子宮內(nèi)膜癌專題知識(shí)corpusuteri子宮體cervix子宮頸StructureofuterusendometriummyometriumSerouslayerPrevalencefourthmostmalignancyinwomen（女性惡性腫瘤中第四位）ranksthirdinthemalignanttumorsoffemalereproductivesystem（女性生殖系統(tǒng)惡性腫瘤中第3位）Epidemiology

55-69years

75%postmenopausal絕經(jīng)后25%pre-menopausal絕經(jīng)前(5%<40years)DaysProliferativephasesecretoryphasemenseovaryendometriumestrogenestrogen/progestroneovulationEffectofestrogen/progesteronefunctionuponendometriumEndometrialHyperplasia

andEndometrialCancerSimplehyperplasia

withnuclearatypia

without~Complexhyperplasiawithnuclearatypia

without~

SimplehyperplasiaComplexhyperplasia

單純?cè)錾^長

復(fù)雜性增生過長

NuclearAtypia(核異型性）Nuclearenlargement核增大Increaseinnuclear/cytoplasmratio核/漿百分比增大Prominentnucleoli核仁明顯Coarseabundantchromatin染色體粗大RiskofHyperplasiato

EndometrialCarcinoma

hyperplasiawithnuclearatypiaisconsideredthepre-malignantdiseasesPathology

DiffuselesionsFocallesionHistologicaltypes

typeIestrogen-dependent

Endometrioidadenocarcinoma

（宮內(nèi)膜樣腺癌）80~90%,G1typeII

estrogen-independent

high-grade

endometrioidcancer,G2/3

papillaryserouscarcinoma

clearcellcarcinoma

Celldifferentiation

（細(xì)胞分化）G1（I級(jí)）:fairlygooddifferentiation分化很好G2（II級(jí)）:moderatedifferentiation中檔分化G3（III級(jí)）:poordifferentiation分化差G1G2G3Withsolidcomponent

≤5%5-50%>50%Serous~Clear-cell~SpreadPatterns

轉(zhuǎn)移方式

Directextension（直接蔓延）Lymphaticspread（淋巴轉(zhuǎn)移）Hematogenousspread（血行播散）Transtubalpassageofexfoliatedcells（脫落細(xì)胞經(jīng)輸卵管轉(zhuǎn)移）DirectextensionCervicalinvolvement宮頸受累Myometriuminvasion肌層浸潤LymphaticspreadingPelviclymphnode,盆腔淋巴結(jié)，PLNPara-aorticlymphnode,腹主動(dòng)脈旁淋巴結(jié)，PANClinicalFindings

Vaginalbleeding（陰道流血）

Esp.postmenopausalbleeding（絕經(jīng)后陰道流血）UterineenlargementDiagnosis1.Fractionaldilationandcurretage（分段診刮）

擴(kuò)張棒刮匙Diagnosis-

Fractionaldilation&currettage12EstablishthediagnosisHelpidentifycervicalinvolvementLimitMisseddiagnosis

Falsepositivecervicalinvolvement

Diagnosis-----Endometrialsampling*Simple,non-traumaticprocedure.*Moldabilitypermitseasyinsertionintoamarkedlyanteverted(前屈)orretroverted(后屈)uterus.*Nocervicaldilationnecessaryinmostcases.*Lessdiscomfort,bleeding,tissueabrasionthanD&Cmethod.NormalendometriumHyperplasiaHyperplasiawithatypiaEndometrialcarcinomaDiagnosis-

endometrialcytologyDiagnosis-

endometrialassessmentsonographicallyNormalendometriumstripe正常子宮內(nèi)膜線>5mmDiagnosis---

hysteroscopyEndometrialCarcinomaSimplehyperplasiaComplexhyperplasiaNormalendometriumAtrophicendometriumNormalendometriumEMCaIaEMCaIbEMCaIIDiagnosis-----MRIDifferentiationDiagnosisCervicalCancer

postcoitalbleedingStaging

ClinicalStaging（臨床分期）pre-treatmentevaluation

Surgicallypathologicalstaging（手術(shù)病理分期）ClinicalStaging

StageCharacteristics________________________________________IIIExtendsoutsidetheuterusbutnotoutsidethetruepelvis,mayinvolveparametriumIVExtendsoutsidethetruepelvisorinvolvesthebladderorrectum________________________________________Surgical-pathologicalstaging

StageCharacteristics_____________________________________IIIATumorinvadesserousand/oradnexes,and/orpositiveperitonealcytologyIIIBVaginalmetastasesIIICMetastasestopelvicand/orparaaorticlymphnodesIVATumorinvasionofbladderand/orrectumIVBDistantmetastases,includingintra-abdominaland/oringuinalnodes______________________________________Treatment

1.operation

Stage

Itotalabdominalhystere