1、Diagnosis and Treatment of Diagnosis and Treatment of Ovarian Cancer Ovarian Cancer Shen Keng Shen Keng Department of OB/GYN Department of OB/GYN Peking Union Medical College HospitalPeking Union Medical College Hospital Epidemiology and Genetic FactorsEpidemiology and Genetic Factors Ovarian cancer
2、 is the second most common gynecological malignancy, but the commonest malignancy of the female genital tract to result in death Incidence: In general population lifetime risk for ovarian cancer in a women is roughly 1/70 or 1.4%. Epidemiology and Genetic FactorsEpidemiology and Genetic Factors The
3、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 Epidemiology and Genetic FactorsEpidemiology and Genetic Factors High risk factors: 1. More than 40yrs. 2. Caucasian r
4、ace (white) 3. Late menopause. 4. Infertility 5. Positive family history of CA ovary 6. BRCA gene Epidemiology and Genetic FactorsEpidemiology and Genetic Factors Family history is the strongest risk factor for ovarian cancer Women with one affected first class relative: risk rate for ovarian cancer
5、 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 unproven Unfavourable type poorly differentiated clear ce
6、ll tumours capsule penetration ruptured capsule positive washings stage II: standard operation + adjuvant therapy 早期卵巢癌的化疗早期卵巢癌的化疗 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
7、外转移 Management of Ovarian CancerManagement 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, immunotherapy) unpro
8、ven Chemotherapy in ovarian cancerChemotherapy 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(2
9、000-) Combination ChemotherapyCombination 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 ne
10、rutoxicity and myelosuppresion Combination ChemotherapyCombination 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
11、. Neurotoxicity and nephrotoxicity are less severe with carboplatin than with cisplatin Other important side effect include alopecia and mucositis. Combination ChemotherapyCombination Chemotherapy Paclitaxel acts as a mitotic spindle poison. Paclitaxel is also a very effective drug for ovarian cance
12、r at the present time Some patients exhibit hypersensitivity to paclitaxel. Other side effect include myelosuppression , nerotoxicity, mucositis, diarrhea, alopcia nausea and vomiting 卵巢上皮癌的化疗卵巢上皮癌的化疗 铂基础治疗方案通常联合铂基础治疗方案通常联合: : 紫杉醇紫杉醇 环磷酰胺环磷酰胺 阿霉素阿霉素 通常需要间隔通常需要间隔3- 43- 4周至少周至少6 6个周期的治疗个周期的治疗 晚期卵巢癌的化疗
13、 *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 ChemotherapyCombination Chemotherapy Combination chemotherapy most often is used as postoperative treatment for advanced epithelial ovarian cancer. Combination chemotherapy with six courses of cisplatin or carboplatin plus pac
14、litaxel 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. CA125 levels ,and imaging studies if appropriate 卵巢癌病人化疗存活率卵巢癌病人化疗存活率 McGuire WP et al. N Engl J Med. 1996 Post-Therapy SurveillancePos
15、t-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 cancer For this reason there remains significant controversy as to what constitutes optimal posttherapy surveillance. Post-Therapy SurveillancePost-Therapy Surveillance Sc
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