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1、Ovarian carcinom 卵 巢 肿 瘤,Department of Obstetrics and Gynecology 妇产科 Zhang Wei 张 蔚,卵巢,女性内生殖器,Difficult to be detected in earlier period 不易早期发现 The 5year survival of Ovarian carcinoma is low (25%-30%) 卵巢恶性肿瘤5年存活率较低,Purpose and Request,Clinical manifestations 临床表现,2,Diagnosis and treatment 诊断及治疗,3,His
2、tological types 组织学分类,1,Histological types 组织学分类,Malignancy 恶性,Benign 良性,Borderline 交界性,Histological types 组织学分类,Epithelia tumors 上皮性肿瘤 Germ cell tumors 生殖细胞肿瘤 Sex cord stromal tumors 性索间质肿瘤 Lipid cell tumor 脂质细胞瘤 Gonadoblastoma 性腺母细胞瘤 非卵巢特异性软组织肿瘤 No-classified tumors 未分类肿瘤 Metastases tumors 转移性肿瘤 T
3、umour-like condition 瘤样病变,Clinical manifestations 临床表现,Ovary benign tumor 卵巢良性肿瘤,Slowmoving, mostly asymptomatic in earlier period; Compression symptom may be found when tumor augmentation,发展缓慢，早期多无 症状，肿块增大可 出现压迫症状,eisimptmtik adj.无症状的,Ovary malignancy tumor 卵巢恶性肿瘤,Frequently asymptomatic in earlier
4、 period, Once symptoms occurrence Most include: abdominal distension, abdominal mass and ascites,早期常无症状，一旦出现常表现为：腹胀腹部肿块和腹水,saiti:z n.腹水,Complications 并发症,Torsion of pedicle 蒂扭转 Rupture 破裂 Infection 感染 Canceration 恶变,Diagnosis 诊断,Ultrasound 超声检查,Tumor marker 肿瘤记标物,Abdominoscope 腹腔镜检查,Radiological dia
5、gnosis 放射学,Cytological examination 细胞学,Tumor marker 肿瘤记标物,AFP endodermal sinus tumor 卵巢内胚窦瘤 HCG choriocarcinoma 绒毛膜癌 CA125 Ovarian epithelial cancer 卵巢上皮癌 性激素 Granular cell carcinoma 颗粒细胞癌,Differentiate 良性肿瘤和恶性肿瘤鉴别,Route of metastasis 转移途径,Direct metastasis 直接蔓延 Abdominal metastasis 腹腔转移 Lymphatic m
6、etastasis 淋巴转移 Hematogenous metastasis 血行转移,mtstsis n.转移,FIGO staging of ovarian neoplasms,Stage Definition I growth limited to the ovaries 肿瘤局限于卵巢 I a one ovary involved 局限单侧卵巢 I b both ovary involved 局限双侧卵 I c a orb with ruptured capsule, tumor on the surface of capsule, positive peritoneal washin
7、gs or malignant ascites a 或b 肿瘤伴以下任何情况：包膜破裂，卵巢 表面有肿瘤，腹水或腹腔液中洗液中含有恶性细胞 extension of the neoplasm from the ovary to the pelvis 卵巢肿瘤向盆 腔内转移 a extension to the uterus and tubes 蔓延到子宫和输卵管 b extension to other pelvic tissues 蔓延到其他盆腔组织,Stage definition,c a or b with rupture capsule, positive peritoneal was
8、hings or malignant ascites a 或b 伴包膜破裂或腹腔冲洗液含恶性细胞 disease extension to the abdominal cavity 肿瘤向腹腔转移 a abdominal peritoneal surfaces with microscopic metastases 盆腔腹膜表面有镜下转移 b tumor metastasis2cm in size 腹腔转移灶直径2cm c tumor metastasis2cm in size 腹腔转移灶直径2cm distant metastatic disease 远处转移,FIGO staging of
9、 ovarian neoplasms,Therapy 治疗,Purpose of surgery手术目的 Clarify a diagnosis 明确诊断 Excision of tumors 切除肿瘤 Malignancy tumor carry out operation-Pathology staging 恶性肿瘤进行手术-病理分期,Ovary epithelia tumors 卵巢上皮性肿瘤,Risk factors 高危因素,Incessant ovulation 持续排卵 Inherent cause 遗传因素 Environmental factors 环境因素,Histolog
10、ical types 组织学分类,Serous cystadenoma 浆液性囊腺瘤 Mucinous cystadenoma 粘液性囊腺瘤 Endometrioid tumor 卵巢子宫内膜样肿瘤 Clear cell tumor 透明细胞肿瘤 Brenner tumor 勃勒纳瘤 Undifferentiated carcinoma 未分化癌,Serous cystadenoma,Lubricous surface spina bifida cystic 表面光滑囊性 Filled with amber liquid 充满淡黄色液体,Most proportion of ovary mal
11、ignancy tumor , about 40-50% 最常见的卵巢恶性肿瘤,占40-50%,Myxoma peritonei 腹膜粘液瘤,Endometrioid carcinoma,囊液多为 血性,Hydatid fluid is usually uprightness,Operation therapy 手术治疗,Early stage 早期 Choose the surgical procedures according to staging 按分期确定手术方式 Advanced stage 晚期 肿瘤细胞减灭术(Cytoreductive surgory ) :对晚期(期及其以上)
12、患者应尽量切除原发病灶及转移灶，使肿瘤残余灶直径2cm，必要时切除部分肠曲，行结肠造瘘、切除胆囊或脾等,Chemotherapy 化学治疗,Control recurs 控制复发 Ease symptoms 缓解症状,Chemotherapy schema 化疗方案,TP,TC,PC,顺铂 P,环磷酰胺 C,紫杉醇 T,卡铂 C,紫杉醇 T,顺铂 P,Second-line therapy 二线化疗,以往未用铂类者可选用铂类的联合化疗 在铂类药物化疗后6个月以上复发用以铂类为基础 的二线化疗有效 难治性患者选与铂类无交叉耐药的药物,Borderline tumor 交界性肿瘤,Surgical
13、 therapy 手术治疗,Ovarian germ cell tumors 卵巢生殖细胞肿瘤,Pathology types 病理分类,Immature teratoma,Malignancy tumor 恶性肿瘤 The peak incidence adolescent 好发于青年人,属良性肿瘤。切面多为单房，腔内充满油脂 和毛发，有时可见牙齿或骨质,Dysgerminoma 无性细胞瘤,Yolk Sac Tumor 卵黄囊瘤,chemotherapy schema 化疗方案,BEP BVP VAC,长春新碱 V,放线菌素D A,环磷酰胺 C,博来霉素 B,顺铂 P,依托泊苷 E,ova
14、rian sex cord stromal tumor 卵巢性索间质肿瘤,Estrogen-producing granulosa cell tumor 颗粒细胞瘤 Theca cell tumor 卵泡膜细胞瘤 Androgen-producing sertoli-Leydig cell tumor 支持细胞-间质细胞瘤,Fibroma 纤维瘤,Most common in the elderly and accounts for 2-5% of all ovarian neoplasm 多见于中年妇女，占卵巢肿瘤的 2-5% Meigs syndrome.（ascites hydrotho
15、rax ） 梅格斯综合征（腹水 胸水 ）,Fibroma 纤维瘤,A special metastatic adenocarcinoma. 一种特殊的转移性腺癌 Primarily site is gastrointestinal. 原发部位为胃肠道,Krukenberg Tumor,Preservation 预防,Prevent the high risk 预防高危因素 Evolve mass screening, general treatment 开展普查普治 Discover and disposal earlier 早期发现及治疗,Latest advancement 最新进展 近年来, 发现了许多具有判断卵巢癌预后潜力的标志物,细胞周期调节蛋白 Cyclin及 肿瘤蛋白 oncogene ,人激肽释放酶基因 家族 KLK,血红蛋白及血小板 Hb PLT ,生长因子 GF ,1.What are the risk factors of ovarian carcinoma ?,2.How to prevent ovarian carcinoma ?,Main References 主要参考文献,THANK YOU!,