Ovarian malignant tumors account for 23% of gynecologic malignant tumors, ranking second after cervical cancer, and occurring mostly at the age of 40-50. Ovarian cancer is mostly seen as epithelial tumor, and the metastatic route is mainly direct spread and abdominal implantation, lymphatic tract is also an important metastatic route, and hematogenous metastasis is rare.
Risk factors
1. The theory of “continuous ovulation” causes cancer, and some data report that ovarian cancer in women who have not had children has a higher incidence than that in women in general. Ovarian ovulation causes damage to epithelial cells, and in the process of repeated damage and repair, epithelial hyperplasia and cysts may appear and promote carcinogenesis.
Viral infection has been found to cause early ovarian damage to those who suffered from rubella before puberty, making the incidence of ovarian cancer higher than that of the general population. However, the incidence of ovarian cancer is reduced in people with a history of mumps.
3.Environmental pollution radiation damage, industrial pollution, high-fat diet, etc. can cause ovarian cancer, such as asbestos and talcum powder have been proved to be related to the development of ovarian cancer.
Genetic factors have a family history of 20%-25% of ovarian malignant tumor patients. It has been reported that most cases seem to be inherited by autosomal chromosomes. There are often three types of genetic conditions.
(1) Familial ovarian cancer syndrome: If a mother or sister has ovarian cancer, she is a high-risk group and has a higher risk of ovarian cancer than normal women.
(2) Breast-ovarian cancer syndrome: If a mother or sister has one or two types of cancer, the risk of ovarian cancer can be up to 50%.
(3) Coexistence with other malignant tumors: Those with a family history of cancer have an increased risk of ovarian cancer, endometrial cancer and breast cancer.
Abnormal manifestations
1. Lower abdominal discomfort or pelvic drop: it can be accompanied by poor gastric appetite, nausea, stomach discomfort and other symptoms. Most of the symptoms are caused by intestinal peristalsis and tumor traction during position change, especially pelvic discomfort is the most common after eating, which is its characteristic performance.
2. Frequent urination and lower abdominal pain: Most of them are late symptoms, which are caused by the tumor’s nearby organs being stretched or compressed, and the pain may radiate to the thigh, perineum or anus.
3.Sense of abdominal distension, abdominal enlargement and lumps: Even in early clinical stage, ovarian cancer may show ascites, or tumor growth beyond the pelvis, and lumps may be palpable in the abdomen. Patients may notice the thickening of abdominal circumference, tightening of trouser waist or discover the lump by themselves.
4.Tumor with endocrine function may cause excessive secretion of estrogen or androgen, which may lead to precocious puberty, irregular vaginal bleeding or postmenopausal vaginal bleeding, amenorrhea or masculinization.
5.Compression symptoms: If the mass is accompanied by ascites, besides abdominal distension, it may cause compression symptoms such as diaphragmatic elevation, which may cause difficulty in breathing, inability to lie down and palpitations, and increased intra-abdominal pressure, which may affect the venous return of lower limbs and cause edema of abdominal wall and lower limbs.
6.Lack of appetite, abdominal distension, emaciation, weakness, weight loss, etc.
7.The corresponding symptoms produced by cancer metastasis. Such as dry cough, hemoptysis, pleural fluid and dyspnea due to lung metastasis; bone metastasis can produce severe local pain with obvious local pressure points; intestinal metastasis can have deformation of stool, blood in stool and death due to irreversible intestinal obstruction in severe cases.
III. Prevention
1, the prevention of high-risk factors: avoid long-term use of hormones, women with estrogen replacement therapy before and after menopause should pay attention to the use of progestin, and strictly under the guidance of physicians. Middle-aged and elderly women should pay attention to proper physical exercise and avoid excessive obesity. Women with breast cancer, cervical cancer, irregular menstruation, endocrine disorders, hypertension and diabetes must have regular medical checkups.
2. Pay attention to screening: women over 30 years old should have an annual gynecological examination.
3.Women of childbearing age, if a lump is found in the pelvis, they should go to a specialist hospital for further investigation and identification of its benignity or malignancy. If ovarian masses are found during menopause and adolescence, they are generally more likely to be malignant and should be seen as soon as possible.
4. Prophylactic oophorectomy: When women over 50 years of age undergo hysterectomy for other reasons, bilateral oophorectomy should be performed at the same time.
5. Patients with moderate or severe endometrial atypical hyperplasia should be followed up closely and surgical treatment should be given to patients with severe atypical hyperplasia.
6. Patients with ovarian cancer who need to preserve one side of the adnexa for childbirth must have the opposite ovary and uterus removed as soon as possible after the completion of childbirth.
7. Be alert to unexplained abdominal discomfort and seek timely medical attention.
Danger signs
1.Vague lower abdominal discomfort, indigestion, abdominal flatulence or feeling full, especially pelvic discomfort after eating.
2. Endocrine disorders and the appearance of secondary sex characteristics.
3.Irregular vaginal bleeding, abnormal fluid discharge or abnormal leucorrhea during menopause.
4.Progressive enlargement of abdomen in women after excluding pregnancy.
5. Unnamed cause of ascites.
V. High-risk groups
1.Patients suffering from infertility, early onset menstruation and delayed menopause.
2. Those who use hormone replacement therapy.
3.Women who have cancer in their immediate family, especially ovarian cancer, breast cancer, endometrial cancer and colon cancer.
4. Physical examination requirements for high-risk groups of ovarian malignancy: physical examination every six months to a year, and for the general population, every two years. The contents of the physical examination items are as follows.
(1) Gynecological examination: Most pelvic masses and ovarian abnormalities can be detected through gynecological examination, but smaller masses or obese people are difficult to be detected through pelvic examination.
(2) Ultrasound: It is one of the economical, rapid and effective means to screen for pelvic masses. Transvaginal ultrasound is more accurate in showing abnormalities of the ovaries. CT examination is recommended when there is a high suspicion of ovarian malignancy and there is a lack of evidence or if economic conditions allow.
(3) Serum tumor antigen 125 (CA125) test: CA125 and other tumor markers can be useful for diagnosis when the nature of the ovarian mass is unknown.
(4) For those with family history, examination of BRCA1 (breast cancer oncogene) and BRCA2 can further screen for high-risk individuals in the family, but the positive rate of this test in patients with ovarian malignancy is only 5% to 10%.