宫颈肿瘤治疗优秀课件.pptx

CervicalTumor宫颈肿瘤XinLUObstetricsandGynecologyHospitalFudanUniversity 1 医药交流课件 Contents CINHPVHistologyPathologyDiagnosisTreatment CervicalCancerGeneralinformationPathologySpreadpatternFIGOstagingClinicalsignsDiagnosisanddifferentialdiagnosisPrinciplefortreatmentPrevention 2 医药交流课件 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 3 医药交流课件 FemaleReproductiveAnatomy 4 医药交流课件 TransformationZone 5 医药交流课件 CervicalCancer子宫颈癌 Worldreport Accountfor1 3femalemalignanciesNewcases 529800Death 27510085 developingcountryThe4thmostcommoncauseofdeathfrommalignancyinwomen 6 医药交流课件 流行病学 新发病例数 死亡病例数 7 医药交流课件 Cervicalcancerprogression HPVinfectionCINs10 15yrsCarcinomainsituCervicalcancer 8 医药交流课件 Cervicaltumorigenesis ProgressionHostimmunityEnvironmentalfactorsGenetics oncogeneE6 E7tumorsuppresorgnenp53 RbRegression 9 医药交流课件 HighRiskFactors HR HPVUseoforalcontraceptivesSmokingMultiplesexualpartnersHistoryofherpesinfectionHistoryofSTD 10 医药交流课件 HumanPapillomavirus HPV人乳头瘤状病毒 1972 HaraldzurHausen1995 High riskHPVbyInternationalAgencyforResearchonCancer IARC90 cervicalcancerwithHPVinfection 11 医药交流课件 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 12 医药交流课件 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 13 医药交流课件 CIN 14 医药交流课件 HistologicalTypes Squamouscarcinoma80 85 Adenocaricinoma15 20 EndometrialcarcinomaClearcellcarcinomaAdenosquamous3 5 UndifferentiatedcarcinomaFrom 2003年WHO女性生殖器官肿瘤 15 医药交流课件 Spreadpattern LocaltumorextensionmostcommonLymphaticpelvicandpara aorticHematogenousdisseminationuncommon 16 医药交流课件 FIGO stage 17 医药交流课件 Symptoms AsymptomaticAbnormalpapsmearWatery blood tingedvaginaldischargePost coitalbleedingPelvicpain 18 医药交流课件 Diagnosis HistoryPhysicalexaminationCytology papsmear TCT HPV Biopsy colposcopy ConizationImaging 19 医药交流课件 Platformofdiagnosisforcervicaldiseases PapsmearTBSclassificationTCTHPVColposcopy biopsyLEEP 20 医药交流课件 Colposcopy阴道镜 21 医药交流课件 Conization宫颈锥切 22 医药交流课件 DifferentialDiagnosis CervicitisCervicalpolypsBenigncervicaltumor myoma 23 医药交流课件 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 24 医药交流课件 Cervicalpolyps宫颈息肉 25 医药交流课件 Principleforcervicalcancertreatment EvidencebasedmedicineFIGO InternationalFederationofGynecologyandObstetrics NCCN NationalComprehensiveCancerNetwork Individualizedtherapy 26 医药交流课件 TREATMENT Precursor CINsMicro invasivecancerInvasivecancer 27 医药交流课件 CINs CINI followup3 6monthsCINII localtherapyconizationCINIII conizationhysterectomy 28 医药交流课件 StageIa1 hysterectomyStageIa2 modifiedhysterectomyStageIawithpositivemargin IaorCIS radicalhysterectomy Micro invasivecervicalcancer 29 医药交流课件 SurgicaltreatmentIb IIaRadiotherapyChemotherapyCombinedtherapy Treatmentforinvasivecervicalcancer 30 医药交流课件 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 31 医药交流课件 Post surgicaltreatment highriskfactors poordifferentiateddeepmyometrialinvasionLVSILNpositivepositivemargin 32 医药交流课件 Advancedstage b Radiotherapy RT NACT RadiotherapyConcurrentchemo radiotherapy CombinedRTandCT 33 医药交流课件 Trachelectomy FertilitysparingIb 4cmEvaluationofinfertilityfactorProcedureoftrachelectomyComplicationsOutcome 34 医药交流课件 Primaryprevention1 Healthcare2 Sexualbehavior3 Dualprotection4 HPVvaccines4 Cancerscreening5 Treatprecursors Prevention Secondaryprevention1 Earlyscreening2 Earlytreatment 35 医药交流课件 Takehomemessage HPV