A begnino ovarian cancer is a mass of noncancerous cells within an ovary. 
The ovaries are two female reproductive organs that are located in the right or left of the uterus and are attached to this organ through the fallopian tubes. 
A benign tumor is not a cancer, it rarely causes death.

Generally, benign tumors can be removed and usually do not grow. 
The benign tumor does not invade the surrounding tissues.

Benign cancer cells do not spread to other parts of the body. 
The malignant tumor means cancer and is more severe than the benign tumor because it can be deadly. 
Ovarian cancer often clears, but sometimes grows back. 
Malignant tumors can invade and damage surrounding organs and tissues. 
Cancer cells can spread to other parts of the body through the lymphatic system or the bloodstream. 
The cells invade other organs and form new tumors that damage these organs. 
Formations in other organs  of cancer are called metastases.

Benign and malignant cysts
An ovarian cyst may be on the surface of or within an ovary. A cyst contains fluid, but in some cases it also contains solid material. 
Most ovarian cysts are benign (not cancerous). 
The two ovaries are a part of the female reproductive system. 
They produce ovules and two types of female hormones: estrogens and progesterone. 
Benign ovarian neoplasia is usually untreated and may regress over time. 
The malignant ovary tumor has the ability to spread to other parts of the body (metastasize) to  nearby organs and cells, the bloodstream, or the lymphatic system. 
Thus, most of the ovarian masses are benign.
The most common ovarian mass in a fertile woman is a simple functional ovarian cyst that resolves with the next menstrual cycle . 
In postmenopausal women , the most common ovarian mass is a benigncystadenoma . When a patient has no symptoms, most of the ovarian cancers are discovered with physical examination or imaging tests. 
However, sometimes these masses cause pain and the patient asks the doctor for help.

 

What are the causes of ovarian cancer?

Tumors can form in the ovaries as well as in other parts of the body. 
The three types of ovarian tumors are:

  • Epithelial carcinoma , originates from cells on the surface of the ovaries. These are the most common types of ovarian tumors.
  • Germ cell tumors begin in the cells that produce eggs. They can be benign or cancerous. Most are benign.
  • Stromal tumor  arises in the cell that produces female hormones.

Doctors are not sure of the causes of ovarian cancer. However, a number of risk factors have been identified, including:

  • Age – especially postmenopausal women,
  • Smoke ,
  • Obesity,
  • Do not have children or do not breastfeed (however, the contraceptive pillseems to lower the risk),
  • Fertility drugs  (such as Clomid),
  • Hormone replacement therapy,
  • Familiarity or precedent ovarian, breast or colorectal cancer (because the BRCA gene may increase the risk).

According to the theory of incessant ovulation, if during life a woman has many ovulations (hence few pregnancies and short periods of breastfeeding) she has a higher risk of having ovarian cancer

 

Classification of ovarian cancer

Primary Ovarian Tumors

Epithelial ovarian tumors: 60-70%
Serous ovarian tumors:

  • Serous ovarian cystadenoma: 60% of serous tumors
  • Borderline ovarian cystadenoma (limit): 15% of serous tumors
  • Serous ovarian cystadenocarcinoma: 25% of serous tumors, the most common malignant ovarian tumor.

Ovarian mucinous tumors: 20% of all ovarian cancers

  • Mucinous ovarian cystadenoma: 80% of mucinous cancers,
  • Borderline ovarian mucinous cystadenoma: 10-15% of mucinous tumors. 
    Borderline tumor means between malignant and benign,
  • Ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumors.

Ovarian cancer of the endometrioid type: 8-15% of all ovarian cancers

  • Serous ovarian cystoadenofibroma, sometimes classified as a separate category, rather than as epithelial,
  • Adenofibroma of ovary: it can be serous, mucinous, endometrioid, of clear or mixed cells,
  • Ovarian cystadenocarcinoma: Extremely rare.

Clear cell ovary carcinoma: 5% of all ovarian cancers. 
Brenner tumor: 2-3% of ovarian epithelial neoplasms

  • Undifferentiated ovarian carcinoma: 4% of all ovarian cancers,
  • Ovarian squamous cell carcinoma.

Ovarian germ cell tumors: (Usually develops in women under 30 years) 20% of the total

  • Ovarian teratoma: the most common primary benign tumor of the ovary,
  • Mature ovary teratoma
  • Immature ovary teratoma,
  • Specialized ovarian teratomas,
  • Cancer of ovarian stromal cells.

Ovarian Carcinoid Tumors

  • Dysgerminoma of the ovary.

Ovarian tumor of the yolk sac – endodermal sinus tumor. 
Mixed malignant tumors of ovarian germ cells

  • Ovarian choriocarcinoma: 1% of ovarian tumors
  • Primary ovarian choriocarcinoma: extremely rare.

Sex cord tumors, ovarian stromal tumors: 8-10%

  • Ovarian fibroblastoma: 5% of ovarian cancers,
  • Myoma in the ovary: 4% of ovarian cancers.

Tecoma of ovary 1% ovarian cancers. 
Sclerosing ovarian stromal tumor: rare. 
Ovarian tumors of Sertoli cells -Leydig, ovary androblastoma: 0.5% ovarian cancer. 
Ovarian granular cell tumor: the most common malignant tumor of the sexual cords.

  • Juvenile ovarian granulosa cell tumor
  • Grain cell tumor of adult ovary.

Mixed: rare

Ovarian carcinosarcoma: 1%

Others

  • Lymphoma in the ovary
  • Primary ovarian lymphoma
  • Secondary involvement of the ovary with lymphoma
  • Ovarian metastasis
  • Tumor de Krukenburg
  • Other metastatic lesions to the ovary

 


How does it occur? What are the symptoms of ovarian cancer?

There are no early symptoms, usually ovarian cancer is difficult to recognize until the advanced stage (when it becomes larger) given that the symptoms are vague and occur over time. 
The main symptoms are:

Most ovarian neoplasms cause symptoms by exerting pressure on adjacent structures, resulting in increased urinary frequency, pelvic discomfort, and constipation . 
Abdominal swelling is the consequence of tumor enlargement. 
Upper abdominal metastasis causes:

  • Nausea ,
  • Asia ,
  • Swelling,
  • Weight loss and anorexia.
  • The bleeding irregular vaginal is another possible symptom.
  • Shortness of breath is a symptom of patients with hydrothorax or ascites (fluid in the belly) or pleural effusion (accumulation of inflammatory fluid in the lung pleural cavity).

Some tumors, including subtypes of stromal tumors of the sex cords, produce too much estrogen that result in:

  • Early puberty,
  • Bleeding after menopause,
  • Menorragia,
  • Amenorrhea,
  • Menometrorragia,
  • Endometrial hyperplasia / cancer or fibrocystic breast disease .

Some subtypes of stromal tumors of sexual cords produce androgen that cause virilization.

 

How do doctors diagnose ovarian cysts and tumors?

The obstetrician / gynecologist or doctor may feel a lump when doing a routine pelvic exam. 
Most ovarian tumors are benign, but in rare cases they may be carcinogenic. 
That is why it is important to check for growth. 
It should be examined in particular post-menopausal women because there is an increased risk of ovarian cancer.

Tests that look for ovarian cysts or tumors are:

Transvaginal Ultrasonography
This test uses sound waves to create an image of the ovaries and may be helpful for early diagnosis. The ultrasound  helps the doctor determine the size and location of the cyst or tumor. 
Other diagnostic imaging tests.

Computed tomography , magnetic resonance imaging (MRI), and positron emission tomography (PET) are highly detailed examinations. The doctor may use CT to recognize the ovarian tumor and see how much it has spread.

Levels of hormone . Your doctor may order a blood test to check the levels of certain hormones. These are luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol and testosterone.

Laparoscopy
This is a surgical procedure used for the treatment of ovarian cysts. Use a thin device with a camera at the end. 
Fits the abdomen. 
During surgery, the surgeon may find cysts or tumors and may remove a small piece of tissue (biopsy) to perform the cancer test.

CA-125
If your doctor thinks the mass may be carcinogenic, you can request a blood test to look for a protein called CA-125 . 
This level of protein may be higher in some women with ovarian cancer. 
This test is primarily used in women over the age of 35 who have a slightly increased risk of ovarian cancer. 
If the diagnosis is of ovarian cancer, the doctor should use the results of diagnostic tests to determine if the cancer has spread beyond the ovaries. The doctor uses the pictures of the exams as well to determine how much it has spread. 
This diagnostic procedure is called staging and serves the doctor to plan the treatment and to know how much the patient can live.

Evaluation
Before menopause, the normal ovaries are about 3.5 cm. After menopause, it atrophies and reaches about 2 cm or less. 
In a fertile woman, it is normal to have a palpable ovary, but after menopause it usually indicates a tumor, although it may not be malignant. 
Women of childbearing potential should have an inspection if they have an ovary greater than 3 cm in diameter or have a solid consistency.

 

Differential diagnosis

Your doctor should exclude 
non-neoplastic functional cysts, such as follicular cysts, corpus luteum, teo-luteal cyst. 
Other causes of pelvic pain.

  • Polycystic ovary syndrome

    guniita – bigstockphoto.com

  • Endometrioma
  • Tumor of the malignant ovary.
  • In the intestine: colon cancer , appendicitis , diverticulitis .
  • Gynecological: pelvic inflammatory disease, tube-ovarian abscess, uterine cancer (for example, myoma ), ectopic pregnancy, para-ovarian cyst .
  • Pelvic neoplasms, for example retroperitoneal tumors, small bowel tumors and mesothelial tumors.

 

What to do? When is it best to have ovarian cancer?

Many patients with simple ovarian cysts based on ultrasonography do not need treatment. 
Women with small, simple ovarian cysts (less than 50 mm in diameter) usually do not need monitoring since these cysts are usually physiological and almost always resolve within three menstrual cycles. 
Women with simple ovarian cysts of only 50-70 mm in diameter should perform an annual ultrasound and those with large, simple cysts should deepen with an MRI or surgery. 
In a postmenopausal patient, if the cyst is simple and persistent, less than 5 cm, with a normal value of CA-125 can be monitored with ultrasound.
However, ovarian cysts that persist or increase in size are unlikely to be functional and may require surgery.

Oral contraceptives
The contraceptive pill is not recommended because it has not been shown that its use resolves functional ovarian cysts.

Surgery for ovarian cancer
If preventive measures fail or there are conditions for the operation, surgical treatment of benign ovarian tumors is usually very effective and is a cure with minimal impact on reproductive capacity. 
Persistent simple ovarian cysts larger than 5-10 cm, especially if symptomatic and complex ovarian cysts are usually removed by the surgeon. 
For girls and young women, cystectomy is preferable to oophorectomy to preserve maximum fertility. 
Laparoscopic surgery for benign ovarian tumors allows reducing the risk of adverse effects of traditional surgery. 
The pain is reduced and  fewer hospital days are needed compared to laparotomy.
There is no difference between the procedures regarding tumor recurrence, feverand postoperative infections .

If the tumor can not be operated on, the oncologist may recommend palliative (to reduce the symptoms) or chemotherapy.

 

Twisting the ovary

It usually begins with laparoscopic surgery with the unwinding of the ovary concerned and possibly attachment to the pelvic wall. 
Salpingo-oophorectomy is the surgical removal of one or both ovaries, along with the uterine tube. It may be indicated if there is severe vascular necrosis, peritonitis or necrotic tissue. 
Immediate surgery is indicated for a hemorrhagic cyst. 
If malignant tumors have been discovered, laparotomy is indicated. 
The peritoneal pseudomyxoma (peritoneal mucinous tumor and mucinous ascites in the basin and abdomen) is treated with surgical resection.

 

Diet and nutrition for ovarian cancer

Following the principles of naturopathy and hygiene, tumors can be treated with a brief fast and a controlled diet that reduces the acidity of the blood. 
We recommend eating lots of fruits and vegetables, unrefined cereals, baking soda and saffron. 
Avoid meat, eggs, milk and dairy products, fried foods and sugars. 
A healthy diet is essential for the prevention of ovarian cancer.

Complications of ovarian cancer

The twisting of a cyst in the ovary may be seen. 
The bleeding is common for tumors right ovaries. 
It can be caused by the rupture of a cyst in the ovary. 
Infertility can occur as a result of ovarian cancers or their treatment.

 

What is the life expectancy? Prognosis of ovarian cancer

Mortality depends on the type and size of the tumor, complications associated with the age of the patient. 
Most small ovarian cysts in premenopausal women resolve spontaneously. 
Ovarian torsion: If the patient is operated within six hours of the onset of symptoms, the tissue generally can survive. 
The prognosis of surgically removed cyst is ultimately determined from the composition.

 

Can it heal? Survival in 5 years

  • First stage (located in the ovaries): 80/90%
  • Second stage (spread to the fallopian tubes or uterus and eventually ascites): 50/60%
  • Third stage (diffusion or limited metastasis in the pelvic area and possibly positive lymph nodes in the groin or back of the peritoneum): 20/35%
  • Fourth stage ( metastases in the liver and other organs, pleural effusion): 10%.

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