Both in the past and in the present early diagnosis of ovarian cancer (RY) is a difficult task. Despite the fact that recently the survival rate for this disease has increased slightly, the prognosis is still unsatisfactory. Now they are considering a preventive ovariectomy in women who do not plan to have children anymore, especially during surgical interventions for benign ovarian diseases.
Ovarian cancer (RYA) occurs in 1-2% of women. The risk of a tumor increases after 40 years, the peak incidence occurs at 55-60 years, it closely correlates with the age of menopause in Western countries. It is possible that changes in the concentration of go-nadotropins or other factors associated with menopause, under certain conditions, trigger the carcinogenesis process. But there is no scientific evidence on this subject.
The ovary produces eggs and serves as the main synthesis site. estrogen. After the end of the reproductive period, only the function of hormone synthesis remains. The adverse effects of ovariectomy on some metabolic parameters are well known. Over the past decade, a lot of information has been accumulated on the characteristics of the endocrine status, sexuality and psychology of women during the postmenopausal period (natural or surgical), effective methods have been developed for adequate replacement of ovarian function.
In 1981 Grundsell et al. investigated the frequency of any previous operations on the pelvic organs in 352 women with ovarian cancer (RV): 21 (6%) patients underwent surgery, and 16 (4.6%) women over the age of 40 years. Other researchers (Bloom, Gibbs, Grogan, Kpfler, and Terz) have similar results.
Ovarian cancer incidence and onset of natural menopause
According to Mckenzie, Christ and Paloucek, 3.6% of women who underwent surgery on the pelvic organs with preservation of ovarian tissue will have another operation for benign ovarian neoplasms, which will be a weighty argument in favor of preventive ovariectomy.
When analyzing data from a national survey, 12,316 cases ovarian cancer (RYA) Averette and Nguyen found that 18.2% of women had previously had a hysterectomy with ovarian preservation. Abdominal access was used in 7.2% of cases, vaginal access in 4.2%, there were no indications in 6.8%. Further Boike et al. reported that 57.4% of hysterectomies were performed in patients over the age of 40. Thus, the implementation of preventive ovariectomy during operations in this group of women would prevent the occurrence of 1286 cases of ovarian cancer (RV).
Given the annual occurrence of 24,000 new episodes ovarian cancer (RYA), including in 5-14% of cases after hysterectomy with preservation of the ovaries, preventive ovariectomy in patients older than 40 years would reduce the incidence of at least 1000 cases.
We cannot but worry about the fact of frequent identification ovarian cancer (RYA) in advanced stages of the disease. Establishing such a diagnosis in a woman who underwent surgery on the pelvic organs while preserving the ovaries is an unpleasant event. According to Randall et al., Unilateral ovariectomy does not affect the subsequent incidence of ovarian cancer (OV).
All patients who prophylactic oophorectomy is indicatedshould get full information about the advantages and disadvantages of this method. A woman must decide on her own, without excessive pressure from the doctor. The issue of future fertility should be addressed. The patient needs to receive truthful answers to questions about appearance, libido and other psychosexual problems. We believe that when planning genital surgery, preventive ovariectomy should be offered to all women during perimenopause (age 40-50 years).
Causes of the disease
To date, scientists have not been able to establish the exact cause of ovarian cancer. Among the possible causes is a genetic factor. According to scientists, “by inheritance” this insidious disease is transmitted in 50% of cases. Another important factor in the development of oncology is the hormonal changes that affect the female body. That is why the peak incidence occurs in the menopause and postmenopausal period.
At the same time, doctors note that women who have given birth are less susceptible to this disease. The use of birth control pills also reduces the likelihood of developing ovarian cancer.
Statistics show that women who have previously experienced breast cancer are more likely to suffer from this disease. In such women, the likelihood of ovarian oncology increases by 2 times!
It is noted that this type of oncology is most common in developed countries. Cancer can provoke eating foods high in protein. Not the last factor is the pollution of the atmosphere with carcinogens. Is it because ovarian cancer is more often found in residents of large cities?
How to check yourself
- Go to the website zhigiluchsvet.rf - there you will see a test of seven questions.
- Answer the questions.
- According to the test results, get a preliminary result: do you have an increased risk of developing hereditary ovarian cancer.
- If so, sign up for a FREE molecular genetic examination to detect BRCA1,2 gene mutations.
If the results of genetic tests confirm the presence of mutations and a high risk of developing ovarian cancer, you can get a consultation at the Medical Genetic Research Center. True, face-to-face consultation and further examinations are so far available only to residents of Moscow and Tomsk - where are these centers. The rest (the program is available in 50 cities of Russia) will be offered brochures with the recommendations of experts from the Russian Society of Clinical Oncology.
Why is it necessary
If you have a mutation in the BRCA gene, this does not mean that you have ovarian cancer. But this means that you have a higher risk of encountering it than 85% of other women. It is also important that the cancer treatment protocol in the presence of a mutation is significantly different from that in the absence of a mutation.
It is interesting that in Russia, the analysis for mutations in the BRCA gene is cheaper than in many other countries. The fact is that it is possible to carry out complete gene sequencing - and it is really expensive. And you can explore the specific "segments" responsible for the development of hereditary diseases. So, in Russia there are only eight defects that are “guilty” of most oncological problems: seven in the BRCA 1 gene and one in BRCA 2. They are checked. Therefore, the average diagnostic price, even in paid laboratories, is 5,000 rubles.
A genetic analysis is done once in a lifetime; it does not need to be repeated annually: you are warned once and for all. But the question of what to do with this knowledge remains open. In the United States (is it still up to date on the history of Angelina Jolie?), Ovariectomy is provided for such cases - removal of healthy ovaries before the first cancer cells are detected. No body - no problem ... It seems to be.
But ovarian removal is not just infertility, it is premature menopause and all the diseases associated with it. In addition, if you seriously delved into all the plots associated with the pink ribbons, then you know that a mutation in the same BRCA gene is responsible for “hereditary” breast cancer. As it turned out, pancreatic cancer is also associated with BRCA breakdowns. You can’t delete everything preventively ...
Types of Ovarian Cancer
Ovarian cancer is a malignant tumor that occurs in the tissues of the ovaries. As you know, the ovaries are a paired organ that is located on both sides of the pelvis and is responsible for the production of "female" hormones - estrogen and progesterone. Outside, the ovaries are covered with a layer of epithelial cells, which most often degenerate into malignant. Given the specifics, this cancer can be divided into three types: primary, secondary and metastatic cancer.
This lesion appears on both ovaries and is characterized by compaction and tuberosity of the endometrial tissues. Such a tumor rarely reaches a significant size, and doctors can detect a glandular structure with patches of squamous epithelium. As a rule, such a lesion is more common in young women under the age of 30.
This type of oncology appears in the case when benign cystic tumors are converted to malignant. A feature of this type of cancer can be large tumor sizes, with the presence of internal contents in the form of a mucous structure. As a rule, pathogenic changes are more often affected by papillomas and serous cystomas. As for the age of women prone to secondary ovarian cancer, more often patients aged 40-60 face this ailment.
Such an oncological tumor is considered the most dangerous, because it arises as a result of the entry into the ovaries of malignant cells from the affected neighboring organs (usually from the stomach). Cancer cells through the blood and lymph enter the ovaries, where cancer also forms. Moreover, this disease is characterized by rapid development and scattering of metastases in the peritoneum of the pelvis.
Symptoms of Ovarian Cancer
One of the reasons for the late diagnosis of such an oncological tumor is the presence of nonspecific symptoms, which can be taken for the manifestation of other diseases.
For example, quite often, ovarian oncology is mistaken for digestive tract diseases. The fact is that the development of the tumor is accompanied by poor appetite, bloating, a feeling of fullness of the stomach, increased gas formation, pain in the abdomen radiating to the lower back, a constant feeling of nausea and diarrhea.
In addition, the symptoms of ovarian cancer often resemble problems with the genitourinary system. In this case, when contacting a doctor, a woman may complain of urging to urinate immediately, discomfort in the pelvis and pain in intimacy.
Other symptoms of this disease include a menstrual cycle disorder, a sudden change in body weight, and perhaps the most obvious symptom of an ailment - an enlarged stomach. This anomaly occurs at the moment when the tumor penetrates into the abdominal cavity and fluid accumulates in the abdomen.
We also add that with some types of tumors in the body of a woman, the hormone estrogen begins to be produced intensively, as a result of which she begins to experience increased sex drive and looks younger in her eyes. On the contrary, if male hormones begin to be produced due to the tumor, the woman begins to have breast atrophy and develop hirsutism (male-type hair growth).
Diagnosis of the disease
As noted above, the weak point in the fight against this insidious disease is the late detection of a malignant tumor in the ovaries. The fact is that at the early stage the presence of this disease does not show preventive examinations and blood tests. Responding to misleading symptoms and attempts to treat the gastrointestinal tract or genitourinary system only delay the moment the tumor is detected. True, in fairness it should be noted that such treatment does not produce results, the symptoms in the stomach and lower abdomen only intensify, which suggests the presence of another problem and leads the patient to the decision to examine the body in detail.
The presence of small tumors allows you to detect magnetic resonance imaging, CT or ultrasound. At later stages, the tumor and metastases can be seen during gynecological examination. In any case, a patient with a suspected ovarian cancer is taken a blood test. There is also a special analysis that identifies tumor markers. It is noted that in the presence of this tumor, the patient has an increase in CA-125 protein, fetoprotein and gonadotropin. If necessary, specialists take ovarian puncture.
In the fight against ovarian cancer, there are two main areas:
- surgical removal of the ovaries, uterus, fallopian tubes and omentum,
- chemotherapy with drugs that destroy cancer cells.
The method of combating the disease is chosen solely by the oncologist, based on the stage of the disease and the spread of malignant cells. However, given the frequent recurrence of the tumor after chemotherapy, most doctors are inclined towards an operative treatment method.
Before the operation, an express biopsy is mandatory. She helps to choose the tactics of further treatment. For example, the strong spread of malignant cells implies chemotherapy and only then surgery.
In addition to preventing metastasis, chemotherapy can be used to remove small foci and residual cells on organs that have not been excised, as well as to stop the development of the tumor and prolong the patient's life, in the late stages of the disease. This procedure is also mandatory after the operation to remove the ovaries.
Recently, the radiosurgical method has been widely used to treat ovarian cancer, in which a high-power ionizing ray acts on a malignant neoplasm. In this case, it is possible to achieve the exact impact and destruction of the tumor without affecting neighboring organs. In addition, during such an operation, anesthesia is almost never used, since patients tolerate the effects of ionizing rays.
Ovarian Cancer Prevention
The preventive measures to prevent these malignant tumors include the use of oral contraception, as well as pregnancy and the natural feeding of the baby.
In addition, doctors recommend avoiding unprotected sex and undergo a timely examination by a gynecologist, with an ultrasound scan, in order to identify and treat infectious diseases in time. If the examination shows the presence of benign tumors, they must be removed.
The detection of ovarian oncology at an early stage in 80% of cases allows you to save the patient's life for 5 years or more. However, for this it is important that the malignant cells do not go beyond the ovary. When metastases spread outside the pelvis and are found in neighboring organs, the probability of living for 5 years is reduced to 30%. The cause of death, as a rule, is severe exhaustion, intestinal obstruction, or fluid accumulation in the abdominal cavity. Take care of yourself and do not forget about regular visits to the gynecologist!