2019年Ovarian-carcinom-卵巢肿瘤.ppt

Ovariancarcinom卵巢肿瘤DepartmentofObstetricsandGynecology妇产科ZhangWei张蔚卵巢女性内生殖器Difficulttobedetectedinearlierperiod不易早期发现The5－yearsurvivalofOvariancarcinomaislow(25%-30%)卵巢恶性肿瘤5年存活率较低PurposeandRequestClinicalmanifestations临床表现2Diagnosisandtreatment诊断及治疗3Histologicaltypes组织学分类1Histologicaltypes组织学分类Malignancy恶性Benign良性Borderline交界性Histologicaltypes组织学分类Epitheliatumors上皮性肿瘤Germcelltumors生殖细胞肿瘤Sexcordstromaltumors性索间质肿瘤Lipidcelltumor脂质细胞瘤Gonadoblastoma性腺母细胞瘤非卵巢特异性软组织肿瘤No-classifiedtumors未分类肿瘤Metastasestumors转移性肿瘤Tumour-likecondition瘤样病变Clinicalmanifestations临床表现Ovarybenigntumor卵巢良性肿瘤Slow－moving,mostlyasymptomaticinearlierperiod;Compressionsymptommaybefoundwhentumoraugmentation发展缓慢，早期多无症状，肿块增大可出现压迫症状[,eisimptə'mætik]adj.无症状的Ovarymalignancytumor卵巢恶性肿瘤Frequentlyasymptomaticinearlierperiod,OncesymptomsoccurrenceMostinclude:abdominaldistension,abdominalmassandascites早期常无症状，一旦出现常表现为：腹胀﹑腹部肿块和腹水[ə'saiti:z]n.腹水Complications并发症Torsionofpedicle蒂扭转Rupture破裂Infection感染Canceration恶变Diagnosis诊断Ultrasound超声检查Tumormarker肿瘤记标物Abdominoscope腹腔镜检查Radiologicaldiagnosis放射学Cytologicalexamination细胞学Tumormarker肿瘤记标物AFPendodermalsinustumor卵巢内胚窦瘤HCGchoriocarcinoma绒毛膜癌CA125Ovarianepithelialcancer卵巢上皮癌性激素Granularcellcarcinoma颗粒细胞癌Differentiate良性肿瘤和恶性肿瘤鉴别鉴别内容良性肿瘤恶性肿瘤病史病程长，生长缓慢病程短，迅速增长包块部位及性质单侧多，囊性，光滑，活动双侧多，实性或囊性，不规则，固定，后穹窿性结节或包块腹水征多无常有腹水，可能查到恶性细胞一般情况良好可能消瘦，恶病质B型超声为液性暗区，边界清晰，有间隔光带液性暗区内有杂乱光团、光点，界限不清CA125(50岁)35IU/ml35IU/mlRouteofmetastasis转移途径Directmetastasis直接蔓延Abdominalmetastasis腹腔转移Lymphaticmetastasis淋巴转移Hematogenousmetastasis血行转移[mə'tæstəsis]n.转移FIGOstagingofovarianneoplasmsStageDefinitionIgrowthlimitedtotheovaries肿瘤局限于卵巢Iaoneovaryinvolved局限单侧卵巢Ibbothovaryinvolved局限双侧卵IcⅠaorbwithrupturedcapsule,tumoronthesurfaceofcapsule,positiveperitonealwashingsormalignantascitesⅠa或Ⅰb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Ⅱextensionoftheneoplasmfromtheovarytothepelvis卵巢肿瘤向盆腔内转移Ⅱaextensiontotheuterusandtubes蔓延到子宫和输卵管Ⅱbextensiontootherpelvictissues蔓延到其他盆腔组织StagedefinitionⅡcⅡaorⅡbwithrupturecapsule,positiveperitonealwashingsormalignantascitesⅡa或Ⅱb伴包膜破裂或腹腔冲洗液含恶性细胞Ⅲdiseaseextensiontotheabdominalcavity肿瘤向腹腔转移Ⅲaabdominalperitonealsurfaceswithmicroscopicmetastases盆腔腹膜表面有镜下转移Ⅲbtumormetastasis≤2cminsize腹腔转移灶直径≤2cmⅢctumormetastasis＞2cminsize腹腔转移灶直径＞2cmⅥdistantmetastaticdisease远处转移FIGOstagingofovarianneoplasmsTherapy治疗Purposeofsurgery手术目的Clarifyadiagnosis明确诊断Excisionoftumors切除肿瘤Malignancytumorcarryoutoperation-Pathologystaging恶性肿瘤进行手术-病理分期Ovaryepitheliatumors卵巢上皮性肿瘤Riskfactors高危因素Incessantovulation持续排卵Inherentcause遗传因素Environmentalfactors环境因素Histologicaltypes组织学分类Serouscystadenoma浆液性囊腺瘤Mucinouscystadenoma粘液性囊腺瘤Endometrioidtumor卵巢子宫内膜样肿瘤Clearcelltumor透明细胞肿瘤Brennertumor勃勒纳瘤Undifferentiatedcarcinoma未分化癌SerouscystadenomaLubricoussurfacespinabifidacystic表面光滑囊性Filledwithamberliquid充满淡黄色液体Mostproportionofovarymalignancytumor,about40-50%最常见的卵巢恶性肿瘤,占40-50%Myxomaperitonei腹膜粘液瘤Endometrioidcarcinoma囊液多为血性HydatidfluidisusuallyuprightnessOperationtherapy手术治疗Earlystage早期Choosethesurgicalproceduresaccordingtostaging按分期确定手术方式Advancedstage晚期肿瘤细胞减灭术(Cytoreductivesurgory):对晚期(Ⅱ期及其以上)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Controlrecurs控制复发Easesymptoms缓解症状Chemotherapyschema化疗方案TPTCPC顺铂P环磷酰胺C紫杉醇T卡铂C紫杉醇T顺铂PSecond-linetherapy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Borderlinetumor交界性肿瘤Surgicaltherapy手术治疗Ovariangermcelltumors卵巢生殖细胞肿瘤Pathologytypes病理分类classify分类characteristic特点Teratoma畸胎瘤spinabifidacystica囊性dysgerminoma无性细胞瘤commonestinyoungeragegroupsandchild-bearingperiod青春期及生育期妇女多见yolksactumor卵黄囊瘤highlymalignant,produceAFP恶性程度高，产生AFPgonadoblastoma胚胎癌multipledifferentiationpotential具有多分化潜能choriocarcinoma绒癌highlymalignant,produceHCG恶性程度极高,HCG升高ImmatureteratomaMalignancytumor恶性肿瘤Thepeakincidenceadolescent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YolkSacTumor卵黄囊瘤chemotherapyschema化疗方案BEPBVPVAC长春新碱V放线菌素DA环磷酰胺C博来霉素B顺铂P依托泊苷Eovariansexcordstromaltumor卵巢性索间质肿瘤Estrogen-producinggranulosacelltumor颗粒细胞瘤Thecacelltumor卵泡膜细胞瘤Androgen-producingsertoli-Leydigcelltumor支持细胞-间质细胞瘤Fibroma纤维瘤Mostcommonintheelderlyandaccountsfor2-5%ofallovarianneoplasm多见于中年妇女，占卵巢肿瘤的2-5%Meig’ssyndrome.（asciteshydrothorax）梅格斯综合征（腹水胸水）Fibroma纤维瘤Aspecialmetastaticadenocarcinoma.一种特殊的转移性腺癌Primarilysiteisgastrointestinal.原发部位为胃肠道KrukenbergTumorPreservation预防Preventthehighrisk预防高危因素Evolvemassscreening,generaltreatment开展普查普治Discoveranddisposalearlier早期发现及治疗Latestadvancement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Prognosis预后细胞周期调节蛋白〈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〉?Question1.Whataretheriskfactorsofovariancarcinoma?2.Howtopreventovariancarcinoma?MainReferences主要参考文献22.TextbookofObstetrics&Gynecology/狄文,马丁主编.—北京:科学出版社,2006，291－300。11.乐杰,谢幸,丰有吉,妇产科学[M].人民卫生出版社,2004,305-316.THANKYOU!