Cancer of the ovary

Cancer of the ovary. The most common serous, mucinous and endometrioid malignant tumors of the ovary. Serous cancer develops usually from cilioepithelial cystoma, characterized by the accumulation of serous fluid inside the malignant cystic formations. With the germination of the capsule and metastasis, ascites is formed. Mucinous cancer is manifested by the development of tumor formations containing mucus; When a breakthrough into the abdominal cavity develops pseudomixoma of the peritoneum. Endometrial cancer is a dense tumor, which by morphological structure is a glandular cancer with foci of flat epithelium. Serous cancer occurs more often at the age of 40-60 years, mucinous - after 60 pet, endometrioid - up to 30 years. In 40-70% of cases, a malignant tumor affects both ovaries. Metastasis of these forms of ovarian cancer occurs in the abdominal cavity (peritoneum, in the omentum). Metastatic ascites, pleurisy can develop. Relatively rare occur metastases in the liver, lungs, other organs. Recurrence of ovarian cancer is more often localized in the pelvic area.

Diagnosis. Timely diagnosis largely determines the success of modern treatment for ovarian cancer. Unfortunately, up to the present time in 60-80% of patients the diagnosis is established in the stage of tumor dissemination. Regular examinations of the gynecologist are important. With such a survey, a round, often mobile tumor of the ovary with a tendency to growth can be found. The examination data can be refined by ultrasonic tomography. The question of the presence of a benign or malignant tumor remains usually unclear, but indications for surgical intervention in such cases are obvious. At later stages of the disease, there is dissemination along the peritoneum, pleura, and ascites and pleurisy. Diagnostic value has laparoscopy with biopsy for morphological analysis, as well as cytological examination of exudate. Clinical examination in such cases involves the exclusion of metastasis in the ovaries and abdominal cavity of tumors of other localizations (from the stomach, intestine, pancreas).

For the treatment of ovarian cancer, surgical intervention and chemotherapy are used. With a localized form of the disease, the uterus is removed with the appendages and the resection of the large omentum. In disseminated ovarian cancer, palliative surgery is used, the purpose of which is to reduce the tumor mass before chemotherapy. The use of chemotherapy for ovarian cancer, which improves the results of treatment with a localized form of the disease, takes the leading place in the disseminated nature of the tumor. Chemotherapy can also be used in the preoperative period to reduce manifestations of the disease and increase the volume of the subsequent operation. The most effective combination of cisplatin with cyclophosphamide and adriamycin; Weakened patients are prescribed cyclophosphamide or thiophosphamide. Intervals between courses should not exceed 3-4 weeks. In the absence of clinical manifestations of the disease on the background of postoperative chemotherapy, laparoscopy (after 6-12 months) is performed to establish the completeness of remission. Only when a complete remission and a period of chemotherapy is reached for at least 12 months can the issue of discontinuing treatment be resolved. Radiation therapy is rarely used, mainly with relapse of the tumor. In ascites and pleurisy enter intraperitoneally thiophosphamide, cisplatinum.

Among the rarer forms of malignant tumors of the ovary are the clear cell (mesonephrine) cancer, Brenner's malignant tumor; Stromal tumors (ovarian granulomas occur at a young age, characterized by an aggressive course.Disgerminoma has a rapid growth rate, metastasizes to the retroperitoneal lymph nodes, lungs, other organs.The development of the tumor is accompanied by a disruption of the menstrual cycle.This radical surgery is prescribed thiophosphamide or cyclophosphamide. Have different morphological structure, include elements of disgerminoma, embryonic cancer, chorion carcinoma.Mastastases arise in the abdominal cavity, retroperitoneal lymph nodes, lungs.In determining the diagnosis and dynamic observation, it is useful to determine the tumor markers (a-fetoprotein, choric gonadotropin) .In a localized form The diseases produce a radical operation with subsequent chemotherapy.With the disseminated form it is advisable to start treatment with chemotherapy, and upon reaching remission after 3-6 courses, to remove the remaining tumor nodes.Current chemotherapy of ovarian teratocarcinoma includes combinations of several antitumor drugs (cisplatin with vinblastine, bleomycetin, dacti- Nomycin and cyclophosphamide or cisplatin with etoposide and bleomycetin). Cellular cancer, androblastoma, gonadoblastoma); Embryonic swollen (dysherminoma, teratocarcinoma, fetal cancer, chorion carcinoma). The clinical course and principles of treatment of the clear-cell cancer and Brenner's malignant tumor are almost the same as in mucinous cancer. Granulosocellular carcinoma is characterized by endometrial hyperplasia, accompanied by uterine bleeding, resulting from high estrogen production. With androblastome, there are signs of virilization (male-type hair, voice changes, cessation of menstruation) due to hyperproduction of androgens. Both types of tumors occur more often in the age of up to 30 years. Characteristic is the occurrence of metastases in the retroperitoneal lymph nodes and lungs, sometimes many years after the operation. For early detection of recurrence and metastases, a dynamic determination of the level of estrogens and androgens is advisable. The main method of treatment is surgical. After a radical operation, chemotherapy is not performed. At the advanced stage of the disease, radiotherapy and chemotherapy (thiophosphamide, adriamycin, cyclophosphamide) are used.

Gonadoblastoma is a mixed morphological variant - a combination of granulosa cell carcinoma and acroblostoma. Embryonic malignant ovarian tumors occur at a young age, characterized by an aggressive course. Disgerminoma has a fast growth rate, metastasizes to retroperitoneal lymph nodes, lungs, other organs. The development of the tumor is accompanied by a violation of the menstrual cycle. After a radical operation, a thiophosphamide or cyclophosphamide is administered. Teratocarcinomas can have a different morphological structure, include elements of disgerminoma, embryonic cancer, chorion carcinoma. Metastases arise in the abdominal cavity, retroperitoneal lymph nodes, lungs. When determining the diagnosis and dynamic observation, it is useful to determine the tumor markers ((-fetoprotein, chorionic gonadotropin) .With the localized form of the disease, a radical operation is performed followed by chemotherapy, with disseminated form it is advisable to start treatment with chemotherapy, and when remission is achieved after 3-6 courses - Remaining tumor nodes Modern chemotherapy of ovarian teratocarcinoma includes combinations of several antitumor drugs (cisplatin with vinblastine, bleomycetin, dactinomycin and cyclophosphamide or cisplatin with etoposide and bleomycetin).