卵巢癌是我们机构中第二普遍但最致命的妇科恶性肿瘤。这项研究旨在确定可疑病变的非诊断率,并回顾我院高度可疑恶性肿瘤的卵巢肿瘤的管理挑战。
■对病房患者记录进行为期三年的回顾性审查,诊所,剧院,并进行了组织病理学实验室。高度怀疑卵巢癌的病例(卵巢肿瘤具有恶性放射学特征,伴有任何腹水,胸腔积液,以及恶病质,贫血,或转移的证据)被包括在内。与放射学各专业的顾问进行了深入访谈,放射肿瘤学,病理学,和妇科肿瘤学在妇科肿瘤学多学科小组会议。
■发现了122例高度可疑的卵巢恶性肿瘤,平均年龄为40.6岁。其中,28(23%)进行了手术,77%没有任何形式的组织学诊断。在那些做手术的人中,13例(46.4%)进行了前期手术,15例(53.6%)进行了新辅助化疗(NACT),然后进行了间隔减积手术(IDS)。只有两个案例记录了完全(R0)的剔除。在那些接受过前期手术的人中,1例(7.7%)是卵巢肌瘤,1例(7.7%)是纤维肉瘤,2例(15.4%)是交界性卵巢肿瘤。在三例病例中,根据腹水或胸水细胞学上的恶性细胞开始化疗。在所有的恶性肿瘤中,上皮癌最常见,占48%。除了案件的一般晚期陈述,治疗资金不足,癌症护理健康保险覆盖率低,常规免疫组织化学不可用,缺乏种系和体细胞测试,一些化疗药物的不可用或过高的成本,无法使用维持疗法,管理毒性的能力不足,所有专业的技能不足,计算机断层扫描和正电子发射断层扫描不可用/功能不稳定,缺乏介入放射学设施等都被认为是对管理的挑战。
大多数高度怀疑卵巢癌的肿瘤患者没有获得组织学诊断,可能未确诊死亡。尽管在手术和化疗选择方面取得了进展,但卵巢癌的管理仍然是一个挑战。全民健康保险,基础设施建设,建议对所有相关学科进行培训。
UNASSIGNED: Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in suspected lesions and reviewing the management challenges of ovarian tumours highly suspicious for malignancy in our hospital.
UNASSIGNED: A three-year retrospective review of patients\' records from the ward, clinic, theatre, and histopathology laboratory was carried out. Cases with high indices of suspicion for ovarian cancer (ovarian tumour with malignant radiologic features with any of ascites, pleural effusion, as well as cachexia, anaemia, or evidence of metastasis) were included. In-depth interviews were carried out with a consultant from each specialty of Radiology, Radio-oncology, Pathology, and Gynaecologic oncology at the gynaecologic oncology multidisciplinary team meeting.
UNASSIGNED: One hundred and twenty-two cases of highly suspicious ovarian malignancies were seen with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% did not have any form of histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Only two cases had documented complete (R0) debulking. Among those that had upfront surgery, one case (7.7%) was an ovarian fibroid and one (7.7%) was a fibrosarcoma while two cases (15.4%) were borderline ovarian tumours. Chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology in three cases. Of all the malignant cases, epithelial carcinomas were commonest accounting for 48%. Aside from the general late presentation of cases, insufficient funds for treatment, poor coverage of health insurance for cancer care, unavailability of routine immunohistochemistry, lack of germline and somatic testing, non-availability or prohibitive cost of some chemotherapeutic agents, unavailability of maintenance therapies, inadequate capacity to manage toxicities, inadequate skill across all specialties, unavailability / erratic function of computerized tomography scans and unavailable positron emission tomography, lack of interventional radiology facility amongst others were all identified as challenges to management.
UNASSIGNED: Most patients with tumours highly suspicious for ovarian cancers did not get a histologic diagnosis and probably died undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. Health insurance for all, infrastructure development, and training of all disciplines involved is recommended.