宫颈肿瘤治疗PPT课件.pptx

CervicalTumor宫颈肿瘤XinLUObstetricsandGynecologyHospitalFudanUniversity,Contents,CINHPVHistologyPathologyDiagnosisTreatment,CervicalCancerGeneralinformationPathologySpreadpatternFIGOstagingClinicalsignsDiagnosisanddifferentialdiagnosisPrinciplefortreatmentPrevention,Keywords,HumanPapillomavirus(HPV)RadicalHysterectomy(RH)Radiotherapy(RT)Chemotherapy(CT)Neoadjuvantchemotherapy(NACT)Concurrentchemo-radiotherapy(CCCR)RadicalTrachelectomy,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,FemaleReproductiveAnatomy,TransformationZone,CervicalCancer子宫颈癌,Worldreport:Accountfor1/3femalemalignanciesNewcases:529800Death:27510085%developingcountryThe4thmostcommoncauseofdeathfrommalignancyinwomen.,流行病学,新发病例数,死亡病例数,Cervicalcancerprogression,HPVinfectionCINs10-15yrsCarcinomainsituCervicalcancer,Cervicaltumorigenesis,ProgressionHostimmunityEnvironmentalfactorsGenetics:oncogeneE6,E7tumorsuppresorgnenp53,RbRegression,HighRiskFactors,HR-HPVUseoforalcontraceptivesSmokingMultiplesexualpartnersHistoryofherpesinfectionHistoryofSTD,HumanPapillomavirus,HPV人乳头瘤状病毒,1972：HaraldzurHausen1995：High-riskHPVbyInternationalAgencyforResearchonCancer，IARC90%cervicalcancerwithHPVinfection,HPV,HighriskHPV（HR-HPV）oncogenicHPVHPV16,18,31,33,35,39,45,51,52,56,58,59,68,73,82HSIL,Cervicalcancer,LowriskHPV（LR-HPV）non-carcinogenicHPVHPV6,11,42,43,44,54,61,70,72,81LSIL,Precursors,CIN:宫颈上皮内瘤样病变CINI：milddysplasia，1/3CINII：moderatedysplasia，1/3-2/3CINIII：severedysplasiaCIS(carcinomainsitu)原位癌,CIN,HistologicalTypes,Squamouscarcinoma80-85%Adenocaricinoma15-20%EndometrialcarcinomaClearcellcarcinomaAdenosquamous3-5%UndifferentiatedcarcinomaFrom：2003年WHO女性生殖器官肿瘤,Spreadpattern,LocaltumorextensionmostcommonLymphaticpelvicandpara-aorticHematogenousdisseminationuncommon,FIGO,stage,Symptoms,AsymptomaticAbnormalpapsmearWatery,blood-tingedvaginaldischargePost-coitalbleedingPelvicpain,Diagnosis,HistoryPhysicalexaminationCytology(papsmear,TCT,HPV)Biopsy(colposcopy)ConizationImaging,Platformofdiagnosisforcervicaldiseases,PapsmearTBSclassificationTCTHPVColposcopy-biopsyLEEP,Colposcopy阴道镜,Conization宫颈锥切,DifferentialDiagnosis,CervicitisCervicalpolypsBenigncervicaltumor: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,Cervicalpolyps宫颈息肉,Principleforcervicalcancertreatment,EvidencebasedmedicineFIGO(InternationalFederationofGynecologyandObstetrics)NCCN(NationalComprehensiveCancerNetwork)Individualizedtherapy；,TREATMENT,Precursor-CINsMicro-invasivecancerInvasivecancer,CINs,CINI:followup36monthsCINII:localtherapyconizationCINIII:conizationhysterectomy,StageIa1:hysterectomyStageIa2:modifiedhysterectomyStageIawithpositivemargin(IaorCIS):radicalhysterectomy,Micro-invasivecervicalcancer,SurgicaltreatmentIb-IIaRadiotherapyChemotherapyCombinedtherapy,Treatmentforinvasivecervicalcancer,Cervicalcacner（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-surgicaltreatment(highriskfactors),poordifferentiateddeepmyometrialinvasionLVSILNpositivepositivemargin,Advancedstage（b，),Radiotherapy(RT)NACT+RadiotherapyConcurrentchemo-radiotherapy；CombinedRTandCT,Trachelectomy,FertilitysparingIb4cmEvaluationofinfertilityfactorProcedureoftrachelectomyComplicationsOutcome,Primaryprevention1.Healthcare2.Sexualbehavior3.Dualprotection4.HPVvaccines4.Cancerscreening5.Treatprecursors,Prevention,Secondaryprevention1.Earlyscreening2.Earlytreatment,Takehomemessage,HP