What Is Stage 3 Ovarian Cancer?

Ovarian malignancy is one of the common malignant tumors of female reproductive organs, and its incidence is second only to cervical cancer and uterine body cancer. Epithelial cancer is most common in ovarian malignancies, followed by malignant germ cell tumors. Among them, ovarian epithelial cancer has the highest mortality rate of various types of gynecological tumors, posing a serious threat to women's lives. Because the ovary is deep in the pelvis, it is small and lacks typical symptoms, making it difficult to detect early. Patients with epithelial ovarian cancer find that the tumor is limited to the ovary in less than 30%, and most of them have spread to the pelvic and abdominal organs, so early diagnosis is a major problem. ^[1]

Basic Information

nickname: Ovarian cancer
English name: Ovarian M alignant Tumor
English alias: ovarian cancer
Visiting department: Oncology

Common locations: Ovary
Common symptoms: Pain, irregular menstruation, weight loss, lower abdominal mass, peritoneal effusion, malignant
Contagious: no

Causes of Ovarian Malignancies

The etiology of ovarian malignancies is still unclear and may be related to the following factors: genetic factors, especially when there are patients with ovarian cancer, breast cancer, pancreatic cancer, prostate cancer, colorectal cancer in the family, the risk of ovarian cancer in relatives may Increase. Endocrine factors, such as early menarche and no birth history.

Epithelial ovarian cancer is more common in postmenopausal women, while malignant germ cell tumors are more common in adolescents or young women.

Clinical manifestations of ovarian malignant tumors

Symptoms

(1) Epithelial ovarian cancer

There are no obvious symptoms in the early stage, and about 70% of the patients are already at the advanced stage. The common symptoms in the advanced stage are as follows.

Abdominal distension: It is mainly caused by the enlargement of the mass or combined with abdominal and pelvic effusion.

Abdominal pain: Malignant ovarian tumors may cause a certain degree of abdominal pain due to changes in the tumor, such as bleeding, necrosis, and rapid growth.

Wasting : Advanced patients may be accompanied by weight loss.

(2) Malignant ovarian germ cell tumor

Symptoms of ovarian malignant germ cell tumors are different from those of epithelial cancer. Abdominal masses and bloating appear early. Fever can often occur due to bleeding or necrotic infection in the tumor, or acute abdomen due to tumor torsion or tumor rupture. Among them, 60% to 70% of patients are at the early stage of consultation.

2. Signs

(1) Pelvic mass: 75% of ovarian malignant tumors grow on both sides, while only 15% of benign ovarian tumors grow on both sides.

(2) Abdominal fluid: Although benign ovarian tumors, such as fibroids, can also be accompanied by ascites fluid, there are many cases of malignant ovarian tumors with ascites fluid.

Ovarian malignancy

Ultrasound examination

The size, morphology, cystic solidity, location of tumor, and the relationship with surrounding organs can be tentatively clarified.

2.CT and magnetic resonance examination

Further clarify the nature of the tumor and understand the extent of tumor invasion of the abdominal and pelvic organs.

Gastroscopy

If necessary, gastrointestinal examination is performed to exclude the primary tumor of the gastrointestinal tract.

Diagnosis of ovarian malignancy

Early screening

About 20% of ovarian cancers can be diagnosed at an early stage and are usually detected by the following procedures:

(1) Routine gynecological health examination;

(2) Visiting a hospital for certain symptoms;

(3) Ovarian cancer screening: Common methods include transvaginal ultrasound (TVUS) and serum CA-125 examination.

2. Auxiliary inspection

(1) Tumor markers: CA12-5 (marker for epithelial ovarian cancer); AFP (alpha-fetoprotein, specific value for endodermal sinus tumor); CA199, CEA (often elevated in mucinous ovarian cancer) Wait.

(2) Ultrasound.

(3) CT.

(4) MRI.

(5) PET-CT scan, etc.

Ovarian Cancer Treatment

1. Principles of treatment ^[2]

Surgery combined with chemotherapy is the main treatment method for ovarian malignant tumors. In addition, targeted therapy, endocrine therapy, and radiation therapy have certain effects.

2. Surgical treatment

The purpose of surgery: removal of tumor, clear diagnosis, accurate staging, judgment of prognosis and guidance of treatment.

Operation principle:

(1) The open surgery of the mid-longitudinal incision of the lower abdomen can be used for comprehensive staging, initial tumor reduction, intermittent tumor reduction, or secondary tumor reduction.

(2) The frozen pathological examination during the operation is helpful to confirm the diagnosis and determine the scope of the operation.

(3) In selected patients, experienced gynecological oncologists can choose laparoscopy to complete surgical staging and tumor reduction.

(4) Laparoscopy is helpful for assessing whether a new patient can achieve a satisfactory tumor reduction surgery. If the assessment fails to achieve a satisfactory tumor reduction surgery, neoadjuvant chemotherapy can be considered.

(5) If the patients with epithelial ovarian cancer are younger, reproductive function is required. For A, stage ovarian epithelial cancer (low-grade serous carcinoma, G1 endometrioid carcinoma), sex cord mesenchymal tumors, unilateral appendectomy can be performed + Thoroughly staged surgery, retaining the healthy side attachment and uterus. Any stage of malignant ovarian germ cell tumor with fertility requirements can retain fertility if the uterus and contralateral ovaries are normal.

(6) It is recommended that the operation be performed by a gynecological oncologist.

3. Chemotherapy

(1) Encourage patients with ovarian, fallopian tube or peritoneal cancer to participate in clinical trials in diagnosis and treatment.

(2) Before any initial treatment, there are fertility requirements, and those who need to retain fertility function must consult a reproductive specialist.

(3) Before starting chemotherapy, ensure that the general state and organ function of the patient can tolerate chemotherapy.

(4) Close observation and follow-up of chemotherapy patients should be made to deal with various complications during chemotherapy in time. Monitor patients' blood routine and biochemical indicators during chemotherapy. The chemotherapy regimen and dose need to be adjusted based on the toxic reactions and treatment goals that occur during chemotherapy.

(5) After the end of chemotherapy, the treatment effect and complications need to be evaluated.

(6) Paclitaxel combined with platinum is a first-line chemotherapy regimen for ovarian cancer.

4. Targeted therapy and immunotherapy

In recent years, targeted therapies targeting polyadenylate diphosphate ribose polymerase (PARP), vascular endothelial growth factor receptor (VEGFR), etc. have made great progress, which helps to extend the survival of patients. There are many PARP inhibitors. Following Olaparib's first approval by the US FDA for recurrent ovarian cancer, Niraparib and Rucaparib have also been approved for ovarian cancer. The US NCCN guidelines recommend PARP inhibitors as maintenance treatment after effective chemotherapy for platinum-sensitive recurrent ovarian cancer, effectively improving the survival benefit of patients with platinum-sensitive recurrent ovarian cancer, and reducing the risk of disease progression or death. Especially patients with platinum-sensitive recurrent ovarian cancer with BRCA mutations benefit more. The safety of PARP inhibitors is good. Most patients can be treated continuously. The adverse reactions are mild and the clinical treatment is easy. In addition, after PARP inhibitors have progressed in treating tumors, chemotherapy can be selected again based on the patient's condition. Existing research shows that the progress of taking PARP inhibitors has not affected the efficacy of re-chemotherapy. Immunotherapy is mainly immune checkpoint inhibitors, including PD-1 / PD-L1 inhibitors and CTLA-4 inhibitors. Current research shows that the effectiveness of a single drug is about 10%, and the efficacy of combining with other drugs needs further study.

5. Radiotherapy

The radiosensitivity of ovarian malignant tumors varies greatly. Ovarian endodermal sinus tumor, immature teratoma, and embryo cancer are the least sensitive. Epithelial ovarian cancer is moderately sensitive. Asexual cell tumors are the most sensitive. However, due to the good effect of chemotherapy and the side effects of abdominal and pelvic radiotherapy, radiotherapy has been rarely used for the initial treatment of ovarian malignant tumors.

Malignant ovarian tumor prevention

1. Regular physical examination, such as blood CA125, transvaginal ultrasound, etc.

2. Oral contraceptives.

3. Correctly deal with pelvic mass.

4. Preventive ovarian salpingectomy: For carriers of germline mutations in the BRCA gene without fertility requirements, preventative surgery may be considered after consultation with a gynecological oncologist.