Ovarian malignant tumors

　　The etiology of ovarian tumors is still unclear, but environmental, racial, genetic factors, menstrual status, and reproductive status are all related factors. The specific introduction is as follows:

　　(I) Environmental Factors

　　The incidence of ovarian malignant tumors in developed 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 ovarian malignant tumors; smoking and deficiencies in vitamins A, C, and E may also be related to the occurrence of the disease.

　　(II) Endocrine Factors

　　Ovarian malignant tumors often occur in nulliparous or childless women, and pregnancy seems to have an antagonistic effect on ovarian malignant tumors, as the repeated damage to the ovarian surface epithelium caused by daily ovulation is related to the occurrence of ovarian malignant tumors. In addition, breast cancer, endometrial cancer, and ovarian malignant tumors often occur concurrently, and all three diseases depend on this hormone. The risk of disease in women with frequent ovulation and infertility is relatively increased; however, long-term oral contraceptives and reducing the frequency of ovulation can significantly reduce the risk of ovarian cancer.

　　(Three) Genetic and family factors

　　About 20%-25% of patients with ovarian malignant tumors have cancer patients in their direct relatives.

　　Complications of ovarian malignant tumors include:

　　1. Torsion of the pedicle is a common gynecological acute abdomen. It often occurs in tumors with long pedicles, medium size, high mobility, and center of gravity on one side. The pedicle is composed of the pelvic infundibulopelvic ligament, the ovarian固有ligament, and the fallopian tube. The typical symptom is sudden severe pain in one side of the lower abdomen, often accompanied by nausea and vomiting. The gynecological examination may feel a large tension of the mass, tenderness, especially at the pedicle.

　　2. Rupture. It is divided into spontaneous and traumatic rupture. The severity of symptoms depends on the size of the rupture, the amount and nature of the fluid flowing into the abdominal cavity.

　　3. Infection. It often occurs secondary to torsion or rupture of the tumor pedicle, with clinical manifestations of peritonitis. The tumor should be surgically removed after anti-infection treatment. If infection cannot be controlled within a short period of time, emergency surgery should be performed.

　　4. Malignant transformation. There are no symptoms in the early stage, making it difficult to detect. If the rapid growth of ovarian tumors is found, it should be checked.

　　Ovarian malignant tumors, also known as ovarian cancer, present with different symptoms at different stages of the disease:

　　Early symptoms

　　1. Edema of the vulva and lower limbs: With the growth of ovarian cancer, the pelvic veins are compressed, leading to poor blood flow, impeding lymphatic return, and causing edema of the vulva and lower limbs.

　　2. Decreased menstrual flow or amenorrhea: The menstrual periods of most ovarian cancer patients remain unchanged. As the tumor grows, cancer cells may destroy the normal ovarian tissue, leading to dysregulation of ovarian function and causing decreased menstrual flow or amenorrhea.

　　3. Lumbar and abdominal pain: If the tissues adjacent to the ovary are infiltrated by cancer or become adherent, it is easy to cause hidden pain or dull pain in the lumbar and abdominal region.

　　4. Gastrointestinal symptoms: If middle-aged women frequently feel abdominal distension and loss of appetite without discovering gastrointestinal diseases after digestion department examination, they should visit a gynecologist. This is because ovarian tumors can compress and stretch the surrounding ligaments, along with the stimulation of ascites, often leading to gastrointestinal symptoms.

　　Late symptoms

　　1. Early symptoms include occasional discomfort in the lower abdomen or a sense of坠坠痛 in one side of the lower abdomen.

　　2. Feeling of abdominal distension: Due to the rapid growth of the tumor, abdominal distension may occur in a short period of time, along with abdominal mass and ascites. Small tumors can only be detected during pelvic examination. As the mass gradually grows and exceeds the pelvic cavity, the mass can be palpated in the abdomen.

　　3. Compression symptoms: When the tumor infiltrates or compresses surrounding tissues or nerves, it can cause abdominal pain, lumbar pain, or sciatic nerve pain. If it compresses the pelvic veins, edema of the lower limbs may occur; a large tumor can compress the bladder, leading to frequent urination, difficulty in urination, and retention of urine; compression of the rectum results in constipation; compression of the gastrointestinal tract leads to gastrointestinal symptoms; compression of the diaphragm can cause dyspnea and inability to lie flat.

　　4. Due to the rapid growth of the tumor, malnutrition and emaciation may occur, forming cachexia.

　　5、因癌肿转移而出现相应的症状，卵巢恶性肿瘤极少引起疼痛，如发生肿瘤破裂、出血或感染或由于浸润压迫邻近脏器可引起腹痛、腰痛。

　　6、可出现月经紊乱、阴道出血。若双侧卵巢均被癌组织破坏，可引起月经失调和闭经，肺转移可出现咳嗽、咳血、胸水；骨转移可造成转移灶局部剧疼。肠道转移可有便血，严重的可造成肠梗阻。

　　卵巢癌转移扩散症状

　　1、直接蔓延：晚期的卵巢癌，不仅与围围组织粘连，而且可直接浸润这些组织，如子宫、壁层腹膜、阔韧带、输卵管、结肠及小肠，甚至可通过输卵管而蔓延至子宫腔。

　　2、淋巴道转移：淋巴道转移是卵巢癌的常见转移方式。通常是转移至腹主动脉旁淋巴结，但也可沿圆韧带而转移到腹股沟淋巴结。

　　3、植入性转移：卵巢癌可穿破包膜、肠管等处，形成大量的结节状或乳头状的转移癌，特别是浆液性囊腺癌的乳头状组织，更容易穿破瘤体包膜，而扩散在腹腔各处，并引起大量腹水。

　　4、血行转移：卵巢恶性肿瘤除肉瘤、恶性畸胎瘤及晚期者外，很少经血行转移。一般远隔部位转移可达肝、胸膜、肺等部位。

　　卵巢恶性肿瘤的后果十分严重，并且现如今并没有彻底治愈该病的方法，因此预防该病显得尤为的重要。

　　应做到定期筛查、早发现、早治疗、做好随访是预防卵巢恶性肿瘤的最佳方案。同时，应缩短CA125的复测时间，提高警惕性，如有CA125进行性升高，尽管不太显着，临床应予干预，做进一步检查。多数患者因病程时间长对疾病变化有所了解，因此对肿瘤标记物尤其敏感，严重影响情绪，但CA125既有假阳性可能（如炎症），也有假阴性，因此临床医师的解释显得极为重要。

　　卵巢恶性肿瘤患者应做如下检查：

　　（1）血清肿瘤标记物测定

　　血清CAl25是卵巢上皮性癌诊断及监测的一项重要指标。其他肿瘤标志物包括血清绒毛膜促性腺激素、血清CEA、血清AFP、。

　　（2）影像学检查

　　超声检查有助于判断盆腔肿块的来源及性质；可测定卵巢的大小、外形轮廓及实质的囊实性变化；对盆腔肿块的大小、形状、内部结构，与周围脏器的关系及来源也可作出判断。必要时可行阴道超声检查。CT及MRI适于对盆腔肿块的进一步定位，了解其大小、范围及性质。并可判断肿瘤浸润及转移范围，有利于术前分期，指导手术。X线检查如胸腹部摄片、胃肠摄片、静脉肾盂造影等检查可协助诊断卵巢癌转移状况。

　　(3) Ascitic cytological examination

　　It helps with qualitative diagnosis and clinical staging of ovarian cancer. In cases with obvious ascites, peritoneal puncture and fluid aspiration for cytological examination can be performed. In cases with little ascites, puncture can be made through the posterior fornix of the vagina or peritoneal lavage fluid can be aspirated through laparoscopy for cytological examination.

　　(4) Laparoscopic examination

　　For the diagnosis of ovarian cancer, clinical staging, and treatment follow-up. Early detection of metastasis and recurrence has its unique role. It is also possible to take living tissue for histological examination. The pelvic and abdominal organs can be examined under direct vision, and a large-scale lavage of the peritoneum can be performed under direct vision, thereby increasing the positive rate of peritoneal lavage fluid.

　　(5) Laparotomy

　　If a pelvic mass is found and its nature cannot be determined by various non-invasive examinations, and ovarian cancer cannot be ruled out, laparotomy should be performed.

　　Ovarian cancer patients should pay special attention to their diet and hygiene in daily life. Therapeutic diet can greatly alleviate the pain of the disease. The following points should be noted in the diet of patients:

　　(1) Avoid smoking and drinking.

　　(2) Avoid刺激性食物 such as scallions, garlic, peppers, and cassia.

　　(3) Avoid greasy, fried, moldy, and salted foods.

　　(4) Avoid warm and active blood foods such as mutton, dog meat, chives, and pepper.

　　(5) It is advisable to eat more foods with antitumor effects: horseshoe crabs, sea horses, turtles, dragon pearl tea, hawthorn.

　　(6) Hemorrhage should be treated with goat blood, snails, shrimps, cuttlefish, spinach, lotus root, mushrooms, malan head, stone ear, hickory nuts, persimmon cake.

　　(7) Infections should be treated with eels, warty clams, water snakes, needlefish, carp, kelp, celery, sesame, buckwheat, rapeseed, toon, red beans, mung beans.

　　(8) Abdominal pain and distension should be treated with pork kidneys, myrica, hawthorn, tangerine cake, walnuts, chestnuts.

　　Ovarian malignant tumors are primarily treated with surgery, and adjuvant chemotherapy is of great significance. Radiotherapy and other treatments should be given as appropriate.

　　1. Surgical treatment

　　Surgery is the most important component of comprehensive treatment for ovarian cancer and has decisive significance for staging diagnosis.

　　(1) Comprehensive exploratory laparotomy: A comprehensive exploration should be performed during the first operation to accurately determine the extent of the lesion. After laparotomy, abdominal fluid or peritoneal lavage fluid should be collected for cytological examination; then, a comprehensive exploration of the pelvic and abdominal organs, including intestines, mesentery, omentum, liver, spleen, diaphragm, peritoneum, and retroperitoneal lymph nodes should be conducted to determine the extent of metastasis and infiltration. In addition to biopsying suspicious areas, the peritoneum at the lateral sulcus of the colon, the diaphragmatic surface, and the rectouterine pouch should also be biopsied or smeared for cytological examination to improve the accuracy of surgical staging.

　　(2) Radical surgery for early cases: It is performed based on comprehensive staging exploration. Since elderly patients do not have the issue of preserving fertility, once ovarian malignant tumors are diagnosed during surgery, even if it is in the early stage, it is also principle to perform a hysterectomy and bilateral adnexectomy, retroperitoneal lymph node dissection, omentectomy, and appendectomy.

　　(3) Cytoreductive surgery for advanced cases: Most patients are already in the advanced stage (III or IV) at the time of surgery, with widespread metastasis in the abdominal cavity. The surgical scope includes the entire uterus and both adnexa, omentum, and appendix, and most or almost all of the metastatic foci in the pelvis and abdomen should be resected, hence the term 'cytoreductive surgery' or 'large resection', the purpose of which is to reduce the number of malignant tumor cells to the minimum. Satisfactory cytoreductive surgery should ensure that the diameter of each residual focus is

　　2. Chemotherapy

　　For well-differentiated I a and I b stage ovarian epithelial cancers (except clear cell carcinoma) with no pelvic adhesions, chemotherapy may not be required after standardized radical surgery, and close follow-up is necessary. Chemotherapy is also not required after surgery for l a and l b stage ovarian sex cord-stromal tumors. For all other cases, effective chemotherapy should be performed. The chemotherapy regimen for ovarian malignant tumors primarily uses cisplatin-based combination chemotherapy. The main regimens are cisplatin plus cyclophosphamide (PC regimen) and cisplatin, cyclophosphamide, and doxorubicin combined (PAC regimen). Other drugs, such as mitoxantrone, paclitaxel, and ifosfamide, etc. These chemotherapy drugs have good efficacy for ovarian cancer.

　　3. Radiation Therapy

　　Radiation therapy is applicable for preoperative and postoperative adjuvant treatment and palliative treatment for advanced and recurrent cancer foci. Germ cell tumors are most sensitive to radiation therapy, granulosa cell tumors are moderately sensitive, and epithelial cancers also have certain sensitivity. For germ cell tumors, even in advanced cases, postoperative radiotherapy can achieve good therapeutic effects.