강남세브란스  자궁암 난소암 클리닉

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부인과 종양에 대한 경험이 없더라도 성인 여성이라면 누구나 주변 사람들을 통해 자궁에 혹이 생겨서 수술을 받아야 한다는 말을 들어 보았을 것이다.
자궁에 생기는 종양들은 종류나 수반되는 질병이 다양해서 제대로 알고 치료에 임하는 것이 중요하다. 통증과 출혈을 동반하는 자궁의 불청객, 부인과 종양에 대해 알아보자.


STEP1…  자궁의 혹 : 자궁근종과 자궁선종

자궁근종과 자궁선종(선근증), 무엇이 다를까?
 자궁근종과 자궁선종은 만성골반 및 하복부 통증, 생리통, 생리과다, 원인불명의 불규칙 자궁출혈 및 배뇨장애, 빈뇨, 과도한 변비, 성교통증 등을 보이는 여성이라면 한 번쯤 의심해 봐야 하는 가장 흔한 부인과 양성종양이다. 두 질환의 발생 원인은 다르지만 증상은 유사하고 동반하여 나타나기도 하며, 치료법에 약간의 차이가 있다.

 자궁근종은 자궁을 대부분 이루고 있는 근육층에 생기는 종양으로 위치나 크기에 따라 자궁절제술, 자궁근종절제술, 약물요법 등의 치료를 시행할 수 있다. 자궁선종(선근증)은 자궁내막조직이 근육층에 침투하여 자궁의 크기가 커지는 증상을 말하며 자궁절제술, 약물요법 등의 치료를 할 수 있다.

치료방법 알아보기

자궁절제술
: 전체 자궁을 절제하는 방법으로 향후 근(선)종 및 자궁에서 생기는 질환을 예방할 수 있으나 임신이 불가능하다. 특히 자궁선종은 혹과 정상 자궁조직과의 경계가 없어 자궁선종 조직만 제거할 수 있는 경우는 매우 드물다. 따라서 생리통, 월경과다 등의 증상이 너무 심한 경우는 전체자궁을 절제하게 된다. 주로 복강경 수술법을 시행하며 자궁이 너무 크거나 유착이 심하면 개복수술을 하는 편이다.

자궁근종 절제술 : 향후 임신을 해야 하는 젊은 여성이나 자궁을 남기기 원하는 환자에게 시행할 수 있다. 그러나 남아 있는 자궁에서 자궁근종이 재발할 가능성이 높다. 자궁근종의 위치나 크기, 추후 임신 시 발생할 수 있는 합병증 등을 고려하여 개복술과 복강경술, 자궁경술 등의 수술방법을 결정하게 된다.

약물요법 : 수술 전 근종의 크기를 줄이거나 빈혈을 교정하는 등의 일시적인 효과를 기대하고 사용하게 된다. 자궁선종의 경우 증상이 있는 환자에서 소염 진통제, 피임약, 호르몬 주사, 호르몬 자궁 내 장치 요법 등을 사용한다.

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STEP2… 난소의 혹 : 낭종, 악성종양

종류도 모양도 다양한 난소낭종
 난소낭종이란 난소에 생기는 물이 찬 혹을 말한다. 난소는 자궁 양 옆에 두 개가 있는 작은 장기로 배란(난자를 만들고 배출하는 일)과 여성호르몬 생성을 담당하는 중요한 장기이다. 그 과정에서 혹이 잘 생기는데 이것을 난소낭종이라고 이른다. 대부분의 난소낭종은 기능성 낭종이며 대개 1~3개월 내에 스스로 소멸되는 경우가 많다. 하지만 기능성 낭종 외에도 많은 종류의 혹이 난소에 생길 수 있으며 자궁내막증 환자의 난소에 혹이 생기는 경우를 자궁내막증이라고 한다. 그 외에도 기형종, 점액종 등 병리학적 분류에 따라 여러 가지 종류가 있다. 또한 기능성 낭종이더라도 크기가 큰 낭종은 통증이나 염전(꼬이는 현상) 등의 문제를 일으킬 수 있으므로 주의가 필요하다.

 난소낭종의 종류는 매우 다양하므로 크기나 검사상 발견된 특징, 발생 연령 등을 고려하여 정기관찰 및 수술 여부를 결정하게 된다. 특히 폐경 이후의 난소 종양은 확실한 진단을 위하여 수술하는 것이 좋다. 치료는 난소 전체를 제거하는 난소절제술, 난소의 낭종만 제거하는 난소낭종제거술 등이 있으며 대부분 복강경술을 시행하지만 검사상 악성종양 가능성이 의심되는 경우에는 개복술을 하기도 한다.

소리 없이 다가오는 난소암
 난소암은 암이 발생하는 조직에 따라 크게 상피성 난소암, 배세포 종양, 그리고 성삭 기질 종양으로 구분된다. 난소암의 90% 이상은 난소 표면의 상피세포에서 발생하는 상피성 난소암이다.

 상피성 난소암은 암이 상당히 진행하기까지 특별한 증상이 나타나지 않는 경우가 많다. 간혹 증상이 나타나는 경우도 그 증상이 하복부나 복부의 불편감, 통증, 소화기 장애에 의한 증상 등과 같이 비특이적이고 불분명하여 다른 질환으로 오인하여 진단이 늦어지는 경우가 많다.

 환자가 호소하는 증상과 신체검진을 통해 난소암이 의심되면 골반내진, 종양표지자 혈액검사(CA 125), 경질 초음파, 전산화 단층촬영(CT), 자기공명영상(MRI) 등의 검사를 통해 자궁의 종양과 난소 종양의 여부, 종양 내부의 구조, 암 전이 유무 등을 자세히 조사한다. 이러한 검사를 통해 양성 종양인지 악성 종양인지를 추정할 수 있으나, 최종적인 진단은 개복수술 또는 복강경 수술을 통해 난소종괴를 적출하여 조직병리검사로 하게 된다.

난소암의 치료법
 난소암의 일반적 치료는 수술, 방사선, 및 항암화학치료의 세 가지로 구별된다. 난소암의 수술적 치료에서 수술 후 병리 결과를 확인하고 주치의를 부인종양 전문의로 바꾸는 경우에는 부인암 치료의 적절성에 문제가 생길 수 있으므로 난소암의 가능성이 조금이라도 있는 물혹이나 종양이 발견되면 부인종양 전문의에 의한 적절한 수술을 권장한다.

 부인종양 전문의가 적절한 수술범위를 선택하여 수술함으로써 수술 중 우발적인 종양의 전이를 예방하고 장기적으로 환자의 생존율도 좋아지게 된다. 난소암에서 항암화학요법은 수술과 더불어 중요한 난소암의 치료방법이다. 항암화학요법의 치료 기간과 횟수는 암세포의 종류, 항암제의 종류, 치료에 대한 반응률, 부작용의 정도에 따라 다르다. 난소 외부로 암세포의 확산이 의심되는 1기 말 이상의 난소암의 경우에는 수술 후 대개 4~6차례의 항암화학요법을 실시하게 된다.

 3기 및 4기의 난소암은 광범위하게 전이하기 때문에 수술 전의 검사에서 개복수술을 하더라도 암의 완전한 절제가 어려울 것이라고 예상되는 경우에는 우선적으로 항암화학요법을 실시하여 암이 작아지게 한 이후에 수술을 하기도 한다.

앞서가는 강남세브란스 부인암 진료팀
 강남세브란스병원 부인암 진료팀은 2008년부터 미국 GOG (Gynecologic Oncology Group) 임상연구에 적극적으로 참여하고 있으며 현재 부인암 진료팀에서 난소암으로 치료받는 다수의 환자들이 GOG 218/213 연구에 등록되어 있다.

 이것은 혈관내피 성장인자수용체의 억제제이고 아바스틴(Avsatin)이라는 이름으로 상품화되어 임상에서 사용되고 있는 베바시주맵(Bevacizumab)을 무료로 투여 받고 동시에 기존의 표준치료법인 3주 간격의 항암화학요법이 아닌 파클리탁셀(paclitaxel)을 매주 투여하는 용량집중 파클리탁셀(dose-dense paclitaxel) 요법을 적용받고 있다는 것을 뜻한다. 용량집중 요법은 표준 치료보다 11개월 이상의 무병 생존율 (progression free survival, PFS)을 증가시키고 3년 생존율을 7% 증가시켰다고 ‘THE LANCET’ 에 최초 보고된 이후, ‘NCCN(미국 종합 암 네트워크) guideline 2010’ 에서 즉시 표준 치료로 추천되었다. 미국과 유럽에서 이 치료를 다시 검증하는 임상시험이 현재 진행 중인데 강남세브란스에서도 용량집중(dose-dense) 요법이 GOG 임상연구를 통해 진행 중에 있다.


 강남세브란스병원 부인암 진료팀은 2008년부터 미국 GOG (Gynecologic Oncology Group) 임상연구에 적극적으로 참여하고 있으며 현재 부인암 진료팀에서 난소암으로 치료받는 다수의 환자들이 GOG 218/213 연구에 등록되어 있다.


 미국과 유럽에서 용량집중 치료를 다시 검증하는 임상시험이 진행 중인데 강남세브란스에서도 이 요법을 GOG 임상연구를 통해 진행 중에 있다.


강남세브란스 암전문병원 자궁암난소암 클리닉 바로가기


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2012/03/23 17:09 2012/03/23 17:09

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