Metastatic tumors make up 5-6% of malignant ovarian ones. Most often the lasts of the genital organs, breast, gastrointestinal tract and malignant lymphomas metastasize in the ovariums.
The lesion occurs by implantation, hematogenous or lymphogenous. It is also possible with the direct transition of the oncoma to the ovarium from a neighboring organ (germination). The clinical picture of primary and ovarian cancer is similar, often together with marked amenorrhea. This is explained by the presence of luteinized cells in the stroma of a metastatic one, similar to those found in the stroma of hormone-active tumors, as well as in foci of tekamatosis.
Oncomas are mainly bilateral, of solid structure, ranging in size from 2-3 cm to 15-20 cm. They are oval, large-hilly, can be gigantic; the color is whitish, grayish-white, yellowish with crimson tinge. The consistency is often dense, sometimes soft. These ones are not associated with the uterus, have a well-defined leg. Diagnostic errors are due to the fact that they are mistaken for an ovarian tumor in the absence of symptoms from the primary focus. They occur mainly in women under 40-45 years. They are characterized by rapid growth and may occur before the primary focus.
In the early stages, the disease is asymptomatic. Some patients show common signs: loss of appetite, weight loss, unmotivated weakness, irritability, fatigue and fever. Sometimes there are violations of the menstrual cycle. There is an increase in the size of metastasis in the ovary causes pain, a sensation of pressure or distention in the lower abdomen. When the bladder is pressed, urination disorders are noted, and when the rectum is pressed, constipation occurs.
The diagnosis is made on the basis of anamnesis (the presence of a primary oncological process in another body), complaints, results of a general and gynecological examination and data from additional studies. The signs that suspect metastatic cancer are the presence of a dense tumor-like formation with a bumpy surface in the ovarian region, a rapid increase, bilateral lesion, ascites, and the discovery of multiple nodes in the pelvic peritoneum during a pelvic examination and rectal examination.
Patients with suspected metastatic ovarian cancer are referred to an ultrasound of the pelvic organs. Laparoscopy with biopsy and subsequent histological examination is prescribed. For differentiation of primary and metastatic ovarian cancer or to detect metastases in other organs, mammography is performed. The examination plan may vary depending on the symptoms.
The defeat in malignant oncomas of the genital organs occurs by contact, hematogenous or lymphogenous. With malignant ones of the fallopian tubes, ovarian involvement is observed in 13%. In most cases, the tumor passes directly from the fallopian tube to the ovary. It is sometimes difficult to figure out where the oncoma is located in the ovarium or fallopian tube. Cervical malignancy metastasizes in less than 1% of cases. This usually occurs in advanced stages, as well as in adenocarcinoma of the cervix. Secondary neoplasm of uterine cancer of the body to the ovaries is observed in 5%. It can go directly to the ovarium. However, multiple cancers of the uterus and ovariums are much more common. Endometrial adenocarcinoma and endometrial malignancy are usually combined.
Breast cancer often metastasizes to the ovariums. At autopsies of deaths from disseminated breast malignancy, ovarian damage is detected in 24%. In 80% of cases it is bilateral. With ovariectomy in terms of complex treatment, metastatic process is detected in 20-30% of patients, and in 60% of the patients the lesion is also bilateral. Metastases in the early stages of breast malignancy are rarely observed, although their exact frequency is unknown.
Krukenberg ones account for 30–40% of secondary neoplasm ovarian tumors. These ones are formed by cricoid cells containing a large amount of mucus, and there is mri malignancy of the stomach, less often – of the colon, mammary gland or bile ducts. It is extremely rare for Krukenberg metastases to occur in cervical or bladder cancer. A distinctive feature of all these ones is the ability of their tissue to mucus.
Metastases of the gastrointestinal tract
Not all secondary neoplasms of malignant gastrointestinal oncomas are Krukenberg. The lasts without intracellular mucus formation are usually observed in cases of cancer of the colon, less often – small intestine. Metastatic processes in the ovaries occur in 1-2% of patients with colon cancer.
Damage to the ovaries in hemoblastosis
Secondary neoplasms to the ovariums (usually both) are also observed in hemoblastosis. With lymphogranulomatosis, tumors are found in 5% of patients. Sometimes they are the only diseased organ of the pelvis and abdomen.
In the case of operability in the primary focus, in satisfactory condition of the patient, it is possible to remove the oncoma and ovaries. If there is no recurrence of the primary one and the identification of metastatic processes, their removal is indicated. The volume of surgery for secondary neoplasms – hysterectomy with appendages, removal of the greater omentum. After surgery, it is advisable to conduct several courses of combined chemotherapy with drugs in accordance with the sensitivity of the tumor and its metastases. With the generalization of the last process, removal of metastatic ovaries is performed only for vital reasons with a palliative target.