子宫内膜癌专题知识

子宫内膜癌专题知识corpusuteri子宫体cervix子宫颈StructureofuterusendometriummyometriumSerouslayerPrevalencefourthmostmalignancyinwomen（女性恶性肿瘤中第四位）ranksthirdinthemalignanttumorsoffemalereproductivesystem（女性生殖系统恶性肿瘤中第3位）Epidemiology

55-69years

75%postmenopausal绝经后25%pre-menopausal绝经前(5%<40years)DaysProliferativephasesecretoryphasemenseovaryendometriumestrogenestrogen/progestroneovulationEffectofestrogen/progesteronefunctionuponendometriumEndometrialHyperplasia

andEndometrialCancerSimplehyperplasia

withnuclearatypia

without~Complexhyperplasiawithnuclearatypia

without~

SimplehyperplasiaComplexhyperplasia

单纯增生过长

复杂性增生过长

NuclearAtypia(核异型性）Nuclearenlargement核增大Increaseinnuclear/cytoplasmratio核/浆百分比增大Prominentnucleoli核仁明显Coarseabundantchromatin染色体粗大RiskofHyperplasiato

EndometrialCarcinoma

hyperplasiawithnuclearatypiaisconsideredthepre-malignantdiseasesPathology

DiffuselesionsFocallesionHistologicaltypes

typeIestrogen-dependent

Endometrioidadenocarcinoma

（宫内膜样腺癌）80~90%,G1typeII

estrogen-independent

high-grade

endometrioidcancer,G2/3

papillaryserouscarcinoma

clearcellcarcinoma

Celldifferentiation

（细胞分化）G1（I级）:fairlygooddifferentiation分化很好G2（II级）:moderatedifferentiation中档分化G3（III级）:poordifferentiation分化差G1G2G3Withsolidcomponent

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

转移方式

Directextension（直接蔓延）Lymphaticspread（淋巴转移）Hematogenousspread（血行播散）Transtubalpassageofexfoliatedcells（脱落细胞经输卵管转移）DirectextensionCervicalinvolvement宫颈受累Myometriuminvasion肌层浸润LymphaticspreadingPelviclymphnode,盆腔淋巴结，PLNPara-aorticlymphnode,腹主动脉旁淋巴结，PANClinicalFindings

Vaginalbleeding（阴道流血）

Esp.postmenopausalbleeding（绝经后阴道流血）UterineenlargementDiagnosis1.Fractionaldilationandcurretage（分段诊刮）

扩张棒刮匙Diagnosis-

Fractionaldilation&currettage12EstablishthediagnosisHelpidentifycervicalinvolvementLimitMisseddiagnosis

Falsepositivecervicalinvolvement

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

endometrialcytologyDiagnosis-

endometrialassessmentsonographicallyNormalendometriumstripe正常子宫内膜线>5mmDiagnosis---

hysteroscopyEndometrialCarcinomaSimplehyperplasiaComplexhyperplasiaNormalendometriumAtrophicendometriumNormalendometriumEMCaIaEMCaIbEMCaIIDiagnosis-----MRIDifferentiationDiagnosisCervicalCancer

postcoitalbleedingStaging

ClinicalStaging（临床分期）pre-treatmentevaluation

Surgicallypathologicalstaging（手术病理分期）ClinicalStaging

StageCharacteristics________________________________________IIIExtendsoutsidetheuterusbutnotoutsidethetruepelvis,mayinvolveparametriumIVExtendsoutsidethetruepelvisorinvolvesthebladderorrectum________________________________________Surgical-pathologicalstaging

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

1.operation

Stage

Itotalabdominalhystere