Get detailed information about the symptoms of ovarian tumors

• Factors that are associated with a low risk of developing ovarian cancer
• Symptoms of ovarian cancer
• Diagnosis of ovarian cancer
• Ovarian cancer treatment
• Surgical treatment of ovarian cancer
• Systemic drug treatment (chemotherapy) for ovarian cancer
• Monitoring of patients with ovarian cancer
• Prices at Euroonko for treatment of ovarian cancer

The etiology of the development of ovarian tumors, as for most human tumors, is completely unknown. But there are certain risk factors for developing this disease in women:

• Up to 10% of ovarian cancer cases are familial. The risk of ovarian cancer is increased if you have a relative with breast or ovarian cancer, especially if diagnosed during childbearing years. Genetic predisposition in women who carry BRCA1 or BRCA2 gene mutations. Therefore, if a genetic predisposition to the development of breast or ovarian tumors is suspected, a genetic examination is performed to determine the presence/absence of mutations in the BRCA1 or BRCA2 genes.
• Early onset of menarche and late onset of menopause are also thought to increase the risk of developing ovarian cancer.

Symptoms of ovarian cancer

The insidiousness of ovarian cancer is that in the early stages it is asymptomatic, or the symptoms are minor and patients do not pay attention to them. Most often, the first signs of ovarian cancer are detected when the process is already at stages 3-4.

The most common symptoms are:

• Pain in the lower abdomen. Usually this is a mild or nagging pain, often one-sided, which goes away on its own for quite a long time.
• Feeling of heaviness in the lower abdomen.
• An increase in the volume of the abdomen, the appearance of areas of “hardening” in it.
• Impaired urination and difficulty in bowel movements. This is due to the pressure of tumor masses on the wall of the bladder or rectum. Because of this, there is a frequent urge to urinate, constipation, a feeling of incomplete emptying of the bladder or intestines, and bloating.
• Metastasis of the tumor through the peritoneum leads to the development of ascites (accumulation of fluid in the abdominal cavity), which is accompanied by an increase in abdominal volume, general deterioration of health, shortness of breath, inability to eat or a feeling of fullness from a small amount of food.
• In the last stages, general symptoms characteristic of a malignant process appear - weight loss, even cachexia (exhaustion), deterioration of general condition, severe weakness, etc.

Stages

Today there are 4 stages of ovarian cancer:

Diagnosis of ovarian cancer

Transvaginal ultrasound (trusound) and determination of the CA 125 marker in blood serum are used as diagnostic methods. The combination of these two methods has high specificity for diagnosing ovarian cancer.

Additional research methods such as magnetic resonance imaging (MRI) or positron emission tomography (PET) can provide additional information, but are not necessary studies in routine practice during preoperative preparation. If the results of TRUS are questionable, the use of MRI can help us in correctly diagnosing ovarian tumors (malignant/benign tumor). The final diagnosis of ovarian cancer is made only after a morphological (examination of cellular/tissue composition) examination.

CA 125 (carbohydrate antigen 125) is the main marker of ovarian cancer. Normal levels in blood serum are up to 35 IU/ml. In most cases of ovarian cancer, its concentration increases 5 times or more. The concentration of CA 125 in the blood serum can also increase in various non-tumor diseases: inflammatory changes in the abdominal cavity, pelvis, menstruation, benign tumors of the female reproductive system (ovarian cysts). However, in most of these cases, the concentration of CA 125 in the blood serum does not exceed 100 IU/ml.

ICD 10 code

Ovarian tumor ICD 10 is coded C56 - malignant neoplasms of the female genital organs (C51-C58), including malignant neoplasms of the skin of the female genital organs:

• Malignant neoplasms of the vulva – C51.
• Malignant neoplasms of the vagina – C52.
• Malignant neoplasm of the cervix – C53.
• Malignant neoplasm of the uterine body – C54.
• Malignant neoplasm of the uterus of unspecified localization – C55.
• Malignant neoplasm of the ovaries C56.
• Malignant neoplasm of unspecified other female genital organs – C57.
• Malignant neoplasm of the placenta – C58. Includes chorionic carcinoma NOS, chorionepithelioma NOS.

Malignant neoplasms of the ovary C56 – ovarian tumors, germinomas, various syndromes. ICD 10 codes are an international classification of diseases that contain coded medical diagnoses. ICD 10 codes are used when filling out medical documents - they briefly describe information about the patient’s diseases. There is also a classification according to the stages of ovarian cancer:

• T0 – no tumor detected.
• Tx – assessment data for the primary tumor is insufficient.
• T1 – the tumor has not spread beyond the ovaries.
• T1a – one ovary is affected, there is no tumor growth on the surface of the organ, the capsule is not affected.
• T1b – the tumor has affected both ovaries, has not spread beyond the ovaries, there is no tumor growth on the surface of the ovaries, the capsules are not damaged.
• T1c – tumor growth is observed on the surface of one or two ovaries, the capsule is damaged, and malignant cells are present in the ascitic fluid.
• T2 – one or both ovaries are affected, the walls and organs of the small pelvis are involved in the malignant process.
• T2a – the malignant tumor has grown or metastasized into the fallopian tubes.
• T2b – the malignant tumor has spread to other tissues of the pelvis.
• T2c – the tumor is limited to the pelvis, malignant cells were found in the ascitic fluid.
• T3 – one or both ovaries are affected, metastases are found in regional lymph nodes and/or outside the pelvis.
• T3a – confirmed intraperitoneal metastases outside the pelvis.
• T3b – intraperitoneal metastases are confirmed outside the pelvis and no more than 2 cm in size.
• T3c – confirmed intraperitoneal metastases outside the pelvis and larger than 2 cm.
• M1 – distant metastases were detected.

Surgical treatment of ovarian cancer

The goal of surgical treatment is to remove as much of the primary tumor and its metastases as possible. The operation that is preferred for ovarian cancer is extirpation of the uterus and appendages and resection of the greater omentum (i.e. complete removal of the uterus, fallopian tubes and ovaries on both sides). For patients who want to preserve reproductive function, it is possible to perform unilateral removal of the appendages with adequate staging and no changes in the preserved structures.

For ovarian cancer, there is such a thing as cytoreductive surgery, an operation that is performed to reduce the volume of the tumor. It can be optimal (when the volume of the residual tumor does not exceed 1 cm in the greatest dimension) and non-optimal (the volume of the residual tumor is more than 1 cm). For patients who did not undergo maximum cytoreduction at the first stage, it is possible to perform an intermediate cytoreductive operation if there are positive dynamics or stabilization during chemotherapy.

Make an appointment with an oncologist-gynecologist

Prevention

Preventing cancer is very difficult, but there are methods that can reduce the risk of developing it. For example, if a BRCA gene mutation is detected, a prophylactic oophorectomy (removal of the ovaries) can be performed.

Since the risk of cancer directly depends on the number of ovulations (the earlier menarche occurs, and menopause later, the fewer pregnancies a woman has had, the more ovulations that occur in her lifetime), it is assumed that the use of combined oral contraceptives, which stop ovulation for the duration of their use, reduces risk of developing ovarian cancer.

Systemic drug treatment (chemotherapy) for ovarian cancer

For ovarian cancer, different chemotherapy options can be used depending on the stage of the disease.

Neoadjuvant chemotherapy is preoperative chemotherapy for patients who cannot undergo surgical treatment at the first stage. When the desired effect is achieved, the patient subsequently undergoes surgical treatment.

Adjuvant chemotherapy is postoperative chemotherapy, carried out in the postoperative period in patients depending on the stage of the disease; in the early stages it is carried out in patients with intermediate and high risk (determined by the attending oncologist depending on certain characteristics).

Curative chemotherapy is carried out in the case of initially widespread disease or the presence of relapse of the disease.

When the disease relapses after previously administered platinum-based chemotherapy, attention is paid to the time from the end of treatment until the relapse occurs. If less than 6 months have passed since the end of chemotherapy or a relapse occurred during chemotherapy, the tumor is considered not sensitive to platinum drugs (platinum-resistant), and these drugs are not used in further treatment. Chemotherapy for patients with platinum-resistant disease is usually characterized by low antitumor effect and short life expectancy.

If 6 months or more have passed, the tumor is sensitive to platinum drugs (platinum-sensitive). With the development of a stable and long-term effect after platinum-containing chemotherapy, there is a high probability of a repeated response to treatment regimens with platinum derivatives.

As first-line therapy (i.e., what is used first), in the absence of contraindications, combinations based on platinum drugs are used, for example, paclitaxel at a dose of 175 mg/m2 with carboplatin AUC6 every 3 weeks for 6 courses of treatment. Carboplatin can also be combined with gemcitabine, docetaxel, liposomal doxorubicin, but in accordance with European recommendations, the combination of carboplatin with paclitaxel is in first place in terms of evidence.

Recovery after treatment

With a normal rehabilitation period, complete recovery after treatment for ovarian cancer takes up to 6 weeks for women. If the uterus has been removed, you must stop having sex for 3-4 weeks. In some cases, your doctor may prescribe hormonal medications and vitamin D.

If you need a second opinion to clarify your diagnosis or treatment plan, send us an application and documents for consultation, or schedule an in-person consultation by phone.

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Expert opinion

Prices at Euroonko for treatment of ovarian cancer

• Consultation with an oncologist— RUB 5,100.
• Consultation with a chemotherapist— 6,900 .
• Ovarian resection - 62,900 rubles.
• Ovariectomy— 116,600 .
• Wertheim's operation - 247,500 rubles.
• Immunotherapy (without the cost of medications) - 19,000 rubles.

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Risk factors for ovarian tumors

Scientists around the world are working to determine the causes of ovarian tumors. So far, a clear answer to this question has not been found.

Just a few theories are mentioned:

• hormonal;
• viral;
• genetic.

In the case of benign formations, risk factors include:

• 
  increased production of estrogen (hyperestrogenism), which promotes excessive cell proliferation and pathological tissue proliferation;

• disorders in the embryonic period of development (tumors of the sex cord, germ cell formations);
• high infection index;
• premorbid background (a condition that precedes the disease and weakens the body);
• later menarche;
• impaired menstrual function;
• early onset of menopause;
• frequent inflammation of the appendages and ovaries;
• uterine fibroids;
• primary infertility;
• abortions.

A relationship between the formation of benign ovarian tumors and hereditary endocrine diseases has been revealed:

• thyroid diseases;
• diabetes;
• human papillomavirus;
• herpes virus type 2.

Risk factors in the case of malignant tumors are as follows:

• hormonal imbalance, which significantly disrupts the menstrual cycle;
• heredity factor (if there is a family history of ovarian cancer, then the risks that a woman will need treatment for ovarian tumors abroad increase);
• climatic age;
• taking medications that stimulate the ovulation process in large quantities, as well as without medical supervision;
• weak immune functions;
• frequent inflammatory processes of the reproductive organs;
• inattention to one’s health (refusal from regular preventive examinations and timely treatment of diseases);
• harmful working conditions;
• smoking.