Ovarian cancer treatment: a review of effective treatments. Surgical treatment of ovarian cancer Life after surgery for ovarian cancer

17.06.2020

Ovarian cancer ranks third among female malignant pathologies. Interestingly, the pathology is most common in developed countries. Diagnosis of ovarian oncology is difficult, since the symptomatology is often correlated with other diseases. Initial symptoms, indicating precisely this ailment, are often attributed to irritable bowel syndrome. As a result, while studies of the gastrointestinal tract are being carried out, pathological cells are actively spreading. Hence, a completely reasonable conclusion - one cannot neglect gynecological examinations, since in many cases not only a woman's health depends on them, but also her life.

According to statistics, malignant ovarian pathology is observed in patients aged 50–70 years, up to 45 years of age the disease is very rare. And it is with this form of cancer that more deaths are observed than with any other malignant pathology of the genital organs.

Oncology and ovaries

Various tissues are involved in the structure of the ovaries, and any cells can become the center for the development of a certain form of oncology. There are at least ten types of cancer of this organ. Each of them has its own characteristics of treatment along with subsequent prognosis. Metastases, which are caused by the pathology of the ovaries, are introduced both into nearby tissues and organs through the lymph, and into distant parts of the body through the blood, mainly they are distributed to the liver and lung tissue.

Some of the diagnosed tumors are not malignant and carry the definition of borderline tumors. Such neoplasms develop rather slowly, and therefore are not as dangerous for health as other forms of malignant neoplasms in the ovaries.

If we talk about forecasts, then with border formations, the five-year survival rate reaches from 77 to 99%.

As for other forms of ovarian cancer, the range of a favorable prognosis is quite wide, given the varying degrees of aggressiveness of pathologies and the individual immune response of patients.

Serous form of pathology

According to statistics, serous ovarian cancer is diagnosed most often, he owns at least 10% of all cases. This form of cancer is mainly observed in women under forty. Quite often, it is the malignant form that is found, while there are three stages of its development:

low;
moderate;
high.

This form of pathology proceeds very aggressively, with both ovaries affected in 50% of cases. The stage of the cancer does not affect the lesion. A serous tumor may look different, but it is generally similar in shape to cauliflower. Usually, by the time the patient is prescribed an operation, the neoplasm is growing throughout the organ. The spread of the serous form is possible in the abdominal cavity, and pathology can also lead to the development of ascites.

The danger of this form is the absence of symptoms on initial stages... The pathology of the first and second stages is quite often diagnosed accidentally during an operation for another reason.

At a later stage, symptoms of serous oncology include:

growth of the abdomen in size;
disturbed work of the intestines, bladder;
shortness of breath and shortness of breath;
weight loss;
an increase in body temperature for no apparent reason;
swollen lymph nodes.

Causes Leading to Ovarian Cancer and Common Symptoms

Among the risk factors that can lead to the development of oncological processes in the ovaries:

genetic predisposition;
malignant processes occurring in the chest, body of the uterus;
postmenopause;
the woman has never become pregnant during her entire life.

Many women, reaching menopause, do not see the point in gynecological examinations, which increases the risk of developing oncology. It should be understood that the formation of malignant tumors most often occurs in the older age group. According to statistics, about 70% of patients who are eventually diagnosed with a malignant organ pathology turn to a specialist at the third or fourth stage of the disease.

The initial symptoms in this pathology include discomfort in the lower abdomen. Sometimes there is an accumulation of fluid in the abdominal cavity, which is diagnosed as ascites. As a result, there is an increase in the size of the abdomen, which may be due to an increase in the ovaries. There is pain in the pelvic region, anemia occurs, and weight loss occurs.

There are cases of tumor production of hormones that affect the accelerated growth of the mucous membrane of the uterine layer, increased hair growth and enlargement of the mammary gland.

Frequent flatulence develops, with food, the feeling of satiety occurs pathologically quickly. Symptoms typical for malignant neoplasms in the ovary, can be accompanied by many other pathologies.

Pathology treatment

There are cases when the operation is necessary as a diagnostic tool, since accurate data on the course of the process are often obtained during laparoscopy or laparotomy. However, most often it is the operation that is indicated as the main therapeutic method for ovarian cancer.

Volume surgical intervention corresponds to the stage of pathology. Radical operations suggest both partial excision of the fallopian tube and ovary, and complete hysterectomy. If the patient intends to acquire offspring in the future, and the neoplasm is at an early stage, its size is small, there are no metastases, the appointment of a minimally invasive surgery with preservation of organs is possible.

In cases where before surgical intervention it is not possible to establish the stage of development of the disease, the specialist removes the fallopian tube, damaged ovary, and also takes material for biopsy. After receiving the results, he can prescribe an additional surgical procedure if necessary. If, for certain reasons, surgical intervention is not feasible, chemotherapy is prescribed.

Surgical intervention can show good results, while a relapse of ovarian cancer is quite possible, after a few years, the appearance of metastases is possible. For this reason, patients are advised to undergo regular check-ups.

When both ovaries are removed, the production of estrogen in the woman's body stops, which leads to the development of menopause, regardless of how old she is. A decrease in hormone levels increases the risk of developing other pathologies, including osteoporosis. Possible fatigue, this is quite normal side effect after oncology treatment. Most effective method bounce back and cheer up - small physical exercise, physiotherapy exercises or short walks. The attending physician will prescribe a reasonable level of exercise.

After the surgery, an appointment is required proper nutrition and minimizing stressful situations... It is advisable to include a large number of protein products in the menu, as they help in the restoration and formation of tissues. Food is fractional, but food intake is quite frequent. Be sure to include a large number of fruits and vegetables in the menu.

The main effective treatment for ovarian cancer remains surgical. The operation has a greater impact on the end result than subsequent therapy. The effectiveness of further treatment largely depends on the thoroughness of the primary operation.

Front operation the entire abdominal cavity must be carefully examined. Particular attention is paid to the condition of the surface of the diaphragm and the space between the colon and the peritoneum, since they may have metastases, sometimes unnoticed. Even if no visible nodules are found in the subphrenic region, peritoneal washings may contain tumor cells.

At the same time, in a significant part of patients with localized tumor diagnosis sometimes a more extensive process is found, for the treatment of which local methods are not suitable.

For patients in Stage I of the disease in most cases is effective surgical method treatment. Usually abdominal hysterectomy with bilateral salpingectomy and oophorectomy is performed. The second ovary is usually removed even with one-sided initial localization of the tumor, since in 20% of cases, due to hidden metastases, a tumor usually develops in it in the future.

Young patientswishing to preserve the ovary, you can try a more conservative operation. With greater confidence, conservative surgery can be recommended for cases of tumors with unexpressed malignancy, although most gynecologists, for obvious reasons, prefer a radical approach, unless, of course, the patient plans to have children in the future.

For cases with more late stages of the disease (stages II-IV) most oncologists are of the opinion about the maximum possible removal of the tumor during the primary operation. Good palliative effect is achieved even if the tumor is shrinking surgically.

However, only a few results indicate that the life expectancy of patients increases if all or almost all of the tumor is not removed. Many operable tumors are characterized by a low grade of malignancy, which in itself is the basis for a favorable prognosis. Nevertheless, the maximum size of the tumor site remaining after resection is a good guideline for the subsequent prescription of a course of chemotherapy and further prognosis.

When calculation of patient survival according to the linear regression equation, it turns out that the greatest contribution is made by such parameters as the histological characteristics of the tumor and the maximum size of its area remaining after the operation. If, as a result of the operation, the size of the tumor has not decreased to 1.6 cm (or less) in diameter, then such an operation is ineffective.

If after operations the patient has palpable residual lumps, then chemotherapy or radiation therapy is unlikely to be effective. Therefore, at least some of them may require reoperation, which should be performed by an experienced surgeon. Complex operations such as removal of the pelvic organs, removal of the omentum, resection of the large intestine, and complete removal parietal pelvic peritoneum.

Research carried out within the framework of the Inter-European cooperation in a randomized group of 319 primary operated patients who underwent chemotherapy, the effectiveness of reoperation was confirmed. Patients who underwent second-look laparotomy experienced improved overall survival as well as progression-free survival.

Despite application of ultrasonic methods, CT and MRI, there is no way to monitor the effectiveness of treatment for advanced cancer. Again, it all comes down to different survey methods. Therefore, it is sometimes advisable to carry out surgery, even going beyond the "second glance". If, during laparoscopic examination, tumor foci are not detected and the results of the analysis of intraperitoneal washings are negative, then for final confidence in a favorable outcome, in some cases, laparotomy can be done.

It is difficult, of course, to assert that a laparotomy " second glance»Can prolong the life of a patient with an ovarian tumor, however, as a result of its implementation, it will be possible to use more reasonable tactics of further treatment. Now everyone understands that second-look laparotomy only determines the choice of the method of subsequent treatment.

Recently has changed significantly the role of the gynecologist in the treatment of ovarian cancer. The initial examination of patients with localized and generalized tumors and the choice of surgical technique have become of paramount importance. Also, the opinion of the surgeon when choosing a method of treatment was no less important. Although second-glance laparotomy is the most reliable method of monitoring the effectiveness of treatment, its true therapeutic benefit remains questionable.

Surgical, radiation and chemotherapy methods are used to treat ovarian cancer.

Surgery considered basic. Most oncologists are confident that all patients with ovarian tumors should be treated with surgery. This is due to the impossibility of making a perfectly accurate diagnosis of cancer: if the doctor is mistaken in determining the stage of the tumor, then refusal of the operation can lead to irreparable consequences.

In cancer, one or both ovaries are removed, or supravaginal or complete removal of the uterus is performed.

Why is it sometimes necessary to remove both appendages in case of a cancerous tumor in one of the ovaries? The fact is that the risk of developing a malignant process in the second ovary is very high. After some time, the cancer may recur and the patient will have to undergo treatment again.

Treatment with chemotherapy drugs is used simultaneously with the operation. The goals of this therapy are as follows:

prevention of metastasis and tumor re-development;
impact on probable residual elements of cancer cells;
inhibition of tumor growth;
facilitating the patient's life in advanced cases.

Radiation therapy is never used alone. The task of irradiation is to ensure a high percentage of the effectiveness of surgical and drug exposure.

The protocol for the treatment of ovarian cancer is determined only after a thorough examination of the patient: the state of the urinary system, liver is assessed, and a blood test is performed. During chemotherapy, the blood is examined several times, at least once a week.

In addition, the choice of a treatment regimen depends on the following circumstances:

from the presence of concomitant diseases;
from a picture of blood;
from the weight of the patient;
from the histological type of tumor;
from the stage of the process.

Surgical treatment of ovarian cancer

Operation is the main link in successful treatment cancerous tumor. Currently, the intervention is carried out using a laparotomy - through an incision over the pubic area. Simultaneously with the operation, the surgeon takes materials for further research. This can be tissue samples or fluid that has accumulated in abdominal.

Ovariectomy is the resection of one or two appendages.
A pagysterectomy is an operation that is performed at a later stage of tumor development, when the uterus has to be removed as well.
Extirpation is the complete removal of the uterus with the ovaries, omentum and cervix.

If the tumor affects only the reproductive system, then the doctor removes the uterus with appendages, the nearest lymph nodes, sometimes - appendix (appendix).

If the ovarian cancer was invasive, then some elements of the digestive and urinary systems must also be removed.

Immediately after surgery, the patient is prescribed a course of medications and, in some cases, radiation therapy.

Palliative operations for ovarian cancer are performed when the process is at an advanced stage, and it is not possible to completely cure the patient. The essence of palliative treatment is to alleviate the patient's condition and to prolong life as much as possible.

Radiation therapy

The principle of radiation therapy is the effect of radioactive rays on the zone of malignant lesion. The rays contribute to the destruction of cancer cells, affecting healthy tissues to a much lesser extent.

Most often, radiation is prescribed for recurrence of cancer, as well as for palliative treatment to reduce pain, discomfort and slow down the progression of the process.

Radiation treatment is carried out in stationary conditions... To alleviate the condition of patients, it may take from one to ten sessions, the duration of which is determined by the oncologist. Along with the course of radiation therapy, you can take chemotherapy to completely control the cancer process.

If radiation is prescribed after surgery, then its goal is to destroy cancer cells that could possibly remain in the body.

When a tumor grows in the tissue of the abdominal organs, as well as when fluid accumulates, it makes no sense to prescribe radiation therapy, because radioactive rays can have a negative effect on healthy nearby organs.

Ovarian cancer treatment with chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to kill a tumor. These medicines inhibit the development of malignant cells. They are injected into a vein or artery.

It has been noticed that ovarian cancer is extremely sensitive to chemotherapy. In many patients, the pathological focus becomes much smaller, and in the early stages of the process, even a complete cure may occur.

Chemotherapy drugs are used after surgery to prevent tumor regrowth. In addition, special drugs can reduce the size of the neoplasm before the operation and somewhat reduce the negative manifestations of the disease.

Chemotherapy courses for ovarian cancer are carried out on an outpatient basis, for 4-5 months, with short breaks. In total, from 2 to 4 courses are carried out.

Sometimes drugs are injected directly into the abdominal cavity through a catheter. This method can increase the survival rate of women with malignant tumors. However, with intra-abdominal administration, undesirable effects may occur, for example, severe pain, the development of infection, diseases of the digestive system.

The most common medications for ovarian cancer are:

Carboplatin - 100 mg / m² for five days;
Paclitaxel - 175 mg / m² during the day;
Topotecan - 1.5 mg / m² for 5 days;
Cisplatin - 15-20 mg / m² for 5 days;
Docetaxel - 75-100 mg / m² once, every three weeks;
Gemcitabine - 1 mg / m² on the first, eighth and fifteenth day every 28 days;
Etoposide - 50 mg / m² for 21 days;
Vepesid - 50 mg / m² for 21 days;
Bevacizumab (Avastin) 5-10 mg / kg every 2 weeks

Cytotoxic drugs are almost never prescribed in the form self-treatment, but only in combination with each other. For example, the combination of Taxol + Carboplatin for ovarian cancer is called the "gold standard" of treatment. This combination is less toxic than a similar Cyclophosphamide-Cisplatin combination, but just as effective. Taxol with Carboplatin provides relatively quick results and a guaranteed 6-year patient survival rate.

Doxorubicin, or Kelix for ovarian cancer, is often used in conjunction with Cyclophosphamide or taxanes. In this case, the increase in the toxic effect of drugs does not occur. Kelix is \u200b\u200busually administered intravenously (2 mg / ml), while other drugs can be administered with a different route. For example, oral cyclophosphamide is prescribed at a dosage of 1-2 mg / kg per day.

Avastin for ovarian cancer is relatively recent. This is one of the new drugs based on Bevacizumab that inhibit the development of a malignant tumor. Avastin is administered only by intravenous drip method. Another variant of administration, including intravenous jet, is prohibited.

One more recently popular anticancer drug - Refnot - is a tumor necrosis factor (thymosin α-1). It is a fairly strong cytostatic and cytotoxic agent with minimal side effects. However, Refnot is not commonly used for ovarian cancer: it is usually prescribed to treat breast cancer.

In addition to anticancer drugs, doctors often prescribe immunomodulators - these are drugs that support immune system a person in a "combat" state. The use of immunomodulators is still controversial in the ranks of medical specialists. Some of them consider such drugs useless in oncology, while others are sure of their necessity. Thus, there is an opinion that the most common drug Roncoleukin for ovarian cancer increases antitumor immunity, which significantly increases the effectiveness of chemotherapy. In addition to Roncoleukin, medications such as Timalin, Mielopid, Betaleukin and interferons have a similar effect.

Thermoperfusion for ovarian cancer

Thermoperfusion is one of the options for treating cancer, which involves thermal effects on tissues. Heat damages the protein structure of cancer cells, without affecting healthy areas, which can significantly reduce the size of the neoplasm. In addition, thermotherapy increases the sensitivity of tumor tissues to radiation and chemotherapy.

The essence of thermoperfusion is the treatment of ovaries and nearby organs, which have undergone a cancerous lesion, with a warm anticancer agent (up to 44 ° C), which significantly increases the effectiveness of its action.

In addition to the antitumor effect, this method also has a number of side effects. These are edema, increased thrombus formation, bleeding, pain. Over time, these symptoms go away on their own. Less commonly, dyspeptic disorders may occur, as well as exacerbation chronic diseases of cardio-vascular system.

Active clinical trials of thermotherapy are currently underway. This is done in order to increase the effectiveness of the method and eliminate its possible negative consequences.

Treatment of ovarian cancer with folk remedies

Can a cancerous tumor be cured with folk recipes? The issue is controversial. The vast majority of specialists in traditional medicine do not welcome the use of folk remedies, especially in the form of self-treatment. Attempts to cure the tumor on their own can lead to an aggravation of the process, and valuable time for starting timely treatment can be lost.

Nevertheless, many recipes are known, the authors of which promise a quick cure for ovarian cancer. We suggest you familiarize yourself with some of them.

Known active use mint for problems in the genital area: for example, with heavy menstrual bleeding, with painful menopause, etc. Mint is successfully used for ovarian cancer: it is customary to ingest flea mint tea, half a cup three times a day. During treatment, you can do douching with the same solution. To prepare such tea, you need to brew 20 g of mint leaves in 500 ml of boiling water and insist from 2 to 3 hours.
Flaxseed oil and flaxseed are used very often for ovarian cancer. The dosage of oil is from 1 tsp. up to 1 tbsp. l. morning and evening. You can take it in the form of capsules that are sold in pharmacies. To do this, you need to drink from 10 to 14 capsules at a time. Flaxseed is used in the amount of 3 tbsp. spoons mixed with 200 ml of water. This "cocktail" should be drunk three times a day, at least for one month.
Hemlock has a good reputation in the fight against cancer - it is used to treat many malignant tumors... Hemlock for ovarian cancer (especially in combination with other techniques) can lead to a positive result. The tincture of this plant should be taken with a gradual increase in dose: starting from 1 drop per 200 ml of water 1 time per day before meals, bringing to 40 drops. Simultaneously with the amount of the drug, the amount of water also increases (for every 12 drops + 50 ml). After reaching 40 cap. the dosage is reduced in the opposite direction, 1 drop per day. The amount of water is also reduced by 50 ml every 12 drops. The duration of such treatment is as long as it takes for complete healing.
Oats are considered the first cure for malignant tumors by many. An infusion of oats for ovarian cancer is prepared very simply: one glass of oat grains is poured into an enamel container and 1000 ml of water is poured, brought to a boil and cooked over low heat for about 20 minutes. After that, remove from the heat and insist in a warm place for at least 2 hours. The broth is filtered and divided into three steps. Drink 30 minutes before meals three times a day. It is not recommended to cook the broth several days in advance, it is better to take it fresh.

Nobody rules out efficiency folk treatment... However, before using such methods, consultation with an oncologist should be mandatory.

Ovarian cancer treatment by stage

Treatment of ovarian cancer at stage 1 is most often carried out only through surgery. In this case, the surgeon makes a hysterectomy, bilateral salpingo-oophorectomy and excision of the omentum. In addition, biopsy material and peritoneal fluid wash are removed during surgery. In most cases, stage 1 does not require complementary treatment, except for surgical.

Treatment of ovarian cancer in stage 2 is carried out by analogy with the first stage, but in addition, radiation therapy or systemic chemotherapy is prescribed, which involves the use of platinum-based medicines in conjunction with alkylating drugs or Paclitaxel.

Treatment of stage 3 ovarian cancer requires a combined approach that combines surgery and mandatory chemotherapy. Intraperitoneal chemotherapy is often used, with the use of Cisplatin and various combinations with it.

Treatment for stage 4 ovarian cancer is more complex and less optimistic. The main methods of influencing such a tumor are:

cytoreductive surgery is the removal of one main affected part of a cancerous growth that cannot be removed completely;
systemic chemotherapy - the use of Cisplatin or Carboplatin in combination with taxanes or other similar drugs;
consolidating or supportive treatment is the appointment of more than six consecutive courses of chemotherapy, which allows you to postpone development or completely avoid relapses. This treatment is most suitable for patients with chemosensitive tumors.

Ovarian cancer treatment in Israel

Cancer treatment in Israel is carried out in modern high-tech medical centers, which are equipped with special specialized departments for the therapy of female oncology. A number of specialists are engaged in treatment at the same time - this is a surgeon-oncologist, a gynecologist-oncologist, a chemotherapist-oncologist and a radiologist. Most of Israel's medical institutions are represented by eminent professors, known all over the world.

The availability of the most modern diagnostic and treatment equipment in clinics is also important. Much attention is paid to the development of medicine in this country, including priority funding from the state. therefore medical centers, as a rule, have a powerful diagnostic base, thanks to which complex examinations can be carried out in just a few days.

Chemotherapy treatment in Israel is based on the use of the latest medical suppliesdeveloped according to the latest clinical research.

For foreign patients, a coordinator is always provided who speaks the required language.

Upon admission, the patient must undergo a mandatory examination, which for ovarian cancer can cost about $ 6,000. Surgical intervention costs about $ 20,000, and one chemotherapy course costs about $ 3,000.

Ovarian cancer treatment in Germany

In Germany, there is a special program for the application of advanced technologies in the daily practice of oncology clinics. This is due to insufficient early diagnosis cancerous tumors.

Needless to say, doctors in German medical institutions are especially pedantic and highly qualified, and the equipment of the clinics is presented with the latest technology.

For each case and each patient, a consultation is always gathered, which determines an individual treatment approach.

The most common treatment standards for ovarian cancer in Germany are:

surgical system "Da Vinci" (remote robotic surgery);
radiosurgery Cyber \u200b\u200bKnife System;
internal radiation exposure to the tumor;
ultrasound ablation method;
treatment with monoclonal antibodies.

Surgery in Germany can cost approximately $ 3,000 to $ 10,000. The price for one course of chemotherapy treatment ranges from $ 10,000 to $ 15,000.

New in the treatment of ovarian cancer

In the United States of America, a regimen for the treatment of ovarian cancer with photodynamic therapy has been developed. Development is based on the fact that cancer tumor found in most cases only when the spread of metastases to other organs begins. After that, the operation and chemotherapy drugs no longer have the required effectiveness. Therefore, a new method of treatment was invented, which is called photodynamic therapy. The patient is invited to take a special drug - Phthalocyanine, which produces active oxygen, which can have a detrimental effect on cancer structures under the influence of infrared rays. In addition, gene therapy is prescribed, which reduces the degree of protection of cells from active oxygen. This therapeutic method can be combined with surgical treatment, which reduces the likelihood of body intoxication.
A revolutionary new anticancer drug, Olaparib, has been developed in the UK. The goal of this drug is to prolong the life of patients with ovarian cancer by at least five years. Olaparib is currently being tested and will soon be available for treatment.

Rehabilitation after treatment for ovarian cancer

After treatment for ovarian cancer, a number of side effects and exacerbations can occur that must be removed or mitigated. The rehabilitation scheme will be prescribed by the attending physician.

Several options for rehabilitation therapy are known that can be used with a sufficient degree of effectiveness.

Treatment with maintenance drugs:
- antiemetic drugs - Zofran, Ativan, etc.;
- laxative medicines - Duphalac, etc., which are prescribed against the background of an appropriate diet;
- hormonal agents are medicines that normalize the hormonal background of a woman after removing two ovaries;
- immunomodulating drugs - interleukin, etc.
Psychological treatment:
- selection by specialists of a specific diet and exercise therapy;
- involvement of social services for patient care;
- psychotherapist consultations;
- communication with patients who have undergone a similar pathology.
Physiotherapy, swimming and rehabilitation gymnastics.

Postoperative treatment with folk methods

Folk remedies, even in the postoperative stage, should be used only after approval by an oncologist. It should be noted that many drugs have contraindications for admission.

Boron uterus tincture: pour 100 g of chopped grass with 500 ml of vodka and insist for 14 days in a dark place, sometimes stirring the contents. Drink 1 tsp. 4 rubles / day. Duration of admission - up to 4 consecutive months.
A decoction or tincture of the golden mustache: carefully grind the ground part of the plant, pour boiling water and cook for a quarter of an hour, then filter and cool. Take a decoction of 100 ml three times a day, and alcohol tincture - 1 tbsp. l. in a glass of water.
Freshly squeezed beet juice, settled for one hour: drink, starting from 50 ml, gradually increasing the dose to 0.5-1 liters per day.
Infusion of hop cones: grind dry cones to a powder. Pour 200 ml of boiling water over two teaspoons of this powder and leave for 3 hours. Drink 50 ml three times a day before meals.

Treatment of recurrent ovarian cancer, as well as their prevention, is carried out by such alternative methods:

infusion of celandine with calendula: mix the raw materials in equal proportions and pour 200 ml of boiling water (can be brewed in a thermos), leave for 2 hours. Take 100 ml 3 r. / day before meals;
alcohol tincture propolis (sold in pharmacies): take 30 drops / day.

Treatment for ovarian cancer is most effective in the early stages of tumor growth. With the further spread of the malignant process, the prognosis of the disease becomes much less optimistic.

In premenopausal women, the ovaries are the main source of estrogen. Therefore, if a premenopausal woman has hormone-positive breast cancer, the cessation of ovarian function (namely, the production of hormones by them) can give an effective result. Such termination of ovarian function can be achieved either with the help of medication or by surgical removal.

Both drug suppression of ovarian function and their prompt removal are equally effective in reducing the level of estrogen in the blood. And this leads to the fact that breast cancer cells receive less stimulating effect from hormones.

If the ovaries are surgically removed, the patient immediately goes through menopause. More gradually, menopause occurs when the ovarian function is switched off by medication, which can last for several months. At the same time, side effects of such treatment are noted: hot flashes, vaginal dryness, mood swings, depression, weight gain and edema. All these phenomena are associated with a sharp decrease in the content of estrogen in the blood. These side effects can be managed.

It is necessary to understand that such a treatment, which affects the ovaries, is shown only for premenopausal women, that is, those who have preserved ovarian function, and, of course, when breast cancer is hormone-positive. Therefore, before carrying out such treatment, the doctor must make sure that the patient still has ovarian function. Some women who were premenopausal at the time of breast cancer diagnosis may find that ovarian function is suppressed after chemotherapy. But chemotherapy-induced menopause is usually only temporary. And usually, over time, ovarian function is restored, within a year, and sometimes two.

If the patient is already postmenopausal, which usually begins at the age of 50 to 52, suppression or removal of ovarian function is not indicated. If more than two years have passed since the last menstrual period, this means that ovulation no longer occurs in the ovary, and, therefore, estrogen is not formed. Therefore, surgical removal of such ovaries or suppression of their function by medication does not make sense.

Medication effect

This method consists in the fact that the patient is prescribed special hormonal drugs, which suppress the production of hormones by the pituitary gland that stimulate the ovaries. One of the brightest representatives of such a drug is zoladex (goselerin). Zoladex is a synthetic analogue of the pituitary gland's natural luteinizing-releasing hormone. This drug is used for various tumors in both women and men (prostate cancer). Its mechanism of action is that it suppresses the production of FSH and LH by the pituitary gland - hormones that regulate menstrual cycle... Zoladex is given by injection into the abdomen once every 28 days. Local anesthesia is possible during the injection. But since syringes are designed for this particular procedure, pain relief is often unnecessary. The first injection is done in a hospital, and the next in the clinic or at home by a nurse who comes from the clinic. Side effects Zoladexa is practically the same as when taking other drugs that suppress the effect of estrogen in the body (as well as with menopause): these are hot flashes, sweating, decreased sex drive, sometimes headaches, depression, and vaginal dryness are observed. In the first month of taking the drug, spotting may appear, which is associated with a decrease in estrogen levels. Sometimes there are joint pains, itching on the skin and soreness at the injection site. Rarely, there may be changes in blood pressure, which does not lead to discontinuation of the drug and to any special treatment. Zoladex should not be used during pregnancy as there is some risk of miscarriage or fetal abnormalities.

Before starting treatment in women with the potential to become pregnant, a thorough examination should be carried out in order to exclude the presence of pregnancy. During therapy, non-hormonal contraceptive methods should be used until menstruation resumes. In addition, the use of the drug zoladex is not recommended during lactation, that is, breastfeeding.

Surgical removal of the ovaries

Currently, this surgery is usually performed using an endoscopic technique, which allows the operation to be performed using a small incision. Removal of the ovaries leads to a sharp decrease in the level of sex hormones in a woman's body. However, it should be remembered that in the body, in addition to the ovaries, estrogen, albeit in very small quantities, is also produced by the adrenal glands.

Radiation exposure

This procedure was widely used in the past and is rarely used today.

Termination of ovarian function, in addition to leading to a decrease in the level of hormones in the blood, makes pregnancy impossible. The possibility of becoming pregnant in the future depends on whether the function of the ovaries has been terminated temporarily or permanently. Various factors, such as chemotherapy, hormonal treatment, the patient's age and the stage of the disease, affect the possibility of future pregnancy.

Removal of the ovaries

Deciding on such a method hormonal treatmenthow the effect on the ovaries is a very important and crucial moment in the treatment of breast cancer. This is especially true for those patients who do not yet have children. However, if you are in your forties and your menstrual cycle is still on, but you have lymph nodes affected by cancer, your doctor may recommend several methods to lower your blood estrogen levels. This can be suppression of ovarian function, their removal and the appointment of aromatase inhibitors. The choice of methods will depend on the risk of cancer recurrence.

Removal of the ovaries is often used as a preventive measure for breast and ovarian cancer in the presence of a proven gene abnormality (BRCA1 or BRCA2). With this removal of the ovaries, the risk of developing breast cancer is reduced by 50%.

The value of such treatment will depend on how early menopause affects quality of life (fertility, hot flashes, etc.) and general state health ( elevated level cholesterol and effects on bone tissue).

Removal of the ovaries to prevent the risk of their cancer

Surgical removal of the ovaries can also be performed after chemotherapy to reduce the risk of ovarian cancer, regardless of menopausal status. Removing the ovaries both before and after menopause reduces the risk of developing breast cancer. This treatment is ideal for patients with both a familial predisposition to breast cancer and an identified gene abnormality such as BRCA1 or BRCA2.

If ovarian removal is performed before menopause, the risk of both breast and ovarian cancer is reduced. If you have had breast cancer and have entered menopause after chemotherapy, removal of your ovaries may be done to reduce your risk of ovarian cancer. When ovarian cancer is surgically removed, the risk of ovarian cancer is reduced by 80%. Unfortunately, it is impossible to reduce this risk to zero, since even after the removal of the ovaries, tissue remains in the small pelvis that is similar in function to that of the ovaries.

Removal of the ovaries or drug suppression of ovarian function can cause some side effects.

Infertility. If the removal of the ovaries was made to the patient before the onset of menopause, then infertility occurs, since the body no longer produces eggs.
Osteoporosis. External changes bone tissue when the ovaries are removed or their function is suppressed, they are associated with a sharp decrease in the level of estrogen in the blood. And the younger the patient who has undergone this type of hormone therapy, the more pronounced the osteoporosis.
Menopause symptoms. If the removal of the ovaries or the suppression of their function is carried out in a premenopausal woman, then after that she will have menopause. Moreover, with surgical removal of the ovaries, menopause occurs much faster. As a result, hot flashes, swelling or weight gain, vaginal dryness, mood swings, depression appear.

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Breast cancer treatment in Israel

Today in Israel, breast cancer can be completely cured. According to the Israeli Ministry of Health, Israel currently has a 95% survival rate for this disease. This is the highest rate in the world. For comparison: according to the National Cancer Register, the incidence in Russia in 2000 compared to 1980 increased by 72%, and the survival rate is 50%.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Alice asks:

What are the consequences of surgical treatment for ovarian cancer?

The main consequence of the surgical treatment of ovarian cancer is to remove from the abdominal cavity all foci of tumor growth visible to the naked eye. This means that during the operation, the doctor must remove any tissue affected by the tumor growth. If the cancer has severely damaged any organ, then it is removed completely, provided that it is not vital. As a rule, removal of both ovaries, uterus, fallopian tubes and the greater omentum is performed, since all of these organs are affected by tumor structures and are not vital. Metastatic foci on the peritoneum and in the abdominal organs (intestines, liver, etc.) are carefully exfoliated. Affected by tumor growth the lymph nodes removed completely. The result of this radical nature of the operation is the removal of the maximum number of tumor elements.

After the operation, if necessary, chemotherapy is carried out, which is used to destroy the remaining single cancer cells that were not visible to the naked eye and therefore could not be removed during surgery. Without removing the primary tumor and visible to the eye metastases only with the help of chemotherapy it is impossible to cure ovarian cancer. Chemotherapy without surgery will only stop the progression of the tumor and prolong the woman's life. And chemotherapy after surgery will allow you to recover completely.

Thus, after removal of metastases and the primary tumor itself, a woman has a good chance of a complete recovery from ovarian cancer. Moreover, these chances are higher, the earlier was the stage of the tumor according to the FIGO classification. Therefore, the main consequence of the surgical treatment of ovarian cancer is the possibility of complete recovery. For women with terminal cancer, the operation significantly increases life expectancy and improves its quality.

In addition, surgical treatment of ovarian cancer often results in the impossibility of having children in the future, since all reproductive organs (uterus, fallopian tubes and ovaries) are removed during the operation. In rare cases, in young women with early stages tumor, it is possible to remove only one affected ovary while preserving the uterus and fallopian tubes... After such an organ-preserving operation, the possibility of pregnancy in a woman rises to 70%.

Another important consequence of surgery for ovarian cancer is the restoration of normal patency of the intestines and urinary tract, and, consequently, the normalization of the processes of urination and defecation. In addition, after the operation, the woman ceases to suffer from bloating and other painful symptoms of digestive disorders (heartburn, nausea, vomiting, etc.), since numerous metastases in the peritoneum are removed and adhesions that interfere with the normal functioning of the gastrointestinal tract are dissected.

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