Symptoms of late stage spread of ovarian cancer

The main manifestations of late-stage spread of ovarian cancer include extensive pelvic and abdominal metastasis, distant organ involvement, and cancer cachexia. Common symptoms include intractable abdominal pain, large amounts of ascites, intestinal obstruction, weight loss, anemia, and dyspnea. The spread of ovarian cancer usually indicates that the disease has entered the terminal stage, and a palliative treatment plan needs to be formulated based on the pathological type and genetic testing results.

1. Extensive metastasis to the pelvic and abdominal cavity

Transperitoneal dissemination of tumor cells can lead to pie-shaped thickening of the omentum and multiple peritoneal nodules, which may cause intractable lower abdominal pain or lumbosacral pain. This kind of pain often worsens continuously and is difficult to relieve with ordinary analgesics. Physical examination can reveal a fixed and hard pelvic mass, and tumor markers such as CA125 are often significantly elevated. Intraperitoneal metastasis can stimulate peritoneal inflammatory exudation, and most patients will develop moderate to large amounts of ascites.

2. Digestive tract infiltration

Invasion of the intestinal serosa layer by cancer cells may lead to incomplete intestinal obstruction, manifested by paroxysmal colic, abdominal distension, vomiting, and decreased defecation and exhaustion. Invasion of the gastric antrum can cause early satiety and difficulty eating. Enhanced CT shows irregular thickening of the intestinal wall and fusion of mesenteric lymph nodes into clusters. Gastrointestinal decompression combined with intravenous nutritional support can temporarily relieve symptoms, but tumor obstruction is prone to recurrence.

3. Distant organ metastasis

Multiple low-density lesions appear when hematogenously metastasizes to the liver, which may cause dull pain and jaundice in the liver area. Pulmonary metastasis is often asymptomatic in the early stage, and cough, hemoptysis and pleural effusion appear in the later stage. Bone metastases tend to occur in the spine and pelvis. Pain is obvious at night and pathological fractures may occur. Brain metastases are relatively rare, but sudden onset headache, vomiting, or neurological deficits may occur.

4. Metabolic disorder syndrome

Tumor wasting results in protein-energy malnutrition manifested by progressive wasting, sarcopenia, and hypoalbuminemia. Myelosuppression can cause leukopenia and severe anemia. Hyponatremia and hypokalemia are common in electrolyte disorders. Such patients often have poor performance status scores and cannot tolerate strong anti-tumor treatments.

5. Thromboembolic events

Tumors release procoagulant substances, which increases the probability of deep vein thrombosis. Sudden swelling of the lower limbs requires alerting to the risk of pulmonary embolism. Some patients develop nonbacterial thrombotic endocarditis, leading to multiple cerebral infarctions. Prophylactic anticoagulation therapy needs to weigh the risk of bleeding, and low molecular weight heparin calcium injection is a common choice.

Patients with advanced ovarian cancer should remain in a semi-recumbent position to relieve dyspnea and eat a high-protein liquid diet to maintain nutrition. It is recommended to use a three-step analgesic regimen for pain management, and oxycodone hydrochloride sustained-release tablets combined with gabapentin capsules can be used to control neuropathic pain. Family members need to assist in recording 24-hour intake and output, and observe changes in consciousness and vomitus properties. The amount of fluid required for palliative abdominal puncture should not exceed 3000 ml each time, and human albumin needs to be supplemented after surgery. It is recommended to develop an individualized supportive treatment plan under the guidance of an oncologist, and consider home hospice care when necessary.