OVARIAN CANCER

Ovarian cancer is very common, all ages can ill, but 20 to 50 years old the most. Since early ovarian cancer patients have few symptoms, so early diagnosis difficult, attendance at the 70% already advanced, little access to early treatment, five-year survival rate always hovering in the 20 ~ 30%, is the most serious threat to women's lives malignant one.

One, classification

Ovarian cancer variety. In 1973 the World Health Organization (WHO) in accordance with the organization in the development of the international unity of origin of ovarian tumor classification, the tumor is divided into nine categories, were: 1. Ordinary "epithelial" tumor; 2. Sex cord stromal tumors; 3. Liposomes (Lipoid) tumors; 4. Germ cell tumors; 5. Gonadal blastoma; 6. Soft tissue-specific ovarian tumor; 7. Unclassified tumor; 8. The secondary (metastatic) tumors; 9. Tumor-like lesions. One of the most common are the following:

(1) The most common epithelial tumors, ovarian tumors accounted for 50 to 70%, with the most serous tumor, followed by mucinous tumors. Their histology and cytology characteristics, they are benign, borderline (low malignant potential tumor) and malignant points. Adenomas of epithelial ovarian cancer 90%.

(2) derived from embryonic germ cell tumors of the reproductive cells period, accounting for about 25% of ovarian tumors, germ cell tumors, benign cystic teratoma mature type (dermoid cyst), a malignant tumor of the embryo, immature teratoma, and Dysgerminoma.

(3) Cable of mesenchymal tumors accounted for 6% of ovarian cancer, there are granulosa cell tumor, theca cell tumor and fibroids.

(4) secondary (metastatic) tumors about 1 to 9%, from the most common gastrointestinal cancer transfer, was found signet ring cell, also known as the molecule's tumor.

2, benign ovarian tumors

Benign ovarian tumors accounted for 75% of ovarian tumors, most were cystic, smooth surface, state clearly, activities.

(1) common types:

1. Serous cystadenoma

About 25% of benign ovarian tumors common in patients aged 30 to 40. Unilateral more. Appearance was gray, smooth surface, the more a single, thin wall, the capsule containing Qingliang transparent pale yellow liquid, some cases that are inside papillary protrusions, group or cluster of group diffuse scattered, said papillary serous cystadenoma. Prominent nipple may wall, the surface spread of cyst growth, and even invade adjacent organs, such as with ascites, while malignant transformation has occurred.

2. About mucinous cystadenoma ovarian tumors 15 to 25%, most commonly in the 30 to 50 years old. For more unilateral. Tumor smooth surface for Portland white, with room, capsule containing powder-like mucus, occasionally wall with papillary protrusions, said papillary mucinous cystadenoma, right wall rupture, the tumor cells in the peritoneal Both surface and offal, a large amount of mucus, said peritoneal myxoma.

3. Also known as cystic teratoma mature teratoma or dermoid cyst. Ovarian tumors of about 10 ~ 20% 97% teratoma. In most of childbearing age. Tumor hand over fist for adult size, and more than 10 cm in diameter, unilateral majority, about 25% are bilateral, appearance for the park - or elliptical in shape, with yellow-white, smooth surface, wall thickness, section mostly single room, often capsule containing sebum and hair, we can see that teeth, bone, cartilage and nerve organizations occasionally thyroid tissue.

(2) clinical performance

Asymptomatic more benign ovarian tumors early, often in gynecological examination was found, or that tumors grow up with complications when patients were aware.

1. Consciously infrarenal abdominal mass in patients with gradually increasing mass in the abdomen or touched mass. Or gynecological examinations found mass.
2. Symptoms tremendous oppression benign ovarian tumors can produce symptoms of oppression. Cross separated from oppression as palpitation, dyspnea; Because of increased intra-abdominal pressure, the impact of lower extremity venous return, can cause lower extremity edema 2; When the bladder pressure can cause frequency, difficulty urinating or urinary retention; Rectal resorption in uterine tumors can cause rectal oppression falling flu or defecation difficult; Gastrointestinal oppression Road may arise abdominal discomfort, such as anorexia.
3. Pain generally benign ovarian tumors without abdominal pain, abdominal pain especially when there are suddenly more torsion of the ovarian tumor caused by the dual tumor rupture, bleeding or infection.

(3) complications

1. Torsion more common, as one of gynecological acute abdomen. Most of the pedicle length, the middle-size, activity, the focus of preferred side of the cystic neoplasms, and more intense in postural changes, early pregnancy or postpartum. Torsion, because venous tumor blocked, cause congestion, Violet was brown, and even vascular hemorrhage. May artery occlusion of tumor necrosis infection. Acute torsion, with a sudden sharp pain in the lower abdomen, can be associated with severe nausea, vomiting, or even shock. Check affected abdominal muscle tension, tenderness significant, larger mass tension. After a diagnosis, surgery to remove the tumor immediately. When the reverse of the Beattie will not switch, preferably in torsion of the proximal clamp cut off to prevent thrombosis off into the blood circulation.

2. Wall tumor rupture may avascular necrosis or tumor pierced wall erosion caused spontaneous rupture; Or because of extrusion, maternity, gynecological examinations and puncture caused by traumatic rupture. After the breakdown of liquid into the abdominal cavity to stimulate the peritoneum, can cause severe abdominal pain, nausea, vomiting, or even shock. Check with abdominal tension, tenderness, anti-peritoneal irritation signs such as sleep, the original mass shrunk or disappeared. After diagnosis, should immediately laparotomy, cyst removal, cleaning peritoneum.

3. Rare infection, the number of secondary tumors torsion or fracture. The main symptoms are fever, abdominal pain, and increased leukocyte varying degrees peritonitis. Infection control should be positive, elective surgical exploration.

4. Malignant transformation benign ovarian malignancy occurred in older postmenopausal especially the latter, tumor rapid increase in the short term, patients with flu bloating, loss of appetite, check tumor volume increased significantly, fixed, and more ascites. Suspected malignant transformation, should be promptly dealt with.

(3) Diagnosis

1. The early history of benign ovarian tumors can be asymptomatic, or larger lumps of complications, palpable abdominal mass, a symptom and pain and oppression.

2. Check larger abdominal tumor, abdominal uplift, fluctuations flu, no mobility Voiced.

3. The gynecological examination in the womb can hit one or both cystic mass, borders clear, smooth, activities, no tenderness, uterine tumor in the side or before the rear.

4. Auxiliary

B - (1): to clear the tumor size, shape, cystic, location and the relationship with the surrounding organs. Identification huge ovarian cyst and ascites.
(2) X-ray examination of the abdomen mature ovarian teratoma-ray images visible teeth or bones. Contrast can understand intestinal tumor location, size and intestinal relations.
3. CT and MRI of the option when necessary.

(4) Differential Diagnosis

1. Ovarian cysts as noneoplastic follicular cysts and corpus luteum cysts generally less than 5 cm in diameter, thin wall, a more natural ~ 2 months dissipated.
2. Uterine fibroid tumors may ovarian and uterine myoma cystic degeneration or subserosal uterine fibroids confusion. Ultrasonography can be diagnosed.
3. Soft increased uterine pregnancy, menopause history, can be diagnosed elevated hCG value. Ultrasonography is the embryo or fetal see Bo move.
4. Many have chronic urinary retention or urinary not dysuria net history, the center of mass in the lower abdomen, border unclear, catheterization after the mass disappearance may be by B-differential.
5. Annex chronic inflammatory mass pelvic inflammatory disease and infertility history, location of the lower mass, tenderness, and a uterus adhesion.
6. Ascites and tuberculous peritonitis (fluid inclusions) and the huge differential ovarian cyst.

Huge ovarian cyst, ascites, tuberculosis peritonitis (fluid inclusions) differential diagnosis

Ovarian cysts <BR> ascites <BR> tuberculous peritonitis

History <BR> consciously abdominal swelling from the side have increased since no mass, and more secondary to liver, kidney, heart disease organ, abdominal swelling gradually low heat, weight loss, gastrointestinal symptoms, often amenorrhea, abdomen gradually bulging <BR> abdominal <BR> seizure of <BR> <BR> search <BR> forward as attending <BR> abdominal protuberance, flanked on both sides of a sudden-, intermediate-more, if volatile <BR> Rana abdominal palpation <BR> can palpable mass, huge cyst is not palpable mass-less than a touch of flu or rub with irregular block of <BR > percussion <BR> drum sound on both sides, the middle voiced no real movement on both sides of Voiced sound, intermediate drum sound, mobility and drums sounded voiced Voiced limits volatile <BR> gynecological examinations <BR> uterus was more top-forward, not, after the dome uterine wall can be palpable sense of a ball Annex normal uterus can also be blurred and intestine and adhesions
B-mode ultrasound images <BR> <BR> round of the dark area of the border neat, smooth irregular dark liquid, which the floating-intestinal irregular cystic fluid dark, the regular bowel wall-league organizations
<BR> Gastrointestinal X-ray angiography were more umbilical <BR> gastrointestinal tube floating above the field, activities of the large intestine without lesions adhesion difficult to push away

(5) Treatment

1. The only benign ovarian tumor treatment is surgical excision. Cyst less than 5 ~ 6 cm in diameter, observed 3 to 6 months, continue to increase, or tumor is smaller than 5 cm in diameter, but for solid tumors, surgical resection should be.
2. Children, pregnant young patients with no more side to side or ovariectomy Annex resection. As for the bilateral benign ovarian tumors, ovarian tumors to be stripped of, as far as possible to retain some ovarian tissue to maintain menstruation and reproductive functions. Right after menopause, and bilateral ovarian tumors while uterine bilateral resection of the annex, was advocated in recent years should be retained normal ovarian tissue, and maintain normal physiological functions of women.
3. Resection of the tumor should be immediately opened exploration, if necessary, frozen biopsy.
4. Unilateral resection, when necessary, post-mortem as the contralateral ovarian biopsy or frozen.

3, malignant ovarian tumors

Malignant ovarian tumors accounted for 25% of ovarian tumors.

(1) common types

1. Serous cystic carcinoma is the most common malignant ovarian tumors, ovarian cancer accounted for 40 to 60%, 50 to 60% for both. The age of onset of 40 to 60 years old. Cystic or cystic tumor was solid, crisp and soft organizations, the surface were Synchronized vegetables, cauliflower-shaped capsule with nipple. Often associated with ascites, while often advanced pelvic peritoneum, the Network Service of abdominal tumors grow and transfer. 5-year survival rate is about 25 ~ 35%.
2. Mucinous adenocarcinoma incidence capsule after serous cystadenocarcinoma, smooth surface, with nodular. Cystic, the capsule can be seen in papillary mucinous processes, five-year survival rates of 40 ~ 50%.
3. Endometrial cancer (adenocarcinoma) rare, accounting for about 20% of ovarian cancer around, and often in the middle size, or part of the section is cystic, intracavitary see papillary processes. Endometrial tissue types with similar adenoma. 5-year survival rate is about 40 ~ 50%.

(2) clinical stage

Primary malignant ovarian tumor stage (FIGO, 1985)

Stage I ovarian tumors confined to a <BR> I ovarian tumors confined to the side, without ascites, the surface of tumor capsule integrity <BR> Ib limited to the bilateral ovarian tumor, without ascites, the surface of tumor capsule integrity <BR> I c I Ib or a tumor, but one or two lateral ovarian tumor surface; or capsule rupture; or there with malignant ascites cells; Lotion or peritoneal positive side <BR> II or bilateral ovarian tumors, pelvic associated with the spread of <BR> Ⅱ a spread and / or transferred to the uterus and / or tubal <BR> II b spread to the it pelvic organizations <BR> c II II II b period or a tumor, but the side or surface of bilateral ovarian tumor; or capsule rupture; or there with malignant ascites cells; positive or peritoneal washings <BR> one or both Phase III ovarian tumors, pelvic peritoneum outside the cultivation and / or retroperitoneal or lymphocytic inguinal node positive. Transfer liver surface as Ⅲ <BR> Ⅲ a tumor limited to the naked eye can see real pelvic lymph node negative, but histology confirmed peritoneal surface under the microscope cultivation.
Ⅲ b side or bilateral ovarian tumors, organized study confirmed the peritoneal surface cultivation, with a diameter more than 2 cm, node-negative <BR> III c peritoneal seeding diameter> 2cm and / or retroperitoneal lymph node-positive or groin <BR> Ⅳ side or bilateral ovarian tumors distant metastasis . If the pleural effusion stage IV cancer, liver real transfer Ⅳ

(3) clinical performance

Early ovarian cancer more asymptomatic, or accompanied by loss of appetite, bloating, gastrointestinal symptoms, is often overlooked. Late increase in the abdomen, abdominal pain and abdominal mass, or the original rapid growth of ovarian cysts, irregular vaginal bleeding and weight loss, anemia, cachexia.

(4) Diagnosis

Not obvious early symptoms of ovarian cancer, so early diagnosis depends on the regular census.

1. Past history should be asked whether particular pelvic mass or the recent history of tumor growth. Women over 40 years of age and unexplained gastrointestinal symptoms, and should be gynecological examinations.
2. Body check, can be found abdominal mass, ascites positive sign.
3. Gynecological examinations beside mass, although it is solid or cystic, irregular activities of the poor, and often bilateral. Triple consultation found dome nodule or mass.
4. Auxiliary

(1) B-understand pelvic mass the size of the capsule is, whether benign or malignant ascites.
(2) cytology puncture through the abdominal cavity search from ascites tumor cells.
3. Immune diagnosis of carcinoembryonic antigen (CEA) in epithelial ovarian cancer in particular mucinous carcinoma increased significantly, a reference value. Alpha-fetoprotein (AFP) help to increase ovarian endodermal sinus tumor diagnosis. Epithelial ovarian cancer monoclonal antibodies and polyclonal antibodies as CA125 application help early diagnosis.
(4) laparoscopy or laparotomy under observation in the heart of pelvic lesions nature, scope, and biopsy.

(5) Treatment

1. Surgical treatment is the most important methods of treatment should first exploratory abdominal surgery, clear lesions, lymph node metastasis. Stage I cancer surgery, abdominal or intraperitoneal should be sent for washing fluid cytology. As for the annex hysterectomy and bilateral resection, resection of the retina and appendectomy resection of tumor capsule integrity, low grade, peritoneal fluid was found in tumor cells Ⅰ a period of young patients may be affected only annex resection and postoperative follow-up closely. II, III and IV cancer surgery and the addition of the same stage of cancer, and abdominal aortic dissection to pelvic lymph nodes, and may pelvic and abdominal diameter of 2 cm above the metastatic tumor resection January 1. Extensive removal of the above on the basis of small residual lesions may be eradicated by chemotherapy or radiotherapy. It is impossible to radical mastectomy, should be most tumor resection and postoperative chemotherapy, to be narrowed again after tumor surgery.

2. Ovarian cancer chemotherapy more sensitive to chemotherapy, with the longest and certainly more effective drugs for alkylating agent, other drugs have a role. Currently used drugs cyclophosphamide, thiotepa, styrene-acrylic acid nitrogen mustard, Dactinomycin, melphalan, of Ning, 5 - fluorouracil and pyrimidine Liujia, cisplatin, doxorubicin,. Alone or in combination repeatedly over course of treatment. Route of administration, with the exception of general application, could still be in the abdominal wall and intraperitoneal administration of arterial injection, to reach a higher local drug concentration, increased efficacy.

3. Radiotherapy large intraperitoneal injection, tissue reaction too, with no tolerance of less. Applications in recent years with high-voltage mobile multiple-irradiation technology to reduce pay response to the prevention of tumor recurrence may play better results. Radioisotopes can also be used intraperitoneal injection of 32P.

4. Disease-free treatment, in recent years the rise of a complementary therapy, which aims to enhance immune function and specificity of anti-tumor cells, has now entered the stage of clinical use.

Surgery, chemotherapy and radiotherapy three methods integrated applications, will enable patients with ovarian cancer survival rate has increased recently.

Ovarian cancer recurrence after treatment often easy, once relapse, treatment is extremely difficult, ineffective, the five-year survival rate can only achieve 20-30%. Therefore, the follow-up should be strengthened. In recent years, and even abroad have repeatedly used again laparotomy, in clear and resection of residual and recurrent lesions, and achieved certain effects. If the tumor has indeed disappeared, stopping chemotherapy. Laparotomy time again to chemotherapy treatment after 12 better.

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