Ovarian tumors

　　The etiology of ovarian tumors is not completely clear, but environmental and endocrine factors are the most important in the pathogenic factors of ovarian tumors.

　　⑴ Environmental factors:The incidence of ovarian cancer in industrialized countries and the upper class is high, which may be related to high cholesterol in the diet. In addition, ionizing radiation and asbestos, talcum powder can affect oocytes and increase the chance of induced ovarian tumors, and the lack of smoking and vitamins A, C, E may also be related to the onset of the disease.

　　⑵ Endocrine factors:Ovarian tumors mostly occur in nulliparous or women who have not given birth, and pregnancy seems to have an antagonistic effect on ovarian tumors. It is believed that the repeated damage to the superficial epithelial cells of the ovary caused by daily ovulation is related to the occurrence of ovarian tumors. In addition, breast cancer, endometrial cancer often occur with ovarian tumors, and the three diseases are all dependent on estrogen.

　　⑶ Genetic and family factors:About 30% - 50% of ovarian tumor patients have direct relatives with tumors.

　　Ovarian tumors can have some life-threatening complications, which should be carefully prevented and treated cautiously. Ovarian tumors often have four complications, and patients with such tumors should undergo regular check-ups.

　　1. Tumor rupture:Can be caused by ischemic necrosis of the cyst wall or tumor erosion piercing the cyst wall, leading to spontaneous rupture; or due to trauma caused by compression, delivery, gynecological examination, and puncture. After rupture, the cyst fluid flows into the peritoneal cavity, stimulating the peritoneum, which can cause severe abdominal pain, nausea, vomiting, and even shock. During examination, there are signs of peritoneal irritation such as abdominal wall tension, tenderness, and rebound pain. The original mass may shrink or disappear. After diagnosis, an immediate laparotomy should be performed to remove the cyst and clean the peritoneal cavity.

　　2. Malignant changes:Malignant transformation of benign ovarian tumors often occurs in older individuals, especially post-menopausal women. The tumor may rapidly increase in size, causing abdominal distension and decreased appetite. Examination shows a significantly increased tumor volume, firmness, and often ascites. Immediate treatment should be sought for suspected malignant transformation.

　　3. Infection:Less common, often secondary to tumor pedicle torsion or rupture. The main symptoms include fever, abdominal pain, increased white blood cells, and varying degrees of peritonitis. Active infection control and scheduled surgical exploration should be carried out.

　　4. Pedicle torsion:Commonly seen, one of the gynecological acute abdomen. It is more common in cystic tumors with long pedicles, medium size, high mobility, and a bias to one side. It often occurs during sudden changes in body position, in the early stages of pregnancy, or after childbirth. After torsion of the pedicle, due to the obstruction of venous return, congestion occurs, appearing purple-brown, and even bleeding from vessel rupture. Necrosis and infection of the tumor can occur due to arterial obstruction. During acute torsion of the pedicle, patients may suddenly experience severe lower abdominal pain, which can be accompanied by nausea, vomiting, and even shock. During examination, the affected side of the abdominal wall muscle is tense, the tenderness is significant, and the tumor tension is large. Once diagnosed, the tumor should be surgically removed immediately. During the operation, do not return the twisted pedicle, but rather clasp and cut it near the site of torsion to prevent thrombus detachment into the blood circulation.

　　Smaller masses generally do not produce symptoms, and occasionally there may be a feeling of坠沉 or pulling pain on the affected side of the lower abdomen. The abdominal mass can be clearly felt, with a smooth surface, no tenderness, and a cystic sensation. Most benign tumors have a longer pedicle formed by the fallopian tube, as there is little adhesion between the tumor and surrounding tissues, so they have a greater mobility. They can often be moved from one side of the lower abdomen to the upper abdomen.

　　Malignant tumors grow rapidly, the masses are often irregular, non-movable, and can be accompanied by ascites. Short-term systemic symptoms such as weakness, fever, and decreased appetite may appear.

　　Functional ovarian tumors such as granulosa cell tumors, due to the production of a large amount of estrogen, can cause symptoms of precocious puberty. Female characteristics such as physique, breasts, and external genitalia develop rapidly, and menstruation occurs, but no ovulation takes place. Skeletal development can exceed the normal range. Estrogen levels in urine increase, and at the same time, the levels of gonadotropins in urine also increase, reaching adult levels beyond the normal pattern.

　　Medium-sized ovarian masses with long pedicles (including retained ovarian cysts) can undergo torsion of the tumor and pedicle, which can lead to hemorrhage and necrosis once twisted. Clinically, it presents as acute abdomen, with symptoms such as abdominal pain, nausea, or vomiting in children. During examination, the abdominal muscles at the tumor site are tense and the tenderness is significant. Patients may have an elevated body temperature and an increase in white blood cells. When the tumor is large, it can compress adjacent organs, causing difficulties in urination and defecation.

　　To prevent the occurrence of ovarian tumors, the following points need to be done:
　　(1) Vigorously carry out publicity, advocate high-protein, high-vitamin A, C, E diet, avoid high-cholesterol diet. Contraception for high-risk women should use oral contraceptives.

　　(2) Women over 30 years old should have a gynecological examination once a year, and high-risk groups should start screening from a young age, B-ultrasound detection can be performed, and routine examination of fetal alpha globulin can be done.

　　(3) Early detection and early treatment. Ovarian cystic masses with a diameter greater than 6cm should be surgically removed and sent for routine pathological examination. Because benign tumors may also have the possibility of malignant transformation if they continue to grow. Solid ovarian tumors should be surgically removed as soon as possible, frozen section examination should be performed during the operation to determine the extent of surgery. For pelvic masses with unclear diagnosis or ineffective conservative treatment, early laparoscopic examination or laparotomy should be performed. All patients with breast cancer, gastrointestinal cancer should have routine gynecological examination after surgery, and regular follow-up to detect metastatic cancer early.

　　(4) Selenium plays such an important role as an auxiliary means in tumor treatment, and selenium is one of the main components of glutathione peroxidase, which can prevent the formation of peroxides and free radicals in the body, can oxidize lipid peroxides or hydrogen peroxide, thus protecting cells in the body and inhibiting the occurrence of cancer.

　　Laboratory examination

　　1. Abdominal ascites cytology examination: percutaneous puncture of the lower abdominal iliac fossa, if there is little ascites, it can be punctured through the posterior fornix, and the ascites is examined for cancer cells.

　　2. Tumor marker measurement:

　　(1) CA125: CA125 has important reference value for the diagnosis of ovarian epithelial cancer, especially in serous cystadenocarcinoma, followed by endometrioid cancer. The positive rate of serous cystadenocarcinoma is over 80%, and the level of CA125 is over 90% with the relief or deterioration of the condition. Therefore, it can also be used as a monitoring method after treatment. The positive rate of advanced ovarian cancer is high, but the positive rate of stage I ovarian malignant tumors is only 50%. Clinically, CA125≥35U/ml is the standard for positivity. CA125 is not specific. The CA125 level is sometimes elevated in some gynecological non-malignant diseases such as acute pelvic inflammatory disease, endometriosis, pelvic and abdominal tuberculosis, ovarian cysts, fibroids, and some non-gynecological diseases.

　　(2) AFP: AFP has specific value for ovarian endodermal sinus tumors, mixed tumors containing endodermal sinus tumor components, dysgerminoma, and embryonal tumors. A certain amount of AFP can also be elevated in some immature teratoma. AFP can be an important marker for the treatment and follow-up of germ cell tumors. Normal values

　　(3) HCG: Patients with germ cell tumors containing primary ovarian choriocarcinoma components have abnormally elevated HCG levels in the blood, and the HCG value of the B subunit in the serum of normal non-pregnant women is negative or

　　(4) CEA: In the late stage of some ovarian malignant tumors, especially in mucinous cystadenocarcinoma, CEA is abnormally elevated, but it is not a specific antigen for ovarian tumors.

　　(5) LDH: LDH levels in the serum of some ovarian malignant tumors are elevated, especially in dysgerminoma.

　　3. Non-ovarian tumor-specific indicators:

　　Sex hormones: granulosa cell tumors and theca luteinoma can produce high levels of estrogen; during luteinization, testosterone, serous, mucinous, or fibrous epithelioma can also secrete a certain amount of estrogen.

　　4. Flow cytometry cell DNA measurement: Flow cytometry (Fcm) method through flow cytometry analysis of tumor DNA content, ovarian malignant tumor DNA content is related to tumor histological classification, grading, clinical staging, recurrence and survival rate.
　　Imaging examination

　　1. Ultrasound examination: It is an important means of diagnosing ovarian tumors, which can judge the size, location, texture of the tumor, its relationship with the uterus, and whether there is ascites, etc. The judgment of benign and malignant is based on experience, which can reach 80% to 90%, but the diagnosis of tumors less than 2cm is difficult by ultrasound, and vaginal ultrasound examination, especially vaginal color Doppler ultrasound examination, can show the changes of blood flow inside the tumor, which can provide reference for distinguishing benign from malignant.

　　2. CT and MRI examination: It is of certain value in judging the size, texture of the tumor, its relationship with the pelvic organs, especially for the enlargement of the pelvic and para-aortic lymph nodes.

　　3. Lymphangiography: It can show the iliac vessels and para-aortic lymph nodes and their metastatic signs, provide preoperative estimation and preparation for lymph node dissection.

　　4. Necessary to choose the following examinations

　　Gastroscopy, colonoscopy: To differentiate primary gastrointestinal primary cancer from ovarian metastatic cancer.

　　Intravenous pyelography: To understand the secretory and excretory function of the kidneys, symptoms of urinary tract compression and obstruction.

　　Radionuclide imaging: Use radioactive nuclides labeled antibodies as tumor positive imaging agents for tumor localization diagnosis.

　　Laparoscopic examination: For pelvic masses that are difficult to定性 in clinical diagnosis, laparoscopic biopsy is performed in patients with ascites, and ascites is taken for pathological and cytological examination for qualitative and preliminary clinical staging.

　　1. Under the guidance of a gynecologist, taking tonifying the liver and kidney, nourishing the essence and blood drugs, such as He Shou Wu, Shu Di, Shan Yao medicine, etc.

　　2. Eating more fruits, vegetables, and their dairy products, etc., which are rich in vitamins and plant estrogens.

　　3. Drinking milk regularly and eating more foods rich in protein and minerals, including fish, shrimp, etc.