The ovary cancer all says
?All say ?
The ovary cancer is a vagina officer one of the familiar tumors, the outbreak rate only next to cervical cancer and corpus uteri cancer but row occupy the third.But cause death, have each kind of gynecology tumor because of the ovary cancer of first, bring serious threat to women’s life.Because of the embryogenesis, embryogeny of ovary, tissue anatomy and endocrine, internal secretion function are more complicated, it the tumor suffer from may be positive or malignant.Because clinical earlier period of ovary cancer have no sympton, discriminate it to organize type and good, the malignancy be very difficult and the ovary cancer goes to discover in the exploratory laparotomy that the tumor limits at only have of the ovary 30%, mostly have already spread to uterus and the double side enclosure, greater omentum and basin are each organ of antrum, so the ovary cancer regardless indeed is one great hard nut to crack in diagnosing and treating.Have another the in the last years experts pathologic appearance to the ovary malignant tumor, the clinical occurrence evolves regulation and treats a project to carry on many studies, backlog a great deal of of experience, so far, domestic and international clinical data statistics, it five year, survival rate only 25% ?s are 30%s.
?The pathology change ?
The complexity of the tissue appearance of the ovary tumor is more than any organs, this is because of:The tissue structure of the ? ovary have latent rich in evolve of have another energy;The ? ovary is very close in the embryogenesis, embryogeny period and the urinary system and parts of mesonephros tissues can get lost into ovary;The ? ovary comes from an embryo reproduction crista, cristae, men and women together source, hereafter square differentiation.The classification method of ovary tumor is a lot of, this chapter classification which adopt to take histogenesis as a basis but have clinical practical meaning.
(A)blastula epithelium(vice- mesonephros body cavity epithelium) the ovary malignant tumor of the source such as syrup liquid gonad cancer, mucilage gonad cancer, mucous membrane, endometrium kind adenocarcinoma, mixing syrup the clear cell carcinoma of kidney in the liquid mucilage cystadenocarcinoma, fiber adenocarcinoma, malignant Bo Lei Na surname neoplasm, pair, divide(anaplasia) cancer etc., these tumors sometimes had flavin to turn an action.
(Two)blastula cell the ovary malignant tumor of the source be like teratocarcinoma and deliver sex chorion epithelioma, dysgerminoma…etc. at first, can sometimes secrete hormone.
(Three)sex don’t differentiation the ovary malignant tumor of the leaf, frond source such as benign tumor 1~6 together sarcoma, malignant mixing mesodermal tumor neoplasm, carcinosarcoma.
(Four)sexual differentiation the ovary malignant tumor of the leaf, frond source stem from the function of ketone body hormone because of have, and then call a function tumor, all belong to a latent malignant tumor.
1.feminization leaf nodule:Have the ? stratum granulosum the cell neoplasm;The ? follicular theca, theca folliculi cell neoplasm;The ? stratum granulosum -follicular cell, granulosa cell neoplasm.
2.macho leaf nodule:There is ? containing a testis cell neoplasm;? Hilus cell neoplasm.
3.the both sexes turn;Two meiocyte neoplasms.
(Five)occurrence from the ovary malignant tumor of mesonephros damaged site is like malignant mesonephroma.
(Six)the occurrence is from malignant adrenal gland cell damaged site neoplasm of the ovary malignant tumor of allosteric site tissue inside the ovary.
?Clinical situation ?
The malignant ovary tumor had no subjective symptom more in early days and appeared a sympton usually condition already till later period.Because the tumor growth quickly can have meteorism, abdominal part lump and ascites in the short run.When tumor to infiltration or stress sacral nerve of the surroundings tissue, can cause abdominal pain, lumbago or sciatica, if stress basin vena cava, can appear lower limbs edema, generally don’t cause menstruation mess, if double the side ovary be all organized breakage by the cancer, can cause to have irregular menses demulcent therapy, reconciliation menostasis.Function in addition and if tumor, can produce homologous estrogenic hormone or the androgen excessive sympton.Such as:Cause sex out of tune sex metrorrhagia of the earlier period function, after the Menopause vagina bleeding, hemorrhage or appear virilism to advertise for elephant.Later period patient the performance then is obviously emaciated, severity Anemia etc. cachexia phenomenon.When gynecology check can the fornix touches to spread after vagina at of the strong and tough tubercle, lump polypeptide is a pair of sides, the cave and convex gravamen of the materiality, surface, fixedly motionless, often the companion contain guts ascites.Sometimes can touch a swollen lymph node on the groin, armpit or clavicle.
?Diagnose ?
(A)diagnose in early days because of earlier period of ovary malignant tumor have no typical model sympton and ketone body advertise for, past detailed inquire disease of history and in earnest check-up and gynecology check still extremely important.Clinical if meet suspicious circumstances should ask for help from the tumor marking of modern image enzymology check and broad sense a thing the check early makes to visit patients at home to break.The so-called and suspicious circumstance may be longer ovary dysfunction, the long-term not clear and causal alimentary canal or urinary tract sympton, young female ovary augmentation or Menopause behind touch ovary, and original Yi is the quick augmentation of ovary neoplasm, enzyme immobilization, become hard etc..
(Two)fixed position the diagnosis canned touch an enclosure to wrap a piece in early days, combined an image check, fixed position diagnosis not difficult.But some cases deliver at first the tumor namely has ovary to outside transfer for hour but the formation basin spread in the lesser tubercle inside antrum, the proper selection is some at this time special check method assistance diagnosis(settle sex), shouldn’t be pure to depend on with diagnose but follow routine to sit a mistake.
(Three)settle sex diagnosis although diagnose a technique to change with each passing day, the fornix absorb the liquid smear check, the cul - de - sac puncture of the uterus rectum liquid check and ascites cytology check to is still after the vagina simple and easy line, quickly basic check.Can immediately and definitely diagnose to the suspicious case, laparoscopy check and histology check.The image enzymology check especially the vagina super voice scan can to earlier period boundary(spread scope) and internal structure(property) of ovary malignant tumor make proptosis to contribute to the diagnosis which settles sex.The endocrine, internal secretion check helps mesenchymoma and parts of companions of the ovary gonad to contain the diagnosis that the comprehensive allosteric site endocrine, internal secretion advertises for an ovary cancer.The examination of the serum tumor marking thing is like CA125, CEA, SONA, SGA etc. is to the sensitivity Gao of the ovary malignant tumor, but its specificity be worse, so, can’t certificate an immunology examination judge its type.But various tumor marking thing symphysis examination, like hour examine CA125, CEA, ferritin and tissue polypeptide antigen(TPA), can raise credibility that settle sex’s diagnosis.
?Treat measure ?
(A)treat the malignant tumor of the principle ovary with surgical operation treat for lord, combine to assist to project a treatment, the chemotherapy waits a comprehensive treatment.
(Two)the surgical operation treat surgical operation should fish for in detail first, include a peritoneal lavage, basin machine with dirty belly cavity and basin antrum, after the peritoneum palpation and diaphragm, peritoneum of lymph node, greater omentum of of much order to live check to expect by carrying on an accurate tumor cent.The surgical operation method is thoroughly divided into surgical operation and retention to grow the conservative sex surgical operation of function.Thoroughly the scope of surgical operation includes a pair of sides enclosures, uterus, greater omentum, appendix vermiformis to cut off and basin the lymph node cleans up Shu after antrum and peritoneum and have to the tumor at the basin antrum extensive implantation transfer of patient, the assertion may well can make swollen oncocyte to reduce to put out Shu.The williams waits for someone a report way surgical operation to cut off a clean patient, the completely give relief from of the post-operative chemotherapy rate is for 83%, basic slice the clean completely gives relief from the rate as 59%, but fraction cut off(save a neoplasm true conjugate diameter, anteroposterior diameter>2 cms) completely give relief from of the post-operative chemotherapy the rate is for 42%.As a result though the malignant generative cell tumor scrolls match chemotherapy sensitive, as far as possible cut off the tumor clean to is still in the surgical operation-treat a successful key.
(Three)the chemistry treat because the ovary neoplasm very early spreads, surgical operation most cases have already can’t clean a focus, and put to treat of effect and apply also very limited, so whole body the chemotherapy be an important ssistance treatment method.Some later period patients, after chemotherapy the lump can contract, for again surgical operation create a beneficial condition.
Treated a malignant ovary tumor and don’t unify a chemotherapy project up to the present, principle BE:? The big dose be continuously intermittent to use the medicine smaller dose to use a medicine for good;The former digit treats a distance to use a medicine one turnover each time or so, intermittent 3~4 turnoverses are or so, since can attain an effective nti- tumor an action, and then be advantageous to the machine ketone body elimination toxicity and recover an immunity function.The chemotherapy of ? symphysis more single chemotherapy curative effect is good:The modern age inclines to drug combination more, but the beard attention toxic reaction of the symphysis chemotherapy be more heavy.? According to drug sensitive indol test, choose a chemotherapy medicine of use the sensitive, can prolong existence time of sufferer.The ? presses the tissue type to draw up a different chemotherapy project.In recent years the ovary cancer in common use chemotherapy project as follows.
l.The epithelium cancer and sex cords ask a quality tumor to much use
(1)PAC project:Venous first day of infusion of the CTX 400 mg
Venous second day of infusion of the ADM 40 mg
The DDP 80 mg belly cavity infuses into the third day
(2)CFP project:Venous first day of infusion of the CTX 400 mg
The 5 FUl50 mg belly cavity infuses into the second day
The DDP 80 mg belly cavity infuses into the third day
(3)CP project:The venous infusion of the CXR 200 mg connects to use 5 days
The venous intravenous drop of the DDP 40 mgs connects to use 5 days
(4)CHFP project:The 5 FUl000 mgs venous intravenous drop on the 1st day or the 8th day
The venous intravenous drop of the DDP 40 mgs on the 1st day, the 8th day
The 00 mgs of CTX l takes orally on the first for 2 the 2~7th days and 9~16 days
2.generative cell tumor and sarcoma much use
(1)VAC project:The VCR 2 mg iliac vein infuses into a l day
Venous 2~6th day of intravenous drop of the ACD 300 ugs
Venous 2~6th day of infusion of the CTX 300 mg
(2)FAC project:The venous intravenous drop of the 5 Fulooomgs connects to use 5 days
The venous intravenous drop of the ACD 300 ugs connects to use 5 days
The venous infusion of the CTX 300 mg connects to use 5 days
(3)PVB project:Venous 1st day of infusion of the VLB 20 mgs(or VCR2 mg)
Muscle or belly cavity of the BLM 30 mg infuse into the 2nd day
The DDP venous intravenous drop of the 20~30 mgs or belly cavity infuse into the 1~5th day
Above everyone’s case treats the distance general partition 3~4 turnovers each time, the concrete circumstance should see patient’s soma, respond circumstances, such as degree, blood elephant and liver and cystic kidney function…etc. but settle.Use a medicine at least 4~6 to treat a distance, later period or not impressionable tumor chemotherapy, treat the distance should a little more and generally 8~10 treat a distance the 1st year and reduce to 3~4 to treat a distance the 2nd years.
(Four)project the emanation sensitivity of the malignant tumor of the immunization therapy ovary difference very big, the blastula sinus in the ovary neoplasm, immaturity teratoma, embryo cancer most not the degree in the granulocyte cancer of the sensitive, ovary epithelioma and sensitive, dysgerminoma most sensitive, after operation again use to put to treat much can control.The ovary cancer compares to early take place belly cavity transfer, so project light upon scope to include belly cavity and basin antrum.The liver, cystic kidney region takes in to protect and the in order to prevent results in the radioactivity hurt.Project the quantity whole belly cavitieses is the 3000 cGY ? 5000 cGYs/6~8s turnover.
Inside the irradiation be inside finger pulp antrum to infuse into body gold(198 AUs) or Lin(32 Ps), can make the belly cavity surface attain outside project light upon don’t easily attain of dose, because its penetrability is in order to limited, can treat form inside the belly cavity shallow transfer, the bottom of the mirror remains tumor or I period tumor Shu rupture with raise five year livability.The weakness is otherwise a belly cavity and have to have never glue to connect, make radioisotope, RI distribution even, can cause an intestine way injury and result in serious result.The general 198 AUs measures to 120~150 milli- curies and the 32 Ps is 10~20 milli- curies.
?Prevent°from ?
The point discovers a tumor in the earlier period, in spite of positive or malignancy of earlier period patient, often have no obvious sympton, benign tumor again have bad mutation may, should evolve periodical census.Discover an ovary malignant tumor for the sake of the earlier period, should notice following what time:
(A)all sex lumps with solid ovaries, or more than 6 cms cysts, should immediately carry on surgical operation excision.
(Two)women after the demulcent therapy, reconciliation Menopause ago the menarche, have the ovary the swollen thing, should consider for the tumor.Grow age women to there is young enclosure capsule lump, observe 2 months has never see to contract the consideration as tumor and observe a period to enlarge at any time surgical operation.
(Three)pelvic inflammatory disease, PID lump, particularly doubt an antrum tuberculosis or endometriosis lump, through treat invalid, fish for in response to the surgical operation while can’t expel a tumor.
(Four)the Menopause discovers the mucous membrane, endometrium adenoma kind hyperplasis behind or inside shell membrane adenocarcinoma, should notice ovary have already had no swollen thing, and carry on a surgical operation treatment in time.
(Five)carry on an antrum surgical operation, all should cautiously the check double side ovary has already had no pathological changes, in addition to the indication of ovary disease, age at 45 years old above, the one who make uterus excision of the rho factor temple disease beard, suggestion cut off a pair of sides enclosures in the meantime.
?Prognosis ?
The prognosis of ovary malignant tumor expects with clinical cent, pathologic fractionation, category and treatment of tumor relevant, expect don’t the effect is more bad and accept to cure according to world-wide locations 45 hospitals of 4892 example with visit covariance, the Ia expects for 5 years, survival rate is 72%, the ? an expects 52%, the ? expects 11%, and the ? expects 5%. When the I expects the tumor in cancer to limit at inside capsule, five year, the survival rate can reach to 90%.The differentiation degree of the swollen oncocyte is more bad to treat effect also more bad, the treatment effect of low and latent malignancy obviously compares epithelioma for good.The embryo cancer prognosis is the most bad in the ovary cancer, but dysgerminoma because of being good to project sensitive prognosis.While in addition processing can not compare with or can not be, produce poor influence towards treating effect would also.
