《卵巢癌的诊断和治疗(医大讲课)课件》由会员分享，可在线阅读，更多相关《卵巢癌的诊断和治疗(医大讲课)课件（79页珍藏版）》请在金锄头文库上搜索。
1、Diagnosis and Treatment of Ovarian Cancer,Shen Keng Department of OB/GYN Peking Union Medical College Hospital,Epidemiology and Genetic Factors,Ovarian cancer is the second most common gynecological malignancy, but the commonest malignancy of the female genital tract to result in death Incidence: In
2、 general population lifetime risk for ovarian cancer in a women is roughly 1/70 or 1.4%.,Epidemiology and Genetic Factors,The incidence in Asia, Africa and Latin America is lower than in Western countries. The most common tumor type is epithelial (85%).,卵巢癌的危险因素,年龄,危险因素,与子宫内膜、结肠、乳腺癌的关系,家庭史,生产史和激素水平,
3、Epidemiology and Genetic Factors,High risk factors: 1. More than 40yrs. 2. Caucasian race (white) 3. Late menopause. 4. Infertility 5. Positive family history of CA ovary 6. BRCA gene,Epidemiology and Genetic Factors,Family history is the strongest risk factor for ovarian cancer Women with one affec
4、ted first class relative: risk rate for ovarian cancer is 5% Women with two affected first class relative: risk rate for ovarian cancer is 7% A member of HOCS: risk rate for ovarian cancer is 20%-50% BRCA1 conservative resection preserve fertility in bilateral borderline tumours adjuvant therapy unp
5、roven Unfavourable type poorly differentiated clear cell tumours capsule penetration ruptured capsule positive washings stage II: standard operation + adjuvant therapy,早期卵巢癌的化疗,FIGO I，II期卵巢癌 “预后好”的患者90%以上可长期无瘤存活，而且不需要辅助化疗。 有高危因素的患者，30%-40%有复发的危险，25%-30%在首次手术后5年内死亡。 与复发有关的高危因素： （1）包膜破裂 （2）肿瘤表面生长 （3）低
6、分化（G3）（4）与周围组织粘连 （5）透明细胞癌 （6）腹腔冲洗液阳性 （7）卵巢癌外转移,Management of Ovarian Cancer,Advanced stage disease Stage III/IV Primary cytoreductive surgery / interval debulking Obtained optimal debulkung (residual tumor 6 months)-secondary debunking following chemotherapy Palliative treatment (Radiotherapy, immun
7、otherapy) unproven,Chemotherapy in ovarian cancer,First line chemotherapy for epithelial ovarian cancer CHexUP and Thio-Tepa protocol ( 1982-1985) PAC or PC (1986-1990) DDP, 5-FU, Ara-c, Bleomycin, CTX. IP & IV Combination (1991-1994) Taxol, DDP/Carpa (1995-2000) Weekly taxol /Carpa(2000-),Combinati
8、on Chemotherapy,Cisplatin acts by binding to DNA and producing cross-links and DNA adducts. Cisplatin is a very effective drug for ovarian cancer. Important side effects include severe nausea and vomiting, dose-related nephrotoxicity, ototoxicity, peripheral nerutoxicity and myelosuppresion,Combinat
9、ion Chemotherapy,The mechanism of action of carboplatin is the same as that of cisplatin, the side effects, however, differ greatly. The most important side effect is thrombocytopenia. Leukopenia and anemia also occur but are less severe. Neurotoxicity and nephrotoxicity are less severe with carbopl
10、atin than with cisplatin Other important side effect include alopecia and mucositis.,Combination Chemotherapy,Paclitaxel acts as a mitotic spindle poison. Paclitaxel is also a very effective drug for ovarian cancer at the present time Some patients exhibit hypersensitivity to paclitaxel. Other side
11、effect include myelosuppression , nerotoxicity, mucositis, diarrhea, alopcia nausea and vomiting,卵巢上皮癌的化疗,铂基础治疗方案通常联合: 紫杉醇 环磷酰胺 阿霉素 通常需要间隔3- 4周至少6个周期的治疗,晚期卵巢癌的化疗,一线治疗 国内 顺铂+环磷酰胺(PC) 顺铂+阿霉素+环磷酰胺(PAC) 国外 泰素顺铂 泰素卡铂 泰素每周疗法,Combination Chemotherapy,Combination chemotherapy most often is used as postopera
12、tive treatment for advanced epithelial ovarian cancer. Combination chemotherapy with six courses of cisplatin or carboplatin plus paclitaxel is the treatment of choice for patients with advanced disease. Courses are given every 3 to 4 weeks with monitoring of tumor status by physical examination. CA
13、125 levels ,and imaging studies if appropriate,卵巢癌病人化疗存活率,McGuire WP et al. N Engl J Med. 1996,Post-Therapy Surveillance,Follow-up after therapy in ovarian cancer is poorly defined. At the present time there is no definitive test for detecting the presence of microscopic recurrent epithelial ovarian
14、 cancer For this reason there remains significant controversy as to what constitutes optimal posttherapy surveillance.,Post-Therapy Surveillance,Screening modalities: 1. Pelvic Examination 2. CA 125 (44% sensitivity, 96% specificity, 65% accuracy) 3. Ultrasound (20%-89% sensitivity, 75%-100% specifi
15、city) 4. Second-look laparotomy 5. CT scan (44% sensitivity, 86% specificity, 63% accuracy) 6. MIR imaging. 6. Position emission tomography (PET) (83% sensitivity, 80% specificity, 82% accuracy),卵巢癌复发的诊断和治疗,首次的规范化治疗(理想的肿瘤细胞减灭术加上以足够疗程的铂类和/或紫杉醇为基础的联合化疗) 70%-80%的患者可获得临床完全缓解. 60%-70%的患者最终还会复发. 对卵巢癌复发的诊断
16、和治疗是卵巢癌治疗中最为棘手的问题. 怎样合理处理复发性卵巢癌意见尚不统一,卵巢癌的复发类型 (1),化疗敏感型卵巢癌: 定义为对初期以铂类药物为基础的治疗有明确反应,且已经达到临床缓解,停用化疗6个月以上,病灶复发.,卵巢癌的复发类型 (2),化疗耐药型卵巢癌: 定义为患者对初期的化疗有反应,但在完成化疗相对短的时间内证实复发,一般认为,完成化疗后6个月内的复发,应考虑为铂类药物耐药,卵巢癌的复发类型(3),顽固性卵巢癌: 是指在初期化疗时对化疗有反应或明显反应的患者中发现有残余病灶,例如:“二探”阳性者.,卵巢癌的复发类型 (4),难治性卵巢癌: 是指对化疗没有产生最小有效反应的患者,包括在初始化疗期间,肿瘤稳定或肿瘤进展者,大约发生于20%的患者. 这类患者对二线化疗的有效反应率最低.,卵巢癌复发的治疗,治疗前的准备: 详细复习病史包括: (1)手术分期. (2)组织学类型和分级. (3)手术的彻底性. (4)和残余瘤的大小及部位. (5)术后化疗的方案,途径,疗程,疗效.
