Changes in the topography of organs and walls of the pelvis and abdominal cavity in advanced ovarian cancer

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Introduction. Currently, malignant tumors of the reproductive system of women are a serious problem in modern public health and account for more than 35% in the structure of female oncological morbidity [1, 2]. Ovarian cancer pathology reaches 46% and ranks 7th in terms of incidence [1]. More than 165 thousand new cases of ovarian cancer pathology are registered annually in the world, with more than 100 thousand patients suffering fatal ovarian cancer [1].
In the territory of the Russian Federation, more than 11 thousand women are registered with ovarian malignant neoplasms every calendar year [1]. In the last 10 years, the incidence of this type of cancer has increased in Russia, and the increase to date has amounted to 8.5%. It should be noted that in the Russian Federation stage I ovarian cancer is detected in 25.2% of cases. Only 13.1% of women seek medical help with stage II ovarian cancer. Stage III of the disease is diagnosed in 39.7% of cases, and stage IV - in 20% of women. Undoubtedly, such a high incidence of ovarian cancer detection at late stages is reflected in the topographic and anatomical features of the organs of the large and, in particular, small pelvis [3, 4].

In the course of ovarian cancer development, the tumor may invade adjacent organs and tissues, leading to changes in the pelvic organ syntopy. This may lead to displacement or compression of adjacent organs and invasion of the bladder, rectum or loops of the large intestine, Douglas space, and uterine apparatus. In addition, the tumor can exert pressure on the ureters or blood vessels, which leads to disruption of blood supply to these organs [3, 4].It should be said that with different localization of malignant neoplasms in the ovaries, the structure of the topographic anatomy of the small pelvis can be variable. In this regard, the course and technique of surgical intervention will also be subject to adjustments.The aim of the work is to investigate changes in the topographic anatomy of the abdominal cavity and pelvic cavity in advanced ovarian cancer.Materials and methods of the study. During the study we retrospectively analyzed the case histories of 45 women of different age groups aged from 30 to 80 years (mean age 54.6±9.6 years) with established disseminated ovarian cancer. Patients with different degrees of cancer process, namely stages III and IV, were selected for the present study.

The material was selected on the basis of the budgetary health care institution of the Voronezh region "Voronezh Regional Clinical Oncological Dispensary".During the study, clinical analysis of the relationship of tumor tissue to adjacent organs and pelvic walls was performed.The results of the study were statistically processed using standard methods of variation statistics. The median (Me) was used as a measure of central tendency, and the interquartile range (Q1-Q3) was used as a measure of variability. Differences were considered significant at a confidence level of at least 95%.

Results of the study. Due to the fact that ovarian cancer at the initial stages does not manifest itself clinically in any way, most women seek medical help at late stages of the disease, when the pathological process involves neighboring anatomical entities, thereby intensifying the clinical picture [2]. Due to the growth of tumor tissue, an enlarged ovary leads to progressive compression (squeezing) of various pelvic structures and organs of the lower abdominal cavity. All leads to marked discomfort in the abdomen, dyspeptic disorders, impaired urination, a feeling of pressure and distention in the pelvis. When the tumor increases more than 15 cm in diameter, there is already a slight increase in abdomen and greater compression of neighboring anatomical formations. That is why it is very important to pay attention to changes in organs and tissues that are in close proximity to the pathological process.

In the course of the study, the following results were obtained from the protocols of the performed surgical interventions (Table 1).

Table 1Indicators of involvement of anatomical structures in the pathologic process (abs. %)

Organ or tissue involved in the pathologic processNumber of observationsAbs,

Organ or tissue involved in the pathologic processNumber of observationsAbs.%

Intestinal adhesions28 62.

2Intestinal ligaments10 22.2

The large omentum40 88.9

The bladder3 6.7

The Douglas space37 82.2

The intrapelvic fascia (fascia endopelvina) lining the small pelvis and the posterior Douglas space, as well as the small and large intestines, were the most frequently anatomical changes. Often the ligaments providing the uterine fixation apparatus and the rectosigmoid section of the large intestine were involved in the process. The diaphragm, mesentery of the small intestine, liver and bladder were less frequently involved in the adhesion process.The study found that the loops of the small intestine and the rectosigmoid section of the large intestine were involved in the process in 28 women, which is 62.2% of the total number of patients studied. During the study it was found that tumor tissues pushed certain parts of the intestine into other regions of the abdominal cavity that were not typical of their normal location. For example, in the present retrospective analysis, displacement of the sigmoid colon into the right ileum and groin by a conglomerate of tumor tissue was noted in a woman diagnosed with C-R OVAR. ST III.

Also, loops of small intestine with different variability invaded large ovarian tumors. This observation was noted in 9 (20%) patients. Entry into the abdominal and pelvic cavity was often difficult due to the ingrowth of intestinal loops into the tumor, and accordingly the surgical team encountered great technical difficulties.In addition to various parts of the intestine, tumors grew into the ligamentous apparatus of the uterus, thus being located intra-legally. Ligaments such as lig. sacrouterinum, lig.teres uteri, lig. latum uteri were most susceptible to interaction with cancerous tissues. These changes occurred in 10 (22.2%) patients.

The greater omentum was involved in the process in the majority of cases in women with this established gynecologic oncogynecologic pathology. It sprouted into the tumor tissue or was completely replaced by it, which gave it the appearance of a "shell". This also made the operation more difficult and increased the time spent on the operation. In the study, this transformation was observed in 40 (88, 9%) women.

37 (82.2%) women had adhesions with posterior Douglas space. This is explained by the fact that the posterior surface of the uterus is closely adjacent to the rectum, which can also lead to the spread of the process to the rectal section of the large intestine.The bladder was less frequently involved, but, nevertheless, it had certain consequences, such as difficult or painful urination, hematuria. This complication was observed in 3 (6.7%) women.

Conclusion. Thus, by conducting a retrospective analysis, it is found that disseminated ovarian cancer is indeed a serious cause of change in the topography of abdominal and pelvic organs.The most common anatomical changes due to disseminated ovarian cancer pathology were investigated. It was observed that the most frequently involved in the pathologic process were the greater omentum, posterior Douglas space and loops of small and large intestine.Due to such serious topographic changes, the entrance to the abdominal cavity and pelvis is difficult, respectively, surgical teams face great technical difficulties, which increases the volume of surgery and the time spent on it. Thus, in addition to cytoreduction of the altered organ, one has to pay quite a lot of attention to complete removal of tumor nodes in the pelvis and abdomen.

 

About the authors

Sofya Sergeevna Khabarova

Voronezh State Medical University named after N.N.Burdenko

Email: sooncheez@mail.ru
ORCID iD: 0009-0002-9477-2732
Russian Federation, 394036. Address: Voronezh region, Voronezh, STUDENTSKAYA str., 10.

Viktoria Sergeevna Samokhina

Voronezh State Medical University named after N.N.Burdenko

Email: viktoria.samokhina.ss@mail.ru
ORCID iD: 0000-0002-9202-4397
Russian Federation, 394036. Address: Voronezh region, Voronezh, STUDENTSKAYA str., 10.

Alexander Vasilyevich Chernykh

Voronezh State Medical University named after N.N. Burdenko

Email: chernyh@vrngmu.ru

Doctor of Medical Sciences, Professor

Russian Federation, 394036, Voronezh region, Voronezh, st. Student, d. 10.

Marina Petrovna Popova

Voronezh State Medical University named after N.N. Burdenko

Email: m_zakurdaeva@rambler.ru
ORCID iD: 0000-0002-1886-8428

Candidate of Medical Sciences

Russian Federation, 394036, Voronezh region, Voronezh, st. Student, d. 10.

Lilia Alekseevna Voronina

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: kravets@vrngmu.ru

Candidate of Medical Sciences

Russian Federation, 394036, Voronezh region, Voronezh, st. Student, d. 10.

References

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