Unit 10 Gynecological Diseases第10单元妇科疾病Pre-reading Activitiesang预习工作. Read the following clinical situation and decide what kind of intervention you will suggest and what disease the patient might be suffering from.阅读下面的临床表现然后决定你将建议做那些干预，病人可能患了那种疾病。
A 55-year-old woman comes to the outpatient office complaining of pelvic pressure and ab-dominal fullness. Her last menstrual period (LMP) was 3 years ago.A、女性，55岁，门诊病人，住宿骨盆压迫感，腹部胀满。
末次月经为3年前。
在阅读这个文章前先理解一下术语。
Try to understand the following terms before you read the text.gynecological [ igainiks'bc^ikal] adj. of or relating to or practicing gynecology $3产科医学的n.ovarian [ ou'vesrisn] adj. of or involving the ovaries [解音I门卵巢的malignancy [ ms'lignsnsi]( medicine) a malignant state ；progressive and resistant to treatment and tending to cause "death 恶性（肿瘤等）salpingectomy [ iS2elpin'd3ekt3mi J surgical removal of one or both Fallopian tubes [妇产]输卵管切除术hysterectomy [ ihista'rektsmi] n. surgical removal of the uterus 子宫切除Text A Ovarian Gancort FocusAbout Ovarian Cancer iSigns and Symptomst Causes| DiagnosisClassificationStaging | Treatment+ Prevention主题A 卵巢癌重点：卵巢癌的相关体征和症状病因诊断分级分期|治疗预防About Ovarian Cancer关于卵巢癌Ovarian cancer is a cancerous growth arising from the ovary. Ovarian Cancer is the second most• 1 •• 2 •新编临床实用医学英语commonly diagnosed gynecologic malignancy，the deadliest gynecologic malignancy，and the fourth leading cause of cancer-related deaths in women in the USA. About 1 in 70 women eventually develop ovarian cancer，and 1 in 100 women dies of it. Ovarian cancer affects pre-dominantly perimenopausal and postmenopausal women.卵巢癌是一种子宫增生性癌。
卵巢癌是妇产科疾病中的第二大疾病和最致命的疾病。
是导致美国女性因肿瘤死亡的第四大疾病。
大概70个女性中就有一个会发展成为卵巢癌，100中有1个因此而死。
卵巢肿瘤主要发生在绝经前和绝经后的女性中。
Etiology and pathology incidence is higher in industrialized countries in which dietary fat intake is high. A history of infertility，late childbearing and delayed menopause increases risk. Use of oral contraceptives significantly decreases risk.病因学和病理学发病率在高脂饮食的工业化国家中高。
有不孕史，晚育和更年期推迟都会增加发病风险。
使用避孕药会显著增加发病风险。
A personal or family historyof endometrial, breast, or colon cancer increases risk. Probably<5% of ovarian cancer cases are related to an inherited autosomal dominant gene, the BRCA 1 gene. Females with XY gonadal dysgenesis are predisposed to ovarian malignant germ cell tumors.有子宫内膜、乳房或结肠癌个人或者家族史会增加发病风险。
大约有<5%的卵巢癌和染色体显性遗传有关,BRCA基因。
女性XY性腺的发育不全有卵巢恶性生殖细胞肿瘤的发病倾向。
Ovarian tumors are the most histologically diverse group of tumors. At least 80% of malignant ovarian tumors arise from the coelomic epithelium. Germ cell tumors, which arise from the primary germ cells of the ovary, occur in young women and are uncommon in women> 30 years. Malignant germ cell tumors include dysgerminomas,immature teratomas, endodermal sinus tumors，embryonal carcinomas，choriocarcinoma，and polyembryomas 1•Stromal ma-lignancies include granulosatheca cell tumors and Sertoli-Leydig cell tumors卵巢肿瘤在肿瘤中有丰富的组织多样性。
至少有80%的恶性卵巢肿瘤是有宫腔上皮细胞发展来的。
生殖细胞肿瘤是由卵巢的初级生殖细胞发展而来的，一般发生在年轻女性，极少发生在>30岁的女性。
恶性生殖细胞肿瘤包括恶性胚胎瘤，畸胎瘤，内胚层窦瘤，胚胎性绒毛膜癌，卵巢多胚瘤。
基质见的恶性肿瘤包括卵泡膜细胞瘤和间质细胞瘤。
Ovarian cancer spreads by direct extension，by intraperineal implantation via exfoliation of cells into the peritoneal cavity，by lymphatic dissemination in the pelvis and para-aortic re-gion ,and, less commonly, hematogenously to the liver or lungs.Signs and Symptoms症状和体征Most women ( 75% ) present with advanced-stage disease，and most have vague，nonspecific symptoms, such as dyspepsia, bloating, early-satiety anorexia, gas pains, and back-ache. The most common early finding is an adnexal mass, which is often solid, irregular, and fixed. A patient may be asymptomatic until an abdominal mass is discovered during routine pel-vic examination or until the disease is advanced. Occasionally, a patient presents with severe ab-dominal pain secondary to torsion of the ovarian mass. Late in the course,pelvic pain,anemia, cachexia, and abdominal swelling due to ovarian enlargement or accumulation of ascetic fluid usually occur. Nodular implants noted on the rectovaginal examination suggest extensive pelvic malignant disease. If these symptoms recently started and occur more than 12 times per month the diagnosis should be considered.75%的女性会发展到疾病晚期，大部分人的症状都很模糊而且非特异，比如消化不良，腹胀，演示，腹胀，背疼。
大部分女性发现疾病是因为子宫附件肿物，肿物呈质硬，不规则，固定。
患者可能到体检发现腹部肿物或Unit 10 Gynecological Diseases • 3 •者疾病晚期才发现。
患者会在卵巢肿物蒂扭转是出现剧烈的腹痛。
在病程晚期，会出现骨盆疼痛，贫血和恶病质，由于卵巢增大和积液引起的腹胀。