What Are the Treatments for an Ovarian Neoplasm?

Ovarian tumors are tumors that occur on the ovary. It is one of the common tumors of female genitalia. Ovarian malignancy is also the tumor with the highest mortality among gynecological malignancies. Although great progress has been made in basic research and clinical diagnosis and treatment of ovarian malignant tumors in recent years, it is unfortunate that the 5-year survival rate is still not significantly improved.

Basic Information

Visiting department

Obstetrics and Gynecology

Multiple groups

Women who have early menarche, late menopause, and no delivery

Common locations

Ovary

Common symptoms

Lower abdomen sinking or pain, abdominal mass, ascites, weakness, fever, loss of appetite

Contagious

no

Causes of Ovarian Cancer

Body factor

Ovarianoma has a high incidence in women who have early menarche, late menopause, and non-birth, and the number of childbirths is high. Women who are breast-feeding and taking oral contraceptives have a reduced risk of disease. This "continuous ovulation" carcinogenesis theory believes that ovulation causes damage to ovarian epithelial cells, and repeated damage and repair processes promote canceration.

2. Genetic factors

It is one of the more etiological factors studied in recent years, and most cases are caused by autosomal dominant inheritance.

Clinical manifestations of ovarian tumors

Benign tumor

Smaller masses generally do not cause symptoms, and occasionally the affected side may sink or feel pain in the lower abdomen. Can clearly touch the abdominal mass, smooth surface, no tenderness, cystic sex. Most benign tumors have a long pedicle formed by the fallopian tube. Because the tumor is more non-adhesive to the surrounding tissue, it has greater mobility, and the mass can often be moved from the lower abdomen side to the upper abdomen.

Malignant tumor

It grows rapidly, the mass is irregular, there is no mobility, and it can be accompanied by ascites, and systemic symptoms such as weakness, fever, and loss of appetite appear in a short time.

3. Functional ovarian tumors

Such as granulosa cell tumors, due to the production of large amounts of estrogen, can cause symptoms of precocious puberty. Female characteristics such as physique, breast, and external genitalia develop rapidly, and menstruation occurs, but ovulation does not occur. Bone development can exceed the normal range. Estrogen increases in urine, while gonadotropin in urine also rises, exceeding the general rule to reach human level.

4. Other

Medium-sized, long pedicled ovarian masses (including retention ovarian cysts) can cause tumor and pedicle torsion. Once reversed, bleeding and necrosis can occur, clinical manifestations of acute abdomen, abdominal pain, nausea or vomiting, abdominal muscle tension at the tumor site during examination, tenderness is obvious, may have increased body temperature and increased white blood cell count. When the tumor is large, compressing adjacent organs can cause difficulty in urination and defecation.

Ovarian tumor examination

Ascites cytology

A puncture of the popliteal fossa of the lower abdomen can be performed through the posterior fornix if there is less ascites.

2. Determination of tumor markers

(1) CA125 has important reference value for the diagnosis of epithelial ovarian cancer, especially serous cystadenocarcinoma, followed by endometrioid carcinoma. The detection rate of serous cystadenocarcinoma is more than 80%, and the CA125 level of more than 90% increases and decreases with the remission or deterioration of the disease, so it can also be used as monitoring after treatment. Clinically, CA12535U / ml is the positive standard. CA125 is not specific. CA125 values of some non-gynecological non-malignant diseases such as acute pelvic inflammatory disease, endometriosis, pelvic abdominal tuberculosis, ovarian cysts, uterine fibroids, and some non-gynecological diseases also increase.

(2) AFP has specific value for ovarian endodermal sinus tumor. Endometrial sinus tumor-containing mixed tumors, asexual cell tumors and embryo tumors, some immature teratomas may also be elevated. AFP can be an important marker before and after treatment and follow-up of germ cell tumor. Normal value is <29µg / L.

(3) HCG in patients with germ cell tumor of HCG primary ovarian cancer component is abnormally elevated in blood, and the HCG value of serum B subunit of normal non-pregnant women is negative or <3.1mg / ml.

(4) CEA Some advanced ovarian malignancies, especially mucinous cystadenocarcinoma, have abnormally high CEA. It is not a specific antigen for ovarian tumors.

(5) LDH is elevated in serum of some ovarian malignant tumors, especially asexual cell tumors are often elevated, but it is not a specific indicator of ovarian tumors.

(6) Sex hormones Granulosa cell tumors and follicular membrane tumors can produce higher levels of estrogen; when luteinized, testosterone can also be secreted. Serous, myxoid, or fibroepithelial tumors can sometimes also secrete a certain amount of estrogen.

3. Flow Cytometry Cell DNA Determination

The flow cytometry (Fcm) method uses a flow cytometer to analyze the DNA map to understand the tumor DNA content. The DNA content of ovarian malignant tumors is related to the histological classification, classification, clinical stage, recurrence and survival rate of the tumor.

4. Imaging examination

(1) Ultrasound is an important method for diagnosing ovarian tumors. Can determine tumor size, location, texture, relationship with the uterus, and the presence or absence of ascites.

(2) CT and MRI examinations have certain value in judging the relationship between tumor size, texture, and various pelvic organs, especially the enlargement of pelvic and para-aortic lymph nodes.

(3) Lymphangiography can show iliac vessels and para-aortic lymph nodes and metastatic signs, provide preoperative evaluation and preparation for lymph node dissection.

5. Other

(1) Gastroscopy and colonoscopy To identify ovarian metastatic cancer with primary gastrointestinal cancer.

(2) Intravenous pyelography Understand the secretory and excretory functions of the kidney, urinary tract compression and obstruction symptoms.

(3) Radioimmunoimaging. Radionuclide-labeled antibodies were used as tumor-positive imaging agents for tumor localization diagnosis.

(4) Laparoscopy For pelvic masses that are difficult to characterize clinically, patients with ascites receive a biopsy by laparoscopy and take ascites for qualitative and preliminary clinical staging of pathology and cytology.

Ovarian tumor diagnosis

Clinical diagnosis

Mainly rely on clinical signs, such as patients feel abdominal distension, constipation, frequent urination, and consciously have a mass in the abdomen. Some tumors can cause precocious puberty, postmenopausal bleeding, virilization, and so on. A gynecological examination should be performed first. If the cystic or parenchymal cystic or parenchymal mass in one or both sides and other pelvic abnormalities are diagnosed, various methods should be used to confirm the diagnosis.

2. Ultrasound

It can help locate pelvic or abdominal tumors with an accuracy rate of more than 90%; distinguish cystic or solid tumors, uterus or accessories; identify ovarian tumors, ascites or encapsulated effusion.

3. Cytological diagnosis

Ovarian tumors with ascites can be used for ascites puncture to check cancer cells. The vaginal posterior fornix smear has a low positive rate for detecting cancer cells, but it is completely harmless to the patient, so it may be a diagnostic method. In some ovarian tumors, the secretion of estrogen, especially in postmenopausal smears, has a high effect on estrogen, which can assist diagnosis.

4.X-ray inspection

Teeth, bones and transparent shadows can be seen on plain abdominal films of mature teratomas. X-ray films of papillary cystadenoma showed calcification. Bowel angiography can rule out bowel tumors and help understand the location of the mass. Pneumoperitoneum and hysterosalpingography can also help to identify the source of pelvic masses.

5. Laparoscopy

Under endoscopic direct vision, it is possible to make a clear diagnosis early, do a biopsy, determine the nature of the tumor, the extent of invasion, assist in staging and observe the effect of chemotherapy, etc., and have certain value in judging the prognosis and guiding treatment.

6. Hormone determination

Elevated levels of estrogen in blood and urine were found in patients with feminized tumors, and 17-hydroxy and 17-ketosteroids in urine were increased in patients with virilized tumors. If there is ovarian chorionic carcinoma, the amount of chorionic gonadotropin in blood and urine is increased.

7. Lymphography

Can be used as one of the estimated staging methods for malignant tumors.

8. Immune diagnosis

Biochemical diagnosis and chromosome examination are still experimental studies, and there is a certain distance from clinical application but it is the direction of development.

Ovarian Cancer Treatment

Surgical treatment

(1) Fully determined staging laparotomy

(2) Re-staging surgery refers to the fact that the first surgery has not been performed in exact stages. Comprehensive investigation and accurate staging were also performed without medication.

(3) The tumor cytoreductive surgery makes every effort to remove the primary lesion and all metastatic tumors, so that the diameter of the residual tumor is less than 2 cm. The degree of initial surgery directly affects the effectiveness and survival of chemotherapy.

(4) "Intermediate" or interval tumor cytoreductive surgery. It is estimated that some advanced ovarian cancers are difficult to remove. First, chemotherapy should be performed with several courses (less than 6 courses of incomplete therapy) before tumor cytoreductive surgery. . It may make the cytoreductive surgery easy, but it is not good for postoperative chemotherapy, and we should strive for cytoreductive surgery first. For those with large tumors and fixed tumors with a large amount of ascites, 1 to 2 courses of chemotherapy are performed first, which is called early chemotherapy, which reduces ascites, reduces tumor mass, and loosens, which can improve the quality of surgery.

(5) Re-tumor cytoreductive surgery refers to surgery for residual tumors or relapsed tumors, but if there are no effective second-line chemotherapy drugs, this surgery is of limited value.

(6) Secondary exploration refers to at least 6 courses of chemotherapy within 1 year after ideal tumor cell depletion. There is no tumor recurrence after clinical physical examination and auxiliary or laboratory testing (including tumor markers such as CA125). The evidence seeker again.

2. chemotherapy

(1) Indication chemotherapy is an important treatment for advanced ovarian cancer, which must be timely, sufficient and standardized. Chemotherapy is the guarantee of the efficacy of surgery, and two methods are indispensable. Except for A well-differentiated tumors, ovarian malignant tumors should be adjuvant chemotherapy for patients with stage IB and above stage IB. Chemotherapy should also be considered for stage IA pathology grade 3 (G3). The curative effect of chemotherapy is related to the size of the residual tumor in the primary cytoreductive surgery. The smaller the residual tumor, the better the effect.

(2) Commonly used chemotherapeutic drugs melphalan (L-PAM), cyclophosphamide (CTX), ifosamide (IFO), thiotepas (TSPA), hexamethamine (HMM), doxorubicin (Arabic (Mycin), fluorouracil (5-Fu), methotrexate (MTX), cisplatin (DDP), carboplatin (CBP), paclitaxel (Taxol), actinomycin D (dactinomycin), Bleomycin (BLM), tobuteken (TPT), vincristine (VCR), etoposide (Vetoside, Vp-16), nitrocarb (antitumor mustard, CLB).

(3) There are many commonly used chemotherapy regimens for ovarian cancer. Different regimens should be selected according to the pathological type of the tumor. It is generally considered that combined chemotherapy is better than single-agent chemotherapy, and usually combined chemotherapy is used: DDP-based combined chemotherapy has been widely used to treat ovarian cancer, and its total effective rate is 70% to 80%, 40% to 50% Clinical complete remission (CR) was achieved, and 25% of them survived for more than 5 years. Epithelial cancer currently uses the PAC regimen and the PC regimen as the first-line standard chemotherapy regimen, while the TP regimen used in Europe and the United States for advanced ovarian cancer has the highest effective rate.

(4) Chemotherapy and duration chemotherapy should be based on systemic chemotherapy (intravenous or oral). It can also be combined with intraperitoneal chemotherapy and arterial intubation chemotherapy or interventional chemotherapy.