The term ovarian cancer includes all malignant tumors of the ovary. In most cases, it is a so-called ovarian carcinoma, rarely find stray (metastases) of other cancers in the ovaries.
Diagnosis ovarian cancer
Ovarian cancer is the second most common cancer of the sex organs in women after uterine cancer (endometrial cancer). Since there are usually no symptoms at the beginning, the diagnosis is often made only at an advanced stage.
Therefore, the prognosis in ovarian cancer is rather unfavorable compared to other cancers because in many cases the tumor can not be completely removed by surgery at the time of diagnosis.
Early stage: Unspecific signs
Normally, ovarian cancer in the initial stage does not cause any characteristic discomfort. Possibly occurring early symptoms can also have a variety of other - often harmless - causes. Examples of non-specific symptoms of ovarian cancer include:
- Disorders of the menstrual cycle: inter-bleeding, too frequent, too rare or failing menstrual bleeding
- newly occurring or unusually severe pain during menstruation or in the period of ovulation
- unusually strong or prolonged menstrual bleeding
- Bleeding after the menopause
- Lower abdominal pain
- Fullness or pressure sensation in the lower abdomen
- inexplicable weight loss
- nocturnal strong sweating
Symptoms in the late stages
As a typical indication of advanced ovarian cancer is often a so-called ascites on. This is due to cancer cells that settle within the abdominal cavity and lead, inter alia, by a disability of the lymph drainage to a fluid accumulation in the abdominal cavity. For the patients, this usually occurs initially as a growth of the abdominal girth.
If the cancer cells spread through the lymphatic vessels to the pleura, it may also lead to a fluid accumulation (pleural effusion). This can then manifest itself through breathing discomfort.
If the tumor is so large that it presses on the surrounding organs, the following symptoms may occur:
- increased urinary frequency
- Urinary obstruction with flank pain
Masculinization in hormone-producing tumors
Rare subgroups of ovarian tumors can produce sex hormones and thereby lead to specific symptoms: If the tumor forms the male sex hormone testosterone, this leads to masculinization (virilization or androgenization), which can be exacerbated by increased body hair growth, hair loss on the head and a deeper voice,
Another type of tumor is the female sex hormone estrogen, which causes thickening of the endometrium. As a result, irregular, absent or increased menstrual bleeding and infertility may occur.
Differential diagnosis: Other causes of the symptoms
Many of the signs of ovarian cancer are nonspecific - which means that a variety of other causes can cause the discomfort. Cycle disorders, for example, are more often caused by an imbalance in hormone balance or by ovarian cysts. Endometriosis - a condition where the lining of the uterus is outside the uterus - is also a common cause of menstrual symptoms.
If the menstrual period stops altogether, an extrauterine pregnancy should also be considered - a pregnancy in which the egg is implanted outside the uterine cavity. On the other hand, pelvic pain associated with fever may cause ovarian inflammation.
Meigs syndrome in benign ovarian tumor
Ascending and pleural effusion may indicate diseases of the lungs, liver and heart as well as various cancers. In rare cases, a benign ovarian tumor (ovarian fibroma) may be the cause - the combination of symptoms is then called Meigs syndrome.
Age and gene mutations as risk factors
About one to two percent of all women develop ovarian cancer in their lifetime. Most women are affected after the age of 45 - younger patients often have a mutation in one gene (BRCA1 or BRCA2), which significantly increases the risk of ovarian cancer. Because these mutated genes are inheritable, there may be an accumulation of ovarian and other cancers, such as breast cancer, in the family.
In addition, the following risk factors may favor the occurrence of ovarian cancer:
- Early first menstrual bleeding (before the 12th year of life)
- Late last menstrual period (after the age of 50)
- Few or no pregnancies
- Medicinal stimulation of ovulation - for example in the context of artificial insemination
- Polycystic Ovarian Syndrome (PCO Syndrome)
- Lynch Syndrome (HNPCC Syndrome)
- nicotine consumption
Since the onset of many ovulations in life (such as when a woman has her period for 40 years) can increase the risk of ovarian cancer, hormonal contraceptives such as the birth control pill may have a protective effect by suppressing ovulation.
Diagnostics by ultrasound
If there is a suspicion of ovarian cancer, the gynecologist will first perform a physical examination with palpation of the abdomen after taking the medical history (anamnesis). Subsequently, an ultrasound examination is usually carried out through the vagina.
On the other hand, a CT or MRI is usually only performed after a reliable diagnosis to plan an operation or to determine the tumor stage.
Operative Staging: Sampling and Therapy
If a malignant tumor of the ovary can not be safely excluded by ultrasound, a sample must be taken. This usually happens through surgery. The sample is sent during the operation to a pathologist who carries out a microscopic examination and notifies the surgical team of the result within a short time (quick-cut).
If ovarian cancer is actually present, the same operation is used to examine how far the tumor has spread and whether other organs have already been affected (staging). In many cases, then even the first treatment step can be done and the tumor can be cut out completely or partially.
Blood test not very meaningful
A blood test with determination of tumor markers - such as CA-125 or CA 15-3 - plays a minor role in the first diagnosis. Because these substances can be elevated in various diseases in the blood and therefore do not specifically point to ovarian cancer.
However, these blood counts may be helpful in follow-up or completed therapy follow-up, as a guide to response to therapy or possible relapse.