Multiple primary cancers of female reproductive tract

Introduction to multiple parts of the female reproductive tract There are many combinations in the primary cancer of the female reproductive tract. Ovarian cancer combined with endometrial cancer is the most common, ovarian and other female genital cancer combined with breast cancer is also a common combination, the majority of female reproductive tract primary cancer has attracted the attention of scholars. With the advancement of medical science, the theory of multi-organ cancer has been accepted, and the discovery and reporting of multiple primary carcinoma (MPC) has increased. Warren and Gafe discovered this phenomenon as early as 1932 and proposed diagnostic criteria: 1 each tumor must have a clear malignant feature; 2 each tumor must be separated from each other; 3 must be excluded from other tumor metastasis or recurrence The possibility. In 1975, Delighisch suggested that the female reproductive tract MPC occurred within one year, which is called synchronous sex; those who occur after one year are called heterogeneous. In recent years, there have been reports of "synchronous" MPCs. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: ascites

The cause of primary cancer in multiple parts of the female reproductive tract

(1) Causes of the disease

Why the endometrium and ovaries are cancerous at the same time, and there is no satisfactory explanation for this problem. Scully, Eifel and Matlock and others proposed the following doctrines to try to explain the cause of this double cancer.

1. Extend Molltrian system During embryogenesis, the ovarian hair growth epithelium is closely related to the Miller tube. In adults, the Miller tube derivative and the ovarian surface can be used as a form unit. Reacts to the surrounding environment. For example, during pregnancy, the interstitial of the cervix, fallopian tubes and ovaries will have a decidual response similar to that of the endometrium. Similarly, the epithelium of these structures will also undergo metaplastic changes (meta-plasic). Changes).

2. Endometriosis malignant theory As early as 1952, Sampson pointed out that malignant transformation can occur in endometriosis, and reported 7 cases of ovarian cancer originating from endometriosis. His diagnostic criteria are: 1 Endometriosis and ovarian cancer coexist in the same ovary, and have the same histological relationship, like the relationship between uterine cancer and benign endometrial tumor, 2 ovarian cancer originated from the endometrial tissue of the ovary Instead of infiltration from other parts, Campbell reported 5 cases of endometrial and ovarian primary adenines in 1961. These 5 patients were all accompanied by endometriosis. The authors believe that ovarian adenomas originate. In ovarian endometriosis, because 5 cases of pathological changes are in full compliance with Sampson's diagnostic criteria, Scully reported systematically the malignant transformation of endometriosis in 1966, he believes that the rate of disease is difficult to estimate, but The malignant condition is definitely present, except that endometrioid cancer can originate from endometriosis, clear cell carcinoma, squamous cell carcinoma, carcinosarcoma and interstitial sarcoma can also originate from endometriosis, he also think Ovarian cancer, which originates from endometriosis, is often accompanied by uterine body cancer. Sometimes, uterine body cancer is small and often overlooked clinically.

3. Oncogene Mutation Theory With the deepening of oncogene research, it is now believed that the occurrence of cancer is related to oncogene mutations. There are many cases of primary cancers in clinical sites that have reported cloacogenic multi-site carcinogenesis. Have a common susceptible area, and this area has more reactions to the same oncogene. Embryogenesis-related tissues show high acceptance of the same oncogene, and the response of each tissue to oncogenes is not necessarily Synchronized, may be delayed in some areas, which may be due to obvious cancer in some areas and only in situ in some areas.

(two) pathogenesis

1. The extended Miller tube system Gricouroff and Lauchlan et al. proposed the concept of the "extended Miller system" to describe the surface of the ovary, the fallopian tube, the endometrium and the cervix. The structures in this system all have an important Similarly, they can form epithelial tumors with similar tissue types, and can also form genital tract stromal tumors with gynecological features. Usually, uterine cancer is mostly differentiated adenocarcinoma, but serous papillary carcinoma. Mucinous carcinoma and clear cell carcinoma can also originate in the endometrium. Another important feature of the extended Miller system is that multiple anatomical sites can simultaneously produce the same or independent tumor or tumor-like proliferation, most common. An example is a bilateral ovarian tumor with benign on one side and malignant on the other. The most typical phenomenon is ovarian serous carcinoma with fallopian tube adenoma-like dysplasia or "in situ carcinoma". In addition, it has been found that When the endometrium develops into adenocarcinoma, the ovary can be accompanied by endometrial and/or endometriosis, and epithelial malignant tumors of the ovary are often accompanied by endometrial atypical hyperplasia. According to the above theoretical and clinical pathological findings, many scholars believe that the endometrial and ovarian primary double cancer has a common embryonic origin - "extended Miller system."

2. Endometriosis malignant theory The normal endometrium can be cancerous under the stimulation of estrogen over-stimulation. It is well known that malignant transformation of endometriosis is also related to estrogen over-stimulation. The ectopic endometrium can change periodically under the action of ovarian hormones, but not as good as the normal endometrium, most of which stay in the early or mid-proliferation phase and no longer continue to develop, ovarian ectopic endometrium and uterus The change in membrane secretory phase was 55%. The results of Tamaya, Janne et al also confirmed the presence of estrogen and progesterone receptors in the ectopic endometrium, indicating that the endometriotic lesions are hormone-dependent and clinically endometriosis. Periodical symptoms and signs of symptoms and hormonal treatment This disease supports the good results in many cases, since the ectopic endometrium and the normal endometrium are hormone-dependent, theoretically, excessive Estrogen stimulation may play a role in the malignant transformation of endometriosis, but no one has confirmed this view so far, although the cause of malignant transformation is unclear, but the malignant change It is definitely there. It has been confirmed in the literature that both uterine adenomyoma and pelvic endometriosis have malignant transformation. Scully analyzed 950 specimens of ovarian endometriosis and found that the malignant rate was less than 1%. However, Kuman And Craic reported 11% of ovarian endometrioid carcinoma with endometriosis, Cummins et al. revealed that 25% of ovarian endometrioid cancers originate from endometriosis, endometrial and ovarian primary The incidence of double cancer with endometriosis is not uniform. Ulbright and Rotl report that the incidence is only 5%. Deligoliach believes that 55.5% of the endometrial and ovarian primary double cancer is accompanied by intrauterine Membrane ectopic disease, and all 5 cases reported by Campbell are associated with endometriosis. In recent years, the incidence of endometriosis has been increasing, and it has become a frequently-occurring disease in gynecology, endometriosis and The relationship between endometrial and primary ovarian cancer is worthy of further study.

3. Oncogene mutation theory Matlock and Deligolisch believe that the endometrium and ovary are closely related in embryogenesis, and have the same cancer gene "susceptible region". When this oncogene is mutated, endometrium and Primary ovarian cancer, in recent years, found that the tumor suppressor gene p53 is closely related to gynecological tumors, and many studies have shown that cervical cancer, uterine cancer and ovary are associated with significant p53 expression abnormalities.

Primary cancer prevention in multiple parts of the female reproductive tract

Regular physical examination, early detection, timely cure, and good follow-up.

Primary cancer complications in multiple parts of the female reproductive tract Complications ascites

Ascites, infection.

Female reproductive tract multi-site primary cancer symptoms Common symptoms Abdominal pain Abdominal postmenopausal bleeding Pelvic mass abnormal Uterine bleeding Lower abdominal mass Vaginal bleeding

Abnormal bleeding is the main symptom of primary uterine and ovarian cancer. Group A patients are younger, 50% have a history of infertility, and myometrial invasion and pelvic diffusion are rare, 6% and 12%, respectively. The patients were older, 90% were menopausal women, and myometrial invasion and pelvic diffusion were more common, accounting for 63% and 45%, respectively. Myometrial invasion and pelvic diffusion were 30% and 38 in group A, respectively. %, group B were 50%, the results showed that abnormal bleeding is the main symptom of primary uterine and ovarian double cancer, accounting for 75.1%, in postmenopausal women, postmenopausal bleeding accounted for 81.8%, followed by abdominal pain or bloating , accounting for 58.6%, primary infertility accounted for 31%, except for group B patients older, postmenopausal bleeding is more common, there is no significant difference in clinical symptoms between the two groups (P> 0.05), abdominal mass is uterus and ovary The most important signs of primary double cancer accounted for 89.3%, and the uterus increased by 44.48%.

Examination of multiple cancers in multiple parts of the female reproductive tract

1. Tumor marker examination, secretion examination.

2. Ultrasound examination has a high diagnostic rate of pelvic mass, 94%, the diagnosis rate of ascites is 77%, and the diagnosis rate of uterine enlargement is low, only 39%.

3. Histopathological examination Diagnostic curettage is helpful for the diagnosis of uterine and ovarian primary double cancer. Preoperative patients undergoing surgical curettage have obtained histological evidence of endometrial cancer. Therefore, all patients with pelvic masses Accompanied by irregular vaginal bleeding, should be treated with curettage, except for endometrial cancer, cervical scraping is not significant for double cancer and preoperative diagnosis, the positive rate is only 17.4%.

4. Laparoscopy and the like.

Diagnosis and diagnosis of primary cancer in multiple parts of female reproductive tract

diagnosis

The diagnosis of primary endometrial and ovarian cancer has not been clear for a long time. Abnormal vaginal bleeding and abdominal mass are the main clinical manifestations, so most patients are diagnosed with ovarian or endometrial cancer, and few people think of the uterus. The diagnosis of membrane and ovarian primary double cancer is pathologically confused with stage II ovarian cancer and stage III mesangial cancer. In 1961, Campbell first explicitly proposed endometrial and ovarian primary double cancer. Diagnosis (Table 1), establishing the concept of primary uterine and ovarian double cancer and mastering its diagnostic criteria, is the key to the diagnosis of primary endometrial and ovarian double cancer, therefore, if the pelvic mass is accompanied by irregular vagina Bleeding, or preoperative, intraoperatively found that the ovary and uterus have been affected by cancer, clinicians should remind pathologists to pay attention to the possibility of primary endometrial and ovarian double cancer, if endometrial cancer and ovarian cancer tissue disease The scientific performance is in full compliance with the diagnostic criteria proposed by Young and Scully, and the diagnosis of primary endometrial and ovarian cancer is established.

Differential diagnosis

In 1985, Ulbright and Roth proposed five criteria to distinguish between endometrial and ovarian primary double cancer and endometrial cancer with ovarian metastasis:

1 small ovary (<5cm);

2 bilateral ovarian involvement, ovarian multi-nodular;

3 deep uterine infiltration;

4 vascular infiltration;

5 fallopian tube involvement, if two of the above criteria are found in the pathological specimen, it should be diagnosed as primary endometrial cancer with ovarian metastasis. If the above indicators are not found in the pathological specimen, the endometrium should be diagnosed. And primary ovarian cancer.

Based on the Ulbright and Roth diagnostic criteria, Young and Scully proposed a relatively complete diagnostic criteria for endometrial and ovarian primary double cancer in 1987 to distinguish endometrial cancer from ovarian metastasis, Young and Scully believe, If endometrial cancer infiltrates into the deep muscle layer and lymphatic vessels and blood vessels, if the tumor involves the fallopian tube mucosa, invading the ovarian surface and its lymphatic vessels and blood vessels, then the ovarian cancer is likely to be secondary, otherwise, if there is no lymph Tube and vascular metastasis, endometrial cancer is very small, limited to the infiltration of the endometrium or only the superficial muscle layer, and there is a manifestation of endometrial atypical hyperplasia around it. Ovarian tumors are confined to the center of the ovary, often accompanied by With endometriosis, these two tumors are likely to be primary tumors, although most endometrial and ovarian primary double cancers are endometrioid carcinomas, but non-endometrial cancers such as mucin Cancer, clear cell carcinoma, can also occur occasionally. Sometimes, the histological types of the two tumors can also be different. According to different histological types, Eifel, Zaino will endometrial and ovarian Sexual double cancer is divided into three groups: group A, endometrial cancer with ovarian endometrioid carcinoma; group B, endometrium and ovary are non-endometrial cancer (for example, papillary mucinous carcinoma, clear cell carcinoma) Group C, endometrium and ovary are two types of cancer with different histological types, such as endometrial endometrial cancer, and ovary is clear cell carcinoma, so the significance of grouping is that the prognosis is different, and the prognosis of group A is good, and Groups B and C had a poor prognosis.

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