Its capsule is initially smooth, with a bumpy surface, over time it grows into adjacent organs and tissues. At small sizes, the formation does not affect the ovary. At 3-4 stages of oncology, it completely replaces its structure. The main features of ovarian dysgerminoma are rapid growth, active metastasis throughout the body.
Causes of development
The main reason for the appearance of pathology is the failure of the folliculogenesis process. Consequently, its formation is preceded by factors that disrupt the development of follicles and the ovaries in general:
- hormonal disbalance,
- low immunity
- severe viral and infectious diseases,
- chronic somatic pathologies,
- genetic predisposition
- pelvic injury,
- inflammatory processes in the genitals.
Indirect influence on the emergence of pathology such factors as poor environmental conditions, harmful working conditions, non-compliance with the daily routine and rules of nutrition. Uncontrolled intake of medicines is also capable of worsening the health of the female genital sphere.
Symptoms of Oncology
Signs of the disease in the early stages are absent. The first symptoms of ovarian dysgerminoma occur when it reaches a diameter of more than 5 cm. Most often this occurs already in stage 2 of the appendage cancer.
- abdominal pain dull or dull, less often - acute nature,
- frequent urination, constipation, diarrhea - caused by the pressure of the tumor on the bladder and intestines,
- violation of the regularity of menstruation - perhaps the complete absence of a cycle
- change in the nature of menstruation - the appearance of pain in their first days, the change in the intensity of bleeding,
- weakness, fatigue,
- exhaustion due to loss of appetite
- pallor of the skin.
At 3-4 stages of dysgerminoma, symptoms of metastasis appear, depending on the type of affected organ or tissue:
- bone tissues - aching limbs, pain when moving joints,
- lungs - heaviness in the chest, cough,
- liver - yellowness of the skin, pain in the right hypochondrium,
- intestines - diarrhea or constipation, flatulence,
- stomach - nausea, vomiting, pain after eating,
- brain - migraine, tinnitus, visual disturbances.
The patient's condition is rapidly deteriorating against the background of progressive intoxication of the body with the products of tumor breakdown. This is manifested by fever, vomiting, nausea, rapid exhaustion.
During a gynecological examination, the female's external genitals look underdeveloped. They are reduced in size, while there may be a change in their proportions. Most often this occurs in patients with a tumor that formed during adolescence.
The most common treatment for ovarian dysgerminoma is surgical intervention. It allows you to completely eliminate the tumor and prevent the recurrence of the disease. If it is not possible, chemotherapy is used. The combination of both therapeutic methods is considered the most effective.
Most effective at stage 1-2 of oncology. This is due to the possibility of complete elimination of the tumor and minimal injury to neighboring tissues due to the absence of their damage. During the intervention, the ovary is completely removed with the formation and the adjacent fallopian tube. The patient after such an operation is able to give birth to a child, as the second functioning appendage remains.
At stage 3, the tumor is removed along with the affected tissues of the organs. Some of them are forbidden to be eliminated because of their vital need, therefore often during surgical intervention most of the formation is removed. The remaining cancer cells are eliminated by chemotherapy.
During the last stage of cancer surgery is not recommended. This is due to the serious condition of the patient, who is not always able to survive the operation. In addition, stage 4 of oncology is characterized by an extensive spread of metastases, the elimination of which is impossible.
Bilateral tumor damage requires the complete removal of the genital organs or both appendages with fallopian tubes. With the elimination of only the affected areas of the ovaries, the probability of recurrence of the disease is high, since the formation has a high degree of malignancy. The presence of the uterus against the absence of both appendages does not deprive a woman of the ability to give birth to a child - fertilization is possible artificially with the help of a donor egg.
After the ovarian dysgerminoma is removed, the development of obesity and other signs of hormonal imbalance are likely. To prevent such conditions, hormone replacement therapy is prescribed.
Radiation and chemical therapy
Chemotherapy for ovarian dysgerminoma is most often used before surgery and immediately after it. In the first case, the drugs can reduce the size of the tumor, completely eliminate small metastases in any part of the body. This facilitates the process of the operation and increases its effectiveness. As a rule, one chemotherapy course is enough for this.
After surgery, another 3-5 courses of treatment are prescribed. They are necessary to prevent the recurrence of the disease. The total duration of such therapy is from one and a half to three years. After each course of treatment, the patient undergoes complete testing, through which her condition and the course of the disease are monitored. In the absence of effective treatment, the types of drugs and treatment regimen change.
The use of chemotherapy as an independent therapeutic method can improve the prognosis of survival at any stage of oncology.
Radiation therapy for the treatment of ovarian cancer is rarely used. This is due to its low efficiency. It is prescribed in the absence of the effectiveness of other methods of treatment or the impossibility of their implementation. Therapy consists of applying ionizing radiation to the tumor. It is dangerous to use it due to the negative impact on other organs of the small pelvis, which are exposed together with the affected appendages.
The most favorable prognosis of survival in case of ovarian dysgerminoma at stage 1 of the disease. The five-year survival rate in this case is about 95% with the removal of the affected appendage and the adjacent pipe. At stages 3-4, this indicator does not exceed 60-80%.
Factors worsening prognosis:
- large size of the tumor,
- the presence of metastases,
- late start of treatment
- lack of surgery.
In order to achieve a long-term relapse, patients with ovarian dysgerminoma need to undergo all the treatment prescribed by the doctor. As a prevention of such diseases, you should visit the gynecologist 2 times a year. This should be done and girls after the onset of menstruation.
Ovarian dysgerminoma is well treatable with surgery. With successful therapy, the woman does not lose her reproductive ability. Refusal of therapy worsens the prognosis of the disease.
Ovarian cancer statistics
In Western European countries, the incidence of ovarian cancer is 18,000 per 1,000 female representatives. In the Russian Federation, ovarian cancer is diagnosed annually in 11,000 women, in Belarus, at 80,000. This pathology accounts for 5% of the structure of the incidence of oncological diseases. In the UK, the incidence of ovarian cancer in 2012 was 7,000 people. On the day, 19 new cases were detected. This is 2% of all new cancer cases. Worldwide in 2012, 239,000 new cases of ovarian cancer were reported.
It is in third place among the malignant neoplasms of the female reproductive organs after cancer of the cervix and body of the uterus. The average age of patients suffering from ovarian cancer is 63-64 years. 28% of ovarian cancer is detected in women over 75 years old. Adolescents and young women are mainly affected by hermiogenic tumors.
The average age of women who detect these neoplasms is 20 years. Their share in the structure of cancer incidence is as follows: 81% of malignant ovarian neoplasms in adolescents and 6% of all ovarian tumors. Nonhermiogenic ovarian tumors occur in women after 50 years. They have adenocarcinomas in 66% of cases.
The incidence of ovarian cancer in the world has increased by 1/3 since the end of the seventies of the last century. Over the past decade, thanks to new research methods, it has decreased by 14%. Unfortunately, the death rate from this neoplasm is growing. So, every year around the world about 152,000 women die from cancer of the uterine appendages.
Most likely, this is due to the fact that it is mainly older people who have severe concomitant somatic pathology die from this neoplasm. Thus, the mortality rate of women suffering from ovarian cancer after 65 years was 37.5, and after seventy years - 65. The highest mortality rate for women over the age of 85 years.
This is due to the problems of herniopathology. Mortality from ovarian cancer is 4% of female mortality and 2% of the total. It is the highest in East Asia and Malaysia.
Causes of Ovarian Cancer
The exact causes of ovarian cancer have not yet been established. It is believed that in 70% of cases the development of tumors contribute to the violation of hormonal homeostasis. 30% of the risk group are women who have never given birth, or have a history of many pregnancies.
In 25% of women, ovarian cancer develops due to multiple abortions. 78% of patients diagnosed with ovarian cancer have a burdened family history. Taking hormonal contraceptives reduces the risk of developing uterine appendages by 50%. 58% of women with this pathology smoked and consumed large quantities of alcohol.
Ovarian Cancer Classification
In order to know what is the prognosis of incidence in ovarian cancer, it is necessary to clarify what are the forms and variants of the course of the disease. According to the histological structure, there are several types of tumors of the uterine appendages. First of all, it should be noted that in most cases, ovarian cancer is adenocarcinoma.
In 66.7% of cases serous adenocarcinoma occurs, in 11.2% of patients mucinous type of tumor is determined, in 11.2% - endometrioid. The clear-cell morphological variant of adenocarcinoma is determined in 5.4% of women, and undifferentiated cells are found in 5.4% of the material studied.
The stage of ovarian cancer directly affects the possibility of radical treatment of a tumor and determines the prognosis of survival. Ovarian cancer of the first stage is characterized by the fact that the malignant neoplasm is located within one or both ovaries. The tumor does not spread outside the body. It is determined in 33.7% of cases. At stage IA, the tumor develops only in one ovary and is located inside it. On the surface of the body there are no atypical cells. If a malignant neoplasm is found in both ovaries, then they are talking about stage IB. At stage IC, a cancerous tumor is detected in both ovaries, but, in addition, there is one of the following signs of the disease:
in the case of cystic neoplasm, there is a rupture of its capsule,
atypical cells are found in the washings from the abdominal cavity,
tumor cells are found on the surface of the ovary.
In 8.7% of cases determine the second stage of ovarian cancer. If a tumor is detected at stage II A, it spreads the uterus or fallopian tubes. At stage IIB, the tumor spreads to the pelvic organs and intestines, but there are no cancer cells in the washes from the abdominal cavity. At stage IIC in 100% of cases, cancer cells are found in washes from the abdominal cavity.
At stage III, the tumor infects the ovaries and metastasizes to the lymph nodes, beyond the pelvis or into the peritoneal cavity. It is diagnosed in 40.9% of cases. In 16.7% of women, ovarian cancer is detected in the fourth stage. Прогноз в этом случае неблагоприятный, поскольку метастазы находят в отдалённых органах или определяют атипичные клетки в полостях организма.
Рак яичников - симптомы и прогноз
Ovarian cancer is an extremely insidious disease, since it is not possible to detect any symptoms in the early stages of the disease. A woman thinks about any pathology, but not about ovarian cancer. Knowing the symptoms of the disease allows you to consult a specialist in a timely manner, which can significantly improve the prognosis of survival.
The main symptoms of the disease are as follows:
I. Painful pulling sensation in the lower abdomen, which give to the legs or lumbosacral region. They occur mainly after the lifting of the severity of sports (98%).
Ii. Discomfort during intercourse (65%).
Iii. Dysmenorrhea (89%).
Iv. Rapid saturability and discomfort while eating (15%).
V. Heartburn, bloating and an increase in the volume of the abdomen (43%).
Vi. Excretion of blood from the vagina (59%).
VII. Rapid recruitment and weight loss (54%).
Viii. Bad state of health in the morning, lethargy, drowsiness and fatigue (96%).
Ix. Bad appetite, nausea and vomiting (43%).
X. Feeling of pressure on the pelvic organs and frequent urge to defecate (38%).
In the case of metastasis of ovarian cancer to other organs, other symptoms appear. Thus, 65% of patients are worried about coughing with blood streaks, shortness of breath and hemoptysis, which indicates the presence of metastases in the lungs. 65% of women with ovarian cancer develop jaundice. In such cases, you should think about metastases in the liver or pancreatic head.
For bone pains that bother 88% of patients in advanced cancer of the appendages, the presence of metastases in bone tissue should be excluded. In 67% of cases, patients begin to be disturbed by headaches that are not stopped by analgesics, coordination of movements is disturbed, and convulsions occur. This may be a sign of brain metastases.
Oncologists secrete non-specific signs of cancer of the uterus:
anemia (in 99% of cases),
high ESR (100%),
chronic fatigue syndrome (in (97),
signs of chronic intoxication (in 76% of patients).
Additional research methods are of little help in making a diagnosis at an early stage of the disease. Thus, doctors of functional diagnostics during ultrasound do not see a small ovarian tumor. She is not noticed in 44% of cases of laparoscopy, and this study is not performed as often.
An accurate diagnosis in 100% of cases is possible only with the help of computer and resonance tomography. Modern method of research, which helps to suspect ovarian cancer, is the definition of tumor markers in the blood. In this pathology, the following tumor markers should be checked:
A. HE4, which is synthesized by ovarian cancer cells. An increase in its level above the marginal rate in 67% of cases indicates ovarian cancer.
B.Β-human chorionic gonadotropin is normally produced by the placenta of a pregnant woman. If its level rises in the blood of a non-pregnant woman, then in 87% of cases it indicates the presence of ovarian cancer.
C.Anmarker AFP (α-fetoprotein) is not a specific marker. It is normally synthesized by the liver of adults and children. Using this tumor marker, the effectiveness of ovarian cancer treatment is evaluated.
D. Estradiol is an estrogenic hormone that is found in the blood of women. Elevated estradiol may suggest ovarian cancer.
Impact of treatment on survival prognosis
With operable tumors, the method of choice is the operative method of treatment. In 75% of cases it is supplemented with adjuvant polychemotherapy. There are several courses of treatment with intervals of 3-4 weeks. 36% of patients first receive treatment with chemotherapeutic drugs, and then surgery.
The nature of the operation is determined by the degree of spread of the cancer process and depends on the general condition of the patient. In 54% of cases, the uterus, ovaries are extirpated, and the omentum is resected. When a tumor is neglected, surgical tactics have to be changed on the operating table.
In 39% of cases perform adnexectomy, which is supplemented with resection of the gland. Full cytoreduction is performed in 41% of patients, optimal in 22% of cases, and in 37% of cases it is necessary to confine to a suboptimal operation. In 0.7% of elderly patients who have stage 4 ovarian cancer, there is a need to reduce the amount of surgery to a minimum: laparotomy and omenectomy.
Ovarian cancer, the symptoms and signs, which we have discussed, have a prognosis that depends on many factors. Table 1 presents interesting data.
Table number 1. Indicators of prediction of survival depending on age
As you can see, the highest survival rate in young women. After sixty five, the forecast becomes less optimistic.
The choice of method of operation, as well as the prediction of survival, depend on the size of the tumor. So, with small cancer sites, provided full complex treatment, 93.5% of patients survive for one year. Three-year and five-year survival in this category of persons is 85%.
For larger cancers that correspond to T2one year survival rate is 92%. The three-year survival rate is 71%, and the five-year one is 55%. With volumetric neoplasms, the survival rate for one year is 76%, the three-year one is 33%, and after five years 21% of the patients remain alive.
Consider the survival rates depending on the histological structure of the tumor. So, for one year, 87% with serous adenocarcinoma, 86.5% with mucinous, 77% with endometrioid, 80% CC with cell-free cancer and 60% of patients with undifferentiated tumor survive. Their three-year survival, respectively, looks like this: 54%, 68%, 46%, 60%, 33%.
Within five years, 41% of patients diagnosed with serous ovarian cancer, 68% with mucinous cancer, 41% with endometrial cancer, 60% with clear cell tumor, survive. In the case of a non-differentiated form of ovarian cancer, the survival rate is the lowest: it is 33%. Chart 1 shows five-year survival rates for patients who have different stages of ovarian cancer.
Schedule number 1. The dependence of the five-year survival for ovarian cancer, depending on the stage of the process
From this graph it can be concluded that the first stage of the disease is the best survival rate. This is due to the fact that, firstly, the tumor is limited to one organ, there are no metastases, and, secondly, in young people there are significantly fewer concomitant diseases that could affect the results of treatment.
When the disease is in the fourth stage, other organs and body systems are affected, symptoms of intoxication appear, under the influence of which chronic diseases are exacerbated. This aggravates the course of ovarian cancer. The prevalence of the tumor does not allow the use of the full range of treatment, which also affects the survival of patients.
You can also trace the dependence of survival on the degree of differentiation of cancer cells. At G1 the degree of cell differentiation annual survival is 88%, with G2 86% with G3 - 82%, and at G4 60%. Five-year survival with different degrees of cell differentiation looks like this: 58%, 32%, 43% and 33%, respectively.
The prognosis of survival of patients with ovarian cancer is directly affected by the adequacy and completeness of the treatment used. Thus, in the case of radical surgery and polychemotherapy, the rate of one-year survival is 79.8% for the first stage of ovarian cancer, 89.6% for combination with polychemotherapy + surgery, and 34% of patients survive after surgery alone. Important for the prediction of survival is whether the adjuvant chemotherapy was completed during the treatment process. So, with the completed treatment with chemopreparations, the five-year survival rate was 50%, with the interrupted treatment - 33.6%.
How does the level of cytoreduction on the survival rate can be estimated based on the following observations. With full cytoreduction, the one-year survival rate was 94.6%, the three-year and five-year - 83.9%. In the case of optimal cytoreduction, this indicator was somewhat different. Within one year, 89.7% of patients survived, within three years, 52.3%, and within five years - 32.2%. When suboptimal cytoreduction was performed, the one-year survival rate was 70%, three-year-old - 23%, and five-year-old - 12.4%.
Thus, ovarian cancer belongs to diseases that are difficult to diagnose, are detected late and are difficult to treat. Only a timely appeal to a specialist when the first signs of pathology of the reproductive system appear can save a woman from ovarian cancer.