The ovary tumor is very familiar, various age all can fall ill, but with 20~50 years old at most see.Ovary malignant tumor because of falling ill in the early years a few sympton, so diagnosed a difficulty in early days, 70% has already belonged to a later period while seek medical advice, canned seldom get to treat in early days, 5 year, the survival rate always went back and forth in 20~30%, was currently to threaten women’s life the most serious one of the malignant tumors.
A, categorize
The category of ovary tumor is numerous.World Health Organization(WHO) drew up according to the histogenesis enzymology origins in 1973 the nations unify of ovary tumor classification method, is divided into nine major types: tumor, one by one in order is:1.common”epithelium” tumor;2.the tumor of sex cords mesenchyme;3.lipid(lipid quality) tumor;4.generative cell tumor;5.gonad blastoma;6.the non- ovary specificity soft tissue tumor;7.DO not categorize a tumor;8.after hair(transfer sex) tumor;9.neoplasm kind pathological changes.Most familiarly have the following several specieses among them:
(A)Epithelium the tumor be the most familiar, take up 50~70% of the ovary tumor, is known as the majority of the syrup liquid tumor to see among them, secondly is a mucilage tumor.With its histology and the cytology characteristics, they are each to separate positively, hand over the kingdom( the low degree the latent malignant tumor) and the malignancy.The epithelium adenoma takes up 90% of the ovary malignant tumor.
(Two)The generative cell tumor comes from the generative cell of embryo period, share ovary tumor about 25%, in the generative cell tumor, positive have results to show familiar type capsule teratoma(dermoid cyst), the malignancy has inside the embryo sac neoplasm, immaturity teratoma and dysgerminoma etc..
(Three)The tumor of sex cords mesenchyme takes up 6% of the ovary tumor and mainly have a granulocyte neoplasm, neoplasm and fibroid of the follicular theca, theca folliculi cell.
(Four)Has 1~9% around after the hair(transfer) tumor, the most familiar for the transfer cancer from stomach and intestines way, mirror bottom it is thus clear that print to quit a cell, and then call database be willing to Bo surname neoplasm.
Two, positive ovary tumor
The positive ovary tumor takes up 75% of the ovary tumor, the most presents capsule, the surface is smooth, the state is clear, can activity.
(A)Familiar type:
1.strach a liquid a cystadenoma
Take up 25% of the ovary benign tumor around, familiar at the 30~40-year-old sufferer.Take single side as polypeptide.The appearance presents a grey color, the surface is smooth, the polypeptide is a single atrium, the capsule wall is thinner, the capsule contain thin yellow clear clearing of liquid, there are parts of cases it is thus clear that inside the wall have the nipple form the enation, cluster cluster conglobation or fill the air to spread at, call a nipple form syrup a liquid a cystadenoma.Nipple can outstanding capsule wall, spread growth in the cyst surface, even invade and close by organ, have an ascites such as the companion, many then have already bad mutation happenned.
2.mucilage the cystadenoma takes up 15~25% of the ovary tumor around, the most familiar in 30~50 years old.The polypeptide is a single side.The tumor surface is smooth, is orchid white, present to have another atrium, the capsule contains the Ou powder kind mucilage, accidentally see a nipple form in the capsule wall enation, call the nipple form mucilage cystadenoma, right capsule wall broken, the oncocyte can be plant in peritoneum and internal organs surface, produce a great deal of mucilage and call a peritoneum myxoma.
3.the mature teratoma calls the capsule teratoma or dermoid cyst again.Share ovary tumor about 10~20%, have 97% of teratoma.Mostly take place is grow age.The tumor polypeptide is an adult hand boxing size, the true conjugate diameter, anteroposterior diameter is much small at the 10 cms, single side mostly, about 25% is a pair of sides, the appearance is park form or form in the Tuo park and present Huang white, the surface is smooth, the capsule wall is thicker, slice leontiasis ossea polypeptide for the single atrium, often contain sebum and hair inside capsule, may also see tooth, palatine bone, cartilage and nervous tissue, accidentally see thyroid gland tissue.
(Two)Clinical situation
The ovary benign tumor had no sympton more in early days, often disheveled hair when the gynecology check now, or need a tumor to have a complication after grow up is just detect by the sufferer.
1.abdominal part lump the sufferer aware of self the inferior belly lump to enlarge gradually or touch to wrap a piece in the abdominal part.Or discover to wrap a piece when the gynecology check.
2.the huge ovary benign tumor of the stress sympton can produce a stress sympton.Such as stress horizontal separate to cause a palpitation, dyspnea;In order to pressing increment inside pneumoperitoneum, affect the lower limbs venous return, can cause two lower limbs edenas;The bladder can cause frequent micturition, dysuria or urine retention when the bladder is press;Be located on the sunken tumor of the uterus rectum can oppress a rectum to cause to crash down feeling or have a bowel movement a difficulty;Oppress the stomach and intestines way can also appear a superior belly unwell, anorexia etc..
3.the abdominal pain positive ovary tumor generally has no abdominal pain, the one who be to appear an abdominal pain to particularly break out, mostly the ovary tumor pedicle turn round with the result that, accidentally is the tumor rupture, bleeding, hemorrhage or infection.
(Three)Complication
1.the pedicle turn round more familiar, is one of the gynecology acute abdomens.BE see in neoplasm pedicle longus more, medium etc. size, movable degree big, the center of gravity be partial to the capsule of one side tumor and much take place at position nasty chop about to move, early trimester of pregnancy or postpartum.The pedicle gets difficulty because of the tumor venous return after turn round, cause a congestion and present purple brown, even afferent rupture bleed.Can because of iliac artery obstruction with the result that tumor occurrence necrosis, infection.When acute pedicle turn round, the sufferer broke out the inferior belly violent ache, serious hour can companion nausea, vomit, even shock.Suffer from the side abdominal wall iliacus strain while check, the tenderness shows Zhao and the lump tension is bigger.After confirm as soon as, should immediately the surgical operation cut off a tumor.Shu don’t turn the pedicle for turn round convolution, proper turn round a near side pliers to clip micking in the pedicle, keep thrombus abscission from get into blood circulation.
2.the tumor rupture can wear through a capsule wall to cause because of necrosis or tumor erosion of the capsule wall ischemia self-moving sex broken;Or squeeze, give birth to baby because of be subjected to, gynecology check and puncture with the result that the trauma is broken.Broken empress the capsule sap flow go into belly cavity, stimulate peritoneum, can cause a violent abdominal pain, nausea, vomit, even shock.Have an abdominal wall strain, tenderness, rebound tenderness while check etc. the belly cavity stimulation ketone body advertise for and the lump contracts or disappears at first.After confirm, should immediately the Pou pneumoperitoneum fish for, cut off a cyst and clean peritoneum.
3.the infection less sees, much turn round at the tumor pedicle after the hair or broken etc..The cardinal sympton has a fever, abdominal pain, leucocyte, white blood cell, WBC to go up and different degree peritonitis.In response to the aggressive control infection, pick a date surgical operation to fish for.
4.the benign tumor of the malignant change ovary is bad to become more occurrence at the age Menopause the latter more and greatly and particularly, tumor quick augmentation in the short run, sufferer meteorism, loss of appetite, check a tumor physical volume to obviously enlarge, fixedly, have ascites more.The Yi one who have malignant change should process in time.
(Three)Diagnose
1.the history ovary of the disease the benign tumor can have no sympton in early days, when the lump was bigger or had a complication, Men and inferior belly then wrap a piece and appear stress sympton and abdominal pain etc..
2.abdominal part check when the tumor be bigger, the abdominal part swells up, there is fluctuation, have no the translation muddy sound.
3.the gynecology check can touch capsule to wrap a piece in a side of the uterus or double side, boundary clear, smooth, activity, have no tenderness, the uterus is located on a side of the tumor or it front, rear.
4.the assistance check
The ? B is super:Can the size, appearance, the capsule solid, part of explicit tumor and with surroundings the relation of the dirty machine.Discriminate huge ovarian cyst and ascites.
The abdominal part even slice of the ? X line mature teratoma of the check ovary it is thus clear that tooth or skeletal shadow elephant.Intestine way the relation between position, size and intestine way which build a shadow and can understand a tumor.
? CT and nuclear magnetic resonance, NMR check can choose an application when it’s necessary.
(Four)Differential diagnosis
1.the born nature cyst of the ovary non- Zhui be like ovarian follicle cyst, lutein cyst…etc., the general true conjugate diameter, anteroposterior diameter sterigma is at the 5 cms, the wall is thin, much in 1~2 month spontaneous regressions.
2.myoma of uterus ovary the tumor probably descends a myoma of uterus with mutation or plasma membrane of the myoma of uterus capsule to confuse.The B super check can definitely diagnose.
3.the Yun uterus augmentation mutation is soft and have already stop menstruating history, the hCG value goes up and can confirm.The B is super to see embryo sac or foetus cardiac loop Bo move.
4.the chronic urine retention has dysuria more or wets the history of not clean disease, wrap a piece to be located on an inferior belly exact center, the boundary isn’t pure, transduction ketonuria behind wrap a piece to namely disappear, may also use B a super check an identification.
5.the enclosure ingluvitis wrap a piece to contain chronic pelvic inflammatory disease and infertility, sterility history and wrap piece position lower, have already touched a pain, have with uterus to glue connect.
6.ascites and tuberculous peritonitis(the encapsulation accumulate a liquid) with huge ovarian cyst identification.
Huge ovarian cyst, ascites, tuberculous peritonitis(the encapsulation accumulate a liquid) differential diagnosis
Ovarian cyst
Ascites
Tuberculous peritonitis
The history of disease
The insight has a lump to start a gradual augmentation from inferior belly a side have no lump, polypeptide after hair at the liver, cystic kidney, heart organ disease, abdominal part gradually the Peng be big and low heat, emaciated, alimentary canal sympton obvious, often menostasis, abdominal part gradually Peng Long
Pneumoperitoneum
Department
Check
Check
Inspection
Abdominal part forward enation, two sides are more even two side evaginationses, the middle is more even, such as frog pneumoperitoneum not certain
Palpation
Can touch a lump, huge cyst then not easy Men’s being pure to could not touch a lump have already kneaded leontiasis ossea or have an irregular piece form a thing
Percussion
Two side drum the sound, the middle muddy sound, have no translation muddy sound two sides solid sound, mid drum sound, have translation muddy sound muddy sound and the drum sound boundary not certain
The gynecology check
The uterus has another a quilt cupula forward, inaction, empress fornix can Men and capsule wall uterus have ballottement uterus the enclosure and can normally can also glue with gut to connect but can not understand
The B super voice
Picture
The circular liquid area opaca, the boundary is tidy, smooth and irregular liquid area opaca, have an intestine Tao Kuang the blastophore to float an irregular capsule liquid area opaca among them, the wall is often a gut light blastophore tissue
X line stomach and intestines
Build a shadow
The stomach and intestines has another quilt umbilicus outwardly gut flotage above, the movable degree is big and have never shared a pathological changes gut to glue connect don’t easily push away
(Five)Treat
1.the only treatment method of positive ovary tumor be a surgical operation to cut off.The cyst true conjugate diameter, anteroposterior diameter sterigma is at the 5~6 cm, can observe for 3~6 months, if continue to enlarge, or tumor true conjugate diameter, anteroposterior diameter although the sterigma is at the 5 cms, is a solid sex tumor, all cut off in response to the surgical operation.
2.to the child, young don’t Yun sufferer, much adopt to suffer from side ovariectomy or suffer from a side enclosure resection.Such as is a pair of sides ovaries benign tumor, proper line the ovary tumor peel off Shu, reserve parts of ovary tissues possibly, with maintenance menstruation and grow a function.In front and back combine to the Menopause a pair of sides ovaries tumor then goes uterus double more side enclosure resection, someone’s assertion should still reserve normal ovary tissue in recent years, and maintain a female and normal physiology function.
3.the tumor cut off should immediately split open to fish for and make to keep a biopsy check in deep freeze when it’s necessary.
4.the single side tumor sees the side ovary Pou or makes to keep a biopsy check in deep freeze when it’s necessary after cut off.
Three, malignant ovary tumor
The malignant ovary tumor takes up 25% of the ovary tumor.
(A)Familiar type
1.the syrup liquid the cystadenocarcinoma be the most familiar malignant ovary tumor, take up 40~60% of the ovary malignant tumor and among them, 50~60% is a pair of sides.Be taken bad age at 40~60 years old.The tumor presents capsule or the capsule solid and organize soft but frailty, the surface presents the kind of condy-loma accuminata and be full of the form nipple of condy-loma accuminata inside capsule.Often merge ascites, the later period often has an antrum peritoneum, big net pneumoperitoneum etc. of tumor implantation and transfer.The 5 years survival rate is about 25~35%.
2.the mucilage cystadenocarcinoma incidence rate be only next to strach a liquid cystadenocarcinoma and the surface is smooth and present a tubercle form.The capsule solid, may also see a nipple form enation for the mucilage inside capsule, the 5 years survival rate is 40~50%.
3.mucous membrane, endometrium kind the cancer(adenocarcinoma) be seldom seen and take up 20% of the ovary malignant tumor around or so, often is medium etc. size, slice the leontiasis ossea solid or parts of capsules, see a nipple form an enation inside capsule antrum.Organize type similar to mucous membrane, endometrium adenoma.The 5 years survival rate is about 40~50%.
(Two)The clinical cent expect
The cent which delivers a sex ovary malignant tumor at first expect(FIGO, 1985)
The ? period tumor is limited by ovary
The tumor of ? an is limited by one side ovary, have no ascites, the surface has no tumor, envelope, peplos integrity
The tumor of ? b is limited by two side ovaries, have no ascites, the surface has no tumor, envelope, peplos integrity
The ? c ? an or the ? b period tumor, but a side ovary surface have a tumor;Or the envelope, peplos be broken;Or appear an ascites to contain a bad sexual cell;Or the belly cavity wash liquid masculine gender
The ? expects a side ovary tumor, companion basin antrum internal diffusion
The ? a spreads a demulcent therapy, reconciliation/or transfer uterus/or fallopian tube
The ? b spreads other basin antrum tissue
The ? c ? an or the ? b period tumor, but a side ovary surface have a tumor;Or the envelope, peplos be broken;Or appear an ascites to contain a bad sexual cell;Or the belly cavity wash liquid masculine gender
The ? expects a side ovary tumor, there is peritoneum implantation outside the basin antrum demulcent therapy, reconciliation/or posterior belly shell membrane or groin the wood fawn on masculine gender.The liver surface transfer settles to expect for the ?
The ? a tumor naked eye see be limited by true pelvic, lymph node feminine gender, but the histology confirm that the peritoneum surface has a microscope a bottom an implantation.
The ? b a side ovary tumor, have the peritoneum surface of histology confirmation the implantation, its true conjugate diameter, anteroposterior diameter none is over the 2 cms, lymph node feminine gender
The ? c belly cavity implantation true conjugate diameter, anteroposterior diameter>2 cm demulcent therapy, reconciliation/or posterior belly shell membrane or inguinal gland masculine gender
The ? expects a side ovary tumor to contain distance transfer.If thoracic cavity water’s hasing a cancer cell is a ? period, liver parenchyma the transfer expects for the ?
(Three)Clinical situation
The ovary cancer had no sympton more in early days, or the companion was loss of appetite, meteorism etc. alimentary canal sympton, is often neglect.The later period appears abdominal part augmentation, abdominal pain and the abdominal part swollen thing, or the original ovarian cyst quickly grow up, the irregular vagina bleed and emaciated, Anemia etc. cachexia.
(Four)Diagnose
The ovary cancer earlier period sympton isn’t obvious, so diagnosed to depend on periodical census in early days.
1.the history of disease’s should specially inquire has already had no basin in the past antrum lump history or recently swollen thing growth circumstance.The one who haven’t clear alimentary canal sympton but reason of women over 40 years of age should go a gynecology check.
2.whole body check, can discover an abdominal part lump, the ascites advertises for masculine gender.
3.gynecology check temple side lump, although solid or the capsule solid, irregular, movable degree bad, often is a pair of sides.Three match to diagnose to discover that fornix tubercle or lump are behind.
4.the assistance check
The ? B super check understanding basin antrum wraps the size, the capsule solid, good malignancy of piece and has already had no ascites.
The ? cytology check takes an ascites to check oncocyte through a belly cavity puncture.
The diagnosis carcinoembryonic antigen(CEA) of the ? immunology is in the cancer of ovary epithelium particularly is the mucilage the cancer go up obviously, there is reference value.The nail foetus proteinase(AFP) goes up to contribute to the blastula sinus neoplasm in the ovary of diagnosis.Monoclonal antibody and polyclonal antibody of the cancer of ovary epithelium contributed to diagnose in early days such as CA125’s applications.
? Laparoscopy or Pou pneumoperitoneum fish for an energy at orthoptic under the pathological changes property, scope of observation basin antrum, and make to live check.
(Five)Treat
1.the surgical operation treatment be the treatment method of most, surgical operation should fish for belly cavity first, explicit pathological changes scope, have already had no lymph node to transfer.The ? expects a cancer at surgical operation of in the meantime, should send to belly cavity liquid or belly cavity douche, rinsing liquid to make a cytology check.May well can do the side enclosure resection, retina resection of whole uteruseses and double and appendectomy, the neoplasm envelope, peplos integrity, malignancy degree are low, belly cavity liquid in do not discover that the ? an of oncocyte expects the young sufferer can only make to suffer from side enclosure resection, post-operative tight with visit.? , ? And ? expect the surgical operation scope of cancer in addition to the demulcent therapy, reconciliation ? expect cancer homology, the beard cleans up the antrum lymph node of abdominal aorta and basin, and possibility basin true conjugate diameter, anteroposterior diameter inside the antrum, belly cavity cuts off one by one in the 2 cms above transfer neoplasm.At above the extensive cut off of basal up, the remenant small scaled pathological changes may use a chemotherapy or put to treat to exterminate.When impossible line cured for good Shu, as well in response to cut off greatly parts of tumors, post-operative chemotherapy, after needing a tumor to contract again surgical operation.
2.chemotherapy ovary cancer to chemotherapy comparison sensitive, the most long use but the effect more affirmative drug is an alkylating agent, the other drug also has a certain action.The in common use drug annulose Lin amide, Mao substitutes Mao, benzene C sour nitrogen Jie and live a new life the mildewed vegetable, Ma3 Fa3 Lan2, neoplasm currently can rather, 5 ? fluorine urea pyrimidines and six nail pyrimidines, agreeable platinum, adriamycin…etc..Can alone or the symphysis again and again carry on many to treat a distance treatment.Route of administration, in addition to the whole body is applied outside and fair at the belly cavity inside use medicine and inferior epigastric artery intubation infusion, make the partial drug attain higher concentration, accentuate curative effect.
3.put to treat big area belly cavity to inject, tissue responds too greatly, sufferer can’t tolerance, application less.Apply a high volt girdle form to move many irradiation techniques in recent years, can reduce to pay a reaction, may rise better effect to the prevention tumor relapse.May also use infusion inside the belly cavity of the radioisotope, RI 32 P.
4.do not need a disease treatment is one species assistance risen in recent years of treatment means, its purpose in order to accentuate the machine ketone body immunity function, the specificity kills to harm swollen oncocyte and have already turned into a clinical usage stage currently.
Surgical operation, chemotherapy and put to treat three species method comprehensive applications, can make ovary cancer sufferer of the livability has an exaltation in the near future.
The ovary cancer often easily relapses after treat, once relapse, treat extremely difficult, ineffective, five year, the livability general can attain 20 ?s 30% be or so.Therefore should strengthen with visit.In recent years, the abroad has an adoption again many Pou pneumoperitoneums to even fish for, with explicit curative effect and excision remnants remaining and be taken bad cooking stove again, obtain certain curative effect.If the tumor indeed has already disappear, can stop a chemotherapy.Again the Pou pneumoperitoneum fish for of time is better after the chemotherapy 12 treat a distance.
