Symptoms of advanced ovarian cancer
Cancer nodes can compress the colon and block its lumen, causing intestinal obstruction, a fatal condition that requires urgent medical assistance.
With a large tumor conglomerate, the condition worsens, intoxication increases, and gastrointestinal compression leads to progressive weight loss and weakness, aggravated by regular constipation and respiratory disorders due to restriction in the movements of the diaphragm, which is the respiratory muscle.
Metastases in the inguinal nodes occur infrequently, but tumor conglomerates are localized in the neurovascular bundle area, which causes such a symptom as constant pain.
An expansion of the cancer conglomerate in the lesser pelvis disrupts venous outflow from the lower extremities, which causes their swelling.
Diagnostics of ovarian cancer is by no means easier nowadays, and the main question whether the process is benign or malignant is clarified only by histological examination of a neoplasm fragment removed during an operation or taken at diagnostic laparoscopy.
Why ovarian cancer is rarely detected at an early stage
Screening involves diagnostics of a malignant process which is early and not yet manifested by clinical symptoms. If the condition can be detected not at stage III, but at stage I, then even the minimum treatment will allow the patient to live 3.5 years longer, and with adequate oncological care, the five-year life expectancy will be ensured for 9 patients out of 10, and not just for 2, as is the case with the lately detected tumor process.
Neoplasm diagnostics in the anatomical zone which is inaccessible to observation is difficult, moreover, science cannot specify benign precancerous processes that precede tumor development. Another unknown factor is how long it will take for a small cancer to become advanced. There is an assumption that the condition initially arises from a variety of sites and becomes stage III in an instant. On the other hand, it is believed that ovarian formations grow so slowly that for most people do not have time enough to manifest.
Diagnostics of early ovarian cancer
Two screening examinations are currently recommended: determination of CA-125 marker level and transvaginal ultrasound examination with a special sensor inserted into the vagina.
The marker can also increase in healthy women who smoke and have undergone hysterectomy, and with a small ovarian tumor, only every second woman at most has an increase in its level. An ultrasound scan reveals three out of four small ovarian tissue lesions, overlooking the fourth one.
We still do not have a sufficiently sensitive and inexpensive diagnostic technique that can be used to monitor the state of the reproductive glands with 100% accuracy. But even worse, the widespread introduction of screening did not affect the final result at all, patients did not begin to live longer. There is only one way out, identification of a malignant ovarian tumor requires to regular gynecologist monitoring and examination by the individual program.
Standard diagnostics of ovarian cancer before treatment
The final diagnosis of ovarian cancer is established only by morphology, through microscopic examination of the tumor tissue. Prior to that, there will be only «suspected cancer».
In this situation, an ultrasound scan with a special vaginal sensor will show the spreading of cancer in the lesser pelvis, the true condition of the abdominal cavity will be revealed only during the operation. A CT scan with contrast enhancement has a better sensitivity and is certainly preferable to transvaginal ultrasound, but does not preclude an ultrasound scan for the convenience of further observation.
A colonoscopy is always performed before surgery, because tumor nodes in the abdominal cavity can compress and invade the colon.
For women after 40 years of age, AFP and chorionic gonadotropin markers are tested for the differential diagnostics of cancer and germ cell ovarian neoplasm, and inhibin is determined to exclude sarcomatous growth.
The compulsory menu of primary diagnostics of the process spreading includes ultrasound examination of the lymph nodes, mammography to exclude breast cancer with metastases in the ovaries, and chest radiography.
Cancer diagnostics by marker
The increase in CA-125 depends on the condition stage; if at the beginning of the malignant process development less than half of the patients show an increase in its level, it almost always increases at stage IV, when there are already distant metastases outside the abdominal cavity.
The cellular structure of the tumor also affects the level of CA-125. Thus, with serous cancer, the increase is more common than with other options: endometrioid, clear-cell and mucinous carcinoma. The marker is age-sensitive: the older the woman, the more reliable the result, false negative tests being frequent in young women.
Normally, CA-125 increases during menstruation and in the first half of pregnancy, with smoking and obesity, benign processes of the reproductive organs and inflammatory conditions of gynecological organs.
Therefore, today CA-125 is used not so much for the initial diagnosis, but for monitoring the course of an already established and treated ovarian cancer, helping to assess treatment effectiveness and relapse development.
Surgical treatment of ovarian cancer
The disease is so sensitive to drug treatment that it is impossible to talk about a cure without surgery. In all stages except IV, surgery is necessary even if it is impossible to remove the entire tumor. Ovarian cancer has a unique feature that is completely unacceptable for all other malignant tumors. It is possible to remove part of the tumor leaving what cannot technically be deleted, and it will not cause a process progression.
At the first stage, a cytoreductive operation is performed, in which everything possible is removed. If nodes remain, it is desirable for the remainder to be no greater than a centimeter. The less tumor amount remains for chemotherapy, the second stage, the better the final result.