《2009SOGC盆腔和卵巢包块初步管理指南》内容预览

ovarian cancer is relatively uncommon, yet it is the deadliest of all gynaecologic malignancies, often affecting perimenopausal and postmenopausal women.According to the Canadian Cancer Society statistics, there were 2300 new cases and 1600 deaths due to ovarian cancer in 2006. In the same report, the estimated five-year survival rate for patients with ovarian cancer (1995–1997) was 38% (95% CI 37%–40%).This rate has not changed signifi-cantly over the past few decades despite significant advances in surgical techniques, chemotherapeutic options, and supportive care that have, however, improved the median survival.Standard management for patients with tumour clinically localized to the ovary(ies) includes com-prehensive surgical staging to guide subsequent need for further adjuvant treatment and to provide prognostic infor-mation. For patients with metastatic disease, numerous ret-rospective and prospective studies have shown that the extent of residual disease after radical surgical debulking is a significant predictor of both progression-free and overall survival.More recently, intraperitoneal chemotherapy has shown significant survival benefits over standard intrave-nous chemotherapy in metastatic disease that has been opti-mally debulked at time of initial surgical exploration,confirming the importance of aggressive surgical tumour resection at the time of initial diagnosis.

A number of case series have shown that patients with ovar-ian cancer whose initial surgery is performed by gynaecologic oncologists are more likely to be appropriately staged and optimally debulked than those managed initially by general gynaecologists and general surgeons.

Despite this, data from a large population-based study suggested that only approximately one third of patients with ovarian cancer were initially managed by gynaecologic oncologists.Likely this is secondary to human resource constraints as well as to the challenges facing physicians in diagnosing cancer preoperatively so appropriate referrals can be made. This guideline is meant to assist physicians in the identifica-tion of patients with increased likelihood of underlying malignancy so appropriate referrals can be made to opti-mize patients’ outcomes in the context of the current Canadian health care system

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