妇产科学宫颈癌.pptx

Cervical Cancer宫颈癌发病癌前病变宫颈癌诊治Incidence and mortality全世界每年有47万新患病人，死亡23万；占女性恶性肿瘤的10%（2002)年轻化：平均年龄52.2岁, 年龄分布成双峰35-39, 60-64区域性：在世界宫颈癌高发区哥伦比亚, 在中国高发区: 山西 内蒙 陕西 湖北 湖南 江西等X105 (人）Risk FactorsSexually-transmitted agentsEarly age at first intercourseMultiple sexual partnersSexually-transmitted diseaseHigh-risk male partnerMultiparityInfection with HPV(human papillomavirus-types 16 and 18) HSV-II, CMV OthersSmokingImmunosuppressionLower incomeTransformation zone 鳞柱交接部 (SCJ)移行带（Transformation zone）鳞状上皮化生（Squamous metaplasia） 宫颈癌前病变（宫颈上皮内瘤样病变）(Cervical Intraepithelial Neoplasia)Cervical dysplasiaCIS (cervical cancer in situ)CIN （宫颈上皮内瘤样病变）宫颈鳞状上皮 正常CIN-I CIN-II CIN-III, CISScreeningCervix cancer is suitable for screeningIt’s a common disease.It has serious consequences.It has a detectable, asymptomatic phase.Early detection and treatment decrease morbidity and mortality.The screening test is acceptable to patients, safe, and affordable.3 steps for ScreeningCytology（Pap、CCT、TCT）ColposcopyBiopsy and histologyPap SmearTCTASCUSLSIL巴氏5级The Bethesda SystemAtypical squamous cellLSILHSILAtypical glandular cellHSILNormal PapColposcopy (阴道镜） Normal cervixCIN5% acetic acidSchiller testLSILHSILcancerBiopsy and pathologybiopsyECCIN-ICISCIN-IIcancerCIN-IIIPathology ●宫颈鳞状细胞癌(cervical squamouscarcinoma)●宫颈腺癌（cervical adenocarcinoma):mucous adenocarcinoma，endometrioid adenocarcinoma ,clear cell adenocarcinoma，serous adenocarcinoma，mesonephric adenocarcinoma●腺鳞癌(adenosquamous carcinoma)宫颈癌-Cervical Cancer临床分期临床表现诊断鉴别诊断治疗I临床分期Clinical StagingIIIAIIBIIIAIIIBFive Year Survival of Cervix Cancer by Stage of DiseaseRoutes of SpreadDirect invasion into surrounding structures including the parametria, corpus, and vaginaLymphatic metastasis fairly orderly and predictable, with involvement in the parametrial, pelvic, common iliac, and para-aortic nodesBlood-borne metastasesIntraperitoneal implantation (much less common)Symptoms·Asymptoms in early stageVaginal bleeding(postcoit