Ovarian cancer is a malignant tumor that occurs in the ovaries. Among the common malignant tumors of female reproductive organs, ovarian cancer ranks third in incidence after cervical cancer and uterine corpus cancer. Because the ovary is located in the pelvic cavity, the disease is insidious and can easily spread and metastasize in the abdominal cavity, 70% to 80% of the first diagnosed ovarian cancer patients can achieve certain curative effect, but the recurrence rate is high. Therefore, compared with other gynecologic tumors, the incidence of ovarian cancer is high, and 80% of patients are already in advanced stages (stage III and IV) when they are diagnosed.
There are many types of ovarian cancer, which can be classified according to the histological origin of the ovaries during the embryonic period. The ovary has its own developmental peculiarities and is composed of cells with multiple functional structures and components, each of which can develop tumors. Twenty to thirty types of tumors can occur in the ovary, the most common being those of epithelial origin on the ovarian surface, which are often referred to as epithelial ovarian cancer.
High risk factors of ovarian cancer
1. Age factor: The incidence rate of ovarian cancer is significantly higher in women over 50 years old.
2. Dietary habits: The occurrence of ovarian cancer is related to unreasonable diet. High-fat diet is the biggest culprit, and the risk of ovarian cancer is significantly higher in the former compared to low-fat diet. In contrast, vegetables and fiber can significantly reduce the risk of ovarian cancer. A daily intake of 10g of vegetable fiber can reduce the risk of ovarian cancer by 37%. In addition, the risk of ovarian cancer can be increased due to excessive gonadotropin production. Increased intake of egg cholesterol also increases the risk of ovarian cancer. Daily intake of egg cholesterol over 100 mg can increase the risk of ovarian cancer by 42%.
Endocrine disorders: Ovulation is closely related to the occurrence of ovarian cancer because epithelial cells are continuously damaged during ovulation, and abnormal repair is inevitable in the process of regenerating cell division and repairing small wounds in the ovary, resulting in cell reproduction errors, which is a cancer-causing possibility. During pregnancy and lactation, the ovaries stop ovulating and take a temporary break from the uninterrupted monthly ovulation, which is a protective effect and reduces the risk of ovarian cancer. It is estimated that each pregnancy reduces the risk of ovarian cancer by 10%, so the risk of ovarian cancer is significantly increased in unmarried, late married, infertile, infertile, infertile, infertile, using ovulatory drugs, and not breastfeeding. The American College of Physicians study showed that the risk of ovarian cancer in infertile women taking ovulatory drugs such as clomiphene for more than 12 cycles was increased by 2 to 3 times. Another study has shown that hormone replacement therapy, which is now widely used, can increase the risk of ovarian cancer.
Family factors: Many studies have shown that family history of ovarian cancer is the most important risk factor for the development of ovarian cancer, and women with a family history of ovarian cancer have a 10% risk of developing ovarian cancer before the age of 70. Approximately 5-10% of ovarian cancer patients are genetically susceptible, and the risk of ovarian cancer in first-degree relatives with a family history of ovarian cancer is 50% higher than that of the general population. Current research shows that most familial ovarian cancers are related to embryonic mutations in genes, and women who carry ovarian cancer susceptibility genes have a 2-4 times higher lifetime risk of ovarian cancer than normal women.
Environmental pollution and bad mood: A lot of research data shows that the use of talcum powder near the genitals or exposure to radiation and smoking can increase the risk of ovarian cancer. In addition, abnormal emotion is also considered as a possible susceptibility factor: it manifests as repressed emotion, especially repressed anger, inability to express emotion, excessive restraint, tolerance, social compliance, avoidance of conflicts, etc. Such psychological conflicts can affect the endocrine and immune system of the body, which leads to the occurrence of ovarian cancer.
Symptoms of ovarian cancer
Early symptoms: 1. edema of vulva and lower limbs; 2. pain in the lower back and abdomen; 3. menorrhagia or amenorrhea; 4. gastrointestinal symptoms: if menopausal women often feel bloated and lose appetite, and no gastrointestinal disease is found after gastroenterological examination, they need to go to gynecology department for consultation. Because ovarian tumor will cause compression and pulling of the surrounding ligaments, coupled with the irritation of ascites, gastrointestinal symptoms will often appear; 5. Sex hormone disorders: The pathological types of ovarian cancer are complex and varied. Some tumors that secrete too much estrogen can cause precocious puberty, menstrual disorders or postmenopausal vaginal bleeding; in the case of testicular mother cell cancer, too much androgen will be produced and masculine signs will appear.
Gynecological diseases that are prone to cancer include cervical erosion, uterine fibroids, endometrial hyperplasia and vulvar pigmented nevus, and such people should be vigilant. Patients with related symptoms should choose a regular hospital to seek medical treatment as soon as possible. If it is inconvenient to come to the hospital, you can contact me by phone for specific communication, so as to make a comprehensive preparation for future visits to the hospital.
Screening of ovarian cancer
Effective screening can detect some early stage ovarian cancer and increase the cure rate of ovarian cancer. The 5-year survival rate of stage I ovarian cancer after treatment is 88%, while that of stage IV is only 18%, which is a huge difference. Since early-stage ovarian cancer does not have unique symptoms, early detection is mainly in the asymptomatic population.
Screening methods: 1) Gynecologic examination is economical and practical 2) Tumor markers assist in diagnosis 3) Imaging examinations: Imaging examinations include transabdominal ultrasound, transvaginal ultrasound, and x-ray examination 4) Preventive surgical intervention: Preventive oophorectomy can be considered for those with hereditary ovarian cancer syndrome. The National Cancer Institute has shown that preventive oophorectomy can reduce the incidence of ovarian cancer in high-risk relatives of families with hereditary ovarian cancer syndrome. Therefore, the decision to perform prophylactic oophorectomy before hysterectomy or other non-gynecologic dissection should be based on a combination of factors such as the patient’s age, risk factors and personal preference.
IV. Treatment
1.Surgical treatment
1.1 For early-stage ovarian cancer, the basic surgical procedure is total hysterectomy with both adnexa and greater omentum
1.2.Middle and late stage ovarian cancer The main surgical procedures for middle and late stage ovarian cancer are tumor cell reduction (tumor reduction) and intermediate tumor reduction (or interval tumor reduction).
2.Chemotherapy
At present, platinum compounds are proven to be the most effective drugs for the treatment of ovarian cancer, and paclitaxel combined with carboplatin is basically the standard first-line chemotherapy regimen.
2.2.Pelvic chemotherapy
2.3.Neoadjuvant chemotherapy
2.4.Consolidation therapy Hormonal drugs (e.g. tamoxifen) or immunotherapy (e.g. interferon) are used.
2.5.Recurrence treatment Platinum-resistant recurrent ovarian cancer is rarely effective for platinum-based secondary therapy, therefore, single agent or combination chemotherapy with different mechanisms of action should be selected as salvage therapy.
3.Other treatments
3.1. Targeted therapy Targeted therapy is a targeted treatment based on the characteristics of tumor tissues that are different from normal tissues. Currently, the main drugs for recurrent ovarian cancer in phase II clinical studies are gefitinib, cetuximab and trastuzumab.
3.2 Gene therapy At present, gene therapy vectors include liposomal, retroviral and adenoviral vector systems.
3.3.Immunotherapy Currently, there is an increasing research on how dendritic cells (DC) play an important role in tumor antigen presentation and tumor immunity, and recently DC vaccines have achieved good results in various anti-tumor experiments.
3.4.Endocrine therapy
3.5.TCM treatment Radiotherapy inhibits and kills tumor cells, but also destroys normal cells in the body, leading to a further decrease in the survival rate of ovarian cancer. In this process, the combination of Chinese medicine treatment can reduce various adverse reactions, and also can support the righteousness, protect the function of spleen and stomach, and improve the immunity of the body.
3.5.1 Combination of Chinese medicine with surgery, radiotherapy and chemotherapy
The combination of Chinese medicine and surgery can improve the general condition of patients, reduce the adverse reactions and complications of surgical trauma, and provide better conditions for post-surgical treatment, which is often used to benefit qi and nourish blood, regulate the spleen and stomach or supplement the innate nature and benefit the acquired nature.
The combination of Chinese medicine and radiotherapy can reduce the toxic side effects of radiotherapy and enhance the therapeutic effect of radiotherapy. For example, for the deficiency of Qi and Yin caused by radiotherapy, the main treatment is to benefit Qi and nourish Blood, nourish Yin and clear heat.
Combination of Chinese medicine and chemotherapy. For the decrease of blood picture, suppression of immune function and gastrointestinal reaction, and damage of liver and spleen function caused by chemotherapy, the method of tonifying Qi and nourishing blood, nourishing liver and kidney, and harmonizing spleen and stomach is often used. During chemotherapy, we can add drugs that harmonize the stomach and lower the rebellion, such as Chen Pi, Jiang Han Xia, Jiang Zhu Ru, to relieve nausea and vomiting and other symptoms of spleen disorders; after chemotherapy, the vital energy is greatly injured, the spleen and kidney are deficient, the qi and blood are weak, and the evil toxins are internalized, we can add drugs that dispel stasis and detoxify the blood, such as Red Vine, Rhubarb, and White Flowering Snake Tongue Herb, while tonifying the kidney and strengthening the spleen, benefiting the qi and nourishing the blood. Studies have shown that Chinese medicine can improve the efficacy of low concentration and small dose chemotherapy drugs, and greatly reduce the toxic side effects of chemotherapy drugs compared with previous high concentration and large dose chemotherapy alone, thus improving the degree of tolerance of chemotherapy patients to chemotherapy, significantly increasing the completion rate of chemotherapy, and reversing the resistance of tumor cells to cisplatin.
3.5.2. Simple Chinese medicine treatment
Chinese medicine treatment can improve symptoms, reduce pain, improve survival quality and prolong survival time (survival with cancer). The principle of treatment is to combine the treatment of correctness and elimination of evil, and to combine the treatment of disease identification and evidence identification. Chinese herbs for correctness, such as Astragalus, Fructus chasteensis, Fructus Lycii, Ginseng, Ganoderma lucidum and Xianling spleen, can enhance the immune function of patients and improve their general condition.
V. Prevention of ovarian cancer
Preventive ovariectomy People with genetic syndrome of ovarian cancer are the high-risk group of ovarian cancer. Preventive oophorectomy should be considered for this group.
Oral contraceptive pills can reduce the risk of ovarian cancer. According to the WHO report, the risk of ovarian cancer decreases by 30% to 60% for those who take the pill, and the risk decreases more significantly as the time of taking the pill increases. The risk decreases by 50% for those who have been taking the pill for more than 5 years. There are reports that ligation of fallopian tubes can also reduce the risk of ovarian cancer.
3. Diet
Recent studies have shown that daily intake of foods high in calcium can reduce the incidence of ovarian cancer. Dr. Goldman of the University of Hawaii analyzed the daily calcium intake of 588 women with ovarian cancer and 607 healthy women. It was found that women who consumed high-calcium foods daily reduced their risk of ovarian cancer by 46% compared to those who did not consume enough calcium. Foods rich in calcium: dairy and dairy products, beans and soy products, fish, shrimp, crab and seafood, vegetables such as celery, rape, carrots, radish tassels, sesame seeds and parsley, fruits and dried fruits such as lemon, loquat, apple, black dates, dried apricots, orange cake, dried peaches, almonds, hawthorn, raisins, pecans, watermelon seeds, pumpkin seeds, peanuts and lotus seeds.
Research shows that eating a lot of cruciferous vegetables and less animal food such as fats, eggs and meat can reduce the occurrence of hormone-dependent tumors. Cruciferous vegetables include cauliflower (cauliflower, kale, white cauliflower, cabbage, chard, etc.).
Increasing folic acid-rich foods may reduce the incidence of ovarian cancer in women. Folic acid is a water-soluble vitamin b, rich in green vegetables such as lettuce, spinach, bok choy, lobelia, rape, chard, lentils, citrus fruits and dried fruits, and whole grains.
Eat more carotenoid-rich foods, in addition to carrots, there are orange fruits and sweet potatoes, cantaloupe, pumpkin and so on. Eat foods high in vitamins, such as cauliflower, green peppers, kiwi, grape juice, tomatoes, melon seeds, sunflower seeds, walnuts, almonds, barley, etc.
Women who regularly eat fried eggs are at increased risk of ovarian cancer. This is because the process of frying eggs can lead to the formation of many biologically active decomposition products, which have a great cytotoxic effect, especially on the affinity of women’s ovarian tissues, which can become cancer and tumor triggering agents, increasing the possibility of ovarian cancer.
4.Psychological care: belief, mentality and care
Belief: Although the reality is cruel, it is important to vent out appropriately, recognize the reality as early as possible, actively understand the relevant knowledge, cancer is not equal to death, and enhance confidence in fighting against cancer.
Mindset: Research shows that a positive and optimistic mindset can enhance the immunity of the body, which not only helps to inhibit the growth of tumor, but also improves the quality of survival.
Care: Care and support from family members and mutual help and encouragement from friends can help patients come out from sadness, disappointment and despair and increase their confidence in overcoming the disease.
5.Lifestyle: Encourage breastfeeding and prolong breastfeeding time, which can reduce the chance of breast cancer and also prevent the occurrence of ovarian cancer. Avoid using sanitary products containing talcum powder, such as talcum powder, on the vulva and perineum. Avoid or reduce exposure to radiation, quit smoking, limit alcohol and other good lifestyle habits.