In the ovaries, which are located in the pelvic area, female reproductive cells develop and mature, hormones are produced. Various negative factors can lead to the appearance of a pathology such as ovarian dysgerminoma. Young women of reproductive age are most susceptible to the disease, neoplasm is also found in adolescents and even children.
What is a pathology?
Ovarian dysgerminoma is a rare pathology that develops in young women who have an infantile physique. Usually the neoplasm is one-sided, characterized by rapid growth. The tumor is round on the leg, has a tuberous capsule, can reach significant sizes (up to 15 cm), completely replacing healthy tissues.
In the section, the neoplasm is compact, pink in color, there are softening areas. Foci of necrosis with zones of decay of a dark color are possible. If the site of necrosis is significant, the tumor becomes flabby, the capsule loses its integrity, the dysgerminoma becomes dark crimson.
The tumor is malignant, early metastases, does not have hormonal activity. If dysgerminoma of the left ovary is diagnosed, then the right paired organ is first affected by metastases, then retroperitoneal lymph nodes. If the disease progresses, then involvement in the pathological process of the spine, liver, and lungs occurs. At a late stage, supraclavicular lymph nodes suffer.
Why does ovarian dysgerminoma develop?
The reasons for the development of pathology are under study. But according to experts, a disease can occur as a result of:
- genetic disorders;
- pathologies of the female genital area of an inflammatory nature;
- infantilism;
- late or early onset of menstruation;
- violations of the monthly cycle;
- infertility.
If several unfavorable factors are present at once, the cells can begin to degenerate, their anatomical structure changes, they grow intensively, destroying healthy tissues.
Symptoms
Ovarian dysgerminoma has non-specific symptoms, and this is precisely its danger. Only indirect signs can indicate the presence of a pathological process:
- a woman suffers from pulling, dull pain in the lower abdomen. When the legs of the neoplasm are twisted, they can become sharp;
- the menstrual cycle is broken;
- the patient complains of weakness;
- the temperature stays in the range of 37.1–38.0 ° C for a long time;
- urination is impaired.
If the process has spread to other organs, then signs are added that indicate their defeat. For example, a patient may have digestive disorders. The patient feels nauseous, sometimes vomiting appears. Patients often lack appetite, their working capacity is reduced, against which a woman can rapidly lose weight. With the further development of the neoplasm, signs of ovarian damage may join. With the decay of the tumor, the patient's ESR increases, symptoms appear that indicate intoxication of the body.
Diagnostics
Often a tumor is detected even when its legs are twisted, the capsule ruptured. But even during a routine examination, a diagnosis of ovarian dysgerminoma can be made.
Diagnosis before surgery will assess its volume and the ability to maintain reproductive function. During a gynecological examination, a painless, rounded neoplasm is palpated, which is located in the area of the appendages, is mobile and has a dense consistency. Having found a tumor, the doctor will direct for an additional examination.
Ultrasound scan
Conducted by a transabdominal or transvaginal sensor. On the echogram, a specialist will find an echopositive formation that has uneven contours and an irregular shape, heterogeneous in structure. If the tumor metastasizes, damage to the second ovary, the presence of fluid in the adjacent space, and an increase in regional lymph nodes can be determined.
Analysis of tumor markers
Used to determine the malignancy of the process. Such a study is carried out in dynamics throughout the course of treatment. If the indicators decrease, then the therapy is effective.
Additional research and differential diagnosis
Additionally, computed tomography, X-ray of the lungs, ovarian biopsy is recommended. Blood tests in the presence of pathology will not show changes. After confirming the diagnosis, the specialist will determine the stage of the disease, which depends on the size of the formation, the presence of metastases.
Differential diagnosis is also carried out with uterine fibroids and other tumors. Fibromyoma can most often be found in the fairer sex in old or middle age. And ovarian dysgerminoma usually affects patients in young and teenage years. Fibromyoma is manifested by polymenorrhea (frequent menstruation) or hypermenorrhea (heavy, prolonged menstruation), dysgerminomas are characterized by scanty periods or their absence. Regardless of the results of differential diagnosis, all detected tumors of the female genital organs are removed.
Therapies
With a diagnosis of right ovarian dysgerminoma or left ovarian dysgerminoma, the treatment will only be surgical, after which chemo- or radiation therapy is recommended.
The choice of method of surgical intervention depends on the age of the patient, the presence of her children, the stage of the pathological process.
At stage IA, in the absence of children, the appendages of the patient are removed only on one side, after which careful lifelong monitoring is indicated. In case of relapse, chemotherapy is performed. If a woman has already realized her reproductive function or is in menopause, the uterus and ovaries are removed.
The second stage is treated by removal of the appendages on the affected side, after which four courses of chemotherapy are performed. Women in old age are recommended to undergo radical surgery and three courses of chemotherapy.
In the third stage, elderly women undergo complete removal of the uterus with appendages and all metastatic foci, after which three courses of chemotherapy are recommended. For women of reproductive age, in some cases, they can remove the appendages on only one side, followed by four courses of chemotherapy.
In the case of the fourth stage, patients of all categories are recommended four courses of chemotherapy.
Radiation therapy is carried out after radical surgery if the process has spread beyond the pelvic area. The radiation program is compiled by a radiologist.
Postoperative monitoring of patients
In order to prevent the spread of the pathological process after the course of treatment, follow-up observation is recommended:
- in the first year after therapy - 1 time per month;
- in the second year - once every 2 months;
- the third - once a quarter;
- in the fourth and fifth year - once every 6 months;
- from the sixth year to the end of life - once a year.
During the examination, it is recommended that:
- gynecological examination;
- PAP test;
- ultrasound examination;
- analysis of tumor markers;
- chest x-ray;
- computed tomography (once a quarter for 2 years).
Forecast
Negative factors that affect a favorable prognosis are:
- patient age (the older the patient, the less favorable the prognosis);
- remnants of the neoplasm, to which there is no access during surgery;
- large tumor sizes;
- two-way process;
- metastases to various organs.
Chemotherapy has a positive effect on the healing process. With unilateral removal of the appendages and chemotherapy, 80% of patients noted that their menstrual cycle was restored. Many were able to conceive and give birth to a healthy baby.
Adequate therapy can ensure complete recovery; in the first stage, 90% of patients survive for five years.
Ovarian dysgerminoma has a poor prognosis for bilateral lesion, spreading beyond the ovaries with metastasis. There is no consensus among experts in this case regarding the survival of the patient. Some are sure that combination therapy will allow 80% of patients to survive. Others indicate the variability of malignancy of the neoplasm.
Ovarian dysgerminoma is a formidable pathology that mainly affects young women. But do not despair. Even if the diagnosis is disappointing, correctly selected therapy will save not only life, but also reproductive functions. And in order to prevent the development of pathology, it is necessary to undergo medical examinations in a timely manner and fulfill all the doctor's prescriptions.