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This review presents data on the predominant mechanisms of metastatic progression of ovarian cancer. The morphological and functional features of the greater omentum are shown, both promoting the spread of cancer cells and having an antitumour effect. The ratio of these two mutually opposite properties depends on the cellular composition, the content of extracellular matrix molecules and the biomechanical properties of the greater omentum during carcinogenesis. Milky spots are the main site of cancer cell implantation. They differ from lymph nodes in a simpler structure and a unique cellular composition (macrophages, B cells, CD4+ and CD8+ T lymphocytes, other immune cells) changing significantly during metastasis. М2­macrophages, adipocytes, CD33+ and CD4+ CD25high CD127low Т­suppressors promote migration, invasion, growth and colonization of cancer cells. The majority of the molecules synthesized in the greater omentum during metastasis also stimulate this process. The exceptions are E­cadherin, CXCL10, CXCL11, CXCR3, which inhibit the growth of tumour foci. In addition, CD8+ T lymphocytes and M1 macrophages also have antitumor effects. Since ovarian cancer is characterized by high mortality, mainly due to metastases, the issue of optimizing methods for predicting the treatment effectiveness depending on the cellular composition and expression of specific molecules in the milky spots of the greater omentum is urgent. These indicators can be applied in clinical practice using molecular genetic and immunohistochemical methods. In order to determine the need for omenectomy in the surgical treatment of ovarian cancer and to predict the outcome, it is advisable to study the morphological and functional properties of the greater omentum and to determine the number of immunocompetent cells and the nature of the expression of genes associated with the worst prognosis, those encoding activin­A, N­cadherin, CCL23, CD36, CD44, CF­1/M­CSF, FABP4, GRO­α, GRO­β, IL­8, ITGA2, MMP9, TP53, VEGF, VEGFR. These molecules are associated with adhesion and angiogenesis systems that play a key role in metastasis. Promising directions in the therapy of metastatic ovarian cancer can be stimulation of the transition of M2­ to M1­macrophages, activation of the anti­tumour antigen­specific response of CD8+ T cells using phagocytes, adaptive transfer of natural killer cells, the use of inhibitors of Wnt pathways, CCR1, CD36, FABP4, PAD4, ITGA2.

Introduction. This article presents data on the manifestations of changes in the microenvironment of the peritoneal cavity in patients with carcinomatosis, expressed by the mineralization of the peritoneum, which in turn leads to functional changes in drainage of the peritoneal cavity.Materials and methods. We examined autopsy tissue of the peritoneum with symptoms of carcinomatosis and intact peritoneum using comparative scanning electron microscopy.Results and discussion. The study of the ultrastructure of peritoneum in patients with PC, revealed the phenomenon of SLL mineralization. The resulting elemental composition profile showed a high content of Ca, P, Na.Conclusions. 1. Carcinomatosis is not a local, but rather a systemic process. Determining the role of mineralization in carcinomatosis is of fundamental importance in carcinogenesis. 2. The serous membranes mineralization in patients with carcinomatosis can become a new treatment target, the impact on which may increase life expectancy and improve the quality of life. 3. The serous membranes demineralization can serve as a part of a combination treatment that includes the subsequent endolymphatic anti-tumour drug therapy.

In the article the anatomical features of the peritoneum structure have been described in accordance with the medical records supplemented by the author’s illustrations. The functional differences of various peritoneum areas are shown based on its structure. Also, issues relating to the anatomical features of the peritoneum such as «hatches» and its influence on the development of peritoneal carcinomatosis have been touched upon.

This article describes the results of scanning electron microscopy in cancer. For the first time visualized the cancer cells migrated via directly serous-lymphatic hatches on the surface peritoneum. Shown the similar results of studies of Japanese scientists, but selected the differences in the mechanisms of this process, in particular in the direction of movement of cancer cells. From data analysis results of quantitative and anatomical evaluation of serous lymph hatches diaphragmatic peritoneum we selected their functional classes. Investigation results have important applied value in oncology.