Ovarian cancer is a malignant tumor of epithelial origin. It makes up 80% of malignant tumors, 25-30% of all ovarian neoplasms (benign and malignant). Clinical forms of ovarian cancer: primary cancer that occurs primarily directly in the ovary; secondary, developing in the ovarian cystoma (cancerous degeneration of the cystoma), and metastatic. Histologically distinguish papillary, glandular and solid cancer of the ovary. Papillary cancer develops from cilioepithelial (papillary, serous) cystoma. Glandular – from a pseudo-mucinous cystoma.
Solid cancer is a former papillary or glandular cancer, degenerated into a solid. The structure of ovarian cancer in 95% of cases is papillary in combination with glandular (at the beginning of the development of cancer, the structure of the tumor is either papillary or glandular). However, soon papillary and glandular structures appear in the ovarian cancer. As the tumor grows, these structures are mixed, but along with this there are continuous fields of cells, which can be called secondary solid. These fields are formed due to the rapid growth of cells and erasure of the main growth pattern. Primary solid cancer is rare (up to 5% of cases). At the same time, a microscopic picture sometimes resembling squamous cell carcinoma is sometimes observed. Tumor cells are small, hyperchromic, such as basal cell cancer cells.
The stroma of ovarian cancers is mostly mild. In advanced cases, extensive areas of tumor decay with severe necrobiosis are observed.
Clinical and anatomical classification of ovarian cancer
There are four stages of ovarian cancer: stage I – the tumor is within the same ovary, there are no metastases; Stage II – going beyond the ovary with damage to the ovary, uterus, one or both tubes; Stage III – spread to the parietal pelvic peritoneum, metastases to regional lymph nodes, to the omentum; Stage IV – germination in neighboring organs (bladder, rectum), intestinal loops with dissemination along the peritoneum outside the pelvis or with metastases to distant lymph nodes and internal organs. The ways of spreading ovarian cancer are as follows: germination through a capsule and transition to neighboring organs; dissemination in the pelvic and abdominal cavity; lymphatic metastasis. Germination through the capsule and involvement of neighboring organs in the tumor conglomerate is more often observed some time after the relative mobility of the tumor. First of all, the fallopian tube is involved in the process, then the perimetry. The uterus is as if blocked by a tumor. In this case, metastases develop in the rectal uterine cavity. The latter can grow into the lumen of the rectum, in the area of the posterior fornix of the vagina. Less commonly, tumor infiltrate spreads to the bladder. When disseminating ovarian cancer, the pelvic peritoneum is first affected, then the greater omentum, intestinal peritoneum, and also the parietal peritoneum of the anterior abdominal wall. In this case, metastatic nodes can be both small (no more than millet grain), and of considerable size. Dissemination more often occurs as a result of the ingress of cancer cells or cancerous masses from the mother’s tumor through the gaps in the tumor capsule (capsule breakthrough) or lymphogenously. Lymphatic metastasis usually occurs in advanced stages of cancer. The lymphatic pathways along which lymph flows from the ovary are extremely extensive and have a large number of anastomoses with lymphatic tracts of various organs. The regional lymph nodes of the ovary are located paraaortally in the perinephric region. From here, lymph with cancer cells spreads along the thoracic duct into the upper abdominal and thoracic cavities. With ovarian cancer, metastatic lesions of the pleura (cancerous pleurisy) and lungs are often found.
Ovarian Cancer Clinic
Ovarian cancer usually develops at a young age (30-50 years), more often against the background of cystoma. In adolescence, hormone-producing ovarian tumors are usually observed. Violation of the menstrual cycle (such as metrorrhagia) in women of menopause is characteristic of ovarian cancer. Ovarian cancer in young women is not accompanied by any menstrual irregularities. As a rule, the initial stages of ovarian cancer are asymptomatic. Sometimes, until a disease is detected, patients are treated for chronic inflammatory diseases of the uterine appendages.
The initial signs of the disease are unpleasant (painful) sensations in the abdomen of uncertain localization, sometimes not related to the pelvic organs (umbilical, inguinal, or the entire abdomen). The pain is initially not intense and patients indicate a feeling of “inconvenience” somewhere in the abdomen. Sometimes there is a feeling of fullness in the abdomen and a feeling in the abdominal cavity of “something foreign” when leaning, defecating, after eating. Pain as the first sign of cancer occurs in 60% of cases. Later, the pain becomes aching, then it becomes more constant and stronger. In some cases, there is a violation of the function of the intestines or bladder (tumor pressure on the rectum or bladder). Despite this, patients remain awake for a long time, active and do not impress cancer patients, even in advanced stages of the disease.