1. How to detect ovarian health problems at an early stage? Ovarian cancer is so talked about that many people even avoid mentioning it intentionally or unintentionally. However, it is not advisable to adopt such an attitude like “ostrich policy”. It is better to know the signs and tests related to ovarian cancer and face it instead of avoiding it. The so-called “triad of ovarian cancer” may be a warning sign for early diagnosis ① Age 40-60 is a high-risk age group for ovarian cancer, so it is necessary for women in this age group to receive regular gynecological checkups. ②A history of ovarian dysfunction with a longer period of dysfunctional ovarian balance, such as PMS, excessive menstruation, breast tenderness, multiple spontaneous abortions, infertility, and premature menopause, seems to imply that the ovaries are like an off-center cam, and various disorders may occur at any time. (iii) Indefinable abdominal discomfort and some kind of persistent digestive symptoms such as loss of appetite and bloating, especially after eating. Paying attention to these early signals and regular checkups are the key to early detection of cancer. 3. Factors of ovarian tumor Some patients are confused, menopause means the loss of ovarian function. The answer is yes. Some people have said that the ovaries can lose their function because of old age, but they will not get tumor because of old age. In fact, as we age, the chance of tumor development in ovaries increases accordingly. The reasons for this may be related to the following factors: ①Tumors have a latent period, and most of them are a gradual development process, and only develop into symptomatic tumors at a certain time. ②The immunity of the body. Tumors are caused by the malignant transformation of own cells. Occasionally, abnormal cells appear in normal human body, but the immune system of the body can capture them and kill them in the cradle. In postmenopausal women, the immunity of the body gradually declines, and the immune surveillance and elimination of the abnormal cells occasionally appear in the body are lacking, so that the abnormal cells can grow unrestrictedly. (3) Long-term stimulation by undesirable factors, each ovulation, causes different degrees of damage to the ovarian epithelium, and during each repair process, abnormal cells may appear, and when they accumulate to a certain degree, together with the decline of the body’s immunity, they may develop into cancer. In fact, although women of any age can develop ovarian cancer, most ovarian cancers occur in women between the ages of 40 and 60, i.e., around the time of menopause, an age group considered to be at high risk for ovarian epithelial cancer. Moreover, once postmenopausal women develop ovarian cancer, their prognosis is often less favorable than that of younger patients, and they are less tolerant of surgery and chemotherapy. Therefore, even though they are old and menopausal, they should have regular gynecological checkups and should not take it lightly. 4. Can girls who have not yet had their first menstrual period also get ovarian cancer? The answer is also yes. Fortunately, the number of ovarian tumors that occur in children is relatively small, accounting for only 4% of all ovarian tumors. Although the incidence of ovarian tumors in young children and adolescent girls is low, the malignant rate is about 50%, and because they are in the growth and development period, they are more dangerous. Unlike epithelial carcinoma, which is common in postmenopausal women, ovarian tumors in young children and adolescent girls are mainly germ cell tumors with a higher malignant ratio, including endodermal sinus tumors, immature teratomas, asexual cell tumors, and non-pregnant choriocarcinoma of the ovary. Malignant tumors in childhood have a common feature, namely, high malignancy, rapid development, and not easy to be diagnosed early. The management of ovarian tumors in childhood has its special problems because any of the treatment modalities may have permanent effects on immature children. Immature tissues in children are sensitive to radiation damage and less tolerant of radiation therapy, so the dose of radiation therapy must be reduced. Moreover, radiotherapy has been gradually replaced by chemotherapy as powerful chemotherapy regimens are already available for germ cell tumors. When treating with surgical modalities, the issue of preservation of reproductive function should be considered, i.e., removal of the primary tumor and metastatic tumors while preserving the uterus and normal ovaries. Due to the development of understanding of malignant germ cell tumors (e.g., recognition of the reversal of the malignancy of immature teratomas) and the emergence of powerful chemotherapy regimens, ovarian malignant germ cell tumors are expected to be the first ovarian malignancies to be overcome. 5.Reference factors for the severity of symptoms of ovarian cancer patients. Ovarian cancer has no conscious symptoms in the early stage, and when symptoms appear, it is often in the late stage. Due to the rapid growth of tumor, there may be abdominal distension, abdominal mass and ascites within a short period of time. The severity of symptoms of ovarian cancer patients depends on: ① the size, location and degree of invasion of adjacent organs; ② the histological type of tumor; ③ the presence of complications. If the tumor infiltrates into the surrounding tissues or compresses nerves, it may cause abdominal pain, lumbago or lower limb pain; if it compresses pelvic veins, lower limb edema may appear; if it is a functional tumor, it may produce corresponding symptoms of excessive estrogen or androgen; in advanced stage, patients show obvious emaciation, severe anemia and other cachectic phenomena. In most cases, the discovery of pelvic mass is accidental, and 50%-70% of patients feel it by themselves, but the tumor is at least 10 cm in size by then. Regular gynecologic examinations are likely to detect smaller masses. Occasional pain and discomfort usually do not attract enough attention from patients, and only when complications occur, such as tumor torsion or rupture, will the problem be exposed. Ascites, especially bloody ascites with positive tumor cells is a sign of advanced ovarian cancer; vaginal bleeding in young girls before menarche or postmenopausal bleeding should be given enough attention. 6.Can ovarian cancer be screened like cervical cancer? Unfortunately, the current screening methods are not yet mature. Cervical cancer can have symptoms (contact bleeding) at an early stage, and it is easy to be exposed during examination, so cervical cancer screening is easy to perform, so it is easy to be detected and treated early. Ovarian cancer, on the other hand, cannot be directly observed because the ovaries are deep in the pelvic cavity and their own volume is very small, so there is a lot of room for development and there are no symptoms in early stage. 7.Some methods that can be applied for ovarian cancer screening ①Double examination (vaginal and abdominal examination) and triple examination (vaginal, rectal and abdominal examination) are important gynecological examinations: it can even be said to be an extra gift from nature to women. Although the results sometimes vary greatly from doctor to doctor, the method is easy and inexpensive. ② Ultrasound: There are two types of ultrasound: transabdominal and transvaginal, with the latter being more sensitive to ovarian tumors. Experienced ultrasound physicians can achieve a diagnostic compliance rate of over 90%. However, sometimes it is still difficult to judge the benignity and malignancy, and it is not easy to detect solid tumors less than 2 cm in diameter. Nowadays, color Doppler scans can also be done to determine the blood flow of ovarian masses to aid in the diagnosis. Computerized body layer scan and MRI are still too expensive as screening tools. (iii) Tumor markers: 80% of ovarian epithelial cancers may have elevated CA125. Chorionic gonadotropin and methemoglobin are tumor markers for germ cell tumors. ④Laparoscopy: laparoscopy is valuable for those who have long-term gastrointestinal symptoms and cannot be detected by internal examination, but have risk factors for ovarian cancer. At the national level, it is neither economical nor practical to screen the general population for ovarian cancer. However, from an individual perspective, because of the self-evident life-threatening nature of ovarian cancer and one’s increasing financial capacity, even costly screening may be worthwhile, especially for those with high-risk factors. Once again, we need to emphasize the importance of regular gynecological checkups and change the practice and concept of “going to the hospital only when there is a disease” so that targeted examinations can be done when traces are detected, early detection and early treatment.