Benjamin I, Rubin S C
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Obstet Gynecol Clin North Am. 1994 Mar;21(1):107-19.
Because ovarian cancer is asymptomatic until the late stages of the disease and because accurate methods of early detection are lacking, only about 40% of these cancers present in stages I and II. As a result, ovarian carcinoma remains the leading cause of death from gynecologic malignancy in the United States. However, proper management of early cases may lead to a good prognosis for long-term survival and, in some cases, may even permit preservation of reproductive capacity. The appropriate management of these early cases includes meticulous and thorough staging at the time of the initial surgery. In women who do not desire further reproduction, total abdominal hysterectomy and bilateral salpingo-oophorectomy should be carried out. In those who eagerly wish to maintain reproductive potential, the uterus and contralateral ovary may be preserved, providing certain criteria have been met. Patients with stage Ia or Ib grade 1 disease can be followed-up without further therapy after definitive surgery; those with Ic or grade 3 tumors should receive adjuvant therapy. Patients with stage I epithelial ovarian cancer who are without evidence of disease after comprehensive staging surgery and primary adjuvant chemotherapy do not require second-look laparotomy. In the future, laparoscopy will play an increasingly important role in the diagnosis and management of early-stage epithelial ovarian cancer.
由于卵巢癌在疾病晚期之前没有症状，且缺乏准确的早期检测方法，这些癌症中只有约40%在I期和II期出现。因此，卵巢癌仍然是美国妇科恶性肿瘤死亡的主要原因。然而，对早期病例的妥善管理可能会带来长期生存的良好预后，在某些情况下，甚至可能允许保留生殖能力。这些早期病例的适当管理包括在初次手术时进行细致而全面的分期。对于不希望进一步生育的女性，应进行全腹子宫切除术和双侧输卵管卵巢切除术。对于热切希望保留生殖潜力的女性，在满足某些标准的情况下，可以保留子宫和对侧卵巢。Ia期或Ib期1级疾病的患者在确定性手术后可以随访而无需进一步治疗；Ic期或3级肿瘤的患者应接受辅助治疗。在综合分期手术和初次辅助化疗后没有疾病证据的I期上皮性卵巢癌患者不需要二次剖腹探查。未来，腹腔镜检查将在早期上皮性卵巢癌的诊断和管理中发挥越来越重要的作用。
