Ovarian cysts usually do not harm women's health and often go away without any treatment. However, in rare cases, some types of cysts can become cancerous. Women who have reached menopause are at greatest risk of developing this complication.
In this article we will talk in detail about and explain under what conditions such formations can turn into cancer. We will also look at the symptoms, diagnosis and treatment of ovarian cysts.
The ovaries are the organs of the female reproductive system. About every 28 days, one of these organs releases an egg as part of the menstrual cycle. The process of releasing an egg by the ovaries is commonly called in medicine. Another function of the ovaries is the production of female sex hormones and.
Ovarian cysts are fluid-filled sacs that can develop in a woman's ovaries. Such formations are usually benign in nature, that is, they are not cancerous. In most cases, they disappear on their own and do not require medical intervention.
Ovarian cysts often develop in women whose reproductive system functions normally. A healthy menstrual cycle involves the formation of cysts.
Ovarian cysts that develop due to regular ovulation during the menstrual cycle are usually called functional ovarian cysts.
Ovarian cysts are usually not cancerous and do not cause symptoms. Many women find out about the presence of such cysts only during the next one.
Cysts and cancer
Ovarian cysts are less likely to form after. Menopause is the period in a woman’s life when she stops. However, if cysts form in, they have a higher chance of becoming cancerous.
Pathological ovarian cysts
Ovarian cysts can sometimes develop as a result of abnormal or excess cell growth. Doctors call such cysts pathological.
Pathological ovarian cysts are sometimes malignant, meaning they can cause ovarian cancer. Women who have gone through menopause have a higher risk of developing abnormal cysts.
Certain medical conditions, for example, can also cause the appearance of pathological cysts. Endometriosis is a disease characterized by the appearance in various areas of the body of particles of endometrial tissue, which in a healthy body should be located exclusively in the uterus. Endometrial implants often develop on the fallopian tubes and ovaries.
Ovarian cancer
Ovarian cancer develops when ovarian cells begin to grow and divide uncontrollably, resulting in the formation of tumors. If this condition is left untreated, tumor cells can spread to nearby tissues or distant structures of the body.
Epithelial tumors of the ovary
Women can develop different types of ovarian cancer, depending on where in the ovary the disease begins to develop. Epithelial ovarian tumors are the most common type of ovarian cancer. It begins to develop in cells located on the outer surface of the ovaries.
Symptoms of ovarian cysts and ovarian cancer
Ovarian cancer may cause abdominal discomfort
With ovarian cysts, women usually experience few or no symptoms. Early stages of ovarian cancer may also have no symptoms or result in minor symptoms.
However, if ovarian cysts become very large, rupture, or block blood flow to the ovaries, they can cause symptoms similar to those of advanced ovarian cancer, such as:
- pain in the pelvic area (this can be a dull or sharp pain in the lower abdomen);
- abdominal discomfort, such as bloating or heaviness;
- feeling full soon after eating small meals;
- loss of appetite;
- problems with urination and bowel movements;
- increased urinary urgency;
- (dyspareunia);
- abnormalities in menstrual cycles (irregularity, too strong or too weak menstruation);
- fever;
- vomit.
If these symptoms occur, you should tell your doctor about it. If a woman has ovarian cancer and experiences acute, unusual or recurring symptoms, she needs to head to the hospital as soon as possible.
Diagnostics
Doctors usually diagnose ovarian cysts using ultrasound (ultrasound). In particular, they may offer the patient the following procedures.
- Transvaginal ultrasound. This is an internal test that involves inserting an ultrasound probe into the vagina to obtain images of the ovaries.
- Transabdominal ultrasound. The doctor scans the patient's lower abdomen with ultrasound equipment to obtain images of the pelvic area.
When a doctor discovers ovarian cysts during an ultrasound, he may suggest that the woman have regular follow-up checks to monitor the development of the cysts.
If your doctor suspects the cysts are cancerous, they may recommend a blood test for cancer antigen 125 (tumor marker CA 125). High levels of CA 125 in the blood may indicate the presence of ovarian cancer.
However, not in every case, a high level of CA 125 is a sign of ovarian cancer, since other medical conditions can also cause increased levels of this tumor marker in the blood, for example:
- pelvic infections;
- menses.
Treatment
Your doctor will need to evaluate the cyst to see if it is cancerous.
Most ovarian cysts do not require treatment and disappear on their own. However, therapy may still be required, depending on the following factors:
- size and appearance of cysts;
- observed symptoms;
- whether the patient has overcome menopause.
Doctors may use the following approaches to treat ovarian cysts.
Waiting and watching
Your doctor may recommend monitoring the cyst to see how quickly it progresses without treatment. In such cases, patients undergo regular ultrasound examinations of the pelvis, which make it possible to record changes in the size and appearance of the cysts.
Medications
Sometimes doctors prescribe it to women. Oral contraceptives do not reduce the size of cysts, but can prevent their further development.
Operations
- are too large;
- do not go away over a long period of time and do not respond to medications;
- seem unusual;
- prevent a woman from becoming pregnant;
- cause pain;
- may be malignant.
Depending on the type of cyst, your doctor may suggest the following surgical options.
- Cystectomy. This procedure involves removing the cysts and preserving the ovary.
- During this operation, the surgeon removes the ovary with the cyst, but leaves the second ovary intact.
- Complete or total. In this procedure, malignant cysts are removed along with the uterus, ovaries and fallopian tubes. After surgery, doctors may offer the woman radiation (radiation) therapy.
Prospects
Ovarian cysts are a relatively common problem. Such formations can form naturally during the menstrual cycle. In the vast majority of cases, ovarian cysts are harmless, non-cancerous, and do not require treatment.
Ovarian cysts that form in women after they reach menopause may be slightly more likely to become cancerous. If a woman has ovarian cysts and begins to experience acute, persistent, or unusual symptoms, she needs to see a doctor as soon as possible.
The standard approach to treating ovarian cysts that do not cause alarming symptoms begins with observation. If a cyst causes serious discomfort to a woman, becomes cancerous, or interferes with pregnancy, the doctor may recommend surgical removal.
Ovarian cancer is diagnosed every year in 25 thousand women over the age of 50. This is a malignant new formation in an organ, which is formed on the basis of affected epithelial cells. At an early stage, this insidious disease occurs with virtually no symptoms, and this is its main danger. The manifestation of symptoms of ovarian cancer occurs when the tumor has already reached a significant size and metastases have spread to other organs.
First signs
In most cases, the patient’s exact diagnosis is made at one of the last stages of development. This explains the high percentage of deaths, so doctors advise all women to approach their health very carefully and, if certain symptoms appear, immediately seek professional advice from a specialist and conduct a comprehensive examination.
Sometimes women, without even knowing about the oncology they have, are treated for a completely different illness. The first signs of ovarian cancer are not specific; in most cases they are disguised as other harmless diseases - intestinal obstruction, constipation, flatulence and painful menstrual bleeding.
The main symptoms are as follows:
- Nagging painful sensation in the lower abdomen and abdominal cavity, radiating to the legs or lumbosacral region, especially occurring after playing sports and lifting weights;
- Discomfort during sexual intercourse;
- Irregularity of the menstrual cycle;
- Unpleasant sensations during eating, rapid satiety;
- Constant bloating, frequent heartburn and increased abdominal volume;
- Bloody vaginal discharge;
- Rapid weight loss and gain;
- Fatigue, lethargy and drowsiness, shortness of breath, feeling unwell in the morning;
- Poor appetite, nausea and vomiting;
- A feeling of pressure on the pelvic organs (bladder and colon), which leads to an increased urge to defecate.
There are signs of ovarian cancer that are associated with the process of metastasis (formation of secondary tumor foci). Patients may experience a severe cough mixed with blood, painful sensations in the bones, yellowing of the skin, as well as neurological changes (impaired coordination of movement, seizures and severe headaches).
Experts also highlight nonspecific symptoms of ovarian cancer, which are very common in other diseases. Among them are the following:
- Anemia (decreased hemoglobin in red blood cells);
- Sharp loss of body weight and loss of appetite;
- A high ESR value (indicating the presence of an inflammatory process in the body);
- Fatigue and feeling unwell even after waking up.
The most common signs of ovarian cancer are spotting, so when they appear, a woman should immediately consult with specialists, take all the necessary tests and find out the cause of this symptom.
Since the tumor is located inside the organ and is small in size, it is practically invisible during ultrasound examination and laparoscopy in the first and second stages. Magnetic resonance and computed tomography, as well as a blood test for relevant cancer markers, will allow the patient to make an accurate diagnosis.
In 95% of the fairer sex, signs and symptoms of ovarian cancer appear already in the fourth and fifth stages of the disease. By this time, the tumor has spread to nearby and distant organs of the abdominal cavity, and it will be impossible to remove it during surgery. In this case, the mortality rate increases.
Many signs of the disease are very similar to non-oncological ailments. But you can also identify it yourself. In this case, they are characterized by constancy and increasing severity. At a late stage, symptoms of ovarian cancer are associated with the appearance of transudate in the abdominal cavity. Many women experience problems with the cardiovascular system and breathing, and malignant cells spread throughout the body, leading to death.
Cyst cancer symptoms
The main symptom of the disease is the appearance of neoplasms in the female reproductive organs. Oncology can also develop against the background of a slow-growing cyst that occurs even before the formation of a small tumor and metastasis. The discovery of such a formation in a little girl who has not had menstrual bleeding also indicates the possibility of the disease occurring in the future.
In most cases, the cyst does not have any symptoms due to its small size and sluggish development process. In many women, malignant and benign formations are detected by chance - during a preventive examination or during pregnancy.
The main symptoms of ovarian cyst cancer are similar to a malignant tumor. Among them are pulling sensations in the abdomen during menstrual bleeding, bowel movements and sexual intercourse, frequent urination resulting from compression of the pelvic organs, discomfort after sports and physical activity, bleeding from the vagina and irregular menstruation. Similar symptoms of ovarian cancer in men.
If a woman over 50 years of age experiences severe abdominal pain, elevated body temperature, lethargy and pallor, as well as various uncharacteristic discharges mixed with blood, she should immediately consult a doctor, a specialized specialist, or call an ambulance. If you experience discomfort, loss of appetite and bloating, any girl should definitely find comprehensive information about the symptoms and photos of ovarian cancer. A timely diagnosis will prevent complications, improve the quality of life and reduce the percentage of deaths.
Diseases of the female reproductive system are common. The diagnosis of ovarian cyst is found in 20 out of 100 women during a medical examination. Timely detection of dangerous indicators is the key to further well-being and health. Modern medicine has achieved a high level of equipment that allows it to take timely measures.
Neoplasms found on the paired female reproductive gland are similar to benign ones. The female part of the population does not consider the problem global and does not go to the doctor for treatment. Often a benign tumor becomes malignant.
Doctors observe the tumor for 3 months without taking any action. After 90 days, the cyst will resolve on its own. The protracted process leads to surgery.
Cystoma in ovarian epithelial tissue is a bubble with liquid contents. The size of the cyst is 5-15 centimeters. Benign formations form in the female body every month. During anovulation, the follicles do not burst in a timely manner, the capsule enlarges, and a follicular cyst forms. Follicular, luteal, and dermoid cysts do not become cancer. Cells of serous and mucinous neoplasms become malignant. Teratomas with mucus-like mass and adipose tissue do not become malignant.
The reasons for the growth of ovarian tumors have been identified by doctors:
- accumulation of blood and follicular secretions in the paired female gland;
- hormonal disorders;
- endometrial hyperplasia
A protracted cystic process with blood spots in the middle of the cycle, hellish pain, requires consultation with a gynecologist to determine the absence of cancer.
Functional cystomas do not require medical intervention.
Types of neoplasms
Tumors are:
- Benign - small seals
- Borderline - advanced cysts
- Malignant - metastasize, menopausal women are prone to
A benign cyst borders with the nearby epithelium, the boundaries are not violated. As the tumor grows, it compresses nearby organs and disrupts the anatomical position and physiology. The histology is similar to unaffected ovarian tissue, does not violate the integrity, and does not move. Using surgical intervention, the patient is completely cured. Disturbed menstrual cycle, endometriosis with endometrial hyperplasia are detected in women of reproductive age.
Borderline cysts are observed in individuals over 30 years of age. Cystomas rarely become malignant. Different cell parameters make diagnosis difficult; cell structures do not move. There is a danger of a tumor appearing on a paired female gland, a nearby organ, or moving into the abdominal cavity. The disease is operable, postoperative prognosis is positive.
A malignant ovarian cyst has no walls and grows rapidly. Atypical cells penetrate healthy structures, causing harm. Tissue cords of the neoplasm spread to elastic tubular formations and lymph nodes, spreading cancer through the blood and lymph to neighboring parts of the body. Metastasis occurs to neighboring, distant organs.
The histology of cancer cells is not similar to cells that are not affected by cancer. Pathological cells are different, taking into account cellular reproduction. Malignant cells are confused with aplasia. At the initial development of the disease, malignant cysts are cured without a trace.
Malignant cyst and cancer are incompatible concepts. Both definitions are dangerous to the life and health of a woman.
Genetics, age, and the tendency for cells to change influence the appearance of malignancy. Every third woman is cured of a malignant ovarian tumor. It is necessary to take a number to the doctor at the first doubt about the disease.
The concept of “malignant ovarian cyst”
Neoplasia is excessive pathological growth of altered epithelial cells. The ovarian epithelium is formed by cells of different etiologies that perform their own activities. Structural and functional ovarian cells degenerated into oncology are a voluminous neoplasm growing from epithelial tissue. Excessive pathological tissue proliferation is not formed by cell growth, but by accumulated liquid exudate in the ovary.
Doctors and scientists have not identified the cause of the disease. For women who are at risk, it is important to monitor their health and get examined.
Causes of cancer development:
- European women - representatives of the fairer sex living in Europe - are more likely to suffer from the disease than Asian girls;
- heredity - having a family history of cancer of a paired female gland, there is a high risk of children, grandchildren, and great-grandchildren acquiring the disease;
- age - proximity to menopause plays a role;
- infertility, in vitro fertilization - the influence of hormonal disorders;
- gynecological dysfunctions - fibroids, endometriosis, chronic gynecological diseases
Indicators, symptoms of the disease
Malignant ovarian tumors are asymptomatic for a long time. Malignant and benign formations exhibit the same symptoms. The clinical picture is expressed:
- constant, periodic pain in the lower abdomen, sharp, aching pain in the sacrum and lower back. Severe growing pain appears when the capsule ruptures or the leg is twisted;
- poisoning: feelings of weakness, increased fatigue, sudden weight loss, loss of appetite;
- disorder of nearby organs: stool retention, diarrhea, frequent “small” trips;
- abdominal dropsy - the abdomen becomes enlarged and swollen;
- tumors of the endocrine glands - production of estrogens, androgens;
- abdominal discomfort, flatulence;
- palpating, a tubercle is felt next to the appendages;
- with malignancy, the erythrocyte sedimentation rate increases;
- increase in body temperature to 38 degrees;
- the presence of discharge with an uncharacteristic color and odor;
- irregular periods
Doctors urge you to check the tumor once again if you have symptoms:
- angiomas;
- increasing sexual desire;
- enlarged breasts;
- blood filled nipples;
- cytology with dead cells;
- larger than normal uterus;
- irregular periods;
- dull soreness in the lower abdomen;
- constipation;
- ishuria
Diagnosis
A malignant cyst is difficult to diagnose. Advanced pathology needs urgent diagnosis. Incorrect examination, long outpatient periods call for radical measures of cystic relief. By treating with anti-inflammatory drugs, doctors look for the etiology of the tumor. The healing process slows down.
A careful study of the clinical picture of the disease with the assumption of a malignant cyst, the duration of the disease, and the appearance lead to the absence of relapses. Pain in the fallopian tube, ovaries, dyspeptic disorders, problems with the urinary system are important criteria for assessing the disease.
Additional events:
- Ultrasound of the reproductive organs, rectum, bladder - excludes compactions;
- MRI, CT establish the parameters, structure, localization of the formation;
- cytological analysis;
- laparoscopic biopsy - a particle of the epithelium of the diseased ovary is taken for cytology, histology;
- blood tests for erythrocyte sedimentation rate, tumor markers - an excess of ESR indicates inflammation and pathology in the body. Oncological “tags” “see” special proteins produced by a malignant neoplasm;
- anamnesis according to the patient
In case of spreading of abscesses to neighboring organs, the following is carried out:
- irrigoscopy;
- FGS, colonoscopy;
- chest x-ray;
- lymph node biopsy
Cancer Treatment Methods
- conservative treatment - stop the disease with the help of anti-inflammatory, antibacterial, hormonal medications;
- surgery
An unoperated cyst is dangerous due to inflammation and death. The cystoma becomes malignant, leading to the death of epithelial tissue and organs.
Operations:
- Laparoscopy - endoscopic surgery helps to avoid scars and deterioration of the condition. The operation is performed when the tumor is small and there are no restrictions.
- Laparotomy is a traditional operation with the opening of muscle, fat, skin, and connective structures. The cyst is enucleated, the ovary is cut off, the gland and appendages are completely removed.
Order of operations:
- Surgical intervention - the neoplasm is removed along with the uterus and appendages. For women of reproductive age who are not pregnant, they try to leave the ovaries, fallopian tubes, and uterus. Recommendations: removal of the unpaired smooth muscle organ, realizing maternal potential. Surgery is combined with chemotherapy and radiation therapy.
- Chemotherapy - there are side effects: nausea, vomiting, hair loss, weakened immunity. Platinum-based drugs are effective. Therapy is selected effectively, as sparingly as possible.
- Radiation therapy - affects the pelvic organs in waves. Effects: ulcers, scars
It is important for women to take preventive measures to help eliminate cystic formations on the gland. The use of OCs, the absence of termination of pregnancy, lactation, constant sex, a balanced diet, and the absence of bad habits help reduce the risk of neoplasms. Taking care of your health and regularly visiting a doctor prolongs your life.
A tumor is an excessive growth of pathologically altered cells of any tissue. Ovarian tissues are formed from cells of different origins and perform different functions. Regardless of the cellular structure, ovarian tumors in women are large formations that grow from ovarian tissue. In the classification, there is also such a thing as tumor-like formations, which are formed not due to cellular growth, but as a result of retention (accumulation) of fluid in the ovarian cavity. Among all diseases of the female genital area, tumors account for an average of 8%.
General characteristics by tumor type
Depending on the cellular changes, all pathological formations are combined into two large groups - malignant and benign. This division is conditional, since many benign formations tend to become malignant during the reproductive period.
Malignant ovarian tumors
They are characterized by the absence of a membrane, rapid growth, and the ability for individual cells and tissue strands of the tumor to penetrate into neighboring healthy tissues with damage to the latter. This also leads to germination into neighboring blood and lymphatic vessels and the spread (dissemination) of cancer cells through the blood and lymph to distant organs. Due to dissemination, metastatic tumors form in other nearby and distant organs.
The histological (under a microscope) structure of cancerous tissue, due to its atypicality, differs significantly from neighboring healthy areas of ovarian tissue. In addition, the malignant cells themselves are diverse in appearance, since they are in the process of division and at different stages of development. The most characteristic feature of malignant cells is their resemblance to embryonic cells (aplasia), but they are not identical to the latter. This is due to a lack of differentiation and therefore loss of the originally intended functionality.
In Russia, malignant neoplasms occupy seventh place in the total number of oncological diseases of the female population, and among all tumors of the female reproductive organs they account for about 13-14%. In the early stages of development, malignant ovarian tumors are completely cured, while in stages III and IV this percentage is much lower.
Benign ovarian tumors
The formations are delimited from neighboring tissues by the membrane and do not extend beyond its boundaries. However, as they increase, they are able to compress neighboring organs and disrupt their anatomical relationship and physiological functions. According to the histological structure, benign tumors differ slightly from the surrounding healthy ovarian tissue, do not destroy it and are not prone to metastasis. Therefore, as a result of surgical removal of a benign neoplasm, complete recovery occurs.
Benign tumors and tumor-like formations of the ovaries
Their relevance is explained by the following factors:
- Possibility of occurrence at any period of life.
- A large number of cases with a tendency to increase morbidity rates: they are in 2nd place among all pathological neoplasms of the female genital organs. They account for about 12% of all endoscopic operations and laparotomies (operations with an incision in the anterior abdominal wall and peritoneum) performed in gynecological departments.
- Decrease in female reproductive potential.
- The absence of specific symptoms, and therefore there are certain difficulties in early diagnosis.
- With 66.5-90.5% benignity of these neoplasms, there is a high risk of their malingization.
- The histological classification is cumbersome due to the fact that the ovaries are one of the most complex cellular structures.
The modern classification of the World Health Organization from 2002 presents a large number of benign ovarian tumors, dividing them into groups and subgroups according to various principles. The most common ones in practical gynecology and abdominal surgery are:
- Tumor-like formations of the ovaries.
- Superficial epithelial-stromal, or epithelial tumors of the ovaries.
Tumor-like formations
These include:
- Follicular cyst, which develops in one ovary and is more common in young women. Its diameter ranges from 2.5 to 10 cm. It is mobile, elastic, can be located above the uterus, behind or to the side of it, and is not prone to malignant degeneration. The cyst manifests itself as disturbances in menstrual cycles in the form of delayed menstruation followed by heavy bleeding, but after several (3-6) menstrual cycles it disappears on its own. However, torsion of the pedicle of an ovarian tumor is possible, and therefore, if it is detected during an ultrasound examination, constant monitoring with ultrasound biometric measurements is necessary until it disappears.
- . Upon palpation (manual palpation) of the abdomen, it is similar to the previous one. Its size in diameter ranges from 3-6.5 cm. Depending on the variants of the tumor, ultrasound can detect a homogeneous structure, the presence of single or multiple septa in the cyst, mesh wall structures of varying density, and blood clots (presumably).
Symptomatically, the cyst is characterized by delayed menstruation, scanty blood discharge from the genital tract, engorgement of the mammary glands and other dubious signs of pregnancy. Therefore, it is necessary to carry out a differential diagnosis of a corpus luteum cyst with an ectopic pregnancy. The cyst may rupture, especially during sexual intercourse.
- Serous or simple cyst. Before histological examination, it is often mistaken for follicular. The possibility of malignancy (malignancy) of the serous cyst is assumed, but this has not been definitively proven. The cyst develops from the remains of the primary embryonic bud and is a mobile, densely elastic formation with a diameter of about 10 cm, but sometimes, although very rarely, it can reach significant sizes. The tumor is more often discovered as a result of torsion of its pedicle or during an ultrasound for another reason. In this case, ovarian tissue is clearly visible next to the tumor.
Follicular cyst
Epithelial ovarian tumors
They represent the most numerous group, constituting on average 70% of all ovarian neoplasms and 10-15% of malignant tumors. Their development occurs from the stroma (base) and surface epithelium of the ovary. Epithelial tumors are usually unilateral (bilateral in nature is considered a suspicion of malignancy), upon palpation they are painless and mobile with a tightly elastic consistency.
With significant sizes, compression of neighboring organs by the tumor occurs mainly in adolescents, and in adult girls and women this is extremely rare. Epithelial formations do not cause menstrual disorders. Possible torsion of the pedicle of the ovarian tumor, hemorrhage into the capsule or its degeneration and rupture, accompanied by severe pain.
Borderline tumors
Among the epithelial formations in the classification, a special group of borderline type is identified: serous, mucinous (mucous), endometriotic and mixed borderline ovarian tumors, borderline Brenner tumor and some other types. Each of the first three types includes tumors of various types, depending on the structures from which they develop. After removal of borderline formations, their relapses are possible.
As a result of studies conducted over the past decades, it has been established that borderline tumors are low-grade tumors and precursors of types I and II malignant ovarian tumors. They occur more often in young women and are diagnosed mainly in the initial stages.
Morphologically, the borderline type of tumors is characterized by the presence of some signs of malignant growth: proliferation of the epithelium, spread throughout the abdominal cavity and damage to the omentum, an increased number of divisions of cell nuclei and atypia of the latter.
The ultrasound computed tomography method is quite informative in the diagnosis of borderline tumors. The criteria are the formation of single multilayered dense one-sided formations, sometimes with areas of necrosis (death). In serous borderline tumors, on the contrary, the process is bilateral in 40% of cases; the ovaries have the appearance of cystic formations with papillary structures without areas of necrosis inside the tumor. Another feature of serous tumors is the possibility of their recurrence many years after surgical treatment - even after 20 years.
Infertility among women with borderline tumors occurs in 30-35% of cases.
Endometrioid cyst
Symptoms
Regardless of whether the neoplasm is benign or malignant, its early subjective manifestations are nonspecific and can be the same for any tumor:
- Minor painful sensations, which are usually characterized by patients as weak “pulling” pain in the lower abdomen, predominantly unilateral.
- Feeling of heaviness in the lower abdominal region.
- Pain of uncertain localization in various parts of the abdominal cavity of a constant or periodic nature.
- Infertility.
- Sometimes (25%) there is a menstrual irregularity.
- Dysuric disorders in the form of frequent urge to urinate.
- An increase in abdominal volume due to flatulence, intestinal dysfunction, manifested by constipation or frequent urge to have ineffective bowel movements.
As the size of the tumor increases, the severity of any of these symptoms increases. The last two symptoms are quite rare, but the earliest manifestation of even a small tumor. Unfortunately, often the patients themselves and even doctors do not attach due importance to these signs. They are caused by the location of the tumor in front of or behind the uterus and irritation of the corresponding organs - the bladder or intestines.
In addition, some types of cysts that develop from germinal, germinal, or, less commonly, fat-like cells are capable of producing hormones, which may cause symptoms such as:
- absence of menstruation for several cycles;
- enlargement of the clitoris, reduction of the mammary glands and the thickness of the subcutaneous tissue;
- development of acne;
- excess body hair growth, baldness, low and rough voice;
- development of Itsenko-Cushing syndrome (with the secretion of glucocorticoid hormones by ovarian tumors emanating from fat-like cells).
These symptoms can appear at any age and even during pregnancy.
The development of metastasis in the later stages of cancer tumors leads to the appearance of effusion in the abdominal cavity, weakness, anemia, shortness of breath, symptoms of intestinal obstruction and others. Often the symptoms of serous borderline tumors are not much different from the symptoms of metastasis of ovarian cancer tumors.
Symptoms of torsion of the tumor stalk
Torsion of the pedicle of an ovarian tumor can be complete or partial, and can occur in both benign and borderline and malignant neoplasms. The surgical (as opposed to the anatomical) pedicle includes vessels, nerves, the fallopian tube, a section of the peritoneum, and the broad ligament of the uterus. Therefore, symptoms of malnutrition of the tumor and corresponding structures arise:
- sudden severe unilateral pain in the lower abdomen, which can gradually decrease and become permanent;
- nausea, vomiting;
- bloating and delayed defecation, less often - dysuric phenomena;
- pallor, “cold” sticky sweat;
- increased body temperature and increased heart rate.
All of these symptoms, except the first one, are not constant and characteristic. With partial torsion, their severity is much less, they can even disappear completely (with independent elimination of torsion) or reappear.
Treatment of ovarian tumor
The result of diagnosing a benign ovarian tumor with a diameter of more than 6 cm or lasting longer than six months, as well as any malignant formation, is surgical treatment. The extent of surgical intervention depends on the type and type of tumor. In case of malignancy, extirpation of the uterus with appendages and partial resection of the greater omentum is performed using laparotomy.
In the presence of a benign tumor, the histological type of the tumor, the woman’s age, and her reproductive and sexual capabilities are taken into account. Currently, more and more often, surgery to remove an ovarian tumor is performed laparoscopically, which makes it possible to provide the patient with conditions for maintaining a high quality of life and a quick return to normal family and social life.
When benign tumors are detected during the reproductive period, the scope of the operation is minimal - resection (partial removal) of the ovary or unilateral adnexectomy (removal of the ovary and fallopian tube). In the case of borderline tumors in the peri- and postmenopausal periods, the scope of the operation is the same as for a malignant tumor, but in reproductive age only adnexectomy is possible, followed by a sectoral (excision of a section of tissue) biopsy of the second ovary and subject to constant monitoring by a gynecologist.
Tumor-like formations (retention cysts) can sometimes be removed by sectoral resection of the ovary or enucleation of the cyst. Torsion of the cyst pedicle is a direct indication for emergency surgery in the form of adnexectomy.
Regular examinations by a doctor at the antenatal clinic and ultrasound examinations allow, in most cases, to timely diagnose and treat ovarian tumors, and prevent the development of malignant neoplasms and their metastasis.
Modern medicine has made some progress in the treatment of cancer of various locations. But the number of such neoplasms is growing rapidly, and they are not always detected in the initial stages. Among all the oncological processes in gynecology, malignant ovarian tumors are the most insidious, they are difficult to find in time, and they quickly metastasize. Who is at risk for this disease and what symptoms should alert a woman?
Read in this article
Risk factors
No reliable reasons for the development of the disease have been identified. But, based on many years of observations, risk groups have been formed.
- It is these women who should be more attentive to their health and undergo regular and thorough examinations. The following factors predisposing to ovarian cancer can be identified: European women are more susceptible to pathology than others.
- For example, in Japanese women the incidence rate is about 3 per 10 thousand, while in American women it is 20. The difference is significant, but no clear reasons for this have been identified. Hereditary predisposition plays an undoubted role.
- Thus, if among close relatives (first and second degree) malignant ovarian diseases have been identified, then the probability in the next generation increases proportionally. Moreover, some “familial cancers” have been identified, including localization in the ovaries. Particular attention is paid to the BRCA-1 and 2 genes, the presence of which in the genome sharply increases the likelihood of malignant tumors of the ovaries and mammary glands. Age.
- Most often, neoplasms appear after 40 years; the older the woman, the greater the likelihood. But there is a separate category of malignant ovarian tumors, which is typical only for young girls (for example, germ cell tumors). Infertility, as well as numerous attempts at IVF, increase the risk of getting sick.
- Also, any gynecological pathology (various types of dysfunction, chronic inflammatory processes, and others) slightly increases the likelihood of malignant tumors of the genital organs.
Patients are also interested in the topic of whether it can be malignant. Of course, but only a histologist can confirm the nature of the formation after removing the structure.
Signs and symptoms
Malignant ovarian tumors may not manifest themselves at all for a long time, this is the whole problem of diseases.
It is not always possible to suspect a disease even during a routine gynecological examination, since the size of the tumor can be no more than 1 cm.
The more pronounced the clinical picture, the higher the stage of ovarian malignancy.
- The most common symptoms include the following:
- Pain in the lower abdomen. They can be constant or periodic, sharp or aching. They can also be localized both in the lower abdomen and in the sacrum and lumbar region. Sometimes there is a feeling of fullness in this area. When a tumor ruptures or torsion, corresponding symptoms arise - acute, increasing pain in the lower abdomen.
- Signs of intoxication are noted: weakness, lethargy, increased fatigue, weight loss.
- When adjacent organs are involved in the process, symptoms of their dysfunction appear, for example, constipation or frequent loose stools, constant urge to urinate, etc.
- If ascites (effusion in the abdominal cavity) appears, the woman notices an enlargement of the abdomen, and her usual clothes become tight.
If these are hormonally active tumors, the clinical picture depends on what they produce. So, if estrogens, women notice “rejuvenation”, then wrinkles go away, skin tone appears, libido increases, and breasts swell. If there are androgens, then the mammary glands become smaller, hair grows excessively in the area of the lower lip and chin, the white line of the abdomen, and the inner thighs.
Types of tumors
- The classification of malignant ovarian tumors is based on their location, degree of differentiation, and predominant tissue. The following types can be distinguished:
- Neoplasms only from epithelial tissue. Among them there are mucinous, serous, endometrioid, clear cell and squamous cell cancer, mixed and undifferentiated tumors.
- Formed from epithelial and stromal components.
- Neoplasms of the sex cord stroma. Among them are granulosa cell, theca cell and androblastoma.
- Germ cell neoplasms: malignant teratoma, embryonal carcinoma, dysgerminoma, choriocarcinoma and mixed types.
It is possible to confirm a particular type of tumor only after histological examination. It is rare to guess a variety based on appearance or some other characteristics.
Stages
Correct staging of the disease is extremely important. This affects treatment tactics, further prognosis and other aspects of management of women with similar diseases.
The name of the stage always contains three Latin letters:
- T – indicates tumor size;
- N – indicates damage to nearby lymph nodes;
- M – corresponds to the number of distant metastases.
Next to each letter there is also a digital designation - 1, 2, 3. By summing up all the readings, the stage of the disease is formed.
Based on the size of the malignant ovarian cyst (tumor), the following are distinguished:
- T0 – if the primary focus is not determined. This also happens when metastases are found without an underlying tumor.
- T1 – if the lesion does not extend beyond the ovaries.
- T2 – the process extends to the parametrium.
- T3 – the tumor also invades other structures of the pelvis (rectum, bladder, etc.).
If nearby lymph nodes are not affected, then N0 is indicated. In the case when a tumor is detected in them - N1. If there is not enough data to reliably judge this, then “x” is indicated in the index position.
The grades with distant metastases are distributed in a similar way: 0 – there are none, 1 – there are, X – unknown.
In the formulation of the diagnosis, you can see a designation similar to the following: for example, T 1 N 1 M 0, etc.
This classification has parallels with the classical stages. In general terms they can be represented as follows:
- Stage 1 – the tumor affects only the ovaries;
- Stage 2 – the process extends to the pelvic area;
- Stage 3 – there is a tumor and its screenings located nearby;
- Stage 4 – with distant metastases and if ascites is associated.
Watch the video about the disease:
Diagnostics
It is not always possible to suspect signs of a malignant ovarian tumor.
But if a woman regularly undergoes gynecological examinations and follows all doctors’ recommendations, the likelihood that she will be diagnosed with cancer at an early stage is high.
- General examination in mirrors, bimanual, as well as rectovaginal examination (through the rectum). In this case, it is possible to detect damage to the parametria, tumors of at least 2 - 3 cm.
- If necessary, diagnostic curettage of the uterine cavity and cervical canal is performed, as well as puncture of the abdominal cavity through the posterior vaginal fornix. In this case, atypical cells suspicious for cancer can be identified.
- , even small formations can be detected.
- Proteins specific for tumors of different localizations also help in diagnosis. Their increase directly increases the risk of a malignant process. As for the ovaries, these are CA-125, HE-4, alphafetoprotein, ROMA index, beta-hCG and some others.
- Also, a doctor may suspect a tumor even after undergoing a general blood test or biochemical study.
If a neoplasm is diagnosed, the following examinations are performed to determine the extent of the process:
- ultrasound examination of the abdominal cavity for the presence of distant metastases;
- CT or ;
- examination of the gastrointestinal tract and FGDS;
- If enlarged lymph nodes are detected, their biopsy is performed.
Treatment
In case of complete confirmation of a malignant ovarian tumor, treatment depends entirely on the stage of the disease. The following main directions are distinguished:
| Treatment method | Carrying out |
| Surgery | Most often, not only the tumor itself is removed, but also the uterus and appendages, as well as the peritoneum, lymph nodes and some other elements. Only in exceptional cases in young and nulliparous women is it possible to preserve reproductive organs in order to realize maternal potential. And even in such situations, in the future, after childbirth, it is recommended to remove the uterus and all associated structures. Most often, surgery is combined with other types of treatment: chemotherapy, radiation. Moreover, such an intervention can be either a primary stage or performed after courses of drug therapy. |
| Chemotherapy | It is selected taking into account the sensitivity of the tumor to drugs. This treatment has many side effects: nausea, vomiting, hair loss, immune suppression and many others. Therefore, the most effective, but at the same time gentle methods are always chosen. Platinum-based drugs are often used. |
| Radiation therapy | It is based on the impact of various types of waves on the pelvic organs. In this case, special conductors are often used in order to act as closely as possible on tumor tissues, while minimally damaging healthy ones. Such treatment also has its undesirable consequences in the form of long-term non-healing ulcers, rough scars, etc. |
In case of relapse (the appearance of metastases in other organs and structures), additional treatment, correction of the basic regimen, or even more radical methods are indicated.
Forecast
The prognosis for detecting a malignant ovarian cyst largely depends on the treatment performed. The earlier a tumor is detected, the higher the percentage of favorable outcomes for women.
- On average, the statistics look like this:
- if the disease is detected at the first stage, the five-year survival rate is 75 - 90%;
- with the second – 55 – 80%;
- with the third - 25 - 40%;
with the fourth – about 10%.
Based on this, it is extremely important to detect ovarian tumors in the early stages, which is not always possible for this location.
Prevention
- The basis of prevention is identifying risk groups among women and carefully monitoring their health. The main recommendations will be as follows:
- Regular examinations by both a gynecologist and a therapist to identify symptoms of a malignant ovarian cyst. An ultrasound examination of the pelvic organs is indicated.
- It should also be remembered that pregnancy and lactation due to the physiological absence of ovulation reduce the risk of cancer of the reproductive system.
- Women who have used stimulation for follicle maturation throughout their life (during IVF, etc.) should continue to take oral contraceptives. There is a large evidence base that confirms the reduction of risks when using them.
If you have a family history of ovarian or breast cancer, or if you have multiple cancers, you should be tested to detect certain genes, such as BRCA-1 and 2.