Pediatric ovarian tumors

　　First, etiology The etiology of ovarian malignant tumors is not yet clear. The classification of ovarian tumors is as follows

　　1, Germ cell tumors: dysgerminoma, endodermal sinus tumor, teratoma (mature - solid, cystic; immature, single-layer epithelium - ovarian stroma, carcinoid, neuroectoderm, mixed), embryonal carcinoma, malignant mixed germ cell tumor, polyembryoma, choriocarcinoma, gonadoblastoma.

　　2, Non-reproductive cell tumor epithelial (serous, mucinous), sex cord-stroma (spermatogonia, supportive-interstitial, mixed).

　　Second, pathogenesis

　　1, Pathogenesis of 'continuous ovulation' carcinogenesis: The incidence of ovarian tumors in women with early menarche, late menopause, and no childbirth is high, while the risk of disease is reduced in women with multiple deliveries, breastfeeding, and oral contraceptives. This 'continuous ovulation' carcinogenesis theory believes that ovulation causes damage to ovarian epithelial cells, and the repeated process of damage and repair promotes carcinogenesis.

　　2, Genetic factors: It is one of the causes of disease that has been studied more in recent years, and most cases are caused by autosomal dominant inheritance. In the past 10 years, there have been significant progress in molecular genetic research. Narod and others have found that the specific gene susceptible to cancer in patients with hereditary breast-ovary malignant tumor (HBOC) is located on chromosome 17, now called BRCA1. Recently, another susceptible gene BRCA1 has been identified on chromosome 13. These two gene mutations make most epithelial ovarian malignant tumors hereditary. The main types of hereditary ovarian malignant tumors are three:

　　(1) High-risk patients: One is the familial ovarian malignant tumor syndrome, where the mother or sister has ovarian malignant tumors, and the patient is a high-risk individual.

　　(2) 50% risk: It is the breast-ovarian malignant tumor syndrome, where one or both parents or sisters have cancer patients, and the risk of developing ovarian malignant tumors is 50%.

　　(3) Has a family history of cancer: The risk of ovarian malignant tumors, endometrial cancer, breast cancer, and colorectal cancer may increase.

　　3, Pathology

　　Histological grading: Undifferentiated cells accounting for 0% to 25% of the cells determined by Broder are G1; undifferentiated cells accounting for 25% to 50% are G2; undifferentiated cells >50% are G3.

　　1, It can cause sexual precocity, torsion of the tumor and pedicle, bleeding and necrosis, which can lead to difficulties in urination and defecation.

　　2, Many diseases are not caused by their own reasons but die from complications. Ovarian tumors are the same, and there may be some fatal tumor complications that should be carefully prevented and treated cautiously. Experts point out that there are four complications of ovarian tumors, and such patients should be examined and re-examined regularly.

　　Firstly, clinical manifestations

　　1. Smaller masses generally do not produce symptoms, occasionally there is a feeling of坠沉 or traction pain in the lower abdomen, and the abdominal mass can be clearly felt. The surface is smooth, without tenderness, and has a cystic feeling. Most benign tumors have a long pedicle formed by the fallopian tube, as the tumor is often non-adherent to surrounding tissues, it has a high degree of mobility and can often be moved from one side of the lower abdomen to the upper abdomen.

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

　　3. Functional ovarian tumors such as granulosa cell tumors can cause symptoms of precocious puberty due to the production of a large amount of estrogen. Female characteristics such as physique, breasts, and external genitalia develop rapidly, and menstruation appears, but there is no ovulation. 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 general rule.

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

　　Secondly, tissue types: here is only a brief description of ovarian tumors that are more common in children.

　　1. Dysgerminoma: also known as germ cell cancer, is the most common malignant germ cell tumor in children and adolescents, morphologically and biologically equivalent to testicular germ cell cancer, pineal gland area, anterior mediastinum, and retroperitoneal extragonadal germ cell cancer.

　　2. Endodermal sinus tumor: almost represents all highly malignant embryonal epithelial tumors, characterized by embryonal cells with a loose reticular structure, similar to the special vascular periadventitial structure in the mouse placental endodermal sinus, and hyaline corpuscles with PAS-positive reactions exist both inside and outside the cells. This tumor was also called yolk sac tumor and contained many small cysts similar to yolk sac vesicles.

　　3. Embryonal carcinoma (embryonal carcinoma): accounting for about 4% of ovarian malignant tumors, with an average age of 14 years at diagnosis. In addition to abdominal masses, half of the patients have abdominal pain. The tumor surface is smooth, with a maximum diameter of up to 10-20 cm. Although the microscopic image is similar to that of an endodermal sinus tumor, the cells are not differentiated, nuclear division is more prominent, hemorrhage and necrosis are more significant, and there are no Schiller-Duval bodies. Clinically, the incidence of endocrine manifestations is higher, including positive pregnancy reactions, increased HCG, and 60% are in stage I at diagnosis. Occasionally, it is bilateral. Stage I lesions only require the removal of the affected ovary and fallopian tube, with a survival rate of up to 50%. Radiotherapy is not effective, and chemotherapy can be referred to as endodermal sinus tumor.

　　4, Malignant mixed germ cell tumor (malignant mixed germ cell tumor): accounting for 20% of pediatric and adolescent ovarian germ cell tumors and 8% of malignant ovarian germ cell tumors, with an average age of diagnosis of 16 years, 40% are girls before menarche. Preoperative AFP and HCG measurements are required, as the tumor may contain endodermal sinus tumor and embryonal carcinoma components. Bilateral lesions can be up to 20%, so the opposite ovary must be checked during surgery.

　　5, Granulosa-theca cell tumor (granulosa-theca cell tumor): accounting for 3% of pediatric ovarian tumors, with an average age of diagnosis of 8 years, 60% of children have precocious puberty, mostly unilateral lesions, with a low tendency towards malignancy. The removal of the affected ovary and fallopian tube, radiotherapy, and chemotherapy are only used for advanced and recurrent cases.

　　6, Epithelial tumors: rare in girls before puberty, and can be divided pathologically into serous, mucinous, endometriosis (endometriosis), or clear cell tumors. The cell morphology can be benign or malignant, with varying degrees of malignancy.

　　1, The most important thing to improve immune system function is: diet, exercise, and controlling stress. Choosing a healthy lifestyle can help us stay away from cancer. Maintaining a good emotional state and appropriate physical exercise can keep the body's immune system in the best state, which is also beneficial for preventing the occurrence of tumors and other diseases. In addition, studies have shown that appropriate exercise not only strengthens the human immune system but also reduces the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here, we mainly understand some issues related to diet in the prevention of tumor occurrence.

　　2, Epidemiological studies in humans and animal experiments show that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucous membranes and vision, and it directly or indirectly participates in the functions of most tissues in the body. Vitamin A exists in animal tissues such as liver, whole eggs, and whole milk, and in plants it exists in the form of beta-carotene and carotenoids, which can be converted into vitamin A in the human body. Overconsumption of vitamin A can cause adverse reactions in the body, while beta-carotene and carotenoids do not have this effect. An increase in low vitamin A levels in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood are more likely to develop lung cancer, and for smokers, the risk of lung cancer is doubled due to low levels of vitamin A intake in the blood. Vitamin A and its mixtures can help clear free radicals in the body (free radicals can cause damage to genetic material), and secondly, they can stimulate the immune system and help differentiate cells within the body into organized tissues (while tumors are characterized by disorganization). Some theories suggest that vitamin A can help reverse the mutation of cells early attacked by carcinogens and become normal growing cells.

　　3. Some studies suggest that simply supplementing beta-carotene drugs cannot reduce the risk of cancer, on the contrary, it may slightly increase the incidence of lung cancer. However, when beta-carotene is combined with vitamin C, E, and other anti-toxin substances, its protective effect becomes evident. The reason is that when it is consumed itself, it can also increase the level of free radicals in the body. In addition, there are interactions between different vitamins. Both human and rat studies have shown that the application of beta-carotene can reduce the level of vitamin E in the body by 40%. A safer strategy is to eat different foods to maintain the balance of vitamins to resist the invasion of cancer, because some protective factors have not been discovered yet.

　　4. Vitamin C and E are another type of anti-tumor substance. They can prevent the harm of carcinogens in food such as nitrosamines. Vitamin C can protect sperm from genetic damage and reduce the risk of leukemia, kidney cancer, and brain tumors in offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has anti-tumor effects like vitamin C and is a scavenger of toxins and free radicals. The combined application of vitamin A, C, and E can produce a better protective effect on the body against toxins than the single application.

　　5. Currently, the research on phytochemicals has attracted widespread attention. Phytochemicals refer to the chemical substances found in plants, including vitamins and other substances found in plants. It has been found that thousands of chemical components exist in plants, many of which have anti-cancer effects. The protective mechanism of these chemical substances not only reduces the activity of carcinogens but also enhances the body's immunity to resist the invasion of carcinogens. The antioxidant activity provided by most plants exceeds that of simple vitamin A, C, and E. For example, a cup of kale only contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100U of vitamin E. It can be inferred that the antioxidant effect of antioxidants in fruits and vegetables is much stronger than that of vitamins we know. There is no doubt that natural plant products will help in the future cancer prevention work.

　　1. Determination of tumor markers

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

　　2. AFP: It has specific value for endodermal sinus tumors in the ovary, mixed tumors containing endodermal sinus tumor components, dysgerminoma, and embryonal tumors. Some immature teratoma can also be elevated. AFP can be an important marker for the treatment and follow-up of germ cell tumors, and the normal value

　　3. HCG: Patients with germinoma components of primary ovarian choriocarcinoma have an abnormally elevated HCG in their blood, and the HCG value of serum B subunit in normal non-pregnant women is negative or

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

　　5. LDH: The serum LDH of some ovarian malignant tumors is elevated, especially in patients with dysgerminoma often elevated.

　　6. Sex hormones: Granulosa cell tumors and theca cell tumors can produce a higher level of estrogen; during luteinization, testosterone can also be secreted. Serous, mucinous, or fibroepithelial tumors can also secrete a certain amount of estrogen at times.

　　Two: Imaging examination

　　1. Ultrasound examination is an important means of diagnosing ovarian tumors, which can judge the size, location, texture, relationship with the uterus, and the presence of ascites, etc. The judgment of benign and malignant depends on experience, which can reach 80% to 90%. However, the diagnosis of tumors less than 2 cm is difficult by ultrasound, and vaginal ultrasound examination, especially vaginal color Doppler ultrasound examination, can show the blood flow changes within the tumor, providing a reference for distinguishing benign and malignant.

　　2. CT and MRI examinations are valuable for judging the size, texture, and relationship of the tumor with the pelvic organs, especially for the enlargement of pelvic and para-aortic lymph nodes.

　　3. Lymphangiography can show iliac vessels and para-aortic lymph nodes and their metastatic signs, providing preoperative evaluation and preparation for lymph node dissection.

　　4. Choose the following examinations if necessary:

　　(1) Gastroscopy, colonoscopy: To differentiate ovarian metastasis from primary gastrointestinal primary cancer.

　　(2) Intravenous pyelography: Understand the secretory and excretory function of the kidneys, and symptoms of urinary tract compression and obstruction.

　　(3) Radionuclide imaging: Use radioactive isotopes labeled with antibodies as tumor positive imaging agents for tumor localization diagnosis.

　　(4) Laparoscopic examination: For pelvic masses that are difficult to determine clinically, perform laparoscopic biopsy for ascites patients, and take ascites for pathological and cytological examination for qualitative and preliminary clinical staging.

　　One: Dietary therapy for pediatric ovarian tumor

　　1. The selection and proportion of Shenqi Invigorating the Spleen Soup:This is the first recipe for the food therapy and health care of ovarian cancer. Korean ginseng 10 grams, Astragalus 10 grams, Codonopsis 18 grams,山药18 grams, Chinese wolfberry 15 grams, Angelica 10 grams, Tangerine peel 5 grams, Longan meat 14 grams, pork ribs 300 grams or a whole chicken, and an appropriate amount of clear water. Preparation method: Wash the Chinese herbs such as Korean ginseng and Astragalus, put them into a cloth bag and tie the mouth, then cook them with the ribs or chicken together with water. Start with high heat and then low heat, cook for 2-3 hours. Remove the cloth bag, add salt, pepper, and other seasoning ingredients. Take 1 small bowl each time, once a day. Eat the meat and drink the soup, and put the leftovers in the refrigerator for storage. Effect: It has the effects of promoting qi and dispersing phlegm, and eliminating blood stasis.

　　2. Chenxiang Beef:Selection and Proportion: 30 grams of dried tangerine peel, 15 grams of cyperus, 500 grams of beef, scallions, ginger, salt in appropriate amount. Preparation method: Boil dried tangerine peel and cyperus with 2000 grams of water for half an hour, remove the dregs, add beef with scallions, ginger, salt, and other seasonings, stew over low heat until tender, cool, and slice for eating. Effect: Relieves liver qi and invigorates the spleen and qi. In the formula, dried tangerine peel has the effect of regulating qi and invigorating the spleen.

　　3. Formula for Ginseng and Astragalus Strengthening the Spleen Soup:10G of ginseng, 10G of Astragalus, 18G of Codonopsis, 18G of Dioscorea, 15G of Chinese wolfberry, 10G of Angelica sinensis, 5G of dried tangerine peel, 14G of longan meat. 300G of pork ribs or 1 whole chicken, appropriate amount of water. Preparation: Clean the traditional Chinese medicine such as ginseng and Astragalus, put them in a cloth bag and tie the mouth, and cook them with the pork ribs or chicken together with water. Boil first with high heat, then with low heat, for 2-3 hours. Remove the cloth bag, add salt, pepper, and other seasonings. Eat 1 small bowl each time, once a day. The above materials can make 5 small bowls. Eat the meat and drink the soup. The extra is stored in the refrigerator. Effect: Tonifies the spleen and lung, and invigorates the stomach and spirit. Note: This diet is suitable for the adjustment after the operation of ovarian cancer.

　　4. Formula for rhubarb porridge:10g of rhubarb, 100g of japonica rice, 5 dates. Appropriate amount of water. Preparation: First, decoct rhubarb with water to make a decoction, remove the dregs, then add japonica rice and dates to cook porridge. Eat on an empty stomach, to a slight diarrhea, but not in excess. Effect: Promotes bowel movements, relieves edema. Note: This diet is mainly suitable for ascites caused by difficulty in urination due to ovarian cancer.

　　II. Foods that are good for children with ovarian tumors

　　High-calcium diet, eat more carrots, more legume foods, more vegetable oils, more fiber foods, and jujube.

　　III. Foods that children with ovarian tumors should not eat

　　Eat less animal fat, fried eggs, sweets, less carbonated drinks, less salt, and less cold, spicy, and irritating foods.

　　Ovarian tumors in children should be surgically removed early, and both ovaries should be explored during the operation. If both ovaries are affected, the tumor should be removed, and efforts should be made to preserve the tissue of one ovary. Even for malignant tumors, pelvic clearance surgery is generally not recommended. Comprehensive treatment with surgery as the main method and chemotherapy as an adjuvant is of great importance, and radiotherapy and other treatments should be given as appropriate.