Salvador Shannon, Gilks Blake, Köbel Martin, Huntsman David, Rosen Barry, Miller Dianne
Department of Obstetrics and Gynecology, University of British Columbia, Canada.
Int J Gynecol Cancer. 2009 Jan;19(1):58-64. doi: 10.1111/IGC.0b013e318199009c.
Epithelial ovarian cancer is the most common cause of mortality from gynecologic malignancy, and most of epithelial cancers are of serous type. The site of origin of pelvic high-grade serous carcinoma has been the subject of debate for 60 years. This paper reviews the evidence that pelvic serous carcinoma originates from the fallopian tube mucosa and puts forward a theory that inflammation in the tube, caused by menstrual cytokines or infection, is critical to the genesis of these tumors. Other risk factors for pelvic serous carcinoma will be reviewed, including oral contraceptive use, parity, infertility, and tubal ligation.Studies were identified for this review by searching the English language literature in the MEDLINE database between the years 1995 and 2007 using the following keywords: fallopian tube neoplasia, ovarian serous adenocarcinoma, pregnancy, oral contraceptive, infertility, pelvic inflammatory disease, cytokines, menstruation, and tubal ligation, followed by an extensive review of bibliographies from articles found through the search.The clinical implications of this theory are discussed, and a change in surgical practice is recommended, with salpingectomy at the time of simple hysterectomy. This theory also has implications for the development of new methods of screening for pelvic serous carcinomas, as there are no screening methods that are currently available to find this form of cancer in an early stage. Inflammatory markers could be detected in the vagina from the fallopian tube indicating possible chronic inflammation and a risk factor for mutagenesis leading to serous carcinoma.
上皮性卵巢癌是妇科恶性肿瘤致死的最常见原因，且大多数上皮性癌为浆液性类型。盆腔高级别浆液性癌的起源部位60年来一直是争论的焦点。本文回顾了盆腔浆液性癌起源于输卵管黏膜的证据，并提出一种理论，即月经细胞因子或感染引起的输卵管炎症对这些肿瘤的发生至关重要。还将回顾盆腔浆液性癌的其他风险因素，包括口服避孕药的使用、生育情况、不孕和输卵管结扎。通过在1995年至2007年期间使用以下关键词在MEDLINE数据库中检索英文文献来确定本综述的研究：输卵管肿瘤形成、卵巢浆液性腺癌、妊娠、口服避孕药、不孕、盆腔炎性疾病、细胞因子、月经和输卵管结扎，随后对通过检索找到的文章的参考文献进行广泛回顾。讨论了该理论的临床意义，并建议改变手术方式，在单纯子宫切除时行输卵管切除术。该理论对盆腔浆液性癌新筛查方法的开发也有影响，因为目前尚无早期发现这种癌症的筛查方法。可从输卵管检测阴道中的炎症标志物，这表明可能存在慢性炎症以及导致浆液性癌的诱变风险因素。
