卵巢癌的诊断和治疗PPT.ppt

Lymph nodes metastasis and retroperitonal lymphadenectomy in ovarian cancer Lymphatic pathway is an important route of metastasis in ovarian cancer. The overall incidence of retroperitoneal positive nodes 54.3% The incidence of positive pelvic nodes 46.7% positive para-aortic nodes 37.5% Both aortic and pelvic nodes positive 48.7% Intestinal metastasis and operation in ovarian cancer Rectosigmoid involved 95.2% Metastasis to small bowel 41.9% Superficial and serosal invasion 64.5% Complete or optimal resection 74.2% resection of the bowel 31.2% Colostomy 9.8% 27.4% survival with mean survival time 30.3 months Conservative surgery in ovarian cancer Germ cell tumor (any stage) Stage I grade I granulosal cell tumor For epithelial cancer : 1. Young patient and desire of reproduction 2 Stage Ia, 3. Grade 1 4. Capsule intake 5. No adhesion 6. Peritoneal cytology negative 7. Multiple biopsies of high risk negative 8. Follow up available Management of Ovarian Cancer Early disease Stage IA/B grade I/II exploratory operation; conservative resection preserve fertility in bilateral borderline tumours adjuvant therapy unproven 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 2cm) First line chemotherap