(1) treatment principles: surgical treatment is the main treatment for ovarian malignant tumors, supplemented by radiotherapy, chemotherapy and other comprehensive treatments.
(2) Surgical treatment: First of all, detailed exploration should be made, including peritoneal lavage, palpation of pelvic and abdominal organs and pelvic and retroperitoneal lymph nodes, and multi-point biopsy of diaphragm, peritoneum and omentum, so as to accurately stage the tumor. Surgical methods are divided into radical surgery and conservative surgery to preserve reproductive function. The scope of thorough operation includes bilateral appendages, uterus, omentum, appendectomy and pelvic and retroperitoneal lymph node dissection. For patients with extensive tumor implantation and metastasis in pelvic cavity, it is advocated to do tumor cell reduction as much as possible. Williams et al. reported that the complete remission rate of postoperative chemotherapy was 83% in patients with clean surgical resection, 59% in patients with basic resection (residual tumor diameter < 2 cm) and 42% in patients with partial resection (tumor diameter > 2 cm). Therefore, although malignant germ cell tumor is sensitive to combined chemotherapy, it is still the key to successful treatment to remove the tumor as much as possible during the operation.
(3) Chemotherapy Because ovarian tumors spread early, most cases can't clear the focus during surgery, and the effect and application of radiotherapy are limited, so systemic chemotherapy is an important adjuvant therapy. In some advanced patients, the tumor can be reduced after chemotherapy, which creates favorable conditions for reoperation. Up to now, there is no unified chemotherapy scheme for the treatment of malignant ovarian tumors. The principles are as follows: ① It is better to use large doses intermittently and small doses continuously; The former means that each course of treatment is about 1 week, and the interval is about 3 ~ 4 weeks, which can not only achieve effective anti-tumor effect, but also help the body to eliminate toxicity and restore immune function. ② The curative effect of combined chemotherapy is better than that of single chemotherapy: in modern times, combined chemotherapy tends to be used, but it should be noted that the toxic reaction of combined chemotherapy is more serious. ③ According to the drug sensitivity test, selecting sensitive chemotherapy drugs can prolong the survival time of patients. ④ Make different chemotherapy schemes according to the tissue type. In recent years, chemotherapy schemes commonly used for ovarian cancer are as follows. L. Epithelial cancer and sexual questioning tumor are commonly used (1)PAC scheme: CTX 4mg intravenous injection on the first day ADM 4mg intravenous injection on the second day DDP 8mg intraperitoneal injection on the third day (2)CFP scheme: CTX 4mg intravenous injection on the first day 5FUl5mg intraperitoneal injection on the second day DDP 8mg intraperitoneal injection on the third day (3). CP scheme: CXR 2mg intravenous infusion for 5 days and DDP 4mg intravenous drip for 5 days (4)CHFP scheme: 5FUlmg intravenous drip on the first day or the eighth day, DDP 4mg intravenous drip on the first day and the eighth day, CTX L mg is taken orally twice a day for 2-7 days and 9-16 days. Germ cell tumors and sarcomas are commonly used (1) VAC scheme: VCR 2mg intravenous drip of ACD 3ug on the 1st day, CTX 3mg intravenous drip on the 2nd to 6th day (2)FAC scheme: 5Fulooomg intravenous drip for 5 days, ACD 3ug intravenous drip for 5 days, CTX 3mg intravenous drip for 5 days (3). PVB regimen: intravenous injection of VLB 2mg (or VCR2mg) on the first day, intramuscular injection of BLM 3mg or intraperitoneal injection of DDP 2～3mg on the second day, or intraperitoneal injection of DDP for more than 1 ~ 5 days, the interval of each course is generally 3 ~ 4 weeks, depending on the patient's physique, reaction degree, hemogram, liver and renal function, etc. Use drugs for at least 4 ~ 6 courses, and for patients with advanced or insensitive tumor chemotherapy, the course of treatment should be more, generally 8 ~ 1 courses in the first year, and reduced to 3 ~ 4 courses in the second year.
(4) The radiosensitivity of radioimmunotherapy for ovarian malignant tumors is very different. Endodermal sinus tumor, immature teratoma, embryonic cancer are the least sensitive, epithelial ovarian cancer and granular cell cancer are moderately sensitive, and asexual cell tumor is the most sensitive. It can be controlled by radiotherapy after operation. Because ovarian cancer has abdominal metastasis earlier, the irradiation range includes abdominal cavity and pelvic cavity. The liver and kidney areas should be protected to avoid radiation damage. The radiation dose in the whole abdominal cavity is 3 ~ 5 cgy/6 ~ 8 weeks. Internal irradiation refers to intraperitoneal injection of limb gold (198AU) or phosphorus (32P), which can make the surface of abdominal cavity reach a dose that is difficult to reach by external irradiation. Because of its limited penetration, it can be used to treat superficial metastasis in abdominal cavity, residual tumor under microscope or ruptured tumor during operation, so as to improve the five-year survival rate. The disadvantage is that there must be no adhesion in the abdominal cavity, so that the radioisotope can be evenly distributed, otherwise it can cause intestinal damage and cause serious consequences. Generally, the amount of 198AU is 12 ~ 15 mCurie, and 32P is 1 ~ 2 mCurie.
"non-toxic and anti-cancer green therapy" is a kind of therapy relative to "fighting poison with poison", which can also be called "non-toxic tumor". Traditional surgery and radiotherapy can only solve local problems; Radiotherapy and chemotherapy can not kill all cancer cells, and make cancer cells and normal tissue cells of human body injured at the same time, and it is easy to form secondary tumors, which is not worth the candle. The "non-toxic anti-cancer green therapy" selectively kills cancer cells, does not damage normal cells, and helps to restore the body's immunity. Under the guidance of the theory of "non-toxic and anti-cancer green therapy", the research team has successively developed non-toxic and anti-cancer patent formulas. These formulas adhere to the principle of "non-toxic and anti-cancer", and are suitable for the treatment of various malignant tumors. They can not only resist cancer, but also have no side effects. They can quickly improve clinical symptoms, improve and protect the immune function of the body, inhibit and directly kill cancer cells as a whole, and obviously inhibit the metastasis and spread of cancer cells. "Non-toxic anti-cancer green therapy" has saved the lives of countless patients in many years of clinical practice.