宫颈肿瘤治疗.ppt

Cervical Tumor 宫颈肿瘤   Xin LUObstetrics and Gynecology Hospital  Fudan University Contents CIN HPV Histology Pathology Diagnosis Treatment Cervical Cancer General information Pathology Spread pattern FIGO staging Clinical signs Diagnosis and differential diagnosis Principle for treatment Prevention 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 Female Reproductive Anatomy Transformation Zone Cervical Cancer 子宫颈癌 World report: Account for 1/3 female malignancies New cases: 529 800 Death: 275 100 85% developing country The 4th most common cause of death from malignancy in women. 流行病学 新发病例数 死亡病例数 Cervical cancer progression HPV infection CINs 10-15yrs Carcinoma in situ Cervical cancer Cervical tumorigenesis Progression Host immunity Environmental factors Genetics: oncogene E6, E7 tumor suppresor gnen p53, Rb Regression High Risk Factors HR-HPV Use of oral contraceptives Smoking Multiple sexual partners History of herpes infection History of STD Human Papillomavirus , HPV 人乳头瘤状病毒 1972： Harald zur Hausen 1995： High-risk HPV by International Agency for Research on Cancer，IARC 90% cervical cancer with HPV infection HPV High risk HPV（HR-HPV） oncogenic HPV HPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82 HSIL, Cervical cancer Low risk HPV（LR-HPV） non-carcinogenic HPV HPV 6,11,42,43,44,54,61,70,72,81 LSIL Precursors CIN: 宫颈上皮内瘤样病变 CIN I：mild dysplasia，1/3 CIN II：moderate dysplasia，1/3-2/3 CIN III：severe dysplasia CIS(carcinoma in situ) 原位癌 CIN Histological Types Squamous carcinoma 80-85% Adenocaricinoma 15-20% Endometrial carcinoma Clear c