The reason why I write about the standardized treatment of late-stage ovarian cancer is because the treatment level of early or relatively early ovarian cancer is not much different from that in foreign countries in most hospitals in my country. The vast majority of doctors have already mastered the early stage (I Stage, II) ovarian cancer treatments. However, the gap between domestic hospitals and foreign hospitals in the treatment of advanced ovarian cancer is not at the same order of magnitude. At present, there are not many teams of doctors who can perform advanced ovarian cancer surgery as well as foreign countries.
Ovarian cancer is the most common epithelial cancer. Therefore, ovarian cancer here, unless otherwise specified, refers to ovarian epithelial cancer. Due to their origin, fallopian tube cancer and primary peritoneal cancer also have all the biological behaviors of ovarian cancer and the same diagnosis and treatment principles, so these two cancers are also included. If there is no explanation, talking about the diagnosis and treatment of ovarian cancer actually refers to ovarian, fallopian tube epithelial cancer and primary peritoneal cancer. Some also include uterine serous adenocarcinoma.
Since the vast majority of ovarian cancers are diagnosed at an advanced stage, there is currently a lack of early diagnostic tools. Therefore, the treatment of advanced ovarian cancer is particularly important. According to epidemiological surveys, ovarian cancer was once the fifth cause of cancer deaths in the United States. Although there is no large-scale epidemiological survey in our country, there is data showing that deaths caused by ovarian cancer accounted for the third cause of cancer deaths in our country. Seven, approximately 40,000 people die from ovarian cancer every year.
Although ovarian cancer is still a terminal disease in the eyes of most doctors, it does not mean that patients with advanced ovarian cancer have no hope of survival. Currently, the average survival time of patients with advanced ovarian cancer in four top hospitals including MD Anderson Cancer Center in the United States has long exceeded 70 months, while the average survival time in most hospitals in my country rarely exceeds 2 years. The national 5-year survival rate for ovarian cancer is only 37%, and this includes the results of early-stage ovarian cancer.
What is the reason why the prognosis of ovarian cancer patients in my country is so different from that in foreign countries? The main reason is the difference between my country\’s first surgery principle and foreign hospitals.
In fact, the most important factor affecting the prognosis of ovarian cancer patients is the size of the residual tumor after the first surgery. The so-called residual tumor means that the tumor has not been completely removed or cannot be removed after the operation.Cut out the tumor cleanly. The currently accepted view is that when the diameter of the residual tumor is greater than or equal to 2 cm, the patient\’s prognosis is very poor. It\’s so bad that having surgery is the same as not having surgery. When the residual tumor is less than 2 cm but larger than 1 cm, the patient\’s prognosis is significantly better than that of patients who do not undergo surgery or whose residual tumor is larger than 2 cm, but the average survival time is about 21 months, that is, less than two years. When the residual tumor is less than 1 cm and the patient receives regular chemotherapy, the patient\’s prognosis will be significantly improved. This is also a satisfactory cytoreduction surgery currently defined by international academic circles. Its 5-year survival rate is approximately 30-40%. The main reason why there is such a big gap is that the size of the residual tumor is not measured with a ruler, but estimated by the doctor\’s eyes based on his subjective feeling. Currently, 89 hospitals in the United States have formulated standardized treatment plans for gynecological tumors, and every year they publish a guideline based on the research results of the previous year. This is the so-called NCCN guideline.
Although the top four hospitals in the United States are leaders and participants in this guideline, they have their own standards: setting the residual tumor standard as \”invisible to the naked eye\”. Or less than 5 mm. Although the difference is only a few millimeters or at most a centimeter, the 5-year survival rate of patients can reach more than 90%, and the average survival period of patients reaches 70 months, exceeding our commonly used indicator \”5-year survival rate.\”
Why should the residual tumor be made so small? Because after ovarian cancer is removed, no matter how thorough it is, there will still be residual cancer cells in the body. These cancer cells, which are invisible to the naked eye, can only be killed by chemotherapy. However, the penetration of these chemotherapy drugs into tumors is only 3-5 mm. Therefore, the smaller the diameter of the residual tumor, the greater the chance that it will be fully penetrated by chemotherapy drugs. If they are too small to be visible to the naked eye, of course they will all be killed in the end. If the residual tumor is larger than 1 cm, there are always a few cancer cells that cannot be penetrated by chemotherapy drugs, which eventually become the source of recurrence. If the residual tumor is less than 1 centimeter, although there will be cancer cells that will slip through the chemotherapy drugs, the process will take much longer. The longer this process is, the longer the patient will survive.
Advanced ovarian cancer refers to patients with stage III and IV. Stage III means that the patient\’s cancer cells have metastasized to the surface of some organs in the abdominal cavity or to the retroperitoneal lymph nodes, while stage IV means that the patient has metastasized beyond the pelvis and abdominal cavity. In stage III patients, no doctor in the world claims to be able to completely eliminate cancer cells and achieve a state of \”invisible to the naked eye\”. Top experts only claim to be able to completely eliminate 91% of patients. In the United States, for gynecological oncologists with specialized surgical training, the standard for surgical residual tumors is still limited to 1 cm, but only 46% of patients will encounter specialized gynecological oncologists; for the remaining 54% of patients, their surgery is It is done by a general gynecologist or an obstetrician-gynecologist or even a surgeon.This is also an important reason why ovarian cancer still leads to death of patients. Since surgery for advanced ovarian cancer requires the participation of hepatobiliary surgeons, gastrointestinal surgeons, vascular surgeons and even thoracic surgeons in order to completely remove the tumor, it is difficult for many specialized hospitals with incomplete disciplines to treat ovarian cancer. The surgery is done. The main reason that restricts the surgeon from completely removing the tumor is that if the surgeon does not have a well-coordinated team and cannot independently remove the tumor on the diaphragm, liver surface, splenic flexure or even the intestinal tube, the tumor will remain in these parts and the operation will be difficult. The effect will be greatly reduced.
Since gynecologists were unable to completely remove the tumor, some people gave the patient three courses of chemotherapy before performing surgery. This will indeed increase the patient\’s tumor resection rate, but long-term follow-up observations show that the average survival time of patients after this \”chemotherapy-surgery-chemotherapy\” is about 22 months, which is different from the time when the residual tumor is removed during surgery. The tumor should be cut until it is larger than 1 cm and less than 2 cm. Therefore, this so-called intermediate surgery plan is gradually being abandoned by the academic community. In fact, only when surgery is truly unresectable, it is recommended to remove most of the tumor first, and then re-excise the tumors that cannot be removed for the first time after 2-3 courses of chemotherapy. Unfortunately, the prognosis for these patients is not very good either. It is better to completely remove the tumor for the first time and make it invisible to the naked eye and then standardize chemotherapy for patients.
Is it difficult to completely remove tumors in patients with advanced ovarian cancer? the answer is negative. After a surgical team cooperates with surgeons for about 15 years, it can basically reach a level that is invisible to the naked eye. Most of my country\’s hospital systems are general hospitals, which cooperate with surgeons to perform an operation, which has more advantages than the American medical system where individuals work alone. It usually takes about 12 years to reach this level.