Diagnostic Classification
The classification of ovarian cyst Many primary ovarian cyst classification, as many as several dozen species, from different parts of ovarian, divided into four broad catego...
Auxiliary (1) B - ultrasound imaging can detect tumor location, size, shape and nature. (2) radiology diagnostic barium contrast barium enema or air ...
Surgery
According to a medical examination and transvaginal ultrasound findings suspected ovarian cancer is often a laparotomy to be confirmed histology, and tumor stage and tumor debulking surgery. Histological need to be certified to remove ovarian cysts Mixed other causes, including non - epithelial ovarian cancer (such as interstitial or germ cell tumors), other primary site of tumor metastasis to the ovary (such as the adhesion of), or benign lesions, such as endometriosis. The adhesion is usually of signet ring cell tumor, representatives from primary adenocarcinoma of the stomach metastatic ovarian cancer. However, other parts of the original cancer, such as colon, appendix, the gallbladder and breast (special lobular invasive carcinoma) will also transfer to ovarian. At laparotomy surgery during the stage, right after the decision-making guidance provided important information, especially for patients with early (discussed below). Finally, the tumor debulking surgery (initial cytoreductive surgery) is the first of an important part of the operation because of residual tumor with a diameter of less than 1 cm larger than the residual tumor with a high survival rate.
Standards include abdominal surgery center longitudinal incision fully exposed to the pelvic and abdominal. A classic abdominal hysterectomy, bilateral tubal ovariectomy, careful exploration of all peritoneal surfaces, OK resection of the retina, the proper time next aortic lymph node biopsy, the involvement of regional clinical random biopsy and peritoneal washings. Beside aortic lymph node biopsy except for aortic lesions adjacent lymph nodes outside the ovary seems to be confined to patients with particularly important, because such patients with tumor staging may later. International Federation of Gynecology and Obstetrics developed ovarian cancer staging. Early patients with ovarian cancer (stage I or II) long-term survival rates as high as 80% to 95%, while in patients with advanced ovarian cancer (stage III or stage IV) lower survival rate (10% ~ 30%). Epithelial ovarian cancer the most common histologic type is serous papillary carcinoma usually associated with the body known as the gravel annulus calcification. Other histologic types and associated clinical features.
Despite the clinics suspected cases of ovarian cancer, the initial surgery is almost always necessary, but it must be recognized that at least two patients may consider other methods of treatment. The first group includes mixed because of ovarian cysts and occult gastrointestinal bleeding led to iron-deficiency anemia patients. When clinical suspicion from the stomach or other gastrointestinal primary site of the molecule metastases, in deciding whether the need for surgery, endoscopic assessment should be conducted (as gastrointestinal endoscopy, colonoscopy or screening clinical indications, the two have done)
The second group, including suspected ovarian cancer surgery but tolerance of poor patients, the disease can not coexist security cytoreductive surgery. Under such circumstances, a reasonable approach is to obtain reliable cytology or biopsy specimens (such as cultivation or ascites from celiac) identify ovarian cancer diagnosis, followed by a platinum-based chemotherapy, as described below. If the treatment of patients with effective and suitable for the changing surgery, then completed three cycles of chemotherapy after the tumor debulking to attempt surgery is reasonable. However, in the initial surgery experienced Gynecologic Oncology physicians can achieve the best tumor debulking of patients, such as intermediate cytoreductive surgery do not seem to benefit from it.
After Chemotherapy
Early ovarian cancer <BR>
The majority of epithelial ovarian cancer patients in need of adjuvant chemotherapy in an attempt to eradicate residual lesions. However, we may have identified a subgroup of patients with ovarian cancer early this group of patients after surgery for a separate 5-year survival rate of 90% to 95%, and postoperative adjuvant chemotherapy did not improve the survival rate. This subgroup of low-risk patients including the A period, an ovarian cancer; Many researchers will also Ⅰ A period of two or 1 B 1 or 2 patients with ovarian cancer, for example, want to preserve the reproductive function of a phase I, an ovarian cancer patients, has assumed full staging, can be considered alone Side tubal ovariectomy. Under such circumstances, if ovarian histological types classified as endometrial carcinoma, endometrial biopsies were conducted to rule out uterine cancer is both reasonable.
Risk factors for recurrence of the early ovarian cancer patients, including Phase 1 C, and the three-stage Phase II ovarian cancer patients. A platinum-based chemotherapy and early ovarian cancer patients in the high-risk related to the overall survival advantage, although the benefit seems to be limited to the staging of patients with incomplete.
For the following reasons, despite the need for the best benefit of chemotherapy cycles still controversial, but early ovarian cancer in high-risk patients normally use paclitaxel and carboplatin for postoperative chemotherapy. Gynecologic Oncology Group conducted a randomized clinical trial of patients with early ovarian cancer using Taxol and carboplatin three cycles of chemotherapy and six cycle, the results showed that the overall survival rate did not significantly different, but according to reports, to accept three cycles of chemotherapy in patients with high recurrence rate. Despite some high-risk patients with early ovarian cancer into the selective application of the whole abdominal radiotherapy, but the platinum-based chemotherapy for more in-depth research, application and also more broadly.
Advanced ovarian cancer <BR>
To taxanes and platinum-based intravenous chemotherapy is the treatment of advanced ovarian cancer after standard program. Platinum Complexes such as carboplatin and cisplatin in ovarian cancer is the most active drugs, these drugs with the formation of the DNA cross-link chain play a role. Instead, as taxanes paclitaxel and docetaxel and stability through a combination of tubulin polymerization of this unique mechanism to play its cytotoxic effect. Two randomized clinical trials showed that, and do not include the taxanes compared to the old regimen, paclitaxel and carboplatin combination chemotherapy can be extended in patients with advanced ovarian cancer-free survival and overall progress in survival time. Not tumor load reduced to the smallest patients (residual tumor diameter> 1 cm), paclitaxel and cisplatin in the treatment group the median overall survival time was 37 months, cyclophosphamide and cisplatin in the treatment group was 25 months.
In short, as a first-line drug Taxol appears to reduce the risk of death by 30%. The three randomized clinical trial of paclitaxel chemotherapy as a first-line part, the results showed no improvement in survival rates, the reason is not very clear. Recently it was reported that the Joint Taxol and carboplatin as first-line treatment with Taxol and cisplatin equally effective, but the former fewer vomiting, leukopenia and nephropathy. It is noteworthy that the best receiving debulking of the tumor in patients with advanced, Taxol and carboplatin joint program overall median survival time is about five years. While most patients can no difficulty to accept such a program, but a peripheral neuropathy may reduce the quality of life in some patients. On this point, and the Taxol and carboplatin combination therapy compared to docetaxel and carboplatin combination therapy can reduce neuropathy and considerable effect, but the role of bone marrow suppression stronger.
Accept Taxol and carboplatin chemotherapy for advanced ovarian cancer patients received more than 50% of clinical complete remission, defined as physical examination, CA125 detection and CT scans were normal. The clinical complete remission in patients with generally accepted medical examination and continuous monitoring of CA125, when a suspicious symptoms, abnormal physical examination or CA125 levels in the clinical indications, such as radiation screening CT scan. Although abdominal exploration of secondary (two exploration surgery) seems to be as high as 75% in patients with subclinical lesions found, but the lack of potential cure of remedial measures at its therapeutic value is uncertain. Thus, in addition to clinical trials are not normally conducted outside two surgical exploration.
While accepting the high activity of the front line chemotherapy, approximately 20% to 30% of patients during treatment were never clinical remission, persistent residual tumor or evidence of disease progression. The poor prognosis indicators advanced tumors, age> .65, the second best of tumor debulking, high-grade or clear cell histology findings, preoperative ascites, three cycles of chemotherapy after CA125 levels to the normal range, and after the first chemotherapy lowest CA125> TI.
Recurrent ovarian cancer treatment <BR>
Recurrence is advanced ovarian cancer patients with major problems. The recurrence of ovarian cancer are usually not a cure, the treatment goal is to reduce symptoms and prevent complications such as intestinal obstruction. Common signs of relapse in the absence of symptoms or physical examination and CT scan was normal circumstances, elevated serum CA125 level. Increased levels of CA 125 is considered the only signs of relapse, usually apparent than clinical tumor earlier, the median interval of at least three months. The treatment of recurrent ovarian cancer because the main goal is to reduce symptoms, and there is no strong evidence that early application of cytotoxic chemotherapy on the typical markers of elevated only in patients with relapsing benefits, such cases are usually considered if the application in the treatment of tamoxifen or aromatase inhibitors. Although less than 20% of the patients on hormone therapy effective, but sometimes patients with CA 125 levels dropped significantly, and some patients with stable disease may extend, thus avoiding the side effects of cytotoxic therapy.
Finally, the only signs of a recurrence in patients with disease progression, the need for second-line chemotherapy. Cytotoxic drugs are usually dependent on the choice of mitigation from the previous intervals. First-line chemotherapy for six months after the end of relapse in patients with platinum-sensitive might have 30% efficiency. The pair of platinum-sensitive, mild symptoms or tumor load in patients with small, single-choice carboplatin chemotherapy is reasonable, usually well tolerated with no apparent hair loss. For some patients, especially heavier and disease symptoms rapid progress, the use of platinum-based combination chemotherapy is reasonable. Mitigation for the first time after a relatively long period of time (more than six to 12 months) for patients with recurrent, if tumor can be removed before chemotherapy can be considered in debulking of the tumor (second cytoreductive surgery). However, this method has yet to random clinical trials to be tested.
Short-term remission after first-line chemotherapy, less than six months time patients usually right (not so) platinum resistance, often accept non-platinum chemotherapy. Moreover, sometimes some patients to platinum-based chemotherapy in the treatment of relapsed, a progressive nerve disease, reduce platelet accumulation of platinum or allergies, the need to switch to other drugs. Consider including drug doxorubicin liposome occasional parked for recreation, gemcitabine, paclitaxel, oral etoposide and vinorelbine. According to reports because each pair of platinum drug resistance in patients with an effective range of 10% to 20%, so the side effects are usually the occurrence and treatment facilities for drug selection. For example, doxorubicin liposome drug once a month, alopecia, nausea or myelosuppression lightest, when the main treatment is to reduce symptoms, doxorubicin liposome is a reasonable choice. Accept doxorubicin liposome-treated patients about 20% -30% of hand-foot syndrome (palmar-plantar erythrodyses - thesia), which is characterized in the palm of the hand, foot and other skin palm pressure point in erythema, tenderness and blister formation, sometimes with mucositis. Doxorubicin liposomes (for patients with relapsing same is true of other drugs) might slow, need three to four cycles can be a noticeable effect. For patients with recurrent, for the occasional Park Kang is another effective option, studies have shown that weekly regimen can be used to improve the survivability of patients. Although as a treatment in patients with platinum resistance of a single drug, doxorubicin liposome and the occasional parked Kang studied for the most extensive, but the above-mentioned other drugs may also effective. For patients with recurrent still need more clinical trials to determine more effective treatment options.
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