Removal of the ovaries for breast cancer. Treatment of ovarian cancer: a review of effective methods

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

Both drug suppression of ovarian function and surgical removal of them are equally effective in reducing the level of estrogen in the blood. And this leads to the fact that breast cancer cells are less stimulated by hormones.

If the ovaries are removed surgically, then the patient immediately goes through menopause. More gradually, menopause occurs with medication "turning off" the function of the ovaries, which can occur for several months. Side effects of this treatment include hot flashes, vaginal dryness, mood swings, depression, weight gain, and swelling. All these phenomena are associated with a sharp decrease in the content of estrogen in the blood. These side effects can be managed.

It must be understood that such a treatment that affects the ovaries is indicated 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 such menopause, which is caused by chemotherapy drugs, 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 between the ages of 50 and 52, ovarian suppression or removal is not indicated. If more than two years have passed since the last menstruation, then 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.

Medical impact

This method consists in the fact that the patient is prescribed special hormonal preparations, which suppress the production of pituitary hormones that stimulate the ovaries. One of the brightest representatives of such a drug is Zoladex (goselerin). Zoladex is a synthetic analogue of the natural luteinizing releasing hormone of the pituitary gland. This drug is used for various tumors in both women and men (for 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. Perhaps local anesthesia during the injection. But since syringes are adapted specifically for this procedure, pain relief is often not necessary. The first injection is given in the hospital, and the subsequent injections are given at the clinic or at home by a nurse who comes from the clinic. Side effects of Zoladex are almost the same as when taking other drugs that suppress the action of estrogen in the body (as well as with menopause): these are hot flashes, sweating, decreased sexual desire, headaches, depression, and vaginal dryness are sometimes observed. In the first month of taking the drug, you may experience bloody issues associated with a decrease in estrogen levels. Sometimes there are pains in the joints, itching on the skin and soreness at the injection site. Changes are rare blood pressure, which does not lead to discontinuation of the use 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 methods of contraception should be used until menstruation resumes. In addition, the use of Zoladex is not recommended during lactation, that is, breastfeeding.

Surgical removal of the ovaries

Currently, this operation 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.

Exposure to radiation

This procedure was widely used in the past, and today it rarely finds its use.

The cessation of ovarian function, in addition to leading to a decrease in the level of hormones in the blood, makes pregnancy impossible. The ability to become pregnant in the future depends on whether the function of the ovaries was stopped temporarily or permanently. The possibility of pregnancy in the future is influenced by various factors, such as chemotherapy, hormonal treatment, the age of the patient and the stage of the disease.

Removal of the ovaries

Deciding on such a method hormonal treatment as an 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 40s and still have menstrual cycles but have cancerous lymph nodes, your doctor may recommend several methods to lower your estrogen levels. This may be the suppression of ovarian function, their removal and the appointment of aromatase inhibitors. The choice of methods will depend on the risk of cancer recurrence.

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

The relevance of such treatment will depend on how early menopause will have an impact on quality of life (fertility, hot flashes, etc.) and general state health ( elevated level cholesterol and effect on bone tissue).

Removal of the ovaries to prevent the risk of their cancer

Surgical removal of the ovaries may also be performed after chemotherapy to reduce the risk of developing ovarian cancer, regardless of menopausal status. Spaying both before and after menopause reduces the risk of developing breast cancer. This method of treatment is excellent for patients with a family predisposition to breast cancer, as well as for identified gene anomalies such as BRCA1 or BRCA2.

If spaying is done before menopause, the risk of both breast and ovarian cancer is reduced. If you have had breast cancer and are going through menopause after chemotherapy, ovaries may be removed to reduce your risk of ovarian cancer. Surgical removal of ovarian cancer reduces the risk of ovarian cancer by 80%. Unfortunately, it is impossible to reduce this risk to zero, since even after the removal of the ovaries, tissue remains in the pelvis, similar in function to the tissue of the ovaries.

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

Infertility. If the removal of the ovaries was performed on the patient before the onset of menopause, then infertility occurs, since the body no longer produces eggs.
Osteoporosis. Changes in bone tissue during removal of the ovaries or suppression of their function are associated with a sharp decrease in the level of estrogen in the blood. And the younger the patient who underwent this species hormone therapy, the more pronounced osteoporosis.
climacteric symptoms. If the removal of the ovaries or the suppression of their function is carried out in a woman in premenopause, then after that she has menopause. Moreover, with surgical removal of the ovaries, menopause occurs much faster. As a result, hot flashes, swelling or weight gain, vaginal dryness, mood changes, and depression appear.

+7 495 66 44 315 - where and how to cure cancer

Breast cancer treatment in Israel

Today in Israel, breast cancer is completely curable. 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%.

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

Surgical treatment is considered the main one. 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 makes a mistake in determining the stage of the tumor, then refusing to operate can lead to irreparable consequences.

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

Why is it sometimes necessary to remove both appendages with 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 again have to undergo treatment.

Simultaneously with the operation, treatment with chemotherapeutic drugs is used. The goals of this therapy are:

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

Radiation therapy never used as a standalone treatment. 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 condition of the urinary system, liver is assessed, a blood test is performed. During chemotherapy, the blood is examined several times, at least once a week.

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

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

Surgical treatment of ovarian cancer

The operation is the main link in the successful treatment of a cancerous tumor. Currently, the intervention is carried out using laparotomy - through an incision above the pubic zone. Simultaneously with the operation, the surgeon takes materials for further research. These may be tissue samples or fluid that has accumulated in the abdominal cavity.

Ovariectomy is the resection of one or two appendages.
Pahysterectomy is an operation that is performed at later stages of tumor development, when the uterus also has to be removed.
Extirpation is the complete removal of the uterus with the ovaries, omentum and cervix.

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

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

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

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

Radiation therapy

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

Most often, radiation is prescribed for cancer recurrence, 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, one to ten sessions may be needed, the duration of which is determined by the oncologist. Chemotherapy can be taken along with the course of radiation therapy to completely control the cancer process.

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

With the growth of a tumor in the tissue of the abdominal organs, as well as with the accumulation of fluid, there is no point in prescribing radiation therapy, because radioactive rays can have a negative effect on healthy nearby organs.

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

Chemotherapy is used after surgery to prevent re-growth of the tumor. In addition, special medications can reduce the size of the neoplasm before surgery 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 allows to increase the survival rate of women with malignant tumors. However, when administered intraperitoneally, adverse effects may occur, for example, severe pain, the development of infection, diseases of the digestive system.

The most common medicines 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;
Vepezid - 50 mg / m² for 21 days;
Bevacizumab (Avastin) 5-10 mg/kg every 2 weeks.

Cytotoxic drugs are almost never prescribed as an independent 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 the similar Cyclophosphamide-Cisplatin combination, but just as effective. Taxol with Carboplatin provide relatively fast results and guaranteed 6-year patient survival.

Doxorubicin, or Kelix for ovarian cancer is often used in conjunction with Cyclophosphamide or taxanes. At the same time, there is no increase in the toxic effect of drugs. Kelix is usually administered intravenously (2 mg/mL), but for other drugs, a different route of administration can be chosen. For example, oral cyclophosphamide is prescribed at a dosage of 1-2 mg/kg per day.

Avastin for ovarian cancer has been used relatively recently. It is one of the new bevacizumab-based drugs that inhibit development malignant tumor. Avastin is administered only by intravenous drip. Another variant of administration, including intravenous inkjet, is prohibited.

Another one of the most popular anticancer drugs– Refnot – is a tumor tissue necrosis factor (thymosin α-1). This is a fairly strong cytostatic and cytotoxic agent with a minimum amount of side effects. However, Refnot for ovarian cancer is not used as often: it is usually prescribed for the treatment of 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 still causes controversy in the ranks 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 in ovarian cancer increases antitumor immunity, which significantly increases the effectiveness of chemotherapy. In addition to Roncoleukin, such medications as Timalin, Mielopid, Betaleukin and interferons have a similar effect.

Thermoperfusion for ovarian cancer

Thermal perfusion is one of the oncology treatment options, which involves thermal effects on tissues. Heat damages the protein structure of cancer cells, while not 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 the ovaries and nearby organs that have undergone a cancerous lesion with a warm antitumor agent (up to 44 ° C), which significantly increases the effectiveness of its action.

In addition to antitumor activity, this method It also has a number of side effects. These are swelling, 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.

Thermotherapy is currently undergoing active clinical trials. 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 cancer be cured with folk recipes? The question is moot. The vast majority of experts in traditional medicine do not welcome the application folk remedies especially in the form of self-treatment. Attempts to cure the tumor on your own can lead to an aggravation of the process, and precious time to start timely treatment may be lost.

Nevertheless, quite a lot of recipes are known, the authors of which promise to get rid of ovarian cancer soon. We invite you to 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 take flea mint tea half a glass three times a day. During treatment, you can do douching with the same solution. To prepare this tea, you need to brew 20 g of mint leaves in 500 ml of boiling water and leave for 2 to 3 hours.
Linseed oil and flaxseed in ovarian cancer is used very often. The dosage of oil is from 1 tsp. up to 1 st. l. in the morning and in the evening. You can take it in the form of capsules, which are sold in pharmacies. To do this, you need to drink at a time from 10 to 14 capsules. Flaxseed is used in the amount of 3 tbsp. spoons mixed with 200 ml of water. Such a "cocktail" must be drunk three times a day, at least for one month.
Good reputation in dealing with cancer possesses hemlock - it is used to treat many malignant tumors. Hemlock in ovarian cancer (especially in combination with other methods) can lead to positive result. The tincture of this plant should be taken with a gradual increase in dose: starting with 1 drop per 200 ml of water 1 time per day before meals, increasing 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.
Many consider ordinary oats to be the first cure for malignant tumors. An infusion of oats for ovarian cancer is prepared very simply: one glass of oat grains is poured into an enameled container and poured with 1000 ml of water, brought to a boil and boiled over low heat for about 20 minutes. After that, they are removed from the fire and insisted in a warm place for at least 2 hours. The broth is filtered and divided into three doses. Drink 30 minutes before meals three times a day. It is not recommended to cook a decoction in advance for several days, it is better to take fresh.

No one rules out efficiency folk treatment. However, before using such methods, consultation with an oncologist should be mandatory.

Treatment of ovarian cancer 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 materials and peritoneal fluids are removed during surgery. In most cases, stage 1 does not require additional treatment other than surgery.

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

Treatment of stage 3 ovarian cancer requires a combined approach that combines surgery and mandatory chemotherapy. The intraperitoneal variant of 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 maintenance treatment is the appointment of more than six consecutive courses of chemotherapy, which allows you to delay the development or completely avoid relapses. This treatment is most suitable for patients with chemosensitive tumors.

Treatment of ovarian cancer in Israel

The treatment of cancerous tumors in Israel is carried out in modern high-tech medical centers, which are equipped with special specialized departments for the treatment of female oncology. Treatment is carried out simultaneously by a number of specialists - a surgeon-oncologist, a gynecologist-oncologist, a chemotherapist-oncologist and a radiologist. Most medical institutions in Israel are represented by eminent professors known throughout the world.

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

Chemotherapeutic treatment in Israel is based on the use of the latest medical preparations developed according to the latest clinical research.

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

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

Treatment of ovarian cancer in Germany

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

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

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

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

surgical system "Da Vinci" (remote robotic surgery);
radiosurgery "Cyber Knife System";
internal radiation exposure to the tumor;
ultrasonic 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 using photodynamic therapy has been developed. The development is based on the fact that a cancerous tumor is detected in most cases only when metastases begin to spread to other organs. After that, the operation and chemotherapy no longer have the necessary effectiveness. Therefore, it was invented new way treatment called photodynamic therapy. The patient is invited to take a special drug - Phthalocyanine, which produces active oxygen that 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 intoxication of the body.
In the UK, a new revolutionary anticancer drug Olaparib has been developed. The goal of this drug is to extend 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 ovarian cancer treatment

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

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

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

Postoperative treatment with folk methods

Folk remedies, even at 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 leave for 14 days in a dark place, sometimes stirring the contents. Drink 1 tsp. 4 rubles / day. Duration of admission - up to 4 months in a row.
A decoction or tincture of a 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 a tincture of alcohol - 1 tbsp. l. in a glass of water.
Freshly squeezed beetroot juice, settled for one hour: drink, starting with 50 ml, gradually increasing the dose to 0.5-1 liter per day.
Infusion of hop cones: grind dry cones to a state of powder. Pour two teaspoons of this powder into 200 ml of boiling water and leave for 3 hours. Drink before meals 50 ml three times a day.

Treatment of recurrence of 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 times a day before meals;
alcohol tincture propolis (sold in pharmacies): take 30 drops / day.

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

In The New York Times, where she spoke about her struggle with the threat of cancer. Following a double mastectomy, that is, the removal of both mammary glands, Jolie underwent surgery to remove the ovaries and fallopian tubes. She spoke about the process of making this difficult decision and urged women to be attentive to their health and understand that a disease detected in time or its adequate prevention increases the chances of a long and happy life. The column caused a stormy response in social networks, including reviews of a negative nature - Jolie was accused of alarmism, carcinophobia
and in advocating inadequate treatments.

A large number of comments condemning the actress confirmed that with all the progress in the field of technology and diagnostics, many still prefer not to know or not think about potential problem until the thunder breaks out, and the awareness of Russians about the prevention of cancer and how to treat them is far from ideal. Another reason for such a negative reaction to the removal of the reproductive system at a similar age lies in the stigmatization of such operations and the women who underwent them - in a child-centric society, “cutting everything off for yourself” automatically means “ceasing to be a woman” and “losing value” in the eyes of men. We asked a gynecological oncologist who took part in the treatment of Angelina Jolie's mother, as well as a geneticist and a psychotherapist, to comment on this situation and talk about new technologies and topical methods for the prevention and treatment of female cancers that everyone should know about.

Every eighth woman in the world suffers from breast cancer. In Russia, the situation is somewhat worse, because in our country women are often dismissive of early diagnosis and doctors do not know it well enough, for example, they often replace mammography with ultrasound or even a simple examination of the mammary glands. With breast cancer, as with any other type of cancer, it is very important to diagnose it as early as possible, then there is a better chance of curing it. Survival directly depends on the stage at which the disease was detected. But there are, of course, many other nuances. For example, some tumors are hormone-sensitive, and in such cases the prognosis is better. There are a number of tumors that do not have hormone receptors, they are often more aggressive, respond worse to chemotherapy and, accordingly, are not treated with hormonal agents.

Fortunately, there is an early diagnosis of breast cancer - for most diseases it is not. If you follow the recommendations of doctors and after the age of 40 undergo a mammogram once a year, then the likelihood of not dying from breast cancer increases significantly. Women from 30 years old need to visit a mammologist and do an ultrasound of the mammary glands every three years, and this is provided that they do not have any special problems with the mammary glands, there were no seals, neoplasms and the patients do not have a genetic predisposition to cancer, like that Or Angelina Jolie.

The genetic risk for developing breast or ovarian cancer is based on a family history of cancer. If your mother, grandmothers or aunts had premenopausal cancer at a young age (that is, breast or ovarian cancer - they are often combined into one syndrome), you are at risk. The chance of getting cancer in this case increases enormously. Of course, there are sporadic cases of the disease, but there are certain syndromes, as in the case of Angelina Jolie - BRCA1 and BRCA2. Carriers of the first type of mutation have an 85% risk of developing breast cancer at a given age, that is, in fact, this is every first carrier.

Genetic tests can reveal if a mutation exists. Doctors are already making conclusions about the risks, they look at the type of mutation, and then everything is already known. It is much more important that the gynecologist or mammologist competently collects an anamnesis. I always ask patients who come with conditional thrush or cervical dysplasia, what their relatives were sick with, what degree of relationship and at what age they had the disease. When a woman says: “My aunt died of breast cancer at the age of 45, my grandmother had ovarian cancer and my mother had a tumor, but it seemed to be benign and she was excised,” the doctor must understand that the patient needs to be checked for the carriage of these mutations. We usually test women whose relatives had ovarian or breast cancer at a young age; those who have already been diagnosed with breast or ovarian cancer before the age of 50; and women who undergo multiple biopsies for breast masses that appear to be benign, but are not entirely clear. It happens that a woman has a very convincing family history of certain cancers, but for some reason the mutation is not found in her. In such cases, we sequence the entire BRCA1 and BRCA2 gene and see if there is a mutation in some atypical loci (locations), and often we find it there.

Routinely undergoing genetic tests makes no sense. Moreover, if parents have the mutation, we recommend that they not test their children until they are 20-25 years old. The risks of oncological diseases begin to grow at 30-35, so, apart from anxiety, this information will not add anything to parents. After the age of 20, we warn you that your risk of getting cancer before the age of 35 is quite low and you have a chance to realize the reproductive function to the extent that you want before that time. However, there is no harm from such tests, except perhaps financial: a test for the most common mutations will cost 15-17 thousand rubles.

Every fourth carrier of the first type of mutation dies of ovarian cancer. Such a sad statistic

I worked in the US for nine years and took part in the treatment of Angelina Jolie's mother when she had a relapse of ovarian cancer. She was then 54 years old, and she died at 56 from breast cancer. She had two mutations at once - both the first and the second types. In their family, indeed, almost all women suffer from breast or ovarian cancer. To all my patients who have a mutation, I explain for a long time what the risks are. Fortunately, in cases of breast cancer, we have intensive screening protocols: we start tracking the condition of mutation carriers much earlier than usual, up to 25 years, every six months we alternate mammography and MRI of the mammary glands, and a mammologist conducts examinations. If these conditions are observed, it is quite possible to postpone the removal of the breast.

With the ovaries, everything is much worse: carriers of the first type of mutation have a 54% chance of getting ovarian cancer - that is, every second woman. Unfortunately, 80% of patients find out about it when the cancer is already in the third stage. At this stage, survival even at the very aggressive treatment- 35% at best. That is, every fourth carrier of the first type of mutation dies of ovarian cancer. Such a sad statistic. For this reason, knowing that the risk increases at the age of 35 years, I recommend prophylactic removal of the ovaries and fallopian tubes by laparoscopic method to all my patients - carriers of BRCA1 and BRCA2 gene mutations.

Such a preventive operation significantly reduces the risk of cancer, but does not reduce it to zero. In 7-10% of cases, when the ovaries are removed, we already find a microscopic tumor. This means that we are late with prevention and the cancer has already begun to develop. There is also a subtype of ovarian cancer called primary peritoneal carcinoma - this is actually the same ovarian cancer, only it does not begin on the ovaries themselves, but on the surfaces of the peritoneum. It can occur even after removal of the ovaries and fallopian tubes in mutation carriers. Less likely, but it cannot be ruled out. We always warn women that they can get ovarian cancer even if they no longer have ovaries, no matter how paradoxical it may sound.

Patients respond to preventive surgery in different ways. Those whose relatives were dying of cancer in front of their eyes sometimes come and ask to have their ovaries and fallopian tubes removed. Another thing is when a woman in her forties gets breast cancer and we detect a mutation in her - at this age it is more difficult to say goodbye to the ovaries, especially if the patient does not have children yet. Then we start the race: we ask the woman to get pregnant and give birth as quickly as possible, and after that we already remove the ovaries. The problem with 40-year-old women is that they often cannot get pregnant quickly - ovarian reserve is usually not very good at this age. A reproductive specialist comes to the rescue, he performs IVF, receives and freezes eggs or embryos, and only then we remove the ovaries, and a woman can endure this pregnancy without ovaries.

Physically, the operation to remove the ovaries of the patient is easily tolerated. The procedure takes 30-40 minutes. A woman comes to the clinic on the day of the operation a couple of hours before the start and goes home the next day, if necessary, she takes sick leave for 3-4 days. Psychologically, this is more difficult to deal with. After the removal of the mammary glands and ovaries, women begin to perceive themselves differently, this greatly changes them psychologically. Although it all depends on the person. Many mastectomy patients immediately put in implants and live as before, enjoying a low risk of developing breast cancer. With the ovaries, there is no option to put implants. Removing the ovaries, for example at the age of 35, a woman enters menopause. She begins menopause, and this adds a whole range of physical and psychological problems. Theoretically, they can be solved or alleviated with the help of hormone replacement therapy (HRT), but there are difficulties here, because with long-term use of HRT itself can provoke the development of breast cancer. So many women forgo hormonal therapy and take some form of non-hormonal medication to help combat hot flashes, mood swings, and everything else. With regard to sexual life, patients with ovaries removed complain of dryness in the vagina and sometimes a decrease in libido, but the dependence of the latter on the presence / absence of ovaries has not yet been proven.

Angelina Jolie was tested for a gene mutation, the risk of developing the disease was assessed based on her pedigree. I think she did examinations for a number of other indicators. Most likely, the actress decided on a mastectomy not only on the basis of a genetic test - of course, an integrated approach is important here. A few years later, Jolie underwent surgery to remove her ovaries. This step is understandable, because women who are naturally menopausal have an increased risk of ovarian cancer. For her, it was a justified preventive measure, given the BRCA1 gene mutation. But at the same time, any woman with a similar mutation should not immediately run away and remove her reproductive organs, since each case is individual, and the risks consist not only of genetic predispositions, but also biochemical changes, tumor markers and other indicators.

A genetic test is enough to pass once in a lifetime. The technique is as follows: first, a screening is given, and if it shows a mutation, a diagnostic test is performed, which allows you to either confirm or refute the existing assumption. Now in Russia, many institutions allow you to do this.

There is no need to interpret the results of a genetic test on your own, since you can read literature and forums, fall into hypochondria and not reach the doctor. An appointment to search for a mutation in the BRCA1 gene is made by a specialist, and it is the geneticist who should interpret the results. Do not leave a person alone with the data received. It is important for the patient to understand everything correctly. The BRCA1 gene is generally very large, and there may now be more than one and a half thousand mutations in it. To figure out what mutation was found in a person and how it will affect the development of the disease, you need to do a lot of work, see all science articles on the topic - this is what a geneticist does.

The identified risks vary. There are mutations that slightly increase the likelihood of developing the disease, they are most common. In such cases, there is no need for surgery, you need to carefully monitor your health. If it is proven that a certain mutation increases the risk of cancer by up to 87% (in Jolie, this is exactly the case - an indicative clinical case), then prompt decisions must be made.

If in every generation women die
from bilateral cancer of the breast or ovaries, of course, the removal of these organs is indicated

Diagnostic tests are very accurate, and yet if a person does not trust a laboratory, he can redo the analysis in other institutions. Mutations in a gene are not a diagnosis or an indication for surgery, but a statement that you need to be attentive to your health. The conclusion can only be made by a doctor after examinations by several specialists (gynecologists, endocrinologists, etc.) and additional tests. In order to make predictions, it is important to consider family history. If close relatives of a woman with a mutation found to have developed cancer before the age of 40–45, then she needs to be on her guard starting at the age of 35 and undergo regular examinations. If in every generation women die of bilateral breast or ovarian cancer, removal of these organs is of course indicated.

Now there is a lot of talk about breast cancer, according to the Ministry of Health, in Russia it is already coming out on top of cancer mortality among women. Recently, cases of detection of this disease have become more frequent, but this is due, rather, to the fact that diagnostic methods are improving. Preventive operations to remove the mammary glands and ovaries are indicated to prevent the development of cancer of these particular organs. But this does not protect against other tumors, therefore, the patient who has had the disease remains on increased alertness and the risk of bowel cancer increases. Sometimes a colonoscopy is prescribed to cure the slightest inflammations and polyps before they develop into cancer.

After the removal of the organs, replacement therapy, and if it is correctly selected, patients do not feel any inconvenience. Many post-menopausal women, even without a high risk of developing cancer, are treated along the same lines. I see no reason why a woman would no longer be considered a woman after having her ovaries removed: she gets enough hormones to feel good and look attractive. Any discrimination on the topic of health and the presence of certain organs seems unethical to me.

Olga Miloradova
psychotherapist

To paraphrase into normal language the indignation of many with Jolie's act, then basically she is accused of cancerophobia. The problem is that cancerophobia can only be diagnosed when there is no threat of oncological disease as such, or in cases where the patient, due to some circumstances, is little aware of the nature of his disease and suspects that its development will go somehow absurd. way.

It would be ridiculous to say that fears for your life with an 87% risk of breast cancer and a 50% chance of ovarian cancer are baseless paranoia, it is also impossible to say that Jolie harbors any illusions or is little aware of her condition. She explains her decision in sufficient detail, consistently and logically, without falling into extremes or messianism, without urging everyone to follow her. In my opinion, she behaves quite sensibly, and, unlike many observers who immediately diagnosed neurosis, psychosis or gangrene of the brain in her, I can say with all responsibility that I can diagnose something like that remotely and based on data gleaned from The media is just ridiculous. Otherwise, given her family history, the occurrence of anxiety-phobic symptoms (which she does not deny when describing her expectation of results) would not only be unsurprising, but, in general, just the most normal in the current situation.

As for the reaction of the public, here everything is much more interesting. Why does everyone still care so much about how a person disposes of his own body, and moreover, why is it beyond logical decisions taken he is ostracized. On the one hand, each of us is very attached to our life roles. To the question "who are you?" a person will first of all present his professional identification: “I am a lawyer”, “I am a student”, “I am a journalist”... But still, the gender role comes to the fore, which is not presented precisely because it seems to be present by default. It is known, for example, that people feel uncomfortable until they can determine the gender of the interlocutor.

The loss of female reproductive organs and reproductive function is automatically associated in the minds of many with the loss of female identity, the loss of the self, the loss of the purpose for existence. Even at that age and with that number of children, when the reproductive function itself, it would seem, is not important, the conscious rejection of the “most important” seems like madness, cannot be adequately perceived, and, of course, the situation is transferred to one’s own “ I”, which terrifies women, and men see it as a kind of protest against the patriarchal system, where the female body itself, with all its inherent functions, is the object of service for its needs. In simpler terms, many, both women and men, sympathized with the "poor" Brad Pitt, as if he had lost a woman (actually not) in the person of his wife.

Before surgery, the entire abdominal cavity must be carefully examined. Special attention pay attention to the state of the surface of the diaphragm and the space between colon and peritoneum, because they may have metastases, sometimes unnoticed. Even if there are no visible nodules in the subphrenic region, peritoneal washes may contain tumor cells.

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

For patients in the first stage of the disease, in most cases it is effective surgical method treatment. An abdominal hysterectomy with bilateral salpingectomy and oophorectomy is usually performed. The second ovary is usually removed even with unilateral initial localization of the tumor, since in 20% of cases, due to latent metastases, a tumor usually also develops in it in the future.

In younger patients who want to keep the ovary, more conservative surgery can be tried. With greater certainty, conservative surgery can be recommended for cases of tumors with an 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 later stages of the disease (stages II-IV), most oncologists are of the opinion about the maximum possible removal tumors at primary surgery. A good palliative effect is achieved even if the size of the tumor can be reduced surgically.

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

When calculating the survival of patients using 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 surgery. 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 the operation the patient has palpable residual seals, then the appointment of a course of chemotherapy or radiation therapy is unlikely to be effective. Therefore, at least some of them may require a second operation, which should be performed by an experienced surgeon. Now more often such complex operations such as removal of the pelvic organs, removal of the omentum, resection of the colon, and complete removal of the parietal pelvic peritoneum.

Studies conducted within the framework of the Inter-European cooperation on a randomized group of 319 initially operated patients who underwent a course of chemotherapy confirmed the effectiveness of reoperation. Patients who underwent second-look laparotomy had improved overall survival as well as progression-free survival.

Despite the use of ultrasound, CT and MRI, there is no way to monitor the effectiveness of the treatment of advanced ovarian cancer. Again it all comes down to various methods examinations. Therefore, sometimes it is advisable to perform a surgical operation, even beyond the scope of the “second look”. If no tumor foci are detected during laparoscopic examination and the results of the analysis of intraperitoneal washings are negative, then in some cases a laparotomy can be done to ensure a favorable outcome.

It is difficult, of course, to argue that a “second look” laparotomy can prolong the life of a patient with an ovarian tumor, but as a result of its implementation, it will be possible to use a more reasonable tactic for further treatment. Now everyone understands that the “second look” laparotomy only determines the choice of the method of subsequent treatment.

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

We welcome your questions and feedback:

Materials for placement and wishes, please send to the address

By submitting material for placement, you agree that all rights to it belong to you

When citing any information, a backlink to MedUniver.com is required

All information provided is subject to mandatory consultation by the attending physician.

The administration reserves the right to delete any information provided by the user

Treatment of ovarian cancer: a review of effective methods

A cancerous tumor is one of the most serious diseases, so the treatment of ovarian cancer is usually prescribed in combination, based on the results of the patient's diagnosis. The main importance in choosing treatment tactics is the degree of development and spread of the tumor process, the general condition of the patient, her age. modern medicine uses, as a rule, several treatment methods at once to get rid of cancer cells for sure.

Treatment options for ovarian cancer

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

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

Simultaneously with the operation, treatment with chemotherapeutic drugs is used. The goals of this therapy are:

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

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

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

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

Ovariectomy is the resection of one or two appendages.
Pahysterectomy is an operation that is performed at later stages of tumor development, when the uterus also has to be removed.
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, and sometimes the vermiform appendix (appendix).

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

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

Radiation therapy

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

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

Treating ovarian cancer with chemotherapy

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

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 allows to increase the survival rate of women with malignant tumors. However, with intra-abdominal administration, adverse effects may occur, for example, severe pain, infection, and diseases of the digestive system.

The most common medicines 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 - mg / m² for 5 days;
Docetaxel - 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;
Vepezid - 50 mg / m² for 21 days;
Bevacizumab (Avastin) 5-10 mg/kg every 2 weeks.

Avastin for ovarian cancer has been used relatively recently. This is one of the new bevacizumab-based drugs that inhibit the development of a malignant tumor. Avastin is administered only by intravenous drip. Another variant of administration, including intravenous inkjet, is prohibited.

Another of the recently popular anticancer drugs - Refnot - is a tumor tissue necrosis factor (thymosin α-1). This is a fairly strong cytostatic and cytotoxic agent with a minimum number of side effects. However, Refnot for ovarian cancer is not used as often: it is usually prescribed for the treatment of breast cancer.

In addition to antitumor drugs, doctors often prescribe immunomodulators - these are drugs that support the human immune system in a “combat” state. The use of immunomodulators is still controversial in the ranks of medical professionals. 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 in ovarian cancer increases antitumor immunity, which significantly increases the effectiveness of chemotherapy. In addition to Roncoleukin, such medications as Timalin, Mielopid, Betaleukin and interferons have a similar effect.

Thermoperfusion for ovarian cancer

Thermal perfusion is one of the oncology treatment options, which involves thermal effects on tissues. High temperature damages the protein structure of cancer cells, while not 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.

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

Thermotherapy is currently undergoing active clinical trials. 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

Is it possible to cure a cancerous tumor with the help of folk recipes? The question is moot. 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 your own can lead to an aggravation of the process, and precious time to start timely treatment can be lost.

Nevertheless, quite a lot of recipes are known, the authors of which promise to get rid of ovarian cancer soon. We invite you to familiarize yourself with some of them.

The active use of mint for problems in the genital area is known: for example, with heavy menstrual bleeding, with painful menopause, etc. Mint is successfully used for ovarian cancer: it is customary to take half a glass of flea mint tea orally three times a day. During treatment, you can do douching with the same solution. To prepare this tea, you need to brew 20 g of mint leaves in 500 ml of boiling water and leave for 2 to 3 hours.
Flaxseed oil and flaxseed in ovarian cancer is used very often. The dosage of oil is from 1 tsp. up to 1 st. l. in the morning and in the evening. You can take it in the form of capsules, which are sold in pharmacies. To do this, you need to drink at a time from 10 to 14 capsules. Flaxseed is used in the amount of 3 tbsp. spoons mixed with 200 ml of water. Such a "cocktail" must 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 in ovarian cancer (especially in combination with other methods) can lead to a positive result. The tincture of this plant should be taken with a gradual increase in dose: starting with 1 drop per 200 ml of water 1 time per day before meals, increasing 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.
Many consider ordinary oats to be the first cure for malignant tumors. An infusion of oats for ovarian cancer is prepared very simply: one glass of oat grains is poured into an enameled container and poured with 1000 ml of water, brought to a boil and boiled over low heat for about 20 minutes. After that, they are removed from the fire and insisted in a warm place for at least 2 hours. The broth is filtered and divided into three doses. Drink 30 minutes before meals three times a day. It is not recommended to cook a decoction in advance for several days, it is better to take fresh.

No one excludes the effectiveness of alternative treatment. However, before using such methods, consultation with an oncologist should be mandatory.

Treatment of ovarian cancer by stage

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 maintenance treatment is the appointment of more than six consecutive courses of chemotherapy, which allows you to delay the development or completely avoid relapses. This treatment is most suitable for patients with chemosensitive tumors.

Treatment of ovarian cancer in Israel

Equally important is the availability of the most modern diagnostic and treatment equipment in clinics. A lot of 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 medicines developed according to the latest clinical studies.

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

Upon admission, patients must undergo a mandatory examination, which in case of ovarian cancer can cost about $. Surgery costs about $1, and one chemotherapy course costs about $3,000.

Treatment of ovarian cancer in Germany

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

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

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

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

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

A surgical operation in Germany can cost from about 3000 to $. The price for one course of chemotherapy treatment is $.

New in the treatment of ovarian cancer

In the United States of America, a regimen for the treatment of ovarian cancer using photodynamic therapy has been developed. The development is based on the fact that a cancerous tumor is detected in most cases only when metastases begin to spread to other organs. After that, the operation and chemotherapy no longer have the necessary 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 that 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 intoxication of the body.
In the UK, a new revolutionary anticancer drug Olaparib has been developed. The goal of this drug is to extend 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 ovarian cancer treatment

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

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

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

Postoperative treatment with folk methods

Folk remedies, even at 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 leave for 14 days in a dark place, sometimes stirring the contents. Drink 1 tsp. 4 rubles / day. Duration of admission - up to 4 months in a row.
A decoction or tincture of a 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 a tincture of alcohol - 1 tbsp. l. in a glass of water.
Freshly squeezed beetroot juice, settled for one hour: drink, starting with 50 ml, gradually increasing the dose to 0.5-1 liter per day.
Infusion of hop cones: grind dry cones to a state of powder. Pour two teaspoons of this powder into 200 ml of boiling water and leave for 3 hours. Drink before meals 50 ml three times a day.

Treatment of recurrence of 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 times a day before meals;
alcohol tincture of propolis (sold in pharmacies): take 30 drops / day.

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

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University. A.A. Bogomolets, specialty - "Medicine"

The latest research relating Treatment of ovarian cancer: a review of effective methods

Share on social networks

Portal about a man and his healthy life iLive.

ATTENTION! SELF-MEDING CAN BE HARMFUL TO YOUR HEALTH!

Be sure to consult with a qualified specialist so as not to harm your health!

Surgical treatment of ovarian cancer

Page navigation:

Surgery in most cases is the main treatment for ovarian cancer, moreover, in some situations, a diagnostic operation is necessary. The choice of the volume of surgical intervention directly depends on the size of the tumor, its type and the prevalence of the pathological process. It should be taken into account that the specified information in some cases is available only during the operation, therefore it is very important to foresee all possible options before starting it.

In ovarian cancer, the goal of surgery is usually to remove all malignant cells or, if this is not possible, to remove as many of them as possible. Typically, surgery involves the removal of the fallopian tubes, uterus, and ovaries;
If the cancer has spread, the surgeon may need to remove some of the surrounding tissue, or at least take a biopsy;
In rare cases, a second operation will be required to completely remove malignant cells;
The general health of the patient or the rate of progression of the oncological process may be a contraindication to the operation.

Surgery for borderline and stage 1 tumors

When it comes to the treatment of borderline tumors or ovarian cancer on early stage surgery is often the only treatment needed. The volume of intervention varies from resection of one ovary and one fallopian tube to a complete abdominal hysterectomy.

Minimal surgery is performed if treatment is necessary for a young patient with a borderline tumor or stage 1a ovarian cancer - in this case, the uterus and one of the ovaries are preserved intact, and the patient retains reproductive function. In patients with stage 1b or 1c cancer, as well as women who are menopausal or not interested in having children, both ovaries, fallopian tubes, uterus and cervix are resected.

Also, the surgeon in this case will perform the excision of the omentum - adipose tissue located in close proximity to the ovaries. Other tissue samples may be taken to determine if the cancer has spread, such as lymph nodes. In addition, "peritoneal washings" will be performed - the surgeon will place a special liquid in the patient's abdominal cavity, part of which will be sent for examination for the presence of cancer cells.

If it is difficult to determine at what stage of development the oncological process is before the surgical intervention, the surgeon can remove only the damaged ovary and fallopian tube, taking many samples of the surrounding tissues. Depending on the result of the biopsy, additional surgery may be performed to remove the uterus, fallopian tube, remaining ovary, and omentum.

After surgery, if the tumor was not completely removed or there is a suspicion that some cancer cells were not removed, a course of chemotherapy is performed.

Stage 2 and 3

If the ovarian cancer has already spread, an operation will be performed in which the doctor removes both ovaries, fallopian tubes, cervix and uterus, and as much of the tumor as possible. Also during the intervention, the surgeon may take biopsies or remove some of the lymph nodes located in the pelvis or abdomen. In addition, doctors will remove the omentum and may remove the appendix with part of the peritoneum.

If the oncological process has spread to the intestine, then a small part of it can be removed, after which the integrity of the intestine is restored. In rare cases, the two ends cannot be connected, in which case the upper part of the intestine is connected to the wall of the peritoneum - a colostomy or ileostomy is performed.

In some patients, treatment may be supplemented by a course of chemotherapy, which can be performed both before and after surgery. In the first case, as the patient completes the course drug treatment control will be held CT scan– if it shows that the size of the tumor has been reduced to acceptable levels, surgery is performed.

This approach allows to increase the efficiency of surgical intervention and significantly simplify its implementation. After surgery, the goal of medical treatment is to destroy any malignant cells that, for whatever reason, were not removed during surgery.

Stage 4

In this case, the operation is performed to reduce the size of the malignant tumor and alleviate the symptomatic manifestations of the disease, prolong the life of the patient and improve her quality of life. Chemotherapy may be given before and/or after surgery.

In some cases, surgery cannot be performed - for example, if the cancer progresses too rapidly, or if the patient's health condition does not allow surgery. In this case, the main method of treatment is chemotherapy, which later (with a good response to medications) can be supplemented with surgery.

Rehabilitation after surgery

After the operation, patients are advised to start moving as soon as possible - as a rule, doctors advise taking walks from the day following the operation. During the time that the patient is in bed, it is very important to perform regular physical exercises, giving a load on the legs - this is necessary to prevent thrombosis. It is also recommended to perform special breathing exercises that help prevent the development of infection of the lower respiratory tract. The physiotherapist or nurse will acquaint the patient with the method of performing the exercises. Also, in order to prevent the formation of blood clots in lower limbs, the patient may be instructed to wear compression stockings for the first day after surgery.

Droppers and drainage

During the first day after surgery, the patient receives all the necessary nutrients through intravenous infusion. The ability to eat light food usually returns the next day - approximately 48 hours after the end of the operation.

also in bladder the patient can be placed a special catheter that provides drainage of urine into a special bag. The catheter will be removed a day or two after the operation.

To drain excess fluid from the postoperative wound, one or two drainage hoses can be placed in the intervention area, which are removed after a few days.

Postoperative wound care

If the patient has undergone a more extensive surgical intervention than the removal of one ovary and one fallopian tube, then the postoperative wound extends from the pubic hairline to the area just above the navel. The wound closes surgical suture and/or special staples. The stitches are usually removed seven days after surgery, but some stitches do not need to be removed and will dissolve on their own. During the first few days, a bandage is usually applied to the wound.

Pain control

After the operation, the patient may experience some discomfort and pain. Pain medications are used to control these factors.

In the early days after major surgery, the patient will usually need a strong pain reliever such as morphine. She can receive it both injectively (with the help of nurses) and with the help of a special pump connected to a catheter placed in her arm - in this case, the help of a nurse is not required.

In some cases, to ease pain a technique such as epidural anesthesia is used. In this case, a special tube is placed in the epidural space of the patient, through which an analgesic is continuously supplied for some time after the operation - such permanent anesthesia can significantly reduce the intensity of pain.

Extract

Most of the women who have undergone surgery ovarian cancer may go home 4-10 days after surgery. In some cases, before the discharge of the patient, it may be necessary to remove the stitches or special staples that tighten the edges of the postoperative wound. Some patients may need some help - for example, women who have undergone major surgery may find it difficult to get home on their own or, for example, climb several flights of stairs. In this case, patients are advised to seek help from relatives or social workers. Difficulties may also arise with aspects of daily life such as cleaning the house, preparing meals, taking care of oneself, and performing work duties.

For at least the first three months after discharge from the hospital, patients are advised to avoid strenuous physical activity and heavy lifting. It is also highly recommended not to drive for at least one and a half months after surgery. In addition, during the first time, wearing a seat belt may cause some inconvenience to the patient - in this case, it is recommended to refuse any trips until the problem disappears.

Consequences and life after surgery

Return to sexual activity

One of the most frequently asked questions by patients before undergoing a hysterectomy is: “How will this surgical intervention affect sex life? First of all, one should take into account the fact that it will take at least a month and a half to heal the surgical wound - during this time, sexual intercourse is strictly undesirable.

Most patients who have undergone a hysterectomy do not experience any problems during sexual intercourse - we can say that the operation did not affect them in any way. sexual life. However, some women who have undergone this surgical intervention note that the volume of their vagina has decreased somewhat, as well as the fact that its slope has changed somewhat. This can lead to the fact that the sensations experienced during sexual intercourse will be different from those that were before the operation. In some cases, there may be a mild pain sensation that will pass with time.

There is also a common misconception that cancer can be passed on to a partner during sexual contact. This is absolutely wrong - sexual contacts are completely safe, cancer is not sexually transmitted.

early menopause

In young patients, the result of surgery, during which the ovaries were removed, will be an early onset of menopause. Physically, this is manifested by the presence of the following factors:

Short-term hot flushes (instant sensation of heat, which in some cases is accompanied by sweating and flushing of the face);
Dry skin;
Vaginal dryness (may lead to difficulty in sexual intercourse);
Reduced sex drive.

Discomfort that occurs during sexual intercourse can be reduced by the use of lubricants, which can be bought at any pharmacy or purchased online.

Also, some patients after treatment for ovarian cancer may be prescribed hormone replacement therapy. This therapeutic course may help reduce some of the problems associated with the early onset of menopause.

Fertility

Very often it is difficult for patients to come to terms with the fact that after a hysterectomy they can no longer have children. The reason for the excitement may also be the patient's fears regarding the fact that she has lost part of her feminine nature. All these emotions are natural and understandable, one way or another, you will have to get used to them. Patients are encouraged to discuss any fears or worries with relatives, friends or a psychologist. Separately, it should be noted all kinds of psychological support organizations for women who are unable to have children.

Psychological complications

After a hysterectomy, many patients experience a whole range of symptoms associated with the surgery. Violation of hormonal function associated with the removal of the ovaries, early onset of menopause (sweating, hot flashes, etc.) - all this becomes a rather heavy blow for a woman.

Separately, it should be noted that after such an operation, depressive symptoms manifest in women, expressed in increased anxiety, fear for their own health in the future, self-doubt and doubts about their femininity. The very fact of the surgical intervention, as well as the negative aspects associated with anesthesia, is a kind of psychological trauma.

It is important to understand that the removal of the uterus in itself does not affect a woman's sexuality in any way - medical reasons for loss of attractiveness or, for example, sudden weight gain is not. Loss of self-confidence and depression are the result of purely psychological aspects of surgery. The only thing that the operation affects is the sexual desire, which decreases markedly with the removal of the ovaries - this is a consequence of a sharp drop in testosterone levels. The problem is quite simply solved with the help of hormone replacement therapy, which supports required level this hormone.

However, such a solution is by no means a universal panacea - the patient's condition will largely depend on her environment and the environment in which she is. After such treatment serious illness, like cancer, a woman will very much need any support and sympathy. Stress is strictly contraindicated - any negative moments can significantly aggravate depression and lead to quite serious moments. The ideal option is to surround the patient with love and care - if a woman feels that she is needed by close people and loved by them, it will be much easier for her to survive what happened.

What is an oophorectomy?

Ovariectomy is a surgery that involves the removal of the ovaries. Ovariocectomy is most often performed for diseases of the ovaries, is used in the treatment of breast cancer, is used as a prophylaxis for ovarian cancer in women at high risk of developing this disease.

Why is oophorectomy used in the treatment of breast cancer?

Removal of the ovaries for breast cancer is the first method in the history of endocrine therapy (hormone therapy) for breast cancer. When observing women suffering from breast cancer, scientists have identified a relationship between the presence of functioning ovaries and the development of breast cancer. Back in the 19th century, surgeons used ovarian removal as a treatment for common forms of breast cancer. The literature provides a sufficient number of cases of regression of metastatic breast cancer after removal of the ovaries.

It is known that for hormone-dependent breast cancer, female sex hormones are a growth stimulator. The main source of these hormones in menstruating women is the ovaries. In menopausal women, the main source of these hormones are the adrenal glands.

In this regard, the removal of the ovaries or turning off the function of the ovaries is one of the treatments for breast cancer.

When is oophorectomy used for breast cancer?

Most often, spaying or turning off ovarian function is used for hormone-dependent breast cancer (Er + PR +) stage 4 as hormone therapy. In stage 3, ovarian shutdown can also be used as a preventive measure that allows complex treatment breast cancer to reduce the risk of cancer recurrence.

What types of oophorectomy are there?

Currently, the term "ovariectomy" often means "turning off the function of the ovaries", which can be carried out with the help of surgical intervention (removal of the ovaries, both open and laparoscopically), the medicinal method (drug goserelin - Buserelin, Zoladex), the radiation method (irradiation of the ovaries).

The most reliable method is surgical removal of the ovaries. However, unlike the drug method, the removal of the ovaries is an irreversible measure - when using the drug method, the ovaries can restore their function. Especially when it comes to women under 45 years old. Radiation therapy is used quite rarely to turn off the ovaries due to the difficulties of adequate "point" exposure.

What is a prophylactic oophorectomy?

Prophylactic oophorectomy is the removal of the ovaries in women at high risk of developing ovarian and breast cancer. It is known that there are hereditary forms of these diseases. In this connection, scientists proposed a method for the prophylactic removal of this organ in order to reduce the risk of developing cancer. In the case of ovarian cancer, oophorectomy does significantly reduce the risk (by about 90%), in the case of breast cancer, the risk reduction is less - about 50%. Currently, there is no consensus regarding prophylactic oophorectomy to reduce the risk of developing breast cancer, which is associated with a significant number of negative manifestations of this operation.

What are the complications of oophorectomy?

Immediate complications of oophorectomy are rare and include infection, bleeding, injury internal organs during surgical intervention. They are very rare. The delayed effects of oophorectomy are more important:

artificial menopause and a decrease in the quality of life. After an oophorectomy, a woman is often worried about the symptoms of menopause - dryness in the vagina, decreased libido, hot flashes, increased sweating, irritability, etc.
Decreased bone mineral density and osteoporosis are among the most common long-term adverse effects of oophorectomy. Bone thinning can lead to bone fractures.

Dmitry Andreevich Krasnozhon, October 29, 2012, 19:22, last revised July 31, 2014.

Removal of the ovaries for breast cancer. Treatment of ovarian cancer: a review of effective methods

Surgical treatment of ovarian cancer

Radiation therapy

Treating ovarian cancer with chemotherapy

Thermoperfusion for ovarian cancer

Treatment of ovarian cancer with folk remedies

Treatment of ovarian cancer by stage

Treatment of ovarian cancer in Israel

Treatment of ovarian cancer in Germany

New in the treatment of ovarian cancer

Rehabilitation after ovarian cancer treatment

Postoperative treatment with folk methods

Every fourth carrier of the first type of mutation dies of ovarian cancer. Such a sad statistic

If in every generation women die from bilateral cancer of the breast or ovaries, of course, the removal of these organs is indicated

We welcome your questions and feedback:

Treatment of ovarian cancer: a review of effective methods

Treatment options for ovarian cancer

Radiation therapy

Treating ovarian cancer with chemotherapy

Thermoperfusion for ovarian cancer

Treatment of ovarian cancer with folk remedies

Treatment of ovarian cancer by stage

Treatment of ovarian cancer in Israel

Treatment of ovarian cancer in Germany

New in the treatment of ovarian cancer

Rehabilitation after ovarian cancer treatment

Postoperative treatment with folk methods

Medical Expert Editor

Other related articles

The latest research relating Treatment of ovarian cancer: a review of effective methods

Share on social networks

Surgical treatment of ovarian cancer

Surgery for borderline and stage 1 tumors

Stage 2 and 3

Stage 4

Rehabilitation after surgery

Droppers and drainage

Postoperative wound care

Pain control

Extract

Consequences and life after surgery

Return to sexual activity

early menopause

Fertility

Psychological complications

If in every generation women die
from bilateral cancer of the breast or ovaries, of course, the removal of these organs is indicated