宫颈肿瘤治疗课件

1、Cervical Tumor Xin LUObstetrics and Gynecology Hospital Fudan University,Contents,CIN HPV Histology Pathology Diagnosis Treatment,Cervical Cancer General information Pathology Spread pattern FIGO staging Clinical signs Diagnosis and differential diagnosis Principle for treatment Prevention,Key words

2、,Human 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,Female Reproductive Anatomy,Transformation Zone,5,学习交流PPT,Cervical Cancer

3、子宫颈癌,World report: Account for 1/3 female malignancies New cases: 529 800 Death: 275 100 85% developing country The 4th most common cause of death from malignancy in women.,流行病学,新发病例数,死亡病例数,7,学习交流PPT,Cervical cancer progression,HPV infection CINs 10-15yrs Carcinoma in situ Cervical cancer,Cervical t

4、umorigenesis,Progression Host immunity Environmental factors Genetics: oncogene E6, E7 tumor suppresor gnen p53, Rb Regression,High Risk Factors,HR-HPV Use of oral contraceptives Smoking Multiple sexual partners History of herpes infection History of STD,Human Papillomavirus , HPV 人乳头瘤状病毒,1972： Hara

5、ld zur Hausen 1995： High-risk HPV by International Agency for Research on Cancer，IARC 90% cervical cancer with HPV infection,HPV,High risk HPV（HR-HPV） oncogenic HPV HPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82 HSIL, Cervical cancer,Low risk HPV（LR-HPV） non-carcinogenic HPV HPV 6,11,42,43,44,54,6

6、1,70,72,81 LSIL,Precursors,CIN: 宫颈上皮内瘤样病变 CIN I：mild dysplasia，1/3 CIN II：moderate dysplasia，1/3-2/3 CIN III：severe dysplasia CIS(carcinoma in situ) 原位癌,CIN,Histological Types,Squamous carcinoma 80-85% Adenocaricinoma 15-20% Endometrial carcinoma Clear cell carcinoma Adenosquamous 3-5% Undifferentia

7、ted carcinoma From：2003年WHO女性生殖器官肿瘤 ,Spread pattern,Local tumor extension most common Lymphatic pelvic and para-aortic Hematogenous dissemination uncommon,FIGO,stage,17,学习交流PPT,Symptoms,Asymptomatic Abnormal pap smear Watery, blood-tinged vaginal discharge Post-coital bleeding Pelvic pain,Diagnosis,

8、History Physical examination Cytology (pap smear, TCT, HPV) Biopsy (colposcopy) Conization Imaging,Platform of diagnosis for cervical diseases,Pap smear TBS classification TCT HPV Colposcopy-biopsy LEEP,Colposcopy 阴道镜,Conization 宫颈锥切,Differential Diagnosis,Cervicitis Cervical polyps Benign cervical

9、tumor:myoma,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,Cervical polyps 宫颈息肉,Principle for cervical cancer treatment,Evidence based medicine FIGO ( International Federation of Gynecology and Obstetrics) NCCN (National Comprehensive Cancer Network) Individualized therapy；,TREATMENT,Precursor- CINs Micro-in

10、vasive cancer Invasive cancer,CINs,CIN I: follow up 36months CIN II: local therapy conization CIN III: conization hysterectomy,Stage Ia1: hysterectomy Stage Ia2: modified hysterectomy Stage Ia with positive margin (Ia or CIS): radical hysterectomy,Micro-invasive cervical cancer,Surgical treatment Ib

11、-IIa Radiotherapy Chemotherapy Combined therapy,Treatment for invasive cervical cancer,Cervical cacner（b-a)RH+PLND+/- PAD,1. 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化肿瘤,Post-surgical treatment(high risk factors),poor differentia

12、ted deep myometrial invasion LVSI LN positive positive margin,Advanced stage（b，),Radiotherapy (RT) NACT + Radiotherapy Concurrent chemo-radiotherapy； Combined RT and CT,Trachelectomy,Fertility sparing Ib 4cm Evaluation of infertility factor Procedure of trachelectomy Complications Outcome,Primary prevention 1. Health care 2. Sexual behavior 3. Dual protection 4. HPV vaccines 4. Cancer screening 5. Treat precursors,Prevention,Secondary prevention 1.Early screening 2. Early treatment,35,学习交流PPT,Take home message,HPV (HR) CINs F