宫颈癌分析.ppt

CERVICAL CANCER... Diagnosis ＆ Treatment CERVICAL CANCER... The most common malignancy in gynecological oncology Incidence: 7.8/100,000 Mortality: 2.7/100,000 Diagnosis: biopsy Main modality of treatment: surgery and radiation Goal of treatment: cure, except stage 4b Special Case 38 yrs, G3/P1, nurse C/O: postcoital bleeding for 2 months Menstruation regular with 30 days cycle and 5 days duration. Abnormal discharge with bad smell. LMP: 12 days ago Pap smear: squamous cell cancer PV: Vulva : Normal, Vaginal: yellowish discharge with bloody stained, Cervix: growth with ulceration and contact bleeding. Uterus: N/S, mobile. Parametrium: thickening not to pelvic sidewall on both side CERVICAL CANCER….. How can we make a diagnosis? How can we evaluate the patient? How can we manage the patient? How should we explain to the patient? Can we prevent cervical cancer? How can we make a diagnosis? SYMPTOMS Abnormal vaginal bleeding postcoital bleeding* contact bleeding Abnormal vaginal discharge Asymptomatic, just abnormal pap smear SYMPTOMS The classic symptom is intermittent, painless metrorragia or spotting only postcoitally or after douching. Probably the first symptom of early cancer of the cervix is a thin, watery, blood-tinged vaginal discharge that frequently goes unrecognized by the patients. As the maligancy enlarges, the bleeding episodes become heavier and more frequent, and they last longer. SYMPTOMS Late symptom or indicators of more advanced disease include the development of pain referred to the flank or leg. Many patients c/o dysuria, hematuria or rectal bleeding or obstipation resulting from bladder or rectal invasion. Distant metastasis and persistent edema of one or both lower extremities as a result of lymphatic and venous blockage by extensive pelvic wall disease are late manifestation of primary disease and frequent manifestations of recurrent disease. How can we make a diagnosis? SIGNS Vagina: m