The presence of a tumor-like formation in the area of the uterine appendages is the main sign of the disease. In the first stage of the disease, a cancerous tumor (unilateral) resembles a cyst – it is round, mobile, painless, and has a tight-elastic consistency. On the incision of a removed cystoma, limited cancerous areas can be found on the inner surface of the capsule (papillary growths with necrobiosis, the contents of a cavity of dark or amber color.
More often the tumor is localized in the rectal uterine cavity and it is easy to detect with rectal-vaginal or rectal examination. In advanced cases (III stage) ovarian cancer tumor usually shrouds and lifts a body of the uterus, the uterus pushing anteriorly almost under pubic symphysis.
often, uterine body presents t it is as if walled up with a bilateral ovarian tumor and does not separately contour.At the same time, the data of the vaginal examination simulate uterine fibroids.In
advanced stages of ovarian cancer, the tumor is of a significant size, goes beyond the small pelvis, with a tuberous surface, uneven consistency, consists of several irregularly shaped nodes, occupying the lower pole of the recto-uterine cavity with protrusion of the posterior fornix of the vagina, the upper pole of the tumor extends beyond the small pelvis. The tumor conglomerate is motionless, often soldered to the pelvic wall. In the III and IV stages of the disease, 80% of patients in the abdominal cavity have ascitic fluid. This often indicates a neglected, disseminated peritoneal form of cancer.
With ovarian cancer, an increase in body temperature to 37.5-38 ° C is often observed. The body temperature is of an irregular nature (subfebrile with a single increase). Such temperature jumps are caused by the absorption of tumor decay products. The well-being of patients, despite an elevated temperature, is usually satisfactory. At the same time, ESR is of great diagnostic value, which, as a rule, is accelerated in the initial stages of the disease (more than 30 mm / h).
Characteristically, the absence of severe pain in the pelvic area and leukocytosis. Anemia may be noted.
The following research methods are important in the diagnosis of ovarian cancer: bi-contrast metrosalpingography, ultrasound scanning of the pelvic organs, radioisotope diagnostics (administration of radioactive phosphorus – P32), x-ray of the lower intestine (irrigography), puncture biopsy of the tumor nodes through the posterior vaginal fornix. In the presence of ascitic fluid and the need for its evacuation, it is recommended to conduct a microscopic cytological examination of the centrifuged sediment. Usually in the sediment there are a large number of atypical cells and scraps of tissue that can indicate not only nature, but also the structure of neoplasms.
A particularly important differential diagnostic method is radiography and tomography of the pelvic organs in conditions of pneumoperitoneum. This allows us to differentiate ovarian neoplasms from uterine fibroids and inflammatory lesions of the appendages.
Using lymphography, you can determine the degree of spread of the tumor into the lymph nodes.
Endoscopic research methods are also important. Bladder cystoscopy should be widely used to exclude tumor invasion into the bladder. Sigmoidoscopy allows in many cases to differentiate an ovarian tumor from a tumor of the rectum and sigmoid colon. Laparoscopy and culdoscopy (celioscopy) can be successfully used to detect earlier stages of ovarian cancer, as well as for differential diagnostic purposes (biopsy is possible).
As a final step in the diagnosis of some patients with suspected ovarian tumor, diagnostic gluttony is indicated. At the same time, it is possible to detect cancer in the early stages, as well as to conduct an urgent histological examination (express histology) of a piece of tissue taken from the most suspicious area of the tumor. In most cases, a definitive diagnosis of ovarian cancer is made by gluttony. Unfortunately, up to 60-70% of patients receive treatment with advanced forms of ovarian cancer.