Malignant epithelial tumors make up 23-25% and are true ovarian cancer. It is customary to distinguish between primary and secondary ovarian cancer. Mostly malignant epithelial tumors of the ovary are secondary, i.e. arise from previous benign or borderline cysts or cysts. More often, malignant growth occurs in serous papillary, less often – mucinous cysts. Primary ovarian cancer accounts for 4-5% of malignant tumors and arises from the elements of the ovary without previous benign neoplasms. A tumor is malignant from the very beginning. Occupying the 3rd place in the incidence among gynecological oncology, ovarian cancer is the leading cause of death in this category of patients. About 200,000 new cases of ovarian cancer are registered annually in the world, and more than 120,000 women die from the progression of the disease. In Russia in 2006, 12,556 newly ill and 7,661 deaths were registered. The standardized incidence rate for 2004 was 11.0 per 100,000 female population, and mortality – 6.0. The incidence of ovarian cancer is increasing by 1.5% annually. Over the past 10 years, the increase in incidence in Russia amounted to 11.9%. The peak incidence is observed between 60 and 70 years. In recent years, the alarming fact of a peak shift by 10 years or more ago has been noted.
Metastasis of ovarian malignant tumors
With metastasis of malignant neoplasms of the ovary, a clear staging does not exist. There are three main pathways for the spread of the tumor: implantation, lymphogenous and hematogenous. The histological form of the tumor mainly determines the pathways of metastasis: for example, implant spread is more typical for epithelial neoplasias, and lymphogenous for germinogenic ones. The frequency of metastasis also depends on the degree of tumor differentiation.
In most cases of malignant course of ovarian epithelial tumors, dissemination occurs by exfoliation of tumor cells from the surface of the affected ovarian tissue with a flow of intraperitoneal fluid throughout the abdominal cavity, affecting the parietal and visceral peritoneum. Ovarian cancer is figuratively called “abdominal disease.” In addition, omentum is a favorite place for ovarian cancer metastasis. Even with stage I, in the absence of macroscopic changes, in 18-20% of patients revealed micrometastases in the greater omentum, and therefore it must be removed even with stage I of the disease. Lymphatic metastases are more common with already common ovarian cancer. However, 10-25% of patients with localized forms of the disease may have metastases in the retroperitoneal lymph nodes. In the pelvic lymph nodes metastasis occurs through the broad ligament and parametrium, in the inguinal – through the round ligament. Metastases in the pelvic lymph nodes are observed in 78% of patients with stage III ovarian cancer. Lumbar lymph nodes are affected in stage I – in 18%, II – 20%, III – 42% and IV – 67% of cases. One of the usual foci of ovarian cancer metastasis is the navel.
Clinic of malignant epithelial ovarian tumors
In ovarian cancer, progression occurs mainly due to dissemination in the peritoneum. This explains the asymptomatic course of the disease in the early stages. Even in the presence of dissemination of malignant epithelial tumors in the abdominal cavity, the clinic of the disease has an erased character, expressed in “discomfort” from the gastrointestinal tract, an increase in the abdomen in volume due to ascites. About 70% of patients with ovarian cancer at the time of diagnosis are stage III or IV of the disease.
Due to the mechanical action of the tumor on the surrounding organs, dull aching pains appear in the lower abdomen, which are constant, but can also stop for a certain period. Sometimes there is a feeling of fullness in the stomach. In cases of torsion of the legs of the tumor or a violation of the integrity of its capsule, pain occurs suddenly and may be of an “acute” nature. With advanced forms of ovarian cancer, the upper half of the pelvis is partially or completely filled with a conglomerate of tumor nodes, an enlarged , tumor-modified omentum is palpated , metastases to the navel, along the peritoneum of the posterior uterine rectal cavity.
When the process spreads to the uterus and fallopian tubes, spotting appears.