Therapy of ovarian cancer

Synonyms in a broader sense

• Ovarian tumor
• Ovarian tumor

Medical: Ovarian carcinoma

English: ovarian cancer

definition

Ovarian cancer (ovarian carcinoma) is a malignant (malignant) tumor of the ovaries that can occur on one or both sides.

One differentiates the type of ovarian cancer on the basis of its fine tissue (histological) picture.
The tumors are thus divided into

• epihelial tumors
• Germ cell tumors as well
• Germ-cord and stromal tumors.

Epithelial tumors are tumors that arise from cells on the surface of the ovaries. They make up about 60% of all malignant ovarian tumors. The germ cell tumors emanating from the germ cells of embryonic development (fruit development) account for about 20% of all malignant ovarian tumors. Stromal tumors are tumors that develop from the ovarian tissue and make up about 5% of all malignant ovarian tumors. Furthermore, around 20% of malignant ovarian tumors are colonizations of cells from a tumor that originally developed elsewhere (metastases). The metastases mostly occur on both sides and about 30% originate from uterine cancer and about 20% from breast cancer (breast cancer) or cancer of the gastrointestinal tract (gastrointestinal cancer).

Please also read our general topic Ovarian cancer.

diagnosis

To the diagnostic measures counting:

• anamnese (Medical history)
• Physical (clinical) / gynecological examination
• Sonography
• Laboratory values ​​/ Tumor markers
• Imaging / X-ray image

Read more about this topic under Gynecological examination

Medical history (anamnesis)

Confirmation of the diagnosis begins with the patient interview (anamnesis), in which the doctor makes a suspicion based on the symptoms presented by the patient and can conclude that ovarian cancer is possible.
In order to clarify whether it is really ovarian cancer or whether something else is hidden behind the symptoms, the doctor must arrange for further tests.

Physical examination

The clinical examination can provide further clues about the disease. It is customary for the doctor to first feel (palpate) the abdomen. In the presence of ovarian cancer, he can sometimes feel a thickening in the ovaries. This should be followed by a two-handed palpation (bimanual palpation). That means that the doctor uses a finger or two of one hand to die Vagina (vagina) and the cervix (Cervix uteri; see also Cervical cancer) and at the same time with the other hand from the outside in the area of ​​the uterus (Uterus) and the Ovaries and Fallopian tubes (Adenexes) is feeling. In this way, abnormal tissue parts can also be felt. Scanning of the rectum (rectal examination) should continue to be carried out in order to detect tumor settlement there. If the physical (clinical) examination continues to show evidence of ovarian cancer, the internal reproductive organs are shown.

Sonography

Means Ultrasound / sonography on the one hand, external changes in the Ovaries (Ovaries), the Womb (uterus) and the nearby lymph nodes are examined for abnormalities. On the other hand, the attending physician should take a look at the surrounding organs in order not to overlook any existing cancer cell deposits (metastases).
The should therefore still be sounded Intestines (Colon) (where possible) that liver (Hepar), the spleen (Splen) and the kidney (Ren).

Supplement an ultrasound examination through the vagina (vagina) respectively (transvaginal sonography). A special ultrasound probe is inserted into the vagina for this purpose. Since the ovaries are on both sides of the uterus, this ultrasound probe can be used to take a look at the ovaries. Of course, the vagina and the are also assessed Uterus.
Further information on the subject is also available at: Ultrasound / sonography

Laboratory values

With the help of Blood values ​​/ laboratory values the function of the organs (liver, kidneys, etc.) can be assessed. In addition, a statement about inflammation in the body can be made on the basis of inflammation values.
So-called are also of particular interest in ovarian cancer Tumor markers for the Ovarian cancer. These are special laboratory values ​​that are increased in some patients in the course of the tumor disease. However, from the height of these values ​​one cannot infer the size or even the malignancy of the tumor. The tumor markers are only important when monitoring the progress, as changes in the value can then be used to make a statement about the behavior of the tumor. Increases in the values ​​indicate further growth (proliferation) of the tumor; the drop in values ​​suggests that the tumor is getting smaller. If the tumor marker values ​​remain the same, one can speculate that the tumor will neither grow nor shrink.

The most common tumor marker for ovarian cancer is CA 125. Strong increases in this are found in particular in serous ovarian cancer. However, CA 125 can also be increased in benign ovarian tumors or in inflammation within the abdominal cavity (intra-abdominal). Other tumor markers that can be determined are CEA, CA 19-9 and CA 72-4. However, these tumor markers are also found in other tumors such as the Colon cancer (Colon carcinoma) or Inflammation in the abdomen elevated. They therefore only give an indication of the presence of ovarian cancer. Other pathological processes in the body must be excluded. AFP (Alpha-fetoprotein) is a very specific tumor marker that is elevated in yolk sac tumor. hCG (human choriogonadotropin), a hormone that is normally produced by the fetus during pregnancy and is therefore elevated in the blood, is also elevated in chorionic carcinoma, which is derived from embryonic cells.

Summary Laboratory values ​​/ tumor markers which can be increased in ovarian cancer:

• CA 125
• CEA
• CA 19-9
• CA 72-4
• AFP
• hCG

Imaging

X-ray image

Becomes a X-ray image of the lung made, cancer cell settlements (metastases) can be recognized.

Computed tomography (CT) and magnetic resonance imaging (MRI)

The Computed Tomography is a radiological representation of the body in which the organism can be viewed in different layers.
However, these examinations are not always necessary. After assessing the previously determined data, the attending physician must consider whether one of these two imaging methods can provide new knowledge and whether it makes sense.

The Magnetic resonance imaging also shows the organism in several layers, but magnetic fields are used instead of x-rays. Means Computed Tomography and Magnetic resonance imaging the doctor can assess in more detail whether there is ovarian cancer and in which organs cancer cell deposits (metastases) may be present.

Alternative diseases (differential diagnosis)

The few symptoms that can occur in ovarian cancer, as well as the masses in the area of ​​the abdomen, can also arise from another cause:

• Pus ulcers (abscesses) of the ovaries, fallopian tubes, appendix (appendix = appendicitis)
• Ulcers of the uterus
• Tumors of the fallopian tubes
• Ectopic pregnancies (extrauterine pregnancies)

can still lead to space claims. Cells emanating from the rectum (rectum) can also penetrate the ovaries (infiltrate) and thus simulate ovarian cancer.

Therapy of epithelial ovarian tumors

The therapy of epithelial ovarian tumors is basically based on one radical operation in combination with a subsequent chemotherapy.
The operation tries to completely remove (resect) the tumor. The principle of radical operation is that the ovaries (ovaries), fallopian tubes (tubae uterinae), uterus, appendix (appendix, appendix), large network (Greater omentum) as well as in the pelvis (pelvis) and on the main artery (aorta) (localized) lymph nodes (Nodi lymphatici) removed. Sometimes it is necessary to remove part of the intestine (colon) as well as parts of the peritoneum (peritoneum).

Chemotherapy follows the operation to kill any remaining cancer cells as much as possible.
As a rule, the following chemotherapeutic agents are used: carboplatin, cyclophosphamide and paclitaxel.

Often there are also operative Follow-up interventions carried out.
This is the case, for example, if the tumor could not be completely removed during a primary surgical procedure (first procedure). A few cycles of chemotherapy should always follow the primary surgery before the second surgery with the aim of completely removing the tumor. However, it makes sense to only perform the second procedure if the chemotherapy is working well. Studies have found that the survival rate of patients with a second operation does not improve if the previously performed chemotherapy works poorly or not at all.

Sometimes a second procedure is done for diagnostic reasons only. This intervention is then called Second look operation designated.
If the first operation and the subsequent chemotherapy resulted in a proven complete regression of the tumor, a second procedure is used to check whether residual tumor is still present.
In 50% of the patients previously described as tumor-free, a residual tumor can still be found in this second procedure. In studies, however, no benefits for the patients after a second look operation were found.
Even if a residual tumor is found in the second procedure, it is questionable whether a new chemotherapy and the prolongation of survival time are questionable.

A second procedure is also carried out if the cancer recurs after the initial tumor has been removed. One then speaks of one Tumor recurrence. A distinction is made between early and late relapses. One speaks of early recurrence when the tumor grows again within one year after removal of the primary tumor. Late recurrences occur more than a year after the primary tumor has been removed.

Please also read our page Removal of the ovaries.

Therapy of stromal tumors

If the tumor is still very small and the woman still wants to have children, it is only possible to remove the ovary affected by the tumor with the associated fallopian tube. However, when the family planning is completed or when the tumor is large, radical surgery is carried out as with epithelial tumors (see above). Then stromal tumors are irradiated with high-dose X-rays because they are sensitive to radiation. Should the stromal tumor be on the radiotherapy do not respond, an attempt to reduce the tumor with chemotherapy can be made.

Therapy of germ cell tumors

If the tumor is confined to one ovary, the ovary and fallopian tubes on the affected side are usually removed (adenectomy) in the case of germ cell tumors. Then chemotherapy with the chemotherapy drugs etopside, bleoycine and cisplatin is carried out. Because dysgerminomas are in contrast to the other germ cell tumors sensitive to radiation these are irradiated with 30-40 Gy postoperatively.

Consequence of the therapy

Every operation, chemotherapy and radiation therapy naturally has side effects and consequences. However, only a few of them will be discussed below.

Will be beyond that in younger women Menopause (climacteric) If the ovaries are removed, those formed in the ovaries are absent Sex hormones. This can lead to premature menopausal phenomena with sweats and hot flashes, and upset depression such as Sleep disorder come. In these patients, the sex hormones can be replaced (substituted) by taking medication and these symptoms can be prevented.

If both ovaries are also removed, one is natural pregnancy excluded, which can be particularly dramatic for younger women. As a "compromise", egg cells can be frozen before starting therapy and artificially fertilized if you want to have children. So it may be possible to become a mother despite the removal of the ovaries.

The use of chemotherapy can also lead to further symptoms.
The chemotherapeutic agents have a particular effect on rapidly dividing cells. These are usually cancer cells, but also intestinal, hair and blood cells. The other healthy cells are also irritated and partially destroyed by the chemotherapeutic agents.
This can manifest itself in disorders of the intestinal function with vomiting and diarrhea, hair loss, increased susceptibility to infections and anemia.

Aftercare

Following treatment for an ovarian tumor (ovarian cancer), a Follow-up examination respectively. In the first two years after treatment, the patient should be examined every three months, in the third to fifth year after treatment every six months, and from the fifth year after the end of the treatment, one examination annually.

The patient should also pay particular attention to whether Digestive problems, serious weight changes or Increase in waist size occur. A significant decrease in performance should also be noticed and reported to the attending physician.

In the follow-up examinations, the patient should be scanned and scanned (ultrasound / sonography) for changes in the abdomen (abdomen) after describing her condition. You should also do a lung exam as well gynecological check respectively.
The gynecological examination should take the form of a palpation examination followed by ultrasound of the vagina (transvaginal sonography). The palpation of the rectum is also important.

They also play an important role in monitoring the progress Tumor markers such as CA 125. With increasing tumor markers it is advisable to perform a computed tomography (CT) in order to detect possible recurrences (renewed tumor growth) at an early stage.