Ovarian cancer: causes, symptoms, treatment, and survival at different stages

Ovarian cancer for diagnosis time often has a common step, as for a fairly long time occurs without overt clinical signs. Intrigue is a tumor and resistance of chemotherapy, as well as frequent inoperability, the rapid spread of the anatomical structures of the pelvis. Dangerous disease is much easier to prevent through screening, early detection and treatment of cysts.

Classification: stage ovarian cancer

Ovarian cancer stadiruetsya, like other tumor TNM system, and classification of cancer in stages is performed and International Federation of Gynecology (FIGO). Last revision carried out in 2014, which changed the parameters for the stages.

According to the TNM stage zero (T0) implies the absence of visualization of the primary tumor. Tis is a carcinoma in situ or tumor "in situ" representing microcenters cancer cells, which affect a specific portion without departing from the capsule without germination vessels and other tissues. In this case, according to the classification of preinvasive carcinoma FIGO stage it is considered to be zero. The first stage and further in both classifications staging point.

Ovarian Cancer Stage 1

The first stage involves the defeat of only organ tissue. Isolate A, B, C steps of:

• A cancerous tumor at step affects only one organ connective tissue capsule malignant cells not touched, the tumor is not located on the surface of the abdominal cavity wash cancerous cell elements negative;
• when B - Malignant cells located in both glands, other characteristics coincide 1A;
• for C characteristic involvement in the process of one organ, or both, but note capsule integrity violation (Break it), the presence of surface growths, as well as positive washings of the abdominal cavity on cancer cells.

Ovarian Cancer Stage 2

If a tumor that affects one or both ovaries, the wall or has spread to surrounding tissues and organs in the pelvis, the process is diagnosed as stage 2. Carcinoma of the ovary in the second step also differentiated into A, B, C substeps:

• for A or characteristic germination or metastases uterine body or into the tube, but the test on flushing of the abdominal cavity is negative;
• As indicated at step spread not only on the uterus and tubes, but also in other parts of the wall adjacent to the tumor, but the test on flushing from the cavity negative cancer cells;
• if the tumor extends only within the pelvic and flush cancer cells is positive, diagnosed with stage 2C.

Ovarian Cancer Stage 3

For the third stage, which is classified into A, B, C form, characterized by the presence of cells in the peritoneum is pelvic metastases or lymph nodes nearest location. Struck two bodies or one. Differentiation stages:

• A - confirmed by biopsy metastases in the peritoneum of the pelvis;
• B - of visible metastases in the peritoneum of the pelvis is small in diameter to 20 mm;
• C - peritoneal metastases beyond the pelvis more than 20 mm and / or spread of cancer cells in hypogastric, iliac, lateral sacral, para-aortic, inguinal lymph nodes.

Ovarian Cancer Stage 4

The last step is described the presence of distant metastases. If cancerous cells present in the liver capsule, diagnosed 3 step metastases in a parenchyma - fourth. Stage 4 also exhibited the presence of tumor in the pleural cavity.

histological classification

Fabric varieties presented the variety of types and it is caused by the presence of several types of cells. The tumor may come from:

• epithelium (80%);
• stroma (connective tissue, blood vessels) - 10%;
• germinal cells (10%).

Epithelial ovarian cancer forms the majority of malignant tumors of the body and is diagnosed in women 40 to 60 years.

Carcinoma, which are formed of epithelial tissue include serous, mucinous, endometrioid, clear cell, squamous, Brenner tumor, and not differentiated carcinoma.

Attention! Most often diagnosed variety of epithelial malignancy serous or mucinous cystoma with papillary excrescences.

Malignant cystoma or adenocarcinoma tumors are secondary, as there were on the basis of benign. Serous carcinoma of the ovary in the lead structure of epithelial tumors.

Cancer on the background of benign tumors - cysts - develops at different rates. So, serous adenoma maligniziruyutsya in 15% of cases, mucinous - 5%.

Serous ovarian cancer responds well to chemotherapy, compared with clear and mucinous, however, not all patients are diagnosed at stage 1-2, which causes a high level of mortality. The higher the grade, the better the prognosis for treatment.

How fast developing ovarian cancer in women

The rate of formation of cancer depends on its species. If the primary tumor, when a body tissue immediately formed portion of the malignant cells, the process progresses pretty quickly: within a year Stage 1 progresses to the third and already gives common abdominal metastases cavity. Therefore, women in menopause should undergo an annual ultrasound and donate blood for tumor markers.

Secondary cancer progresses much slower. Cystoma, which are transformed into cancer can for years to preserve their high quality, but the older a woman gets, the higher the risk of malignancy. Unfortunately, ignoring gynecological examinations, diagnose malignant cyst - adenocarcinoma - already at stage 3-4, when there are widespread metastases and bright signs.

Where ovarian cancer metastasizes

Given the location of the appendages in the pelvis, are following the localization of metastatic processes:

• healthy body and body of the uterus;
• peritoneum;
• stuffing box;
• regional lymph nodes;
• liver;
• pleura.

Important! The danger lies in the rapid spread of cancer cells into the peritoneum leaflets wide range: from adjacent organs and tissues to the liver and pleura.

Ovarian cancer: the code in ICD 10

According to international classifier encoded pathology in section C56.

The causes of ovarian cancer

The underlying cause of the disease lies in the hormonal balance of the ovaries, the pituitary gland and the hypothalamus. Malignancy in most cases characteristic of older women who have reached the 55-60 year mark. Allocate risk factors for ovarian cancer:

• heredity;
• debuting menstruation before age 9;
• early or late menopause;
• infertility;
• endometrial hyperplasia;
• endometriosis;
• fibroids.

Based on the list of diseases, it is clear that there are women with elevated levels of estrogen at risk in the blood, including women with excess weight.

The role of the ECO has not been proven in cancer development.

Symptoms of ovarian cancer in women: the first symptoms

The presence of primary cancers in the early stages is not described specific symptoms, and when achieving a tumor larger a woman has symptoms, but the process is already in the running stage. Cystoma contrary manifest themselves even in benign character, but these complaints are not specific and unobtrusive for a woman, so ignoring the symptoms leads to the progression and the appearance of specific complaints:

• abdominal pain with a predominance in the lumbar region and in the epigastrium with or vague;
• increase and bloating (fluid accumulation in the abdominal metastases in the peritoneum);
• weight loss, weakness, poor appetite;
• indigestion (metastases in the upper floor of the peritoneum);
• violation of urination, defecation.

Ovarian cancer, the first signs and symptoms which may occur complaints of the stomach and intestines, shows running processes. Therefore, women who have addressed to the doctor with bloating, belching, epigastric pain should be evaluated for gynecological pathology.

Patients in the menopause should not be palpated appendages - it should be taken into account during the inspection.

How to diagnose ovarian cancer

The diagnosis of ovarian oncology women is exposed on the basis of complex examination including instrumental and laboratory methods. The final diagnosis endure after the results of the biopsy.

The laboratory methods include:

• determining the level of CA-125 in the blood, usually in women with cancer marker amount exceeds 100 U / ml;
• a blood test for HE4 and CA-125 to the calculation of the index ROMA;
• if the patient's age does not exceed 40 years, perform a blood test for alpha-fetoprotein, inhibin B, and human chorionic gonadotropin, to rule out tumors that occur in the reproductive age;
• with an adverse family history - analysis for the BRCA mutation.

Important! Annual performance of ultrasound and a blood test for CA-125 in the dynamics are screening for women over 40, and can detect carcinoma at an early stage.

At the initial examination female gynecologist may arise suspicion for tumor. In such cases, appoint an ultrasound. Typically, ovarian cancer in the US is suspected in the presence of Education with its own blood supply system, fuzzy edges, presence of cavities, with suspension and inclusion, multiple partitions, necrosis.

During the ultrasound detection of cavities in the ovary perform needle biopsy under ultrasound control.

It is desirable to expand the diagnosis using modern instrumental techniques: CT and MRI with intravenous contrast.

The next step is a diagnostic laparoscopy, which can be over laparotomy. An audit involves the abdominal cavity search screenings and metastasis, lymph node involvement, ingrowth, and wash to look for cancer cells. During the operation, take a biopsy and histological examination carried out immediately. When cancer confirmation performed removal of the ovaries and other necessary measures for the removal of diseased tissue. In addition, after laparotomy exposed the final diagnosis and staging of FIGO and TNM.

In addition to this, in particular, before the operation is performed:

• gastroscopy;
• colonoscopy;
• X-rays of the chest;
• mammography and breast ultrasound;
• curettage of the endometrium.

Studies are needed to eliminate tumor metastasis, as well as to search for a primary source carcinoma, since damage can be secondary.

Ovarian Cancer Treatment

carcinoma therapy involves a comprehensive approach: radical surgery, chemotherapy, immunotherapy and radiation therapy.

Surgery

The operation performed by the median incision on the abdomen, laparoscopy excluded.

Surgical treatment of ovarian cancer in women involves the use of cytoreductive or palliative surgery. The first method is complete excision of the tumor weight at the initial stage of cancer therapy. But if the primary operation is found that proliferation is completely impossible to remove the tumor, spend chemotherapy (1-2 courses) followed by repeated cytoreductive surgery for complete removal carcinoma and surrounding the affected tissues. This surgical treatment is called interventional reduction.

Secondary cytoreductive surgery involves intervention after the woman to hold a full cycle of chemotherapy after the first operation. Also, a secondary operation is conducted at relapse.

Repeated interference with the ovarian cancer is called a second look and is performed after a radical and complete course treatment (primary, secondary operation, chemotherapy and radiotherapy) in order to evaluate whether there is continued disease. Carry out an audit of the abdominal cavity, biopsy of suspicious areas (around 20-40), taking the wash water to a study.

Important! Surgical treatment involves a radical approach: the complete removal of the uterus and appendages, the greater omentum, lymph nodes, and absolutely all the visible changes in the abdominal cavity.

During removal of cancerous tumors, in addition to a thorough and systematic examination of all organs, operate urgent histology, to the operating decisions about appropriate actions depending on the result.

During the operation the tumor growths are removed so that the maximum remaining carcinomas ranged from 1 cm when fully remove the cancer is not possible. The remaining tumor cells to be destroyed with radiation or chemotherapy.

Depending on the stage, the age of the patient and wishes to carry out reproduction, the amount of operation differs.

• 1 and 2 imply extirpation uterine body and appendages on both sides, the gland dissection, inspection entire cavity biopsy and wash water;
• among women of reproductive age with highly differentiated cancer stage 1A of the preservation of a healthy body may be (affected carcinoma is completely removed, the healthy - in part);
• if histologically confirmed endometrial ovarian cancer in young women, be sure to carry out a biopsy of the endometrium, as the malignant process can be synchronous;
• 3 and 4 involve holding the maximum primary cytoreductive surgery, if not completely remove cancer fails, operate chemistry and secondary operation.

Immunotherapy in ovarian cancer

new antigenic structures are formed in the course of normal cells transform into tumor on its surface. Due to these protein molecules of the immune system recognize cancer cells. In this particular antigen is specific for a given tumor, cancer can therefore recognize, by analyzing the presence of the antigen or antibody thereto. With regards to ovarian carcinoma, on the surface of tumor cells formed a specific protein CA-125. In addition, those antigens that are present in embryonic cells, can occur in cancer. These proteins include alpha-fetoprotein, beta hCG.

Based on the ability of cancer cells express new antigens in cancer immunotherapy is used. Ovarian carcinoma is one of the few species of malignant tumors when used immunomodulation.

Preparations for immunotherapy:

• monoclonal antibodies - immunoglobulins against specific antigens carcinoma which destroy these cells make them recognizable for immune system, inhibit the growth of blood vessels in tumors (bevacizumab or Avastin);
• general non-specific therapy - cytokines (interleukins, interferons), in combination with cytostatics (methotrexate, etc.);
• lymphokine activated cells in combination with a cytokine;
• lymphocytes, infiltrating tumor;
• autolimfotsitoterapiya (Fence own lymphocytes and their activation and subsequent administration);
• administering tumor immunodominant peptide in antigen-presenting cells;
• transformation of tumor cells in antigen-presenting by gene transfection.

With the aim of cancer immunotherapy developed many cancer vaccines. Currently no vaccine against ovarian cancer has not been created. The most efficient way is the use of monoclonal antibodies and autolimfotsitoterapiya.

hormonal therapy

According to clinical protocols, hormone treatment for ovarian cancer chemotherapy is performed within 2 and subsequent lines. The reason for the appointment of hormones is no effect on the chemistry of the first cycle (progression cancer of less than 6 months after the last administration of a platinum drug) and platinoustoychivy cancer. Use Letrozole, Tamoxifen, Megestrol.

Radiation therapy

It refers to ovarian cancer tumor sensitive to the use of radiation therapy. The most important use of this method in mucinous ovarian cancer, clear cell and endometrioid species that slabochuvstvitelny to chemotherapy. Radiation treatment is applied at relapse and metastasis to the pelvis. The radiation dose is selected depending on concomitant chemotherapy. The main effect of the beam falls on the sheets in the pockets of the peritoneum.

Chemotherapy

Depending on the stage of the tumor and histotype addressed the issue of the need for chemotherapy and the way of its implementation.

1. In step 1A and 1B and the degree of malignancy of G1, as well as chemotherapy nesvetlokletochnom histotype not performed.
2. In step 1A and 1B, if during the operation was unable to conduct an audit of the abdominal cavity of 6 designate chemistry courses.
3. If the first stage 2-3 is detected degree of malignancy, and clear cell ovarian carcinoma, after operation administered six courses chemistry.
4. Since 1C and step on (step 2-4) himolechenie assigned regardless histotype.

Important! The leading group of drugs to perform chemotherapy are platinum derivatives.

intercalant also used (doxorubicin) derivatives, bis-B-chloroethylamine (cyclophosphamide). The first course or chemical treatment includes said first line combination regimens, total courses conducted 6.

In the third step, if after operation foci were visible, and in the fourth step was added to the traditional scheme Bevacizumab.

Administering chemotherapy to the abdomen is shown after cytoreductive surgery and the presence of residual foci of not more than 1 cm.

The second line chemotherapy is indicated for the ineffectiveness of the first and most often it happens in resistance to platinum drugs carcinoma. In such situations, prescribe bevacizumab, and offer patients participate in clinical trials.

High efficiency products have pazopanib, Nintedanib, however, the Ministry of Health of the Russian Federation, they are not registered for use in the treatment protocol for ovarian cancer.

In order to assess the success of ongoing himiolecheniya woman appointed regular tests for CA-125. The decision to hold chemotherapy second and subsequent lines of a CT, MRI, ultrasound, and based on the patient's complaints.

Treatment of ovarian cancer folk remedies

Of herbal remedies that can help in the fight against cancer, isolated hemlock, aconite, bearberry, celandine, kelp, mushroom Chaga, and herbs with antiestrogenic action (sage, hop, clover, licorice).

Prediction of survival in ovarian cancer

The survival rate is determined on the basis of the continuation of life after five years after issuing the diagnosis. Exodus determined step, histotype, degree of differentiation. The higher the differentiation of tumor tissue (belonging to a particular histotype), the better the prognosis.

Important! Ovarian cancer has long been no symptoms.

That is why survival rates are not as optimistic as in other types of cancer.

Survival in ovarian cancer 1 step

The initial stage is described by the highest rate of survival. In cancer, in situ value fluctuates within 95%, at 1A, 1B stage - 85% 1C - 60%. Full and adequate treatment of early phase allows to bring the value of survival to 100%. Current methods of diagnosis and prompt the operation guarantee success in one step for all women.

Survival in ovarian cancer 2 steps

The second stage is characterized by less optimistic performance. Thus, in 2A, 2B survival rate is 50%, at 2C - 40%.

How many live with ovarian cancer stage 3

The third stage according to the statistical average data is described by 10-15% survival. In 3A, 3B, step 15% of women overcomes the five-year period at 3C - no more than 10% of patients survive 5 years from diagnosis.

How many live with ovarian cancer stage 4

Depending on the location of a metastasis in the fourth step survival rate ranges from 5 to 9%. Metastasis in vital organs results in rapid death due to the impossibility of a full operation.

Clinical guidelines in ovarian cancer

Process diagnosis and treatment of malignant ovarian tumors carried out according to accepted standards of obstetric care for women. All-Russian Association of Oncologists Russia accepted clinical guidelines for the diagnosis and treatment of ovarian cancer on based on which experts are conducting research, define the scope of surgery and indications for chemotherapy. This sets out the requirements for approval.

Prevention of ovarian cancer

The prevention is based on the timely treatment of infertility, cysts, hyperplastic processes of reproductive tract (Endometriosis, polyps, fibroid), as well as regular annual visit gynecological, including ultrasound and blood test for CA-125 in dynamics.

Reviews women

conclusion

Ovarian cancer defines a fairly high level of mortality among women, from first-time diagnosis of cases it is 65%. The annual blood test for CA-125 in women older than 40 years, as well as regular pelvic ultrasound will allow time to suspect pathology and cure the disease completely at an early stage.