Ovarian tumors during pregnancy

　　First, Causes of Disease

　　1. Endocrine factors

      The risk of ovarian cancer in women without pregnancy is twice that of women who have given birth; the risk of disease in women with fewer births is higher than that in women with multiple births; early age of first pregnancy, early menopause, and the use of oral contraceptives have all been confirmed to reduce the risk of ovarian cancer. The above situations indicate that reducing or inhibiting ovulation can reduce the damage to the ovarian epithelium caused by ovulation and may reduce the risk of ovarian cancer. The chance of breast cancer or endometrial cancer with functional ovarian cancer is twice as high as that in general women, and all three are hormone-dependent tumors.

　　2. Genetic and family factors

     20% to 25% of patients with malignant ovarian tumors have a family history. So-called familial ovarian cancer refers to the occurrence of disease across several generations in a family, mainly epithelial cancer. Women with Peutz-Jeghers syndrome have a 5% to 14% chance of developing ovarian tumors.

　　3. Environmental factors and other factors

     The incidence of ovarian cancer is high in industrialized countries, which may be related to dietary components (high cholesterol content); contact with talcum powder, smoking, drinking, and other factors have also been studied, but the increase in relative risk is not significant.

　　Second, Pathogenesis

　　The pelvic blood flow is abundant during pregnancy, but there is no evidence to date that pregnancy accelerates tumor growth and spread.

　　Early symptoms are often absent, and they can be found during gynecological examination. Once symptoms appear, they are often manifested as abdominal distension, abdominal mass, and ascites, but it is already in the late stage of the tumor. The severity of the symptoms depends on. There is a possibility that the pregnant uterus may compress the ovarian tumor, causing the latter to rupture and bleed.

　　1. Ovarian benign tumors

　　Early tumors are small, mostly asymptomatic, and develop slowly. They are occasionally found during gynecological examination. When the tumor grows to a medium size, there is a feeling of abdominal distension or a mass can be palpated in the abdomen. The mass is clear in the boundary, and the gynecological examination can feel spherical masses on one or both sides of the uterus. They are mostly cystic, with smooth surface, not adherent to the uterus, and if the tumor is large enough to fill the pelvis, symptoms of compression such as frequent urination, constipation, shortness of breath, palpitations, abdominal distension, poor mobility of the mass, and no mobile dullness on percussion may occur.

　　2. Ovarian malignant tumors

　　Early symptoms are often absent, and they can be found during gynecological examination. Once symptoms appear, they are often manifested as abdominal distension, abdominal mass, and ascites, but it is already in the late stage of the tumor. The severity of the symptoms depends on:

　　The size, location, and extent of invasion of the adjacent organs by the tumor.

　　The histological type of the tumor.

　　Whether there are complications.

　　If the tumor infiltrates or compresses surrounding tissues or nerves, it can cause abdominal pain, lumbar pain, or lower limb pain; if it compresses pelvic veins, lower limb edema may occur; if it is a functional tumor, it may produce excessive symptoms of estrogen or androgen, and in the late stage, it may show signs of emaciation, severe anemia, and other signs of cachexia. The three-part examination can feel hard nodules in the pelvic cavity through the posterior fornix of the vagina, and the mass is usually bilateral, solid or semi-solid, with uneven surface, non-mobile, often accompanied by ascites, or palpable enlarged lymph nodes in the inguinal or supraclavicular region.

　　Pregnancy with ovarian tumor is due to the rich pelvic blood flow during pregnancy, but to date, there is no evidence to show that pregnancy accelerates tumor growth and spread. In order to ensure the healthy growth of the fetus, a pre-pregnancy physical examination should be done to achieve early detection and pre-pregnancy treatment of ovarian tumors.

　　Currently, there is no single tumor marker (tumormarker) that is exclusively associated with a particular tumor; various types of ovarian tumors can have relatively special markers; they can be used for auxiliary diagnosis and disease monitoring.

　　1. CA125

　　80% of ovarian epithelial cancer patients have CA125 levels higher than the normal value; more than 90% of patients show consistent changes in CA125 levels with disease remission or progression, which can be used for disease monitoring, with high sensitivity, and the normal serum CA125 value is 35U/ml.

　　2. AFP

　　It has specific value for ovarian endodermal sinus tumors, assists in the diagnosis of immature teratoma and mixed aneuploid dysgerminoma containing yolk sac components, with the normal serum value being 20-25ng/ml.

　　3. HCG

　　It is specific for primary ovarian绒癌, and malignant germ cell tumors are often mixed type, with HCG also elevated.

　　4. CEA

　　Primary mucinous ovarian cancer and gastrointestinal ovarian metastases can increase.

　　5. Sex hormones

　　Granulosa cell tumors and theca cell tumors produce a high level of estrogen, serous, mucinous, or Brenner tumors can also secrete a certain amount of estrogen.

　　6. Pelvic B-ultrasound examination

　　Pelvic B-ultrasound examination during pregnancy is the most reliable method for diagnosing ovarian tumors, often discovering ovarian tumors that were missed during pelvic examination during pregnancy, thus making up for the shortcomings of pelvic examination. However, attention should be paid that when performing B-ultrasound examination in the late pregnancy, one should not only focus on observing the fetus, placenta, and amniotic fluid, but also ignore the examination of the uterine adnexa, so as not to miss the adnexal mass. B-ultrasound can not only determine the location, size, shape, and mutual relationship with the uterus of the mass, but also judge whether the content of the mass is cystic, solid, or mixed cystic and solid, and whether there is segmentation, and whether there is fluid accumulation in the pelvic cavity. Any cystic mass may be a functional ovarian cyst or benign tumor. Solid masses with segmentation are generally ovarian tumors. Regular B-ultrasound follow-up during pregnancy after the discovery of ovarian masses is more helpful for further determining the nature of the mass. If the pregnancy exceeds 3 months and the mass remains the same size without change, it may be a benign ovarian tumor. If it gradually shrinks, it is generally a functional or physiological ovarian cyst rather than a tumor. If it gradually increases or there is nodular growth, ovarian malignant tumors should be considered.

　　7. CT examination

　　Harmful to the fetus, forbidden during pregnancy. Although MRI examination can be used during pregnancy, due to its high cost, it is generally unnecessary to perform MRI examination after B-ultrasound examination has confirmed the diagnosis.

　　First, dietetic recipe for pregnant women with ovarian tumors

　　1. Ginseng and Astragalus Invigorating Spleen Soup

　　Ginseng 10G, Astragalus 10G, Codonopsis 18G, 山药18G, Wolfberry 15G, Angelica Sinensis 10G, Tangerine peel 5G, Longan meat 14G, pork ribs 300G or a whole chicken, sufficient amount of water. Preparation: Clean the Chinese herbs such as ginseng and astragalus, put them into a cloth bag and tie it up, then cook them with pork ribs or chicken together with water. Boil with high heat first, then low heat, for 2-3 hours. Remove the cloth bag, add salt, pepper and other seasonings. Take 1 small bowl each time, once a day. Eat the meat and drink the soup, the excess can be stored in the refrigerator. Function: has the effects of promoting qi flow, resolving masses, and eliminating blood stasis;

　　2. Tangerine Peel and Beef

　　Tangerine peel 30 grams, Cyperus rotundus 15 grams, beef 500 grams, scallion, ginger, salt as needed. Preparation: Boil tangerine peel and Cyperus rotundus in 2000 grams of water for half an hour, remove the residue, add beef with scallion, ginger, salt and other seasonings, simmer over low heat until tender, cool and slice to eat. Function: Relieves liver qi, invigorates the spleen and benefits the qi. Tangerine peel in the formula has the effect of regulating qi and invigorating the spleen.

　　3. Ginseng and Astragalus Invigorating Spleen Soup

　　Ginseng 10G, Astragalus 10G, Codonopsis 18G,山药18G, Wolfberry 15G, Angelica Sinensis 10G, Tangerine peel 5G, Longan meat 14G. Pork ribs 300G or a whole chicken, sufficient amount of water. Preparation: Clean the Chinese herbs such as ginseng and astragalus, put them into a cloth bag and tie it up, then cook them with pork ribs or chicken together with water. Boil with high heat first, then low heat, for 2-3 hours. Remove the cloth bag, add salt, pepper and other seasonings. Take 1 small bowl each time, once a day. The above materials can make 5 small bowls. Eat the meat and drink the soup. The excess can be stored in the refrigerator. Function: strengthens the spleen and benefits the lung, opens the appetite and invigorates the spirit.

　　4. Shanlu porridge

　　10g of shanlu, 100g of粳米, 5 dates. Appropriate amount of water. Preparation: First, decoct shanlu with water to make a decoction, remove the residue, then add the rice and dates to cook porridge. Eat on an empty stomach, to the extent of slight diarrhea, do not overdo it. Effect: Promote the function of the bowels and urination, relieve edema. This information is for reference only, please consult a doctor for details.

　　Two, what foods are good for pregnant individuals with ovarian tumors

　　1. Eat more foods with anti-tumor effects: horseshoe crab, hippocampus, turtle, dragon pearl tea, hawthorn.

　　2. For bleeding, eat goat blood, snail, conch, cuttlefish, shepherd's purse, lotus root, mushroom, malan tou, shi er, hickory, persimmon cake.

　　3. For infection, eat eel, whelk, water snake, needlefish, crucian carp, kelp, celery, sesame, buckwheat, rapeseed, toon, red bean, mung bean.

　　4. For abdominal pain and distension, eat pork kidney, myrica, hawthorn, tangerine candy, walnut, chestnut.

　　Three, what foods should pregnant individuals with ovarian tumors avoid

　　1. Avoid smoking and alcohol.

　　2. Avoid刺激性食物 such as scallion, garlic, pepper, cinnamon, etc.

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

　　4. Avoid warm and blood-activating foods such as mutton, dog meat, chive, pepper, etc.

　　Western medical treatment for ovarian tumors during pregnancy:

　　The treatment of ovarian malignant tumors during pregnancy is the same in principle as that of non-pregnant individuals. Once it is determined or suspected to be a malignant ovarian tumor, surgery should be performed as soon as possible, without considering the stage of pregnancy. The primary consideration during surgery is to determine the stage of the tumor, and a frozen section histological examination should be performed to determine the pathological diagnosis and type of the tumor. If the tumor is localized to one ovary, with an intact capsule and no evidence of metastasis (i.e., a tumor at clinical stage Ia); or if the tumor is of low malignancy, unilateral salpingo-oophorectomy may be sufficient. If the contralateral biopsy and pelvic and abdominal cavity lavage cytology examination do not show cancer cells, pregnancy may be allowed to continue to term. For ovarian epithelial carcinoma at stage Ia or above, total hysterectomy with bilateral salpingo-oophorectomy, omentectomy, appendectomy, retroperitoneal lymph node dissection, and resection of metastatic foci should be performed as 'tumor reduction surgery'. For malignant germ cell tumors or granulosa cell tumors, even if the tumor has spread to sites outside the ovary, it may be sufficient to remove the affected ovary and the metastatic cancer, while preserving the pregnant uterus and the contralateral ovary. All pregnant individuals with ovarian malignant tumors should receive chemotherapy. For those with early tumors who have undergone unilateral salpingo-oophorectomy, chemotherapy may begin 6 weeks after full-term delivery; for those who have undergone total hysterectomy with bilateral salpingo-oophorectomy, chemotherapy should start within 5 to 10 days after surgery. The treatment of ovarian metastatic cancer originating from the stomach, colon, liver, or breast, etc., may vary from person to person. Unless acute abdomen occurs, there is no need to rush to remove the ovaries; the pregnant woman may continue her pregnancy until the fetus is mature, or she may be comforted psychologically. Chemotherapy: It is the main adjuvant treatment. Since ovarian malignant tumors are sensitive to chemotherapy, even in cases with widespread metastasis, a certain degree of efficacy can be achieved. It can be used for both prevention of recurrence and for cases with residual cancer after surgery. For patients with advanced disease who are temporarily unable to undergo surgery, chemotherapy can also slow down or shrink the tumor, creating conditions for future surgery.

　　Commonly used drugs include platinum: cisplatin and carboplatin. Alkylating agents: cyclophosphamide, ifosfamide (ifosfamide), stereptozotocin, and lomustine (melfalan). Antimetabolites: fluorouracil. Antitumor antibiotics: actinomycin D, pingyangmycin, etc. Antitumor plant extracts: vincristine, paclitaxel, etc. In recent years, they are mostly used in combination, with platinum drugs as the main drugs. Commonly used combined chemotherapy regimens. Intraperitoneal chemotherapy can not only control ascites but also reduce or eliminate the implanted lesions. Its advantages lie in that the drugs can directly act on the tumor, and the local concentration is significantly higher than that in plasma. The adverse reactions are lighter than those of systemic medication. It is mainly used for early cases, ascites, and small residual intraperitoneal cancer implants. Place 100mg/m2 of cisplatin in 2000ml of normal saline and slowly infuse it into the peritoneal cavity, while performing intravenous hydration to make the urine output reach 100ml per hour, and intravenously infuse 4g/m2 of sodium thiosulfate to reduce nephrotoxic reactions. The treatment is repeated every 3 weeks. Usually, 6 to 8 courses are applied.

　　For benign ovarian tumors, except for those suspected to be ovarian tumor-like lesions, short-term observation can be carried out. Once diagnosed, surgical treatment should be performed. The scope of surgery is determined based on the patient's age, reproductive requirements, and the condition of the opposite ovary. Young patients with unilateral benign tumors should undergo unilateral ovarian cystectomy or oophorectomy, trying to preserve normal ovarian tissue and the normal ovary on the opposite side; even in the case of bilateral benign cysts, it is also advisable to perform ovarian tumor excision to preserve part of the ovarian tissue. Women in the perimenopausal period can undergo unilateral salpingectomy or hysterectomy with bilateral adnexectomy. In addition to visually distinguishing benign and malignant tumors by opening the tumor during surgery, frozen section histological examination should be performed when necessary to determine the nature and the scope of surgery. If the tumor is large or suspicious of malignancy, the tumor should be removed as completely as possible to prevent the leakage of cyst fluid and the implantation of tumor cells in the peritoneal cavity. Large cysts can be punctured and drained, and then removed after the volume is reduced. The drainage rate should be slow to avoid a sudden drop in abdominal pressure leading to shock.