卵巢癌的診斷和治療醫(yī)大講-免費(fèi)閱讀
【正文】 conservative resection – preserve fertility in bilateral borderline tumours – adjuvant therapy unproven ? Unfavourable type – poorly differentiated clear cell tumours – capsule peration – ruptured capsule – positive washings – stage II: standard operation + adjuvant therapy 早期卵巢癌的化療 ? FIGO I， II期卵巢癌 ? “ 預(yù)后好 ” 的患者 90%以上可長期無瘤存活，而且不需要輔助化療。 protective factors for ovarian cancer appear to be conditions associated with fewer lifetime ovulations 1. Use of oral contraceptive pills 2. Shorter duration of reproductive years 3. Conditions of chronic anovulation 4. History of breastfeeding 5. Multiparity Histopathology ? Epithelial ovarian cancer, usually classed simply as adenocarcinoma, include a number of specific histological types: ? Serous adenocarcinoma ? Muconous adenocarcinoma ? Endometrioid adenocarcinoma ? Malignant Brenner tumor (transitional cell) ? Clear cell adenocarcinoma Histopathology ? Malignant Germ Cell Tumor of the Ovary include a number of specific histological types: ? Dysgerminoma ? YolkSac Tumor (endodermal sinus tumor) ? Teratomas ? Choriocarcinoma ? Mixed germ cell tumor Histopathology ? Malignant Tumor of the Gonadal stroma: ? Granulosalcell tumors Adult type Juvenile type ? Sertolicell tumors ? Leydigcell tumors ? SertoliLeydigcell tumors ? Sex cord tumor with annular tubules Spread of ovarian cancer ? Local spread ? Intraabdominal spread ? lymphatic spread ? hemtogenous spread Symptoms ? Symptoms are most often absent with early stage ovarian cancer. When present, symptoms tend to be nonspecific ? GI tract plaints: such as nausea, abdominal cramping, or change in bowel habits,are often the early symptoms of advanced stage disease. By this time, the disease may be widely disseminated throughout the peritoneal cavity ? Abdominal distention: big mass, omental cake, ascites intestinal obstruction Symptoms ? Postmenopausal bleeding may occur from endometrial hyperplasia stimulated by estrogen from a ovarian tumor. ? Virilization is found in 50% of patients who have an androgensecreting SertoliLeydigcell tumor. ? Colicky pain is associated with torsion of a mobile ovarian tumor. ? Constant pain may be experienced with the distention of hemorrhage into a tumor Physical examination ? Fixed, bilateral pelvic masses ? Abdominal mass: omental cake, big ovarian tumor ? Abdominal percussion: ascites ? A nodular tumor in POD ? Pleural effusion ? Meige’s syndrome consists of ascites and hydrothorax associated with fibroma and thea. Preoperative workup ? Pap smear ? (f) Damp。 IV Combination (19911994) ? Taxol, DDP/Carpa (19952022) ? Weekly taxol /Carpa(2022) Combination Chemotherapy ? Cisplatin acts by binding to DNA and producing crosslinks and DNA adducts. ? Cisplatin is a very effective drug for ovarian cancer. ? Important side effects include severe nausea and vomiting, doserelated nephrotoxicity, ototoxicity, peripheral nerutoxicity and myelosuppresion Combination Chemotherapy ? The mechanism of action of carboplatin is the same as that of cisplatin, the side effects, however, differ greatly. ? The most important side effect is thrombocytopenia. Leukopenia and anemia also occur but are less severe. ? Neurotoxicity and nephrotoxicity are less severe with carboplatin than with cisplatin ? Other important side effect include alopecia and muc
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1