《妇产科学》课件：第22章第4节宫颈癌 双语.pptVIP

etiology Human PapillomaVirus (HPV) infection other risk factors RISK FACTORS Multiple sexual partners Early onset of sexual activity Low socioeconomic status Long-term oral contraceptive use High parity cigarette smoking HPV INFECTION HPVs are major etiologic factor in the development of CIN and cervical cancer about 100% cervical cancer and 80% CIN are HPV positive Low-risk HPV: 6, 11, 42, 43, 44 and so on are associated to CINⅠand condyloma (genital warts) High risk HPV: 14 types including HPV16, 18, 31, 33,35, 56, 58...CINⅡ/Ⅲ and cervical cancer HPV16/18 accounts for 70% cases of cervical cancer HPV infection is temporary, disappearing within 12 months 10-15% will persistence，induced CIN Mechanisms of HPV inducing CC HPV contains E6, E7 oncogenes, produced E6, E7 oncoproteins combined with P53 and RB proteins(tumor suppressor proteins), disabling cell cycle arrest and then result in host cell immortalization and malignant transformation. a common process in the transformation zone. The gradurally replacement of columnar epithelium with the stratified squamous epithelium due to the proliferation of reserve cells under the columnar cell layer, with the influence of the acid environment in vagina. 90%宫颈癌起源于宫颈移行带 Pathology of CIN CIN I : cellular with mild dysplasia. The dysplasia cells are limited under 1/3 normal epithelial line. CIN II: cellular with moderate dysplasia. The dysplasia cells are limited under 1/3~2/3 normal epithelial line. CIN III: cellular with severe dysplasia as well as carcinoma in situ. The all of normal epithelial line is involved by dysplasia cells. CIN临床表现 无特殊症状，偶有阴道排液增多，可有宫颈接触性出血。妇检：宫颈可光滑，或见局部红斑、白色上皮或宫颈糜烂样改变，未见明显病灶。 CIN诊断 辅助检查 1.宫颈细胞学检查：筛查手段，特异性高，敏感性低； 2.高危型HPV-DNA检测：敏感性高，特异性低，可与细胞学联 合筛查，也可用于细胞学异常的分流； 3.阴道镜检查：当细胞学为ASC-US并高危型HPV阳性，或LSIL 及以上者，应行阴道镜检查。 4.子宫颈活组织检查：确诊最可靠方法。多点活检，阴道镜指 示下。必要时宫颈管内膜刮取（endocervical curettage,ECC） CIN的治疗 CIN I：细胞学为LSIL及以下者，随访；超过两年病变存在或随访过程中有进展者；或细胞学为HSIL者，进行治疗。治疗手段：阴道镜检查满意者，冷冻或激光；不满意或ECC阳性，宫颈锥切。