Ukuhlinzwa, i-Chemotherapy, i-Radiation, kanye Nezivivinyo Zomtholampilo
Izinketho zokwelashwa zomdlavuza we-ovari zixhomeke esiteji sesifo kanye nezinye izici futhi zingase zibandakanye ukuhlinzwa, i-chemotherapy, izifo ezibhekiswe kuzo, noma izivivinyo zomtholampilo. Ngaphandle kwesisu kakhulu, izihlanganiswa zalezi zindlela zokwelashwa zivame ukusetshenziswa. Ukwelapha kungase kuguquke uma umdlavuza wakho ukuphindaphinda umdlavuza wangaphambili noma uma ukhulelwe.
Ithimba lakho lokunakekela umdlavuza
Isinyathelo sakho sokuqala ekukhetheni izinketho ezinhle zokwelapha ukuqonda ithimba lakho lokunakekelwa ngumdlavuza. Kubalulekile ukwazi ukuthi ngubani ozokwenza indima yokuphatha ukunakekelwa kwakho nokuthi kufanele ubize ngemibuzo.
Ngokuvamile, umdlavuza we-ovariya utholakala okokuqala, noma okungenani usola, udokotela wezifo zesifo sezifo (OB / GYN) noma omunye udokotela wokunakekela oyinhloko. Uma ukhetha izinketho zokwelashwa, kunconywa ukuthi uxhumane nomuntu onogciwane we-oncologist ngaphambi kokuqala umgogodla.
Amanye amalungu eqembu lakho lokunakekelwa kwezempilo angabandakanya udokotela wakho wokunakekela oyinhloko, isisebenzi senhlalakahle ye-oncology noma umeluleki, udokotela wezinkinga (obheka noma yiziphi izicubu ezisusiwe ngesikhathi sokuhlinzwa), futhi mhlawumbe udokotela wokunakekelwa nge-palliative (ogxila ekukhululeni izimpawu ezihlobene nomdlavuza) noma isazi sokuzala.
Izinketho zokwelapha
Kunezinhlobo ezimbili eziyisisekelo zokwelapha umdlavuza we-ovarian:
- Ukwelashwa Kwendawo: Ukwelapha okufana nokwelapha kanye nokwelashwa kwemisebe kuyindlela yokwelashwa yendawo. Belapha umdlavuza lapho kuvela khona kepha ungakhangi ukubhekana nanoma yimaphi amangqamuzana omdlavuza asakaze ngaphezu kwesayithi lokuqala lomdlavuza.
- Izindlela zokwelapha zesistimu: Uma umdlavuza usakazeka ngaphesheya kwendawo yawo yokuqala, ukwelashwa okuhleliwe okufana nokhemotherapy, ukwelashwa okuhlosiwe, noma ukwelashwa kwe-hormonal (ngezicubu ezingezona izifo) ngokuvamile kuyadingeka. Lezi zokwelapha zikhuluma namaseli omdlavuza kungakhathaliseki ukuthi ziphi emzimbeni wakho.
Abantu abaningi abanomdlavuza we-ovarian epithelial bazoba nokuhlanganiswa kwalezi zelashwa.
Ngezinye izikhathi, njenge-germ cell kanye ne-stromal cell tumors, noma isigaba sokuqala (njengesiteji IA) izicubu ze-epithelial, ukuhlinzwa kwedwa, ngaphandle kwe-chemotherapy, kungasebenza.
Ukuhlinzwa
Ukwelashwa yiyona ndlela yokwelashwa okuyinhloko kubantu abaningi abanomdlavuza we-ovarian. Kungashintsha kokubili uhlobo lomdlavuza we-ovarian nesiteji. Ucwaningo luye lwathola ukuthi uma ukuhlinzwa komdlavuza we-ovarian kwenziwa nge-oncologist yezinkinga zokubeletha, imiphumela iba ngcono kangcono kunalokho lapho ukuhlinzwa kwenziwa odokotela bezinye izinto ezikhethekile, ngoba lezi zinqubo eziyinkimbinkimbi.
Noma kunjalo, ngisho nalapho ubona oncologist gynecologic, abantu abaningi bakuthola kuwusizo (futhi ngokuvamile eqinisekisayo) ukuthola umbono wesibili. Uma ucabangela ukwenza kanjalo, ungase ufise ukucabangela esinye sezikhungo zomdlavuza ezikhethiwe zeNational Cancer Institute, ezivame ukuba nezinogqirha ezihlinzeka ngokukhethekile ekuhlinzekeni okukhethekile.
I-Oophorectomy (ye-Germ ne-Stomal Cell Tumors)
Ama-tumor ye-Germ cell kanye ne-stromal cells avame ukutholakala ezinkathini zokuqala. Abantu abaningi abanezikhumba basencane, futhi ukuhlinzwa ukukhipha kuphela i-ovary ethintekile (i-oophorectomy) kungase kuholele ekulondolozeni enye i-ovary nesisu. Ukwelashwa yedwa kungase kuphumelele nasezikhunjini zokuqala ze-epithelial.
Uma kokubili ama-ovaries kudingeka asuswe, kusekhona ezinye izinketho zokulondoloza ukuzala , okufana nemibungu yokuqandisa. Uma unesithakazelo sokwenza lokhu uma kungenzeka, khuluma nodokotela obhekene nokulondolozwa kokuzala ngaphambi kokuba ukwelashwa kwakho kuqale.
Ukwelashwa kwe-Cytoreduction / Debulking (ye-Epithelial Ovarian Cancer)
Cishe amaphesenti angu-80 e-epithelial ovarian cancers atholakala ngezigaba kamuva zesifo (isigaba III nesigaba IV). Ngokungafani nomdlavuza webele nowamaphaphu, lapho ukuhlinzeka ngesifo se-stage IV kungenzi ngcono impilo yokulinda, ukuhlinzekwa kungadlulisela impilo kulabo abanomdlavuza wesigaba IV.
Ibuye ithuthukise ekuzuzeni kamva kusuka kumakhemikhali.
Ukwelashwa komdlavuza we-ovarian epithelial okuthuthukisiwe kubhekiselwa ekuhlinzekeni kwe-cytoreductive (ukuhlinzeka ngokweqile). "I-Cyto" yilizwi eliyisisekelo seseli futhi "ukunciphisa" lisho ukunciphisa, ngakho umgomo walokhu kuhlinzeka ukunciphisa inani lamangqamuzana omdlavuza okwamanje, kunokuqeda yonke umdlavuza.
Kuneziphumo ezintathu ezikhona zalokhu kuhlinzwa:
- Qedela: Wonke umdlavuza obonakalayo ususiwe.
- Okufanele: I- Cancer ihlala, kodwa zonke izindawo zingaphansi kuka-1 cm ububanzi (ngokuvamile ezibhekwa njengezifo zemindeni).
- I-sub-optimal: Ama-noodle amakhulu kuna 1 cm ububanzi ahlala.
Ukuhlinzeka nge-Cytoreductive ukuhlinzwa okude futhi okulukhuni, futhi izingozi zenkambiso ende zivame kakhulu kunezinzuzo. Ngakho-ke, i-cytoreduction "evumelekile" ngokuvamile iyinhloso yokuhlinzwa.
Ngaphezu kokukhipha kokubili ama-ovari nama-tublopian tubes (i-salpingo-oophorectomy yamazwe amabili) kanye nesibindi (hysterectomy), ezinye izicubu zivame ukukhishwa noma zifakwe nge-biopsied kanye. Isibonelo, i- omentum , noma isendlalelo samathambo amafutha anqwaba ama-ovari nama-pelvis, avame ukususwa (i-omentectomy).
Ukuhlanza, inqubo lapho i-saline ifakwa khona esiswini nasesikhwameni bese ihoxiswa ukuze ihlolwe khona ukuba khona kwamangqamuzana omdlavuza "avulekile" esiswini nasesikhwameni, futhi kwenziwa.
Ama-lymph nodes esiswini nasesikhwameni zivame ukuguqulwa noma zisuswe (i-lymph node dissection). Ngaphezu kwalokho, amasampuli angathathwa ebusweni bezitho eziningi ze-pelvic nezisu zesisu, njengesisu, amathumbu, isibindi, i-spleen, isisu, i-gallbladder, noma i-pancreas. Ngezicubu ezinzima ze-epithelial, isithasiselo ngokuvamile sisuswe.
Uma amasampuli athathwa emathunjini, lezi ziphetho zombili zesifunda zisuswe zixhunyaniswa uma kungenzeka. Uma kungenjalo, ukuphela kwamathumbu ngaphambi kokuba indawo yokuhlinzekwa ikhonjiswe esikhumbeni ukuze isilonda singasheshwa ngaphandle (ukudala isisu).
Konke lokhu kuhlinzeka kungenziwa ngokushesha, noma esikhundleni salokho ngemuva kokuba i-chemotherapy inikezwe noma ngemuva kokuphindaphinda komdlavuza.
Imiphumela emibi kakhulu yokuhlinzwa iphuma, izifo, kanye nokuphendula kwe-anesthesia. Njengoba ukuhlinzeka nge-cytoreduction kusebenza isikhathi eside, kunconywa ukuba labo abasengozini babe nokuhlolwa kwenhliziyo nephaphu ngaphambi kokuhlinzwa.
I-Chemotherapy
Ngomdlavuza we-ovari, cishe akunakwenzeka ukususa wonke umdlavuza. Ngisho nalapho ukuhlinza kususa wonke amangqamuzana omdlavuza obonakalayo (njengezinyathelo zangaphambili), izinga lokuphindaphinda liphakeme kakhulu kuma-80%. Lokhu kusho ukuthi ngisho noma umdlavuza obonakalayo ungabonakali, izindawo ezincane zomdlavuza zishiywa ngemuva. Ngakho-ke, i-chemotherapy ivame ukunikezwa bonke kodwa izigaba zokuqala zomdlavuza we-ovary ovarian. I-chemotherapy ivame ukusetshenziswa kakhulu ngezigaba eziphakeme zezinambuzane ze-germ cell.
Izidakamizwa ezisetshenziswayo
Izidakamizwa ezivame ukusetshenziswa zihlanganisa inhlanganisela ye:
- Izidakamizwa zePlatinum: i-Paraplatin (i-carboplatin) noma iPlatinol (i-cisplatin).
- Amatekisi: I-Taxol (paclitaxel) noma i-Taxotere (docetaxel).
Kunezinye izidakamizwa eziningi ezingasetshenziswa kanye, kuhlanganise ne-Doxil (liposomal doxorubicin) ne-Gemzar (gemcitabine).
Ngama-tumor cells, i-chemotherapy ngokuvamile ihlanganisa i-Platinol (cisplatin), i-VP-16 (etoposide), ne-bleomycin.
Izindlela Zokuphatha
I-Chemotherapy inganikezwa ngezindlela ezimbili:
- Ngokwemvelo (IV): IV i-chemotherapy ivame ukunikezwa njalo ngemva kwamasonto amathathu kuya kwangu-4 futhi iphindwe imijikelezo emithathu kuya kweyisithupha. Lokhu kunganikezwa nge-catheter efakwe engalweni yakho, noma ngokusebenzisa i- chemotherapy port noma umugqa we-PICC.
- I-intraperitoneal chemotherapy: Kule nqubo, i-chemotherapy inikezwa ngenaliti efakwe ngqo emgodini wesisu.
Ukuphathwa kwe-IV kuvame kakhulu, kodwa abacwaningi manje bakholelwa ukuthi i-intraperitoneal chemotherapy isetshenziswa kakhulu emdlalweni we-ovarian. Ungase ufune ukubuza ngakho.
Ngo-2016 ukubuyekezwa kokucwaninga, abacwaningi bathola ukuthi imithi yokwelapha i-intraperitoneal yandisa ukwanda komdlavuza we-ovarian ngaphezu kwe-IV chemotherapy. Kulolu cwaningo, kwaqaphela ukuthi imithi yokwelapha i-intraperitoneal yabangele imiphumela emibi kakhulu yokugaya ukudla, imfiva, ubuhlungu, nokutheleleka, kodwa yayingaphansi kwe-IV chemotherapy ukuze ilahlekelwe ukuzwa (i-ototoxicity).
Lokho kusho ukuthi i-intraperitoneal chemotherapy ayibekezelelwanga kanye ne-IV chemotherapy futhi ayikwazi ukusetshenziswa uma kunezinkinga zesifo sezinso noma izicubu ezibomvu ezibalulekile esiswini, ngakho-ke kuvame ukugcinwa kwabesifazane abanesifo se-stage IV nalabo abanesisindo esincane kakhulu .
Okuqhamuka uma udla imishanguzo
Imithi ye-Chemotherapy iphazamisa ukuhlukaniswa kwamaseli ngamaphoyinti ahlukahlukene kulo mjikelezo futhi iphumelela ekubulaleni amaseli akhula ngokushesha, njengama-cell cell. Ngeshwa, ukwelashwa kuthinta amaseli avamile, ahlukanisa ngokushesha, okwenza imiphumela engathandeki.
Imiphumela emibi kakhulu yezidakamizwa zamakhemikhali asetshenziselwa umdlavuza we-ovarian zifaka:
- I -nausea nokuhlanza: Ukwelashwa kwe- chemotherapy-eyabangela ukuhlanza nokuhlanza kuye kwaba ngcono kakhulu eminyakeni yamuva, futhi imishanguzo yokuvimbela manje ivame ukuvumela abantu ukuba baphume nge-chemotherapy ngezincane noma ezingenaso ukuhlanza.
- Ukususwa komnyosa we-Bone okuholela ezingeni eliphansi lamangqamuzana egazi amhlophe, amangqamuzana egazi abomvu namaplatelet. Lizinga eliphansi lohlobo lwegazi elimhlophe elibizwa ngokuthi i-neutrophils elenza abantu babe nezifo ngesikhathi se-chemotherapy .
- Ukukhathala
- Ukulahlekelwa izinwele
Imiphumela emibi kakhulu yesikhathi eside ye-chemotherapy ingabandakanya i- peripheral neuropathy (ukulinganisa, ukuzwa ubuhlungu, nokwehliswa kwezandla nezinyawo) nokulahlekelwa kokuzwa (i-ototoxicity). Kukhona futhi ingozi encane yokuthuthukisa ukwelashwa kwamagciwane wesibili ngaphansi komugqa.
Imiphumela emibi kanye nokuhlukunyezwa kwe-chemotherapy, noma kunjalo, ngokuvamile kuvame kakhulu kunenzuzo yokuphila yalezi zindlela zokwelashwa.
Imithi ehlosiwe
Ukwelashwa okuhlosiwe yizokwelapha eziphazamisa izinyathelo ezithile ekukhuleni komdlavuza. Njengoba ziqondiswa ngokuqondile emangqamuzaneni omdlavuza, ngezinye izikhathi (kodwa hhayi ngaso sonke isikhathi) zinemiphumela emibi kakhulu kune-chemotherapy. Imithi engasetshenziswa ngomdlavuza we-ovari ihlanganisa:
- I-Angiogenesis inhibitors: I-Cancer kudingeka idale imishaya yegazi entsha ukuze ikhule futhi isakaze. I-Angiogenesis inhibitors inqanda le nqubo, ngokuyinhloko ilambile indlala yegazi elisha. I-Avastin (bevacizumab) ngezinye izikhathi inganciphisa ukukhula komdlavuza we-ovari kodwa ingaba nemiphumela emibi kakhulu njengokwelapha, ama-blood clots, kanye nesibindi se-perforated.
- PARP Inhibitors: I-PARP inhibitor yokuqala yamukelwa umdlavuza we-ovarian ngo-2015. Ngokungafani ne-chemotherapy, le mithi inganikezwa ngefomu lepilisi esikhundleni se-IV. Ama-inhibitors we-PAR asebenza ngokuvimbela indlela yokusebenzisa umzimba eyenza amangqamuzana aguqule i-BRCA isakhi sofuzo. Izidakamizwa ezitholakalayo zihlanganisa uLynparza (olaparib), uRubraca (rucapraib), noZejula (niraparib).
Lezi mithi zivame ukusetshenziselwa abesifazane abaguquguqukayo be-BRCA, kodwa bobabili uLynparza noZejula bangasetshenziselwa abesifazane abangenalo ukushintshashintsha kwe-BRCA ukuze baphathe umdlavuza we-ovarian emuva kwe-chemotherapy. Imiphumela emibi ingabandakanya ubuhlungu obuhlangene nobunamahloni, isicanucanu, kanye ne-anemia phakathi kwabanye, kodwa kuvame ukubekezelela kangcono kunokhemotherapy. Kukhona futhi ingozi encane (njengokuthi i-chemotherapy) yamagciwane e-secondary asifo se-leukemia.
Ezinye zokwelapha
Ezinye izinhlobo zokwelashwa zingase zisetshenziswe ngezinhlobo ezahlukene zomdlavuza we-ovari noma izifo ezandakazekayo. Izidakamizwa ze-hormonal therapy zivame ukusetshenziselwa umdlavuza webele. Kodwa izidakamizwa ezifana nezidakamizwa zokuxoshwa kwama-ovari, i-tamoxifen, ne-aromatase inhibitors zingase zisetshenziselwe izicubu ze-stromal cell, kanye nezivunguvungu ze-epithelial cell, ezingavamile. Ukwelashwa kwezidakamizwa akuvame ukusetshenziselwa umdlavuza we-ovari kodwa kungasetshenziswa uma kunezibalo eziningi eziswini esiswini.
Izivivinyo zemitholampilo
Kuningi lokuhlolwa okuqhubekayo emitholampilo okubheke phambili kokubheka ukuhlanganiswa kwezilapha ezingenhla, kanye nokwelapha okusha, kokubili ukuxilongwa komdlavuza we-ovarian kanye nokuphindaphinda. I-National Cancer Institute incoma ukuthi ukhulume nodokotela wakho mayelana nalabo okungenzeka kufanelekile kuwe.
Ngezinye izikhathi indlela kuphela yokusebenzisa ukhetho olusha ukwelashwa ukuba yingxenye yalezi zifundo. Kunezinkolelo eziningi mayelana nokuhlolwa kwemitholampilo , kodwa iqiniso liwukuthi yonke imithi esinawo manje ngomdlavuza yaqala ukufunda ngale ndlela.
Imithi yokwelapha ehambisanayo (i-CAM)
Kuze kube manje, azikho izifundo ezibonisa ukuthi ukwelashwa kwe-CAM kungaphatha umdlavuza we-ovari. Ukwelashwa okuvamile okuqhubekayo ngokuqondene nezinketho ezinjalo kungaba empeleni kungalimaza.
Lokho kusho ukuthi abanye bangasiza ngezimpawu zomdlavuza kanye nemithi yokwelashwa, ngcono izinga lokuphila. Ngenxa yalesi sizathu, izikhungo eziningi zomdlavuza manje zinikeza ngemithi yokwelapha ehlukile . Izinketho eziye zabonisa inzuzo ethile okungenani izifundo ezimbalwa zocwaningo zibandakanya ukukhwabanisa , ukuzindla , i- yoga , ukwelashwa komculo , kanye nokwelashwa kwesilwane .
Izithako kanye nokudla
Khuluma ne-oncologist yakho ngaphambi kokuzama noma yiziphi izithako zokuvithamini noma zamaminerali . Zonke zihlanganiswe yi-isibindi noma izinso futhi zingahle zinciphise noma ziphuthumise imithi ye-metabolism yezidakamizwa zamakhemikhali, ezithinta ukwelashwa. Abanye, ikakhulukazi, baqinisekisa ukuqapha okukhethekile: I-Vitamin E (kanye nomuthi we-Ginkgo biloba) ingakhuphula ukwelapha ngesikhathi nangemva kokuhlinzwa, nezinye izithako zingandisa ingozi yezinhliziyo ezingavamile noma ukuqubuka okuhlobene nesifo sofuzo.
Ngaphezu kwalokho, ama-antioxidant amalungiselelo angaqeda ukuvikela amangqamuzana e-chemotherapy kanye nokwelashwa kwemishanguzo okuhloswe ukubhubhisa; lezi zokwelapha zisebenza ngokubangela ukulimala okwenziwe i-oxydative ekuphatheni kwezakhi zofuzo emangqamuzaneni omdlavuza. Abaningi oncologists bakholelwa ukuthi ukudla ukudla okunomsoco we-antioxidant akuyona inkinga ngenkathi ukwelashwa, noma kunjalo.
Ama-omega-3 fatty acids, noma kunjalo, angasiza kwabanye. Lezi zithako zingasiza ukugcina ubuhlungu bemisipha kulabo abane- cancer cachexia , isimo esithinta ukulahlekelwa kwesisindo, ukulahlekelwa kwesisindo somzimba, nokulahlekelwa kwesidlo esithinta abantu abangamaphesenti angu-80 abanomdlavuza ophakeme.
Kukhona isithakazelo ku- turmeric (nesakhi saso, i-curcumin), isithako esivamile ku-curry nama-mustard abanika lokhu kudla umbala wabo ophuzi. Ezinye izifundo zelabhu zibonisa ukuthi le-turmeric ingase ivuse ukufa kwama-ovarian cell cells, kodwa hhayi evamile, nokuthi ama-cancer e-ovarian "aphethwe" ama-turmeric angase abe ncane amathuba okuba angamelana ne-chemotherapy. Lolu cwaningo aluhambisani nesicelo salo kubantu, kodwa akukho lutho olulimazayo ekusebenziseni isipayisi.
Ukwelapha Ukuphindaphinda
Ngeshwa, cishe amaphesenti angama-80 ama-ovarian khansa aphethwe ngemithi ejwayelekile engaphezulu azobuya. Indlela yokwelapha yokuphindaphindiwe incike esikhathini sayo:
- Ukuphindaphinda ngokushesha ngemuva kokwelashwa: Amacala anjalo abhekwa njenge-platinum refractory, noma amelana ne-platinum chemotherapy. Izinketho zihlanganisa ukuphindaphinda imithi yamakhemikhali kanye nezidakamizwa ezifanayo (nakuba lokhu kuvame ukuphumela ekuphenduleni okungalungile), besebenzisa imithi ehlukile yamakhemikhali (kunezinketho eziningi ezihlukene), noma ucabangela ukuhlolwa komtholampilo.
- Ukuphindaphinda kungakapheli izinyanga eziyisithupha ukwelashwa: Amacala anjalo abhekwa njenge-platinum resistant. Izinketho kuleli phuzu zingase zibe izidakamizwa ezahlukene noma imithi, noma isilingo somtholampilo. Ngokuvamile ukuhlinzwa akunconywa.
- Ukuphindaphinda izinyanga eziyisithupha noma ngaphezulu emva kokuba ukwelashwa kuqediwe: Uma i-chemotherapy yasekuqaleni yayihlanganisa nokusebenzisa imithi ye-platinum chemotherapy (i-Platinol noma i-Paraplatin), lesi sifo sibhekwa njenge-platinum sensitive. Izincomo zokwelapha ziyahlukahluka kodwa zingabandakanya ukuhlinzekwa kwe-cytoreduction kanye nokwelashwa nezidakamizwa zokuqala zamakhemikhali.
Ukwelashwa kokukhulelwa
Amanqamu amaningi e-ovarian akhulelwa ngesikhathi sokukhulelwa yizifo ze-germ cell noma ama-tumor cells. Lezi zicubu ngokuvamile zibandakanya i-ovary eyodwa kuphela, futhi ukuhlinzwa ukukhipha i-ovary kungenzeka ngesikhathi sokukhulelwa, nakuba kulinde kuze kube ngu-trimester yesibili okhethwayo.
Kwabesifazane abakhulelwe abanomdlavuza we-epithelial ovarian kanye nesisindo esiphezulu se-stromal cell noma izifo ze-germ cell, ukuhlinzwa okusetshenziselwa i-cytoreduction kungenzeka. Ukulinda kuze kube sekupheleni kwe-trimester yokuqala, kodwa ukuhlinzwa kungacatshangwa ekuqaleni. I-Chemotherapy iphephile kakhulu emva kwe-trimester yokuqala futhi ingavame ukuqala cishe emavikini angu-16. I-epithelial ovarian cancer, inhlanganisela yeParaplatin (carboplatin) ne-Taxol (paclitaxel) ivame ukusetshenziswa, ngokuhlanganiswa kwePlatinol (cisplatin), i-Velban (i-vinblastine) ne-bleomycin esetshenziselwa izicubu ezingezona izifo.
> Imithombo:
> Fruscio, R., de Haan, J., Van Calsteren, K. et al. Izindlela Ezinhle Nezocwaningo. I-Obstetrics Clinic ne-Gynecology. 2017. 41: 108-117.
> Jaaback, K., Johnson, N., noT. Lawrie. I-intraperitoneal Chemotherapy ye-Initial Management of Epithelial Primary Cancer Ovarian Cancer. I-Cochrane Database yezibuyekezo ezihleliwe . 2016. (1): i-CD005340.
> National Cancer Institute. I-Ovarian Epithelial, I-Tube yama-Fallopian, ne-Primary Peritoneal Cancer Treatment (PDQ) -Health Professional Version. Kubuyekezwe 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> van Driel, W., Koole, S., Sikorska, K. et al. I-Hyperthermic Intraperitoneal Chemotherapy e-Ovarian Cancer. I-New England Journal of Medicine . 2018. 378 (3): 230-240.