1
2 94 1.4 1.7 189 1.4 1.7 190 1.5 1.8 201 1.8 2.1 240 2.5 2.9 328 19.4 23.0 2,571 2.7 3.2 357 3.4 4.0 451 3.4 4.1 458 3.9 4.6 517 6.2 7.3 819 6.6 7.8 874 10.8 12.9 1,439 12.7 15.1 1,686 14.2 16.9 1,887 16.7 19.9 2,219 100.0 118.8 13,278 1a. 1a. 1b. 1b. 1c. 1c. 2a. 2a. 2b. 2b. 2c. 2c.
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% 4 11.1% 3
50% 50%~70 85% 85%~ 90 1. 2. 3. 20%-40% 20%-40% 1. 2. 3. 4. 1. granulosa 2. gonadoblastoma --- Ultrasound (CT) (PET) (MRI) 4
(CXR) (IVP) (LGI) (Endoscope) (Colonofiberoscope) Ultrasound 5
(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% 90% 6
PET-CT PET CT (MRI) 7
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-125 1. 65-90% 2. 97% 3. CA-125 CA-125 肽 (TPA) 1. 55U/L 2. 3. 4. 3 8
Tumor marker - CEA 1. 5ug 5ug L 2. 3. CA19-9 37U 37U ml Tumor marker - germ cell tumor SCC 1. 5ug 5ug L 2. 3. 结 AFP 1. 0-25ug 0-25ug L 2. AFP AFP 3. 7-8 7-8 AFP 400ug L 4. AFP AFP 5. 9
Tumor marker - germ cell tumor Beta-HCG --- a glycoprotein <5mIU ml <7mIU ml 6 8 530 180000mIU ml 9 12 10000 320000mIU ml 6 9 1000 190000mIU 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
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
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
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
VAC (vincristine( vincristine actinomycin D cyclophosphamide) VBP (vinblastine( vinblastine bleomycin cisplatin ) EP (etoposide( etoposide cisplatin) VAC VAC VBP 5000rad (P 32 Au 198 ) 14
CA- 125 CA-125 THE END 15
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
- 10 ~24 5 40%~50 80%10-20 8630 LDH 17
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
: : : 80% Granulosa 3%~6 80 45~55 19
gonadoblastoma 3 7 Y return 20