Differential diagnosis of ovarian cancer

One of the main reasons for the neglect of ovarian cancer is its later detection as a result of the difficulty of diagnosis in the early stages of the disease. When first contacting a doctor, patients suffering from ovarian cancer are usually given a wide variety of diagnoses (ovarian cystomas, uterine fibromyoma, inflammatory process of the uterus appendages, etc.).
Before surgery, it is difficult to distinguish an ovarian cyst from ovarian cancer, especially in the early stages of the disease, when the tumor is mobile and one-sided. Nevertheless, signs such as rapid tumor growth, uneven consistency (tuberosity), limited mobility, signs of abdominal discomfort (aching pain, bloated intestines, impaired bowel function), increased ESR and anemia should alert the doctor.
The final step in the differential diagnosis between any ovarian tumor and a cancerous tumor is laparotomy.
Ovarian cancer is often mixed not only with a cyst, but also with uterine fibroids (25% of cases). The diagnosis of uterine fibroids is usually made in advanced stages of ovarian cancer, when the uterus is involved in a common conglomerate of tumors. However, in the study of uterine fibroids and ovarian cancer, there are clear differences. With fibromyoma, the tumor of the uterus is usually mobile, of dense consistency, has clear boundaries; rectal uterine depression, as a rule, free; palpation of the lower abdomen, muscle tension and soreness (cancerous peritonitis) is not observed; ascitic fluid is not detected; the tumor does not pass to the walls of the pelvis (with the exception of interconnected nodes); for the most part, a uterine tumor grows anteriorly, squeezing the bladder, deviates relatively rarely into the posterior vaginal fornix; Anemia (submucosal fibromyoma) often occurs with normal ESR. The appearance of a tumor during menopause, its rapid growth, a gradual increase in pain – all these are signs that are not characteristic of uterine fibroids. If differential diagnosis is so difficult that it is impossible to say with certainty that the tumor belongs to the uterus, then the final step in the diagnosis should be glancing. Often, the inflammatory process of the uterus is mixed with ovarian cancer. It must be remembered that the latter, as a rule, occurs at a young age, while ovarian cancer is more often in the elderly. The inflammatory process usually begins acutely (in the anamnesis), sharp pain, proceeds with high temperature, elevated ESR and leukocytosis, and the general condition is sharply disturbed. Ovarian cancer begins gradually, without sharp pain, without leukocytosis with an overall satisfactory condition. The most difficult differential diagnosis of ovarian cancer and chronic inflammation of the uterus. It must be remembered that in patients suffering from chronic inflammation of the uterine appendages, acute periods of the disease are noted in the anamnesis, the disease was acute at first, then it went into the chronic stage of the disease, and in menopause the inflammatory process calms down or disappears. Ovarian cancer, on the contrary, develops for the most part gradually, painful phenomena increase. However, in order not to miss a cancerous tumor, any tumor of the uterine appendages in the “cold” stage of the disease should be removed, even if it is asymptomatic and does not cause the patient to feel unwell. Ovarian cancer should also be differentiated from tuberculosis of the uterus. To exclude tuberculosis, immunobiological tests of Mantoux and Koch are performed. With tuberculosis of the appendages, these reactions are positive, with cancer, negative. As a rule, the diagnosis of tuberculosis of the uterus is established on the operating table or after histological examination of the removed tissue. For the purpose of an auxiliary diagnostic and prognostic test, N. S. Baksheev and A. A. Baksheeva recommend testing blood serum proteins, estrogen excretion, and serotonin levels in blood for ovarian cancer. With ovarian cancer, hypoproteinemia is observed, mainly due to a significant decrease in the level of albumin. Globulin functions change to a lesser extent, although their content in advanced stages of cancer is reduced. The degree of hypoproteinemia is more pronounced in ovarian cancer with ascites. Ovarian cancer proceeds against the background of overproduction of estrogen. According to N. S. Baksheev, the possibility of estrogen production by ovarian cancer cells is not ruled out. Patterns between the prevalence of the tumor process and the excretion of pregnandiol are not detected. Ovarian cancer is accompanied by increased production of ketosteroids, catecholamines and serotonin, as evidenced by their high content in the blood, especially in advanced stages

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