Benign and malignant ovarian tumor treatment

1. After a benign tumor diagnosis, treatment should be performed, unless the suspected ovarian tumor-like lesions and can be used for short-term treatment and observation. According to the patient's age, reproductive requirements and the contralateral ovarian surgery scope of the decision. Young, unilateral benign tumor that should be ipsilateral annex or ovariectomy or ovarian tumors Enudeation of retained contralateral normal ovary; Even bilateral tumors, but also for ovarian tumor removal surgery or peeling, for the retention of some ovarian tissue. Women before and after menopause were OK hysterectomy and bilateral Annex surgery. Intraoperative be differentiated ovarian tumor is benign or malignant, in addition to remove the tumor naked eye observation distinction, necessary for the frozen section histological examination to determine the extent of the operation. Must complete tumor removal to prevent the outflow of allantoic fluid and tumor cells in the peritoneal cultivation. Huge cyst can puncture liquid and the volume to be reduced after removal. Prior to puncture puncture protection around the organization, in order to prevent the spillover of the tumor cells. Liquid should speed up slowly to avoid abdominal pressure drop where shock. 2. Cancer treatment is surgery, followed by chemotherapy and radiotherapy treatment. (1) Surgery : Surgery play a key role, particularly in the first surgery is more important. After a suspected malignancies, early laparotomy; First learned of ascites or peritoneal fluid for cytology; Then comprehensive exploration basins, the abdominal cavity; including the diaphragm, liver, spleen, digestive tract, retroperitoneal lymph node and each group within the genitals. Suspicious lesions and prone to various parts of the transfer of materials for histological examination. According to exploration findings, determine tumor stage and the extent of the operation. For advanced cases, should abandon the past only for laparotomy and biopsy of view, to seek surgical treatment. Operation range : principle Ia, Ib period for hysterectomy and bilateral Annex surgery. Ic over the same time period and the big omentum surgery. Cytoreductive surgery is referring to the late (Phase II and above) should be given to the patients with primary lesions and metastases. Residual tumor foci in diameter 1.5-2cm below and, if necessary, with some 71 songs, colostomy fistula, Gallbladder removal or spleen. While many advocates are routine retroperitoneal lymph node dissection (including abdominal aorta and the pelvic lymph node group). Following conditions are met young early thinking may consider retaining the contralateral ovary, but still very cautious : ① Ia clinical period, tumor differentiation good; ② tumor borderline or low malignant; ③ surgery performed as contralateral ovarian tumor was found; ④ after strict conditions were. (2) Chemical treatment : for the main treatment. For ovarian cancer more sensitive to chemotherapy, even with widespread metastatic also made effective. Can be used to prevent recurrence, can also be used for surgical resection not all patients will be temporarily alleviated, or even long-term survival. has been impossible to implement the advanced surgical patients, chemotherapy can reduce the tumor size, to create the conditions for future operations. Application of the most widely drugs alkylating agent, such as phenylalanine nitrogen mustard (Mil flange), chlorambucil, cyclophosphamide and thiotepa, with the objective of 40% efficiency of a 50%. Antimetabolites such as 5-fluorouracil, antitumor antibiotics like actinomycin D (Dactinomycin) and alkaline plant in Changchun new categories such as alkaline also have had some effect. There are three types of drug efficacy has been confirmed; Melamine is Liujia, cisplatin and adriamycin. These drugs can be used alone or in combination, with most of cisplatin as being the safest. In recent years tended to combined chemotherapy because the efficacy is better than a single drug, However, it must be noted chemotherapy side effects may be heavier. Now commonly used chemotherapy drugs, a single drug phenylalanine nitrogen mustard, Liujia melamino, such as chlorambucil. Intraperitoneal chemotherapy can not only control ascites, it also enabled planting lesions decreased or disappeared. The advantage is that drugs can be a direct role in the tumor, significantly higher than the local concentration of plasma concentration. Systemic side effects than medication for Light. Apply mainly to the early cases, ascites and peritoneal small residual tumor grow. Of cisplatin 100 mg/m2 at 2000 ml saline, the slow trickle abdominal retain four hours after discharge, Meanwhile intravenous hydration, urine output per hour up to 150 ml, intravenous sodium thiosulfate 4 g/m2, to protect the bone marrow stem cells and kidney toxicity. Repeated every 3 weeks for treatment. Application 6 -8 usually after chemotherapy treatment, should be held in the second exploration, with the aim of judge the effect of the therapy, early detection of recurrence. Second exploration of valuation, the effect of chemotherapy and after the treatment guidance value. (3) Radiation Therapy : tumor tissue types, different radiotherapy have different sensitivities. If dysgerminoma most sensitive to radiation, granulosa cell tumor moderately sensitive, epithelial carcinoma have a certain sensitivity. For some ovarian cancer, combined with postoperative radiotherapy as dysgerminoma, even advanced cases, despite the good effect. Radiotherapy main application Co. or 60 linear accelerator for radiation applied to the residual lesions diameter "2cm without ascites, no liver, Renal transfer. Irradiation cover the entire abdomen and pelvis, liver, kidney area should be protected. Pelvic radiation volume fractions of 40 ~ (4000 an 5000). upper abdomen 20 ~ 30 Gy (2000 ~ 3000rad), the course of 30 ~ 40 days. Irradiation is the pulp cavity radionuclide perfusion, common 32 P, Peritoneal and can be greater omentum is not easy to achieve external irradiation dose, thereby improving the cure rate. Irradiation apply to : ① cases in the early tumor rupture, the tumor capsule with neighboring tissue adhesions, ascites or peritoneal fluid positive; ② advanced cancer patients have basically cut the net, residual lesions diameter "2cm. 32P dose generally 555MBq ~ 370 (10 ~ 15mCi). at 300 ~ 500ml saline solution, slowly injected into the abdominal tumor after injection, blisters over the body rotation, 32 P so as to evenly distributed in the retroperitoneum. Intraperitoneal adhesions when it banned.