卵巢癌 Ovarian Cancer
Histogenetic classification of ovarian neoplasm
I. Neoplasms derived from coelomic epithelium
A. Serous tumor
B. Mucinous tumor
C. Endometriod tumor
D. Mesonephroid (clear cell) tumor
E. Brenner tumor
F. Undifferentiated carcinoma
G. Carcinosarcoma and mixed mesodermal tumor
II. Neoplasms derived from germ cells
A. Teratoma
1. Mature teratoma
a. Solid adult teratoma
b. Dermoid cyst
c. Struma ovarii
d. Malignant neoplasms secondarily arising from mature cystic teratoma
2. Immature teratoma (partially differentiated teratoma)
B. Dysgerminoma
C. Embryonal carcinoma
D. Endodermal sinus tumor
E. Choriocarcinoma
F. Gonadoblastoma
III. Neoplasms derived from specialized gonadal stroma
A. Granulosa-theca cell tumors
1. Granulosa tumor
2. Thecoma
B. Sertoli-Leydig tumors
1. Arrhenoblastoma
2. Sertoli tumor
C. Gynandroblastoma
D. Lipid cell tumors
IV. Neoplasms derived from nonspecific mesenchyme
A. Fibroma, hemangioma, leiomyoma, lipoma
B. Lymphoma
C. Sarcoma
V. Neoplasms metastatic to the ovary
A. Gastrointestinal tract (Krukenberg)
B. Breast
C. Endometrium
D. Lymphoma
Stage of ovarian cancer
Stage I Growth limited to the ovaries
Stage Ia Growth limited to one ovary; no ascites present containing malignant cells; no tumor on the external surfaces; capsule intact
Stage Ib Growth limited to both ovaries; no ascites present containing malignant cells; no tumor on the external surfaces; capsules intact
Stage Ic Tumor either stage Ia or stage Ib but with tumor on the surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells or with positive peritoneal washings
Stage II Growth involving one or both ovaries with pelvic extension
Stage IIa Extension and/or metastases to the uterus and/or tubes
Stage IIb Extension to other pelvic tissues
Stage IIc Tumor either stage IIa or stag IIb but with tumor on the surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive peitoneal washings
Stage III Tumor involving 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 verified malignant extension to small bowel or omentum
Stage IIIa Tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces
Stage IIIb Tumor of one or both ovaries; histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes negative
Stage IIIc Abdominal implants 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
Stage IV Growth involving one or both ovaries with distant metastasis; if pleural effusion is present, there must be positive cytologic test results to allot a case to stage IV; parenchymal liver metastasis equals stage IV
Pre-operative survey
1. Tumor markers: CA-125, AFP, CEA, β-HCG, LDH, CA19-9 (for mucinous tumors)
2. Lower GI series survey
3. Panendoscope
4. Fr D&C + cervical biopsy
5. Breast exam (and/or mammography)
Surgical therapy in ovarian cancer
1. Peritoneal washing cytology
2. Determination of extent of disease
a. pelvis
b. peritoneal surface
c. diaphragms
d. omentum
e. lymph node
3. Remove all tumors possibly plus pelvic, para-aortic lymph node sampling and omentectomy
Adjuvant therapy
1. Chemotherapy as ovarian cancer protocol.
Requirements for conservative management in epithelial ovarian cancer
1. Stage Ia
2. Well differentiated
3. Young woman of low parity
4. Otherwise normal pelvis
5. encapsulated and free of adhesions
6. No invasion of capsule, lymphatics, or mesovarium
7. Peritoneal washings negative
8. Adequate evaluaiton of opposite ovary and omental biopsy negative
9. Close follow-up probable
10. Excision of residual ovary after completion of childbearing (optional)