Ovarian Cancer

Ovarian cancer is a malignant ovarian tumor. These lie to the left and right of the uterus and have a relatively large amount of space - because during the female cycle their position and size change a bit. A tumor on ovary therefore usually causes symptoms only at an advanced stage and is often noticed late. In about 50 percent of cases, the cancer affects both ovaries.

Physicians distinguish so-called germinal stromal tumors from cancer that arises from the ovarian cells themselves. This form of tumor develops from embryonic germinal cords. 15 to 20 percent of ovarian tumors arise in this way. An example is the Brenner tumor, a roundish, up to several centimeters large tumor, which is usually benign and degenerates only in 0.5 to 9 percent of cases.

Malignant ovarian cancer quickly forms secondary ulcers, called metastases. These spread mainly within the abdominal cavity and the peritoneum. About blood and lymphatic channels can also Liver, Lung, pleura or lymph nodes are affected.

The disease occurs in four stages, which are classified according to the so-called FIGO classification:

  • FIGO I: Early stage. Ovarian cancer affects only the ovarian tissue. It can be an ovary or both ovaries affected.
  • FIGO II: The tumor has already spread in the pelvis.
  • FIGO III: The cancer has spread metastases in the peritoneum (med. Peritoneal Carcinoma) or in the lymph nodes.
  • FIGO IV: Highly advanced stage. The tumor tissue is already outside the abdominal cavity. For example, distant metastases can arise in the lungs. You get there via the bloodstream or lymphatic system.

Most older women are affected by the disease after menopause. Before age 40, ovarian cancer rarely occurs. Ovarian cancer is the second most common cancer of the female reproductive tract after breast cancer. Every year, between 7,000 and 8,000 women are newly diagnosed in Germany, writes the Robert Koch Institute. The risk of developing a malignant tumor on the ovaries is thus 1.5 percent (one out of every 68 women is affected).

In the ovaries, tumors may also occur that are not due to degeneration of the ovarian cells - such as secondary tumors of other cancers. These include the Krukenberg tumor, the secondary tumor of stomach cancer arises.

No ovarian cancer symptoms: Late diagnosis

The treacherous thing about tumors on the ovaries is that they do not cause symptoms in the early stages of the disease. Only in advanced disease causes the ovarian cancer problems. Only in 29 percent of cases is the tumor discovered when it is still confined to the ovarian tissue (stage one of the so-called FIGO classification). This can be a ovary or both ovaries may be affected. In 59 percent of patients, the disease is only diagnosed when the tumor has already formed metastases in the abdominal cavity (FIGO III).

Non-specific signs

Once metastatic in the abdominal cavity in women with ovarian cancer, they feel nonspecific symptoms. These symptoms are not typical of malignant ovarian tumors and may also be associated with other diseases.

The most important signs are:

  • Pressure sensation in the lower abdomen, possibly accompanied by nausea
  • General indigestion, for example, feeling of fullness, loss of appetite, bloating, increased urination, constipation (The tumor may press on adjacent organs, such as the intestine or the Bladder)
  • Inefficiency, fatigue and exhaustion
  • Production of excess ascites (med. Ascites), so that the stomach swells - despite constant or even falling weight
  • Bleeding outside the normal menstrual period, bleeding after menopause (rare ovarian cancer symptoms)
  • In the advanced stage may come fever and night sweats

Similar symptoms also occur in cancerous tumors, which form as secondary tumors of other cancers on the ovaries, such as the Krukenberg tumor. The origin is one stomach cancer.

Swollen lymph nodes

In the third stage of the cancer, metastases can develop in the lymph nodes. Because the cells of the cancerous tumor enter the tissue fluid and are filtered out by the lymph nodes. They settle there and multiply. The result: the lymph nodes swell. This usually causes no complaints. However, the lymph nodes can swell up to several centimeters in diameter due to the proliferation of cancer cells. They are then bare eye recognizable or can be felt. In some cases, only a thickened lymph node leads to the diagnosis of cancer. If painless lymph node swelling occurs for no apparent reason and does not return after a few weeks, you should consult a doctor.

Metastases outside the abdominal cavity

In cases of advanced ovarian cancer, the tumor has left the abdominal cavity (FIGO IV), and then symptoms are triggered by distant metastases in other organs lung often remain symptomless, because they usually settle in the lung periphery. But it can also stubborn cough attacks, hemoptysis or a lung infection occur. For distant metastases in other organs, for example the liver, show up weight loss, loss of appetite, nocturnal sweat or nausea.

Like almost every cancer, ovarian cancer arises from cells that grow unchecked. In the later stage, the tumor then forms metastases, which spread in the surrounding tissue, such as in the abdominal cavity. Why the cells degenerate is not known in detail. However, genetic factors seem to play a role, because ovarian cancer occurs familial and certain gene mutations (mutations) occur in cancer patients frequently. Furthermore, the number of female cycles plays a role in the pathogenesis. Women with a late first menstrual period and an early onset of menopause are therefore less likely to suffer from an ovarian tumor. This also applies to women who have been pregnant one or more times or who have used hormonal contraception over a longer period of time.

Genetic and environmental factors

Changes in BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer. However, they were only found in a small proportion of the women affected. Further genetic factors are currently the subject of research. Breast cancer patients also frequently have altered genes of the BRCA group (breast cancer).Women whose first-degree relatives have breast or ovarian cancer are at an increased risk of contracting. Harmful environmental influences and unhealthy diets can also play a role. There are indications that overweight (obesity) increases the risk of disease.

An initial indication of a tumor on the ovary is the palpation of the abdominal wall and the female reproductive organs. Usually follows an ultrasound examination (medical: sonography) of the abdominal region and the vagina. It already provides information about the size, location and nature of the cancerous tumors. It may also be possible to assess whether the tumor is benign or malignant. How far the disease has spread can be determined by computer or magnetic resonance imaging. Here, the doctor can detect metastases in the chest or abdomen. If there is any suspicion that the tumor has already affected the bladder or the rectum, a cystoscopy or colonoscopy may be used. A reliable diagnosis is only possible after the examination of a tissue sample, which must be surgically removed beforehand.

To assess the course of the disease, the doctor may specific tumor markers to measure in the blood. As the amount of these cellular proteins increases, this indicates increased metastases. After surgical removal of a tumor, the study may provide evidence of a tumor relapse, a so-called relapse.

For ovarian cancer, there is no statutory screening for prevention. Regular gynecological examinations and a vaginal ultrasonic but can help to recognize the cancer early. In the discussion is also whether a blood test In combination with ultrasound, a standard procedure could be to get early evidence of ovarian cancer.

Ovarian cancer therapy essentially involves two procedures: surgery and Chemotherapy. The doctor usually treats the patient with a combination of both. Which therapy is used depends on the stage of the tumor.

Surgery

The chances of a cure for ovarian cancer are highly dependent on the complete removal of the tumor: ovary (usually both), uterus, oviduct and the large abdominal net are therefore usually taken by the doctor. If the tumor is detected very early or if the tumor is unilaterally unilateral, this operation may also be deviated from. If the tumor has already spread extensively, it may also be necessary to remove more parts of the peritoneum, parts of the intestine, the cecum or the lymph nodes.

The OP also serves diagnostic purposes. The doctor has the option to scan the entire abdomen for metastases. Tissue samples can be taken from suspicious, enlarged lymph nodes for further examination.

Chemotherapy

After the operation usually chemotherapy is done. The treatment is designed to prevent the development of tumor foci that may or may not have been completely removed. The drugs either affect the entire body or can be specifically introduced into the abdominal cavity. They kill cancer cells. Most effective against ovarian cancer are platinum-containing substances such as carboplatin, which is given in combination with other drugs such as paclitaxel.

Additional medicines can specifically disrupt certain properties of the tumor and thus support chemotherapy. Substances that the formation of new Suppressing blood vessels worsens the supply of oxygen and nutrients to the tumor, thereby slowing its growth.

If the tumor was discovered very early on the ovary, it may be possible to do without chemotherapy. For patients whom the doctor is unable to operate because of their poor health, even chemotherapy is successful. Only in exceptional cases will one radiotherapy used.

The sooner a tumor is detected, the better it is for ovarian cancer - chances of a cure decline drastically if metastases have already developed in the abdominal cavity. An ovarian disease has a very good prognosis - on average the patients live 15 years and longer after the diagnosis. If the tumor tissue has been completely removed by surgery before the cancerous tissue has spread metastases, complete healing is possible.

Unfortunately, many cases are diagnosed at an advanced stage. The reason: the disease shows no early symptoms. If the cancer has already spread in the abdomen, the chances of recovery are poor. In end stage ovarian cancer, the disease has spread to the whole body. Organs outside the abdominal cavity, such as the liver and lungs, also contain metastases. At this stage, the average ovarian cancer life expectancy is only 14 months. In patients with advanced ovarian cancer, the disease often returns following completed therapy.

The 5-year survival rate for ovarian cancer is about 40 percent - that is, about five years after diagnosis, about half of the patients still live. Overall, ovarian cancer has the worst prognosis of all gynecological cancers.

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