Ovarian cancer

　　As with most cancers, the causes of ovarian cancer are not clear. Research and epidemiological studies generally suggest that the occurrence of ovarian cancer may be related to the following high-risk factors. Continuous ovulation can lead to continuous damage and repair of the surface epithelium of the ovary, which may cause the occurrence of ovarian cancer. Epidemiological studies have found that risk factors for ovarian cancer include nulliparity and infertility, while multiple pregnancies, breastfeeding, and oral contraceptives have a protective effect. The use of ovulation-inducing drugs can increase the risk of ovarian tumors.
　　Environment and other factors
　　Epidemiological evidence suggests that various physical or chemical products of industry may be related to the occurrence of ovarian cancer. Whether the occurrence of ovarian cancer is related to dietary habits or components (high cholesterol content) is still controversial at present.
　　Genetic factors
　　The occurrence of epithelial ovarian cancer is closely related to genetic factors, with 5% to 10% of epithelial ovarian cancers showing genetic abnormalities. The occurrence of epithelial ovarian cancer is associated with three hereditary cancer syndromes, namely, the hereditary breast-ovarian cancer syndrome, the hereditary site-specific ovarian cancer syndrome, and the hereditary nonpolyposis colorectal cancer syndrome. Those with a family history of ovarian cancer, breast cancer, endometrial cancer, and colorectal cancer have a significantly higher incidence of ovarian cancer. Therefore, in addition to routine physical examination, those with a family history of cancer should be more vigilant, closely monitored, and even consider prophylactic ovarianectomy.

　　1. Ovarian pedicle torsion:More common, one of the gynecological acute abdomen. It is often seen in cystic tumors with a long pedicle, medium size, high mobility, and center of gravity biased to one side. It often occurs during sudden changes in body position, in the early stages of pregnancy, or postpartum. After torsion, due to impaired venous return, congestion occurs, appearing purple-brown, and even bleeding due to vascular rupture. Necrosis and infection can occur due to arterial obstruction. During acute torsion, the patient suddenly experiences severe lower abdominal pain, which may be accompanied by nausea, vomiting, and even shock. During examination, the affected side of the abdominal wall muscle is tense, with significant tenderness and the mass has high tension. Once diagnosed, the tumor should be removed immediately. Do not turn the twisted pedicle back during surgery, and it is preferable to clamp and cut it near the site of torsion to prevent thrombus detachment into the blood circulation.

　　2. Tumor rupture:Can be caused by spontaneous rupture due to ischemic necrosis of the cyst wall or tumor erosion through the cyst wall; or due to traumatic rupture caused by compression, delivery, gynecological examination, and puncture. After rupture, the cyst fluid enters the peritoneal cavity, stimulates the peritoneum, and can cause severe abdominal pain, nausea, vomiting, and even shock. During examination, abdominal wall tension, tenderness, rebound pain, and other signs of peritoneal irritation are present, and the original mass may shrink or disappear. After diagnosis, immediate laparotomy should be performed to remove the cyst and clean the peritoneum.

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

　　4. Malignant transformation of benign ovarian tumors:More common in older age groups, especially postmenopausal women. The tumor can rapidly increase in size within a short period, causing abdominal distension and loss of appetite. Examination shows a significant increase in tumor volume, fixation, and often ascites. If malignant transformation is suspected, timely treatment should be sought.

　　(One) Symptoms
　　1. Age: Ovarian cancer often occurs in women around the perimenopausal period, with epithelial ovarian cancer more common in those over 35 years old, while germ cell malignant tumors are more common in those under 35.
　　2. Pain: Malignant ovarian tumors may cause a significant degree of persistent bloating pain due to changes within the tumor, such as bleeding, necrosis, and rapid growth, and local tenderness may be found during examination.
　　3. Menstrual irregularity: Irregular uterine bleeding or postmenopausal bleeding may be seen.
　　4. Weight loss: In the late stage, there is progressive weight loss.
　　(2) Signs
　　1. Bilateral lower abdominal masses: Malignant ovarian tumors occur bilaterally in 75% of cases, while benign ovarian tumors occur bilaterally in only 15% of cases.
　　2. Mass fixation: It is one of the characteristics of ovarian malignant tumors.
　　3. Ascites: Although benign ovarian tumors such as fibromas or papillary cystadenomas can also be complicated by ascites, malignant ovarian tumors are more likely to be associated with ascites, and ascites is often hemorrhagic due to the tumor cells penetrating the tumor wall or having metastasized to the peritoneum (observed by the naked eye or under a microscope).
　　4. Cachexia: In patients with a prolonged course, progressive weight loss, weakness, and fatigue may occur due to long-term consumption and loss of appetite, presenting symptoms of cachexia.

　　Preventive measures:
　　1. All solid ovarian masses and cysts larger than 6 cm should be surgically removed immediately.
　　2. Women before menarche and after menopause with ovarian masses should be considered as tumors. Women of childbearing age with small adnexal cystic masses should be observed for 2 months; if there is no reduction, consider it as a tumor, and if there is an increase during the observation period, surgery should be performed at any time.
　　3. Pelvic inflammatory mass, especially suspected pelvic tuberculosis or endometriotic mass, should be explored surgically if the treatment is ineffective and tumor cannot be excluded.
　　4. After menopause, if there is endometrial adenomatous hyperplasia or endometrial adenocarcinoma, attention should be paid to whether there are tumors in the ovaries, and timely surgical treatment should be performed.
　　During pelvic surgery, careful examination of both ovaries for lesions should be performed. In addition to the indications for ovarian diseases themselves, when a hysterectomy is recommended for uterine diseases in patients over 45 years of age, it is suggested to simultaneously remove both adnexa.

　　(1) Ultrasound:It can clearly define the size, shape, cystic or solid nature, location, and relationship with surrounding organs of the tumor, and distinguish between large ovarian cysts and ascites.

　　(2) X-ray examination:The abdominal plain film of mature teratoma of the ovary can show tooth or bone shadows, and intestinal contrast can help understand the location, size, and relationship of the tumor.

　　(3) CT and MRI examinations:Application can be considered when necessary.

　　The diet of patients with advanced ovarian cancer should be carefully selected, ensuring the intake of essential nutrients for the body while also considering the patient's appetite and appetite. Generally, a high-calorie, low-sodium, low-fat, low-phosphorus, high-quality low-protein light diet is adopted, which can balance nutrition and control the progression of the disease. Specific suggestions are as follows:
　　Reasonable control of salt and water intake
　　The intake of fluid should be adjusted according to the level of edema and urine output, based on an additional 500 milliliters on the basis of the output in the first day. For mild edema, the daily urine output should be greater than 1000 milliliters, and the intake of sodium should be determined according to the actual situation, but water intake should not be excessively restricted; for severe edema accompanied by hypertension and oliguria, the daily water intake should be limited to 1000 milliliters or less.
　　High-quality Protein Diet
　　So-called high-quality protein, milk protein is the best choice, followed by egg and poultry egg protein; then fish protein and lean meat protein; plant protein is inferior protein, such as soy products, daily steamed buns, rice and other protein contained. Taking lean pork as an example, 100 grams contains about 20 grams of protein, so it is advisable to consume 100-200 grams per day. For patients with severe edema and hypoproteinemia, 1 gram per kilogram of body weight per day is appropriate; for moderate edema, it can be followed by the conventional method of 0.5 grams per kilogram of body weight per day. To ensure the intake of calories, foods mainly contain starch, such as wheat starch, sweet potatoes, etc., and can be taken in small and frequent meals, slowly absorbed.

　　Traditional Chinese medicine believes that the occurrence of ovarian cancer is due to insufficient vital energy and internal victory of evil, with the main types of evil being exuberant dampness and Qi stagnation and blood stasis. Traditional Chinese medicine selects appropriate medicine for treatment according to the characteristics of the disease.
　　Qi Stagnation and Blood Stasis Type
　　Symptoms: Lower abdominal mass, hard and resistant to palpation, painful when palpated. Irregular vaginal bleeding or amenorrhea, emaciation with ascites, rough skin, dry mouth without desire for drinking, constipation, tongue with stasis spots and points, thin and涩 pulse, etc.
　　Treatment: Use the method of regulating Qi and activating blood, removing blood stasis and resolving symptoms, and choose Ge Xia Zhu Yu Decoction.
　　Prescription: Taoren, Dan Pi, Chi Shao, Hong Hua, Wu Ling Zhi, Wu Yao, Ji Qiao, Xiang Fu, Ao Shu, Shan Ci Gu, each 15 grams, Dang Gui, Yuan Hu, Bie Jia, each 20 grams, Chuan Xiong 10 grams. For those with excessive vaginal bleeding, add 30 grams of Pu Huang, 30 grams of Di Yu Tan.
　　Exuberant Dampness and Toxin Syndrome
　　Symptoms: Rapidly increasing abdominal mass, abdominal distension and pain with ascites, irregular vaginal bleeding, bitter mouth, dry stool, dark tongue fur thick and greasy, wiry and slippery pulse, etc.
　　Treatment: Use the method of clearing heat and promoting diuresis, removing blood stasis and detoxifying, and choose Wu Ling San with modifications.
　　Prescription: Bai Zhu, Ze Xie, Da Fu Pi, Che Qian Cao, Long Kui, Gui Zhi, each 15 grams, Zhu Ling, Fu Ling, Ban Zhi Lian, Bai Hua She Tong Cao, Bie Jia, each 20 grams. For those with excessive vaginal bleeding, add 30 grams of Stir-fried Pu Huang (wrapped in cloth), 10 grams of San Qi powder (mixed); for constipation, add 10 grams of Dahuang.

　　Traditional Chinese medicine treatment can improve the condition, enhance immunity and prolong life, which is an effective treatment method. It also reduces the side effects after surgery and radiotherapy, but the prescription must be formulated by a traditional Chinese medicine doctor and cannot be taken arbitrarily.