《妇产科学》课件：第11章第1节流产.ppt

* Surgical staging replaced clinical staging in 1989 and has since proved more reliable, more accurate for prognosis and more useful for defining the need for adjuvant therapy than clinical staging. This is primarily because surgical staging more accurately defines the extent of a patient’s disease with respect to metastases, depth of invasion, cervical involvement, etc. * Clinical Stage I disease will be upstaged 30% of the time at laparotomy 5% for positive adnexa (Surgical Stage IIIa) 6% for positive para-aortic lymph nodes (Surgical Stage IIIc) 9% for positive pelvic nodes (Surgical Stage IIIc) 12% for positive cytology on pelvic washings (Surgical Stage IIIa) 6% other (eg. cervical or abdominal disease) Clinical Stage II or III will be upstaged 60% of the time at laparotomy * Clinical Stage I disease will be upstaged 30% of the time at laparotomy 5% for positive adnexa (Surgical Stage IIIa) 6% for positive para-aortic lymph nodes (Surgical Stage IIIc) 9% for positive pelvic nodes (Surgical Stage IIIc) 12% for positive cytology on pelvic washings (Surgical Stage IIIa) 6% other (eg. cervical or abdominal disease) Clinical Stage II or III will be upstaged 60% of the time at laparotomy * More than 95% of patients with Em cancer will report symptoms. Most commonly PMB, or in premenapausal women changes related to the quantity or duration of flow or to intermentrual bleeding. Endometrial biopsy is the main diagnostic tool either in the office or via DC in the OR. * p53 tumor suppressor gene Cell cycle and apoptosis regulation Most commonly mutated gene in human cancers Overexpression (marker for mutation) Associated with poor prognosis not found in hyperplasias late event in carcinogenesis early stage: 10% have p53 mutation advanced stage: 50% have p53 mutation It is associated more strongly with high risk histologies (UPSC, clear cell carcinoma and grade 3 tumors) * Other genetic mutations of interest in endometrial carcinoma are the mutations in mismatch repair