Kawamoto S, Urban B A, Fishman E K
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Radiographics. 1999 Oct;19 Spec No:S85-102; quiz S263-4. doi: 10.1148/radiographics.19.suppl_1.g99oc10s85.
Ovarian cancer is the second most common gynecologic malignancy in the United States and causes more deaths than any other cancer of the female reproductive system. Approximately two-thirds of patients have tumors that have spread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors. In general, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory laparotomy, surgicopathologic staging and debulking of the tumor are undertaken. Patients with advanced cancer frequently undergo second-look surgery after chemotherapy to detect any residual disease. CT can provide staging information for preoperative planning and determination of surgical resectability, demonstrate tumor response to therapy, and allow detection of persistent or recurrent disease. However, a major limitation of CT is the lack of sensitivity for detection of small tumor implants, especially on the small intestine or mesentery. Dedicated CT of the pelvis is best performed with spiral CT. Ovarian carcinoma can spread by means of intraperitoneal implantation, lymphatic invasion, and hematogenous dissemination.
卵巢癌是美国第二常见的妇科恶性肿瘤，其导致的死亡人数超过女性生殖系统的任何其他癌症。大约三分之二的患者在诊断时肿瘤已扩散至盆腔以外。卵巢肿瘤起源于表面上皮或间皮、生殖细胞或性腺间质。上皮性卵巢肿瘤包括浆液性、黏液性、子宫内膜样、透明细胞和未分化肿瘤。一般来说，恶性的可能性随着实性组织成分增加和间隔增厚而增加。手术是卵巢癌治疗的核心。在初次剖腹探查时，进行手术病理分期和肿瘤减瘤术。晚期癌症患者在化疗后常接受二次探查手术以检测任何残留疾病。CT可为术前规划和确定手术可切除性提供分期信息，显示肿瘤对治疗的反应，并能检测持续性或复发性疾病。然而，CT的一个主要局限性是对小肿瘤种植灶的检测缺乏敏感性，尤其是在小肠或肠系膜上。盆腔专用CT最好用螺旋CT进行。卵巢癌可通过腹腔种植、淋巴侵袭和血行播散的方式扩散。
