CervicalCancer

宮頸癌發(fā)病癌前病變宮頸癌診治風(fēng)華絕代梅艷芳著名演員李媛媛Incidenceandmortality全世界每年有47萬新患病人，死亡23萬；占女性惡性腫瘤的10%（2002)年輕化：平均年齡52.2歲,年齡分布成雙峰35-39,60-64區(qū)域性：在世界宮頸癌高發(fā)區(qū)哥倫比亞,在中國高發(fā)區(qū):山西內(nèi)蒙陜西湖北湖南江西等X105(人）RiskFactorsInfectionwithHPV(humanpapillomavirus-types16and18)HSV-II,CMVSexually-transmittedagentsEarlyageatfirstintercourseMultiplesexualpartnersSexually-transmitteddiseaseHigh-riskmalepartnerMultiparityOthersSmokingImmunosuppressionLowerincomeTransformationzone鱗柱交接部(SCJ)移行帶（Transformationzone）鱗狀上皮化生（Squamousmetaplasia）

宮頸癌前病變（宮頸上皮內(nèi)瘤樣病變）(CervicalIntraepithelialNeoplasia)CervicaldysplasiaCIS(cervicalcancerinsitu)CIN（宮頸上皮內(nèi)瘤樣病變）宮頸鱗狀上皮正常CIN-ICIN-IICIN-III,CISCervixcancerissuitableforscreeningIt’sacommondisease.Ithasseriousconsequences.Ithasadetectable,asymptomaticphase.Earlydetectionandtreatmentdecreasemorbidityandmortality.Thescreeningtestisacceptabletopatients,safe,andaffordable.ScreeningCytology（Pap、CCT、TCT）ColposcopyBiopsyandhistology3stepsforScreeningPapSmearTCTNormalPapASCUSLSILHSIL巴氏5級(jí)TheBethesdaSystemAtypicalsquamouscellLSILHSILAtypicalglandularcellColposcopy(陰道鏡）CINSchillertest5%aceticacidNormalcervixHSILcancerLSILBiopsyandpathologybiopsyECCIN-ICIN-IICIN-IIICIScancerPathology●宮頸鱗狀細(xì)胞癌(cervicalsquamouscarcinoma)

●宮頸腺癌（cervicaladenocarcinoma):mucousadenocarcinoma，endometrioidadenocarcinoma,clearcelladenocarcinoma，serousadenocarcinoma，mesonephricadenocarcinoma

●腺鱗癌(adenosquamouscarcinoma)

宮頸癌-CervicalCancer臨床分期臨床表現(xiàn)診斷鑒別診斷治療臨床分期

ClinicalStagingIIIIAIIBIIIAIIIBFiveYearSurvivalofCervixCancerbyStageofDiseaseRoutesofSpread

Directinvasionintosurroundingstructuresincludingtheparametria,corpus,andvaginaLymphaticmetastasisfairlyorderlyandpredictable,withinvolvementintheparametrial,pelvic,commoniliac,andpara-aorticnodesBlood-bornemetastasesIntraperitonealimplantation(muchlesscommon)·AsymptomsinearlystageVaginalbleeding(postcoital,intermenstrual)VaginaldischargeInadvancedcases:foulodor,pelvicpain,urinaryfrequency,andurinaryorrectalpain,sciatica,unilaterallegedema,andureteralobstructionAnemia,weightlossSymptomsInspectcervixforsuspiciousarea(StageI)Measuresizeandevaluateconsistencyofcervix(StageI)Inspectvaginaforextensionofdisease(StageIIandIII)Performbimanualexaminationtodetermineparametrial orpelvicextension(StageIIandIII)Examinelegsforswelling/pain(StageIII)Inspectsupraclavicularandinguinalnodalarea(StageIV)PhysicalExamination晚期

癥狀+體征+活檢病理早期

癥狀及體征不明顯，確診需依賴輔助檢查

workupThePapsmearisthebestscreeningtool:CCTTCTSchillerTest colposcopy conformationofdiagnosisrequiresacervicaltissuebiopsy cervicalconizationDiagnosis宮頸原位癌DifferentialdiagnosisCervicalErosion

Cervicalpolyps

CervicalTuberculosisCervicalPapilloma

CervicalEndometriosisCINCINI消炎隨訪CINII物理療法或錐切

CINIII子宮全切或錐切Leep

Microinvasivedisease

Ia1筋膜外全子宮切除

Ia2次廣泛子宮切除Treatement陰道鏡檢組織活檢頸管診刮宮頸病變（CIN）病理診斷陰性CINICINIICINIII重度非典型增生原位癌錐切或全子宮切除LEEP物理治療（冷凍、電凝、激光）定期復(fù)查診斷結(jié)果處理ConizationLEEPLEEP(Loopelectro-excisionprocedure)Invisivecervicalcancer

●手術(shù)適用于Ib~IIa期

子宮根治術(shù)和盆腔淋巴結(jié)清掃術(shù)

●放療適用于各期

手術(shù)+放療

術(shù)前放射：適用于癌灶大

術(shù)后放射：適用于術(shù)后有癌殘留者

●化學(xué)治療術(shù)前術(shù)后

鉑類，泰素，博萊霉素，環(huán)磷酰胺異環(huán)磷酰胺

BIP方案VPB方案TP.IV動(dòng)脈插管

宮頸癌的光動(dòng)力學(xué)療法（photodynamictherapy,PDT)原理：將光敏劑注入人體后被腫瘤組織選擇性攝取或在較長時(shí)間貯留，經(jīng)適當(dāng)波長光作用后產(chǎn)生特征性熒光或高毒性的中間產(chǎn)物，即經(jīng)過氧分子參與的一系列光化學(xué)反應(yīng)和光生物學(xué)反應(yīng)，釋放出一種局部毒性物質(zhì)——單態(tài)氧，它能破壞癌組織中的微血管，造成局部缺血和細(xì)胞死亡，致病變組織壞死脫落。

適應(yīng)癥：病理診斷為微浸癌及原位癌，年輕要求保留生育功能，或老年患者不能耐受手術(shù)，放療或拒絕手術(shù)的患者，及宮頸癌術(shù)后或放療后復(fù)發(fā)者。QuestionsHowtoperformacervicalcancerscreening?WhatwouldyoudoafteraresultofTCTforCIN-IIIina35-year-old