How to treat ovarian tumors

The ovary is a very small organ, normally located in the pelvic cavity. Since the pelvic cavity is large and the ovaries are very small, the space around the ovaries is particularly large. Therefore, when ovarian malignancies occur, most people seek medical attention at a relatively late stage. Therefore, late-stage ovarian tumors account for the vast majority of ovarian tumors. The few patients with early-stage ovarian tumors are discovered, mostly by luck, such as physical examinations or other surgeries.

The ovary is an organ with a very complex tissue and cell structure, and its cells can differentiate in multiple directions. Therefore, the ovary is an organ with multipotential differentiation, which makes the types of ovarian tumors very numerous. There are dozens of classifications, which is a headache. However, epithelial ovarian tumors are the most common among ovarian tumors, accounting for more than 70% of ovarian malignant tumors, so the standardized treatment of ovarian tumors introduced here refers only to epithelial ovarian tumors. Other types of ovarian tumors are not introduced here.

The tumor cells of early ovarian tumors are only confined to the ovaries, which belongs to stage I, but it is relatively rare. Once the tumor cells metastasize to the organs in the pelvic cavity, it belongs to stage II. Stage II tumors are of course more common than stage I tumors. Stage I tumors and stage IIa tumors are usually called early tumors. If the cancer cells of ovarian tumors metastasize to organs in the abdominal cavity, such as the greater omentum, appendix, abdominal wall, especially the organs under the diaphragm, or there is metastasis to the retroperitoneal lymph nodes, they are all stage III. Metastasis beyond the range of the abdominal cavity is distant metastasis, that is, stage IV, such as metastasis to the liver, lungs, etc. The therapeutic value of distant metastasis is very small. In clinical practice, tumors above IIb are usually called advanced tumors, mainly referring to tumors above IIb and stage III. Stage IV tumors are also relatively rare in clinical practice and have little therapeutic value.

Once an ovarian tumor is diagnosed, surgery should be chosen in principle, except for stage IV tumors. Unlike other tumors, ovarian tumors are still worth surgically treated even when they reach stage IIIc. Other tumors, such as liver cancer, lung cancer and other malignant tumors, are basically worthless when they reach stage III, but ovarian tumors in stage IIIc are still worth treating. The most different biological behavior of ovarian tumors from other tumors is that ovarian tumors are generally limited to metastasis in the abdominal and pelvic cavities, and the same is true for stage III. The process from stage III to stage IV seems to be relatively long.

Different from the surgical principles of other malignant tumors, the treatment principle of ovarian tumors is "tumor cell reduction surgery", which is to use mechanical methods to remove most of the tumor. The first thing to be removed is the pelvic viscera, such as the contralateral ovary, uterus and fallopian tube. Secondly, the greater omentum and appendix in the patient's body that are easily susceptible to cancer cell metastasis should be removed. If no tumor can be seen with the naked eye, the surgery for early ovarian tumors ends here. If the tumor has metastasized to organs such as the peritoneum, mesentery and intestines, ovarian tumor cell reduction surgery is recommended. The so-called cell reduction surgery is to use mechanical methods to mechanically remove tumor cells on the metastatic lesions, and the remaining cancer cells are killed by chemotherapy and other methods to achieve the purpose of treatment. For ovarian tumors, while performing surgical treatment, the lymph nodes of the pelvis and retroperitoneum should also be removed to understand the stage of ovarian tumors. Therefore, the surgery for ovarian tumors is also called staged surgery.