Introduction
Ovarian cancer is a kind of malignant tumor of the ovaries, in which 90%–95% is primary ovarian cancer and the remaining 5%–10% is ovarian metastases from primary cancers at other parts. Although the incidence of ovarian cancer is lower than that of cervical and endometrial cancer, ranking third among gynecological malignancies, the mortality rate is more than the sum of cervical cancer and endometrial cancer, the highest in gynecological cancers, and is the most serious threat to women’s health. Early ovarian cancer is usually absent of symptoms, and even if it is not symptoms are not specific and the role of screening is limited. Thus, early diagnosis is difficult and 60%–70% of cases are advanced by the time patients seek medical services, and the efficacy for advanced cases is poor. The 5-year survival rate of ovarian cancer is 30%–40%. How to improve the efficiency of treatment of ovarian cancer is a serious challenge faced by the gynecologic oncology community in recent years. Thermochemotherapy and intraperitoneal hyperthermic perfusion chemotherapy have achieved good results.
Early ovarian cancer is often asymptomatic, and some patients inadvertently stumble on palpable masses in the lower abdomen or such masses are accidentally found by gynecological examination. Patients often feel abdominal discomfort, but there is generally no significant abdominal pain. When complications occur, such as torsion, rupture, or infection, patients can feel lower abdominal pain. Some patients may present menstrual disorders or amenorrhea. Loss of appetite, indigestion, and other gastrointestinal symptoms often appear in some patients. With the increase of cancer and ascites, some patients may have a sense of increased waist circumference; some even consider it to be obesity and, hence, may try to reduce weight. There may be fatigue, weight loss, and anemia in advanced ovarian cancers.
Treatments
1.Surgery
Ovarian cancer at the early stage produces abdominal planting and lymphatic system metastasis, i.e., subclinical spread. The vast majority of patients should seize the opportunity for surgical treatment. Surgery is not only the most effective treatment but also the necessary means for confirming the diagnosis and defining staging. Once it is suspected as ovarian cancer, early surgery should be carried out. Systematic operational examination and staging are stressed for early ovarian cancer. Correct staging is not only the premise for determining treatment but also a significant basis for estimating prognosis and efficacy comparison. As a result, once ovarian cancer is suspected, early surgery should be carried out. In principle, hysterectomy, adnexectomy, omentectomy, and pelvic and paraaortic lymph node dissection are carried out for early ovarian cancer. For advanced cancer, tumor cells cytoreductive surgery can be carried out to resect the primary tumor and metastases as much as possible and minimize the number of cancer cells. For young patients who have fertility requirements and meet the criteria, conservative surgery to preserve fertility can be carried out. If the first operation is not very complete, with only biopsy or partial resection, or it is considered that the cancer stage is too advanced and surgery cannot achieve satisfactory cytoreduction, surgery should be carried out after one to three courses of chemotherapy. For patients with postoperative residual cancer less than 2 cm, especially cancer less than 1 cm, prognosis is significantly improved. Whether to reoperate on recurrent cancers remains controversial, and comprehensive consideration should be given according to the patient’s specific circumstances.
2.Radiotherapy
Ovarian cancers vary a lot in radiosensitivity. Endodermal sinus tumor of the ovary, immature teratoma, and embryonal carcinoma are the most insensitive. Epithelial ovarian cancer and granular cell carcinoma are moderately sensitive. Dysgerminoma is the most sensitive and can be controlled by radiotherapy after surgery. Because early ovarian cancers result in peritoneal metastasis, the irradiation range includes the abdominal and pelvic cavity.
3.Chemotherapy
Chemotherapy is the main means of adjuvant therapy for ovarian cancers. It not only can tolerate the disease but also has the potential to completely eliminate the cancer. As a result, patient survival time is significantly prolonged. Chemotherapy is mostly used after surgery to kill residual lesion cancer cells that are difficult to be resected completely. Except for certain patients with cancers of stages Ia and Ib as well as those with postoperative borderline tumor who cannot receive chemotherapy, other patients should have chemotherapy. Most ovarian cancers are more sensitive to chemotherapy. Epithelial carcinoma is commonly treated with a TP program (taxol + carboplatin or cisplatin), and germ cell tumors and specific gonadal stromal cells tumors are treated with a BEP program (bleomycin + etoposide + cisplatin) and a VPB program (vincristine + cisplatin + bleomycin).
Because ovarian cancers have intraperitoneal spread, in addition to conventional intravenous administration intraperitoneal administration can also be used for chemotherapy.
4. Hyperthermia
Ovarian cancer hyperthermia focuses on local hyperthermia, thermochemotherapy, and intraperitoneal hyperthermic perfusion chemotherapy. Basic and clinical studies have demonstrated that the efficacy of ovarian cancer hyperthermia combined with chemotherapy is significantly increased compared to chemotherapy alone. In the past 20 years, preoperative thermochemotherapy and intraoperative and postoperative intraperitoneal hyperthermic perfusion chemotherapy have produced good effects.
5.Chelation Detoxification Therapy
Chelation detoxification has the effect of directly killing cancer cells and can also improve immunity. It is recommended to give a full dose and full course of chelation detoxification therapy in the preoperative period, or before and after chemoradiotherapy, to ovarian cancer patients at an early stage; simultaneously applying hyperthermia can help achieve satisfactory effects, increase cure rates, improve the tolerance of the body to surgery and chemoradiotherapy, and reduce chemoradiotherapy side effects.
6.Medical Ozone Therapy
The significance of the application of medical ozone therapy for early ovarian cancer is that it can regulate immune function, directly kill remaining cancer cells, and inhibit cancer recurrence and metastasis. Be sure that the medical ozone systemic treatment is not used at the same day as chelation detoxification. Combining medical ozone therapy application theory with the TCM acupoint theory, medical ozone acupoint injection can be given to enhance the effect of the treatment of cancer. At the same time, medical ozone vaginal or rectal insufflation can also be given. Apply topical treatment to inhibit tumor recurrence and metastasis. For medium-advanced ovarian cancer patients who are in good general condition, EBOO treatment can be given to help suppress tumor progression. For patients in poor general condition and with coagulation disorders, intravenous medical ozone saline, major autohemotherapy, and medical ozone acupoint injection can also be given; medical ozone vaginal insufflation also has a certain effect in cancer control.
7. Biological Treatment
Biological treatment for ovarian cancers is a kind of treatment using cytokines, such as IL-2,IFN-α, and TNFα, and is widely used in patients with ovarian cancer. The efficacy of IL-2 and TNFα in conjunction with other drugs for the treatment of ovarian cancer hydrothorax and seroperitoneum is significant. The method is easy to use and can be applied by direct intramuscular injection or intravenous infusion as well as by direct thoracic and abdominal cavity perfusion. Adoptive immunotherapy, such as multi-factor-induced killer cells CIK, adopts immunotherapy for cancer patients to help eliminate minimal residual lesions, prevent tumor recurrence, and prolong survival time.
8.Traditional Chinese Medicine
Syndrome differentiation of the early stage mostly belongs to the syndrome of stagnation of pathogenic dampness and heat. The prescription recommended is modified Longdan Xiegan Decoction. For the syndrome of qi stagnation and blood stasis, the prescriptions recommended are Xiaoyao Powder plus modified Taohong Siwu Decoction. Syndrome differentiation of advanced ovarian cancers mostly belongs to the syndrome of phlegm dampness and coagulation, and the prescriptions recommended are Sijunzi Decoction plus modified Haizao Yuhu Decoction.
9.Acupuncture
The syndromes of early ovarian cancers are mainly qi stagnation and blood stasis. The therapeutic principle should focus on promoting blood circulation to remove meridian obstruction, as well as softening and resolving hard mass.
The syndromes of medium-advanced ovarian cancers are mainly phlegm dampness and coagulation, as well as deficiencies of both qi and blood. The therapeutic principle should focus on invigorating the spleen for eliminating dampness, eliminating phlegm and softening indurated mass, and replenishing qi and the blood, as well as toning deficiency and reinforcing the primary qi.
10.Medicated Diet, Nutrition, and so on
Nutritional support of early ovarian cancer patients focuses on medicated diet and food therapy. Before conducting chemotherapy or whole-body hyperthermia, total parenteral nutrition can be given 1 day in advance to replenish the consumption of hyperthermia. Because advanced ovarian cancer patients are often accompanied by malnutrition, parenteral nutrition is mostly given. Actively give nutritional support and supplement with enough protein, vitamins, trace elements, and so on to support the body’s tolerance to a variety of anticancer therapies.
11.Others
Adhere to the practice of qigong and taiji. Take music therapy and psychotherapy to reduce psychological stress or fear, which facilitates the rapid and comprehensive rehabilitation of patients. Medium-advanced patients should also pay attention to psychological adjustments, and anticancer confidence, and be encouraged to practice qigong; music therapy; and the regulation of breathing, body, and heart to improve their self-healing powers. All these will help to extend survival time and improve quality of life.
Typical Case
A 69 year old female patient first experienced fatigue and abdominal discomfort one year ago. When she was seen in a hospital in Guangzhou, a 5.2cm×3.9cm×4.6cm mass was found in the left adnexa uteri, which was ill defined, with pelvic fluid. Patient subsequently underwent “cytoreductive surgery + pelvic lymph node dissection”. Postoperative pathological examination: embryonal carcinoma of left ovary; no lymph node cancer. An embryonal carcinoma nodule with diameter of 0.3cm could be seen at the right ovarian tissue. Patient was given chemotherapy 10 days after surgery (specific program was unknown). Due to severe chemotherapy side effects, patient refused to continue and instead resorted to herbal medicine (details unknown). The symptoms varied in degree; she exhibited aggravated abdominal distention for more than 20 days before admission to Clifford Hospital.
Diagnosis: embryonal carcinoma of the left ovary stage IV (with abdominal and retroperitoneum lymph nodes metastases).
Integrative treatments: On admission, symptomatic and supportive treatment, such as decompression, fasting, paracentesis, total parenteral nutritional support, correction of electrolyte disorders were conducted. Chelation and detoxification therapy was applied once a day for 3 days. Patient had good bowel movement after 3 days, relieving abdominal distension. A liquid diet followed. Intravenous ozone saline and chelation and detoxification therapy were applied alternately, once every other day. TCM and acupuncture were combined throughout the entire course of treatment.
After one week, patient’s abdominal distension and ascites were reduced, her appetite normal with HGB 101g/L. She underwent whole body hyperthermia combined with intraperitoneal chemotherapy. Intraperitoneal drugs consisted of cisplatin 100mg + IL-2 one million units, once every 10 days. Abdominal and pelvic local hyperthermia were applied at the interval period, once every other day. Simultaneously conducted hyperthermia and chelation and detoxification therapy and applied EBOO alternately. This protocol continued for 4 weeks. Instruction in Qigong and psychotherapy sessions were provided to relieve mental stress.
Treatment outcome: after integrative treatment for 35 days, the mental state of patient was improved markedly, urine and stool were normal, no futher nausea and vomiting. Appetite was normal, no abdominal distension evident, weight increased by 3 kg. The whole abdominal enhanced CT scan revealed the following after treatment: postoperative changes of ovarian cancer and a 1.5 cm × 1.2 cm × 1.1 cm metastasis mass at the right abdominal cavity. Retroperitoneum lymph node metastases significantly reduced. Blood routine after treatment: WBC 6.2 × 109/L, NEUT 68%, RBC 4.2 × 1012/L, and HGB 110 g/L. Abdominal plain film showed no fluid level and electrolytes normal. Tumor markers were as follows: CEA 58 ng/mL, AFP 28 ng/mL, and CA199 33 U/mL. Currently, patient maintains a weight of 59 kg, with normal appetite, no black stool, pain free, and can perform regular housework. Her KPS was 90. Patient is insistent on taking herbal medicine. She returns to hospital once every 20 days for 1-week duration treatment to undergo whole-body hyperthermia, chelation detoxification, EBOO, acupuncture, and other appropriate integrative treatments.
