卵巢癌的诊断和治疗(医大讲课).pptVIP

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. (6)停用化疗的时间. (7)出现复发的时间等. 对复发性卵巢癌进行定性、分型、定位分析 对患者的生活状态(PS)进行评分,对患者重要器官的功能进行评估.  目前观点认为: 对于复发性卵巢癌的治疗目的一般是趋于保守性的, 因此在选择复发性卵巢癌治疗方案时,对所选择方案的预期毒性作用及其对整个生活质量的影响都应该加以重点考虑. 复发性卵巢癌的手术治疗 手术对复发性卵巢癌的治疗价值尚未确定, 手术的指征和时机还存在一些争论. 复发性卵巢癌的手术治疗主要用于三个方面: 2.12个月复发灶的减灭. 3.切除孤立的复发灶. 对晚期复发卵巢癌是先手术还是先化疗仍有争议. Chemotherapy in Ovarian Cancer Second line chemotherapy for epithelial ovarian cancer Patients with persistent or recurrent diseases should be treated with second line chemotherapy. Unfortunately, response rates for second line chemotherapy are only 10% to 30%. Regarding of the approach, second line chemotherapy for persistent or recurrent ovarian cancer is not curative. Second line chemotherapy for epithelial ovarian cancer Depending on the initial chemotherapy, second line chemotherapy may include: Topotecan Paclitaxel Platinum Ifosfamide Taxotere Hexamethylmelamine Combination Chemotherapy 对复发卵巢癌有效的新药 卵巢癌的治疗: 手术 (I) DeVita et al. Cancer: Principles Practice of Oncology.1993 全腹腔探查 和活检 网膜 几乎所有的病人进 行全子宫、双侧输 卵管及网膜切除术 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