卵巢肿瘤 英文ppt课件.ppt
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1、1,Obstetrics &Gynecology Hospital Fudan University,Ovarian Neoplasm卵巢肿瘤,What is ovarian neoplasm?,2,One single disease or a group of diseases?A group of diseasesBenign or malignant disease?Benign, borderline and malignantCancer or sarcoma?Cancer, sarcoma, germ cell tumor ,3,What we are going to disc
2、ussGeneral principles of ovarian neoplasmBenign 良性Malignant 恶性Epithelial ovarian neoplasm 上皮性卵巢肿瘤Nonepithelial ovarian neoplasm 非上皮性,4,Key points in the sessionPathological classification of ovarian tumorSpread pattern and staging of ovarian cancer Differential diagnosis of benign and malignant ovar
3、ian neoplasmThe use of tumor markers in diagnosis of ovarian neoplasm Principles of primary operation and chemotherapy for ovarian cancer,What is ovarian neoplasm?,5,Female Reproductive Anatomy,7,What is ovarian neoplasm?,Epithelial tumor50-70%上皮性肿瘤,Germ cell tumor20-40%生殖细胞肿瘤,Sex cord-stromal tumor
4、5%性索间质肿瘤,Metastatic tumor5-10%转移性肿瘤Krukenberg tumor (库肯勃瘤),8,Brief descriptionBenign-borderline-malignantEpithelial neoplasm is the most common typeMostly sporadic, 5-10% hereditary for malignanciesHard to be detected in early stage, often advanced when symptom appearedOperations is the most effecti
5、ve treatmentChemotherapy greatly improved prognosis of ovarian cancerAll germ cell tumor can be treated with fertility preserving surgery,9,EpidemiologyAlmost 1/3 of invasive malignancies of the female genital organsThe fifth most common cause of death from malignancy in women.A womans risk at birth
6、 of having ovarian cancer sometime in her life is 1% to 1.5%, and that of dying from ovarian cancer almost 0.5%5 year survival rate : 90% for malignant germ cell tumor; 30-40% for epithelial ovarian cancer,10,Age distribution of ovarian neoplasm,Epithelial ovarian neoplasm50-60 y绝经后妇女 Germ cell neop
7、lasmUnder 30 y育龄年轻妇女,Epithelial ovarian cancer,Epithelial ovarian neoplasm上皮性卵巢肿瘤,11,Etiology & Risk factors -Epithelial ovarian cancer,12,Most benign and malignant ovarian neoplasms are sporadic, with familial or hereditary patterns accounting for 5% to 10% of all epithelial ovarian cancer.,Etiolog
8、y & Risk factors -Epithelial ovarian cancer,13,Sporadic ovarian cancer 散发性卵巢癌Continuous ovulation 持续排卵Early menarche and late menopauseLow parity and infertilityDamage repair process leading to mutation EnvironmentPollution Diet,Etiology & Risk factors -Epithelial ovarian cancer,14,Risk factorsLate
9、parity (35y) InfetilityOld age 50-60yOvulation for more than 40 Protective factorsEarly parity (25y)Oral contraceptive pills OCP,Etiology & Risk factors -Epithelial ovarian cancer,15,Hereditary ovarian cancer 遗传性卵巢癌Hereditary ovarian cancer 5-10% BRCA1, BRCA2 mutation (ovarian and breast cancer)Here
10、ditary non-polyposis colorectal cancer遗传性非息肉性结直肠癌 (HNPCC) Syndrome (Lynch II syndrome) (multiple site adenocarcinoma),Etiology & Risk factors -Epithelial ovarian cancer,16,Hereditary ovarian cancerBRCA1 gene mutation + high-risk families= 28% to 44% lifetime risk of ovarian cancerBRCA2 gene mutation
11、 + high-risk families= 27% lifetime risk of ovarian cancer BRCA1 or BRCA2 mutation= 56% to 87% risk of breast cancerHereditary ovarian cancers occur 10 years younger than those with nonhereditary tumors,17,Epithelial ovarian neoplasm,Others,High Grade Serous HGSC 高级别浆液性,endosalpingeal,endocervical,e
12、ndometrial,mullerian,Clear cellCCC 透明细胞,EndometriodEC 内膜样,MucinousMC黏液性,Low Grade SerousLGSC 低级别浆液性,Faloopian tube origin,Epithelial ovarian neoplams,18,Endometrioid tumor 内膜样肿瘤ovarian endometriosisEndometriod carcinoma 内膜样癌15-20%Complicated with endometrial cancer,Epithelial ovarian neoplasm,19,Ser
13、ous cystadenoma浆液性囊腺瘤,Borderline serous cystademona,Serous cystadenocarcinoma浆液性囊腺癌,Epithelial ovarian neoplasm,20,Mucinous cystadenoma黏液性囊腺瘤,Borderline mucinous cystadenoma,Mucinous cystadenocarcinoma黏液性囊腺癌,Epithelial ovarian neoplasm,21,Benign ovarian tumorUnilateralBall-like with smooth wallSingl
14、e or multiple fociBorderline ovarian tumorlow malignant potentialaverage age is 46 years for borderline tumorslesions tend to remain confined to the ovary for long periodsoccur predominantly in premenopausal womengood prognosisMalignant ovarian tumorPeak incidence 56 to 60 years 30% of ovarian neopl
15、asms in postmenopausal women are malignant,22,Transcelomic 腹腔内扩散The most common and earliest mode of dissemination is by exfoliation of cells then implant along the surfaces of the peritoneal cavity.Lymphatic 经淋巴转移retroperitoneal ( pelvic and paraaortic ) LN spreading is common in advanced- stage di
16、sease. Hematogenous 血行转移uncommon, lungs and liver is the most common sites,Pattern of spread,23,24,Omental Cake,Symptoms-nonspecific 非特异症状,25,Benign and early stage malignancyAlways found during physical examination when the mass is smallBenign and Early stage-vague and nonspecific symptomsOvary dys
17、function - irregular menses Mass occupation- Lower abdominal distention, pressure, or painMass compression - urinary frequency or constipation, dyspareuniaAcute symptoms - pain secondary to rupture or torsion,Symptoms,26,Advanced-stage malignancyAscites or mass occupation, omental /bowel metastases
18、abdominal distention, bloatingGI symptoms: constipation, nausea, anorexia 厌食, or early satiety 早饱Cachexia 恶病质irregular or heavy menses,Signs,27,BenignPelvic mass with smooth wallMalignantsolid, irregular, fixed pelvic mass Pelvic floor nodules upper abdominal mass or ascites,Diagnosis,28,HistoryPhys
19、ical examinationImaging studyLaboratory examinationCytological examinationLaparoscopic examination and biopsyOther auxiliary examination needed,Diagnosis,29,Use of oral contraceptivesPregnancy and breast-feeding historyPrevious gynecologic surgery : tubal ligation or hysterectomy History of ovarian
20、tumor in the familyPrevious cancer history smoking habits exposures to harmful occupational or environmental substances,History,30,Pelvic examination,If the mass is larger than 5cm, is solid rather than cystic, or is bilateral , ovarian cancer may be present.Nodules on the floor of the pelvis indica
21、te ovarian cancer.,benign,Malignant,Diagnosis,31,Image studies,Ultrasonography-most ovarian mass1cm can be foundlow resistance and pulsatile indexes suggest the presence of a cancerous tumor.X-rayCT scanMRI,benign,malignant,Diagnosis,32,Laboratory Tests Serum tumor markersCA125; HE4 epithelial ovari
22、an cancerAFP Yolk sac tumor; other germ cell tumorhCG ovarian choriocarcinomaSex hormones sex cord stromal tumor Tests for genetic mutations Microscopic examination of ovarian cancer cells from ascites or pleural effusion,Diagnosis,33,CA125-epithelial cancer marker 85% of women with clinically appar
23、ent ovarian cancer have increased levels of CA125 ( 35 U/ml).CA125 is not a specific tumor markeras the protein also is increased during other conditionsSome ovarian cancers may not produce enough CA125 to cause a positive test result,Diagnosis,Differential diagnosis,34,35,Benign ovarian tumorPhysil
24、ogical ovarian cyst: follicular cyst; corpus luteum cyst Inflammatory cystUterine myomapregnancyAscites,Differential diagnosis,Differential diagnosis,36,Malignant ovarian neoplasmsEndometriosisTuberculous peritonitis Chronic pelvic inflammatory diseaseMetastatic ovarian tumor (Krukenberg tumor)哑铃状Tu
25、mor from other pelvic organs,What metastatic ovarian cancer might look like,Staging,37,38,Stage ITumor limited to ovaryIa limited to one ovaryIb limited to both ovaryIc Ia or Ib +tumor on ovarian surface; tumor rupture; tumor cell (+) in peritoneal fluid or washing,39,Stage IIWith pelvic extensionII
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