recurrent ovarian malignancy
Introduction
Introduction to recurrent ovarian malignancies The incidence of ovarian cancer ranks third in gynecological cancer, but its mortality rate ranks first. Because the diagnosis of ovarian epithelial cancer is advanced, the ideal treatment of tumor cytoreductive surgery combined with platinum or paclitaxel combined chemotherapy, the prognosis of some patients with ovarian cancer has been greatly improved. basic knowledge The proportion of illness: 0.0002% Susceptible people: women occur Mode of infection: non-infectious Complications: intestinal obstruction
Cause
Causes of recurrent ovarian malignancies
(1) Causes of the disease
The cause of recurrence of recurrent ovarian malignant tumors is related to heredity, internal and external environment, and treatment methods.
Risk factors affecting the recurrence of ovarian cancer:
1. The five-year survival rate of early stage clinical cancer is significantly higher than that of middle and advanced stage cancer, and most of the patients in middle and advanced stage relapse within 1 to 2 years.
2. Pathological type serous carcinoma, clear cell carcinoma is more likely to recur than mucinous carcinoma.
3. Cell fractionation Cell grade II to III is prone to recurrence, which may be related to the degree of differentiation of tumor cells, cell division rate, and metastasis ability.
4. Residual lesions after tumor size shrinkage more than 2cm diameter is easy to relapse, and directly affect the sensitivity of chemotherapy.
5. The postoperative chemotherapy regimen chose non-platinum-based chemotherapy, and the recurrence was significantly higher than that of platinum-based chemotherapy.
6. The general condition of the body is poor, older or have other comorbidities.
7. Chemotherapy resistance In recent years, many studies have found that changes in certain genes or tumor suppressor genes in ovarian tissue are associated with recurrence, such as p53 gene mutation, multidrug resistance gene protein P-gp expression and C-erbB-2 study. It shows that its high level of expression indicates earlier and more recurrence.
(two) pathogenesis
The recurrence mechanism of ovarian malignant tumors is still unclear, and the recurrence rate is still high. The recurrence of ovarian cancer is a serious challenge for all gynecologic oncologists.
Prevention
Recurrent ovarian malignancy prevention
Regular screening, early detection, early treatment, and good follow-up.
The retest time of CA125 should be shortened, and the vigilance should be improved. If there is a progressive increase in CA125, although it is not significant, the clinical should be intervened and further examined. Most patients have an understanding of the disease change due to the long course of the disease, so the tumor is Markers are particularly sensitive and seriously affect mood, but CA125 has both false positives (such as inflammation) and false negatives, so the clinician's explanation is extremely important.
Complication
Recurrent ovarian malignancy complications Complications, intestinal obstruction
Most of the complicated intestinal obstruction and extensive infiltration of the surface of the pelvic organs in the abdominal cavity.
Symptom
Symptoms of recurrent ovarian malignancy Common symptoms Blood in the stool, vaginal bleeding, abdominal pain, ascites
1. The vast majority of recurrences are in the abdomen, pelvic and vaginal stumps, and a few are transferred to the liver, lungs, brain, bones, etc.
2. Conscious symptoms are weight loss, loss of appetite, abdominal distension, abdominal pain, abnormal bowel movements and other gastrointestinal symptoms, and some patients have vaginal bleeding.
3. Abdominal dilatation, flatulence, lumps and lumps, or chest, ascites, individual patients due to intestinal invasion, so that blood treatment, pelvic examination is the most important, especially the anus can not be ignored, should be carefully examined In the case of pelvic conditions, thickened nodules or masses should be described in detail, especially in the residual examination of the remaining parts of the tumor.
4. Definition of recurrent ovarian cancer type ovarian cancer recurrence population: For the convenience of clinical study design and objective evaluation of the therapeutic effects of different units, it is recommended to classify patients with recurrent ovarian cancer.
(1) recurrent ovarian cancer (possibly sensitive to platinum): the first use of platinum-based chemotherapy and has obtained clinically proven remission, recurrence of lesions after more than 6 months of discontinuation, considered to be chemotherapy-sensitive patients .
(2) Drug-resistant ovarian cancer: The initial chemotherapy is effective, but after the completion of chemotherapy, a relatively short time, that is, recurrence within 6 months, should be considered platinum-resistant.
(3) Persistent ovarian cancer: refers to patients who have completed initial chemotherapy and have obvious relief, but there are residual lesions, such as elevated CA125, second-detection pathological examination of microscopic lesions, abnormal CT examination, physical examination with positive signs patient.
(4) refractory ovarian cancer: the initial treatment does not reach partial remission, including patients with stable or even continuous disease progression, accounting for about 20%, and the response rate of such patients to second-line treatment may be the lowest, in many studies In clinical practice, drug-resistant, persistent, and refractory patients are often grouped together and separated from platinum-sensitive patients.
Examine
Examination of recurrent ovarian malignancies
1. Tumor Marker Examination CA125 is a tumor marker that is sensitive to ovarian epithelial tumors. It is especially emphasized that dynamic observation is helpful to judge that the increase of CA125 in the early stage of recurrence is not significant, and some fluctuations.
2. Imaging examination The value of ultrasonography is not very high, its accuracy is only about 60%. CT, MRI examination can determine the location of the lesion, the involvement of organs and the feasibility of speculative surgery, positron emission tomography ( PET) suggesting pots, abnormally high metabolic lesions in the abdominal cavity, all pathologically confirmed ovarian cancer recurrence, the positive predictive value is 100%, while the positive predictive value of CA125 in the same period is 88.9%, positive predictive value of pelvic and abdominal cavity B-ultrasound and CT examination 11.1% and 14.3%, respectively, so PET as a non-invasive examination, clear imaging, accurate positioning, sensitivity, high specificity, may become an important method for early diagnosis and localization of ovarian epithelial cancer recurrence, providing re-treatment A reliable basis.
3. Other auxiliary examinations for laparoscopy and histopathological examination.
Diagnosis
Diagnosis and diagnosis of recurrent ovarian malignant tumors
diagnosis
The diagnosis of ovarian cancer recurrence should be qualitative, localized and typed to individualized treatment according to different conditions, and can be diagnosed according to clinical manifestations, symptoms and the above examination.
Differential diagnosis
Pay attention to the differentiation of the digestive tract, urinary tract and gynecological symptoms caused by other causes.
