宫颈肿瘤治疗ppt演示课件

.,1,Cervical Tumor 宫颈肿瘤 Xin LUObstetrics and Gynecology Hospital Fudan University,.,2,Contents,CIN HPVHistologyPathologyDiagnosisTreatment,Cervical Cancer General informationPathologySpread pattern FIGO staging Clinical signsDiagnosis and differential diagnosis Principle for treatmentPrevention,.,3,Key words,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,.,4,Female Reproductive Anatomy,.,5,Transformation Zone,.,6,Cervical Cancer 子宫颈癌,World report: Account for 1/3 female malignanciesNew cases: 529 800Death: 275 10085% developing countryThe 4th most common cause of death from malignancy in women.,.,7,流行病学,新发病例数,死亡病例数,.,8,Cervical cancer progression,HPV infection CINs 10-15yrs Carcinoma in situ Cervical cancer,.,9,Cervical tumorigenesis,ProgressionHost immunityEnvironmental factorsGenetics: oncogene E6, E7 tumor suppresor gnen p53, RbRegression,.,10,High Risk Factors,HR-HPVUse of oral contraceptivesSmoking Multiple sexual partnersHistory of herpes infection History of STD,.,11,Human Papillomavirus , HPV 人乳头瘤状病毒,1972： Harald zur Hausen1995： High-risk HPV by International Agency for Research on Cancer，IARC90% cervical cancer with HPV infection,.,12,HPV,High risk HPV（HR-HPV）oncogenic HPVHPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82HSIL, Cervical cancer,Low risk HPV（LR-HPV）non-carcinogenic HPV HPV 6,11,42,43,44,54,61,70,72,81LSIL,.,13,Precursors,CIN: 宫颈上皮内瘤样病变CIN I：mild dysplasia，1/3CIN II：moderate dysplasia，1/3-2/3 CIN III：severe dysplasia CIS(carcinoma in situ) 原位癌,.,14,CIN,.,15,Histological Types,Squamous carcinoma 80-85%Adenocaricinoma 15-20%Endometrial carcinomaClear cell carcinomaAdenosquamous 3-5%Undifferentiated carcinoma From：2003年WHO女性生殖器官肿瘤,.,16,Spread pattern,Local tumor extension most commonLymphatic pelvic and para-aortic Hematogenous disseminationuncommon,.,17,FIGO,stage,.,18,Symptoms,AsymptomaticAbnormal pap smearWatery, blood-tinged vaginal dischargePost-coital bleedingPelvic pain,.,19,Diagnosis,HistoryPhysical examinationCytology (pap smear, TCT, HPV)Biopsy (colposcopy)ConizationImaging,.,20,Platform of diagnosis for cervical diseases,Pap smear TBS classificationTCTHPVColposcopy-biopsyLEEP,.,21,Colposcopy 阴道镜,.,22,Conization 宫颈锥切,.,23,Differential Diagnosis,CervicitisCervical polypsBenign cervical tumor:myoma,.,24,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,.,25,Cervical polyps 宫颈息肉,.,26,Principle for cervical cancer treatment,Evidence based medicineFIGO ( International Federation of Gynecology and Obstetrics) NCCN (National Comprehensive Cancer Network)Individualized therapy；,.,27,TREATMENT,Precursor- CINsMicro-invasive cancerInvasive cancer,.,28,CINs,CIN I: follow up 36monthsCIN II: local therapy conizationCIN III: conization hysterectomy,.,29,Stage Ia1: hysterectomyStage Ia2: modified hysterectomyStage Ia with positive margin (Ia or CIS): radical hysterectomy,Micro-invasive cervical cancer,.,30,Surgical treatment Ib-IIaRadiotherapyChemotherapy Combined therapy,Treatment for invasive cervical cancer,.,31,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,.,32,Post-surgical treatment(high risk factors),poor differentiateddeep myometrial invasionLVSILN positivepositive margin,.,33,Advanced stage（b，),Radiotherapy (RT)NACT + RadiotherapyConcurrent chemo-radiotherapy；Combined RT and CT,.,34,Trachelectomy,Fertility sparing Ib 4cmEvaluation of infertility factorProcedure of trachelectomyComplications Outcome,.,35,Primary prevention1. Health care2. Sexual behavior 3. Dual protection4. HPV vaccines4. Cancer screening5. Treat precursors,Prevention,Secondary prevention1.Early screening2. Early treatment,.,36,Take home message,