How fast can ovarian cancer spread

Ovarian cancer

Ovarian cancer (Ovarian cancer): Malignant tumor of the ovaries. Ovarian cancer is the second most common malignant disease of the female genital organs and is associated with a high mortality rate. This type of cancer exists in many histologically distinguishable forms, some also occur at a young age, but most affect women over 50 years of age. Since ovarian cancer does not show any early symptoms, it is only recognized in 75% of cases when it has already metastasized inside or outside the pelvis. A cure is usually not possible in these cases.

Leading complaints

As a rule, at the beginning there are no typical symptoms that indicate an illness. Nevertheless, one should pay attention to certain signs and go to the gynecologist - especially if they have only existed for a short time and are more severe than normal cycle symptoms:

  • Bleeding outside of your menstrual period or after menopause
  • Pain in the lower abdomen
  • Foreign body sensation
  • Digestive complaints such as gas, bloating, pain during bowel movements
  • Problems urinating or urinating more frequently
  • Increase in waist size due to water retention in the abdominal cavity (ascites)
  • General deterioration, general tiredness, exhaustion, weight loss.

When to the doctor

In the next two days, though

  • Your lower abdomen is rapidly increasing in size.

The illness

causes

Corresponding to the immense number of different types of ovarian cancer, the researchers assume that there are a number of disease processes that, alone or in combination, lead to the degeneration of one of the many tissues in the ovary. The repeated injuries to the surface epithelium that occur during ovulation are seen as one of these causes, and the division processes during egg maturation are another. In addition, heredity plays a causal role in around 5% of diseases. Certain genetic changes increase the risk of developing ovarian cancer.

course

Ovarian cancer spreads in four stages:

  • Stage I: The tumor affects one or both ovaries.
  • Stage II: The cancer cells spread in the pelvis.
  • Stage III: The tumor spreads outside the pelvis into the abdominal cavity and / or into the lymph nodes.
  • Stage IV: The cancer cells also spread outside of the abdominal cavity into other regions of the body (distant metastases).

Risk factors

  • Childlessness or infertility (infertility)
  • Sexual maturity set in early
  • Later onset of menopause
  • Pre-existing cancer of the female breast, uterus or intestine
  • Obesity
  • Hormone replacement therapy for menopausal symptoms
  • Medicinal ovulation induction, for example for artificial insemination (in vitro fertilization).

Types

Since the ovary consists of many different tissues, there is also a very confusing number of different types of ovarian cancer, comparable to the very large number of benign ovarian tumors. Ovarian cancer often forms via cyst-like precursors. This is the most common serous cystadenocarcinoma, the malignant variant of the serous cystoma. There are also semi-malignant (semi-malignant) forms called LMP or borderline ovarian cancer.

Directions of spread of ovarian cancer. The most common type of ovarian cancer is serous cystadenocarcinoma. At the time of diagnosis, the cancer had already spread to the other side of the body or to the abdominal cavity in half of the cases.
Georg Thieme Verlag, Stuttgart

Complications

The flushing of cancer cells into the abdominal cavity creates a malignant ascites (ascites), which quickly spreads the cancer throughout the body. This is punctured by the doctor. In addition, it is possible to inject cytostatics into the abdominal cavity in order to prevent the cells from spreading further, but this usually only works temporarily.

In addition to metastases, cancer recurrences often develop. If possible, the latter will be operated on again.

If cancer cells cause a malignant pleural effusion (watery accumulation of secretion in the chest cavity), there is a risk of shortness of breath, pain and nausea. The doctor will then puncture the accumulation of water, and the pleural leaves can also be stuck together by injecting a drug into the space between the pleura, so that the effusion cannot "follow up".

The tumor masses in the pelvis narrow the ureters, causing renal colic-like pain that extends into kidney failure. If the tumor is large and has spread so far that it constricts the intestines, for example, constipation, nausea, vomiting and pain occur.

Diagnostic assurance

Palpation. To determine the size of the tumor and its nature, the doctor feels the area around the ovaries from the vagina and the outer abdominal wall. Palpation of the rectum also provides information on the extent of the tumor.

Ultrasonic. With the vaginal ultrasound it is usually possible to make a preliminary decision as to whether a suspected ovarian tumor is actually present and whether it is malignant. Accordingly, the doctor searches the entire abdominal and pelvic area for metastases or enlarged lymph nodes.

CT. The computed tomography shows the extent of the tumor as well as any affected lymph nodes and metastases. The CT findings (in the case of metastases, possibly also on an additional MRI finding) determine how extensive and in what type of operation the operation has to be carried out.

Blood test. The laboratory often shows elevated tumor markers. Their informative value is rather low in the context of diagnostics, but they significantly support the control of the therapy. It is possible that genetic changes can also be detected in molecular genetic laboratory diagnostics; this is increasingly being attempted in the case of gynecological cancers that occur more often in the family.

Further investigations. Additional examinations such as a bladder and colonoscopy, possibly also an excretory urogram (AUG), an X-ray examination using contrast media to visualize the urinary tract, kidneys, renal pelvis, ureters and bladder, provide further information on the extent of the tumor.

treatment

Treatment depends on how far the tumor has progressed and which organs in the body are affected.

Operative treatment

The operation serves on the one hand to secure the diagnosis and on the other hand to determine the exact stage and to plan further therapy. For this purpose, the suspicious ovarian tissue is usually examined fine-tissue during the operation (quick section). Then, if necessary, adjacent tissue, all other tumor foci and (almost always) the other ovary, uterus and accessible and / or suspicious lymph nodes are removed, as well as sections of the intestine and parts of the peritoneum in the event of a tumor.

chemotherapy

Depending on the type and stage of the tumor, chemotherapy with cytostatic drugs may then be necessary. The standard therapy is a combination therapy of carboplatin and paclitaxel (Taxol®).

Antibody therapy

The current guidelines recommend the antibody bevacizumab in addition to chemotherapy with carboplatin and paclitaxel at an advanced stage. This inhibits the formation of new blood vessels in the tumor tissue, so that the time until the tumor recurs can be extended.

Hormone therapy and radiation therapy

Irradiation and hormone therapy, which is often effective in breast cancer, unfortunately have no effect on ovarian cancer.

rehabilitation

After a tumor disease, patients generally have the option of applying for medical rehabilitation. Medical or oncological rehabilitation is the term used to describe all medical, psychosocial and professional services for reintegration into family, society and professional life, which are normally financed by the pension insurance. The "rehab" is an important aid in coping with the disease and usually lasts 3 weeks. The aim is for the patient to process the various psychological, physical and social consequences of the illness with the support of therapists and counselors and to regain physical fitness.

Psycho-oncological care

In every phase of cancer, a psycho-oncologist is recommended as a contact person who looks after both the affected woman and the relatives. This happens during the inpatient stay or in the post-inpatient environment. During the psycho-oncological counseling, questions about the illness and treatment, problems in everyday life and at work can be discussed. In addition, it is clarified what kind of support family and friends can provide or need themselves.

Psycho-oncological offers are run by various professional groups, v. a. by psychotherapists, psychologists, social workers, social pedagogues, physiotherapists or employees in the care sector.

Aftercare

Follow-up care includes regular check-ups in order to identify relapse and the occurrence of metastases as well as long-term effects of cancer therapy at an early stage:

  • Every 3 months in the 1st to 3rd year
  • Every 6 months in the 4th and 5th year
  • From the 6th year onwards, once a year as part of the cancer screening program.

These time intervals are deviated from on a case-by-case basis due to the individual risk of relapse, long-term consequences of the therapy and possible concomitant diseases.

Follow-up visits include:

  • The conversation with the gynecologist or oncologist
  • The physical examination with weight control, gynecological and rectal palpation and examination for edema formation
  • Vaginal swab
  • Ultrasound of the vagina, kidneys and small pelvis.

Complications

After the operation. By removing the ovaries before the onset of menopause, women (including young) go through menopause - with the typical menopausal symptoms that set in abruptly. Most symptoms are relieved by taking hormones. Local therapy with an ointment or cream containing estrogen helps against vaginal dryness (inserted into the vagina) or against hot flashes (applied to the skin). Hormone replacement therapy is not recommended for ovarian cancer, as the administration of estrogen would stimulate any residual tumor to grow.

The surgery can shorten the vagina and lose its ability to moisten. Both of these lead to problems during sexual intercourse. Here, too, ointments or creams containing estrogen help.

Other possible consequences of the operation are adhesions in the surgical area, which cause unpleasant sensations or pain during sexual intercourse, when defecating or when urinating.

If lymph nodes in the pelvis and abdominal cavity have been removed, there is a risk of lymphedema in the genital area, in the groin and on the legs, which can be uncomfortable and painful.

After radiation treatment. Acute consequences occur days after the radiation and usually subside within a few weeks. These include

  • Diarrhea and / or irritable bowel symptoms
  • Painful irritation of the mucous membranes in the vagina, bladder or intestine
  • Problems urinating
  • Infections
  • Reddened and burning skin on the abdomen.

Long-term effects occur months to years after treatment and can then persist. Which includes

  • Inflammation of the mucous membranes with bleeding
  • (Lymph) edema of the legs
  • Bladder dysfunction
  • Problems with bowel movements due to inflammation of the sphincter
  • dry and / or narrowed vagina.

After chemotherapy. During treatment with natural or synthetic substances that are supposed to inhibit cell growth and cell division (cytostatics), tissue that is renewed more quickly is particularly damaged: hair roots, mucous membranes of the stomach and intestines and the blood-forming system in the bone marrow. Possible side effects are hair loss, nausea, vomiting, diarrhea and increased susceptibility to infections. Appropriate medication can largely alleviate the side effects. After the end of chemotherapy, the side effects usually go away.

After antibody therapy. Treatment with antibodies also has undesirable side effects. High blood pressure, exhaustion and weakness (fatigue), wound healing disorders, nausea, diarrhea or vomiting are very common. Frequent and serious side effects are gastrointestinal perforations, bleeding and blood clots in the vessels, which can lead to a heart attack or stroke.

forecast

The prognosis is poor overall, but in the specific case it depends heavily on the tissue type and the extent of the tumor at the time of diagnosis, as well as on the patient's age and general condition. In the early stages, ovarian cancer is easily curable. The 5-year survival rate (averaged over all patients) is 30 to 40%. The main reason for this is the mostly late diagnosis and the high risk of recurrence.

prophylaxis

Current studies show that women with pre-existing stresses who carry mutations in the breast cancer genes BRCA-1 (BReast-CAncer-1) and BRCA-2 (BReast-CAncer-2) benefit from preventive surgical removal of their ovaries. The procedure not only reduces the risk of developing ovarian cancer, it also reduces the risk of developing breast cancer.

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What you can do yourself

No other disease affects the intimacy, self-image and body feeling of women as much as removal of the ovaries and uterus. Frequent consequences are problems and bias in dealing with sexuality, fear of being touched by the partner, and even permanent aversion to sexual intercourse. All of this in turn worsens self-esteem, which again blocks a relaxed, pleasurable experience of sexuality: a vicious circle. And a sensitive topic that is often not discussed with the partner and that the doctor rarely addresses. Try not to hide your problems with the "new" sexuality and seek professional help. The difficulties are by no means only psychological. Typical consequences of the operation, radiation treatment and removal of lymph nodes in the pelvic region are the narrowing and scarring of the vaginal entrance and only limited humidification (lubrication). This leads to severe pain during sexual intercourse, especially in the early days.

The following tips will help you to alleviate the symptoms:

Vaginal infections.

The vaginal tissue is susceptible to infection after radiation. Wash (only) that outer Sex organ with water and a little mild soap. Most experts no longer recommend vaginal douching because it aggravates symptoms and disrupts the acidic pH environment of the vagina.

Cold compresses and cool hip baths alleviate any remaining wound sensation. Wear loose, heat-resistant and absorbent underwear made of cotton.

Vaginal dryness.

Lubricating creams and estrogen ointments improve the suppleness and moisture of the vagina. Vaginal stretchers (dilators) have been specially developed to gently stretch the vagina after gynecological operations or radiation treatments. They are available in different shapes, diameters and lengths and even made to measure. They are inserted like a tampon, whereby the insertion is made easier with lubricating cream. Even carefully practiced sexual intercourse gradually regenerates the elasticity of the vagina. Light bleeding after sex is normal and not a cause for concern.

Chronic leg swelling.

Lymph drainage, compression stockings and tights help against water retention in the legs (lymphedema). Go swimming a lot. This works like a kind of lymphatic drainage and is an optimal prevention against edema. Try to avoid carrying heavy loads and avoid too hot and long foot baths, full baths and long stays in the sun. A rule of thumb: Better to run and lie than sit and stand.

Urinary bladder inflammation, urinary incontinence.

The consequences of inflammation of the urinary bladder and intestines that occur after radiation treatment, if properly treated, improve after a few weeks. A common problem after extensive operations in the pelvic area is that small amounts of urine leak out in an uncontrolled manner. As the function of the bladder muscles is impaired by the treatment, women suffer from urinary incontinence. Usually this disorder is temporary and is resolved with consistent medication use. Regular pelvic floor exercise has proven effective in preventing urinary incontinence.

Diarrhea and irritable bowel discomfort.

According to a study, if intestinal complaints occur as a result of radiation therapy, these can be avoided or at least alleviated if the women take selenium as the sodium salt during treatment: Thanks to this dietary supplement, only 21% of the treated women had to struggle with diarrhea compared to 45% of the women Women without selenium.Selenium reduced radiation-related symptoms without impairing the benefits of radiation.

Menopausal symptoms.

If an ovary is removed or if ovarian function is permanently lost as a result of radiation, typical menopausal symptoms arise, which can be treated accordingly.

Complementary medicine

Homeopathy, Traditional Chinese Medicine (TCM), Ayurveda and Anthroposophy each have their own concepts for tumor therapy.

homeopathy

showed no effectiveness in cancer therapy in controlled studies. However, many sufferers find the homeopathic remedies used to be helpful against therapy-related fatigue, physical weakness, dizziness, loss of appetite, a feeling of fullness and nausea.

Ayurveda

Possibly helps preventive against some types of cancer, but is therapeutically rather unexplored and also not free from side effects.

acupuncture

may help relieve symptoms associated with chemotherapy, such as nausea, but has no effect on the course of the disease.

Mistletoe therapy

against cancer has been known for 100 years. While many patients are convinced of the treatment with mistletoe preparations, experts are more critical, because to date there is no reliable proof of the effectiveness against tumor diseases. Studies only show that an improvement in quality of life is possible. Therapy with mistletoe preparations therefore does not play a role in the currently valid guidelines for cancer therapy.

Prevention and early detection

Since there are no early symptoms in ovarian cancer, the only preventive measure is the annual early detection of cancer, including a vaginal ultrasound, which is not paid for by the health insurers and is offered as an individual health service (IGeL).

According to experts, ultrasound through the vagina is not suitable for reliable early detection of ovarian cancer. On the one hand, there is a risk of receiving a false-positive result (that is, in truth there is no tumor). On the other hand, there is currently no evidence that early treatment reduces mortality. The combination of vaginal ultrasound and the determination of the tumor marker CA-125 in the blood also does not allow (absolutely) reliable early detection.

In the case of cancers occurring in families, the fallopian tubes are removed on both sides of women from the age of 40 (adnexectomy). This preventive intervention reduces the risk of cancer by 80%.

Further information

  • www.noggo.de - website of the North-East German Society for Gynecological Oncology e. V., Berlin: Specialist information and self-help tips on all types of cancer in women, the ovarian cancer brochure can be ordered free of charge.
  • www.selbsthilfekrebs.de - website of the oncological patient seminar Berlin-Brandenburg e. V. (OPS), Charité University Hospital, Berlin: Users can find detailed information on cancer of the ovaries, fallopian tubes and peritoneum as well as useful information on studies, self-help and social benefits. In addition, two hotlines are available to users of the site (one for medical advice, one for advice from those affected). Book tips, links and further addresses complete the range of services.
  • www.eierstockkrebs-forum.de - Internet offer of the North-East German Society for Gynecological Oncology, Berlin: information portal and forum for patients and relatives.
  • H. Delbrück: Ovarian Cancer. Advice and help for those affected and their families. Kohlhammer, 2004. Patient guide with current information on therapy options and their consequences.
  • J.Sehouli; W. Lichtenegger: Ovarian cancer: 100 questions - 100 answers. akademos, 2003. Provides clear and understandable answers to questions posed by women with breast cancer. Topics such as nutrition and sexuality also find their place. For patients and relatives.

Authors

Dr. med. Astrid Waskowiak, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and leading complaints", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 11:03


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.