Ovarian cancer (OC) is a heterogenous disease in terms of genetic mutations and tumor phenotypes and can be divided into I and II types. Type II high grade tumors are more common, accompanied by ascites, and are the main cause of cancer-related death in women. OC associated ascites is considered as valuable source of tumor material containing a wide range of dissolved components and cell populations. Over the past decades, the cellular and acellular components of ascites have been studied, but its effect on chemoresistance and the development of metastasis continues to be studied. This review describes the pathogenesis of ascites in OC, it’s cellular and acellular components, many of which are prognostic factors as well as markers of the effectiveness of anticancer therapy. Further study of the ascitic fluid composition in OC will help to identify not only prognostic factors, but also the points of application of targeted drugs and will improve the results of OC treatment.

Рак шейки матки: проблемы профилактики и скрининга в Российской ФедерацииЛ.А

Introduction/Background At present, there are numerous confirmed data on multitarget effect of indole-3-carbinol (I3C) and epigallocatechin-3-gallate (EGCG) against tumors of different origin. The aim was to study the effectiveness of combined therapy for patients with ovarian cancer (OC) when I3C and I3C with EGCG are included in its scheme. Methodology The study included 284 patients with an ascitic form of advanced serous OC. All of them underwent combined treatment: polychemotherapy (TP, TC, DC) and cytoreductive surgery. At the same time, treatment with neoadjuvant chemotherapy (NACT) was provided in the 1st (n=46), the 2nd (n=76) and the 3rd (n=42) groups and prolonged (60 months) usage of I3C (for the 1st group) and its combination with EGCG (for the 2nd, 3rdgroups). In addition, prolonged polychemotherapy (PPCT) was given in the 3rd group. Two groups of treatment-naive patients (without I3C, EGCG) were taken as control arm: in the 1st group (n=40) treatment included operation+6 courses of adjuvant chemotherapy (ACT); the 2nd group (n=80) was treated by NACT+operation+6 courses of ACT. The observation period was 60 months. Results The overall survival (OS) in the 1st and 2nd studies groups were higher than in the control’s groups, amounted to 65.2% and 63.2%, against 40% and 36.3%, respectively. OS in 3rd studies group achieved of 71.4%, as was as a longer progression-free survival (PFS) a median was of 48.5 months. In the 1st and 2nd studies group the median of PFS were of 39.5 and 42.5 months, in the control’s groups were 24.5 and 22 months. Conclusion We result that the usage of drugs with multitarget effects (I3C, EGCG) in addition to standard therapy of OC increased its effectiveness by forming conditions (increasing the efficacy of NACT, maintaining the sensitivity of the tumor to first-line of PCT, reducing the number of ascites relapses) to achieve a longer duration PFS, OS. Disclosure Nothing to disclose.

A review article presents the modern methods of screening and early diagnosis of primary ovarian cancer (OC). This issue is still relevant in view of the continuing upward trend in incidence rate ratios along with a slight decrease in mortality and 5-year survival rate, as well as the lack of clear definition of the concept of pathogenesis. The diagnostic value of tumor markers and their potential, advantages and disadvantages are discussed. In light of this the need becomes evident for combination of tumor markers with radiological method of imaging, such as transvaginal sonography as the most affordable, safe and multi-reproducible method enabling to most accurately determine the nature of the process, its nosology belonging, as well as to carry out the required dynamic monitoring within a short time. More advanced imaging techniques such as computer tomography or magnetic resonance imaging proved too expensive for widespread use in view of their limited sensitivity and specificity. Attempt to assess the performance of marker screening on the base of CA-125 in groups, divided by clinical and pathogenic way of OC development also proved to be ineffective. Currently, none of the presented algorithms can meet the criteria of economic efficiency, even in the most developed countries. In view of the above, possible options to enhance their performance by developing reliable multimarker panels, the use of ultrasound color power doppler mapping, and others are considered. In addition, the feasibility and application prospects of ultrasound elastometry, mass-spectrometry, IVDMIA tests, OVA dx-test as part of screening programs are discussed. The data of recent studies on the direct comparison of diagnostic tests is given. The importance of genetic counseling for persons at high risk of cancer development process is noted. In case of mutation detection in the BRCA1, BRCA2 genes, in some countries a wide range of preventive activities is recommended: from regular «targeted» preventive examinations to the prophylactic oophorectomy and mastectomy. Increased survival rate of patients with OC is the main aim of all scientific research.

Introduction. Ovarian cancer (OC) in Russia is ranked the seventh within the structure of general cancer diseases and the third within the gynecological tumors, due to such reasons the problem of early diagnostics is still actual. New technologies, such as color Doppler ultrasonography,3D power Doppler ultrasonography contribute to increasing of opportunities of ultrasound analysis to detect any malignancy signs.Materials and methods. The paper sets out the results of comprehensive ultrasound study of 68 patients with morphologically verified OC at stages IА–В, IIА–В. The control group was made of 100 female patients with morphologically verified ovarian tumors (serosal cystadenomas, thecomas, fibromas). A complex of the following ultrasound methods was used during the study: 2D and 3D ultrasonography in B mode, in color Doppler and power mapping mode, 3D angiography, spectrum Doppler imaging.Results. Maximum size of tumor varied within a range between 37 and 300 mm (108 ± 61.2 mm). It worth noting that no direct dependence between the size of neoplasm and process phase was established. When assessing the echostructure, all ovarian tumors were divided into 3 structure types: cystic type (57.8 % of cases), cystic and solid type (33.3 % of cases), solid type (8.9 % of cases). The conducted analysis of types of small pelvis neoplasm echostructures enabled to evolve the sonographic types of ovarian tumors, more or less associated with the malignant transformation. The most relevanl Doppler ultrasonography exponents characteristic for benignant and malignant processes: resistance index in benignant tumors was 0.56, at OC – 0.32 (р < 0.001); average arterial blood velocity in benignant tumors – 7.8 cm/s, at OC – 20.1 cm/s (р < 0.001); average maximum venous flow velocity in benignant tumors – 3.2 cm/s, at OC – 9.3 cm/s (р < 0.001).Conclusion. Therefore modern ultrasonography can detect and differentiate rather efficiently the localized variants of OC, provided that the main part of diagnosis is formed in mode of color and power Doppler mapping, which shall be taken into consideration during the primary diagnostics of OC.

In spite of all of modern medicine»s advances, ovarian cancer (OC) mortality remains to be incommensurably high and to hold the lead among gynecological cancers. The initial cause of this deplorable statistics is the absence of a clear concept of the pathogenesis of OC and hence the justified prevention and methodology of early diagnosis of the disease; in this connection, therapy that proves to be ineffective is frequently used by medical oncologists in their daily practice. As a consequence, there is a high proportion of its further progression: the rates of early and late recurrences were about 30 and 60–65 %, respectively; most of which are drug resistant to further chemotherapy cycles. By taking into account these strikingly modest statistics, it becomes apparent that oncologists desire to make changes in the existing treatment regimen to achieve meaningful results. To use target drugs is one of these promising areas owing to new views on the concept of the pathogenesis of OC.Nevertheless, considering a wide variety of the signaling cascades and molecules, which are involved in the process of carcinogenesis, even target compounds, if they have only one point of application, cannot always produce their desirable therapeutic effect and their co-administration is responsible for high toxicity. In this light, the most effective drugs are indole-3-carbinol and epigallocathechin-3-gallate, which virtually cause no adverse reactions and can block various molecular targets at different levels of the mechanism of malignant transformation. Based on L. A. Ashrafyan, s concept of two pathogenetic variants of sporadic OC (2009) and on the recent findings in molecular biology and epigenetics, the incorporation of the above medications into the standard treatment regimen for OC should increase survival rates and change the nature of recurrence by that of more locally advanced forms. On this basis, a clinical trial was carried out to study the efficiency of using antitumor drugs based on indole-3-carbinol and epigallocathechin-3-gallate as part of combination therapy for OC. The results of the clinical trial performed are suggestive of considerably higher survival rates in the groups receiving the above drugs than in the control groups. In addition, the multitarget effect of indole-3-carbinol and epigallocathechin-3-gallate can effectively remodel the function of a cancer stem cell, the main source of recurrences and metastases, and may be considered as an important adjunct to the existing strategy of antitumor therapy.

Int r oduction . Ovaria n cance r (OC) in Russia is ranked the seventh within the structure of general cancer diseases and the third within the gynecological tumors, due to such reasons the problem of early diagnostics is still actual. New technologies, such as color Doppler ultrasonography, 3 D power Doppler ultrasonography contribute to increasing of opportunities of ultrasound analysis to detect any malignancy signs. Material s and methods. Th e paper sets out the results of comprehensive ultrasound study of 68 patients with morphologically verified OC at stages IА–В, IIА–В. The control group was made of 100 female patients with morphologically verified ovarian tumors (serosal cystadenomas, thecomas, fibromas). A complex of the following ultrasound methods was used during the study: 2D and 3D ultrasonography in B mode, in color Doppler and power mapping mode, 3D angiography, spectrum Doppler imaging. Results . Maximu m size of tumor varied within a range between 37 and 300 mm (108 ± 61.2 mm). It worth noting that no direct dependence between the size of neoplasm and process phase was established. When assessing the echostructure, all ovarian tumors were divided into 3 structure types: cystic type (57.8 % of cases), cystic and solid type (33.3 % of cases), solid type (8.9 % of cases). The conducted analysis of types of small pelvis neoplasm echostructures enabled to evolve the sonographic types of ovarian tumors, more or less associated with the malignant transformation. The most relevanl Doppler ultrasonography exponents characteristic for benignant and malignant processes: resistance index in benignant tumors was 0.56, at OC – 0.32 (р < 0.001); average arterial blood velocity in benignant tumors – 7.8 cm/s, at OC – 20.1 cm/s (р < 0.001); average maximum venous flow velocity in benignant tumors – 3.2 cm/s, at OC – 9.3 cm/s (р < 0.001). Conclusion . Therefor e moder n ultrasonography can detect and differentiate rather efficiently the localized variants of OC, provided that the main part of diagnosis is formed in mode of color and power Doppler mapping, which shall be taken into consideration during the primary diagnostics of OC.