Alternative diseases (differential diagnosis)

The few symptoms that can occur in ovarian cancer, as well as the masses in the abdominal area can also have another cause: they can continue to cause masses. Cells from the rectum (rectum tumor – rectal tumor – rectum tumor) can also penetrate (infiltrate) into the ovaries and thus simulate ovarian cancer.

Pus ulcers (abscesses) of the ovaries, fallopian tubes, appendix (appendix = appendicitis)
Ulcers of the uterus
Tumors of the fallopian tubes
Ectopic pregnancies (ectopic pregnancies)

The therapy of epithelial ovarian tumors is basically based on radical surgery in combination with subsequent chemotherapy.

The operation attempts to remove the tumor completely (resect it). The principle of radical surgery is that a longitudinal incision is made in the abdomen (abdominal longitudinal incision) to remove the ovaries (ovaries), the fallopian tubes (tubae uterinae), the uterus (uterus), the appendix (appendix), the large network (omentum majus), as well as (localized) lymph accounts (nodi lymphatici) located in the pelvis (pelvis) and the aorta (aorta). Sometimes a removal of part of the intestine (colon) as well as parts of the peritoneum is necessary.

Chemotherapy is performed after the operation in order to kill remaining cancer cells as far as possible. The following chemotherapeutic agents are usually used: carboplatin, cyclophosphamide and paclitaxel. Additional surgical procedures are often performed.

This is the case, for example, if the tumor could not be completely removed during a primary surgical procedure (initial intervention). A few cycles of chemotherapy should always follow the primary operation before the second operation is performed with the aim of completely removing the tumor. However, it makes sense to perform the second operation only if the chemotherapy is effective.

Studies have shown that the survival rate of patients with a second operation does not improve if the previously performed chemotherapy has a poor response or no response at all. Sometimes a second operation is performed for diagnostic reasons only. This operation is then called second look surgery.

If the first operation and the subsequent chemotherapy resulted in a proven complete tumor regression, a second operation is performed to check whether there are still tumor remnants. In 50% of the patients who were previously considered tumor-free, a residual tumor can still be found in this second operation. In studies, however, no advantages for the patients after a second look surgery were found.

Even if a residual tumor is found in the second operation, the decision to repeat chemotherapy and the extension of survival time is questionable. A second operation is also performed if the cancer recurs after removal of the first tumor. This is then referred to as a tumor recurrence. A distinction is made between early relapses and late relapses.Early recurrence is when the tumor grows again within one year after removal of the primary tumor. Late recurrences occur more than one year after removal of the primary tumor.