Cov qog nqaij hlav zes qe menyuam nyob qib xya ntawm txhua tus qog nqaij hlav thiab thib peb ntawm cov qog nqaij hlav hauv gynecology. Nws cuam tshuam rau kev sib deev ncaj ncees thaum lub sij hawm premenopause thiab menopause, tab sis kuj tshwm sim rau cov poj niam hnub nyoog qis dua 40 xyoo. Kev kuaj mob ntxov ntxov ntawm lub zes qe menyuam yog lub luag haujlwm tseem ceeb ntawm kev tiv thaiv oncological kuaj. Kev tshawb pom raws sij hawm ua rau nws muaj peev xwm pib kho thaum pib thiab ua kom muaj feem cuam tshuam ntawm kev kho mob.
Kev piav qhia tus kab mob. Keeb kwm
Carcinoma ntawm tus khub gonads ntawm tus poj niam yog cov qog uas muaj cov kab mob malignant (malignant) uas cuam tshuam rau zes qe menyuam. Mob qog noj ntshav tuaj yeem yog thawj (nws lub hauv paus tseem ceeb yog nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam) thiab metastatic (qhov tseem ceeb yog nyob rau hauv lwm qhov ntawm lub cev). Cov hauv qab no yog suav tias yog thawj:
- Carcinoma yog ib hom mob qog nqaij hlav uas tsim los ntawm cov tawv nqaij, cov qog nqaij hlav.
- Dysgerminoma yog ib qho mob qog noj ntshav uas tsim los ntawm cov hlwb tseem ceeb ntawm gonads. Neoplasm yogib qho ntawm feem ntau thiab suav txog li 20% ntawm tag nrho cov qog ntawm zes qe menyuam malignant.
- Teratoma los ntawm txheej kab mob.
- Chorioncarcinoma - ib hom mob qog noj ntshav phem tshaj plaws ntawm zes qe menyuam, yog kev hloov pauv ntawm chorion epithelium.
- Ovarian stroma yog ib qho qog ntawm lub hauv paus uas tsis yog epithelial.
Metastatic mob qog noj ntshav ntawm tus khub gonads yog cov qog qog nqaij hlav ntawm zes qe menyuam, uas tshwm sim los ntawm hematopoietic, lymphogenous, implantation txav ntawm malignant hlwb los ntawm lwm lub cev.
Feem ntau lub zes qe menyuam raug cuam tshuam los ntawm kev mob qog noj ntshav ntawm txoj hnyuv, ncauj tsev menyuam, lub mis. Metastases ncav cuag qhov loj me - txog li 20 cm - thiab sai sai kis los ntawm peritoneum. Cov qog zes qe menyuam thib ob tshwm sim hauv cov poj niam hnub nyoog 45-60.
Txawm tias muaj kev nce qib hauv kev kuaj mob qog noj ntshav ntawm zes qe menyuam hauv cov poj niam, kwv yees li 75% ntawm cov kab mob tau kuaj pom nyob rau theem tom ntej. Yog vim li cas rau qhov no yog ntev asymptomatic chav kawm ntawm pathology.
Kev faib tawm
Cov qog nqaij hlav zes qe menyuam yog systematized los ntawm qhov chaw tshwm sim, theem thiab nthuav dav.
Muaj 4 qib ntawm cov qog loj hlob:
- I (T1) - tus cwj pwm los ntawm kev sib kis ntawm zes qe menyuam. Kev tuag ntawm theem no yog kwv yees li 9%. Tab sis nrhiav kev mob qog noj ntshav nyob rau theem no tsis tshua muaj.
- II (T2) - tus yam ntxwv ntawm cov qog kis mus rau ob lub zes qe menyuam thiab lub plab pelvic.
- III (T3 / N1) - gonadal lesion nrog metastasis rau cov qog ntshav los yog peritoneum.
- IV (M1) - kev tsim ntawm theem nrab foci hauv lwm yamlub cev. Kev ciaj sia nyob rau theem no yog 17%. Qhov laj thawj tseem ceeb ntawm kev tuag yog cov kua dej ntau hauv lub plab kab noj hniav, depletion ntawm metastasized organs.
Kev kuaj mob qog noj ntshav ntawm zes qe menyuam thaum pib txo qis kev pheej hmoo ntawm qog nqaij hlav thiab tshwm sim ntawm cov teeb meem loj, ua rau feem ntau tuag.
Caus ntawm oncology
Yam cuam tshuam rau qhov tshwm sim ntawm cov qog ntawm zes qe menyuam tseem tsis tau kawm kom ntxaws, tsuas muaj qhov kev xav xwb.
Qhov kev xav tseem ceeb yog qhov qog nqaij hlav zes qe menyuam yog tsim thaum lub cev tsim cov tshuaj estrogen ntev. Cov lus no yog raws li kev soj ntsuam ntawm cov poj niam uas tau siv tshuaj tiv thaiv kab mob hormonal rau ntau tshaj 5 xyoos. Cov cuab yeej tshuaj tshuaj tseem ceeb ntawm cov tshuaj yog kev tawm tsam ntawm kev tsim cov tshuaj gonadotropic, uas ua rau muaj kev pheej hmoo ntawm cov qog hloov mus rau hauv cov ntaub so ntswg estrogen.
Kev tshawb fawb txog noob caj noob ces ua ke nrog kev kuaj mob lig thiab ntxov ntxov ntawm kev mob qog noj ntshav ntawm zes qe menyuam hauv cov poj niam qhia tias kev loj hlob ntawm tus kab mob yog cuam tshuam los ntawm kev hloov pauv. Hauv qhov no, cov txheeb ze ze tshaj plaws ntawm cov neeg mob qog noj ntshav tau pom zoo kom kuaj xyuas kev tiv thaiv.
Kuj, muaj lwm yam laj thawj uas cuam tshuam qhov tshwm sim ntawm cov qog nqaij hlav hauv zes qe menyuam:
- polyps ntawm lub cev thiab ncauj tsev menyuam.
- Ovarian dysfunction.
- Kev cuam tshuam ntawm cov thyroid thiab qog adrenal.
- Kev loj hlob ntau dhau ntawm endometrium.
- Nquag unilateral thiab ob togoophorites.
- Kev tsis muaj menyuam.
- Feem ntau ib txhij o ntawm zes qe menyuam thiab cov hlab ntsha fallopian (adnexitis lossis salpingo-oophoritis).
- Benign, hormonally dependent neoplasms ntawm cov nqaij mos ntawm lub tsev menyuam (fibroids).
- qog zoo li tsim los ntawm cov ntaub so ntswg ntawm lub tsev menyuam (fibroids).
- Ovarian cyst.
- Ntxhais hluas nkauj thiab pib ntawm kev sib deev.
- Kev rho menyuam rov qab ua rau hormonal tsis txaus thiab zes qe menyuam tsis ua haujlwm.
Kuj, rog dhau thiab tus cwj pwm tsis zoo tuaj yeem cuam tshuam rau kev ua haujlwm tsis zoo ntawm tus poj niam tus khub gonads thiab tshwm sim ntawm cov hlwb tsis zoo hauv lawv.
Clinical signs
Kev kuaj mob ntxov ntxov ntawm cov qog nqaij hlav zes qe menyuam pab pib kho raws sijhawm, qhov txiaj ntsig tau zoo nyob rau hauv feem ntau. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum tau ua tib zoo saib xyuas qhov kev hloov me ntsis hauv lub cev thiab kev noj qab haus huv sab hauv. Cov tsos mob ntawm cov qog nqaij hlav zes qe menyuam yog sib txawv. Lawv loj hlob raws li cov qog kis:
- Nyob zoo ib tsoom phooj ywg.
- Kev tsis muaj zog.
- Nyob.
- Nyob rau hauv qhov kub thiab txias.
- Kev qab los noj mov.
- Meteorism.
- khaw cia.
- Dysuric manifestations.
Txoj kev kuaj mob qog noj ntshav zes qe menyuam
Kev lees paub ntawm cov qog nyob rau theem pib tso cai rau koj pib kho raws sijhawm thiab ncua sij hawm tshem tawm. Nyob ntawm kev faib tawm thiab chaw kho mob ntawm cov qog nqaij hlav zes qe menyuam, kev kuaj mob thiab kev kho mob tau ua nyob rau hauv ntau txoj kev. Cov txheej txheem thiab kev ntsuas tus kab mobsiv complex. Lawv suav nrog kev kuaj mob, anamnesis, kuaj, kuaj gynecological siv ntau yam twj paj nruag thiab khoom siv.
Nyob ntawm lub tsev kho mob, kev kuaj mob ntawm zes qe menyuam yuav muaj qee qhov sib txawv. Tab sis txhawm rau txheeb xyuas tag nrho cov duab rau kev tiv thaiv thiab kho cov hom phiaj, cov kev tshawb fawb zoo sib xws yog siv:
- kuaj gynecological.
- Kev kuaj ntshav hauv plab ultrasound.
- Axial xam tomography.
- Kev kuaj hluav taws xob ntawm lub plab kab noj hniav.
- Diagnostic laparoscopy.
- Kev kuaj mob tshwj xeeb.
Cov kev tshuaj ntsuam no yog txheej txheem rau kev kuaj pom cov qog ntawm zes qe menyuam.
Kev Tshawb Fawb Kev Tshawb Fawb
Kev kuaj hauv oncology tau sau ua ke nrog kev kuaj mob thiab ntsuas ntsuas. Lawv tso cai txhais cov ntaub ntawv biopsy thiab muaj qhov tseem ceeb prognostic tseem ceeb. Cov kev tshawb fawb histological thiab cytological yog qhov tseem ceeb tshaj plaws:
- Histology ntawm tus poj niam qhov chaw mos biopsy yog txoj kev tshawb fawb nyob rau hauv lub tshuab kuaj kab mob ntawm cov ntaub so ntswg coj los ntawm lub cev xeeb tub txhawm rau txiav txim siab nws qhov xwm txheej. Cov khoom siv rau kev tsom xam yog kev khawb ntawm qhov endometrium hauv ob sab phlu ntawm lub tsev menyuam. Kev ntsuam xyuas yog teem caij thiab ceev. Kev kuaj mob xwm txheej ceev tau ua tiav hauv ib nrab teev thiab feem ntau ua tiav thaum lub sijhawm phais.
- Cervical cytology scraping, lossis Pap smear, yog ua kom kuaj tau cov mob qog noj ntshav ntawm lub cev los ntawm cov smear tau noj. khoom siv rauKev tshawb fawb yog ib qho biopsy los ntawm ecto- thiab endocervix. Kev tshuaj xyuas tso cai rau koj los ntsuas qhov loj me, thaj tsam sab nraud, tus lej thiab xwm txheej ntawm cov hlwb.
- Kev soj ntsuam ntawm aspirates los ntawm Uterine Cavity yog nqa tawm nyob rau hauv thiaj li yuav kuaj cov kab mob ntawm lub uterine lub cev. Cov khoom siv rau kev tshawb fawb - luam tawm los ntawm cov khoom siv hauv lub cev los yog kev cia siab ntawm cov ntsiab lus ntawm lub cev nrog lub catheter.
Tsis tas li ntawd, kev kuaj mob qog noj ntshav ntawm zes qe menyuam yog ua los ntawm kev tshuaj xyuas cov qog nqaij hlav hauv cov ntshav lossis zis. Cov kab mob qog muaj feem cuam tshuam yog cov proteins, ribozymes, qog cov khoom tawg uas tsim los ntawm cov ntaub so ntswg noj qab haus huv rau kev nkag mus ntawm cov qog nqaij hlav cancer:
- CA-125 yog ib qho kev sim uas ntsuas cov cim qog nqaij hlav zes qe menyuam.
- Cancer-embryonic antigen - kuaj pom cov ntaub so ntswg ntawm cov qog nqaij hlav hauv cov ntshav.
- Squamous cell carcinoma (SCC) antigen - kuaj pom squamous cell carcinoma protein.
- Oncoprotein E7 - tus cim uas txiav txim siab qhov tshwm sim ntawm kev mob qog noj ntshav hauv tsev menyuam hauv cov poj niam uas muaj tus kabmob papillomavirus hom 16 thiab 18.
- Oncomarker CA 72-4 - ib qho kev sim rau kev txiav txim siab cov ntsiab lus ntawm glycoprotein tsim los ntawm malignant cells ntawm glandular cov ntaub so ntswg.
- HE4 yog ib qho protein uas zais los ntawm cov hlwb ntawm cov kab mob ua me nyuam.
Kev kuaj mob thiab tshuaj biochemical tsawg dua, tab sis yog tsis muaj lawv yuav tsis muaj daim duab tiav ntawm tus kab mob.
Instrumental method
Kev kuaj mob qog nqaij hlav zes qe menyuam hauv cov poj niam yog ua los ntawm ntau yam khoom siv. Ib qho kev kuaj thawj zaug yog ultrasound. Nws tso cai rau koj los ntsuas qhov ntim, zoo li, qauv, qib ntawm kev sib kis ntawm neoplasms.
Kev kuaj mob khees xaws zes qe menyuam feem ntau siv los ntawm ultrasound. Kev kuaj ultrasound tuaj yeem ua tau transvaginally lossis transabdominally. Cov txheej txheem tom kawg yog muab cov transducer tso rau ntawm lub plab mog. Xws li manipulation, raws li txoj cai, precedes transvaginal. Nrog rau txoj kev no, lub transducer tau muab tso rau hauv qhov chaw mos, uas tso cai rau kev kawm paub ntau ntxiv ntawm tus poj niam qhov chaw mos. Ultrasound tuaj yeem ua tau rau txhua lub hnub nyoog, thiab rau cov kab mob gynecological hauv txhua theem ntawm kev coj khaub ncaws.
MRI ntawm lub plab pelvic yog ib txoj hauv kev uas tsis yog kev kuaj xyuas los ntawm kev kho cov xov tooj cua nthwv dej tawm los ntawm hydrogen atoms nyob rau hauv kev cuam tshuam ntawm cov hlau nplaum.
CT scan ntawm lub plab hnyuv siab raum - kev tshuaj xyuas ntawm cov plab hnyuv siab raum siv lub tomograph. Txoj kev kuaj mob tuaj yeem ua tiav nrog kev siv X-ray sib piv cov neeg ua haujlwm lossis tsis muaj lawv. Txoj kev tso cai rau kuaj pom cov qog hauv asymptomatic cancer.
Laparoscopy ntawm zes qe menyuam yog ib qho kev tawm tsam me me uas tso cai rau koj los ntsuas qhov pom ntawm lub plab hnyuv siab raum thiab, yog tias tsim nyog, coj biomaterial rau kev tshawb fawb histological thiab cytological.
Differential diagnosis - Dab tsi yog qhov taw qhia?
Tam sim no, tsis muaj ntau lub hom phiaj qhia ntau yam uas tsis yog-tus txheej txheem rau thaum ntxov dif. kuaj mob cancer ntawm zes qe menyuam. Cov kws kho mob siv ib txoj hauv kev uas ua kom haum rau ntau yam kev tshawb fawb.
Ib yam tseem ceeb hauv kev tsis saib xyuas ntawm cov qog nqaij hlav ntawm zes qe menyuam yog nwskev tshawb pom lig vim qhov nyuaj ntawm kev kuaj mob hauv thawj theem. Thaum thawj zaug mus ntsib, tus kws kho mob feem ntau ua rau lwm yam kev kuaj mob: zes qe menyuam cystoma, o ntawm appendages, uterine fibromyoma. Ua ntej kev phais, nws yog ib qho nyuaj rau kev paub qhov txawv cystoma los ntawm cov qog malignant, tshwj xeeb tshaj yog tias nws yog mobile thiab unilateral. Tab sis muaj ntau cov cim qhia, nyob rau hauv lub xub ntiag ntawm qhov kev kuaj thawj zaug yog nug:
- Kev loj hlob ntawm neoplasm.
- Kev sib haum xeeb.
- qog nqaij hlav immobile.
- Txo ESR hauv qhov mob hnyav.
- Mantoux thiab Koch kev xeem tsis zoo.
- Presence of hypoproteinemia.
- Tsawg albumin qib.
- Estrogen overproduction.
- nce ntshav qib ntawm ketosteroids, serotonin.
Yog tias nws tsis tuaj yeem paub qhov txawv ntawm cov qog nqaij hlav los ntawm lwm qhov neoplasm, lawv mus rau kev phais plab.
Kev kuaj mob sib txawv ntawm cov qog nqaij hlav zes qe menyuam tso cai rau koj paub qhov txawv ntawm tus kab mob los ntawm lwm yam thaum ntxov. Kev kuaj pom tus qog ntawm cov theem pib ua rau muaj kev coj ua raws sijhawm ntawm txoj cai ntsuas los tawm tsam nws.
Kev kuaj mob ntxov ntxov
Raws li cov ntaub ntawv txheeb cais, thawj theem thiab theem ob ntawm kev mob qog noj ntshav zes qe menyuam tsuas yog kuaj pom hauv 37.3% ntawm cov neeg mob. Txawm hais tias muaj qee qhov kev ua tiav, qhov kev tuag ntawm oncology ntawm tus khub gonads yog kwv yees li 40%.
Kev kuaj mob qog noj ntshav ntawm zes qe menyuam thaum ntxov yog xyaum tsis ua tiav vim tsis muaj cov cim qhia qhia meej txog kab mob,tshwj xeeb ntawm txoj kev tshawb fawb, nrog rau cov khoom lom ntawm cov qog. Kev tshuaj ntsuam xyuas thiab kev kuaj mob yog siv los kuaj mob asymptomatic oncology:
- kuaj gynecological nrog kev ntsuas pom ntawm tus poj niam lub cev xeeb tub.
- Kev txiav txim siab ntawm CA-125 onomarker
- pab smear.
- HPV test.
- Kev hloov pauv hauv plab ultrasound.
Kev tshuaj ntsuam tsis tas yuav pab kom paub txog mob qog noj ntshav. Qee qhov xwm txheej, kev sim rau cov cim qog ua rau pom qhov tsis zoo. Kev kuaj ntxiv raug txiav txim. Cov kev kuaj mob tsis suav nrog hauv cov npe CHI dawb thiab feem ntau kim heev.
Cov txiaj ntsig tsis zoo-tsis zoo kuj tseem muaj nyob rau theem pib ntawm tus kab mob. Lub caij no, cov qog tsis ploj mus qhov twg, tab sis ntawm qhov tsis sib xws, nws metastasizes mus rau lwm yam kabmob. Cov tsos mob pib tshwm sim, uas feem ntau qhia txog theem loj ntawm pathology.
Peculiarities ntawm kev kuaj mob oncology hauv postmenopause
Raws li kev txheeb cais, 80% ntawm cov qog nqaij hlav malignant yog tsim rau cov poj niam hnub nyoog tshaj 50 xyoo. Feem ntau, carcinomas muaj cov qauv cystic. Hauv kev sib piv rau kev kuaj mob qog noj ntshav ntawm zes qe menyuam, kev tshawb fawb Doppler yog txaus los tshuaj xyuas lub cyst, yog tias cov ntshav CA-125 nyob rau hauv qhov qub. Kev soj ntsuam mus sij hawm ntev ntawm cov neeg mob nyob rau theem kawg ntawm kev ua poj niam cev xeeb tub tau pom tias hauv 53% ntawm cov neeg mob cyst tshwm sim sai sai.
Muaj ntau yam kev kuaj mob uas pab txheeb xyuas cov qog nyob rau theem pib, tab sis nyob rau hauvlawv feem ntau mus tsis tau pom dua. Thiab tseem, thawj qhov kev kuaj mob ntawm zes qe menyuam hauv cov poj niam postmenopausal yog nyob ntawm qhov muaj cov tsos mob zoo li no.
Ib qho tshwm sim yog pom. Qhov tshwm sim ntawm kev coj khaub ncaws yog vim muaj kev ua haujlwm ntawm zes qe menyuam, cov khoom tsim tawm uas ploj zuj zus nyob rau hauv menopause. Nyob rau hauv lub sij hawm post-menopausal, los ntshav los ntawm qhov chaw mos yog ib qho laj thawj tseem ceeb mus ntsib kws kho mob gynecologist. Cov ntshav tawm ntawm cov tswj hwm thaum pib ntawm kev tuag ntawm kev ua haujlwm ntawm kev ua me nyuam kuj suav tias yog qhov txawv txav.
Thaum lub caij tsis muaj hnub nyoog, lub zes qe menyuam nres tso cov tshuaj hormones estrogenic. Kev nce qib ntawm cov poj niam steroid hormones tom qab lub cev tsis muaj zog zaum kawg yuav qhia tau tias muaj cov hlwb tsis zoo hauv lub cev.
Nyob rau hauv menopause, ib xyoos ib zaug mammogram yuav tsum tau. Kev txheeb xyuas qhia tau tias zes qe menyuam metastasis feem ntau muaj lub ntsiab lus tseem ceeb hauv cov qog mammary. Hauv cov poj niam uas muaj hnub nyoog tshaj 50 xyoo, thaum kuaj lub mis, nws yuav tsum tau tsom rau cov neoplasms uas tau tshwm sim hauv nws, vim tias lawv tuaj yeem ua rau mob qog noj ntshav thaum ntxov.
