Introduction:
Ovarian cancerIt is one of the common tumors of female reproductive organs, and its incidence rate ranks third only after cervical cancer and endometrial cancer. However, due to the death of ovarian cancer, it is the first in all kinds of gynecological tumors, posing a serious threat to women's lives. Due to the embryonic development of the ovary, the tissue anatomy and endocrine function are complex, and the tumor it may have is benign or malignant. Because of the early asymptomatic clinical stage of ovarian cancer, it is quite difficult to identify its tissue type and benign and malignant. Only 30% of ovarian cancers were found to be confined to the ovary during laparotomy. Most of them have spread to the uterus, bilateral attachments, large nets. Membrane and pelvic organs, so ovarian cancer is indeed a big problem in diagnosis and treatment. Over the years, experts have carried out many discussions on the pathological morphology, clinical development and treatment of ovarian malignant tumors, and accumulated a lot of experience. So far, according to the statistics of clinical data at home and abroad, its five-year survival rate is only 25%. ~30%.
Cause:
The cause can be divided into the following aspects: external factors of cancer incidence (including chemical, physical, biological and other carcinogenic factors); internal factors of cancer incidence (including immune function, endocrine, genetic, mental factors, etc.), as well as dietary malnutrition and bad living habits Wait.
symptom:
(a) symptoms
1. Most of the ages occur in women who are perimenopausal. Ovarian epithelial cancer is more common in people over the age of 35, and germ cell malignant tumors often occur in people under 35 years of age.
2, painful malignant ovarian tumor may cause a considerable degree of sustained pain due to changes in the tumor, such as bleeding, necrosis, rapid growth. During the examination, it was found to have local tenderness.
3, irregular menstruation see irregular uterine bleeding, postmenopausal bleeding.
4, the late stage of weight loss is progressive weight loss.
(two) signs
1. Bilateral lower abdominal mass malignant ovarian tumors accounted for 75% of bilateral growth, while benign ovarian tumors accounted for only 15%.
2. The mass is fixed as one of the characteristics of ovarian malignant tumors.
3. Ascites Although benign ovarian tumors such as fibroids or papillary cystadenoma can also be associated with ascites, malignant ovarian tumors with ascites are more, and because malignant tumor cells have penetrated the tumor wall or have metastasized to the peritoneum (visual observation Or microscopic examination), ascites is more bloody.
4. The long-term consumption of cachexia is delayed due to long-term consumption and loss of appetite, and there are symptoms such as progressive weight loss, fatigue, and burnout.
diagnosis:
(I) Early diagnosis Because there are no typical symptoms and signs in the early stage of ovarian malignant tumors, it is still extremely important to ask about the medical history and serious physical examination and gynecological examination. Clinically, in case of suspicious circumstances, modern imaging studies and generalized tumor marker examinations should be used to make early diagnosis. The so-called suspicious situation may be longer ovarian dysfunction, long-term unexplained digestive tract or urinary tract symptoms, young female ovarian enlargement or menopause touch the ovary, and the suspected ovarian tumor is rapidly increasing, fixed, hardened, etc. .
(2) Those who can reach the accessory block in the early stage of positioning diagnosis, combined with image examination, positioning diagnosis is not difficult. However, in some cases, the primary tumor has an extra-ovarian metastasis and forms a small nodule in the pelvic cavity. At this time, some special examination methods should be selected to assist the diagnosis (qualitative), and should not rely solely on follow-up and follow the mistake.
(3) Qualitative diagnosis Although the diagnostic technology is changing with each passing day, the vaginal sputum smear examination, uterine rectal puncture fluid examination and ascites cytology examination are still simple, easy and fast basic examination. For suspicious cases, laparoscopic and histological examinations can be immediately and clearly diagnosed. Imaging studies, especially vaginal ultrasound scans, can be useful for qualitative diagnosis of the boundaries (interval) and internal structures (properties) of early ovarian malignancies. Endocrine examination contributes to the diagnosis of ovarian gonadal stromal tumors and some ovarian cancers with ectopic endocrine syndrome. The detection of serum tumor markers such as CA125, CEA, SONA, SGA, etc. is highly sensitive to ovarian malignant tumors, and its specificity is poor. Therefore, it cannot be judged by a single immunological test. However, a combination of multiple tumor markers, such as simultaneous detection of CA125, CEA, ferritin and tissue polypeptide antigen (TPA), can improve the reliability of qualitative diagnosis.
Identification
1, ovarian non-neoplastic cysts such as follicular cysts, corpus luteum cysts, etc., generally less than 5cm in diameter, thin wall, more naturally disappear in 1 to 2 months.
2, uterine fibroids ovarian tumors may be confused with uterine fibroids cystic or subserosal uterine fibroids. B-ultrasound can confirm the diagnosis.
3, early pregnancy uterus increased and soft, there is a history of menopause, hCG value can be diagnosed. B super sees embryo sac or fetal heart pulsation.
4, chronic urinary retention has a history of dysuria or urinary insufficiency, the mass is located in the middle of the lower abdomen, the boundary is unclear, the mass after the catheterization disappears, can also be identified by B-ultrasound.
5, the attachment inflammatory mass has a history of chronic pelvic inflammatory disease and infertility, the position of the mass is low, there is tenderness, and there is adhesion to the uterus.
6, ascites and tuberculous peritonitis (encapsulated effusion) and large ovarian cysts.
Differential diagnosis of giant ovarian cysts, ascites, tuberculous peritonitis (envelope effusion)
Ovarian cyst ascites tuberculous peritonitis
The history of the disease has a mass that gradually increases from the lower abdomen side without a lump, and is often secondary to liver, kidney, and heart organ diseases. The abdomen gradually expands and lowers fever, and the symptoms of weight loss and digestive tract are obvious. The amenorrhea gradually enlarges and the abdomen gradually expands.
The examination of the abdomen is raised forward, and the sides are flat on both sides, and the middle is flat, such as the frog's abdomen
Palpation can touch the lumps, huge cysts are not easy to clear, no lumps or lumps or irregular blocks
Percussion on both sides of the drum sound, middle voiced sound, no moving voiced sound on both sides of the sound, the middle drum sound, there is a moving voiced voiced sound and drum sound limit
Gynecological examination of the uterus is topped forward, inactive, after the sputum can be sputum and the wall of the uterus has a floating ball feel uterine attachment can be normal, can also be stuck with the intestinal tube and can not understand
B-mode ultrasound
The image is a circular liquid dark area with neat borders and smooth irregular liquid dark areas. Among them, intestinal light clusters float irregular cystic liquid dark areas, and the walls are usually intestinal light clusters.
X-ray gastrointestinal
The gastrointestinal tract is mostly floated by the umbilicus to the upper and lower intestines, and the activity is large, and the intestinal adhesion is not easy to push open.
complication:
1, pedicle torsion is more common, one of the gynecological acute abdomen. It is more common in cystic tumors with long tumor size, moderate size, large mobility, and one side of the center of gravity. It occurs mostly in sudden changes in body position, early pregnancy or postpartum. After the pedicle is reversed, the tumor venous return is blocked, causing congestion, purple-brown, and even rupture of blood vessels. Tumor necrosis and infection may occur due to arterial obstruction. When the acute pedicle is twisted, the patient suddenly has severe pain in the lower abdomen. In severe cases, it may be accompanied by nausea, vomiting, or even shock. During the examination, the affected side of the abdominal wall muscles were tense, the tenderness was significant, and the mass of the mass was large. Once diagnosed, the tumor should be surgically removed immediately. Do not turn the twisted pedicle back during surgery. It should be cut off at the proximal side of the pedicle to prevent the thrombus from falling into the blood circulation.
2. Tumor rupture may cause spontaneous rupture due to ischemic necrosis of the cyst wall or tumor erosion through the wall of the capsule; or traumatic rupture due to extrusion, childbirth, gynecological examination and puncture. After rupture, the cystic fluid flows into the abdominal cavity, stimulating the peritoneum, which can cause severe abdominal pain, nausea, vomiting, and even shock. During the examination, there were signs of abdominal irritation such as abdominal wall tension, tenderness, and rebound tenderness. The original mass was reduced or disappeared. Immediately after diagnosis, the laparotomy should be performed to remove the cyst and clean the peritoneum.
3, infection is less common, and more secondary to tumor pedicle torsion or rupture. The main symptoms are fever, abdominal pain, elevated white blood cells and varying degrees of peritonitis. Infection should be actively controlled and selected for surgical exploration.
4, malignant ovarian benign tumor malignant more occurs in older, especially menopausal, the tumor rapidly increased in a short period of time, patients with abdominal distension, loss of appetite, examination of tumor volume increased significantly, fixed, mostly ascites. Those suspected of having a vicious change should be dealt with in a timely manner.
treatment:
First, Western medicine treatment
1. Surgical treatment should be explored in detail, including peritoneal lavage, pelvic and abdominal organs and pelvic cavity, palpation of retroperitoneal lymph nodes and multiple biopsy of diaphragm, peritoneum and omentum for accurate tumor staging. . The surgical approach is divided into thorough surgery and conservative surgery to preserve fertility. The scope of complete surgery includes bilateral attachments, uterus, omentum, appendectomy, and pelvic and retroperitoneal lymph node dissection. For patients with extensive tumor metastasis in the pelvis, it is recommended to do cytoreductive surgery as much as possible. Williams et al reported that patients who underwent surgical resection had a complete remission rate of 83% after surgery, and a complete remission rate of 59% for the basic debrider (remaining tumor diameter <2 cm) and partial resection (diagnosis diameter >2 cm). The complete response rate for postoperative chemotherapy was 42%. Therefore, although malignant germ cell tumors are sensitive to combination chemotherapy, it is still the key to successful treatment to remove the tumor as much as possible during surgery.
2. Chemotherapy Because ovarian tumors spread very early, most cases can not clear the lesions during surgery, and the effect and application of radiotherapy are limited, so systemic chemotherapy is an important adjuvant treatment. In some advanced patients, the mass can be reduced after chemotherapy, creating favorable conditions for reoperation.
There is no unified chemotherapy for the treatment of malignant ovarian tumors. The principle is: 1 large dose intermittent medication is better for continuous administration of the drug; the former refers to the treatment for about 1 week per treatment, intermittent for 3 to 4 weeks, which can achieve effective anti-tumor effect. It is also beneficial to the body to eliminate toxicity and restore immune function. 2 combined chemotherapy is better than single chemotherapy: more frequent combination therapy in recent times, but it should be noted that the toxicity of combined chemotherapy is heavier. 3 According to the drug sensitivity test, the use of sensitive chemotherapeutic drugs can prolong the survival time of patients. 4 Develop different chemotherapy regimens according to the type of organization. In recent years, the common chemotherapy regimen for ovarian cancer is as follows.
(1) Epithelial cancer and sexual cord tumors are often used
(1) PAC program: CTX 400mg intravenous injection on the first day
ADM 40mg intravenous injection the next day
DDP 80mg intraperitoneal injection for the third day
(2) CFP program: CTX 400mg intravenous injection on the first day
5FUl50mg intraperitoneal injection the next day
DDP 80mg intraperitoneal injection for the third day
(3) CP program: CXR 200mg intravenous injection for 5 days
DDP 40mg intravenous drip for 5 days
(4) CHFP program: 5FUl000mg intravenous drip on day 1 or day 8
DDP 40mg intravenous drip on day 1 and day 8
CTX l00mg oral 2 times a day 2nd to 7th day and 9 to 16 days
(2) germ cell tumors and sarcoma multi-purpose
(1) VAC program: VCR 2mg intravenous injection on day l
ACD 300ug intravenous drip 2nd to 6th day
CTX 300mg intravenous injection for the second to sixth days
(2) FAC program: 5Fulooomg intravenous drip for 5 days
ACD 300ug intravenous drip for 5 days
CTX 300mg intravenous injection for 5 days
(3) PVB program: VLB 20mg (or VCR2mg) intravenous injection on the first day
BLM 30mg muscle or intraperitoneal injection on day 2
DDP 20 ~ 30mg intravenous drip or intraperitoneal injection of the first 1-5 days
Each of the above regimens is usually 3 to 4 weeks apart, depending on the patient's constitution, degree of response, blood and liver and kidney function. At least 4 to 6 courses of medication, advanced or insensitive tumor chemotherapy, the course of treatment should be more, generally 8 to 10 courses in the first year, reduced to 3 to 4 courses in the second year.
(4) Radioimmunotherapy The radiosensitivity of ovarian malignant tumors varies greatly. Ovarian endodermal sinus tumors, immature teratomas, embryonic cancers are least sensitive, ovarian epithelial cancer and granulosa cell carcinoma are moderately sensitive, and neutrophiloma is the most Sensitive, can be controlled by radiotherapy after surgery. Because of the early abdominal metastasis of ovarian cancer, the scope of irradiation includes the abdominal cavity and pelvic cavity. The liver and kidney areas are protected from radiation damage. The total amount of radiation is from 3000cGY to 5000cGY/6 to 8 weeks.
Internal irradiation refers to the injection of limb gold (198AU) or phosphorus (32P) into the abdominal cavity, which can make the surface of the abdominal cavity difficult to reach by external irradiation. Due to its limited penetrability, it can be used to treat superficial metastasis in the abdominal cavity. Or stage I tumor rupture, to improve the five-year survival rate. The disadvantage is that the abdominal cavity must be free of adhesions, so that the distribution of radioisotopes is uniform, otherwise it can cause intestinal damage and cause serious consequences. Generally, the amount of 198AU is 120 to 150 millicuries, and 32P is 10 to 20 millicuries.
Second, Chinese medicine treatment
1. Massage therapy:
1 The patient is supine, the doctor sits or stands on the side, and the single palm is pressed 10 times on the lower abdomen. The technique should be deep and soft, and then the palm vibration method is 3 to 5 minutes.
2 palms of the thumb on the blood hole, the remaining 4 fingers to press the lap muscle, click on the sputum in parallel, operate for 3 to 5 minutes.
3 Click and pluck the Sanyinjiao and Yinlingquan points for 1 minute each.
4 The patient is lying on his back, and the doctor's single palm is placed on the squatting and squatting point of the sputum, and the upper and lower squats are pressed repeatedly, and the heat is transmitted through the lower abdomen.
5 doctors with a single-handed food, the middle finger together, slightly hooked to the patient's long strong point 5 to 10 times.
6揉 According to the patient's Shenshu and Mingmen points for 1 minute each.
2. Auxiliary techniques:
1 If the patient sees a multi-color white sticky or yellow turbid, sputum or odor, the itch is burning, the tongue is red and muddy, and the pulse is slippery. The basic technique is added: straight back and back, with heat as the degree; click on the Yinling Spring and the ground machine for 1 minute each; press the foot Sanli and Quchi points for 1 minute each.
2 If the symptoms are seen, the amount is dripping, the dripping is constant, the thin and pale, the waist is sore, the lower abdomen is cold, the tongue is light, the fur is white, and the pulse is late. Basic techniques plus: horizontal rubbing Shenshu, Baqi points, with heat as the degree; click Guanyuan point for 1 minute; 揉 press Baihui point for 1 to 3 minutes.
prevention:
(1) All solid ovarian masses, or cysts larger than 6 cm, should be surgically removed immediately.
(B) before menarche and postmenopausal women, there are ovarian masses, should be considered as tumors. Women of childbearing age have small attachment cystic masses. Those who have not seen the reduction for 2 months are considered as tumors.
(C) pelvic inflammatory mass, especially suspected pelvic tuberculosis or endometriosis lumps, after treatment is ineffective, can not rule out the tumor should be surgical exploration.
(D) endometrial adenomatous hyperplasia or endometrial adenocarcinoma after menopause, should pay attention to the presence or absence of tumors in the ovary, and timely surgical treatment.
(5) When performing pelvic surgery, both sides should be carefully examined for the presence or absence of lesions in both ovaries. In addition to the indications for ovarian disease itself, when the age is 45 years or older, the disease of the uterus should be hysterectomy. It is recommended to remove the bilateral attachment at the same time. .
First, general care
Psychological care: Most patients with ovarian cancer have advanced stage and are easy to metastasize and relapse. Most patients have undergone surgery and repeated chemotherapy. Some patients have poor efficacy and lack of confidence in treatment. In addition, chemotherapy makes it difficult for patients to express in words. Physical discomfort, prone to anxiety, fear, depression; paclitaxel is expensive, there is a certain pressure on the patient's economy; paclitaxel causes hair loss, which is a heavy blow to the female patient's love psychology. In response to his psychological reaction, he introduced the effects of paclitaxel treatment at home and abroad, and introduced successful cases to establish confidence in the fight against disease. At the same time, explain to the patient how to use paclitaxel and cisplatin and the possible adverse reactions and treatment methods after treatment, so that patients have enough psychological preparation to cooperate with treatment.
Prognosis: The short-term efficacy of ovarian cancer has improved significantly with the development of clinical research and medical level, but the survival rate of advanced ovarian cancer is still decreasing with time. Most of the current observations are that the factors that influence the prognosis of ovarian cancer are mainly the stage, the size of the residual foci and the degree of tumor differentiation. The correct staging can guide the initial treatment to be thorough and complete, laying a good foundation for future treatment. If Ic is misdiagnosed as Ia, Ib, or invasive cancer is misdiagnosed or missed as a junctional tumor, because the prognosis of the two is completely different, it will eventually lead to adverse results, so the wrong diagnosis will affect the prognosis. The residual foci were closely related to the prognosis, and the 5-year survival rate of differentiation was 60%, and the difference was 7%. The thoroughness of the first debulking technique and the size of the residual tumor volume are also important factors affecting prognosis. Older people have a worse prognosis than younger ones because older people are more likely to develop poorly differentiated tumors. Other pathological histological classifications are also associated with prognosis.
Second, diet therapy
Squid ginkgo
60 grams of squid meat, 10 pieces of ginkgo, seasoning amount. Wash the two flavors, put in the pot, add some water, cook until the meat is rotten, add seasoning Serve. Take it once a day, even with soup.
2. Iron (iron food) leaves red jujube soup
200 grams of iron leaves, 10 red dates. Wash the two flavors into the pot, add some water, and cook for juice. 1 dose per day, 3 times serving, 30 days for a course of treatment.
3. Dragon Ball Tea
15 grams of dragon sunflower seeds, 30 grams of medical stone, brown sugar right amount. The dragon's sunflower and the maifan stone are boiled with water, and the slag is taken for juice and transferred to brown sugar. Drink on a daily basis for tea.
4. Motherwort boiled eggs
50 grams of motherwort, 2 eggs. Motherwort is washed and cut into sections, and cooked with the eggs and water. After the eggs are cooked, the eggs are removed and the eggs are cooked for a while. Take 1 dose a day and eat egg soup.
5. Purple grass quail eggs
60 grams of comfrey root and 4 quail eggs. The comfrey and quail eggs are boiled together with water until the eggs are ripe. Go to comfrey. 1 dose a day, eat eggs, and even served for 15 days.
6. Chen Xiang beef; selection and ratio: 30 grams of dried tangerine peel, 15 grams of fragrant aconite, 500 grams of beef, onion, ginger, salt amount. Production method: Add 2,000 grams of dried tangerine peel and fragrant aconite to the slag, add beef, onion, ginger, salt and other spices, simmer until simmered, cool and sliced food. Efficacy: Shugan qi, spleen and Qi. Fang Zhong Chen Pi has the power of qi and spleen.
7. Shenqi Jianpi Decoction formula: Korean ginseng 10G, Astragalus 10G, Codonopsis pilosula 18G, Chinese yam 18G, Chinese wolfberry 15G, Angelica 10G, dried tangerine peel 5G, longan meat 14G. Pork ribs 300G or 1 light-light chicken, water amount. Method: Wash Chinese medicinal herbs such as Korean ginseng and scutellaria, put them into a cloth bag and pour them with pork ribs or chicken. Start with a small fire and cook for 2-3 hours. Remove the bag and add seasonings such as salt and pepper. 1 small bowl each time, once a day. The above materials can be made into 5 small bowls. Eat meat and soup. Excess is placed in the refrigerator for storage. Efficacy: spleen and lung, appetizing and strong. Note: This meal is suitable for conditioning after ovarian cancer surgery
8. Shanglu porridge formula: Shanglu 10g, glutinous rice 100g, jujube 5 pieces. The amount of water is appropriate. System of law: First, the commercial land water decoction, to the residue, and then add glutinous rice, jujube porridge. Eat on an empty stomach, with a small profit, not excessive. Efficacy: Jiantong Li two will, diuretic swelling. Note: This meal is mainly suitable for ascites caused by dysuria caused by ovarian cancer.
Ovary cancer to eat those good for the body?
1. Diet is not partial, eat more fiber-rich, trace elements and cellulosic foods, such as mushrooms, soybeans, fresh vegetables, mushrooms and turtles, kelp, seaweed, oysters and so on.
2. In the advanced stage of ovarian cancer, you can not eat, you can replenish or give intravenous high nutrient infusion.
3. In addition to milk and eggs, eat more fresh vegetables, fruits, protein and vitamins, and eat raw pork.
4. Postoperative care should be taken to nourish the body and regulate menstruation, nourishing liver and kidney products, such as pomegranate, mangosteen, longan, mulberry, black sesame, black fungus, mung bean, placenta, squid, squid.
5. Cauliflower (cauliflower), kale, white broccoli, cabbage, pakchoi, etc.; or natural foods rich in vitamin E, such as soybeans, cabbage and so on. Ovarian cancer patients who have consumed these vegetables for a long time have survived for a long time, but vitamin pills do not have this effect. At the same time, the study pointed out that patients who ate the most dairy products after the disease had a 30% higher chance of early death than those who ate the least dairy products.
6. Eat more foods with anti-ovarian tumors: sputum, hippocampus, scorpion, dragon pearl tea, hawthorn.
7. Bleeding should eat sheep blood, lion lion, mussel, squid, leeks, medlar, mushroom, Malan head, stone ear, medlar, dried persimmon.
8. Infection should be eaten squid, clam, water snake, needle fish, squid, eucalyptus, celery, sesame, buckwheat, rape, citron, red bean, mung bean.
9. Abdominal pain, abdominal distension should eat pork loin, bayberry, hawthorn, orange cake, walnut, chestnut.
It is best not to eat those foods for ovarian cancer?
1. Patients with ovarian cancer should have a light diet, do not eat or eat high doses of lactose and excessive animal fat.
2. Do not eat smoked, mildew, food containing nitrite, eat less fried, spicy, pickled food, no smoking, no alcohol, no overeating.
3. Avoid tobacco and alcohol.
4. Avoid irritating food such as onions, garlic, pepper, cinnamon.
5. Avoid fatty, fried, mildew, pickled food.
One-day medication and general diet for patients with ovarian cancer
breakfast
Milk, eggs, glutinous rice kernels, oatmeal, barley, black rice, rice porridge, sugared garlic, walnuts, hazelnuts, cashews
lunch
Corn noodles, cold salad broccoli, mushrooms, black fungus, white radish, pork ribs, bean curd skin soup, steamed yellow croaker, fried sage, white scallions, fried asparagus, fat head fish, black fungus, white mushroom, tofu soup
dinner
Glutinous rice, black rice, corn, sweet potato, Jiangmi porridge, sesame paste with spinach, tomato sauce, shrimp, sea scallop or scallop fried lettuce, whole wheat bread, lily, rapeseed, mushrooms, porridge green pepper, onion fried beef, green onion / Mix with parsley
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