医学课件-宫颈肿瘤治疗教学课件

1、.1 Cervical Tumor 宫颈肿瘤 Xin LUObstetrics and Gynecology Hospital Fudan University.1 Cervical Tumor 宫颈肿瘤 .2ContentsCIN HPVHistologyPathologyDiagnosisTreatment Cervical Cancer General informationPathologySpread pattern FIGO staging Clinical signsDiagnosis and differential diagnosis Principle for treatm

2、entPrevention.2ContentsCIN Cervical Canc.3Key wordsHuman Papillomavirus (HPV)Radical Hysterectomy (RH)Radiotherapy (RT)Chemotherapy (CT)Neoadjuvant chemotherapy (NACT) Concurrent chemo-radiotherapy (CCCR)Radical Trachelectomy人乳头瘤状病毒广泛全子宫切除术放射治疗化学治疗新辅助化疗同步放化疗宫颈根治术.3Key wordsHuman Papillomaviru.4Femal

3、e Reproductive Anatomy.4Female Reproductive Anatomy.5Transformation Zone.5Transformation Zone.6Cervical Cancer 子宫颈癌World report: Account for 1/3 female malignanciesNew cases: 529 800Death: 275 10085% developing countryThe 4th most common cause of death from malignancy in women.6Cervical Cancer 子宫颈癌W

4、orld re.7流行病学新发病例数死亡病例数.7流行病学新发病例数死亡病例数.8Cervical cancer progression HPV infection CINs 10-15yrs Carcinoma in situ Cervical cancer.8Cervical cancer progression.9Cervical tumorigenesisProgressionHost immunityEnvironmental factorsGenetics: oncogene E6, E7 tumor suppresor gnen p53, RbRegression.9Cervic

5、al tumorigenesisProgre.10High Risk FactorsHR-HPVUse of oral contraceptivesSmoking Multiple sexual partnersHistory of herpes infection History of STD.10High Risk FactorsHR-HPV.11Human Papillomavirus , HPV 人乳头瘤状病毒1972： Harald zur Hausen1995： High-risk HPV by International Agency for Research on Cancer

6、，IARC90% cervical cancer with HPV infection.11Human Papillomavirus , HPV.12HPVHigh risk HPV（HR-HPV）oncogenic HPVHPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82HSIL, Cervical cancerLow risk HPV（LR-HPV）non-carcinogenic HPV HPV 6,11,42,43,44,54,61,70,72,81LSIL.12HPVHigh risk HPV（HR-HPV）.13PrecursorsCI

7、N: 宫颈上皮内瘤样病变CIN I：mild dysplasia，1/3CIN II：moderate dysplasia，1/3-2/3 CIN III：severe dysplasia CIS(carcinoma in situ) 原位癌.13PrecursorsCIN: 宫颈上皮内瘤样病变.14CIN.14CIN.15Histological TypesSquamous carcinoma 80-85%Adenocaricinoma 15-20%Endometrial carcinomaClear cell carcinomaAdenosquamous 3-5%Undifferentia

8、ted carcinoma From：2003年WHO女性生殖器官肿瘤.15Histological TypesSquamous .16Spread patternLocal tumor extension most commonLymphatic pelvic and para-aortic Hematogenous disseminationuncommon.16Spread patternLocal tumor e.17FIGOstage.17FIGOstage.18SymptomsAsymptomaticAbnormal pap smearWatery, blood-tinged va

9、ginal dischargePost-coital bleedingPelvic pain.18SymptomsAsymptomatic.19DiagnosisHistoryPhysical examinationCytology (pap smear, TCT, HPV)Biopsy (colposcopy)ConizationImaging.19Diagnosis.20Platform of diagnosis for cervical diseasesPap smear TBS classificationTCTHPVColposcopy-biopsyLEEP.20Platform o

10、f diagnosis for c.21Colposcopy 阴道镜.21Colposcopy 阴道镜.22Conization 宫颈锥切.22Conization 宫颈锥切.23Differential DiagnosisCervicitisCervical polypsBenign cervical tumor:myoma.23Differential Diagnosis.24宫颈糜烂分度 轻 度 中 度 重 度宫颈糜烂分型 单纯型 颗粒型 乳突型.24宫颈糜烂分度宫颈糜烂分型.25Cervical polyps 宫颈息肉 .25Cervical polyps 宫颈息肉 .26 Princ

11、iple for cervical cancer treatmentEvidence based medicineFIGO ( International Federation of Gynecology and Obstetrics) NCCN (National Comprehensive Cancer Network)Individualized therapy；.26 Principle for cervical can.27TREATMENTPrecursor- CINsMicro-invasive cancerInvasive cancer .27TREATMENTPrecurso

12、r- CINs.28CINsCIN I: follow up 36monthsCIN II: local therapy conizationCIN III: conization hysterectomy.28CINsCIN I: follow up 36mon.29Stage Ia1: hysterectomyStage Ia2: modified hysterectomyStage Ia with positive margin (Ia or CIS): radical hysterectomyMicro-invasive cervical cancer.29Stage Ia1: hys

13、terectomyMicr.30Surgical treatment Ib-IIaRadiotherapyChemotherapy Combined therapyTreatment for invasive cervical cancer.30Treatment for invasive cerv.31Cervical cacner（b-a)RH+PLND+/- PAD1. 标准的手术方式：广泛全子宫切除+盆腔淋巴清扫术;2.盆腔淋巴结清扫术 腹股沟深淋巴结 髂淋巴结 闭孔淋巴结3.腹主动脉旁淋巴结取样的指征： 可疑的腹主动脉旁及髂总淋巴结 大块附件病灶及增大的盆腔淋巴结 浸润肌层全层的低分

14、化肿瘤 .31Cervical cacner（b-a)RH+P.32Post-surgical treatment(high risk factors) poor differentiateddeep myometrial invasionLVSILN positivepositive margin .32Post-surgical treatment(hi.33Advanced stage（b，)Radiotherapy (RT)NACT + RadiotherapyConcurrent chemo-radiotherapy；Combined RT and CT.33Advanced sta

15、ge（b，)Radi.34TrachelectomyFertility sparing Ib 4cmEvaluation of infertility factorProcedure of trachelectomyComplications Outcome .34TrachelectomyFertility spar.35Primary prevention1. Health care2. Sexual behavior 3. Dual protection4. HPV vaccines4. Cancer screening5. Treat precursors PreventionSecondary prevention1.Early screening2. Early treatment.35Primary prevention Prevent.36Take home message HPV (HR)CINsFIGO