Ovarian cancer metastasis is a malignant neoplasm of the ovary that has arisen as a result of the spread of primary tumor cells located in another organ. In the initial stages, it is asymptomatic. With large metastases, there are pains, a feeling of pressure, difficulty urinating, constipation and an increase in the size of the abdomen. Palpation reveals a voluminous formation. Menstrual cycle disorders are possible. The diagnosis is made taking into account anamnesis, clinical manifestations and the results of additional studies. Treatment – surgery, chemotherapy, hormone therapy, radiotherapy.
Meaning
Ovarian cancer metastasis is a secondary ovarian tumor that has arisen as a result of hematogenous, lymphogenic or implantation spread of malignant cells from another organ. It is 5-6% of the total number of malignant neoplasms of the ovary. Previously, it was considered a fairly rare disease, currently there is an increase in the number of cases of this pathology. The peak incidence occurs at the age of 45-60 years.
Most often, ovarian cancer metastasis is detected in oncological diseases of the gastrointestinal tract and genitals, breast cancer and malignant lymphoma. Characterized by a faster progression compared to primary ovarian cancer. Secondary neoplasms reach significant sizes and are complicated early by dissemination along the peritoneum, which makes the prognosis heavier and makes it impossible to use radical methods of treatment. Diagnostics and treatment are carried out by specialists in the field of oncology and gynecology.
Causes
From 30 to 40% of the total number of secondary ovarian lesions are Krukenberg tumors. Most often, such neoplasms occur with stomach cancer, less often there is metastasis of malignant tumors of the colon and bile ducts. In colorectal cancer, along with Krukenberg tumors, other types of metastases (non-mucosal) can be detected. Non-Krukenberg secondary neoplasms can be detected in bladder cancer and cervical cancer.
One of the most common causes of ovarian metastases is breast cancer. During autopsy, ovarian cancer metastasis is detected in 24% of patients who died from malignant breast tumors, and in 80% of cases there is a bilateral lesion. When examining tissue samples of internal genitalia removed during the complex treatment of breast cancer, secondary foci in the ovaries are found in 23-30% of patients, bilateral lesion is determined in 60% of cases.
Malignant tumors of the fallopian tubes are complicated by ovarian cancer metastasis in 13% of patients. The cause of the lesion is usually a local aggressive growth of the primary neoplasm, although other ways of spreading are possible. With cancer of the uterine body, metastatic ovarian lesion is detected in 5% of patients, with cervical cancer – in 1% of patients. Germination or spreading as a result of dissemination is possible. Ovarian damage is also likely as a result of metastasis in hemoblastosis. In particular, the diagnosis of “ovarian cancer metastasisr” is made by 5% of patients with lymphogranulomatosis.
Pathanatomy
Metastatic neoplasms of the ovaries are oval nodes of yellowish, gray-white or whitish color ranging in size from 2 to 20 cm. Non-Krukenberg tumors are non-mucosal, usually dense, solid structure, connected to the ovary by a well-defined leg. Krukenberg tumors consist of ring-shaped cells with a pronounced ability to form mucus. Bilateral ovarian lesions prevail over unilateral ones. Sometimes ovarian cancer metastasis is mistaken for a primary neoplasm due to the absence of clinical manifestations of the primary tumor.
Symptoms
In the early stages, the disease is asymptomatic. Some patients have common signs of cancer: loss of appetite, weight loss, unmotivated weakness, irritability, fatigue and fever. Sometimes menstrual irregularities are observed. With an increase in the size of the metastasis in the ovary, pain, a feeling of pressure or swelling in the lower abdomen appear. When the bladder is compressed, urination disorders are noted, when the rectum is compressed, constipation is noted.
Ascites occurs. When the tumor leg is torn or twisted, symptoms of an “acute abdomen” suddenly appear: nausea, vomiting, sharp intense pain, tachycardia, collapse. When the mucus-forming ovarian cancer metastasis ruptures, mucus pours into the abdominal cavity. The outpouring of mucus from an infected neoplasm entails the development of peritonitis. In the later stages, there is pronounced general weakness, weight loss up to cachexia and signs of intestinal obstruction.
Diagnostics
The diagnosis is made on the basis of anamnesis (the presence of a primary oncological process in another organ), complaints, the results of a general and gynecological examination and additional research data. Signs that make it possible to suspect ovarian cancer metastasis are the presence of a dense tumor-like formation with a bumpy surface in the ovary area, a rapid increase in tumor size, bilateral lesion, ascites, the detection of multiple nodes in the peritoneum of the pelvis during gynecological examination and rectal examination.
Patients with suspected ovarian cancer metastasis are referred for ultrasound of the pelvic organs. Laparoscopy is prescribed with a biopsy and subsequent histological examination. To differentiate primary and ovarian cancer metastasis (in the absence of an already established diagnosis of cancer) or to detect metastases in other organs, mammography is performed, CT, MRI and ultrasound of the abdominal cavity, ultrasound of the breast and thyroid gland, chest X-ray, gastroscopy, colonoscopy, radiography or scintigraphy of skeletal bones and other studies are prescribed. The examination plan may vary depending on the existing symptoms.
Treatment
Treatment tactics are determined taking into account the localization and type of primary tumor, the presence of foci in other organs, the general condition of a patient with ovarian cancer metastasis and some other factors. Combination therapy is usually used, which may include chemotherapy, radiotherapy, surgery, immunochemotherapy and hormone therapy. Combinations of various conservative and operative techniques are selected individually.
If there are indications for radical surgical intervention, a pangisterectomy (removal of the uterus with adnexectomy) is performed by laparotomy access. During the operation, the internal genitals are removed along with the large omentum, since ovarian cancer metastasis is often accompanied by dissemination through the abdominal cavity. Even if metastases in the peritoneum are not visually detected due to their small size, they can be detected during subsequent histological examination. If necessary, adenectomy of the affected lymph nodes is performed simultaneously. If volumetric surgery is contraindicated due to obesity or concomitant serious diseases, a vaginal pangisterectomy is performed.
If it is impossible to carry out radical removal of ovarian cancer metastasis, excision of the main conglomerate is performed. With the generalization of the oncological process (the presence of metastases in various organs), the operation is performed only for vital indications. An obligatory stage of surgical intervention is the revision of the abdominal organs. Chemotherapy for ovarian cancer metastasis is used both in the pre- and postoperative period. Radiotherapy is prescribed less often, usually in combination with chemotherapy. Hormonal agents are selected individually.
Forecast
The prognosis is unfavorable in most cases. In the early stages, ovarian cancer metastasis is asymptomatic, so the tumor is often diagnosed only at the stage of abdominal organ damage, the formation of inoperable conglomerates, multiple metastases to various organs, etc. The cause of death of the patient may be cancerous cachexia, intestinal obstruction, ascites or dysfunction of various organs caused by the growth of the primary tumor or distant metastases. All patients treated for ovarian cancer metastasis are shown regular examinations and blood tests for cancer markers for 5 years after the end of therapy.