卵巢癌(2).ppt

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悠侪文
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2 , , , , , ,278 1a. 1a. 1b. 1b. 1c. 1c. 2a. 2a. 2b. 2b. 2c. 2c.

3 3a. 3b. 3c. FIGO 1a 86.9% 86.9% 1b 71.3% 71.3% 1c 79.2% 2a 66.6% 66.6% 2b 55.1% 55.1% 2c 57.0% 3a 41.1% 41.1% 3b 24.9% 24.9% 3c 23.4% % 3

4 50% 50%~70 85% 85%~ %-40% 20%-40% granulosa 2. gonadoblastoma --- Ultrasound (CT) (PET) (MRI) 4

5 (CXR) (IVP) (LGI) (Endoscope) (Colonofiberoscope) Ultrasound 5

6 (CT) X-ray A CT scan series of the lower abdomen showing ovarian cancer that has metastasized (spread) to the peritoneum This CT scan of the lower abdomen shows a massive amount of free abdominal fluid (ascites) in a patient with ovarian cancer. (PET-CT) PET β+ CT CT 90% 89% % 90% 6

7 PET-CT PET CT (MRI) 7

8 Tumor marker 1. ( ( epithelial stromal tumor) CA125, TPA, CA19-9, CEA 2. ( ( germ cell tumor) a. beta-hcg ( hcg) b. alpha-fetoprotein ( AFP) c. LDH d. SCC antigen 3. ( sex-cord stromal tumor) a. granulosa estradiol estradiol inhibin mullerian inhibitory substance (MIS) b. gonadoblastoma testosterone testosterone DHEA Tumor marker - CA % 2. 97% 3. CA-125 CA-125 肽 (TPA) 1. 55U/L

9 Tumor marker - CEA 1. 5ug 5ug L CA U 37U ml Tumor marker - germ cell tumor SCC 1. 5ug 5ug L 结 AFP ug 0-25ug L 2. AFP AFP AFP 400ug L 4. AFP AFP 5. 9

10 Tumor marker - germ cell tumor Beta-HCG --- a glycoprotein <5mIU ml <7mIU ml mIU ml mIU ml mIU ml Tumor marker - germ cell tumor LDH: LDH, lactic dehydrogenase,, is a glycolytic enzyme that reversibly catalyzes the conversion of pyruvate to lactate. It is believed that rapidly proliferating populations of neoplastic cells depend largely on glycolytic mechanisms for deriving energy and have a high requirement for LDH to regenerate nicotinamide- adenine dinucleotide (NAD) from reduced nicotinamide-adenine dinucleotide (NADH) and support continued glycolysis. 10

11 Tumor marker - granulosa cell tumor Estradiol: Estradiol was identified as one of the first substances secreted by GCT and is responsible for some of clinical manifestations. Theca cells, in tumor stroma,, are responsible for producing the estradiol precursor, androstenedione, which in turn is converted to estradiol through the action of aromatase present in granulosa cells. In the rare case of an androgen-secreting GCT, it may also be possible to use testosterone or its precursors as a tumor marker. Inhibin: Tumor marker - granulosa cell tumor Inhibin is a heterodimeric polypeptide hormone produced by granulosa cells of normal ovarian follicles. A protein negative feedback regulator of follicle- stimulating hormone (FSH) secretion by the anterior pituitary. Inhibin secretion is stimulated by FSH and luteinizing hormone (LH). 11

12 Inhibin: Tumor marker - granulosa cell tumor Premenopausal women with elevated inhibin levels => amenorrhea and infertility. After tumor resection => regain menstrual activity and were able to conceive normal pregnancies. (because of normalization of inhibin levels) Elevated inhibin levels may also be observed in epithelial ovarian cancers, especially of the mucinous variety. Tumor marker - granulosa cell tumor Mullerian inhibitory substance (MIS): Also referred to as antimullerian hormone. In males, it is produced by the testicular Sertoli cells and causes regression of the fetal mullerian ducts. In females, it is produced by the granulosa cells in the developing follicles of the ovary. Normal postmenopausal women were found to have undetectable MIS levels, and premenopausal women never had values greater than 5 g/l. 12

13 Tumor marker - granulosa cell tumor Mullerian inhibitory substance (MIS): MIS levels were normal in 93% of other gynecologic and nongynecologic cancers. MIS serum assays are not commercially available but may be performed on a research basis. 2 13

14 VAC (vincristine( vincristine actinomycin D cyclophosphamide) VBP (vinblastine( vinblastine bleomycin cisplatin ) EP (etoposide( etoposide cisplatin) VAC VAC VBP 5000rad (P 32 Au 198 ) 14

15 CA- 125 CA-125 THE END 15

16 卵巢癌的分類 -上皮細胞癌 ( Epithelial Stromal Tumor) 漿液性囊腺癌最常見的卵巢惡性腫瘤占40 50 多為雙側體積較大 5 年存活率僅為20% 30 腺體上皮向囊腔內呈乳突狀生長分泌漿液卵巢癌的分類 -上皮細胞癌 ( Epithelial Stromal Tumor) 黏液性囊腺癌占卵巢惡性腫瘤的10 單側多見瘤體較大預后較漿液性囊腺癌好 5年存活率為40% 50% 少有乳突狀增生分泌黏液 16

17 - 10 ~ %~50 80% LDH 17

18 卵巢癌的分類生殖細胞癌 ( Germ Cell Tumor) 畸胎瘤成熟畸胎瘤屬良性腫瘤是最常見的良性腫瘤占卵巢腫瘤的 10%~20% 占生殖細胞瘤的 85%~97% 任何年齡均有可能發生,以20~40歲居多若轉為惡性則癒後較差存活率約15~30% 未成熟畸胎瘤是惡性腫瘤好發于青少年復發及轉移率均高 5 年存活率僅20 左右卵巢癌的分類生殖細胞癌 ( Germ Cell Tumor) 內胚屬竇狀瘤多見於兒童及年經婦女較罕見惡性程度高生長迅速易早期轉移癒後差平均生存期僅一年 18

19 : : : 80% Granulosa 3%~ ~55 19

20 gonadoblastoma 3 7 Y return 20

認識膀胱腫瘤(Bladder Tumor)

認識膀胱腫瘤(Bladder Tumor) 頭頸癌手冊我的姓名 : 認識頭頸部腫瘤 ( ) 看診醫院 : 財團法人長庚紀念醫院手術日期 : 我的醫師 : 個案管理師 : 聯絡方式 : 長庚紀念醫院編印目錄 : 前言前言頭頸部的構造及功能頭頸癌的疾病介紹頭頸癌的主要症狀頭頸癌的預防