Why is it detected late?
The ovaries are located deep in the pelvis, and the abdominal cavity is spacious: the tumor can grow without squeezing neighboring organs or causing noticeable sensations. In addition, there is no effective screening test that can be used on all women—neither ultrasound nor CA-125 are suitable for mass screening.
Symptoms, when they appear, are nonspecific and closely resemble gastroenterological symptoms. A woman spends months treating “bloating” and “gastritis”, but the diagnosis is made later than it could be.
The only practical guideline that really works is to pay attention not to the nature of the symptoms, but to their novelty, constancy and increase. Bloating, which occurs from time to time and is associated with food, is common. Bloating, which appeared for the first time, occurs almost every day for several weeks and gets worse, requires examination.
Symptoms
- Constant bloating and feeling of fullness
- Quick satiety when eating, decreased appetite
- Increase in abdominal volume, sometimes with general weight loss
- Heaviness, discomfort or pain in the lower abdomen and pelvis
- Frequent urination and urge
- Bowel problems: constipation or diarrhea
- Fatigue, weakness
- Pain during intercourse
- Bloody discharge - less common than with uterine tumors
- Shortness of breath due to fluid accumulation in the abdominal and pleural cavity
- In the early stages - no symptoms
Risk factors and the role of heredity
- Mutations of the BRCA1 and BRCA2 genes significantly increase the risk of both ovarian and breast cancer
- Cancer of the ovaries, breast, endometrium or intestines in close relatives
- Lynch syndrome
- Age: most cases after menopause
- Lack of childbirth and breastfeeding
- Early onset and late cessation of menstruation
- Endometriosis – increases the risk of certain types of tumors
- Obesity
- Smoking—for some types of tumors
- Long-term use of combined contraceptives, on the contrary, reduces the risk
Diagnostics
- Examination by a gynecologist with bimanual examination
- Transvaginal ultrasound with Dopplerography - assessment of the structure of the formation: septa, solid component, blood flow
- Tumor marker CA-125 - increases not only in tumors, therefore it is assessed in a complex
- HE4 and calculation of the ROMA index significantly increase the accuracy of risk assessment
- Tumor markers AFP, beta-hCG, LDH for suspected germ cell tumors in young women
- CT or MRI of the abdominal cavity and pelvis
- X-ray or CT scan of the chest
- Examination of the gastrointestinal tract to exclude metastases from other organs
- Diagnostic laparoscopy with biopsy
- Genetic testing for BRCA for a confirmed diagnosis and in families with a family history
An important clarification about CA-125: this marker increases in endometriosis, fibroids, inflammation, pregnancy, menstruation, and even liver disease. Therefore, its isolated increase does not mean cancer, and a normal value does not exclude it. It gains value in combination with ultrasound, HE4 and the ROMA index.
Treatment
- Surgical treatment is the basis: removal of the uterus with appendages, greater omentum and affected areas of the peritoneum
- Maximum complete removal of tumor tissue, which directly affects the prognosis
- Laparoscopic access in early stages and for diagnosis
- Organ-conserving surgeries in young women in the early stages of certain types of tumors
- Chemotherapy is a mandatory component for most stages
- Neoadjuvant chemotherapy before surgery for advanced disease
- Targeted therapy, including for BRCA mutations
- Removal of giant cysts with resection of the omentum for large tumors
- Post-treatment follow-up with CA-125 monitoring and imaging
- Discussion of fertility preservation in young patients before treatment
What really reduces the risk
- Long-term use of combined hormonal contraceptives has been proven to reduce the risk
- Childbirth and breastfeeding
- Tubal ligation or removal during other operations
- Preventive removal of tubes and ovaries in women with BRCA mutations after implementation of reproductive plans - discussed individually
- Maintaining normal body weight
- Quitting smoking
- Regular examinations by a gynecologist with ultrasound
- Genetic counseling for family history
Where to get examined in Tashkent
We need high-quality transvaginal ultrasound with Doppler ultrasound, a laboratory for CA-125 and HE4 with ROMA calculation, access to CT and consultation with a gynecological oncologist.
In Tashkent, such an examination is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; When the diagnosis is confirmed, treatment is determined jointly with the oncology service.
If bloating, rapid satiety, or heaviness in the lower abdomen appear for the first time and last for several weeks, do not treat it as gastritis. Do a pelvic ultrasound and pass CA-125 with HE4. These are simple studies that can change a lot. Clinic contacts are below.
