Early diagnosis and screening prevention methods for ovarian cancer

1How much do you know about ovarian cancer?

Ovarian cancer is a relatively common malignant tumor of the female reproductive tract. Due to the low early diagnosis rate, the vast majority of patients are already at an advanced stage when diagnosed, and the current overall 5-year survival rate is low. Therefore, although ovarian cancer only occupies the third place in the incidence of female reproductive organs, it causes more than 1,000 deaths. It ranks first among malignant tumors of the reproductive tract and ranks seventh among Chinese women dying of ovarian cancer. It is estimated that tens of thousands of women die from ovarian cancer every year, more often than cervical cancer.

2How to diagnose early?

The ovary is a very small organ, and the fallopian tube is even smaller. Once a tumor occurs, there are almost no symptoms in the early stages. Even in the late stage, there are only some non-specific symptoms such as abdominal distension, loss of appetite, inability to eat, and indigestion. When symptoms and signs such as ascites and masses appear, it is generally in the late stage.

Once an ovarian tumor occurs, pelvic ultrasound diagnosis and examination of tumor markers such as blood CA 125, HE4 and CA199 should be carried out. If necessary, CT or MR examination should be carried out. Confirmed. However, among advanced ovarian tumors, the positive rate for tumors diagnosed by doctors is not low. Because most advanced ovarian tumors are accompanied by intrapelvic metastasis, especially ascites and metastatic lesions in the uterine-rectal fossa, these two signs are very important to use triadic examination and digital anal examination to determine whether the condition is still worthy of surgery. Ascites can be determined by percussion, but metastases in the pelvic cavity cannot be solved by imaging examinations for doctors to judge whether they can be completely removed during surgery. Since many ovarian cancer patients are first admitted to departments such as internal medicine and surgery, if doctors in these departments are accustomed to performing digital anal examinations on patients, many patients still have the opportunity for surgery.

3 What is the census method?

Many people combine ultrasound examination with ovarian cancer tumor markers such as CA125 and HE4 values ​​for the general screening of ovarian cancer. Considering the efficiency, early ovarian cancer cannot be detected. Currently, there is no generally recognized and good method for screening for ovarian cancer.

4 Why can removal of fallopian tubes prevent ovarian cancer?

The classification of ovarian tumors is very complicated. The ovarian cancer we are talking about here actually refers to ovarian epithelial cancer, which is about Accounting for more than 80% of ovarian malignant tumors. Among them, serous ovarian cancer accounts for the vast majority of epithelial ovarian cancer. Studies have found that cancer cells in ovarian epithelial cancer come from mutations in the epithelial cells of the fallopian tube. Now more and more Evidence shows that ovarian cancer is related to mutations in fallopian tube epithelial cells. Therefore, removing the fallopian tubes of people who carry such genes can theoretically prevent ovarian cancer, but there is currently no large-scale, prospective Supported by research.

5 Is ovarian cancer hereditary?

Ovarian cancer is not abnormal, but people who carry the BRCA1 gene are more likely to Suffering from breast and ovarian cancer. Inheriting susceptibility genes for cancer, rather than directly inheriting cancer. Currently, many types of oncogenes have been found to be related to ovarian cancer, and BRCA1/2 is only the more common one, about 10- 25% of breast and ovarian cancers are related to this. Such people are prone to breast cancer, ovarian cancer, fallopian tube cancer and primary peritoneal cancer, and their incidence rate is as high as 70%. Therefore, for people from such high-risk families, A patient\’s request for fallopian tube removal can be accepted with informed consent.

However, breast removal is generally not advocated , because the breast organ is located on the surface of the human body, early stage breast cancer is relatively easy to diagnose. Such people should be taught to palpate their breasts themselves. Once they find induration or lumps, they should go to the hospital for examination in time to detect breast cancer early.

6 Is there any place where I can test for these genes that are prone to cancer?

Technically speaking, it is not difficult to detect these genes. A very small number of medical institutions have started from research and have carried out research in this area, but they have not yet launched cancer gene testing for the public, mainly due to ethical reasons Limitations. Several genes have been found to be related to the occurrence of ovarian cancer, called \”ovarian cancer-related genes\”, but these genes are also related to the occurrence of other tumors, and there is no specific ovarian cancer gene. In the mechanism of ovarian cancer , more isP53Gene mutations are not specific. At present, it is technically possible to draw a complete set of human genetic maps, but if everyone goes for testing, it will impact the bottom line of social ethics and involve citizens\’ personal privacy. This is This is not allowed in the whole world.

7 Who needs preventive fallopian tube resection?

Due to the lack of specific ovarian cancer genes and the obstruction of old ideas, preventive removal of fallopian tubes for any individual will cause controversy. The current view is that for women who are preparing for sterilization, Fallopian tube resection can be used instead of fallopian tube ligation; for women undergoing hysterectomy, it is recommended to remove both fallopian tubes at the same time. If there are female members in the family (such as mother, aunt, sister, etc.) who have suffered from breast cancer or ovarian cancer, I If there is no desire to have children, and the age is equal to or exceeds 45 years old, or If you are undergoing abdominal or lower abdominal or even pelvic surgery, you can ask the doctor to preventively remove both fallopian tubes.

8 Is it necessary to remove the ovaries? What are the effects of removing the fallopian tubes on the human body? Harm?

The occurrence of ovarian epithelial cancer has little to do with the ovaries themselves, so there is no need to remove the ovaries. Of course, postmenopausal women can consider removing both ovaries. The fallopian tube is the only physiological function of humans Its function is to fertilize and transport pregnant eggs. Once there is no need for fertility, the fallopian tube becomes redundant. Many people have their fallopian tubes removed due to disease, and it has not yet been found that removing the fallopian tubes is harmful to the human body. For high-risk groups, I personally recommend that the fallopian tube be removed at the age of 45 The fallopian tubes can be removed later.

9 Why should the fallopian tubes be removed after the age of 45?

First, people below this age may have fertility requirements; second, ovarian epithelial cancer occurs at an older age. Of course, there are young patients, but they are a minority after all. This is just my personal opinion, and there is currently no academic Recognized standard.

10 Is it difficult to remove the fallopian tube?

Salpingectomy is a very small operation. Using laparoscopic surgery, it only takes a few minutes. It is very simple to do this operation while doing other surgeries. It is not recommended to go to the hospital specifically for fallopian tube resection.

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