ovarian cyst
Introduction
Introduction to ovarian cysts Ovarian cysts are a type of ovarian tumor in a broad sense that can be affected by various ages, but are most common among women aged 20-50. Ovarian tumors are common tumors of female genitalia. They have various natures and forms, of which cysticity is common and malignant transformation is high. Early diagnosis is difficult, 70% of the patients are in advanced stage, and rarely get early treatment. The 5-year survival rate is always 20-30%, which is one of the most serious malignant tumors that threaten women's lives. Ovarian cysts have no obvious clinical manifestations in the early stage. Patients are often found in other gynecological examinations because of other diseases. After the tumor grows, the patients feel. The symptoms and signs are due to the nature, size and development of the tumor. , with or without secondary degeneration or complications. basic knowledge The proportion of illness: 0.012% Susceptible people: good for women aged 20-50 Mode of infection: non-infectious Complications: ovarian cancer, corpus luteum cyst, abdominal pain, hemolytic anemia
Cause
Ovarian cyst etiology
1, long-term diet structure, poor living habits, excessive psychological stress and other factors cause excessive acidification of the body, the body's overall function declines, causing kidney deficiency, liver and kidney homology, kidney deficiency and liver deficiency, which in turn causes the lower coke metabolic cycle to slow down, Causes ovarian diseases and endocrine disorders, immune function declines, and thus develops ovarian tissue abnormal proliferation, eventually leading to ovarian cysts, and even cancer.
2, body tissue fluid acidification, body cells in acidic body fluids, and then the body's normal cells dissolved oxygen decreased, resulting in decreased cell activity, metabolic cycle slowed down, down to 65% of normal values, normal cells can not survive, but There are also cells that change the chromosomes to take the initiative to mutate, the phenotype of the cells changes, the tumor traits are expressed, and these cells rapidly expand to form a true tumor entity.
3, in addition, due to body acidification of the body of other tissues of cancer, and due to decreased body function, body tissue fluid acidification, resulting in ovarian cysts.
Endocrine factors (25%):
Although the ovary is small, it is an important organ that produces eggs and ovulates, endocrine hormones, and balance endocrine. Ovarian tumors occur mostly in the endocrine reproductive age. The basic pathophysiological changes in many patients with ovarian cysts and polycystic ovary syndrome in clinical practice are that the ovaries produce too much androgen, and the excessive production of androgens is the result of the synergistic effects of multiple endocrine system functions in the body.
Lifestyle factor (15%):
Long-term diet structure, poor living habits, excessive psychological stress caused by excessive acidification of the body, the overall function of the human body decreased, and the immune function developed into abnormal proliferation of ovarian tissue, resulting in ovarian cysts and even cancer.
Environmental factors (23%):
Food contamination, such as plant growth hormones used in vegetables, such as hormones in lean meat concentrates in formulas such as livestock and poultry. In recent years, with the improvement of living standards and changes in eating habits in China, and some young and middle-aged women abuse hormone drugs and tonics such as breast milk, weight loss, and aging, the ovarian tumors are high-rising and young. May be relevant.
Gene (10%):
According to statistics, 20-25% of patients with ovarian tumors have a family history.
Prevention
Ovarian cyst prevention
Ovarian cysts are easily overlooked because of their early asymptomatic and difficult to prevent. Close monitoring and follow-up of high-risk groups, early diagnosis and treatment can improve the prognosis.
1. Carry out health publicity and education, high protein, rich in vitamin A diet, avoid high cholesterol food. High-risk women can be prevented by oral contraceptives.
2, high-risk population screening: mainly include: risk assessment, genetic counseling, BRCA gene testing. Appropriate medical interventions are performed for patients who are considered to be at high risk of screening.
3, pay attention to the diagnosis and treatment of ovarian tumors: annual physical examination, with B-ultrasound, CA125 and other tests. Ovarian cysts greater than 125px should be surgically removed. Women who are concerned about prepubertal, postmenopausal or oral contraceptives are found to have ovarian enlargement and should be diagnosed promptly. If the pelvic mass is unclear or the treatment is ineffective, the operation should be performed early.
Women with breast cancer and gastrointestinal cancer should be followed closely after treatment and regular gynaecological examination to determine whether there is any metastasis.
Complication
Ovarian cyst complications Complications Ovarian cancer corpus luteum cyst abdominal pain hemolytic anemia
Ovarian Cancer
Although the ovarian volume is small, it is the best organ for tumors; the number of tumors is also the first in the whole body. The ovary is a common disease in gynecology. It can occur at any age, but it is more common in women in the growth stage because the ovaries are located in the pelvis. Within, can not directly peep, and early asymptomatic, and lack of good early diagnosis and identification methods, once found as a malignant tumor, often has advanced lesions, so to date, the 5-year survival rate of ovarian cancer is still only 25 %-30% is the most threatening disease in gynecological tumors.
Pregnancy with ovarian tumors is more prone to torsion and rupture than non-pregnancy; tumors embedded in the pelvic cavity can cause miscarriage during early pregnancy, obstructive dystocia can occur in obstructive birth canal in late pregnancy.
The benign tumors combined with pregnancy are most common in mature cystic teratoma and serous or mucinous cystadenoma. The malignant cystic adenocarcinoma is more common. In the first half of pregnancy, the corpus luteum cyst can still be combined, so during early pregnancy. This possibility should be considered when ovarian cysts are found.
In early pregnancy, it is easier to find ovarian tumors; it is more difficult after the second trimester. When ovarian cysts are found in early pregnancy, such as unilateral, active, cystic tumors can be operated after 3 months of pregnancy. Can reduce the possibility of miscarriage, on the other hand to observe whether it is a natural corpus luteum cyst shrinking or disappear, such as found in the third trimester, can be operated after the fetus survives, such as due to tumor obstruction of the birth canal should be cesarean section, while resecting the tumor If ovarian cancer or suspected malignant or malignant changes should be timely surgery, should not wait.
Cystic, solid, benign or malignant ovarian ovarian tumors can have complications, and complications can occur at any time, some have incentives, and some have no.
Tumor pedicle twist
About 10% of ovarian tumors are reversed, and the condition of ovarian tumor pedicle is reversed. The tumor pedicle is long and the tumor fist is large to the fetal head. It has no adhesion to the surrounding tissue. The tumor is easy to move in the abdominal cavity. Cystic teratoma Mucinous and serous cystadenoma are most prone to pedicle torsion. The pedicle of this type of tumor is generally long and the center of gravity is biased to one side. The tumor is easily affected by intestinal peristalsis or body position changes, and many patients It is claimed that before the onset of pain, there have been activities such as getting up or bending over, but sometimes the patient is awakened by pain (may also have turned over during sleep, or caused by intestinal fissure), such as ovarian tumor patients with pregnancy, The tumor pedicle recurrence usually occurs in the first half of pregnancy or postpartum. Because of the mid-pregnancy, the ovarian tumor rises into the abdominal cavity with the uterus, which is larger than the previous activity in the pelvic cavity. The uterus shrinks, the abdominal wall is loose, and the ovarian tumor has more room for exercise. Therefore, it is also prone to twisting.
First, the vein is blocked and the artery continues to supply. The tumor is congested and purple-brown. The blood vessels in the cyst can be ruptured, the blood is filled in the cyst, and even the intra-abdominal hemorrhage occurs. If the tumor pedicle is severely twisted, the artery is also blocked. Tumor necrosis.
The main symptoms of the patient are sudden severe pain in the lower abdomen, and those with mild painful episodes, the tumor pedicle is reversed slowly but not severely, and the torsion is sharp with vomiting; the even factor endometrial vascular congestion causes a small amount of uterine bleeding. There are many cases of lower abdominal movable mass in the medical history, and there may be a similar episode of abdominal pain.
Rupture and piercing
The former refers to the rupture or rupture of the cystic tumor, and the content overflows into the abdominal cavity; the latter refers to the cystic sac that erodes the wall of the capsule and enters the abdominal cavity, such as a serous cystadenoma or a papillary wall of cancer.
The rupture rate of ovarian tumors is about 3%, and malignant terats are most prone to rupture.
Spontaneous rupture is more common. Due to the rapid growth, the local blood supply of the cyst wall is insufficient. The incremental cyst fluid is broken from the weak part of the capsule wall and overflows into the abdominal cavity. Different tumor contents can form different in the abdominal cavity. Consequences, in the process of forming these conditions may lead to retinitis, intestinal adhesions and even intestinal obstruction.
Less traumatic fissure, can occur in the larger cystic tumor patients after severe abdominal injury, occasional ovarian cyst tumor incarcerated in the uterus rectal fossa, during the delivery process for the fetus exposed part of the crowd, but more The reason is small and the unclear cystic tumor is squeezed at the time of double diagnosis or repeated examination under anesthesia. Therefore, when examining ovarian tumors, even when performing B-ultrasound examination, it is necessary to move gently, and the patient with small cysts ruptures. Most of them only have mild abdominal pain, but they can produce different symptoms due to the different nature of cystic tumors. The rupture or rupture of large cystic tumors often causes severe pain, and the vomiting is caused by the stimulation of the tumor contents into the abdominal cavity. Unequal shock, abdominal examination has tenderness and abdominal wall tension, the original mass disappears or can only reach less than the mass before the onset of pain, the contents of the capsule overflow, or the irritant can appear ascites sign, double diagnosis: The posterior vaginal canal may have tenderness and contact with a reduced mass or a floating uterus.
Bleeding
In the laparotomy, it was found that there were a small number of ovarian cysts in the ovarian cyst, but it did not cause symptoms. Occasionally, a large number of hemorrhages in the tumor, especially the worsening of the tumor, can produce symptoms like tumor pedicle torsion. The twist or rupture of the tumor pedicle can cause unequal bleeding in the sacral cavity and even cause shock.
infection
The incidence of ovarian tumor co-infection, the highest 20%, can be caused by various reasons, most infections secondary to tumor pedicle torsion or infection, ovarian tumor pedicle torsion or perforation and intestinal adhesion, secondary E. coli infection, and even The tumor content is discharged from an organ (intestine, bladder) adjacent to the adhesion, such as a cystic teratoma.
Due to the abdominal wall tension caused by peritonitis, it is difficult to find out the realm of the tumor, and sometimes it is misdiagnosed as an abscess. The patient often has a lower abdominal mass and then has abdominal pain and elevated body temperature and other infection symptoms.
Incarceration
Ovarian tumors smaller than the size of the fetus can be squeezed into the uterine rectal fossa, and can even be squeezed into the uterine bladder to cause defecation or dysuria.
Edema
Cysts are mainly fibroids, and can cause edema, resulting in a rapid increase in tumor volume, often misdiagnosed as a malignant tumor.
ascites
Ascites can be complicated by benign or malignant, cystic or sudden, intact or ruptured ovarian tumors, ascites are pale yellow, yellow-green, or reddish or even obvious blood; sometimes due to mixed mucus or other tumor contents And turbid.
Ascites is often associated with malignant ovarian cysts, especially those with peritoneal implantation or metastasis. Ascites is directly proportional to the malignancy of the tumor. Ascites is most often associated with substantial primary cancer, accounting for 75%. Ascites can also occur in no A benign tumor that reverses, necrotic or inflammatory changes.
Meigs syndrome (Meigs syndrome)
Ovarian fibroids often have ascites and pleural effusion.
The clinical manifestations of Meigs syndrome patients are often similar to advanced cirrhosis, congestive heart failure or advanced malignant tumors, but after removal of the tumor, ascites and pleural effusion disappear, this syndrome often occurs in the ovarian solid tumor, Brenner's tumor and granulosa cell tumor.
Endometrial changes
Endometrial changes can be seen in ovarian tumors with abnormal endocrine effects.
Peripheral complications of malignant ovarian tumors
Cystic malignant ovaries have a greater impact on the whole body and can cause various systemic complications.
Anemia is common in cancer patients, which may be caused by hemorrhage, poor hematopoiesis or hemolysis. It is known that necrotic products of tumors can accelerate the destruction of red blood cells and inhibit the hematopoietic cells of bone marrow. Hemolysis is currently considered to be an autoimmune phenomenon. Hemolysis occurs by forming antibodies against the patient's own red blood cells. This autoimmune, hemolytic anemia, can occur in patients with benign ovarian tumors. After resection of ovarian tumors, hemolytic disease disappears. In addition, due to autoimmune response Caused by dermatomyositis, it is reported that there are antibodies in the serum of ovarian cancer patients that react with tumor extracts. On the surface of striated muscle and skin collagen bundles, immunoglobulins are also found, which are released into the blood circulation of tumor antigens and muscles. The antibody on the surface of collagen reacts, causing the patient to have clinical manifestations of dermatomyositis. Therefore, if dermatomyositis occurs after surgical resection of patients with ovarian malignant tumors, it is thought that there may be recurrence.
Extraperital growth of ovarian tumors
Some ovarian tumors are deeply buried in the orbital area in one or most of the ovarian tumors. Most of them enter the ipsilateral broad ligament, which causes the uterus to shift. Gradually, the sigmoid colon, rectum, bladder, and ureter are displaced. The pressure is compressed, resulting in compression symptoms of various organs, such as urination, difficulty in defecation, abdominal pain, lower extremity edema; some can even enter the kidneys, causing hydronephrosis.
Ovarian tumors that grow extraperitoneally, occasionally in multi-atrial mucinous cystadenocarcinoma, are easy to damage adjacent organs during operative resection - ureter, bladder or intestine, through modern image examination (B-ultrasound, CT, MRI), not difficult Judge.
Symptom
Symptoms of ovarian cysts Common symptoms Abdominal pain Abdominal mass ovarian enlargement Weight loss Ascites bloating Ovarian amenorrhea follicles Increase gastrointestinal symptoms Pleural effusion
symptom:
Ovarian cysts have no obvious clinical manifestations in the early stage. Patients are often found in other gynecological examinations because of other diseases. After the tumor grows, the patients feel. The symptoms and signs are due to the nature, size and development of the tumor. , with or without secondary degeneration or complications.
1, lower abdomen discomfort
For the initial symptoms before the patient touches the lower abdominal mass, due to the weight of the tumor itself and the influence of intestinal peristalsis and body position changes, the tumor moves in the pelvic cavity and the pelvic funnel ligament is involved, so that the patient has inflated lower abdomen or olfactory fossa. , falling feeling.
2, abdominal circumference thickening, intra-abdominal mass
It is the most common phenomenon in the main complaint. The patient perceives that his clothes or belts appear to be small, only to notice that the abdomen is enlarged, or accidentally feels in the morning. Therefore, he finds a mass in the abdomen by the abdomen, and the abdominal distension is uncomfortable.
3, abdominal pain
If the tumor has no complications, there is very little pain. Therefore, patients with ovarian tumors feel abdominal pain, especially in sudden cases. Many tumor pedicles are twisted, or even due to tumor rupture, bleeding or infection. In addition, malignant cysts cause abdominal pain. Leg pain, pain often makes patients see an emergency.
4, menstrual disorders
Generally, ovarian and even bilateral ovarian cysts do not cause all menstrual disorders because they do not destroy all normal ovarian tissues. Some uterine bleeding is not endocrine, or ovarian tumors cause changes in pelvic vascular distribution, causing intrauterine Membrane congestion; or due to direct transfer of ovarian malignant tumors to the endometrium, menstrual disorders due to endocrine tumors often combined with other secretion effects.
5, compression symptoms
Huge ovarian tumors can cause difficulty in breathing and palpitations due to compression of the diaphragm. Ovarian tumors with large amounts of ascites can also cause this symptom; however, some patients with ovarian tumors have dyspnea caused by one or both pleural effusions. And often combined with ascites to form the so-called Megags syndrome.
A large benign ovarian cyst fills the entire abdominal cavity, increasing the intra-abdominal pressure, affecting the lower extremity venous return, which can lead to abdominal wall and bilateral lower extremity edema; while the malignant ovarian cyst fixed in the pelvic cavity compresses the iliac vein, often causing edema of one lower limb.
The pelvic and abdominal organs are under pressure, and it is difficult to urinate, urinary retention, urgency or poor stool.
Signs:
1, intra-abdominal mass
Intra-abdominal masses below medium size, such as no complications or malignant changes, the most characteristic of which is mobility, often from the pelvic cavity to the abdominal cavity, the mass is generally no tenderness, but if there are complications or malignant changes, not only the mass itself It is tender and even has symptoms of peritoneal irritation.
2, ascites sign
Ascites is often characterized by malignant tumors, but benign cysts such as ovarian fibroids and papillary cystadenoma can also produce ascites, endocrine symptoms such as hairy, thickened voice, clitoris hypertrophy and other masculinized cysts.
3, cachexia
It is characterized by extreme swelling of the abdomen, significant weight loss, painful facial expression and severe exhaustion.
Clinically, the diagnosis of ovarian tumors should meet four requirements: (1) whether it is an ovarian tumor; (2) what kind of ovarian tumor is; (3) whether there is any complication; and (4) which side grows.
Examine
Examination of ovarian cysts
Pregnancy test, total gastrointestinal fluoroscopy, hysterosalpingography, intravenous pyelography, ultrasound diagnosis or CT, MRI, as well as abdominal puncture, laparoscopy, laparotomy, etc. in some special cases.
Diagnosis
Diagnosis and differentiation of ovarian cysts
diagnosis
Once an ovarian cyst is found, it should be determined as soon as possible whether it is a neoplastic cyst or a non-neoplastic cyst. Can be based on the speed of tumor growth, size, traits, and the corresponding examinations, such as: hysterosalpingography, intravenous pyelography, ultrasound or abdominal tomography, nuclear magnetic resonance, and even laparoscopy, laparotomy, can be clearly diagnosed, if Tumorous cysts, whether or not suspected of being malignant, require early surgical resection.
1, imaging examination
B-ultrasound: The easiest and most convenient diagnostic method. It can detect the location, size and shape of the mass, suggesting cystic or solid, with or without nipple in the capsule, as well as identifying ovarian tumors, ascites and encapsulated effusion. The clinical diagnosis coincidence rate is >90%, but the diameter is less than 25px and is not easy to measure. At the same time, ultrasound Doppler scan can measure the blood flow changes of ovary and its new tissue, which is helpful for diagnosis.
Abdominal plain film: ovarian teratoma, which can show bones and teeth. The wall of the capsule is a calcified layer with increased density, and the cystic cavity is transparent and transparent.
CT, MRI, PET-CT: can clearly show the mass, positioning and qualitative, benign tumors are more uniform absorption, the capsule wall is thin, smooth, malignant tumor contour is irregular, infiltrating around or with ascites, and can understand the liver, There is no metastasis of the lungs and retroperitoneal lymph nodes.
Pelvic lymph node angiography can determine whether there is lymphatic metastasis in ovarian tumors.
2, tumor markers: At present, no tumor markers are unique and unique to a certain tumor, and each type can have relatively special markers, which can be used for differential diagnosis and disease monitoring. 1CA125: 80% of patients with ovarian intraepithelial neoplasia are higher than normal. More than 90% of patients with CA125 level are consistent with the remission or deterioration of the disease, which can be used for disease monitoring and high sensitivity. 2AFP: It has specific value for ovarian endodermal sinus tumors, and it is helpful for the diagnosis of immature teratomas and mixed dysplasia cells containing yolk sac components. 3HCG: Primary ovarian choriocarcinoma is specific. 4 sex hormones: functional ovarian tumors that can secrete hormones, such as granulosa cell tumors, ovarian cell tumors can produce higher estrogen. Serous, mucinous or Brenner tumors sometimes secrete a certain amount of estrogen.
3, laparoscopy: can directly observe the condition of the mass, while the pelvic and abdominal cavity and diaphragmatic exploration, and in the suspicious part of the multi-point biopsy, aspirating peritoneal fluid for cytology.
4, cytological examination: vaginal exfoliative cytology smear is not high for the detection of cancer cells, the significance is not significant. Ascites or peritoneal lavage fluid to find cancer cells is of significance for further staging and treatment of stage I patients with ovarian cancer. The pleural effusion should be cytologically examined for clinical metastasis.
5. In recent years, research on early diagnosis techniques for ovarian cancer has made continuous progress, especially in the fields of mass spectrometry, biochip, gene diagnosis and immunology.
Differential diagnosis
1, uterine fibroids: subserosal fibroids or fibroids cystic changes easily confused with ovarian solid tumors or cysts. Fibroids are often multiple, connected to the uterus, with menstrual abnormalities such as menstruation and other symptoms, the tumor moves with the palace and the cervix. B-ultrasound and other tests can help diagnose.
2, pregnancy uterus: early or mid-pregnancy, the three-compartment of the palace and the cervix seem to be disconnected, easy to mistake the soft palace body as ovarian tumors. However, pregnant women have a history of menopause. If you can ask for a detailed history, you can identify them by HCG or B-ultrasound.
3, ascites: a large number of ascites should be identified with large ovarian cysts, ascites often have liver disease, history of heart disease, lying on both sides of the abdomen as the frog belly, percussive abdominal drum sound, both sides of the sound, mobile voiced positive; huge cyst When lying down, the middle of the abdomen is bulged, the percussion is dull, the drum sounds on both sides of the abdomen, and the mobile voiced sound is negative; the boundary of the lower abdominal mass is clear, and the B-mode ultrasound examination can be identified.
4, the attachment of inflammatory mass: there is a history of chronic pelvic inflammatory disease and infertility, the position of the mass is low, there is tenderness, and adhesion to the uterus.
5, urinary retention: more dysuria or urinary dysfunction, increased bladder such as mass in the lower abdomen in the middle, the boundary is unclear, the catheter disappears after catheterization, can also be identified by B-ultrasound.
