Ovarian cancer is a kind of malignant tumor of ovarian tumor, which refers to malignant tumor growing on ovary, 90%-95% of which is primary cancer of ovary, and the other 5%-10% is primary cancer of other parts metastasized to ovary. Because ovarian cancer lacks symptoms in the early stage, and even if there are symptoms, they are not specific, and the role of screening is limited, so early diagnosis is difficult, and 60% to 70% of the cases are already in advanced stage when they are diagnosed, and the treatment effect of advanced cases is poor. Therefore, although the incidence rate of ovarian cancer is lower than that of cervical cancer and endometrial cancer and ranks third among gynecological malignancies, the mortality rate exceeds that of cervical cancer and endometrial cancer combined, ranking first among gynecological cancers and is the biggest threat to women’s health.
Ultrasound examination
Ultrasound can clarify the size, location, shape, internal structure and source of tumor, and its diagnostic rate can reach 90%. The application of vaginal color flow Doppler ultrasound further improves the diagnostic accuracy.
Laparoscopy
It can directly see the pelvic and abdominal organs, clarify the presence or absence of tumor and the specific situation of tumor, the presence or absence of metastasis and the site of metastasis, combined with biopsy histopathological examination has the value of confirming the diagnosis, and can be clinically staged.
Radiological diagnosis
Abdominal plain radiography can show teeth and bone for ovarian mature teratoma. If isolated calcified foci in the pelvis are found, it indicates the presence of pelvic lymph node tuberculosis, which can be used as a basis for further differential diagnosis between ovarian cancer and tuberculosis. Gastrointestinal tract imaging and gastroscopy and enteroscopy can understand whether the pelvic mass is a metastatic cancer of the digestive tract. Lymphography can determine whether there is lymph node metastasis.
Differential diagnosis
The pelvic masses found may originate from the ovaries, or from other gynecological organs, or from the urinary or digestive tract, and may be benign or malignant, or may be other non-neoplastic masses, and it is necessary to differentiate them because of their different treatments.
Benign ovarian tumor
Medical history
Gradual growth with a long course is often asymptomatic
Rapidly growing, short duration of disease often has symptoms such as abdominal distension, abdominal discomfort, poor appetite and may appear as malignant mass.
Physical signs
unilateral more, mobile, smooth surface, generally without ascites.
Bilateral, fixed, solid or cystic, with uneven surface, often with ascites, and cancer cells can be found.
Ultrasound
well-defined margins of the mass, with a liquid dark area within, which may have interval light bands.
The circumference of the mass is unclear, and there are disorganized light spots and light clusters within the liquid dark area.
Tumor markers
Mostly negative or low value.
often positive with elevated levels.
Benign ovarian tumors and early ovarian cancer are sometimes difficult to distinguish preoperatively or even intraoperatively and require open abdominal exploration or pathology for a definitive diagnosis.
Acute abdominal pain caused by tumor
Generally, ovarian tumors mostly do not have acute abdominal pain, but sudden abdominal pain can occur in the following cases
Rupture
The incidence is about 3%, which can rupture spontaneously or by external pressure. The severity of symptoms depends on the nature of the cyst and the amount of cystic fluid flowing into the abdominal cavity. It may cause mild abdominal pain or severe abdominal pain, nausea, vomiting, sometimes leading to internal bleeding and shock. Examination may reveal rebound pain with abdominal pressure, and the original mass may not be palpable or may only be palpable as a deflated mass. Any suspected rupture of the mass should be immediately explored by abdominal dissection to remove the tumor and thoroughly clean the abdominal cavity.
Malignant transformation
Benign ovarian tumors can become malignant. If rapid growth of tumor or ascites is found, the possibility of malignancy should be considered and early surgery should be performed.
Treatment of benign tumors
Once diagnosed, ovarian tumors should be treated with early surgery. The scope of surgery depends on the patient’s age, whether she has fertility requirements and bilateral ovarian conditions. For patients with unilateral tumors of reproductive age, ovarian tumor debulking should be performed as far as possible. For women before and after menopause, total hysterectomy and bilateral adnexal resection are usually performed. During surgery, we should try to avoid rupture of the tumor, carefully distinguish the nature of the tumor, except for the possibility of malignancy, and send frozen sections for pathological examination if necessary. The operation can be open or trans-laparoscopic. Nowadays, laparoscopic surgery is mainly performed for benign tumors. For huge tumors, laparoscopic removal of the tumor is more difficult than open surgery.
Prognosis
The prognosis of ovarian cancer is related to clinical stage, histological type, pathological grading, treatment method and DNA content of tumor cells. With the improvement of surgical techniques and new chemotherapeutic drugs and chemotherapy regimens, the 5-year survival rate of ovarian cancer has been greatly improved, which can reach more than 90% for stage I, 70% to 80% for stage II, and 30% to 40% for stages III and IV.