Juvenile and pediatric ovarian tumors

　　Ovarian tumors in children under 1 year of age are related to hormones in their mothers' bodies; the onset before menarche is due to the endocrine activity at this time. The patient's teratoma originates from the developmental variation of their cells during embryonic development.

　　With the rapid growth of tumors, corresponding compression symptoms may occur, such as compression of adjacent organs, which can lead to difficulties in urination and defecation. Immature teratoma can infiltrate and spread around, early metastasis to the para-aortic lymph nodes, and late widespread dissemination through the blood vessels. 20% to 30% of patients may have the capsule ruptured and (or) peritoneal implantation during laparotomy, and sometimes blood-containing ascites may occur. Immature teratoma often combines with other components of germ cell tumors, such as endodermal sinus tumor, dysgerminoma, choriocarcinoma, etc.

　　The clinical manifestations of ovarian tumors in adolescents and children are diverse, and the main characteristics include the following aspects:

　　1. Although the incidence of ovarian tumors in children is low, once they occur, the tumor grows rapidly, and the malignancy is higher than that in adults. The initial symptoms are not obvious and are difficult to diagnose early. If treatment is not timely or thorough, the prognosis is poor.

　　2. During the embryonic period, the ovary is located in the abdominal cavity and descends to the pelvic cavity only during puberty. The pelvis of children is narrow and cannot accommodate large masses, so young girls with ovarian tumors often present with abdominal masses as the main symptom.

　　3. Abdominal pain is a common symptom, mostly persistent pain around the umbilicus or lower abdomen, caused by the stimulation of the peritoneum, compression of surrounding tissues, or adhesion. Sometimes, spontaneous rupture of malignant tumors can also cause abdominal pain.

　　4. The pelvis of children is smaller, and the tumor rapidly ascends to the abdominal cavity. After the ovarian tumor ascends, the pedicle is elongated, and children are active, so cystic masses are more prone to torsion, causing acute abdominal pain and peritoneal irritation signs.

　　5. Ovarian tumors with endocrine function, such as granulosa cell tumors, theca cell tumors, annular tubular sex cord-stromal tumors, and primary绒癌, can all cause symptoms of precocious puberty in the same sex.

　　Adolescents can perform self-examinations daily, waking up in the morning before urination, bending their legs to relax the abdominal wall, and then carefully touching the lower abdomen with their hands, which may help to detect a mass. Adolescents have thin abdominal walls and not very developed abdominal muscles, so it is easy to feel a mass through the abdominal wall. Children can be examined by their mothers. When adolescents have abdominal symptoms such as abdominal pain and distension, especially when an abdominal mass is found, in addition to considering common causes, the possibility of ovarian tumors should also be considered.

　　There are many diagnostic methods for ovarian tumors in adolescents and children, among which the most important diagnostic methods include the following:

　　1. Alpha-fetoprotein (AFP) and chorionic gonadotropin (HCG) are sensitive and reliable tumor markers, and routine determination should be performed for adolescents and children with ovarian tumors.

　　2. CT, MRI, and other imaging examinations are helpful for diagnosis.

　　3. Abdominal X-ray. Patients with dermoid cysts may show the outline of the mass, and there may be calcification points inside.

　　4. Ultrasound examination suggests the nature of abdominal masses, estimates the range of the mass and its relationship with surrounding organs.

　　6. Laparoscopy can differentiate the nature of different abdominal and pelvic masses, and has significance for early diagnosis, re-staging, prognosis judgment, and treatment guidance for patients with malignant ovarian tumors.

　　Patients with ovarian tumors should not only eat foods that are beneficial to their condition but also pay attention to dietary taboos.

　　Firstly, for patients with ovarian tumors, dietary considerations should be taken.:

　　1. It is recommended to consume eels, clams, water snakes, needlefish, carp, celery, sesame, buckwheat, rapeseed, toon, red beans, and mung beans for infection.

　　2. Eat more foods with anti-tumor effects, such as hippocampus, turtle, dragon pearl tea, hawthorn.

　　3. For bleeding, eat goat blood, snails, clam, cuttlefish, shepherd's purse, lotus root, mushrooms, malan head, stone ear, hickory, persimmon candy.

　　4. For abdominal pain and distension, eat pork kidneys, myrica, hawthorn, tangerine candy, walnuts, chestnuts.

　　II. Diet taboos for ovarian tumor patients:

　　1. Avoid warm and blood-activating foods such as lamb, dog meat, chives, and pepper.

　　2. Avoid fatty, fried, moldy, and preserved foods.

　　3. Avoid刺激性食物 such as scallions, garlic, chili, cinnamon, etc.

　　4. Avoid smoking and alcohol.

　　For the treatment of ovarian tumors in adolescents and children, there are mainly the following three methods:

　　1. Surgical Treatment

　　The formulation of treatment plans not only needs to consider the thoroughness of treatment but also try to preserve the endocrine and reproductive functions of adolescents and children. As long as the ovary retains tissue with a diameter of more than 1.5cm, the majority of patients will have normal menstruation after surgery, and the pregnancy rate can reach 71.4%. Benign ovarian tumors must retain the healthy ovary or part of both ovaries; for malignant tumors, the fertility function should be preserved as much as possible during surgery based on the patient's general condition, clinical stage, and tissue type, and supplemented with chemotherapy after surgery.

　　2. Radiotherapy

　　Ovarian malignant tumors of different tissue types have different sensitivity to radiotherapy, among which teratoma is the most sensitive to radiotherapy, granulosa cell tumor is moderately sensitive, and epithelial tumors also have certain sensitivity. Postoperative external irradiation is mainly aimed at residual cancer foci in the pelvis and abdomen. For those with minimal residual cancer foci without adhesions in the abdominal cavity, radioactive isotopes can be infused 7-14 days after surgery, commonly 32P10-15mCi, placed in 300-500ml of physiological saline, and slowly injected into the abdominal cavity.

　　3. Chemotherapy

　　Before surgery, 1-2 courses of chemotherapy can be used to improve the success rate of surgery; postoperative chemotherapy can prevent recurrence. For those with incomplete resection, chemotherapy can provide temporary or even long-term survival; for those who cannot be resected, chemotherapy can reduce the tumor size and loosen it, creating conditions for reoperation. Chemotherapy for malignant tumor patients usually adopts the VAC regimen, which is vincristine plus actinomycin D plus cyclophosphamide, or the VBP regimen, which is vincristine plus cisplatin plus mitomycin.