Swollen ovaries. Ovarian neoplasm: causes, symptoms, diagnostic tests and treatment. Symptoms of individual tumors

Ovarian neoplasms (a tumor of the right ovary in women, as well as a tumor of the left ovary in women) is a fairly common pathological condition in gynecological practice. It is difficult to find a woman who has never met with a diagnosis of "ovarian tumor" in her life, whether it is benign or has a different histological basis. An ovarian tumor is a volumetric formation that is formed from the tissue of this uterine appendage. Neoplasms are united only by an additional volume that is formed on the ovary. The remaining characteristics of the tumor have a rather diverse palette, both in terms of etiology and pathogenesis, and in terms of histological structure and signs of good quality.

Tumors of the ovaries have a fairly voluminous classification according to their histological structure. However, the most generalized classification can be called the following.

All tumors can be divided into benign (benign ovarian tumor in women) and malignant. Benign neoplasms of the ovary grow slowly, they do not affect adjacent organs, and also do not have the ability to metastatic spread. Gynecology notes that malignant ovarian tumors grow rapidly, have the ability to metastasize, grow into surrounding organs and tissues, and also affect the lymphatic system.

If a benign tumor is diagnosed, then you should not relax and let the problem take its course. This does not mean at all that a benign tumor will not become a significant risk to a woman's health. Benign tumors have a pronounced and confirmed tendency to malignancy.

Hormone-producing neoplasms can also be distinguished among ovarian tumors. They are able to secrete hormones and change the hormonal background of a woman to an unusual physiological one.

Ovarian tumor: dangerous or not, causes

The question of the cause of the formation of both benign and malignant tumors is still open.

1. Among the theories of the occurrence of these processes, one can single out hereditary, which is based on genetic aspects that have the ability to be transmitted from mother or father to a girl.
2. Virus theory, which also takes place in the etiopathogenesis of neoplasms. Viral agents, affecting the ovary, provoke the formation of a tumor.
3. The hormonal cause is also the most commonly used theory in explaining the appearance of this type of neoplasm. The fact that the background of hyperestrogenism, a condition in which an increased amount of estrogen in a woman's body predominates, often causes diffuse or focal hyperplasia, and subsequently the formation of tumors.

Malignant and benign ovarian tumors: clinical guidelines and risk factors

Risk factors for the occurrence of such pathological conditions are:

The prognosis for women who have any ovarian neoplasms is a rather vague question. It all depends on the histological structure of the tumor. After all, the difference between a follicular cyst and a malignant neoplasm is significant.

Ovarian tumor: icb-10 code

In addition to many multifaceted classification of ovarian tumors. Such pathological conditions also have their place in the international classification of diseases of the tenth revision.

C56 is a group that combines malignant tumors of this uterine appendage.

And secondary malignant tumors are encrypted as C79.

Ovarian tumor in women: symptoms and treatment

The clinical picture of an ovarian tumor has a rather diverse palette. Among them, one can single out the main symptoms of an ovarian tumor in women, which characterize the presence of neoplasms in the pelvis.

Only timely seeking medical help will prevent the development of a pathological condition and conduct therapy in the early stages of the disease.

Ovarian tumors: classification, clinic, diagnosis, treatment

Tumors of the ovary are multifaceted and diverse in their histological structure of education, which have many classifications.

There are several forms of ovarian tumor:

• Benign tumors that do not have fast growth dynamics, the lack of the possibility of metastasis. However, no specialist in the field of medicine can guarantee that such formations cannot have malignant degeneration.
• Malignant neoplasms that can grow at lightning speed, grow into organs located in the neighborhood, metastasize through the lymphatic route, affecting more and more organs and systems of the human body.
• Hormone-producing ovarian tumors are those neoplasms that secrete, synthesize steroids that affect all levels of regulation of the ovarian-menstrual cycle, as well as the body as a whole (the so-called hormonally active ovarian tumors).

Benign ovarian tumors: classification

They also divide the classification according to the degree of spread of the pathological focus of the uterine appendage - ovary:

1. stage - the ovarian tumor is localized, limited to only one given organ. Does not apply to adjacent structures.
2. stage - the tumor can move to adjacent organs, involving new structures of the woman's body in the process, violating their anatomy and functional state.
3. stage is characterized by the presence of metastatic foci in the nodes of the lymphatic system.
4. stage is characterized by the presence of metastases in organs and systems.

The most voluminous classification divides the pathological process according to the histological structure

1. Epithelial neoplasm is a group of tumors that are widespread and most commonly encountered.
   • These include a serous tumor, which contains a serous secretion as a content.
   • Mucinous formations containing mucus and having the potential to grow and form large tumors. This type of neoplasm can reach gigantic sizes.
   • Endometrioid neoplasms, which contain blood inside, and are identical in structure to endometrial tissue.
   • Hormone-producing ovarian tumors (epithelial). Tumors that produce female sex steroids for estrogen.
2. Sex cord tumors

Granulosa cell formations, androblastomas, thecomas, all tumors are hormonally active, releasing both estrogens and androgens (male and female sex steroids).

3. Germ cell tumors - a germ cell tumor of the ovary in girls.



These include dysgerminoma, which worries girls at a very young age, an ovarian teratoma tumor, which may contain the rudiments of hair, nails, teeth, and bones.

Malignant ovarian tumors are classified as follows

• Epithelial tumors are papillary, glandular, adenocarcinoma, and solid cancers.
• There is also a borderline serous papillary tumor of the ovary.
• Connective tissue tumors are represented by sarcomas.
• Neoplasms emanating from the cells of the follicle. These include granulosa cell carcinoma, malignant thecablastoma, semioma, which develops from immature germ cells.
• Metastatic ovarian cancer is known as Krukenberg cancer, which spreads from the ovary to the stomach, intestines, gallbladder, and pancreas. Metastatic adenocarcinoma, ovarian cancer that is metastasized from the breast.

Signs of malignancy of a tumor of the ovaries and uterus

Symptoms of malignancy of tumors can be the appearance of a rapid growth rate of neoplasms, the appearance of pain symptoms with severe pain, dysfunction of adjacent organs, the appearance of complaints from other organs and systems that did not previously bother the woman. Perhaps the appearance of weakness, fatigue, loss of appetite, weight loss.

Ovarian tumor in women: forecasts

Ovarian neoplasms are so diverse that the prognosis for women with different types of tumors varies quite a bit.

Benign neoplasms need surgical and medical correction, and after it they pose no threats.
However, neoplasms left to chance have every chance of developing into a malignant tumor.

Malignant e neoplasms are dangerous at any stage, and the sooner measures are taken to treat them, the more favorable the prognosis will be for such a patient. Relapses, that is, the resumption of the appearance of malignant neoplasms, are observed more often in those patients who have been treated at a later stage. Therefore, it is so important to identify the pathological process at the early stages of its occurrence and development in order to take the necessary measures to eliminate it.

It is for the early identification of such processes of the reproductive system that preventive examinations are mandatory. Or consultations of gynecologists with the appearance of any pathological symptoms.

In order to identify the pathological process, the following diagnostic measures are used:

• Gynecological examination, both in the mirrors and bimanual, and if necessary - rectovaginal.
• Ultrasound diagnostics of the pelvic organs and abdominal cavity.
• Gastroscopy to rule out metastasis of ovarian cancer.
• Magnetic resonance or computed tomography.
• Blood tests for the level of tumor markers.

If other organs are suspected to be involved in the process, narrow specialists may be involved, who prescribe an additional amount of necessary diagnostic measures.

Video: Ovarian tumors in young people

Content

Ovarian tumors are detected in a significant number of women during gynecological examinations. Their detection requires close attention from the patient and the specialist.

Symptoms of an ovarian tumor in women

Tumors and tumor-like formations of the ovaries are often found in gynecological practice. The clinical picture does not depend on whether the neoplasm is benign or malignant. Signs include:

• minor pain in the lower abdomen, usually unilateral localization;
• subjective feeling of heaviness;
• infertility;
• disorder of menstrual function;
• false urge to urinate;
• an increase in the size of the abdomen due to defecation disorders and flatulence.

The intensity of the signs increases with an increase in the size of the formation. With hormone-dependent neoplasms, the following symptoms may occur:

• disappearance of menstruation;
• an increase in the size of the clitoris and mammary glands;
• acne;
• hirsutism;
• Itsenko-Cushing's syndrome.

The clinical picture of malignant seals implies:

• effusion in the abdominal cavity;
• anemia
• weakness;
• shortness of breath
• symptoms of intestinal obstruction.

With some formations, torsion of the legs is possible, which can be either partial or complete. Signs are associated with the presence of vessels, nerves, wide uterine ligament, tubes and peritoneal area:

• unilateral pain of varying intensity;
• vomiting or nausea;
• dysuric phenomena, bloating;
• cold sweat and pallor;
• temperature increase.

Partial torsion is characterized by mild symptoms. An ovarian tumor in women has common symptoms of menopause.

general characteristics

A tumor of the ovary according to the ICD is an excessive proliferation of cellular elements of tissues that are pathologically altered. True ovarian tumors are volumetric formations. There are also tumor-like neoplasms. They appear due to the accumulation of fluid in the ovary (retention).

Comment. In the structure of gynecological diseases, a benign neoplasm of the ovary is about 8%.

Gynecologists distinguish between benign and malignant seals. However, this differentiation is considered conditional. Benign formations tend to turn into malignant ones under certain conditions.

Benign ovarian tumors

A separate membrane is noted, which limits the tumor of the appendage in women from neighboring tissues. However, as they grow, such formations can lead to compression and disrupt the functions of organs located in the immediate vicinity.

Benign seals in their structure resemble healthy tissue. They are not prone to metastasis and do not destroy the ovaries. That is why after removal comes a complete recovery.

Benign seals:

• occur at any age;
• are in second place in terms of prevalence;
• negatively affect reproductive function;
• differ in the risk of malignancy;
• are difficult to classify.

Borderline ovarian tumors in women

Border formations include the following varieties:

• mucinous or mucous;
• serous;
• endometrioid;
• mixed;
• Brenner's neoplasm.

After the removal of borderline varieties, their recurrence is possible. Seals are characterized by a low degree of malignancy and are detected mainly in young women (in the early stages). Infertility is detected in 30% of cases.

Malignant tumors of the ovaries

Tumors that are malignant do not have a shell. They are characterized by rapid growth, as well as the possibility of germination in neighboring tissues, which causes their damage. In addition, cancer cells can enter both the blood and lymphatic vessels and spread to other organs. Tumor growth leads to metastasis.

The histological structure of malignant tumors differs from benign ones. Different stages of malignant cell division are also expressed histologically. A feature of cancerous structures is the lack of differentiation.

At the initial stages, malignant tumors are completely curable. Sometimes there are tumors of the ovaries in girls.

Ovarian tumors: classification

There are several types of ovarian tumors that can have different prognosis and different treatment tactics.

Epithelial ovarian tumors

This type is the most common and accounts for about 70% of all ovarian formations. In 10-15% of cases, malignant degeneration is noted.

A benign neoplasm of the ovary develops from the stroma and epithelium (superficial). It is usually characterized by unilateral localization and painlessness on palpation. Complications include torsion of the leg, hemorrhage, rupture of the capsule, which causes intense pain.

Sex cord stromal tumors

This species has an embryonic etiology and pathogenesis. Diagnosis occurs in the process of ultrasound.

Sertoli and Leydig cell tumors

A neoplasm on the ovary in women is a rare variety, and can be detected in representatives of different age groups.

germ cell tumors

Formations of this variety include dermoid cysts and teratomas.

Tumors of the ovaries

There are so-called tumor-like formations that develop in the ovaries:

• Follicular cysts. Typical for women in the reproductive cycle. The size is up to 10 cm. The follicular cyst is not dangerous, since it does not degenerate into a malignant neoplasm. Symptoms of cysts include menstrual irregularities, bleeding. In most cases, a benign tumor-like formation regresses on its own within several cycles. Otherwise, torsion of the leg and subsequent surgical intervention is possible.
• Luteal cyst (yellow body). The volume of the neoplasm can reach 6 cm. Cysts have different densities, differ in the presence of clots and septa. The clinical picture includes delayed menstruation, breast engorgement. Of the complications, there is a violation of the integrity of the cyst, for example, with intimacy.
• Serous (simple) cyst. According to some experts, there is a possibility of a rebirth of education. Its size is 5-10 cm. Symptoms are usually absent. Pathology is detected in the process of performing an ultrasound examination.

Causes of tumors

Seal on the ovary in women is formed due to viral, genetic and hormonal factors. Some types of tumors arise due to intrauterine disorders.

The risk group includes women who have a violation of hormonal function, infertility, frequent infectious processes. Benign tumors are often associated with diabetes mellitus, thyroid pathologies, HPV and herpes. Hormonal ovarian tumor requires specific therapy.

Diagnosis of an ovarian tumor

It is possible to determine neoplasms in the ovarian region during a gynecological examination. Formations can have both right-sided and left-sided localization.

Diagnostics is supplemented:

• ultrasound examination of the pelvic organs;
• MRI and CT;
• analysis to determine the level of oncomarker CA-125.

In some cases, it may be necessary to perform laparoscopy followed by histological diagnosis.

Ovarian tumor in women: treatment

There are several basic treatment tactics, the choice of which depends on the type of seal and its size.

Surgical removal of an ovarian tumor

The extent of the operation depends on whether the mass is benign or malignant. Cancerous neoplasms are eliminated during extirpation (of the uterus and appendages). Laparotomy is recommended.

Benign seals are removed during laparoscopy. The expediency of intervention depends on the results of histological diagnosis.

The volume of operations for benign neoplasms in women in the reproductive cycle is minimal, which is associated with the need to preserve reproductive function. When the pedicle of the cyst is twisted, the operation is urgent.

Medical

Conservative treatment is possible for cysts in which there is a hormonal imbalance. Functional and luteal cysts are subject to observation. In the absence of regression, surgical intervention is performed. If necessary, operations are supplemented with hormone therapy (endometrioid neoplasms).

Conservative antibiotic treatment is mandatory after operations for the removal of benign and malignant neoplasms. Drug treatment (chemotherapy) is carried out after operations for malignant seals.

Treatment of an ovarian tumor with folk remedies

The use of traditional medicine is ineffective in the treatment of benign and malignant tumors. Some herbs have a hormonal effect and can cause the growth of neoplasms. In this connection, the use of folk remedies is possible as a supportive and prophylactic agent after consulting a doctor. In the complex treatment, the upland uterus, red brush, yarrow are used.

Complications of ovarian tumors

Lack of treatment can lead to serious complications. Some types of benign neoplasms eventually transform into malignant ones. Large formations cause dysuric disorders, flatulence, constipation due to compression of the bladder and intestines.

During intercourse and intense physical activity, torsion of the legs can occur, which is dangerous for intra-abdominal bleeding. In such cases, immediate surgical intervention is required.

Prevention of ovarian tumor

Prevention of the formation of benign and malignant tumors includes timely preventive examinations, treatment of inflammatory diseases. The rejection of abortions, unreasonable surgical interventions is essential. A woman needs to monitor the hormonal background and adhere to monogamous intimate relationships.

Conclusion

Ovarian tumors can be either benign or malignant. Their treatment and prognosis depends on the type of seals, the history of the woman.

Ovarian cancer treatment stage 1, 2, 3. Symptoms, signs, metastases, prognosis.

What are ovarian tumors?

According to the histogenetic principle, ovarian tumors are classified as follows:

1. epithelial tumors;
2. Sex cord stromal tumors;
3. germ cell tumors;
4. Follicular cyst. Yellow cyst. (Tumor-like processes).

Within each class of tumors (except the fourth point) there are benign, borderline and malignant forms.

In addition to the possible malignant degeneration, there is a danger of other complications of ovarian tumors:

1. torsion of the cystoma leg;
2. cyst suppuration;
3. hemorrhage into the cyst;
4. rupture of the cyst membrane.

The decision on the tactics of treatment is made in each case individually, depending on the nature of the ovarian tumor, the age of the woman and the results of a special examination.

What are the most common symptoms of ovarian tumors?

Most often, ovarian tumors occur without symptoms.

• Early and relatively constant symptoms of ovarian tumors (benign and malignant) include pain, sometimes very light, referred to by patients only as "sipping" in the lower abdomen, mostly unilateral.
• Sometimes there is a feeling of heaviness in the lower abdomen, constant or recurrent pain in the abdomen without a specific localization, sometimes in the epigastric region or hypochondrium.
• Pain can stop for more or less long periods of time.
• The disease can manifest itself for the first time with sudden sharp pains as a result of torsion of the tumor stem or rupture of its capsule.
• Among the relatively early but rare symptoms of the disease is a disorder of urination or bowel function as a result of the pressure of even a small ovarian tumor located in front of or behind the uterus.
• The first symptom may be an increase in the abdomen or the appearance of a "hardening" in it.
• With malignant tumors of the ovaries, as well as with malignancy of benign tumors, at first there are usually no pronounced features of a malignant nature.

The most noticeable symptoms, but not early ones, are:

1. deterioration in general condition;
2. fast fatiguability;
3. weight loss.

Pain sensations are more pronounced, bloating is more often noted, especially in the upper section, and saturation from small portions of food, which is due to the large volume of the tumor, the appearance of metastases in the omentum and visceral peritoneum, creating difficulties in the discharge of gases, the accumulation of ascites (fluid in the abdominal cavity ).

As the tumor grows or ascites increases, the abdomen increases, shortness of breath develops. The progression of the tumor is sometimes accompanied by an increase in body temperature.

Thus, the analysis of subjective and objective symptoms of the disease in cases of both early and advanced stages of malignant ovarian tumors showed that the focus on symptoms cannot serve the purpose of early diagnosis, since symptoms characteristic only of the early stages of the disease have not been identified.

How common are benign tumors?

Benign ovarian tumors (BOTs) account for 66.8% to 80.3% of all ovarian neoplasms, which is 4 times higher than the number of malignant neoplasms of these organs.

The most common among DOTs are: germ cell (mature teratoma) and epithelial tumors.

What are the causes of benign ovarian tumors?

The epidemiological factors that determine the spread of tumors of the reproductive system include genetic predisposition, metabolic features caused by the structure of nutrition, including the consumption of vitamins A, C, E.

The nutritional factor affects the change in the hormonal status of women. Food rich in fats and proteins leads to stimulation of the endocrine system, a change in the hormonal balance towards an increase in the content of gonadotropic and steroid hormones of the ovary and, as a result, to a more frequent appearance of neoplasms in hormone-dependent organs. In 36% of patients, various menstrual dysfunctions are noted.

From the extragenital pathology, which is conducive to the occurrence of ovarian tumors (mucinous), it can be noted:

1. obesity;
2. diabetes;
3. thyroid disease.

In the history of patients with benign ovarian tumors, a high frequency of chronic inflammatory processes of the genitals, as well as operations on the pelvic organs and abdominal cavity, was noted.

Late menarche increases the risk of developing benign ovarian tumors. A small risk of benign ovarian tumors is observed with hypomenstrual syndrome and the use of contraceptives.

In addition, risk factors for the occurrence of benign ovarian tumors include:

• lack of sexual life or its irregularity;
• the use of the IUD;
• primary and secondary infertility (after an abortion);
• artificial abortions;
• pathology in childbirth;
• the use of biogenic stimulants;
• diseases of the gastrointestinal tract, liver, kidneys.

How do benign ovarian tumors progress?

Usually benign neoplasms of the ovaries occur in women under 50 years of age.

At the initial stage of the development of the disease, they are asymptomatic. In the future, there are complaints of dull pulling pains in the lower abdomen, lumbar and inguinal regions. As a rule, pain is not associated with menstruation. They arise as a result of irritation and inflammation of the serous integument, irritation of nerve endings, tension of the tumor capsule, and impaired blood supply to the tumor wall. If the tumor stem is twisted and/or ruptured, the pain will be paroxysmal in nature.

Another complaint may be menstrual dysfunction. Complaints of constipation and dysuria, as a rule, appear with large neoplasms. Most often, benign tumors of the ovaries are found on routine examinations, by chance.

Of the benign tumors of the ovaries, dermoid cysts occupy the first place in frequency. They are characterized by inclusions of mature tissues that are not related to the tissues of the reproductive system (bones, cartilage, skin, teeth).

The frequency of malignancy of dermoid cysts does not exceed 2%, while in 75% of cases this occurs over the age of 40 years. The risk of torsion of the tumor stem is 15% due to the high mobility of the neoplasm, which is usually located anterior to the uterus. Both ovaries are affected in 10% of cases. The recommended volume of surgery for dermoid cysts is ovarian resection within healthy tissues.

The risk of epithelial ovarian tumors increases with age. In women younger than 50 years, serous ovarian cystadenomas occupy the second place in frequency (66 and 20%, respectively). Serous cystadenomas are usually multi-chamber, sometimes with papillary growths. Tumor-forming epithelial cells secrete a serous fluid that fills the cavities. Mucinous ovarian tumors are usually multi-chambered, with a smooth capsule, bilateral in 10% of cases and can reach considerable sizes. The contents of the cysts are mucous.

How are benign ovarian tumors diagnosed?

Diagnosis includes bimanual gynecological examination, pelvic ultrasound.

X-ray of the abdominal cavity sometimes suggests the nature of a pelvic volumetric formation: rare scattered calcifications are characteristic of serous tumors, large shadows for a dermoid cyst.

The diagnostic value of CA-125 in benign ovarian tumors is low, since the marker can also increase in other diseases in women of the childbearing period - uterine fibroids, pregnancy, inflammatory diseases of the uterine appendages, endometriosis.

How are benign ovarian tumors treated?

Surgical treatment of patients with benign ovarian tumors. Laparoscopic surgeries are widely used.

What are the characteristics of an ovarian tumor from the sex cord stroma (benign)?

Benign tumors of the ovaries from the stroma of the sex cord include ovarian fibromas. The tumor is usually small in size and may have a diffuse form (the entire ovary is affected) and limited, when the ovarian tissue is partially preserved and the tumor has a pronounced capsule.

Ovarian fibroids are most common in women near or in menopause, but can also occur in younger women.

Fibroma is characterized by slow growth and can develop over 10 years or more. Fibroma is asymptomatic until it reaches a significant size and begins to put pressure on neighboring organs. Fibroma is often accompanied by anemia and ascites may occur.

Treatment is surgical, and in young women it is desirable to limit the removal of only the tumor and preserve childbearing function. The prognosis is favorable.

What are the characteristics of benign epithelial tumors?

Epithelial tumors are the most common of the benign ovarian tumors.

Epithelial tumors are subdivided into celioepithelial (serous) tumors and pseudomucinous tumors.

Celioepithelial serous tumors are formed mainly in elderly women and occur without noticeable symptoms. Treatment is surgical only.

Of all benign ovarian tumors, celioepithelial papillary tumors are the most potentially malignant. Most of these tumors occur in women from 20 to 40 years old, but also occur after 40.

The clinic of papillary tumors is characterized by pain and heaviness in the lower abdomen, in some cases ascites is possible. Surgical treatment.

Pseudomucial tumors are the largest ovarian tumors. They usually occur in older women, less often in reproductive age. Women complain of pain, heaviness in the abdomen and an increase in its volume. Treatment is to remove the tumor.

What are ovarian tumors? What are their features (how are they manifested, features of diagnosis and treatment)?

Among neoplasms of the ovaries, tumor-like processes account for about 30-40%, and true ovarian tumors, respectively, 60-70%.

The most common forms of tumor-like formations of the ovaries

Follicular cyst
A follicular cyst is formed from a non-ovulated follicle, in which follicular fluid accumulates and atrophy of the cells lining its inner surface occurs. The value does not exceed 10 cm, and a larger size indicates an ovarian tumor. The follicular cyst tends to regress and if a follicular cyst is found, it is indicated to observe the cyst for some time before deciding on an operation.

Cyst of the corpus luteum
A corpus luteum cyst can form as a result of an inflammatory process in the ovaries. In the cells of the cyst wall of the corpus luteum, the same changes are observed as in the menstrual corpus luteum. Most often, the corpus luteum cyst undergoes self-resorption, when the contents resolve and the cavity falls off. Rarely, a corpus luteum cyst develops into a corpus luteum cyst. The prognosis is favorable.

Paraovarian cyst
The paraovarian cyst is formed from the ovarian epididymis located in the mesosalpinx. A paraovarian cyst generally develops asymptomatically and only when large in size can cause mild pain. Surgical treatment. The prognosis is favorable.

Tubal-ovarian inflammatory cyst
A tubal-ovarian inflammatory cyst is formed as a result of the fusion of the tube and the ovary affected by the inflammatory process. Surgical treatment. The prognosis is favorable.

What are borderline ovarian tumors?

Borderline ovarian tumors are low grade tumors. For a long time they do not go beyond the ovaries. Borderline tumors in most cases occur in women aged 30-50 years.

Borderline tumors account for about 10% of all serous tumors. Borderline ovarian tumors can be serous, mucinous, endometrioid, Brenner tumors.

Borderline tumors are staged according to the FIGO (International Federation of Gynecological Oncology) classification adopted for ovarian cancer (OC).

Serous tumors arise as a result of immersion of the surface epithelium deep into the ovary. In serous tumors, small inclusions are often found - psammoma bodies. If there are papillary growths on the capsule, the tumor is called papillary.

Mucinous tumors account for 8-10% of all epithelial ovarian tumors. These tumors have a mucous content and can reach a gigantic size, occupying the entire abdominal cavity. In 95% of cases, they do not go beyond the ovaries. To make a correct diagnosis, as many sections as possible should be examined.

Endometrioid borderline tumors resemble the endometrium in structure, their histological structure is very diverse.

Borderline Brenner tumors are extremely rare, not a single case of microinvasion and recurrence after radical removal of this tumor has been described.

The diagnosis is made, as a rule, with an urgent histological examination of the removed tumor.

How are borderline ovarian tumors treated?

The main treatment for borderline tumors is surgery.

In cases where, with a tumor size within stage I, it is desirable to preserve reproductive function, unilateral salpingo-oophorectomy with wedge resection of the contralateral ovary and submenopausal portion of the greater omentum is possible.

In cases of complete removal of the tumor in patients with local forms of the disease and the diagnosis is established based on the results of the study of the removed tumor, a second operation is not required. Chemotherapy or radiation therapy is not indicated.

With a widespread process (stages II-III), surgical intervention is performed in the amount of extirpation of the uterus with appendages, resection of the greater omentum and cytoreductive measures similar to those performed for ovarian cancer. Chemotherapy is indicated in cases where invasive tumor implants are identified during surgery (even if they are completely excised). The same chemotherapy regimens are used as in the treatment of ovarian cancer.

ovarian cancer

What is the incidence of ovarian cancer?

The problem of early diagnosis of malignant ovarian tumors is one of the most difficult and unresolved. Its relevance is due to the undoubted increase in morbidity and mortality from this pathology, noted over the past decades in many countries of the world.

The majority (75-87%) of patients with malignant ovarian tumors are admitted for treatment in advanced stages of the disease.

At the same time, it is known that if in the early stages of the disease the five-year survival rate is 60-100%, then in the third and fourth stages its value does not exceed.

Many authors believe that the late diagnosis of malignant ovarian tumors is due to both the limited clinical methods of research and the absence or insufficiency of subjective sensations in patients and, consequently, late seeking medical help.

Malignant neoplasms of the ovaries account for only about a quarter of all cancers of the female genital organs, while mortality due to this pathology reaches half of all deaths from their number.

The difficulty of early diagnosis, rapid growth, early implantation metastasis in the serous membranes of the small pelvis and abdominal cavity, poor results in the treatment of common forms - all this gives reason to consider ovarian cancer as one of the most malignant tumors with an extremely unfavorable prognosis.

The incidence of ovarian cancer is high in industrialized countries. Even with a high level of medical care, ovarian cancer in 65-80% of cases is recognized in stages III-IV.

The peak incidence of epithelial malignant neoplasms of the ovaries falls on the age range of 40-70 years, the average age of patients is 54 years.

A sharp increase in the incidence after 40 years is associated mainly with hormonal imbalance, primarily in the pituitary - ovaries system.

Early forms of the disease (ovarian cancer stage I-II) are diagnosed in 29.4% of cases, advanced (stage III-IV) - 45.7%, 19.6%, respectively.

What are the types of ovarian cancer and how common are they?

In the structure of malignant neoplasms of the ovaries, 80-90% are epithelial tumors, that is, ovarian cancer itself. The generally accepted histological classification of ovarian tumors is the WHO classification (1992).

For non-epithelial tumors, there are significant differences both in terms of treatment tactics and prognosis. The prognosis is generally better than for ovarian cancer itself.

In the structure of epithelial malignant tumors, 42% are serous carcinomas, 15% are mucinous, 15% are endometrioid, and 17% are undifferentiated.

The prognostic significance of the tumor histotype in cases of advanced ovarian cancer remains the subject of debate today. For early ovarian cancer, the clear cell histotype is the least favorable in terms of prognosis. A low degree of tumor differentiation is an unfavorable prognostic factor. However, in this case, we are talking primarily about the early stages of ovarian cancer.

Epithelial tumors:

1. serous;
2. Mucinous;
3. endometrioid;
4. Clear cell;
5. Mixed epithelial;
6. undifferentiated carcinoma;
7. Unclassified epithelial.

What are the stages of ovarian cancer?

Features of metastasis led to significant differences in approaches to the staging of the process. For this pathology, the classification proposed for the first time in 1964 by the Cancer Committee of the International Federation of Gynecologists and Obstetricians (FIGO), based primarily on laparotomy data, has become much more widespread.

According to this classification, tumor damage to the ovarian tissue, spread of the tumor to neighboring tissues, involvement of lymph nodes in the tumor process and the presence of metastases in other organs and tissues are taken into account.

What diagnostic measures should be performed in this disease?

The following diagnostic measures are required:

1. laboratory tests (general blood test with the determination of the leukocyte count and platelet count; biochemical blood test, including the determination of total protein, urea and creatinine, bilirubin, liver enzymes, blood glucose; serological blood test with the determination of RW, Rh factor, blood group, HbSAg ; urinalysis; ECG; determination of the level of CA-125);
2. gynecological vaginal and rectovaginal examination;
3. in the presence of bloody discharge from the vagina, a separate diagnostic curettage of the uterus is performed, followed by a histological examination;
4. ultrasound examination of the abdominal cavity and small pelvis;
5. x-ray examination of the chest;
6. examination of the gastrointestinal tract in order to exclude the metastatic nature of the ovarian lesion (EGD or X-ray examination of the stomach is required, colonoscopy or barium enema if indicated);
7. computed and / or magnetic resonance imaging of the abdominal cavity and small pelvis is performed according to indications;
8. patients under 30 need to determine beta-chorionic gonadotropin and alpha-fetoprotein.

How is ovarian cancer treated (general principles of treatment and treatment of patients by stages)?

All patients with suspected ovarian cancer are subject to laparotomy, the purpose of which is to accurately establish the diagnosis and extent of the tumor process, as well as the maximum possible removal of tumor masses.

It should always be borne in mind that it is the size of the largest of the residual tumors after the initial operation that determines the prognosis of treatment in general, since modern chemotherapy makes it possible to cure a significant number of patients with a disseminated tumor process, and the proportion of cured patients is higher, the smaller the size of the residual tumor.

The routine volume of surgical intervention is a hysterectomy with appendages, as well as removal of the greater omentum.

Treatment by stages

Treatment of early stages of ovarian cancer

Ovarian cancer IA and B stages of high and moderate differentiation (G1 and G2), excluding the clear cell histotype. After surgical intervention, which consists in hysterectomy with appendages, resection of the greater omentum and a thorough revision of the abdominal cavity, observation is recommended for this category of patients.

Conservative tactics aimed at preserving childbearing function (unilateral adnexectomy with resection of the second ovary, omentectomy), as an exception, is possible in young patients with stage IA ovarian cancer who want to preserve fertility, with highly differentiated carcinomas, when careful dispensary observation is really possible. After the birth of a child or the end of childbearing age, removal of the opposing appendages and uterus should be planned.

Treatment of IC, II A, B, C stages of ovarian cancer

In other cases (ovarian cancer IA, B stages of a low degree of differentiation, clear cell carcinoma regardless of stage, ovarian cancer IC, II A, B, C stages), additional treatment is necessary.

After surgery, including hysterectomy with adnexa, resection of the greater omentum, and, if necessary, combined operations for the purpose of maximum cytoreduction, it is mandatory to carry out standard first-line combined chemotherapy regimens, including platinum derivatives.

All courses are one day. 6 courses of polychemotherapy are carried out with an interval of 3 weeks.

Treatment of patients with III-IV stages of ovarian cancer

Potentially, all patients with stage III-IV ovarian cancer should undergo cytoreductive surgery. An experienced surgeon is able to perform such an operation in the optimal volume in more than 50% of cases.

Patients with stage III-IV ovarian cancer after surgery, including extirpation of the uterus with appendages and resection of the greater omentum, as well as surgical cytoreduction, undergo standard chemotherapy, including platinum derivatives and taxanes.

In stage IV of the disease, the presence of tumor pleurisy does not change the tactics of treatment.

In cases where large unresectable metastases in the liver, metastases in the lung parenchyma, massive damage to the mediastinum, significant metastases in the supraclavicular lymph nodes are detected, cytoreductive surgery in the optimal volume is impossible. In such cases, there is no need for heavy combined operations within the abdominal cavity and small pelvis in order to resect all visible tumor formations.

Computed tomography within the abdominal cavity may also reveal signs that the performance of cytoreductive surgery in the optimal volume is doubtful. This is involvement in the tumor process of the gates of the liver, the need for suprarenal lymphadenectomy. The presence of non-displaceable tumor masses in the pelvis is not a sign of inoperability.

In those situations where the scope of the operation at the first stage was not optimal, or the operation was limited to a biopsy, after three courses of chemotherapy, it is advisable to decide on a second surgical intervention (interval operation), primarily in the case of positive dynamics after chemotherapy.

Currently, multicenter randomized trials are being conducted to evaluate the effectiveness of neoadjuvant (preoperative) chemotherapy in the treatment of patients in whom optimal cytoreduction at the first stage of treatment is technically impossible. However, until the results of these studies are available, all patients with advanced ovarian cancer should be treated with surgery whenever possible.

How is recurrent ovarian cancer treated?

The prognosis for patients who experience recurrence of ovarian cancer after cisplatin-containing chemotherapy is unfavorable. Treatment is purely palliative.

Chemotherapy according to the same schemes as the initial one is justified in cases where the interval between the end of primary treatment and relapse was more than 6 months. Treatment is more effective, the longer this interval.

In cases where the progression of the tumor process began already during the primary treatment or immediately after its completion, a change in the chemotherapy regimen is indicated. If taxanes were not used at the first stage, paclitaxel monotherapy is indicated.

In other cases, it is possible to use docetaxel, topotecan, gemcitabine, vinorelbine, altretamine, oxaliplatin, irinotecan, ifosfamide, liposomal doxorubicin, oral etoposide, tamoxifen. Preference is given to the least toxic drugs, primarily those whose administration or administration does not require hospitalization.

The expediency of radiotherapy with the pelvic-abdominal field or locally on the area of ​​recurrence, the expediency of repeated surgical interventions is determined individually by a consultation with the participation of a surgeon, a radiologist and a chemotherapist.

What are non-epithelial tumors?

These tumors are much rarer than ovarian cancer, accounting for approximately 10% of all malignant ovarian tumors.

Among them are:

• germ cell tumors (dysgerminoma, mature and immature teratoma, ovarian struma, carcinoid, yolk sac tumor or endodermal sinus tumor, embryonic cancer, polyembryoma, choriocarcinoma, mixed germ cell tumors);
• sex cord stromal tumors (granulosa cell, theca cell, androblastoma);
• metastatic;
• rare tumors.

What are germ cell tumors (features of clinical manifestations, diagnosis and treatment)?

Germinogenic tumors develop most often from the gonads, the presence of this type of tumor outside the gonads is explained by the migration of primary germ cells from the yolk sac to the mesentery of the rectum, then to the sex cords. Only 3% of germ cell tumors are malignant. In Asians and blacks, they are more common (15%). 70% of all tumors occur before age 20.

The clinical picture, diagnostic and therapeutic tactics for various non-epithelial tumors are largely similar.

Diagnostics

If a germ cell tumor of the ovaries is suspected (usually after ultrasound), the level of alpha-fetoprotein (AFP) and beta-chorionic gonadotropin, the activity of liver enzymes (AST and ALT), alkaline phosphatase and lactate dehydrogenase are determined. A chest x-ray is mandatory, as these tumors metastasize to the lungs and mediastinum.

What is a dysgerminoma?

Dysgerminoma develops from primary germ cells. In 75% of patients, dysgerminoma does not spread beyond the ovaries. This is the only germ cell tumor that so often affects both ovaries. With a unilateral lesion, in 5-10% of cases, dysgerminoma develops in the second ovary within 2 years.

Treatment

After complete surgical removal of the tumor (more often removal of the affected ovary and biopsy of the second ovary), stage IA patients may be observed. In other cases, 3-4 courses of polychemotherapy are indicated.

In cases where patients initially had elevated levels of beta-chorionic gonadotropin and alpha-fetoprotein, the systematic determination of these markers is indicated both for assessing the effect of chemotherapy and for monitoring in cases of achieving complete clinical regression.

Patients who have not achieved normalization of tumor markers, with tumor recurrence, with progression of the tumor process during treatment, undergo second-line polychemotherapy.

The 5-year survival rate for stage I exceeds 95%.

In the late stages of the disease, the use of chemotherapy according to the indicated schemes made it possible to increase long-term results from 63% to 85-90%.

What is an immature teratoma?

An immature teratoma contains tumor elements resembling embryonic tissue.

The most important point in the diagnosis of teratomas is the assessment of their degree of maturity. Depending on the degree of differentiation and the number of immature elements, there are highly, moderately and poorly differentiated immature teratoma.

Treatment

Only with immature teratoma IA stage GI (highly differentiated tumor) surgical treatment is carried out in the amount of unilateral adnexectomy. In the presence of a moderately and poorly differentiated tumor, as well as in stage II, III of the disease, regardless of differentiation, chemotherapy is performed at the second stage according to the above schemes.

The overall 5-year survival rate for all stages is 70-80%.

What is a yolk sac tumor?

Yolk sac tumor, or endodermal sinus tumor, grows from elements of the yolk sac. Of the diagnostic features, the level of AFP is sharply expressed.

Treatment - surgical, surgery in the amount of unilateral adnexectomy, chemotherapy is required according to the above schemes.

What are stromal cell tumors (sex cord stromal tumor)?

Stromal cell tumors account for 5% of all malignant ovarian tumors.

Most stromal cell tumors of the ovaries are detected at stage I of the disease.

The most common are granulosa cell tumors. It must be remembered that granulosa cell tumors can be combined with endometrial hyperplasia and endometrial cancer.

Surgical staging for granulosa cell tumors is performed in the same scope as for ovarian cancer.

The extent of the operation depends both on the stage of the disease and on the age of the patient.

Patients with granulosa cell tumors in the first stage of the disease in the premenarche (juvenile form) or at a young reproductive age usually undergo an organ-preserving operation in the amount of unilateral adnexectomy, a biopsy of the contralateral ovary if its tumor is suspected. The role of subsequent polychemotherapy in young patients has not been determined.

In women who have completed childbearing, the scope of the operation should be extended to bilateral adnexectomy with hysterectomy. In women older than 40 years, granulosa cell tumors are more likely to develop relapses, often delayed in time. This is one of the arguments in prescribing subsequent polychemotherapy for some older patients, although no convincing evidence of its benefits has been obtained.

In the presence of a number of factors: rupture of the tumor capsule, low degree of differentiation, tumor size more than 10 cm, patients can undergo radiation therapy or cisplatin-containing chemotherapy.

Patients with a widespread tumor process (stages II-IV) are shown polychemotherapy after cytoreductive operations, or radiation therapy (with a local tumor process). Combination chemotherapy with platinum preparations is preferred.

The overall five-year survival rate of patients with granulosa cell tumors ranges from 85 to 90%, reaching 95% at stage I.

When monitoring patients in the future, the tumor marker inhibin can be used, although it is not always strictly specific in detecting relapses. Isolated recurrent tumor nodes of a granulosa cell tumor can be removed surgically with the appointment of subsequent combined chemotherapy with platinum drugs.

Androblastomas

Androblastomas (Sertoli-Leydig tumors) and malignant thecomas are extremely rare and should be treated according to the treatment regimen for granulosa cell tumors.

- a group of pathological additional formations of the ovarian tissue resulting from a violation of the processes of cell proliferation and differentiation. The development of a benign ovarian tumor may be accompanied by abdominal pain, menstrual and reproductive dysfunction, dysuria, defecation disorder, and an increase in the size of the abdomen. Diagnosis of benign ovarian tumors is based on data from vaginal examination, ultrasound, determination of tumor markers, MRI, laparoscopy, and other studies. Treatment of ovarian tumors is surgical in order to restore specific female functions and exclude malignancy.

General information

They are an acute problem in gynecology, since they often develop in women of childbearing age, causing a decrease in reproductive potential. Among all ovarian formations, benign tumors make up about 80%, but many of them are prone to malignancy. Timely detection and removal of ovarian tumors is extremely important in terms of preventing ovarian cancer.

Causes of the development of benign ovarian tumors

The question of the causality of benign ovarian tumors remains debatable. Various theories consider the hormonal, viral, genetic nature of ovarian tumors as etiological moments. It is believed that the development of benign ovarian tumors is preceded by a state of hyperestrogenism, causing diffuse, and then focal hyperplasia and cell proliferation. Embryonic disorders play a role in the development of germ cell formations and sex cord tumors.

The risk groups for the development of benign ovarian tumors include women with a high infectious index and a premorbid background; late menarche and violation of the formation of menstrual function; early menopause; frequent inflammation of the ovaries and uterine appendages (oophoritis, adnexitis), primary infertility, uterine fibroids, primary amenorrhea, abortion. Benign ovarian tumors are often associated with hereditary endocrinopathies - diabetes mellitus, thyroid disease, carriage of HPV and type II herpes virus.

Classification

According to the clinical and morphological classification of benign ovarian tumors, there are:

• epithelial tumors (superficial epithelial-stromal). Benign tumors of the ovaries of the epithelial type are represented by serous, mucinous, endometrioid, clear cell (mesonephroid), mixed epithelial tumors and Brenner tumors. Most often among them, operative gynecology is faced with cystadenoma and adenoma.
• sex cord and stromal tumors. The main type of stromal tumor is ovarian fibroma.
• germ cell tumors. Germinogenic tumors include teratomas, dermoid cysts, etc.

On the basis of hormonal activity, hormonally inactive and hormone-producing benign ovarian tumors are differentiated. The latter of them can be feminizing and believing.

Symptoms of benign ovarian tumors

Early and relatively constant symptoms of benign ovarian tumors include pulling, predominantly one-sided pain with localization in the lower abdomen, not associated with menstruation. Pollakiuria and flatulence may occur as a result of tumor pressure on the bladder and intestines. Against this background, patients often note an increase in the size of the abdomen.

As they grow, benign ovarian tumors usually form a stalk, which includes ligaments of the artery, lymphatic vessels, and nerves. In this regard, the clinic often manifests with symptoms of an acute abdomen due to torsion of the tumor stem, vascular compression, ischemia and necrosis. A quarter of patients with benign ovarian tumors have menstrual irregularities and infertility. With ovarian fibromas, anemia, ascites and hydrothorax can develop, which regress after removal of the tumors.

Feminizing tumors contribute to precocious puberty in girls, endometrial hyperplasia, dysfunctional uterine bleeding in reproductive age, and spotting in postmenopausal women. Virilizing benign ovarian tumors are accompanied by signs of masculinization: amenorrhea, hypotrophy of the mammary glands, infertility, coarsening of the voice, hirsutism, clitoral hypertrophy, and baldness.

Diagnostics

Benign ovarian tumors are recognized based on history and instrumental examinations. In a gynecological examination, the presence of a tumor, its localization, size, consistency, mobility, sensitivity, the nature of the surface, and the relationship with the pelvic organs are determined. Conducting a rectovaginal examination makes it possible to exclude the germination of the tumor in adjacent organs.

Diagnostic laparoscopy for benign ovarian tumors has 100% diagnostic accuracy and often develops into a therapeutic one. True benign ovarian tumors are differentiated from retention ovarian cysts (the latter usually disappear within 1-3 menstrual cycles on their own or after COC administration).

Treatment of benign ovarian tumors

Detection of a benign ovarian tumor is a clear indication for its removal. Surgical tactics in relation to benign ovarian tumors is determined by the age, reproductive status of the woman and the histotype of the formation. Typically, the intervention is to remove the affected ovary (oophorectomy) or adnexectomy. In patients of reproductive age, it is permissible to perform wedge resection of the ovary with emergency histological diagnosis and revision of the other ovary.

In perimenopause, as well as with bilateral localization of benign ovarian tumors or suspicion of their malignancy, the removal of the appendages is performed along with the removal of the uterus (panhysterectomy). The access of choice for benign ovarian tumors is currently laparoscopic, which allows to reduce surgical trauma, the risk of adhesions and thromboembolism, accelerate rehabilitation and improve reproductive prognosis.

Prevention

It has been proven that long-term use of monophasic COCs has a preventive effect on benign ovarian tumors. To exclude unwanted hormonal changes, it is important that the selection of contraception is carried out only by a gynecologist. In addition, it was noted that in patients with realized generative function, benign ovarian tumors develop less frequently. Therefore, women are strongly discouraged from terminating a pregnancy, especially the first one.

It is also known that women who have undergone hysterectomy or tubal ligation have a lower risk of developing ovarian tumors, although this protective mechanism remains unclear. A certain importance in the prevention of benign ovarian tumors is given to the sufficient intake of vegetable fiber, selenium and vitamin A. Regular gynecological examinations and pelvic ultrasound are distinguished as screening measures for benign ovarian tumors.

An ovarian tumor in women manifests itself through various symptoms. Signs depend on the type, size and stage of development of the disease. A neoplasm is a pathological disease that is formed as a result of intensive cell division. Affected cells have a malignant and benign property and are dangerous for the condition and life of the patient. The tumor can develop regardless of age. People in the age category from 45 to 60 years old are affected due to hormonal imbalance.

An ovarian tumor is a large growth formed from ovarian material due to uncontrolled cell division. No specific cause for the development of benign ovarian cancers has been identified. However, there are theories about hormones and genetics as the basis for the formation of pathology. Specialists emphasize the influence of an increased amount of estrogen on the occurrence of neoplasms. The activity of hormones provokes an intensive production of cystic cells. Among the existing reasons for the formation of growths note:

• complex genetic structure;
• early onset of menopause symptoms;
• chronic ovarian diseases;
• abortions, especially before the age of 18;
• early development of the reproductive system;
• transferred operational impacts in the pelvic area and abdominal cavity;
• failure in the functioning of the endocrine gland;
• inflamed penis;
• taking alcohol and drugs;
• diabetes.

Dense formations on the ovary in patients occur due to hormonal imbalance, viral infections and genetic predisposition. It is possible to develop certain types of neoplasms due to intrauterine abnormalities. Women with hormonal dysfunction, infertility and regular infectious lesions are at high risk. Benign growths can be based on existing chronic diseases such as diabetes, thyroid dysfunction and herpes rashes. An education based on an imbalance of hormones requires special treatment.

Tumor symptoms

According to statistics, every year 25,000 women experience ovarian cancer. The initial stage does not allow to detect oncology due to the reduced manifestation of symptoms. When detected, the neoplasm is usually already in a running form. The main signs of the presence of a pathological disease are called:

• depression and lethargy;
• constant fatigue;
• palpable weakness in the body.

Signs of an existing build-up begin to appear in the later stages of development. Education is modified and takes on a malignant character. The characteristic signs of a malignant lesion of the ovary are:

• pain in the lower abdomen, reflected in the lumbar region;
• failure of the cycle of menstruation;
• abdominal growth, heartburn and flatulence occur;
• rapid weight loss or gain;
• feeling unwell, especially noticeable in the morning, nausea;
• feeling of discomfort during the sexual process;
• inability to conceive a child, lack of ovulation;
• constant trips to the toilet due to the pressure of the tumor.

For a long time, the symptoms are not pronounced. A noticeable first sign appears when the growth expands. There is constant discomfort in the patient's life. Clearly, the regimen and habitual way of life are changing.

Types of tumors

Benign ovarian tumors are grouped into 4 types. The division takes place on the availability of information about the type and structure of the tumor. Doctors distinguish 4 classifications of growth: stromal, epithelial, hormonally active and germinogenic. The classification is characterized by individual characteristics of the growth and development of the cyst. To select the correct method of treatment, the patient must undergo a complete examination. The diagnosis is established by the results of the examined tissues taken during a biopsy or surgical exposure.

Epithelial tumor

The epithelial outgrowth on the ovary is created from the outer ovarian material. Cystadenoma is considered the central tumor of this group. According to statistics, more than 70% of patients undergo this type of oncology. Epithelial lesions on the ovary differ in the structure and contents of the tumor. The species is divided into 6 subtypes:

• Simple serous cystadenoma. Outwardly, it looks like a shell with a transparent inside, called serous. The build-up size is between 50 and 150 mm. A distinctive feature of this form is a thick, inelastic capsule. Cystadenoma develops only on one part of the left or right organ. Typically, the tumor is found in women after 50 years of age.
• Papillary serous cystadenoma. The form is characterized by papillae from the inner area of ​​the pathology. Many places are suitable for localizing the build-up. It is able to form both inside and outside the cyst.
• Mucinous cystadenoma. It has the form of a small multi-chamber shell filled with liquid - mucin. A characteristic feature of the species is an increase in the size of the neoplasm due to the expansion of the cells of the capsule. The disease is not treatable with medicines and folk methods. The tumor gains mobility as a result of connection with the pedicle of the appendage. Also, the growth fuses with the uterus and other organs of the abdominal cavity. The mucinous form has the ability to mutate into cancer. The view extends to the middle female age.
• Pseudomyxoma of the appendage and peritoneum. This subspecies appears when healthy cells of the ovary or abdominal cavity are damaged by mucin. Most of the patients are women over 50 years of age. It is impossible to detect concomitant signs over a long period. The cyst is removed surgically. Education has a high risk of recurrence.

• Brenner tumor. The form occurs in rare cases. Patients over the age of 40 are affected. There are no symptoms, which is why the cyst is detected in the last stages. Signs of a tumor are similar to a fibroma. During the examination, one cannot do without a histological examination of the cells.
• Mixed epithelial ovarian tumors. The form is distinguished by the appearance of a growth of a serous and mucinous type. With the help of a microscope, you can see a number of multi-chamber membranes with contents of serosa or mucin.

Stromal tumor

The stromal type of tumor is typical for women after 50 years. However, cases of girls at an early age have been recorded. According to the statistics of all oncological diseases in children, it is stromal formation that develops in 5% of cases. Pathology is characterized by bleeding from the vagina.

The situation arises because of the ability of some types of tumors to produce estrogens. High levels of hormones cause bleeding, similar to menstrual flow during menopause. With the formation of ovarian formation in girls, the mammary glands begin to swell and blood clots are released from the genitals.

Sometimes this form of ovarian tumor provokes intensive production of androgens. The situation suspends the menstrual cycle, there is a failure in the function of reproduction. The disease leads to swelling of the labia. In addition, women note severe pain in the lower abdomen and pain in the left side.

Hormonally active tumor

Tumors that form against the background of hormones appear in the uterine appendages. Pathology produces a high level of hormones, leading to dysfunction of the endocrine and thyroid glands. Emerging problems become an obstacle for women to conceive and develop the fetus during pregnancy. 1/10 cases of development of the ovarian form is characterized by ovarian oncology, depending on the hormonal amount.

There are 4 types of hormonal neoplasms: folliculoma, thecoma, androblastoma, Brenner tumor. The follicle is built from material taken from inside the follicle. During the development of growth in girls, premature sexual development, the release of blood clots, swelling of the mammary glands, intensive growth of pubic and armpit hair are noted.

An ovarian tumor in women with the onset of menopause has the following symptoms:

• bleeding;
• high sexual arousal;
• breast growth and associated pain.

There is a high probability of developing uterine cancer. Folliculomas often affect both glands. Thecoma of the ovary is a growth formed from the theca material responsible for the production of estrogens. A special feature of such a neoplasm is:

• rapid expansion of the cyst;
• defeat unilaterally;
• the presence in the body of contents with tumor cells.

There is a possibility of mixing benign cells with malignant ones. Thecoma is accompanied by the following symptoms:

• failure of the cycle of menstruation;
• the formation of mastitis;
• early puberty;
• high level of sexual desire.

For the treatment of this pathology, surgical intervention is prescribed. This is due to the poor prognosis for hormonal tumors. Androblastoma consists of germ cells involved in the production of androgens. The disease appears rarely, adversely affects the health of women. Types of androblastoma:

• undifferentiated. There is a high level of testosterone in the blood.
• differentiated. There are no signs of cancer.
• mixed.

Symptoms of androblastoma include:

• Weak discharge during menstruation or a decrease in their number to zero.
• Breast size is reduced.
• A masculine physique is being formed.
• The body is covered with hair in the male manner.
• Sexual desire is completely absent.

Cancer of the appendages is distinguished by a pronounced clinic, in contrast to the cyst of the appendage. Androblastoma is benign. However, the bilateral development of a neoplasm can modify the formation in a malignant direction.

Brenner's tumor is considered the rarest type of hormonal growth. The volume of such pathology reaches 20 mm. The foundation is a group of cells that produce estrogens. The symptoms are similar to thecoma and folliculoma.

germ cell tumor

A germ cell cyst is often benign. The neoplasm develops from the embryonic material of the gonads, which stopped their growth and development at the initial stage. The formation of the tumor falls on the childhood period and the age of reproduction. There are 2 types of germ cell growth:

• Dysgerminomas are created from the initial sexual material.
• Non-disgerminomas are constructed from cells located close to the genitals.

The appearance of germinogens resembles an ovoid or spherical sphere. Cutting the growth, you can see a brown or yellowish tone of the lesion. Dead areas are also noted. There is a possibility of formation of foci of hemorrhage. Benignity can develop into malignancy.

Treatment of an ovarian tumor

If the ovarian tumor has a size of more than 60 mm with the preservation of the form for more than 6 months or is malignant, surgery is prescribed. The amount of surgical treatment is based on the type of neoplasm. To combat cancer cells, hysterectomy and incomplete resection of the greater omentum using laparotomy are prescribed.

Surgical excision of an ovarian tumor

Surgical intervention is prescribed for a malignant type and an increased size of the growth. The operation is performed on the basis of the established diagnosis. Many factors influence the surgical process. Among them note:

• type of tumor lesion;
• build-up size;
• the nature of the flow;
• affected area;
• the age category of patients, the desire to maintain reproductive function and the possibility of childbearing.

If a tumor is detected in the early stages, it becomes possible to apply the laparoscopy method. The method eliminates malignant cells, minimally damaging the healthy material of the ovary. This helps to recover faster in the postoperative period. Patients are able to return to their usual way of life.

Finding a benign tumor in the reproductive age category requires minimal surgical intervention. The doctor resorts to an incomplete resection of the ovary or a procedure for unilateral excision of the ovary and fallopian tube. With poor functioning of the second ovary, patients are offered stimulation - cryopreservation of eggs. The method will help a woman in the future to give birth to a child with the help of IVF.

If the pathology is detected when the menopause threshold is crossed, surgical intervention is performed as in the malignant nature of the growth. If the pedicle of the tumor is twisted or the integrity of the membrane is injured, an urgent operation is performed comparable to an adnexectomy. Before and after the operation, the patient undergoes chemotherapy. The procedure helps to facilitate the flow of surgical exposure and remove unremoved affected cells.

Radiation therapy has a similar effect. Together with these methods of treatment, the use of immunomodulators and the intake of vitamins are required. In the case of a wide area of ​​\u200b\u200bdistribution of the pathology, it is required to excise the uterus with appendages. After the exposure, the patient undergoes hormonal therapy for the rest of her life.

Therapeutic treatment of ovarian tumor

All patients undergo surgery to remove oncology, regardless of its nature. The method of operational impact is influenced by the type of growth, the territory of distribution and the severity of symptoms. There are 2 types of operation:

• Excision of the tumor together with the organ with benign properties.
• Elimination of the uterus with appendages and the greater omentum in the early stages of oncology development.

If a woman has not given birth, one ovary is excised, and after the birth of children, the rest of the organs are removed. This method is appropriate if the ovarian membrane is not affected by the affected cells, there are no signs of the spread of metastases. After elimination of the ovarian neoplasm, the patients undergo chemotherapy and radiation therapy. Procedures can reduce the likelihood of a relapse in the future. For patients who underwent surgery in the early stages, funds containing platinum (Cisplatin, Carboplatin) are prescribed. In the later stages, women undergo 6 courses of intravenous Paclitaxel and Carboplatin.

According to statistics, the probability of a second oncological process is more than 30%. Many patients resort to folk remedies to cure ovarian tumors. Thanks to the research, experts have compiled a list of herbs and products that have a detrimental effect on the affected cells:

• In the fight against cancer cells, red pepper is effective. The product contains the substance capsaicin, which, getting on the affected areas, destroys them. The product is prepared with 2 kg of red pepper and flax oil. Vegetables are washed and cut. It is important to use an eye mask and gloves to avoid contact of irritants with mucous membranes. Pour oil into a 2 liter jar and add finely chopped pepper. The resulting solution should be placed in a cool place for 1 week. Then the mixture is passed through a gauze fabric, the resulting liquid is drunk 1 tsp each. 4 times a day. The drug requires careful handling due to the increased risk of burns to internal organs.
• The golden mustache proved to be effective in the gynecological field. 100 freshly picked leaves, carefully peel and finely chop. Chopped greens are put in a glass vessel and poured with water. The lid of the jar must be tightly screwed on. The mixture is left in a dark place for half a month. It is recommended to drink 10 drops of the solution daily. The tincture is washed down with plenty of water.

Possible complications and prognosis

The prognosis for the treatment of benign tumors is favorable. Rare cases of cancer recurrence have been reported. With repeated disease, the likelihood of malignancy increases. If the ovarian mass is malignant, early detection reduces the five-year survival rate to 90%. The presence of distant metastases reduces the rate to 20%.

Usually, benign neoplasms are detected on time. Sometimes the affected cells are affected by malignancy. The structure of the cyst affects the risk of virilizing outgrowth:

• Epithelial - 50% of patients.
• Mucinous - less than 25%.
• Granulosa cell - up to 35%.

A virilizing neoplasm of the ovary is difficult to detect, since the symptoms of ovarian cancer in the early stages are similar to signs of a cyst. A constant feeling of weakness in the body and malaise indicate the neglect of the disease. To treat cancer, they resort to an operation to excise an ovarian tumor. Among the complications, torsion of the ovarian pedicle is distinguished completely or partially. Complete is characterized by a violation of blood flow in the area where the tumor focus is located. The situation causes tissue necrosis. This pathology requires prompt removal of the growth.

A complication can cause the accumulation of pus inside the tumor. Affected bacteria enter the internal environment of the neoplasm and provoke the process of suppuration. The impact of negative factors helps microorganisms break through the protection and create fistulas. In such a case, the patient needs urgent removal of the cyst.

The negative outcome is injury to the integrity of the tumor membrane. The situation rarely occurs, but the likelihood of such an outcome exists. Rupture of the capsule can occur due to dead tissue, trauma to the abdomen and careless gynecological exposure during the examination. The disease is characterized by acute pain and internal bleeding. The situation requires immediate hospitalization and an operation to remove the ovarian tumor. There is also a failure in reproductive function, due to which women are faced with the inability to conceive a child.

Tumor during pregnancy

In medical practice, cases have been recorded when ovarian tumors were formed in patients during pregnancy. Often, pathology is detected during a routine examination of patients. If the growth is found in the first months of pregnancy, it is forbidden to excise the formation until 18 weeks. Operational exposure can provoke a miscarriage. At the end of the set period, the embryo is covered with a placenta, which acts as a kind of protection, and it is allowed to remove the tumor. In order to avoid unwanted complications, before the specified time, a woman should undergo an ultrasound procedure weekly. If there is a suspicion that the tumor has changed to a malignant side, the doctor prescribes an operation, regardless of the gestational age.

Pathology of the ovaries provokes the development of complications during pregnancy. A common threat is the likelihood of interrupting the pregnancy process. There is a high risk of violation of the position of the fetus in the womb. If the neoplasm is low, the child may take a transverse position, polyhydramnios will develop, which will lead to prolapse of the umbilical cord and a dangerous turn of the child's head towards the small pelvis. A large build-up gives the woman additional pain of a pulling nature in the lower abdomen.

The choice of surgical intervention depends on the assessment of the vital activity of the fetus. It is important to find out whether there may be problems in the stable course of childbirth due to the presence of oncology. If the admission of childbirth in a natural way is impossible, they resort to a caesarean section. During the operation, the affected cells are excised and a thorough examination of healthy tissues and organs is carried out.

Usually, the formation of the ovaries is not an obstacle to the birth of a baby through the birth canal. The situation goes without any complications. Before deciding on surgery, doctors study the condition of the ovaries, the types and behavior of the growth. The clinical nature of the neoplasm is also monitored. If the tumor is found in the later weeks of pregnancy, the surgical intervention is transferred to the postpartum period.

The absolute indications for immediate surgery, regardless of the gestational age, are the malignant nature of ovarian cancer, an enlarged size of more than 100 mm, and a high rate of expansion of the pathology. In the early months of pregnancy, the doctor removes the omentum and the damaged ovary. As soon as the fetus is able to show independent vital activity, they resort to a caesarean section to extract the child. Then the surgeon excised the uterus together with the appendages and the omentum. After the surgical manipulations, the patient undergoes a course of chemotherapy.

Prevention of ovarian tumor

At this time, there are no specific recommendations for preventive actions to prevent the formation of ovarian tumors. This is due to the absence of etiological factors for the occurrence of pathology. Treatment of ovarian tumors in women is characterized by a favorable prognosis. Proper examination, establishing the correct diagnosis and prescribing suitable treatment help women get rid of oncology. The manifestation of the smallest symptom of a developed neoplasm signals an immediate appeal for help to a doctor.

Regular medical examinations and treatment of infectious and inflammatory processes act as a warning for the appearance of oncological formations. An important role is played by the rejection of abortions and groundless operational influences. It is important for women to regulate hormone levels and be committed to monogamous sexual relationships. Experts advise to follow the following recommendations:

• Give up bad habits, especially alcohol and smoking.
• Adhere to breastfeeding the baby.
• Try to have time to get pregnant in the interval from 20 to 28 years.
• Timely notice and treat gynecological pathologies, infectious diseases and inflammatory processes.
• In the presence of a hereditary predisposition to cancer, be examined by a geneticist.
• Scheduled diagnostics at the gynecologist twice a year.

The formation of appendages can overtake any woman, regardless of age. Patients are able to help themselves with a cure for oncology when they become familiar with the existing causes of the development of cancer cells. Acquaintance with the symptoms will help to pass the examination in time and identify the disease at an early stage.