Ovarian cancer: can malignant oncology be cured? PHOTO

Ovarian cancer is a specific type of tumor that affects paired organs in the body. In terms of severity of manifestation, this disease is second only to malignant tumors in the cervix. It is predominantly formed in women of pre-retirement age. At the same time, benign tumors are registered in 80% of cases and only 20% undergo malignant neoplasms. However, during menopause the figure reaches 50%.

Malignant formations in the female genital organs change the entire reproductive system of a woman. The ovaries secrete a number of hormones: estrogen, androgen and progestin, and also regulate the endocrine system. This is where the maturation of the egg occurs. Damage to the ovaries by cancer cells leads to disruption of the female body’s performance.

Every year, 165 thousand cancer lesions are recorded in world statistics. The figure is dangerous because 101 thousand die from cancer. Ovarian cancer accounts for 4% of the lesions in women. Mortality occurs in 5% of cases of ovarian cancer in women.

Often the onset of the disease occurs in the form of a cyst, which, as it grows, enters the tumor stage, changing the epithelial composition of ovarian cells. This is followed by the formation of metastases. Girls who have not reached puberty, as well as women whose age threshold has reached menopause, need to be attentive to their health. It is this category of women that is susceptible to cancer. According to statistics, such cysts develop into cancer in 80% of registered cases. Secondary ovarian cancer develops.

The likelihood of missing a disease is associated with late diagnosis. All over the world, doctors are trying to find the right solution that will lead to early diagnosis. Unfortunately, today the likelihood of diagnosis at the initial stage of the disease is low. This is the main cause of increased mortality in women with a malignant growth.

Ultrasound examination of the ovaries

When conducting a transabdominal study, the sensor is placed in the suprapubic region. The doctor evaluates the condition of not only the pelvis, but also the abdominal organs (search for metastases in regional lymph nodes).

With transvaginal, the sensor is inserted directly into the vagina. This is a more informative method, since the gonads are in close proximity to the device.

During the study, the location, size, structure, shape, and contours of organs are assessed. The condition of the fallopian tubes and uterus is also examined. The procedure should be carried out on the 5th–8th day of the menstrual cycle.

Normally, a woman of reproductive age has the following indicators:

• volume 5–8 cm;
• thickness 0.1–0.2 cm;
• length 0.25–0.4 cm;
• width 0.15–0.3 cm;
• homogeneous structure;
• oval shape;
• clear contours;
• the presence of follicles of varying degrees of maturity, including dominant.

It is important to understand that often the ultrasound picture precedes the appearance of the first symptoms of the disease. Therefore, it is necessary to conduct the study annually.

Ultrasound is an indicative method; it shows possible manifestations of ovarian cancer, but making a diagnosis based only on the conclusion is incorrect. Signs on ultrasound of ovarian cancer are not always specific, therefore, if there is a suspicion of cancer, it is necessary to undergo a full range of diagnostic measures.

Prognosis and prevention

Achieving a full recovery when the diagnosis is confirmed is only possible at stage 1 of the disease. After successful treatment at stage 2, it is possible to achieve stable remission, but in other cases the prognosis is considered unfavorable. With stage 4 ovarian cancer, life expectancy ranges from several months to 5 years (this depends on the general clinical picture and characteristics of the body).

Cancer prevention is not specific:

• high-quality treatment of gynecological diseases, including infertility;
• prevention of a continuous ovulatory cycle - pregnancy;
• compliance with recommendations regarding the use of oral contraceptives;
• refusal of abortion.

A balanced diet, limited consumption of animal fats and the fight against bad habits will help prevent the development of many diseases. An active lifestyle, preventive examinations and timely response to the appearance of alarming symptoms are the key to good health and longevity.

Ultrasound picture for oncology

Signs on ultrasound of ovarian cancer are varied. The most common symptoms are:

• resizing;
• abnormal shape;
• the presence of a formation (it is worth remembering that not only cancer, but ovarian cysts can look like this on an ultrasound);
• blurred contours;
• asymmetrical arrangement;
• heterogeneity of structure;
• neovascularization (increased number of blood vessels);
• the presence of free fluid in the pouch of Douglas;
• change in the condition of nearby lymph nodes (signs of metastasis).

Three videos show what ovarian cancer can look like on an ultrasound machine monitor:

If two or more symptoms are described, the patient is referred for a consultation with an oncologist to determine further management tactics.

Unlike normal tissues, in oncology, space-occupying formations with increased echogenicity are visualized; in the absence of pathology, the ovary has a homogeneous structure, areas of fibrosis in the capsule do not exceed 2–3 mm (hyperechoic formations are lighter than normal tissues).

Often there are changes in the contours (normally they are clear and uneven due to growing follicles), an increase in the volume of the organ due to edema. Free fluid is also often detected in the pelvis or abdominal cavity.

Cancer significantly affects the quality and length of life. Malignant neoplasms in the final stages can permanently deprive a woman of the ability to become a mother and accelerate the onset of menopause. Among other things, oncopathologies are life-threatening and potentially disabling diseases. Therefore, it is necessary to regularly undergo preventive examinations and treat precancerous changes.

Additionally, watch a video about a malignant ovarian tumor:

Have you had an ultrasound of the ovaries and have you or your loved ones encountered such a terrible disease as cancer? Share your experience in the comments. All the best.

Metastases in ovarian lesions

Despite the initial diagnosis, the manifestation of metastases in the patient’s body is possible in the future. This indicator determines the last stages of oncology. Initially, the manifestation of metastases will be decisive in the doctor’s choice of treatment.

If we consider the distribution zones, metastases penetrate into neighboring, closely located organs. The fallopian tubes and uterus are more severely affected. The tumor also grows into the navel. With germination and an increase in the area of ​​coverage by cancer cells, the process penetrates beyond the ovary and invades the peritoneal organs. The tumor travels through the lymph nodes to distant organs, for example, the lungs. Infection of the entire cardiovascular system is also possible.

The initial location of the tumor is called primary, and new formations are called cancer metastases.

If you schematically build a chain of lesions, it will look like this: the abdominal cavity comes first, then the lymph nodes, liver, pleura and diaphragm. The lesion concerns the intestines, then the fallopian tubes. This pattern can often occur in patients, but it is not fundamental for all cases of cancer.

Cancer cells formed in the ovaries are the most progressive form of cancer, which covers large areas and grows by metastases. Doctors note that the most dangerous lesion is epithelial neoplasms, which quickly spread and damage the abdominal area, greater omentum and lymph. Such tumors cannot be treated with drugs and can only be removed surgically.

What is ovarian cancer

Ovarian cancer is a malignant neoplasm that originates from the epithelial cells that cover the outside of the ovary. Ovarian cancer is the second most common gynecological malignancy after cervical cancer. At the same time, it is much more formidable - due to early metastasis, scant clinical manifestations and, as a result, late diagnosis, half of women die from ovarian cancer within a year.

The reasons have not been fully established. There are risk factors for ovarian cancer: irregular sex life, absence of childbirth, oral contraceptives, bad heredity, previous breast cancer, uterine fibroids, chronic adnexitis, etc.

In the early stages, ovarian cancer occurs without clinical signs. Symptoms of the disease appear when the tumor metastasizes and spreads to nearby organs. The complaints of patients with ovarian cancer are very similar to those with inflammation of the ovary (adnexitis): discomfort and pain in the lower abdomen on one or both sides. Tumor invasion of surrounding organs and tissues leads to accumulation of fluid in the abdomen (ascites); the abdomen increases in size, which in about half of the cases forces you to consult a doctor.

There are 4 stages of ovarian cancer. In stage 1, the tumor does not extend beyond the ovary(s). In stage 2, it spreads throughout the pelvis (to the fallopian tubes, uterus, etc.). At stage 3 - it spreads to the peritoneum, omentum, metastasizes to the inguinal and retroperitoneal lymph nodes, abdominal organs. At stage 4 - the rectum and bladder grow; metastasizes to distant lymph nodes and internal organs outside the abdominal cavity, primarily to the lungs.

Ovarian cancer is diagnosed by a gynecologist or oncologist based on instrumental examination data: pelvic ultrasound, computed tomography, magnetic resonance imaging (MRI), as well as the results of a cytological examination of ascitic fluid obtained during puncture of the abdominal cavity. It is useful to determine the level of the tumor marker - CA-125. The final diagnosis is made after histological examination of the removed tumor.

General characteristics by tumor type

Depending on the cellular changes, all pathological formations are combined into two large groups - malignant and benign. This division is conditional, since many benign formations tend to become malignant during the reproductive period.

Malignant ovarian tumors

They are characterized by the absence of a membrane, rapid growth, and the ability for individual cells and tissue strands of the tumor to penetrate into neighboring healthy tissues with damage to the latter. This also leads to germination into neighboring blood and lymphatic vessels and the spread (dissemination) of cancer cells through the blood and lymph to distant organs. Due to dissemination, metastatic tumors form in other nearby and distant organs.

The histological (under a microscope) structure of cancerous tissue, due to its atypicality, differs significantly from neighboring healthy areas of ovarian tissue. In addition, the malignant cells themselves are diverse in appearance, since they are in the process of division and at different stages of development. The most characteristic feature of malignant cells is their resemblance to embryonic cells (aplasia), but they are not identical to the latter. This is due to a lack of differentiation and therefore loss of the originally intended functionality.

In Russia, malignant neoplasms occupy seventh place in the total number of oncological diseases of the female population, and among all tumors of the female reproductive organs they account for about 13-14%. In the early stages of development, malignant ovarian tumors are completely cured, while in stages III and IV this percentage is much lower.

Benign ovarian tumors

The formations are delimited from neighboring tissues by the membrane and do not extend beyond its boundaries. However, as they increase, they are able to compress neighboring organs and disrupt their anatomical relationship and physiological functions. According to the histological structure, benign tumors differ slightly from the surrounding healthy ovarian tissue, do not destroy it and are not prone to metastasis. Therefore, as a result of surgical removal of a benign neoplasm, complete recovery occurs.

Causes of ovarian cancer

Not fully understood. There are risk factors for the disease:

• irregular sex life;
• absence of pregnancy and childbirth;
• long-term use of oral contraceptives;
• bad heredity;
• age 60-70 years;
• previously suffered breast cancer, mastopathy, uterine fibroids;
• early and late menopause; uterine bleeding in postmenopause;
• chronic adnexitis;
• ruptures and injuries of the ovary, including during surgical interventions on the pelvic organs;
• menstrual irregularities, primarily shortening of the cycle due to abnormal acceleration of ovulation;
• sexually transmitted diseases: gonorrhea, ureaplasma, chlamydia, syphilis;
• Excessive consumption of animal fats and fried foods.

Diagnosis of the disease

To make a correct diagnosis, it is better to extensively examine the entire body. Due to its vague symptoms, especially in the initial stages of the disease, ovarian cancer is easily confused with many other diseases.

Having turned to a specialist for help, a woman is recommended to undergo an ultrasound or CT scan. Only after the results obtained can we talk about the presence and course of oncology.

A number of procedures to help collect anamnesis:

• Initial examination and palpation of the patient, collection of all information (menstrual cycle, pregnancy and childbirth, previous gynecological processes, complaints).
• Blood test, where the indicators are leukocytes, ESR, platelets.
• Hormone test.
• Collecting data that markers show.

Differential diagnosis with uterine fibroids, endometriosis, the presence of cysts or ectopic pregnancy and many other gynecological diseases is suitable to identify malignant accumulations. Late stages and stages indicate the appearance of compaction, enlargement of the abdominal cavity, and shortness of breath. The first stages hide the symptom, which complicates the diagnosis.

Let's consider the hardware methods used to diagnose the disease:

1. Transvaginal and transabdominal ultrasound is a fairly informative way to determine the location of a tumor in the pelvic or abdominal organs. It is also a fairly clear examination to understand the structure of the fluid in a tumor growth.
2. Computed tomography indicates the exact location, size and presence of metastases in a woman’s body. gives a clear picture of the lymph nodes. The most commonly used examination is PET-CT.
3. MRI is similar in principle to CT, the difference is in the use of waves of a different direction. It is carried out to determine metastasis.
4. Histology. Mandatory analysis of the obtained biomaterial to determine the nature of tumor cells.
5. Laparoscopy is the insertion of a laparoscope into the abdominal cavity through an incision to examine the tumor. The method is applicable for all cases that cannot be diagnosed. Laparoscopy allows you to collect biomaterial for further research. The presence of fluid in the abdominal cavity is taken for examination.
6. X-ray – detection of metastases in all organs of the body.

If cancer cells are detected, the doctor will refer you for additional examination: cystoscopy, blood tests for kidney and liver indicators, colonoscopy. During the treatment process, the patient needs to constantly monitor the dynamics of changes in the structure of the blood. The doctor is interested in the levels of lactate dehydrogenase, human chorionic gonadotropin, alpha-fetoprotein, CA-125, and HE4. The norm for the HE tumor marker in premenopause does not exceed 70; in postmenopause it reaches 140.

Symptoms and stages of ovarian cancer

Early clinical manifestations of the disease are very scarce and nonspecific; very reminiscent of ovarian inflammation (adnexitis), misleading patients. Women feel discomfort and pain in the lower abdomen on one or both sides. At a late stage of the disease, the symptoms of ovarian cancer are determined by the involvement of internal organs and lymph nodes in the process, as well as intoxication and exhaustion of the body.

There are 4 stages of ovarian cancer:

• Stage 1 ovarian cancer - the tumor affects only the ovaries: one or both; comes to the surface of the ovary, but does not grow into other organs, including the omentum. There is no ascites. There are no metastases. Clinical symptoms are absent or insignificant - pain in the lower abdomen as with adnexitis;
• Stage 2 of ovarian cancer - the tumor spreads to the organs and tissues of the pelvis: fallopian tubes, uterus, omentum. There are still no metastases. At stage 2, pain and discomfort in the lower abdomen intensify, ascites forms;
• Stage 3 ovarian cancer - the tumor spreads to the peritoneum; Metastases appear in the inguinal and retroperitoneal lymph nodes and in the liver. Patients complain of constant pressing and bursting pain in the lower abdomen and lower back, significant enlargement of the abdomen due to progressive ascites. If the tumor reaches a large size and compresses the bladder, colon, or inferior vena cava; symptoms of cystitis, colitis, varicose veins appear;
• Stage 4 ovarian cancer - the tumor continues to grow in size, grows and/or compresses the uterus, bladder, and colon. The tumor metastasizes to distant lymph nodes and internal organs outside the abdominal cavity, primarily to the lungs. The abdomen becomes very large, painful and tense due to giant ascites. Signs of cystitis and colitis are expressed, constipation, flatulence, and stool retention are noted. Pain appears and progresses in internal organs affected by metastases. Manifestations of general intoxication and exhaustion of the body develop: patients become weaker, lose weight, lose appetite, body temperature rises to 38 degrees in the evenings; anemia and encephalopathy develop, etc.

Symptoms

Regardless of whether the neoplasm is benign or malignant, its early subjective manifestations are nonspecific and can be the same for any tumor:

1. Minor painful sensations, which are usually characterized by patients as weak “pulling” pain in the lower abdomen, predominantly unilateral.
2. Feeling of heaviness in the lower abdominal region.
3. Pain of uncertain localization in various parts of the abdominal cavity of a constant or periodic nature.
4. Infertility.
5. Sometimes (25%) there is a menstrual irregularity.
6. Dysuric disorders in the form of frequent urge to urinate.
7. An increase in abdominal volume due to flatulence, intestinal dysfunction, manifested by constipation or frequent urge to have ineffective bowel movements.

As the size of the tumor increases, the severity of any of these symptoms increases. The last two symptoms are quite rare, but the earliest manifestation of even a small tumor. Unfortunately, often the patients themselves and even doctors do not attach due importance to these signs. They are caused by the location of the tumor in front of or behind the uterus and irritation of the corresponding organs - the bladder or intestines.

In addition, some types of cysts that develop from germinal, germinal, or, less commonly, fat-like cells are capable of producing hormones, which may cause symptoms such as:

• absence of menstruation for several cycles;
• enlargement of the clitoris, reduction of the mammary glands and the thickness of the subcutaneous tissue;
• development of acne;
• excess body hair growth, baldness, low and rough voice;
• development of Itsenko-Cushing syndrome (with the secretion of glucocorticoid hormones by ovarian tumors emanating from fat-like cells).

These symptoms can appear at any age and even during pregnancy.

The development of metastasis in the later stages of cancer tumors leads to the appearance of effusion in the abdominal cavity, weakness, anemia, shortness of breath, symptoms of intestinal obstruction and others. Often the symptoms of serous borderline tumors are not much different from the symptoms of metastasis of ovarian cancer tumors.

Symptoms of torsion of the tumor stalk

Torsion of the pedicle of an ovarian tumor can be complete or partial, and can occur in both benign and borderline and malignant neoplasms. The surgical (as opposed to the anatomical) pedicle includes vessels, nerves, the fallopian tube, a section of the peritoneum, and the broad ligament of the uterus. Therefore, symptoms of malnutrition of the tumor and corresponding structures arise:

• sudden severe unilateral pain in the lower abdomen, which can gradually decrease and become permanent;
• nausea, vomiting;
• bloating and delayed defecation, less often - dysuric phenomena;
• pallor, “cold” sticky sweat;
• increased body temperature and increased heart rate.

All of these symptoms, except the first one, are not constant and characteristic. With partial torsion, their severity is much less, they can even disappear completely (with independent elimination of torsion) or reappear.

Diagnosis of ovarian cancer

The disease is diagnosed by a gynecologist, oncologist, and endoscopist. First, the doctor interviews and examines the patient. If a tumor is suspected, an ultrasound scan of the abdominal cavity and pelvis is prescribed. The search for metastases is carried out using CT, MRI, positron emission tomography (PET tomography).

In a number of situations, to clarify the diagnosis, a cytological examination of ascitic fluid is performed, which is obtained by puncturing the anterior abdominal wall. Biopsy of the affected ovary is not recommended due to the risk of tumor dissemination.

In difficult diagnostic cases, visual examination of the ovaries using endoscopic laparoscopy is indicated.

Determination of tumor markers, primarily CA-125, has a very high diagnostic value - an increase in the level of CA-125 in the blood is detected in 80% of patients with ovarian cancer.

Causes

In addition to genetic predisposition, another key provoking factor is hormonal imbalance. Numerous studies have found that nulliparous and infertile women get sick much more often than those who have children. This phenomenon is due to the non-stop ovulatory cycle without interruption during pregnancy. Constant hormonal stimulation leads to thinning, tissue damage and the creation of suitable conditions for tumor formation.

The main causes of ovarian cancer are:

• uncontrolled use of oral contraceptives;
• late first birth;
• abortions, miscarriages;
• chronic diseases of the appendages, accompanied by an inflammatory process;
• cysts and benign tumors left without treatment;
• early puberty or late onset of menopause.

One of the most common causes of cancer is excess body weight. The survival rate among such patients is significantly lower than among women with normal weight. An unhealthy diet with excessive consumption of animal fats, alcohol and tobacco addiction increase the likelihood of developing cancer. Radiation exposure has a similar effect.

Ovarian cancer can occur against the background of a breast tumor. Hypertension, atherosclerosis, diabetes mellitus are also risk factors, because all these diseases cause increased androgen levels and hormonal imbalance.

Ovarian cancer treatment

The most effective combination of surgery and chemotherapy.

In the first stage of the disease, only the ovaries are removed; at stages 2-4, the ovaries, fallopian tubes, uterus, omentum and nearby lymph nodes are removed. If the tumor grows into other organs, partial or complete removal of these organs is performed. In case of ovarian cancer, it is advisable to remove the tumor regardless of its size, extent and extent of metastasis.

Surgical treatment as an independent method of treatment is indicated only for stage 1 of the disease. In all other cases, surgical treatment is combined with chemotherapy with several cytotoxic drugs (polychemotherapy). In advanced cases, polychemotherapy is carried out before surgery to reduce the size of the tumor. For stage 2-4 ovarian cancer, chemotherapy is very useful after surgery to destroy unremoved tumor cells and prevent recurrence of the disease.

Features of treatment

There are 2 effective ways to treat ovarian cancer: surgery and chemotherapy. In the absence of damage to the peritoneum and other organs, resection of the uterus, appendages and omentum is performed. This is a radical but justified method that reduces the risk of relapse to a minimum. If only one ovary is affected and it is necessary to preserve reproductive function, part of the gonad is removed with the obligatory collection of biopsy material from the second organ.

Removal of a large part of the formation with all metastatic foci is mandatory in severe forms. The more atypical cells are eliminated, the higher the chances of improving quality and increasing life expectancy.

Important! At stage 4, surgery is rarely performed, since treatment in this case will be ineffective. Antitumor drugs are prescribed to reduce the severity of symptoms.

Chemotherapy involves systemic use:

• "Cyclophosphamide";
• "Paclitaxel";
• "Carboplatinum".

These funds are administered within one day. Re-use of medications is carried out no earlier than after 3 weeks. To achieve the desired result, you need to complete 6 courses. More than half of patients live 12-18 months without relapse after treatment. The drugs have a lot of side effects. The dosage is calculated taking into account the severity of the disease, age and general condition of the woman.

Questions from patients – answers from Botkin.pro doctors online:

Help decipher the tumor markers of ovarian cancer

Tell me, please, I need to do laparoscopy, the left ovarian cyst was tested, the tumor marker CA 125 showed 113 when the norm is 35, and the tumor marker HE is 28.4 pmol, the ROMA index is 2.3. What does it mean? And will they take me for laparoscopy?

Article under development. Ovarian tumors on ultrasound The current WHO classification of various histotypes of ovarian tumors distinguishes benign, borderline and malignant. The borderline type includes tumors that do not have all the morphological signs of malignancy, for example, there is no infiltrative growth. ?0% are epithelial tumors; among them, 80% are benign and borderline. Depending on the content, they are divided into mucinous and serous; Based on the presence of septations and growths, serous cystadenomas are divided into smooth-walled and papillary. Serous cystadenomas contain anechoic serous fluid. Serous smooth-walled cystadenomas in 75% of cases have a round shape and a clear internal contour; can reach large sizes, but usually do not exceed 15 cm. Single vessels with a blood flow of average resistance are identified in the wall; looks like a follicular cyst. The main difference from follicular cysts does not disappear or decrease after observation of 8-12 weeks. In 10% of cases, tumors are in both ovaries, sometimes located intraligamentally. Ascites is rare. Benign echo signs do not guarantee the benign nature of the formation; oncological alertness in menopausal patients. Serous papillary cystadenomas are characterized by multilocularity and the presence of papillary growths of 60% inside and 40% outside. Papillary growths are parietal echopositive structures of various sizes and echogenicity. The septa, as a rule, are single and have the appearance of thin echogenic linear structures. In papillary structures and septa there are often zones of neovascularization with an average level of blood flow resistance. Bilateral ovarian damage in 25%; the mobility of formations is often reduced; often ascites. They are classified as borderline tumors - the risk of malignancy is 50%. Superficial papillomas on echograms can have the appearance of vegetations on the surface of the ovary - an irregularly shaped mass with an unclear contour, a heterogeneous internal structure (with multiple areas of low and high echogenicity), an almost normal ovary is directly adjacent to the tissue. Mucinous tumors contain a viscous mucus-like fluid called mucin; On ultrasound, the contents are predominantly anechoic with many echogenic linear and point inclusions, multi-chamber is typical, the contents of some chambers may be hypoechoic. Bilateral ovarian involvement, interligamentous location is rare; ascites uncommon. They are also divided into smooth-walled and papillary. They have a tendency to grow rapidly and can reach large sizes. With CDK, neovascularization can be seen in some septa and echogenic inclusions. When the tumor capsule ruptures, for example during surgery, a peritoneal myxoma occurs, almost always accompanied by ascites. Ovarian myxoma is a type of mucinous cystadenomas. On ultrasound, myxoma has similar features to the maternal tumor, almost always ascites. With papillary mucinous cystadenoma, there are echopositive inclusions of oval and irregular shape of various locations. Rare types of epithelial tumors include endometroid cystadenomas, Brenner tumors, clear cell and mixed epithelial tumors. Germ cell tumors are a group of tumors from ovarian germ cells - teratomas and dysgerminomas. In the reproductive period they account for 15% of all tumors and only 3-5% of them are malignant. In childhood and adolescence, germ cell tumors predominate; malignant tumors account for 30%. Teratomas, depending on the degree of differentiation of tissue elements, are divided into mature (benign) and immature (malignant). The ratio of mature to immature teratomas is 100:1. Mature teratomas account for a quarter of benign ovarian tumors. the most common variant is dermoid cysts; mostly one-sided; size 5-15 cm; mobile, have a long feeding stalk. pronounced morphological polymorphism leads to various variants of the echo picture: 60% - round in shape, fairly smooth contour, predominantly hypoechoic with hyperechoic inclusions; 30% has an active shadow, as it contains hair, bones, nails, teeth and other derivatives of the dermis; in 20% completely high echogenicity. There are invisible tumors - medium echogenicity with blurred contours, merging with the surrounding tissues. With CDK, mature teratomas have single zones of vascularization, RI is normal. Immature teratomas, like most malignant neoplasms, have an irregular shape, a bumpy outline, and a chaotic internal structure. On ultrasound it shows a mixed structure with an uneven contour. In CDK, there are areas of pronounced neovascularization with a low RI value. Ascites practically does not occur. Dysgerminomas can be benign, but often have a malignant nature; they are the most common malignant tumor during pregnancy and in children. On ultrasound, the structure is predominantly echo-positive with an uneven contour, typically lobulated; multiple hypo- and hyperechoic areas - zones of degeneration and petrification. Bilateral in 10%; grows quickly and comes in large sizes. In the presence of a mixed tumor structure (with elements of chorionic carcinoma), there is a high level of hCG. Sex cord stromal tumors arise from the sex cord cells of the embryonic gonads, accounting for 10% of all ovarian tumors. NM include hormonally inactive fibromas and hormonally active theca, granulosa and adrenocyte tumors. Fibroids are always unilateral, with a dense, almost stony consistency when examined bilaterally; more often in postmenopause. On ultrasound it has a round or oval shape with a clear, even contour; within medium or reduced echogenicity. In 30% there are multiple multiple echo-negative inclusions - necrosis; Behind the tumor there is an axial shadow. Fibroids can be multiple. With colorectal dosage, vessels in fibromas, as a rule, are not detected; in rare cases, there are single pixels along the periphery of the section. Diff. diagnosis with subserous fibroids when an intact ovary is visible. The character is benign, but may be accompanied by Meigs syndrome - ascites, pleural effusion, anemia. After the tumor is removed, complications disappear. Hormonal activity is not typical for fibroids. A characteristic feature of hormone-producing tumors is the severity of clinical symptoms despite their relatively small size. Granulosa cell tumors (folliculomas) are more common between the ages of 40 and 60 years. On ultrasound, it is usually a unilateral, round-shaped formation with a predominantly echo-positive (solid) internal structure, sometimes lobulated, and echo-negative, often multiple, inclusions (with areas of hemorrhagic changes and necrosis). The tumor can have cystic variants and is practically no different from ovarian cystadenomas. The size of the tumor rarely exceeds 10 cm. Visualization of intratumoral blood flow of a mosaic type (heterogeneous in speed and direction) is characteristic. The frequency of malignant variants of granulosa cell tumors ranges from 4 to 66%. Tumors often have a benign course, but the hyperestrogenization they cause is a risk factor for the development of endometrial hyperplastic processes. Considering the high probability of development of pathological processes in the endometrium, a thorough examination of the signs of Meigs syndrome: ascites, pleural effusion is recommended. Theca cell tumors (thecomas) are usually unilateral and often have a predominantly solid, fibroma-like structure with possible dystrophic changes. Echographically, the internal structure of theca cell tumors may also be similar to ovarian folliculomas. The tumor size is usually less than 10 cm. Theca cell tumors are three times less common than granulosa cell tumors. Visualization of the central intratumoral blood flow of a mosaic type is characteristic. Additionally, signs of Meigs syndrome may be detected: ascites, pleural effusion. In most cases, tumors are characterized by distinct symptoms of hyperestrogenization, and therefore examination of the uterus helps to identify the tumor, since excess estrogen levels cause changes in the endometrium. Adrenocellular tumors (androblastomas) have an ultrasound similarity to granulosa and theca cell tumors - a predominantly echo-positive structure with the presence of multiple hyperechoic areas and hypoechoic inclusions. Visualization of intratumoral blood flow is also characteristic. The tumor is characterized by a slow growth and a predominantly benign course. In most cases, the size of the tumor does not exceed 5 cm in diameter. Malignant variants occur in approximately a quarter of patients. The tumor in most cases has virilizing properties, leading to defeminization of patients. The average age of patients is 25-35 years. Bilateral ovarian damage is quite common. Androblastomas account for 1.5-2% of ovarian neoplasms. Malignant ovarian tumors In the structure of mortality among women from malignant neoplasms of the internal genitalia, ovarian cancer accounts for 50%. Serous, mucinous, endometroid cystadenocarcinomas. malignant cystadenofibromas and other malignant variants of epithelial tumors are very similar to each other and often have a mixed structure. The contents of cancerous tumors are often bizarre. the fancier, the more likely it is to have cancer. Lumpy, uneven and unclear contours also indicate malignancy. The presence of echogenic structures and inclusions (papillary growths) in predominantly anechoic formations is characteristic of 80% of malignant tumors and only 15% of pre-malignant ones. Septa are not a differential feature, but if there are many and some with areas of thickening and vascularization, then the presence of a malignant process is likely. Involvement of neighboring organs, free fluid in the pelvis and abdominal cavity are an unfavorable factor. With CDK, in the vast majority of cases, numerous zones of neovascularization with chaotically scattered vessels are detected inside malignant tumors (RI 15 cm/sec). Ovarian cancer is characterized by ascites. With cancerous ascites, the loops of the small intestine have the appearance of an “atomic mushroom” due to damage to the mesenteric lymph nodes. With ascites of benign processes, intestinal loops remain free-floating. With malignant ascites, against the background of free fluid, metastatic nodules of various sizes scattered throughout the peritoneum can be detected. Metastatic tumors on ultrasound Tumors of various locations and histological structures can metastasize to the ovaries - cancers, sarcomas, hypernephroma, melanoma, etc. The first place is occupied by metastases of breast cancer (about 50%), then metastases from the gastrointestinal tract (about 30%) and genitals ( about 20%). Metastatically, tumors are characterized by bilateral involvement of the ovaries and often have an oval-nub shape, repeating the contours of the ovary, and resemble enlarged ovaries. With small sizes, a characteristic feature of the internal structure is predominantly low and medium echogenicity; the follicular apparatus is absent. Increasing in size, the tumors transform into a tuberous outline, the internal structure becomes heterogeneous - predominantly echo-positive with numerous echo-negative inclusions. Metastatic tumors practically do not change the size of the ovaries, but can also reach large sizes - 30-40 cm. Ascites is detected in 70% of cases.

Ovarian tumors: classification, clinical picture, diagnosis, treatment

Ovarian tumors are multifaceted and diverse in histological structure, which have many classifications.

There are several forms of ovarian tumor:

• Benign tumors that do not have rapid growth dynamics and lack the possibility of metastasis. However, no medical specialist can guarantee that such formations cannot have malignant degeneration.
• Malignant neoplasms that can grow at lightning speed, germinate into organs located nearby, and metastasize through the lymphatic route, affecting more and more new organs and systems of the human body.
• Hormone-producing ovarian tumors are those neoplasms that secrete and synthesize steroids that affect all levels of regulation of the ovarian-menstrual cycle, as well as the body as a whole (the so-called hormonally active ovarian tumors).

Benign ovarian tumors: classification

There is also a classification according to the degree of spread of the pathological focus of the uterine appendage - ovary:

1. stage - the ovarian tumor is localized, limited to only one given organ. Does not apply to adjacent structures.
2. stage - the tumor can spread to adjacent organs, involving new structures of the woman’s body in the process, disrupting their anatomy and functional state.
3. the stage is characterized by the presence of metastatic foci in the nodes of the lymphatic system.
4. stage is characterized by the presence of metastases in organs and systems.

The most comprehensive classification divides the pathological process according to histological structure

1. Epithelial neoplasm is a group of tumors that are widespread and the most common.
   These include a serous tumor, which contains serous secretion as its contents.
2. Mucinous formations containing mucus and having the potential to grow and form large tumors. This type of neoplasm can reach gigantic sizes.
3. Endometrioid neoplasms, which contain blood inside and are identical in structure to endometrial tissue.
4. Hormone-producing ovarian tumors (epithelial). Tumors that produce female sex steroids for estrogen.
5. Sex cord tumors

Granulosa cell formations, androblastomas, thecomas, all tumors are hormonally active, secreting both estrogens and androgens (male and female sex steroids).

6. Germ cell tumors—germ cell tumors of the ovary in girls.

These include dysgerminoma, which worries girls at a very young age, and an ovarian teratoma tumor, which may contain the rudiments of hair, nails, teeth, and bones.

Malignant ovarian tumors have the following classification

• Epithelial tumors include papillary cancer, glandular cancer, adenocarcinoma, and solid cancer.
• Borderline serous papillary tumor of the ovary is also found.
• Connective tissue tumors are represented by sarcomas.
• Neoplasms arising from follicle cells. These include granulosa cell carcinoma, malignant thecablastoma, and semioma, which develops from immature germ cells.
• Metastatic ovarian cancer known as Krukenberg cancer, which from the ovary metastatically spreads to the stomach, intestines, gallbladder and pancreas. Metastatic adenocarcinoma, ovarian cancer that is metastasized from the breast.

Signs of malignancy of ovarian and uterine tumors

Symptoms of malignancy of tumors can be the appearance of a rapid growth rate of tumors, the appearance of painful symptoms with severe pain, dysfunction of adjacent organs, the appearance of complaints from other organs and systems that have not previously bothered the woman. You may experience weakness, fatigue, decreased appetite, and weight loss.

Ovarian tumor in women: prognosis

Ovarian neoplasms are so diverse that the prognosis for women with different types of tumors varies quite widely.

Benign neoplasms require surgical and drug correction, and after that they pose no threat.

However, neoplasms left to chance have every chance of developing into a malignant tumor.

Malignant neoplasms are dangerous at any stage, and the sooner measures are taken to treat them, the more favorable the prognosis will be for such a patient. Relapses, that is, the resumption of the appearance of malignant neoplasms, are observed more often in those patients who were treated at a later stage. Therefore, it is so important to identify the pathological process in the early stages of its occurrence and development in order to take the necessary amount of measures to eliminate it.

It is for early identification of such processes of the reproductive system that preventive examinations are necessary. Or consultations with gynecologists if any pathological symptoms appear.

To identify the pathological process, the following diagnostic measures are used:

• Gynecological examination, both in speculum and bimanual, and, if necessary, rectovaginal.
• Ultrasound diagnostics of the pelvic and abdominal organs.
• Gastroscopy to exclude metastasis of ovarian cancer.
• Magnetic resonance or computed tomography.
• Blood tests for tumor marker levels.

If there is a suspicion that other organs are involved in the process, specialized specialists may be involved who prescribe an additional amount of necessary diagnostic measures.

Treatment

Based on the stage of the disease, it is possible to determine the required type of treatment for an ovarian tumor - the extent of the surgical stage and individual selection of a course of polychemotherapy. The standard is to remove the uterus with appendages and greater omentum. The operation must be performed to a radical extent for the detected pathology.

At the Oncology Research Institute named after N.N. Petrov has created a unique operating room with KarlStorz equipment (Germany), where the largest surgeons in the North-West perform surgical treatment of all malignant pathologies of the reproductive system, including laparoscopic access.

The Department of Gynecological Oncology also deals with such a serious problem as surgical treatment during pregnancy. Cases of the need to remove an ovarian cyst during pregnancy are not uncommon, and limitations in radiological diagnostics often leave questions when making a clinical diagnosis. It is most rational to operate on pregnant women with ovarian tumors in a planned manner, having determined the nature of the tumor through urgent intraoperative cytological and histological studies.