Everything women need to know about ovarian cancer

Ovarian cancer develops from the epithelial tissues of the organ. A malignant tumor of the ovary is common and ranks third among malignant diseases of the female genital area. Ovarian cancer most often occurs in women over 60 years of age. There is a high incidence of ovarian cancer in infertile women who use drugs throughout their lives to stimulate ovulation and who often have abortions. Metastases of ovarian cancer are found in various organs and tissues - breast, uterus, thyroid gland, gastrointestinal tract, bones. Ovarian cancer is a rapidly growing tumor; often the tumor produces latent metastases, which are discovered many years after the cancer is removed.

At the Yusupov Hospital, using modern equipment, you can undergo tests for ovarian cancer, take tests, and undergo treatment. The oncology department of the hospital is a modern oncology clinic, which provides treatment using modern cancer treatment methods and uses innovative drugs. The department is equipped with modern medical diagnostic equipment from leading manufacturers in the world. Patients are provided with comfortable hospital rooms, services of rehabilitation specialists, a psychologist, and patient care is provided by trained and experienced clinic staff. When filling out medical documents, hospital doctors use ICD 10 codes.

Causes

Oncology refers to that part of medical practice in which the causes and mechanisms of disease development are blurred and not fully understood. Of course, there are factors that increase the likelihood of developing cancer, but even if they are present, this does not mean that cancer will definitely appear.

These factors include:

1. genetic predisposition - it has been precisely established that girls who have had cases of malignant neoplasms of the reproductive system or other organs in their family are more likely to be susceptible to this disease. Genes were also studied that, when identified in the human body, increase the likelihood of disease;
2. age - it is not known for sure why, but in older women, cancer of the uterine appendages is more common than in young girls. Perhaps this is due to the gradual depletion of all the body's resources and the cells' decline in their previous normal functioning;
3. hormonal imbalance - menstrual irregularities contribute to the occurrence of pathology. It should be said that with a greater number of ovulations, the risk of aggressive neoplasm increases. For example, it appears more often in girls with early menarche and women with late menopause. The risk increases in nulliparous women, as well as in patients using hormonal drugs to stimulate ovulation;
4. chronic inflammatory processes in different parts of the genitourinary system;
5. avitaminosis;
6. chronic fatigue;
7. poor environmental conditions;
8. negative effects of radiation;
9. eating foods with carcinogens.

Important! Any oncological disease is polyetiological, that is, several causes lead to it, each of which can be of primary importance.

Classification by place of origin

The area of ​​the body in which the pathology develops plays a certain role in the characteristics of any disease. If the process began precisely in the tissues of the ovaries, then we are talking about its primary form, also known as endometrioid cancer. With this disease, squamous epithelium with focal localization is detected in the ovaries. In the vast majority of cases, the tumor affects both appendages, forming a dense consistency and lumpy surface. This type of cancer is predominantly detected in women under 35 years of age.

Expert opinion

Anna Alekseenko

Obstetrician-gynecologist Experience 5 years

The secondary form is a type of disease in which a benign neoplasm has transformed into a malignant tumor. Some of the cysts, most of which do not have an aggressive course, can, over time, if there is a negative impact on them, develop into a cancerous process. Therefore, even if cystic formations are detected, it is necessary to urgently consult a doctor to draw up a further treatment plan.

Granulosa cell tumor of the ovary: definition and code according to ICD-10

Granulosa cell tumor of the ovary (GCT) in the International Classification of Diseases (ICD-10) is designated by code D27. This group includes benign gonadal neoplasms of various origins. Malignant processes are encoded with the C56 code.

Histological classification classifies GCT as a group of sex cord tumors. This is a non-epithelial formation, presumably arising from the tissues of premordial follicles. According to statistics, pathology is detected in 0.5-7% of cases (according to various authors). Granulosa cell tumor is usually observed during menopause (40-60 years), less often in girls who have not reached puberty. It occurs extremely rarely during the reproductive period.

Distinctive features of the pathology:

• Early manifestation of disease symptoms (in 70% of patients).
• Predominantly unilateral lesion.
• Low probability of developing metastases.

Stages of the disease

Stages
Stage 1. The most treatable, but also less detectable because it has virtually no symptoms. At this stage of development, the lesion affects only the contents of the ovary, without extending beyond its membrane. Symptoms at an early stage are erased and resemble the manifestation of other diseases not related to the reproductive function of a woman.

Stage 2. Further progression of the pathology leads to the spread of the lesion beyond the boundaries of the ovarian capsule. Other organs located in the pelvis are involved in the pathological process. Often, already at this stage, an accumulation of serous fluid in the abdominal cavity, called ascites, can be observed.

Stage 3. The malignant tumor continues its aggressive takeover of the tissues surrounding it. Now it extends beyond the pelvis. During examination, the pathology is clearly determined in the reproductive system, but additional instrumental diagnostic methods make it possible to determine the increase in the extent of the lesion. This degree is manifested by the occurrence of ascites and other clinical manifestations of cancer.

Stage 4. Metastases are spread over all parts of the girl’s body. A severe course is observed, in which treatment is ineffective, the percentage of recovery and survival is extremely low. If a tumor is detected at this stage, specialists prescribe therapy aimed at improving the quality of life and prolonging it.

Stages of oncology development

• Stage 1 - The tumor can be located on one ovary or on both at once. But the neoplasm is located within the organ.
• Stage 2 - The neoplasm begins to cover the nearest organs: fallopian tubes, bladder, or grow into the abdominal cavity.
• Stage 3 - Metastases affect local lymph nodes. The first symptoms of abdominal pain, weakness, nausea, etc. appear.
• Stage 4 - The tumor metastasizes to distant organs: liver, lungs, brain, kidneys, etc.

TNM classification

It is used for various oncological diseases, depending on the extent of the lesion. Classification by this method is based on the determination of three criteria - tumor size (T), involvement of regional lymph nodes (N) and the presence of distant metastases (M).

T1 – malignant process limited to ovarian tissue:

• T1a – the neoplasm predominantly affects one uterine appendage, does not reach its surface, and cancer cells are not found in the abdominal cavity;
• T1b – the tumor affects both ovaries, and there is also no growth into their capsules and no spread of atypical cells into the peritoneal cavity;
• T1c – pathology develops in one or two appendages, grows into their membranes, can rupture them, and cells are present in the surrounding space.

T2 – cancer is localized in the pelvis:

• T2a – metastasis to the body of the uterus and its tubes, but there are no atypical elements in the ascitic fluid and washings from the abdominal cavity;
• T2b – the tumor has invaded other organs in this area of ​​the body, but there are still no cancer cells in the surrounding fluid;
• Stage T2c - the process can involve all structures of the pelvis, cancer cells are detected in the abdominal cavity.

T3 – in addition to damage to the pelvic organs, minor metastases are detected in nearby systems and regional lymph nodes:

• T3a – microscopic metastases are located in the peritoneum;
• T3b – they do not exceed 2 cm in diameter;
• T3c – become more than 2 cm or are detected in nearby lymph nodes.
• N0 – lymph nodes are not affected;
• N1 – pathological changes in regional lymph nodes;
• M0 – no distant metastases;
• M1 – metastasis to parts of the body distant from the primary focus.

Note! Even if a cancerous tumor has not been diagnosed, but atypical cells are found in different organs, this indicates the significant severity of the oncology, and the doctor automatically diagnoses stage 4 cancer.

Histology of granulosa cell tumors of the ovary

The histological structure of a granulosa cell tumor resembles a follicle in one of the stages of its development. The characteristics of education depend on its form:

• An adult tumor can be of high, intermediate or low differentiation.
• In the juvenile form, clear signs of cell differentiation are not detected.

Histology reveals nuclear atypia and various mitotic activity. Foci of necrosis and hemorrhage may be detected. The variability of morphological changes complicates the diagnosis of the disease and does not allow clearly defining the criteria that determine the prognosis of the disease.

Question to the expert

I am 27 years old, a tumor was found in the ovaries (according to the conclusion - granulosa cell). The ovary was removed, the second one was left. Can a granulosa cell tumor metastasize and will it grow back?

Granulosa cell tumors diagnosed at a young age may recur within the first 5 years after surgery. All this time you need to be observed by an oncologist. The tumor gives distant metastases extremely rarely, and usually spreads to nearby organs - the uterus, fallopian tubes, and peritoneum.

Symptoms

Depending on the degree of damage and the severity of the disease, the symptoms will vary; the first signs are distinguished:

1. general weakness, decreased ability to work;
2. feeling of discomfort in the lower abdomen of low intensity;
3. other symptoms that are similar to the clinic for diseases of the excretory and food systems.

Actually, due to the fact that in the clinic of ovarian cancer there is no typical typicality for it, it is detected extremely rarely in the early stages, since either the course of the disease goes unnoticed by the girl or is perceived as a pathology of other organs.

Symptoms of stage 1 cancer include:

1. feeling as if the stomach is full;
2. regular bloating;
3. increased frequency of urination;
4. dyspeptic disorders;
5. painful sensations localized in the lower abdomen, often radiating to the lower back or rectum, aggravated by physical activity and sexual intercourse.

Stage 2 is characterized by:

1. painful syndrome localized in the lower abdomen of moderate intensity, pain radiating to the lumbar region and rectum;
2. increased menstruation - the release of more blood, bleeding, which occurs regardless of the phases of the cycle, especially after sexual relations;
3. flatulence and diarrhea;
4. enlargement of the abdomen due to the accumulation of ascitic fluid;
5. weight loss, poor appetite.

Stage 3 symptoms include:

1. constant gas formation and a feeling of fullness in the abdomen;
2. periodic nausea and vomiting;
3. pain during bowel movements;
4. frequent urge to urinate;
5. increased bleeding;
6. general weakness, pallor, which can be explained by anemia;
7. increase in abdominal circumference;
8. intense pain syndrome.

Stage 4 clinic includes:

1. menstrual irregularities, also leading to hormonal imbalance;
2. the presence of edema not only in the abdomen, but also in other parts of the body;
3. shortness of breath and short-term apnea;
4. pathological vaginal discharge;
5. very severe pain, the localization of which may vary;
6. lack of appetite;
7. intoxication, characterized by an increase in temperature.

Important! The variety and brightness of symptoms at the last stage is explained by extensive metastasis and involvement of various organs and systems in the process.

Symptoms and treatment of ovarian cancer

Manifestations of ovarian cancer become pronounced in the later stages; at an early stage of development, the signs of cancer are similar to the symptoms of digestive disorders, diseases of the stomach, and intestines. A progressive form of cancer is manifested by the following symptoms:

• The abdomen enlarges and flatulence develops.
• Pain appears in the lower back and pelvic area.
• Dyspeptic phenomena.
• The lower extremities swell.
• Anemia develops.
• Signs of cardiovascular failure appear.
• The woman loses weight and feels constant weakness.

Signs of ovarian cancer:

• Weakness, malaise.
• Nausea, indigestion.
• Flatulence.
• Feeling of overeating.
• Frequent urge to urinate.
• Constipation or diarrhea occurs periodically.
• Pain in the lower abdomen and lower back.

During the examination, the doctor may detect a tumor in the ovary. The tumor has a dense consistency and a nodular surface. The doctor will be able to determine the nature of the tumor after examining and testing the patient. Ovarian cancer is characterized by rapid tumor growth and rapid spread of metastases. Ovarian cancer is treated with surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy. Removal of the ovaries is performed together with the removal of lymph nodes, the greater omentum, and often the uterus is removed along with the appendages. The exception is serous ovarian cancer (stage 1a) and the patient’s desire to preserve the uterus, as well as the widespread occurrence of the malignant process. Chemotherapy is used before or after surgery. In the first case, it is used as a neoadjuvant method to help control tumor growth and reduce tumor size. In the second case, chemotherapy kills tumor metastases.

The Yusupov Hospital provides consultations, examinations of patients, diagnosis and treatment of ovarian cancer. An annual examination by a gynecologist, and after 40 years at least twice a year, helps to timely detect the development of diseases of the ovary, uterus and mammary gland. A woman's survival prognosis improves if the tumor is detected before it has spread to adjacent organs and tissues. The hospital provides various types of treatment, including surgery, chemotherapy, targeted therapy, and radiation therapy. At the diagnostic center you can undergo ultrasound, CT, MRI, and tests. You can make an appointment with a doctor by phone.

Diagnostics

At the very beginning of cancer formation, it is very difficult to recognize it, since the affected area is insignificant and the clinical picture is erased. Therefore, when examined by a gynecologist, the disease can be diagnosed only during an ultrasound examination, which will determine the tumor in the ovary. If the tumor is large, it can be detected by palpation or gynecological examination. In any case, a more detailed diagnosis is impossible without the use of laboratory and instrumental methods.

Standard laboratory diagnostic activities include the collection of biological materials for analysis. Anemia will be detected in the blood, and there will probably also be signs of inflammation in it. When the tumor grows into the bladder and rectum, blood will be present in the urine and stool. Specific blood tests are aimed at detecting tumor markers in the blood, indicating that a malignant process is present in the body.

Ultrasound is the first step in a more detailed study of the formed oncological process. Other instrumental diagnostic methods will follow. Using computed tomography and magnetic resonance imaging, the extent of the lesion and metastasis can be assessed. If necessary, radiography of various internal organs is also performed.

Expert opinion

Natalya Matveeva

Obstetrician-gynecologist, Gynecologist, Ultrasound specialist

To determine the malignancy of the formation, a biopsy is performed, which involves taking part of the affected tissue. This material will then be studied histologically to determine the presence of atypicality. Cancer cells can be found in ascitic fluid taken during abdominal puncture. Material is also collected from the lymph nodes to characterize the extent of the disease.

Relapse

The reappearance of the tumor can be provoked by choosing the wrong method of surgical treatment, prescribing an inadequate dose of cytostatics and carrying out an insufficient number of other therapeutic methods. Also, much will depend on the patient’s condition, the presence of chronic diseases and negative external influences. To detect a relapse, a blood test is performed to identify onomarkers, as well as instrumental diagnostic methods. Its treatment will depend on the stage of the pathological process and the patient’s well-being.

Observation after treatment

Observation is necessary for at least 5 years, during which the patient must be in the field of view of medical workers. She needs to regularly come for examination to a gynecologist, who conducts examinations, ultrasounds, and also refers her to computed tomography, magnetic resonance imaging, and, if necessary, to specialists. During her stay in a medical facility, a woman submits biological materials for analysis.

Important! Systematic completion of routine examinations will help protect her health and life in case of possible relapses through timely diagnosis and treatment.

C56 Malignant neoplasm of the ovary

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Can a cyst develop into cancer?

Some types of benign neoplasms do tend to become malignant. Therefore, when a cyst is detected in the ovary, it is necessary to decide on its prompt treatment and possible surgical removal in order to prevent unwanted dangerous consequences of a possible transformation.

In the diagnosis and treatment of ovarian cancer, much will depend on the woman and her attention to her own health. At the slightest disturbance in your health, it is recommended to consult a doctor, who will conduct all the necessary examinations to make sure that there is no serious component that led to the deterioration of the patient’s condition. If an oncological pathology is detected and timely seeking medical help, the chance of recovery is quite high.