子宫内膜癌英语课件

EndometrialCarcinoma

1子宫内膜癌英语课件5/8/2024GeneralDescriptionEndometrialCarcinomaisoneofthemostcommonmalignancyoffemalegenitaltract.Theincidenceisincreasingworldwideinrecentyears.Overall,2%-3%ofwomendeveloputerinecancerduringtheirlifetime.2子宫内膜癌英语课件5/8/2024GeneralDescriptionAmalignantepithelialdiseasethatoccursinendometrialglandofuterusAlsocalledendometrialcancer3子宫内膜癌英语课件5/8/2024Classification

(pathogenetic,biologicbehavior)Estrogendependenttypehaveahistoryofexposuretounopposedestrogen(eitherendogenousorexogenous).HyperplasticendometriumBetterdifferentiafedER(+),PR(+)Merefavorableprognesis4子宫内膜癌英语课件5/8/2024

Estrogenindependenttype--Havenosourceofestrogenstimulationofendometrium.--Arisinginbackgroundofatrophicendemetrium--Lessdifferentiated--ER(-)PR(-)--Poorprognosis5子宫内膜癌英语课件5/8/2024

RiskFactors1.Medicalconditionsa.Diabetesmellitus,hypertension.b.Overweight---obesity(excessestrogenasaresultofperipheralconversionofadrenallyderivedandrostenedionebyaromatizationinfat).c.Latemenopause.6子宫内膜癌英语课件5/8/2024RiskFactors2.Somegynecologicdiseases(Long-termendogenousestrogenexposure)-polycysticovarysyndrome-functioningovariantumors-anovulatingdysfunctionalbleeding-Infertility,Nulliparity.7子宫内膜癌英语课件5/8/2024RiskFactors3.ProlongedUseofestrogena.Prolongedmenopausalestrogenreplacementtherapywithoutprogestogen.b.Prolongeduseoftheantiestrogentamoxifenforbreastcancer.8子宫内膜癌英语课件5/8/2024RiskFactors4.Geneticfactorsandotherfactorsa.Endometrialandovariancancerarethesimultaneouslyoccurringwithothergenitalmalignancy,reportedincidence(1.4~3.8%).b.Familyhistoryoftumorishigher.(12-28%)

9子宫内膜癌英语课件5/8/2024FivehistologicalsubtypesEndometrioidadenocarcinomaMucinouscarcinomaSerousadenocarcinomaClearcellcarcinomaCarcinosarcoma10子宫内膜癌英语课件5/8/2024Fivehistologicalsubtypes

--EndometrioidAdenocarcinomaAccountforabout80~90%.Welldifferentiated.Prognosisisbetter.11子宫内膜癌英语课件5/8/2024Fivehistologicalsubtypes

--MucinouscarcinomaRare(about5%)a.Mostofthemisawelldifferentiated.b.Behaviorissimilartothatofcommonendometrialcarcinoma.12子宫内膜癌英语课件5/8/2024

Fivehistologicalsubtypes

--Serousadenocarcinoma

a.Architectureisidenticalwithcomplexpapillary.b.Moreaggressivelywithdeepmyometrialandlymphaticinvasion.c.Simulatingthebehaviorofovariancarcinoma.13子宫内膜癌英语课件5/8/2024Fivehistologicalsubtypes

--Clearcellcarcinomaa.Araresubtypeb.Ishighgradeandaggressivec.Prognosisissimilartoorworsethanthatofpapillaryserouscarcinomad.Survivalrateislower33%~64%14子宫内膜癌英语课件5/8/2024Fivehistologicalsubtypes

--Carcinosarcoma（MMMT）

Rare(about5%)Mostofthemisawelldifferentiated.15子宫内膜癌英语课件5/8/2024MetastasisRouteofthedisease

DirectextensionLymphaticmetastasis:importantrouteHematogenousmetastasis16子宫内膜癌英语课件5/8/2024channelsoftransfer转移途径1、Directlytothecervixandfromfallopiantubetoovary.直接蔓延UpwardalongtheuterineAngle→fallopiantubeDownward→cervicalcanalandvaginaPenetratemusclewall→sarcomuscularlayer→pelvicabdomenMembrane,uterusrectumfossaandgreateromentum17子宫内膜癌英语课件5/8/20242.

Viathelymphaticstopelvicandpara-aorticlymphnodesCervicalanddeepmuscularisinvolvementorpoordifferentiationispronetometastasis,metastasisrules:Uterinefunduscarcinoma→ovary→abdominalpara-aorticlymphnode;Uterinecornercarcinoma→inguinallymphnode;Loweruterinesegmentorcervicalcancerinvolvement:metastasisisthesameascervicalcancer.18子宫内膜癌英语课件5/8/20243．Spreadtothelung,liverandotherorgansbyblood.

Rare,late肺胸腔骨原发灶19子宫内膜癌英语课件5/8/2024Surgicalpathologicstaging

(FIGO1988)StageIIa*TumourlimitedtotheendometriumIb*InvasiontolessthanhalfofthemyometriumIc*InvasionequaltoormorethanhalfofthemyometriumStageIIIIa*EndocervicalglandularinvolvementonlyIIb*Cervicalstromalinvasion20子宫内膜癌英语课件5/8/2024Surgicalpathologicstaging

(FIGO2000)StageIII

IIIa*Tumourinvadestheserosaofthecorpusuteriand/oradnexaeand/orpositivecytologicalfindingsIIIb*VaginalmetastasesIIIc*Metastasestopelvicand/orpara-aorticlymphnodesStageIVIVa*Tumourinvasionofbladderand/orbowelmucosaIVb*Distantmetastases,includingintra-abdominalmetastasisand/oringuinallymphnodes21子宫内膜癌英语课件5/8/2024StageIa*

Tumorlimitedtotheendometrium

StageIb*

Invasiontolessthanhalfofthemyometrium

StageIc*

Invasionequaltoormorethanhalfofthemyometrium22子宫内膜癌英语课件5/8/2024StageIIa*

Endocervicalglandularinvolvementonly

StageIIb*

Cervicalstromalinvasion

23子宫内膜癌英语课件5/8/2024StageIIIa*

Tumorinvadestheserosaofthecorpusuteriand/oradnexaeand/orpositivecytologicalfindings

StageIIIb*

Vaginalmetastases

StageIIIc*

Metastasestopelvicand/orpara-aorticlymphnodes24子宫内膜癌英语课件5/8/2024StageIVa*

Tumorinvasionofbladderand/orbowelmucosa

StageIVb*

Distantmetastases,includingintra-abdominalmetastasisand/oringuinallymphnodes

25子宫内膜癌英语课件5/8/2024ClinicalFeatures--SymptomsAsymptomaic(aboutlessthan5%)Abnormalvaginalbleeding(premenopausalorpostmenopausal,minimalornonpersistant)Abnormalvaginaldischarge(25%infectionofuterinecontents)Pelvicpressureordiscomfort(uterineenlargementorextrauterinediseasespread)26子宫内膜癌英语课件5/8/2024ClinicalFeatures--SignsNoevidenceinearlystageonphysicalexaminationSlightenlargementofuterinesizeandsoftUterusfixed,immobile,adenexalmessinadvancedstage27子宫内膜癌英语课件5/8/2024UltrasonographyUsefuladjuvantmethodSignificancesSizeoflesionInvasionofendometriumorcervixResistantindexofnewvesselsAuxiliarydiagnosis28子宫内膜癌英语课件5/8/2024Endometrialcarcinomaina58-year-oldwomanwithsubstantialpostmenopausalbleeding.(A)SagittaltransvaginalUSscanshowstheendometriumwithathicknessof44mmandalargeareaofmixedechogenicitysuggestiveofamass.(B)Transversesonohysterogramshowsa50-mm-diameterpolypoidmassprotrudingintotheendometrialcavity(calipersindicatethestalkofthemass).Histopathologicfindingsindicatedpoorlydifferentiatedendometrialcarcinoma.

AB29子宫内膜癌英语课件5/8/2024AuxiliarydiagnosisMRI,CTandPETCT:showedthepenetrationdepth,abdominalorganmetastasis,Retroperitoneallymphnodemetastasis.MRI:accuratedisplayoflesionscope,myometricalinvasiondepthandpelviclymphnodemetastasiswasfavorableforpreoperativestagingofendometrialcancer.PET:allofthemshowedaggregationlesionsof18f-fdg,whichwasconducivetothedetectionoflesions.However,thepreoperativestagingofendometrialcancerwaspoorlydiagnosed.

30子宫内膜癌英语课件5/8/2024IA期子宫内膜癌，子宫内膜不规则增厚，局部形成菜花样肿块，肌层未见受累子宫内膜癌MRI影像31子宫内膜癌英语课件5/8/2024II期子宫内膜癌侵及宫颈间质

子宫内膜癌MRI影像32子宫内膜癌英语课件5/8/2024SpecialExaminationDilationandfractionalcurettage(D.C)Mosteffective,definitiveprocedureandcommonlyusedSignificance-Establishedcorrectdiagnosis,clinicalstage-differentiatedfromcervicalcancerorcervicalinvolvement33子宫内膜癌英语课件5/8/2024(2)分段诊刮术fractionalcurettage:是确诊宫内膜癌最常见最可靠的方法FirstSecond注意：1、先刮宫颈管再刮宫腔

2、刮出物分瓶送检34子宫内膜癌英语课件5/8/2024HysteroscopySignificance-Directobservation-Takingsamplecorrectly-Identifyingpolypsandsubmucousmyoma35子宫内膜癌英语课件5/8/2024（3）其它：宫腔镜检查，细胞学检查,CA125等Hysteroscopy,performedonanoutpatientendometrialbiopsy36子宫内膜癌英语课件5/8/2024Paptest-Unreliablediagnostictest-30%-50%abnormalpaptestresultsOthers-MRI,CT,chestx-ray,IVurography,cystoscopy,sigmoidoscopy,

37子宫内膜癌英语课件5/8/2024DiagnosisHistory,andclinicalsign,relatedriskfactorssymptomsDiagnosticmethods38子宫内膜癌英语课件5/8/2024DifferentialDiagnosisSenileendometritis/vaginitisDysfunctionaluterinebleedingSubmucousmyoma/EndometrialpolypsCervixcancer/Sarcomaofuterus/Primarycarcinomaoffallopiantube39子宫内膜癌英语课件5/8/2024TreatmentSurgeryRadiationChemotherapyHormonetherapyEarlystage---surge+postoperativeadjuvanttherapyAdvancedstage---radiation+surge+medicine40子宫内膜癌英语课件5/8/2024PrincipleofchoiceGeneralcondition(Age,complication)ClinicalstageTumourpathologictype41子宫内膜癌英语课件5/8/2024SurgeryObjectOperativepathologicstage,findingprognosisriskfactorsRemoveuterusandmetastasistumourStageI:Radicalendometrialcarcinoma.mp4Abdorminalhysterectomy+bilateralsalpingoophorectomy+selectivelymphadenectomyclearcellorpapillarycarcinoma–omentectomy+appenditectomy42子宫内膜癌英语课件5/8/2024StageIIRadicalhysterectomy+pelviclymphadenectomy+paraorticlymphadenectomyStageIII,IVCytoreductivesurgery43子宫内膜癌英语课件5/8/2024IndicationsofpelviclymphadenectomySpecialpathogeneticpatternEndometrialcancer,grade3ornodifferentiationMyo-invasionmorethan½Sizeoflesionmorethan50%ofuterinecavityInvolvementinisthmusofuterus44子宫内膜癌英语课件5/8/2024RadiationtherapyRadiationaloneRadiationwithsurgery45子宫内膜癌英语课件5/8/2024Radiationcombinedsurgery

--RadiationaftersurgeryAdenexal/serosal/parametrialspreadVaginalmetastasisLymphnodemetastasisIntraperitonealspreadBladder/rectalinvasionMyoinvasion>50%G3<50%myoinvasion46子宫内膜癌英语课件5/8/2024IndicationsforradiationaloneElderlyorobesityMultiplechronicoracutemedicalillness(hypertension,cardialdisease,diabetes,pulmonary,renal)Advancedstageunsuitableforsurgery47子宫内膜癌英语课件5/8/2024HormoneTherapymechenismMostendometrialcancershavebothER&PR.(Estrogendependentsubtype)Indications:AdvancedorrecurrentstageEarlystageanddesireforfertilityUseddrugsMPA48子宫内膜癌英语课件5/8/2024