Ovarian cancer: first signs and symptoms of oncology, metastases, treatment in Moscow

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, 2022.

Hormone-producing ovarian tumors

Hormonally active tumors are neoplasms that develop from the endocrine glands and are characterized by excessive release of hormones or the products of their formation.

Hormone-producing tumors can be diagnosed in all glands of the human body. The tumor releases large amounts of hormones, which leads to symptoms and signs of hyperfunction. Hormone-producing tumors can have both a benign and malignant course.

Hormone-producing ovarian tumors are neoplasms that are usually divided depending on the hormone that they secrete. A hormone-active ovarian tumor intensely secretes either estrogens or androgens.

The etiology of the development of any type of neoplasm is not fully understood. Research is ongoing, but so far achievements will be limited only to identifying possible causes:

Hormonal disorders. A woman’s hormonal background and a history of pregnancy and childbirth are of great importance. Due to ovulation, ovarian tissue is damaged, which is accompanied by subsequent regeneration. But sometimes such increased cell division becomes pathological. There is no ovulation during pregnancy and breastfeeding, so at this time the risk of developing a neoplasm is significantly reduced. Facts such as early onset of menstruation, late menopause, lack of childbirth and refusal to breastfeed increase the risks.
Compounded medical history and genetic predisposition. Two percent of neoplasms are associated with this factor. With an unfavorable family history and cancer diagnosis in close relatives, patients have a high risk of developing ovarian cancer. In this case, it is necessary to undergo examination and see a gynecologist.
Eating large amounts of foods high in carcinogens and animal fats. Statistical data supports this statement due to the study of eating habits in certain countries of the world and their comparison with the incidence of cancer.

The reasons why some tumors produce hormones and others do not remain unknown at this time.

Types and degrees of ovarian cancer

There are more than 30 different types of ovarian cancer, classified according to the type of cell from which they arise. Ovarian cancers start in three common cell types:

superficial epithelium - cells covering the outer lining of the ovaries;
germ cells intended to form eggs;
stromal cells, which secrete hormones and connect various structures.

Epithelial ovarian tumors develop from cells that cover the outer surface of the ovary. Most epithelial ovarian tumors are benign. There are several types of benign epithelial tumors, including serous adenomas, mucinous adenomas, and Brenner tumors. Cancerous epithelial tumors are carcinomas, meaning they start in the tissue lining the ovaries. These are the most common and deadliest of all types of ovarian cancer, accounting for 85-90% of all ovarian cancers. Unfortunately, nearly 70% of women with advanced epithelial ovarian cancer are not diagnosed until the disease has reached the terminal stage.

There are several epithelial ovarian tumors whose appearance under a microscope does not allow them to be clearly identified as malignant. They are called borderline or low-grade tumors (LMP tumors).

Ovarian germ cell tumors are most benign (not cancerous), although some are cancerous and can be life-threatening. The most common germ cell malignancies are maturing teratomas, dysgerminomas, and endodermal sinus tumors. Germ cell malignancies most often occur in adolescents and women in their twenties. Today, 90% of patients with ovarian germ cell malignancies can be cured and their fertility preserved.

Ovarian stromal tumors are a rare class of tumors of the connective tissue cells that support the ovary and those that produce female hormones - mainly estrogen and progesterone. The most common tumors are granulosa tissue and Sertoli-Leydig cell tumors. These tumors are quite rare and are usually considered low-grade cancer. About 70% are stage I (cancer limited to one or both ovaries). Granulosa cell tumors (GCTs) are considered stromal tumors and include tumors composed of granulosa cells, theca cells, and fibroblasts. GCTs account for approximately 2% of all ovarian tumors.

Introduction

Ovarian Information

The ovaries are one of the most important organs of the female reproductive system. In the pelvis, 2 ovaries are attached to the uterus on both sides. During the premenopausal period, they have an oblong shape, each length is 3.8 cm. The glands contain female reproductive cells - eggs. The ovaries produce the hormones estrogen and progesterone. These substances affect many processes in a woman’s body: breast growth, body shape, hair, regularity of menstruation, pregnancy. During menopause, ovarian function slows down.

Fallopian tube information

The uterine (fallopian) tubes also belong to the female reproductive system. These are narrow tubes that connect the ovaries to the uterus. A woman has 2 fallopian tubes, one on each side of her uterus. Ovulation occurs monthly when one ovary releases an egg. The latter moves towards the uterus through the fallopian tube.

Peritoneum Information

The peritoneum is the tissue lining the lower part of the abdominal cavity and most of its organs. These tissues cover a number of pelvic organs. The surface of the tissues is covered with a fluid called peritoneal. This fluid helps organs move around in the abdominal cavity, preventing them from sticking together.

Information about ovarian, fallopian tube and peritoneal cancer

The term "ovarian cancer" is often used to refer to cancer that begins in cells of the ovaries, fallopian tubes, or peritoneum. These cancers are very similar, so they are usually treated the same. The cancer process starts when healthy cells change their size and structure, forming a tumor. It can be malignant or benign. If a benign tumor never grows into neighboring organs, then a malignant (cancerous) tumor spreads to other parts of the body.

An ovarian cyst is an abnormal growth of tissue that forms the surface of the ovary. It may occur during normal menstruation and disappear after treatment. Simple ovarian cysts are not cancer.

The surface of the ovaries, the lining of the fallopian tubes, and the cells lining the abdominal cavity are made of the same type of cells, so their diseases look the same under a microscope. Peritoneal cancer can develop even after removal of the ovaries and fallopian tubes. Like ovarian cancer, some types of peritoneal cancer can start in the fallopian tube and then spread into the abdomen.

Stages of ovarian cancer

There are four stages - from initial I (early stage) to stage IV (advanced stage). The treatment plan and prognosis (likely course and outcome of the disease) will be determined by the stage of the cancer.

The grade of the tumor does not match the stage of the cancer. The grade (G) describes how healthy the cancer cells appear when viewed under a microscope. The grade of cancer helps doctors predict how quickly the cancer will spread and develop treatment options:

GX : Fabric cannot be rated.
GB : tissue considered borderline malignant. This is usually called low malignant potential.
G1 : tissue is well differentiated (contains many healthy cells).
G2 : tissue is moderately differentiated (there are more abnormal cells than healthy cells).
G3-G4 : Tissue is poorly differentiated or undifferentiated (more cells appear abnormal and lack normal tissue structures).

Symptoms and signs

Ovarian cancer, its first signs, is difficult to detect, especially in the early stages. This is partly due to the fact that the ovaries are located deep in the abdominal cavity. The most common signs and symptoms of ovarian cancer are:

bloating;
pelvic or abdominal pain;
problems eating or feeling full quickly;
feeling the need to urinate urgently or frequently.

Additional symptoms may include:

fatigue, constant lethargy;
upset stomach or heartburn;
low back pain or vague pain throughout the entire back;
pain during intimacy;
constipation or changes in menstruation.

When symptoms are persistent and do not improve with normal interventions (such as diet changes, exercise, laxatives, rest), a woman should definitely consult a doctor. Persistence of symptoms is key. Because these signs and symptoms of ovarian cancer are described as vague or unclear, only about 15% of ovarian cancers are diagnosed in the early stages. Symptoms usually occur in advanced stages, when the growth of the tumor puts pressure on the bladder and rectum and fluid begins to form.

Diagnostics

Most women are diagnosed with an advanced stage, because often the manifestations are not acute or intense, they are vague. In most cases, ovarian cancer is not detected during a routine gynecological examination unless the doctor notes that the ovary is enlarged.

Although there is no reliable screening test for ovarian cancer, women, especially those at high risk for the disease, should undergo a number of tests. Source: Modern Diagnosis of Ovarian Cancer. Nikogosyan S.O., Kuznetsov V.V. Russian journal of oncology No. 5, 2013. p. 52-56.

Pelvic examination : Women aged 18 years and older should have a mandatory annual vaginal examination. Women age 35 and older should have an annual rectovaginal exam (the doctor inserts fingers into the rectum and vagina at the same time to feel for abnormal swelling and determine tenderness).
Transvaginal sonography : This is an ultrasound examination performed using a transducer placed in the vagina.
CA-125 test : This blood test determines whether the level of CA-125, a protein produced by ovarian cancer cells, is elevated in the blood of a woman at high risk for ovarian cancer or a woman with an abnormal pelvic examination. Although CA-125 is an important test, it is not always a key marker of disease. Some non-cancerous ovarian diseases may also increase CA-125 levels, and some types of ovarian cancer may not produce enough levels of CA-125 to cause a positive test result. For these reasons, the CA-Test 125 is not routinely used as a screening test for individuals at average risk of ovarian cancer.

If any of these tests are positive, the woman should consult a gynecological oncologist who can perform a CT scan and evaluate the test results, the ovaries, and identify metastases. The only way to most definitely confirm a diagnosis of ovarian cancer is with a biopsy - a procedure in which the doctor takes a sample of the tumor and examines it under a microscope Source: Comprehensive Diagnosis of Ovarian Cancer. Smirnova T.L., Igonin Yu.A. International scientific research journal No. 4, 2022. p. 181-183.

Follow-up and control

Treatment for people diagnosed with cancer does not end when active therapy is completed. Your doctors will continue to check to see if the cancer has returned, monitor any side effects, and monitor your overall health. This is called follow-up.

Experts recommend pelvic examinations every 2-4 months for the first 4 years after treatment, and then every 6 months for the next 3 years. For all three types of cancer, follow-up may include x-rays, CT scans, MRIs, ultrasounds, and blood tests (CA-125 determination).

Women who have had ovarian/fallopian tube cancer have an increased risk of developing breast cancer, colon cancer, or Lynch syndrome (some types of ovarian/fallopian tube cancer).

Relapse control

One of the goals of follow-up is to monitor relapse. The cancer process resumes due to the fact that small areas of undetected cancer cells may remain in the body. Over time, the number of these cells may increase until they appear on test results or cause abnormal signs.

Monitoring long-term and delayed side effects

Long-term side effects may persist after the treatment period. Other side effects, called delayed ones, may take months or even years to develop.

Discuss with your doctor the risk of these side effects depending on the type of cancer, your individual treatment plan, and your overall health. If your treatment is known to cause some late effects, you may need to have certain physical examinations, scans or blood tests to detect and treat them.

Maintaining your own medical records

You and your doctor will work together to develop a personalized follow-up plan. Be sure to discuss any concerns about your future physical or emotional health.

Ovarian cancer treatment

Clinical guidelines for the treatment of ovarian cancer have been developed.

Surgery to remove a malignant tumor is the most common method for diagnosing and treating ovarian cancer. It is best performed by a qualified gynecological oncologist. Most women with ovarian cancer will undergo surgery at some point during the course of their disease, and each surgery has a different purpose Source: Stages in the Development of Ovarian Cancer Surgery. Kozhevnikova O.V., Kuznetsov V.V., Ananyev V.S. Russian journal of oncology, 2022. p. 102-106.
Chemotherapy . Before starting treatment, it is important to understand how chemotherapy works. This is a cancer treatment using chemicals designed to kill cancer cells or stop their growth. The goal of chemotherapy is to cure cancer, shrink a tumor before surgery or radiation treatment, destroy cells that may have spread, or control the growth of a tumor.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Please note that this therapy is rarely used to treat ovarian cancer. It is more often used in other parts of the body where the cancer has spread.
Additional treatments . Some women with ovarian cancer turn to complementary therapy to strengthen their fight against the disease, as well as relieve stress and reduce side effects such as fatigue, pain and nausea Source: A New Look at Ovarian Cancer Treatment. Khokhlova S.V. Tumors of the female reproductive system No. 1, 2010. p. 68-71.

Clinical trials are scientific studies aimed at finding ways to improve health and treat cancer. Each study attempts to answer scientific questions and find better ways to prevent, diagnose or treat cancer. Many women undergoing treatment for ovarian cancer take part in clinical trials. By participating in these trials, patients may have access to new treatment options that are not available to women outside of clinical trials Source: Ovarian Cancer Coping Strategy. Savonevich E.L., Zhlobich M.V., Garelik T.M., Miklashevich F.S., Oshurik O.S., Gronvald Y. Journal of obstetrics and women’s diseases, 2016. p. 61-62.

Recommendations

Women at high risk of ovarian cancer should undergo genetic counseling. They may be offered genetic testing for BRCA1 and BRCA2. Women who wish to preserve fertility can be screened with transvaginal ultrasound every six months, although the effectiveness of this approach has not been clearly established.

Young women should be advised to take oral contraceptives before they plan to have a baby.

Women who do not wish to preserve their fertility or who have children can undergo prophylactic bilateral salpingo-oophorectomy. The risk should be clearly documented, preferably established using BRCA1 and BRCA2 tests before surgery. Because mutations in the BRCA1 and BRCA2 genes also increase the risk of developing breast cancer, annual mammography screening starting at age 25 is recommended. Women with Lynch syndrome should undergo periodic screening mammography, colonoscopy, and endometrial biopsy.

Article sources:

Modern diagnosis of ovarian cancer. Nikogosyan S.O., Kuznetsov V.V. Russian journal of oncology No. 5, 2013. p. 52-56
Comprehensive diagnosis of ovarian cancer. Smirnova T.L., Igonin Yu.A. International scientific research journal No. 4, 2022. p. 181-183
Primary multiple ovarian cancer. Bekhtereva S.A., Domozhirova A.S., Aksenova I.A., Pshichenko S.V. Research'n Practical Medicine Journal, 2018
Strategy for overcoming ovarian cancer. Savonevich E.L., Zhlobich M.V., Garelik T.M., Miklashevich F.S., Oshurik O.S., Gronvald Y. Journal of obstetrics and women’s diseases, 2016. p. 61-62
Stages of development of ovarian cancer surgery. Kozhevnikova O.V., Kuznetsov V.V., Ananyev V.S. Russian journal of oncology, 2022. p. 102-106
A new look at the treatment of ovarian cancer. Khokhlova S.V. Tumors of the female reproductive system No. 1, 2010. p. 68-71
Risk factors for developing ovarian cancer. Savonevich E.L. Journal of Grodno State Medical University No. 3, 2010. p. 74-76

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Risk factors and prevention

A risk factor is anything that increases a person's chance of developing cancer. Knowing your risk factors and discussing them with your doctor can help you make more informed lifestyle and health care choices.

The risk of developing cancer in women can be increased by the following factors:

Anamnesis of life. A family history of breast or ovarian cancer increases the risk of developing cancer.
Hormone replacement therapy. Women who take estrogen-only hormone replacement therapy (HRT) after menopause have an increased risk of cancer. The longer women take therapy, the higher the risk. After treatment ends, the risk decreases over time.
Genetics. About 10 to 15% of ovarian/fallopian tube cancers are due to genetic mutations that run in families. This inherited risk is called a generative mutation.
Genetic syndromes. There are other genetic conditions that can cause ovarian/fallopian tube cancer. Of these, the most common are:
Peutz-Jeghers syndrome (PJE). This syndrome is associated with the appearance of numerous polyps in the stomach, intestines, as well as increased pigmentation of the skin of the face and hands. SPE increases the risk of developing ovarian/fallopian tube, breast and some other types of cancer
Nevus basal cell syndrome (NBCCS). Gorlin syndrome (another name) provokes the development of fibroids. There is a small risk that these benign growths may develop into a type of ovarian cancer called fibrosarcoma. People with NBCCS often have multiple basal cell skin cancers and jaw cysts. They may develop medulloblastomas during childhood.
Li-Fraumeni syndrome and ataxia-telangiectasia. There are other hereditary syndromes associated with these cancers, and research in this area is ongoing. Only genetic testing can determine whether a person has a genetic mutation.

Prevention

Research has shown that several factors can reduce the risk of developing ovarian/fallopian tube cancer:

Breast-feeding. Long-term breastfeeding reduces the risk of developing cancer.
Pregnancy. Full-term pregnancies prevent the appearance of cancer.
Surgical intervention. Women who have had a hysterectomy or tubal ligation have a lower risk of developing ovarian/fallopian tube cancer. Hysterectomy – removal of the body and sometimes the cervix. Tubal ligation is the ligation or surgical closure of the fallopian tubes to prevent pregnancy.