The screening currently carried out with the help of transvaginal ultrasound and the determination of the tumor marker CA-125 for the early detection of ovarian tumors has proven to be insufficient according to recent studies worldwide. A study carried out by the World Health Organization highlights the fact that in 2020 more than 313,000 new cases were diagnosed globally, with ovarian cancer ranking 18th in the ranking of oncological pathologies. Learn more about ovarian tumors
Confirmation of the diagnosis of ovarian carcinoma is made with the help of the histopathological examination, depending on the type of cells identified, the pathology being classified as follows:
Serous carcinoma Mucinous carcinoma Endometrioid carcinoma Clear cell carcinoma Transitional cell carcinoma Mixed carcinoma Undifferentiated carcinoma.
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Ovarian cancer risk factors
The main risk factors involved in the occurrence of ovarian cancer are represented by:
Getting older and with it, the onset of menopause The number of pregnancies of the patient – the risk of developing ovarian cancer is inversely proportional to the number of pregnancies. Women who have had several pregnancies have a lower risk of developing ovarian cancer compared to those who have not had or had fewer pregnancies Heredocollateral history of ovarian cancer or breast cancer Personal history of ovarian tumors Overweight Administration of hormonal treatments of substitution after menopause Endometriosis Early menarche and late menopause – the onset of menstruation at a young age and the onset of menopause at an advanced age increase the risk of ovarian tumors Smoking – there are a number of studies that indicate an increase in the incidence of epithelial ovarian cancer in smokers.
Simptome cancer ovarian
The symptomatology of patients diagnosed with this type of tumors is in most cases non-specific, this characteristic representing the main factor involved in the late detection of this pathology.
Most symptoms appear late, usually in stage III or IV ovarian cancer and are represented by:
Sensation of abdominal fullness Abdominal distension Feeling of nausea Early satiety in conditions of quantitatively reduced food intake Alterations of intestinal transit Urinary manifestations Dorsalgia (pain in the back area) Dyspareunia (pain on intimate contact) Unintentional weight loss.
These manifestations are met inconstantly and usually appear a few months before the diagnosis of ovarian cancer is confirmed.
In certain situations, a paraneoplastic syndrome can be detected in the form of cerebellar degeneration manifested by:
Ataxia (difficult coordination of movements) Dysarthria (speech disorders due to weakening of the muscles of the face, neck and tongue) Nystagmus (involuntary jerky movements of the eyes vertically or horizontally) Vertigo (feeling of dizziness) Diplopia (double vision).
They are due to the immune response against nervous system antigens induced by ovarian tumor cells. The paraneoplastic syndrome can precede the appearance of the primary ovarian tumor by several months or even years.
Screening medical cancer de ovare
The evaluation of patients who associate risk factors for ovarian cancer is carried out through serum determinations of CA 125, HE4 values human epididymis protein and the ROMA score (calculation algorithm with the help of which the risk of ovarian tumor malignancy is estimated) which is adjusted according to the patient’s age and pre- or postmenopausal status.
CA 125 it represents a tumor marker with reduced specificity in the case of ovarian cancer, its serum values being due to several pathologies, including endometriosis, liver cirrhosis or pelvic inflammatory disease. In the case of people with a family history of breast or ovarian cancer, the doctor can recommend testing for the presence of BRCA1 and BRCA2 genesalong with tumor markers determined in the usual way.
They are currently being developed new screening test designs for ovarian cancer which include multiple tumor markers in order to increase the rate of early diagnosis of this pathology.
Along with the listed laboratory investigations, ovarian cancer screening includes examination by transvaginal or abdominal ultrasound of patients by the gynecologist during periodic examinations.
Stages of ovarian cancer
Ovarian carcinoma staging involves performing an exploratory abdominal laparotomy with a detailed examination of the entire cavity and is performed in accordance with the classification guide of the International Federation of Obstetrics and Gynecology FIGO as follows:
Stage I ovarian cancer includes tumors limited to the ovary-IA, limited to both ovaries-IB, rupture of the ovarian capsule and the presence of tumor cells in the peritoneal lavage fluid-IC. In this stage of evolution, the pathology can be asymptomatic or it can generate the appearance of non-specific manifestations represented by constipation, flatulence, feeling of early satiety.
Stage II ovarian cancer represents tumor extension at the level of fallopian tubes or uterus-IIA, pelvic tissues-IIB, pelvic lavage or ascites fluid-IIV. The clinical picture specific to this stage of evolution is accompanied by painful discomfort in the lower abdomen, and sometimes ascites (abnormal accumulation of fluid in the abdominal cavities).
Stage III ovarian cancer involves abdominal extension and/or regional lymph nodes with microscopic peritoneal metastases-IIIA, macroscopic ≤ 2 cm-IIIB or macroscopic ≥ 2 cm -IIIC. Patients in the III stage of the evolution of ovarian carcinoma present neoplastic impregnation syndrome manifested by anemia, loss of appetite, weight loss accompanied by flatulence, abdominal distension and urinary disorders (dysuria – difficulty urinating, hematuria, pollakiuria – frequent urination in small quantities).
Stage IV ovarian cancer associates the presence of distant metastases, (outside the peritoneal cavity) at the hepatic or splenic, pulmonary, integumentary or cerebral level. Stage IV can develop with thrombophlebitis in the lower limbs, respiratory manifestations due to the accumulation of fluid at the pleural level or intestinal occlusion.
Ovarian cancer treatment options
The treatment options for patients with ovarian tumors vary according to the stage of evolution of the tumor, the age and the general state of health of the patient and include partial or radical surgical cytoreduction and local peritoneal or systemic chemotherapy.
Targeted therapy it considers certain vulnerable tumor cells and is used especially in the case of recurrent ovarian tumors.
Hormonal therapy it aims to block estrogen receptors that favor the growth and development of ovarian tumors, and can be used both in recurrent forms of the disease and in those with slow evolution.
Monoclonal antibodies directed against the growth factor of the vascular endothelium can be used both in monotherapy and in combination with chemotherapy in patients in late stages of ovarian cancer evolution.
Ovarian cancer surgery
The early stages of the disease I and II show indications of:
Total hysterectomy (removal of the uterus)
Bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes).
Omentectomy (removal of the omentum-fold of the peritoneum that envelops the organs of the abdominal cavity).
Taking biopsies from the level of the paracolic recesses and the paraaortic pelvic lymph nodes is mandatory for estimating the risk of tumor cell metastasis. Young patients who wish to become pregnant in the future may present an indication for unilateral salpingo-oophorectomy in the situation where the tumor is limited to one ovary, and the histology is favorable.
The surgical intervention performed in the case of advanced tumors in stage IIB-IIIC of evolution includes removal of the entire female reproductive system with omentectomy and staging biopsies in order to achieve optimal cytoreduction and reduce the risk of residual disease.
In patients with ovarian neoplasm in stage IV of evolution, radical surgical intervention it can increase the survival rate up to 5 years postoperatively for approximately half of these patients and even up to 10 years in certain situations.
The risk of ovarian carcinoma can be reduced by quitting smoking, maintaining an adequate body weight with the help of a healthy lifestyle and performing periodic gynecological examinations. Early detection of ovarian cancer considerably increases the patient’s life expectancy and reduces the risk of metastases in other systems and organs.
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2023-11-22 23:12:46
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