卵巢癌的诊断和治疗

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1、DiagnosisandTreatmentofOvarianCancerShenKengDepartmentofOB/GYNPekingUnionMedicalCollegeHospitalEpidemiologyandGeneticFactorsOvariancanceristhesecondmostcommongynecologicalmalignancy,butthecommonestmalignancyofthefemalegenitaltracttoresultindeathIncidence:Ingeneralpopulationlifetimeriskforovari

2、ancancerinawomenisroughly1/70or1.4%.EpidemiologyandGeneticFactorsTheincidenceinAsia,AfricaandLatinAmericaislowerthaninWesterncountries.Themostcommontumortypeisepithelial(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EpidemiologyandGeneticFactorsHighriskfactors:1.Morethan40yrs.2.Caucasianrace(wh

3、ite)3.Latemenopause.4.Infertility5.PositivefamilyhistoryofCAovary6.BRCAgeneEpidemiologyandGeneticFactorsFamilyhistoryisthestrongestriskfactorforovariancancerWomenwithoneaffectedfirstclassrelative:riskrateforovariancanceris5%Womenwithtwoaffectedfirstclassrelative:riskrateforovariancanceris7%Ame

4、mberofHOCS:riskrateforovariancanceris20%--50%BRCA1&BRCA2geneassociatedwithHOCSEpidemiologyandGeneticFactorsPrevention&protectivefactorsforovariancancerappeartobeconditionsassociatedwithfewerlifetimeovulations1.Useoforalcontraceptivepills2.Shorterdurationofreproductiveyears3.Conditionsofchronic

5、anovulation4.Historyofbreastfeeding5.MultiparityHistopathologyEpithelialovariancancer,usuallyclassedsimplyasadenocarcinoma,includeanumberofspecifichistologicaltypes:SerousadenocarcinomaMuconousadenocarcinomaEndometrioidadenocarcinomaMalignantBrennertumor(transitionalcell)Clearcelladenocarcinom

6、aHistopathologyMalignantGermCellTumoroftheOvaryincludeanumberofspecifichistologicaltypes:DysgerminomaYolk-SacTumor(endodermalsinustumor)TeratomasChoriocarcinomaMixedgermcelltumorHistopathologyMalignantTumoroftheGonadalstroma:Granulosal-celltumorsAdulttypeJuveniletypeSertoli-celltumorsLeydig-ce

7、lltumorsSertoli-Leydig-celltumorsSexcordtumorwithannulartubulesSpreadofovariancancerLocalspreadIntra-abdominalspreadlymphaticspreadhemtogenousspreadSymptomsSymptomsaremostoftenabsentwithearlystageovariancancer.Whenpresent,symptomstendto