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.1 Cervical Tumor Cervical Tumor 宫颈肿瘤宫颈肿瘤 Xin LU Xin LUObstetrics and Gynecology Hospital Obstetrics and Gynecology Hospital Fudan University Fudan University.1 Cervical Tumor 宫颈肿宫颈肿瘤瘤 .2ContentsContentsuuCIN CIN t tHPVHPVt tHistologyHistologyt tPathologyPathologyt tDiagnosisDiagnosist tTreatmentTreatment uuCervical Cancer Cervical Cancer uuGeneral informationGeneral informationuuPathologyPathologyuuSpread pattern Spread pattern uuFIGO staging FIGO staging uuClinical signsClinical signsuuDiagnosis and Diagnosis and differential diagnosis differential diagnosis uuPrinciple for Principle for treatmenttreatmentuuPreventionPrevention.2ContentsCIN Cervical Canc.3Key wordsKey wordsn nHuman Papillomavirus(Human Papillomavirus(HPV)HPV)n nRadical Hysterectomy(RHRadical Hysterectomy(RH)n nRadiotherapy(RT)Radiotherapy(RT)n nChemotherapy(CT)Chemotherapy(CT)n nN Neoadjuvant chemotherapyeoadjuvant chemotherapy (NACT)(NACT)n nConcurrent chemo-radiotherapy Concurrent chemo-radiotherapy (CCCR)(CCCR)n nRadical TrachelectomyRadical Trachelectomy人乳头瘤状病毒人乳头瘤状病毒人乳头瘤状病毒人乳头瘤状病毒广泛全子宫切除术广泛全子宫切除术广泛全子宫切除术广泛全子宫切除术放射治疗放射治疗放射治疗放射治疗化学治疗化学治疗化学治疗化学治疗新辅助化疗新辅助化疗新辅助化疗新辅助化疗同步放化疗同步放化疗同步放化疗同步放化疗宫颈根治术宫颈根治术宫颈根治术宫颈根治术.3Key wordsHuman Papillomaviru.4Female Reproductive AnatomyFemale Reproductive Anatomy.4Female Reproductive Anatomy.5Transformation Zone.5Transformation Zone.6Cervical Cancer Cervical Cancer 子宫颈癌子宫颈癌uuWorld report:World report:t tAccount forAccount for 1/3 1/3 female female malignanciesmalignanciest tNew cases:New cases:529 800529 800t tDeath:Death:275 100275 100t85%developing countryuuThe The 4th4th most common cause of most common cause of death from malignancy in women.death from malignancy in women.6Cervical Cancer 子子宫颈宫颈癌癌World re.7流行病学流行病学新新发病例数病例数死亡病例数死亡病例数.7流行病学新流行病学新发发病例数死亡病例数病例数死亡病例数.8Cervical cancer progressionCervical cancer progression HPV infection HPV infection HPV infection HPV infection CINs CINs CINs CINs 10-15yrs10-15yrs10-15yrs10-15yrs Carcinoma in situ Carcinoma in situ Carcinoma in situ Carcinoma in situ Cervical cancer Cervical cancer Cervical cancer Cervical cancer.8Cervical cancer progression.9Cervical tumorigenesisCervical tumorigenesisn nProgressionuuHost immunityuuEnvironmental factorsuuGenetics:t toncogene E6,E7 tumor suppresor gnen p53,Rbn nRegression.9Cervical tumorigenesisProgre.10High Risk FactorsuuHR-HPVuuUse of oral contraceptivesuuSmoking uuMultiple sexual partnersuuHistory of herpes infection uuHistory of STD.10High Risk FactorsHR-HPV.11Human Papillomavirus,HPVHuman Papillomavirus,HPV 人乳头瘤状病毒人乳头瘤状病毒n1972：Harald zur Hausenn19951995：High-risk HPV by by International Agency for Research on Cancer，IARCn90%cervical cancer with HPV infection.11Human Papillomavirus,HPV.12HPVHPVHigh risk HPV（HR-HPV）oncogenic HPVHPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82HSIL,Cervical cancernLow risk HPV（LR-HPV）nnon-carcinogenic HPV nHPV 6,11,42,43,44,54,61,70,72,81nLSIL.12HPVHigh risk HPV（HR-HPV）.13PrecursorsPrecursorsCIN:CIN:宫颈上皮内瘤样病变宫颈上皮内瘤样病变n nCIN ICIN I：mild dysplasiamild dysplasia，1/31/3n nCIN IICIN II：moderate dysplasiamoderate dysplasia，1/3-2/3 1/3-2/3 n nCIN IIICIN III：severe dysplasia severe dysplasia n nCIS(carcinoma in situ)CIS(carcinoma in situ)原位癌原位癌.13PrecursorsCIN:宫颈宫颈上皮内瘤上皮内瘤样样病病变变.14CINCIN.14CIN.15Histological TypesHistological TypesSquamous carcinoma 80-85%Squamous carcinoma 80-85%Adenocaricinoma 15-20%Adenocaricinoma 15-20%Endometrial carcinomaEndometrial carcinomaClear cell carcinomaClear cell carcinomaAdenosquamous 3-5%Adenosquamous 3-5%Undifferentiated carcinomaUndifferentiated carcinoma From From：20032003年年WHOWHO女性生殖器官肿瘤女性生殖器官肿瘤.15Histological TypesSquamous.16Spread patternSpread patternn nLocal tumor extension Local tumor extension uumost commonmost commonn nLymphatic Lymphatic uupelvic and parapelvic and para-aortic aortic n nHematogenousHematogenous disseminationdisseminationuuuncommonuncommon.16Spread patternLocal tumor e.17FIGOstage.17FIGOstage.18Symptomsn nAsymptomaticn nAbnormal pap smearn nWatery,blood-tinged vaginal dischargen nPost-coital bleedingn nPelvic pain.18SymptomsAsymptomatic.19DiagnosisuuHistoryuuPhysical examinationuuCytology(pap smear,TCT,HPV)uuBiopsy(colposcopy)uuConizationuuImaging.19Diagnosis.20Platform of diagnosis for cervical Platform of diagnosis for cervical diseasesdiseasesvvPap smear TBS classificationPap smear TBS classificationvvTCTTCTvvHPVHPVvvColposcopy-biopsyColposcopy-biopsyvvLEEPLEEP.20Platform of diagnosis for c.21.21Colposcopy 阴道阴道镜镜.22Conization Conization 宫颈锥切宫颈锥切.22Conization 宫颈锥宫颈锥切切.23Differential DiagnosisuuCervicitisuuCervical polypsuuBenign cervical tumor:myoma.23Differential Diagnosis.24宫颈糜烂分度宫颈糜烂分度n n 轻轻 度度n n 中中 度度n n 重重 度度宫颈糜烂分型宫颈糜烂分型 单纯型型 颗粒型粒型 乳突型乳突型.24宫颈宫颈糜糜烂烂分度分度宫颈宫颈糜糜烂烂分型分型.25.25Cervical polyps 宫颈宫颈息肉息肉.26 Principle for cervical cancerPrinciple for cervical cancer treatment treatmentn nEvidence based medicineuuFIGO(International Federation of Gynecology and International Federation of Gynecology and Obstetrics)Obstetrics)uuNCCN(National Comprehensive Cancer Network)National Comprehensive Cancer Network)n nIndividualized therapy；.26 Principle for cervical can.27TREATMENTTREATMENTn nPrecursor-CINsn nMicro-invasive cancern nInvasive cancer .27TREATMENTPrecursor-CINs.28CINsCINsn nCIN I:follow up 3CIN I:follow up 36months6monthsn nCIN II:CIN II:uulocal therapy local therapy uuconizationconizationn nCIN III:CIN III:uuconization conization uuhysterectomyhysterectomy.28CINsCIN I:follow up 36mon.29n nStage Ia1:hysterectomyStage Ia1:hysterectomyn nStage Ia2:modified hysterectomyStage Ia2:modified hysterectomyn nStage Ia with positive margin(Ia Stage Ia with positive margin(Ia or CIS):radical hysterectomyor CIS):radical hysterectomyMicro-invasive cervical cancer.29Stage Ia1:hysterectomyMicr.30n nSurgical treatment Ib-IIaSurgical treatment Ib-IIan nRadiotherapyRadiotherapyn nChemotherapy Chemotherapy n nCombined therapyCombined therapyTreatment for invasive cervical cancer.30Treatment for invasive cerv.31Cervical cacnerCervical cacner（-RH+PLND+/-PADRH+PLND+/-PAD1.1.标准的手术方式：广泛全子宫切除标准的手术方式：广泛全子宫切除标准的手术方式：广泛全子宫切除标准的手术方式：广泛全子宫切除+盆腔淋巴清扫术盆腔淋巴清扫术盆腔淋巴清扫术盆腔淋巴清扫术;2.2.2.2.盆腔淋巴结清扫术盆腔淋巴结清扫术盆腔淋巴结清扫术盆腔淋巴结清扫术 腹股沟深淋巴结腹股沟深淋巴结腹股沟深淋巴结腹股沟深淋巴结 髂淋巴结髂淋巴结髂淋巴结髂淋巴结 闭孔淋巴结闭孔淋巴结闭孔淋巴结闭孔淋巴结3.3.3.3.腹主动脉旁淋巴结取样的指征：腹主动脉旁淋巴结取样的指征：腹主动脉旁淋巴结取样的指征：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可疑的腹主动脉旁及髂总淋巴结可疑的腹主动脉旁及髂总淋巴结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大块附件病灶及增大的盆腔淋巴结大块附件病灶及增大的盆腔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浸润肌层全层的低分化肿瘤浸润肌层全层的低分化肿瘤浸润肌层全层的低分化肿瘤 .31Cervical cacner（b-a)RH+P.32Post-surgical treatmentPost-surgical treatment(high risk factors)(high risk factors)poor differentiated poor differentiateddeep myometrial invasiondeep myometrial invasionLVSILVSILN positiveLN positivepositive marginpositive margin .32Post-surgical treatment(hi.33Advanced stageAdvanced stage（n nRadiotherapy(RT)n nNACT+Radiotherapyn nConcurrent chemo-radiotherapy；n nCombined RT and CT.33Advanced stage（b，)Radi.34TrachelectomyTrachelectomyn nFertility sparing Fertility sparing n nIb 4cmIb 4cmn nEvaluation of infertility factorEvaluation of infertility factorn nProcedure of trachelectomyProcedure of trachelectomyn nComplications Complications n nOutcome 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 messageTake home messagen nHPV(HR)HPV(HR)n nCINsCINsn nFIGO stageFIGO stagen nSurgery:Radical hysterectomy and PLNDSurgery:Radical hysterectomy and PLNDn nPost-operation treatment:high risk factorsPost-operation treatment:high risk factorsn nRT and CTRT and CTn nFertility sparing trachelectomyFertility sparing trachelectomyn nHPV VaccineHPV Vaccine.36Take home message HPV(HR).37OB/GYN Hospital of Fudan University THANKSTHANKS .37OB/GYN Hospital of Fudan Un
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