加载中…
Ovarian Cancer 卵巢癌
Ovarian cancer is the second most common gynecologic malignancy, but the most common cause of death among women who develop gynecologic cancer, and it is the fifth most common cancer in females. The majority (90 percent) of primary ovarian tumors derive from epithelial cells, although they can also arise from germ cell tumors, sex cord-stromal tumors, and mixed cell type tumors.
卵巢癌是妇科第二最常见妇科恶性肿瘤，但却是妇科癌症最常见的死亡原因，也是女性第五最常见癌症。大多数（90%）原发性卵巢癌来源于上皮细胞，尽管它们也可为源自生殖细胞肿瘤、性索间质肿瘤和混合细胞型肿瘤。
I. Clinical manifestations 临床表现
A. Most ovarian cancers are diagnosed between the ages of 40 and 65. Symptoms of early stage disease are often vague. Acute symptoms due to ovarian rupture or torsion are unusual. As a result, 75 to 85 percent of cases of ovarian cancer are advanced at the time of diagnosis. More advanced disease is typically associated with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases.
大多数的卵巢癌发生在40-65岁，早期常无明显症状，因卵巢破裂和扭转而出现的急性症状也不多见。因此，75-85%的卵巢癌病例发现时都是进展期了。更多的进展期病例出现典型的腹部膨隆、恶心、食欲减退以及因腹水和网膜或肠转移的存在所致的早期饱胀感。
B. Most women have nonspecific symptoms, such as lower abdominal discomfort or pressure, gas, bloating, constipation, irregular menstrual cycles/ abnormal vaginal bleeding, low-back pain, fatigue, nausea, indigestion, urinary frequency, or dyspareunia.
多数的女性都出现非特异症状，如下腹部不适或压迫感、气胀，胃部气胀、便秘，月经不调/不规则阴道出血，腰背部疼痛、疲乏、恶心、消化不良、尿频以及性欲减退等
II. Physical examination 体格检查
A. Palpation of an asymptomatic adnexal mass during a routine pelvic examination is the usual presentation for ovarian cancer. The presence of a solid, irregular, fixed pelvic mass on pelvic examination is highly suggestive of an ovarian malignancy. However, endometriomas and tubo-ovarian abscesses are benign tumors that may be fixed, while cystadenofibromas and tubo-ovarian abscesses are benign masses that feel irregular. The diagnosis of malignancy is almost certain if a fixed, irregular pelvic mass is associated with an upper abdominal mass or ascites.
A. 对卵巢癌来无症状的附件肿块进行常规的骨盆触诊检查，常常是首先要做的。骨盆检查中出现硬的、不规则的和固定的肿块常常高度怀疑卵巢恶性肿瘤。但是，子宫内膜瘤和输卵管卵巢脓肿是良性肿瘤，它们也可能是固定的，囊腺纤维瘤和输卵管卵巢脓肿是不规则的良性肿块。如果一个固定的、不规则的盆腔肿块同时伴有上腹部肿块和腹水，那么恶性的诊断几乎是肯定的。
Differential Diagnosis of Adnexal Masses in Women 女性附件肿块的鉴别诊断
Extraovarian mass 卵巢外肿块
Ectopic pregnancy 异位妊娠
Hydosalpinx or tuboovarian abscess ？或输卵管卵巢脓肿
Paraovarian cyst 卵巢旁囊肿
Peritoneal inclusion cyst 腹膜包裹性囊肿
Pedunculated fibroid
有蒂纤维瘤或有蒂平滑肌瘤
Diverticular abscess 憩室脓肿
Appendiceal abscess 阑尾脓肿
Ovarian mass 卵巢肿块
Simple or hemorrhagic physiologic cysts (eg, follicular, corpus luteum) 单纯/出血性的生理性囊肿（如卵泡、黄体等）
Endometrioma 子宫内膜瘤 Theca lutein
cysts 卵泡膜黄素化囊肿
Benign or malignant neoplasms (eg, epithelial, germ cell, sex-cord)
良恶性肿瘤（如上皮性、生殖细胞源性、性索源性）
Metastatic carcinoma (eg, breast, colon, endometrium)
转移性的恶性肿瘤（如乳腺、结肠、子宫内膜）
III. Diagnostic evaluation 诊断评价
A. The finding of a pelvic mass usually requires surgery for definitive histologic diagnosis. Tumor markers (eg, serum CA 125) and ultrasound examination can help distinguish between malignant and benign pelvic masses.
A. 发现盆腔肿块通常需要外科获取可靠的组织学诊断，肿瘤标记物（如血清CA125）和超声检查有助于鉴别盆腔良恶性肿瘤。
B. A complete pelvic examination and assessment of cervical cytology should be performed preoperatively. Routine hematologic and biochemical assessments should be obtained prior to surgery. Ultrasonography for diagnosis of ovarian malignancy has a sensitivity of 62 to 100 percent and a specificity of 77 to 95 percent.
B. 术前应有完整的骨盆检查和子宫颈细胞学检查，以及血液学和生化学检查。超声波检查的敏感度可达62-100%，甚至77-95%。
C. It is reasonable to pursue a period of observation in a premenopausal woman with an adnexal mass if the mass is not clinically suspicious on ultrasonography. Adnexal masses that are mobile, purely cystic, unilateral, less than 8 to 10 cm in diameter, and have smooth internal and external contours by ultrasound are highly unlikely to be malignant and can be followed for two months; the majority of physiologic cysts will regress during this time.
C. 对于绝经期前妇女的附件肿块，若未被临床超声检查所怀疑，可以随访观察一段时间。可移动附件肿块，单纯囊肿，单侧、直径小于8-10cm、超声检查内外轮廓光滑者，不大可能是恶性肿瘤，应该随访两个月，大多数生理性的囊肿会在此期间内消失。
D. Exploration is indicated if there is no resolution within two months. However, women who have solid, fixed, irregularly shaped, or large masses should undergo surgery. A mass that increases in size or does not regress must be presumed to be neoplastic and should be removed surgically.
D. 如果2个月内肿块没有消退，即为手术探查指征。不管怎样，质硬、固定、形状不规则的、体积大的肿块应行手术治疗。逐渐增大、不消退的肿块必定为一新生物，应被手术切除。
E. The threshold for surgical intervention is lower in postmenopausal women; those with cysts greater than 3 cm should undergo exploratory surgery, laparotomy, or laparoscopy.
E. 绝经后妇女外科手术指征较宽，合并囊肿、直径大于3cm者应行手术探查、剖腹探查或腹腔镜检查。
F. Tumor markers. CA 125: The preoperative evaluation of a woman with suspected ovarian cancer should include measurement of the CA 125 concentration. The serum CA 125 (normal <35 U/mL) is elevated (>65 U/mL) in 80 percent of women with epithelial ovarian cancer. It is also increased in patients with other malignancies, including endometrial cancer and certain pancreatic cancers; in endometriosis, uterine leiomyoma, and pelvic inflammatory disease; and in approximately 1 percent of healthy women.
F. 肿瘤标志物. CA125：可疑卵巢癌妇女术前评估应该包括CA125浓度的测定。血清CA125（正常<35 U/mL）在80%的上皮性卵巢癌是升高的（>65U/mL），但在其他一些恶性肿瘤包括子宫内膜癌和部分胰腺癌，以及子宫内膜异位、子宫平滑肌瘤、盆腔炎性疾病和大约1%的健康妇女也有增加。
IV. Staging 疾病分期
A. Surgery is necessary for diagnosis, accurate staging and optimal cytoreduction, and is crucial for the successful treatment of EOC. Ovarian malignancies are surgically staged according to the 2002 revised American Joint Committee on Cancer (AJCC) and International Federation of Gynecologic Oncologists (FIGO) joint staging system, as long as the patient is an appropriate surgical candidate.
手术对于诊断、精确分期和适当的减瘤是需要的，对于上皮性卵巢癌的成功治疗也是关键的。卵巢恶性肿瘤的临床外科分期是按照2002年修订的美国癌症联合会和国际妇科肿瘤联合会的综合分期系统，只要病人是合适的外科手术病例。
Definitions of the Stages in Primary Carcinoma of the Ovary
原发性卵巢癌的分期
Stage
分期 Definition
标准
I
I期
IA
IA期
IB
IB期
IC
IC期 Growth is limited to the
ovaries
肿瘤生长限于卵巢内
Growth is limited to one ovary; no ascites present containing malignant cells; no tumor on the external surface; capsule is intact
肿瘤生长限于一侧卵巢内；腹水中无恶性肿瘤细胞出现，浆膜面无肿瘤侵润，浆膜完整。
Growth is limited to both ovaries; no ascites present containing malignant cells; no tumor on the external surfaces; capsules are
Intact.
肿瘤生长限于双侧卵巢内；腹水中无恶性肿瘤细胞出现，浆膜面无肿瘤侵润，双侧浆膜完整。
Tumor is classified as either stage IA or IB but with tumor on the surface of one or both ovaries; or with ruptured capsule
; or with ascites containing malignant cells present or with
positive peritoneal washings.
肿瘤分级如IA或IB，一侧或双侧卵巢表面肿瘤侵润；或者浆膜破裂；或者腹水查到恶性肿瘤细胞或腹膜灌洗阳性。
II
II期
IIA
IIA期
lIB
IIB期
IIC
IIC期 Growth involves one or both
ovaries with pelvic extension
肿瘤生长涉及一侧或双侧卵巢，并有盆腔蔓延
Extension and/or metastases to the uterus and/or tubes
侵及和/或转移到子宫和/或输卵管
Extension to other pelvic tissues
侵及其他骨盆组织
Tumor is either stage IIA or lIB but with tumor on the surface of one or both ovaries; or with capsule
ruptured; or with ascites containing malignant cells present or
with positive peritoneal washings.
肿瘤分期如IIA或IIB，一侧或双侧卵巢表面肿瘤侵润；或者浆膜破裂；或者腹水查到恶性肿瘤细胞或腹膜灌洗阳性。
III
III期
IlIA
IIIA期
IIIB
IIIB期
IIIC
IIIC期 Tumor involves one or both
ovaries with peritoneal implants outside the pelvis and/or positive
retroperitoneal or inguinal nodes; superficial liver metastasis
equals stage III; tumor is limited to the true pelvis but with
histologically proven malignant extension to small bowel or
omentum
肿瘤生长涉及一侧或双侧卵巢，并有骨盆外腹膜种植和/或腹膜后或腹股沟淋巴结肿大；肝表面转移即为III期；肿瘤限于小骨盆，但组织学证实已侵及小肠和网膜。
Tumor is grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces
肿瘤局限于小骨盆，淋巴结无肿大，但显微镜下组织学确定有腹膜表面转移。
Tumor involves one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2cm in diameter; nodes are negative
肿瘤生长涉及一侧或双侧卵巢；组织学证实腹膜表面种植，但种植灶直径不超过2cm；淋巴结无肿大。
Abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes.
腹部种植灶直径大于2cm和/或腹膜后或腹股沟淋巴结肿大。
IV
IV期 Growth involves one or both
ovaries with distant metastases; if pleural effusion is present,
there must be positive cytology findings to assign a case to stage
IV; parenchymal liver metastasis equals stage IV.
肿瘤生长涉及一侧或双侧卵巢，并有远处转移；如果出现胸水，胸水细胞学阳性，即为IV期；肝实质转移也为IV期。
B. Procedure 处理
1. The staging procedure is usually approached through a laparotomy incision. Any free fluid in the cul-de-sac is submitted for cytologic evaluation. Washings of the peritoneal cavity are obtained by instilling and removing 50 to 100 mL of saline. The affected adnexa should be removed intact and a frozen section obtained to determine or confirm the diagnosis. Thorough surgical staging should be carried out in the absence of obvious stage IV disease. Preservation of the uterus and a normal appearing contralateral adnexa is an option in women desirous of maintaining future fertility.
1. 手术探查常常是分期过程的开始。任何穹窿部的游离液体均应送细胞学检查。用50-100ml盐水进行腹膜腔灌洗。受累附件应完整切除，并送冰冻切片以决定或确定诊断。彻底的外科治疗应该在IV到来之前得以实施。希望保留生育功能的妇女，可保留子宫和对侧看来正常的卵巢。
2. All intraperitoneal surfaces should be carefully inspected and suspicious areas or adhesions should be biopsied. If there is no evidence of disease, multiple intraperitoneal biopsies should be performed, including from the cul-de-sac, both gutters, bladder peritoneum, and bowel mesentery.
2. 所有的腹膜内表面要仔细检查，可疑区域或粘着物应送活组织检查。若有病变证据，可行多处腹膜活组织检查，包括穹窿部、双侧最下腹、膀胱腹膜返褶和肠系膜等处。
3. The diaphragm is evaluated by either biopsy or cytologic smear. A complete omentectomy should be performed.
3. 膈的评估依赖于活组织检查或细胞学涂片。完整的系膜切除术应该被实施。
4. The retroperitoneal spaces are explored to dissect the pelvic and paraaortic lymph nodes. Any enlarged lymph nodes should be resected and submitted separately for histopathologic evaluation.
4. 腹膜后空间要探查，骨盆和主动脉旁淋巴结应仔细解剖。任何增大淋巴结都要切除，并分别送组织学检查。
5. For patients with advanced disease, optimal cytoreduction (debulking) should be attempted at the time of initial surgery. The majority of women with EOC (except for those with stage I disease) will require surgery and chemotherapy.
5. 对于进展期病人，最佳的细胞减数在外科一开始就应该被尝试。大多数上皮性卵巢癌妇女（除了那些I期病例）要求进行手术治疗和化疗。
V. Treatment of ovarian cancer 卵巢癌的治疗
A. Cytoreductive surgery improves response to chemotherapy and survival of women with advanced ovarian cancer. Operative management is designed to remove as much tumor as possible. When a malignant tumor is present, a thorough abdominal exploration, total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, omentectomy, and removal of all gross cancer are standard therapy.
A. 外科细胞减数治疗可以提高进展期卵巢癌妇女的化疗效果和存活率。手术处理应尽可能多地切除肿瘤。当恶性肿瘤确诊后，彻底的剖腹探查、完全的腹式子宫切除术、双侧双卵管卵巢切除术、淋巴结切除术、网膜切除术和所有的肉眼能看到的癌组织切除术是标准的治疗。
B. Adjuvant therapy 辅助治疗
1. Patients with stage IA or IB disease (who have been completely surgically staged) and who have borderline, well- or moderately differentiated tumors do not benefit from additional chemotherapy because their prognosis is excellent with surgery alone.
1. IA或IB期（已经有彻底外科治疗者）或者两者临界、分化良好或中等的肿瘤，传统化疗是没有益处的。因为单有外科治疗它们的预后就很好。
2. Chemotherapy improves survival and is an effective means of palliation of ovarian cancer. In patients who are at increased risk of recurrence (stage I G3 and all IC-IV), chemotherapy is recommended. Sequential clinical trials of chemotherapy agents demonstrate that cisplatin (or carboplatin) given in combination with paclitaxel is the most active combination identified.
2. 化疗可提高生存率，是缓解卵巢癌的有效方法。对复发风险增加的病例（I G3和所有IC-IV期）来说，化疗是推荐的。连续的化学治疗临床试验显示顺铂（或卡铂）加紫杉醇是已经证实最有效的联合。
References: See page 184.
参考文献：见184页
Ovarian cancer is the second most common gynecologic malignancy, but the most common cause of death among women who develop gynecologic cancer, and it is the fifth most common cancer in females. The majority (90 percent) of primary ovarian tumors derive from epithelial cells, although they can also arise from germ cell tumors, sex cord-stromal tumors, and mixed cell type tumors.
卵巢癌是妇科第二最常见妇科恶性肿瘤，但却是妇科癌症最常见的死亡原因，也是女性第五最常见癌症。大多数（90%）原发性卵巢癌来源于上皮细胞，尽管它们也可为源自生殖细胞肿瘤、性索间质肿瘤和混合细胞型肿瘤。
I. Clinical manifestations 临床表现
A. Most ovarian cancers are diagnosed between the ages of 40 and 65. Symptoms of early stage disease are often vague. Acute symptoms due to ovarian rupture or torsion are unusual. As a result, 75 to 85 percent of cases of ovarian cancer are advanced at the time of diagnosis. More advanced disease is typically associated with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases.
大多数的卵巢癌发生在40-65岁，早期常无明显症状，因卵巢破裂和扭转而出现的急性症状也不多见。因此，75-85%的卵巢癌病例发现时都是进展期了。更多的进展期病例出现典型的腹部膨隆、恶心、食欲减退以及因腹水和网膜或肠转移的存在所致的早期饱胀感。
B. Most women have nonspecific symptoms, such as lower abdominal discomfort or pressure, gas, bloating, constipation, irregular menstrual cycles/ abnormal vaginal bleeding, low-back pain, fatigue, nausea, indigestion, urinary frequency, or dyspareunia.
多数的女性都出现非特异症状，如下腹部不适或压迫感、气胀，胃部气胀、便秘，月经不调/不规则阴道出血，腰背部疼痛、疲乏、恶心、消化不良、尿频以及性欲减退等
II. Physical examination 体格检查
A. Palpation of an asymptomatic adnexal mass during a routine pelvic examination is the usual presentation for ovarian cancer. The presence of a solid, irregular, fixed pelvic mass on pelvic examination is highly suggestive of an ovarian malignancy. However, endometriomas and tubo-ovarian abscesses are benign tumors that may be fixed, while cystadenofibromas and tubo-ovarian abscesses are benign masses that feel irregular. The diagnosis of malignancy is almost certain if a fixed, irregular pelvic mass is associated with an upper abdominal mass or ascites.
A. 对卵巢癌来无症状的附件肿块进行常规的骨盆触诊检查，常常是首先要做的。骨盆检查中出现硬的、不规则的和固定的肿块常常高度怀疑卵巢恶性肿瘤。但是，子宫内膜瘤和输卵管卵巢脓肿是良性肿瘤，它们也可能是固定的，囊腺纤维瘤和输卵管卵巢脓肿是不规则的良性肿块。如果一个固定的、不规则的盆腔肿块同时伴有上腹部肿块和腹水，那么恶性的诊断几乎是肯定的。
Differential Diagnosis of Adnexal Masses in Women 女性附件肿块的鉴别诊断
Extraovarian mass 卵巢外肿块
Ectopic pregnancy 异位妊娠
Hydosalpinx or tuboovarian abscess ？或输卵管卵巢脓肿
Paraovarian cyst 卵巢旁囊肿
Peritoneal inclusion cyst 腹膜包裹性囊肿
Diverticular abscess 憩室脓肿
Appendiceal abscess 阑尾脓肿
Ovarian mass 卵巢肿块
Simple or hemorrhagic physiologic cysts (eg, follicular, corpus luteum) 单纯/出血性的生理性囊肿（如卵泡、黄体等）
Endometrioma 子宫内膜瘤
Benign or malignant neoplasms (eg, epithelial, germ cell, sex-cord)
良恶性肿瘤（如上皮性、生殖细胞源性、性索源性）
Metastatic carcinoma (eg, breast, colon, endometrium)
转移性的恶性肿瘤（如乳腺、结肠、子宫内膜）
III. Diagnostic evaluation 诊断评价
A. The finding of a pelvic mass usually requires surgery for definitive histologic diagnosis. Tumor markers (eg, serum CA 125) and ultrasound examination can help distinguish between malignant and benign pelvic masses.
A. 发现盆腔肿块通常需要外科获取可靠的组织学诊断，肿瘤标记物（如血清CA125）和超声检查有助于鉴别盆腔良恶性肿瘤。
B. A complete pelvic examination and assessment of cervical cytology should be performed preoperatively. Routine hematologic and biochemical assessments should be obtained prior to surgery. Ultrasonography for diagnosis of ovarian malignancy has a sensitivity of 62 to 100 percent and a specificity of 77 to 95 percent.
B. 术前应有完整的骨盆检查和子宫颈细胞学检查，以及血液学和生化学检查。超声波检查的敏感度可达62-100%，甚至77-95%。
C. It is reasonable to pursue a period of observation in a premenopausal woman with an adnexal mass if the mass is not clinically suspicious on ultrasonography. Adnexal masses that are mobile, purely cystic, unilateral, less than 8 to 10 cm in diameter, and have smooth internal and external contours by ultrasound are highly unlikely to be malignant and can be followed for two months; the majority of physiologic cysts will regress during this time.
C. 对于绝经期前妇女的附件肿块，若未被临床超声检查所怀疑，可以随访观察一段时间。可移动附件肿块，单纯囊肿，单侧、直径小于8-10cm、超声检查内外轮廓光滑者，不大可能是恶性肿瘤，应该随访两个月，大多数生理性的囊肿会在此期间内消失。
D. Exploration is indicated if there is no resolution within two months. However, women who have solid, fixed, irregularly shaped, or large masses should undergo surgery. A mass that increases in size or does not regress must be presumed to be neoplastic and should be removed surgically.
D. 如果2个月内肿块没有消退，即为手术探查指征。不管怎样，质硬、固定、形状不规则的、体积大的肿块应行手术治疗。逐渐增大、不消退的肿块必定为一新生物，应被手术切除。
E. The threshold for surgical intervention is lower in postmenopausal women; those with cysts greater than 3 cm should undergo exploratory surgery, laparotomy, or laparoscopy.
E. 绝经后妇女外科手术指征较宽，合并囊肿、直径大于3cm者应行手术探查、剖腹探查或腹腔镜检查。
F. Tumor markers. CA 125: The preoperative evaluation of a woman with suspected ovarian cancer should include measurement of the CA 125 concentration. The serum CA 125 (normal <35 U/mL) is elevated (>65 U/mL) in 80 percent of women with epithelial ovarian cancer. It is also increased in patients with other malignancies, including endometrial cancer and certain pancreatic cancers; in endometriosis, uterine leiomyoma, and pelvic inflammatory disease; and in approximately 1 percent of healthy women.
F. 肿瘤标志物. CA125：可疑卵巢癌妇女术前评估应该包括CA125浓度的测定。血清CA125（正常<35 U/mL）在80%的上皮性卵巢癌是升高的（>65U/mL），但在其他一些恶性肿瘤包括子宫内膜癌和部分胰腺癌，以及子宫内膜异位、子宫平滑肌瘤、盆腔炎性疾病和大约1%的健康妇女也有增加。
IV. Staging 疾病分期
A. Surgery is necessary for diagnosis, accurate staging and optimal cytoreduction, and is crucial for the successful treatment of EOC. Ovarian malignancies are surgically staged according to the 2002 revised American Joint Committee on Cancer (AJCC) and International Federation of Gynecologic Oncologists (FIGO) joint staging system, as long as the patient is an appropriate surgical candidate.
手术对于诊断、精确分期和适当的减瘤是需要的，对于上皮性卵巢癌的成功治疗也是关键的。卵巢恶性肿瘤的临床外科分期是按照2002年修订的美国癌症联合会和国际妇科肿瘤联合会的综合分期系统，只要病人是合适的外科手术病例。
Definitions of the Stages in Primary Carcinoma of the Ovary
原发性卵巢癌的分期
Stage
分期
标准
I
I期
IA
IA期
IB
IB期
IC
IC期
肿瘤生长限于卵巢内
Growth is limited to one ovary; no ascites present containing malignant cells; no tumor on the external surface; capsule is intact
肿瘤生长限于一侧卵巢内；腹水中无恶性肿瘤细胞出现，浆膜面无肿瘤侵润，浆膜完整。
Growth is limited to both ovaries; no ascites present containing malignant cells; no tumor on the external surfaces; capsules are
Intact.
肿瘤生长限于双侧卵巢内；腹水中无恶性肿瘤细胞出现，浆膜面无肿瘤侵润，双侧浆膜完整。
Tumor is classified as either stage IA or IB but with tumor on the surface of one or both ovaries; or with ruptured capsule
; or with ascites containing malignant cells present or with
positive peritoneal washings.肿瘤分级如IA或IB，一侧或双侧卵巢表面肿瘤侵润；或者浆膜破裂；或者腹水查到恶性肿瘤细胞或腹膜灌洗阳性。
II
II期
IIA
IIA期
lIB
IIB期
IIC
IIC期
肿瘤生长涉及一侧或双侧卵巢，并有盆腔蔓延
Extension and/or metastases to the uterus and/or tubes
侵及和/或转移到子宫和/或输卵管
Extension to other pelvic tissues
侵及其他骨盆组织
Tumor is either stage IIA or lIB but with tumor on the surface of one or both ovaries; or with capsule
ruptured; or with ascites containing malignant cells present or
with positive peritoneal washings.肿瘤分期如IIA或IIB，一侧或双侧卵巢表面肿瘤侵润；或者浆膜破裂；或者腹水查到恶性肿瘤细胞或腹膜灌洗阳性。
III
III期
IlIA
IIIA期
IIIB
IIIB期
IIIC
IIIC期
肿瘤生长涉及一侧或双侧卵巢，并有骨盆外腹膜种植和/或腹膜后或腹股沟淋巴结肿大；肝表面转移即为III期；肿瘤限于小骨盆，但组织学证实已侵及小肠和网膜。
Tumor is grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces
肿瘤局限于小骨盆，淋巴结无肿大，但显微镜下组织学确定有腹膜表面转移。
Tumor involves one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2cm in diameter; nodes are negative
肿瘤生长涉及一侧或双侧卵巢；组织学证实腹膜表面种植，但种植灶直径不超过2cm；淋巴结无肿大。
Abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes.
腹部种植灶直径大于2cm和/或腹膜后或腹股沟淋巴结肿大。
IV
IV期
肿瘤生长涉及一侧或双侧卵巢，并有远处转移；如果出现胸水，胸水细胞学阳性，即为IV期；肝实质转移也为IV期。
B. Procedure 处理
1. The staging procedure is usually approached through a laparotomy incision. Any free fluid in the cul-de-sac is submitted for cytologic evaluation. Washings of the peritoneal cavity are obtained by instilling and removing 50 to 100 mL of saline. The affected adnexa should be removed intact and a frozen section obtained to determine or confirm the diagnosis. Thorough surgical staging should be carried out in the absence of obvious stage IV disease. Preservation of the uterus and a normal appearing contralateral adnexa is an option in women desirous of maintaining future fertility.
1. 手术探查常常是分期过程的开始。任何穹窿部的游离液体均应送细胞学检查。用50-100ml盐水进行腹膜腔灌洗。受累附件应完整切除，并送冰冻切片以决定或确定诊断。彻底的外科治疗应该在IV到来之前得以实施。希望保留生育功能的妇女，可保留子宫和对侧看来正常的卵巢。
2. All intraperitoneal surfaces should be carefully inspected and suspicious areas or adhesions should be biopsied. If there is no evidence of disease, multiple intraperitoneal biopsies should be performed, including from the cul-de-sac, both gutters, bladder peritoneum, and bowel mesentery.
2. 所有的腹膜内表面要仔细检查，可疑区域或粘着物应送活组织检查。若有病变证据，可行多处腹膜活组织检查，包括穹窿部、双侧最下腹、膀胱腹膜返褶和肠系膜等处。
3. The diaphragm is evaluated by either biopsy or cytologic smear. A complete omentectomy should be performed.
3. 膈的评估依赖于活组织检查或细胞学涂片。完整的系膜切除术应该被实施。
4. The retroperitoneal spaces are explored to dissect the pelvic and paraaortic lymph nodes. Any enlarged lymph nodes should be resected and submitted separately for histopathologic evaluation.
4. 腹膜后空间要探查，骨盆和主动脉旁淋巴结应仔细解剖。任何增大淋巴结都要切除，并分别送组织学检查。
5. For patients with advanced disease, optimal cytoreduction (debulking) should be attempted at the time of initial surgery. The majority of women with EOC (except for those with stage I disease) will require surgery and chemotherapy.
5. 对于进展期病人，最佳的细胞减数在外科一开始就应该被尝试。大多数上皮性卵巢癌妇女（除了那些I期病例）要求进行手术治疗和化疗。
V. Treatment of ovarian cancer 卵巢癌的治疗
A. Cytoreductive surgery improves response to chemotherapy and survival of women with advanced ovarian cancer. Operative management is designed to remove as much tumor as possible. When a malignant tumor is present, a thorough abdominal exploration, total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, omentectomy, and removal of all gross cancer are standard therapy.
A. 外科细胞减数治疗可以提高进展期卵巢癌妇女的化疗效果和存活率。手术处理应尽可能多地切除肿瘤。当恶性肿瘤确诊后，彻底的剖腹探查、完全的腹式子宫切除术、双侧双卵管卵巢切除术、淋巴结切除术、网膜切除术和所有的肉眼能看到的癌组织切除术是标准的治疗。
B. Adjuvant therapy 辅助治疗
1. Patients with stage IA or IB disease (who have been completely surgically staged) and who have borderline, well- or moderately differentiated tumors do not benefit from additional chemotherapy because their prognosis is excellent with surgery alone.
1. IA或IB期（已经有彻底外科治疗者）或者两者临界、分化良好或中等的肿瘤，传统化疗是没有益处的。因为单有外科治疗它们的预后就很好。
2. Chemotherapy improves survival and is an effective means of palliation of ovarian cancer. In patients who are at increased risk of recurrence (stage I G3 and all IC-IV), chemotherapy is recommended. Sequential clinical trials of chemotherapy agents demonstrate that cisplatin (or carboplatin) given in combination with paclitaxel is the most active combination identified.
2. 化疗可提高生存率，是缓解卵巢癌的有效方法。对复发风险增加的病例（I G3和所有IC-IV期）来说，化疗是推荐的。连续的化学治疗临床试验显示顺铂（或卡铂）加紫杉醇是已经证实最有效的联合。
References: See page 184.
参考文献：见184页
顶
后一篇 >obstetrics