ERKEN EVRE OVER KANSERLERİNDE PROGNOZ VE STANDART TEDAVİ UYGULAMALARI

Öz

Over kanseri jinekolojik maligniteler içerisinde üçüncü sıklıkta olmasına karşın mortalite oranı en yüksek olan jinekolojik malignitedir. Premenopozal dönemde saptanan overe ait kistlerin ya da adneksial kitlelerin benign ya da malign ayrımında sonografik bulgular, kitle boyutu ve biyokimyasal belirteçler büyük önem taşımaktadır. Postmenopozal over kistlerine yaklaşımda ise malignite riski indeksi hesaplanması kullanılmaktadır. Tümörün evresi, kalıntı hastalık hacmi, histolojik alt tip ve derece, CA 125 düzeyi, cerrahi açıdan tümör dökülmesi, kapsül penetrasyonu ve sitolojik malign asit prognostik faktörlerdir. Tüm epitelyal over kanserleri için optimal tedavi uterusun adneksler ile birlikte çıkarılmasıdır. Fertilite koruyucu cerrahide yenileme riski nedeniyle, uygun hastaların seçimi çok kritik bir önem taşı- maktadır. Kapsamlı cerrahi evreleme yapılan evre IA ya da IB derece 1 epitelyal over kanserlerinde cerrahi sonrası kemoterapiye gerek yoktur ve izlem önerilir. Suboptimal cerrahi evreleme yapılan ve evre I hastalık olarak görünen olgularda ise adjuvan kemoterapinin yarar ve yan etkileri tartışılmalıdır

Anahtar Kelimeler

• Erken Evre Over Kanseri, Prognoz, Tedavi.

Öz

Ovarian cancer is the third common gynecologic malignancy and moreover it is the leading cause of death related with gynecologic malignancies. Evaluation of ovarian cysts during the postmenopausal period to differentiate benign and malignant tumors by using physical examination, laboratory testing and sonography has a crucial role in diagnosis and the treatment. MRI (Malignancy Risk Index) can be used for evaluation of the postmenopausal ovarian cysts. Tumor stage, histological type and grade, CA-125 level, rupture of tumor capsule, malignant ascites or positive peritoneal washing are the important prognostic factors. Total abdominal hysterectomy and bilaterally salpingo-ophorectomy is the best surgical approach to all types of epithelial ovarian cancers. Fertility sparing management is very critical because of the risk for recurrence; therefore patients must be carefully selected. Adjuvant chemotherapy is not necessary for the patients accurately surgical staged with early stage ovarian cancers (stage 1 and 2) and following is recommended. However, adjuvant chemotherapy for patients who had stage 1 disease with suboptimal surgical staging is still remains debated.

Anahtar Kelimeler

• Early-stage Ovarian Cancer, Prognosis, Treatment

Kaynakça

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