Cervical Cancer宫颈癌-中英文
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• Cervical cancer is the only gynecologic malignancy that is not surgically staged
age at diagnosis of patients with cervical cancer is 52.2 years old.
Normal cervix
Cervical polyp
Acute cervicitis
Erosion of cervix
Cervical cancer
CERVICAL CANCER…..
HPV 6, 11, 40, 42, 43, 44,
54, 61, 70, 72, 81
Lead to:
Benign cervical changes
Genital warts
High-Risk
HPV 16, 18, Precancer cervical changes
31, 33, 35, 39,
·
Cervical Cancer
Cervical cancer
• Etiology （病因） : HPV • Diagnosis （诊断） : biopsy, stage • Theraphy （治疗） : surgery and radiation • Prevention （预防）
CERVICAL CANCER...
• Stage（FIGO）:
• Pelvic examination骨盆检查, Rectovaginal examination 直肠阴道检查, Intravenous pyelography (IVP)， ultrasonography or CT
• Staging is clinical, but can use IVP and CT
组织病理学是诊断的金标准！
• TCT is the most common and effective screening
method.
Normal
Cervicitis
Squamous Cell Carcinoma
（鳞状细胞癌）
TCT results
ASCUS: atypical squamous cells of undetermined
significance（意义不明确的非典型鳞状细胞）
LSIL/HSIL: low-grade/High-grade squamous
intraepithelial lesion（低度/高度鳞状上皮内病变）
AGUS: atypical glandular cell of undetermined
significance （意义不明确的非典型腺细胞）.
Squamous cell carcinoma 鳞癌
Adenocarcinoma 腺癌
How can we make a diagnosis?
• TCT is only a screening test! • Definitive diagnosis of
cervical cancer requires a BIOPSY!
SCC： Squamous Cell Carcinoma
Colposcopy Examination
TCT is only a screening test. A definitive diagnosis requires inspection（视诊） of a well-visualized（直观） cervix with a colposcope.
• Areas of abnormality（white epithelium（白色上皮）, mosaicism（嵌合体）, and punctation（斑点）） are selectively punch biopsied（打孔活检）.
Cone biopsy
• Indications for cone biopsy
Long persistence of HPV can lead to cancer
HPV
How can we make a diagnosis?
SYMPTOMS（症状）
• Abnormal vaginal bleeding: postcoital bleeding*（同房后阴道流血）、contact bleeding （接触性出血）
外生型
糜烂型
溃疡型
内生型
宫颈癌类型
宫颈鳞癌—外生型（菜花型）
宫颈鳞癌—溃疡型（空洞型）
How can we make a diagnosis?
CLINICAL TESTS:
• Thin-prep cytologic test （液基薄层细胞学检测， TCT）
• Colposcopy and target biopsy（阴道镜及镜下活检） • Endocervical curettage (颈管骚刮术，ECC) • Cone biopsy（锥切） • Biopsy（活检）
Human Papillomavirus (HPV) 人乳头瘤病毒
• Long known to cause warts （疣）
• Over 200 types identified
• Most benign, but 15-20 can cause cancers
• Very common
– 20,000,000 curr ent cases in US – 6,200,000 new cases annually – 80% of women have HPV by age 50 – 50% of college students are infected
1.The lesion cannot be fully visualized . 2.The ECC is positive. 3.There is significant discrepancy（偏差） between the TCT and biopsy. 4.A biopsy reveals microinvasive squamous cell carcinoma （微小鳞状上皮细胞癌） 5.A biopsy reveals adenocarcinoma in situ（原位癌）
• Abnormal vaginal discharge（异常阴道分泌物）
SYMPTOMS
• pain referred to the flank or leg • bladder or rectal invasion ：dysuria（排尿困难）,
hematuria（血尿） ,rectal bleeding（直肠出 血） ,obstipation（顽固性便秘） • lymphatic and venous blockage :persistent edema（水肿）
• Adenocacinoma（腺癌）
15%-20%
• Others （其他）
5%-10%
Metastatic path （转移途径）
i. direct spreading直接蔓延: the most common way, exogenic type, cervical canal type
ii. lymphatic metastasis淋巴转移: tumor embolus （癌栓） in lymphatic space
HPV & Cervical Cancer
• HPV recognized as the underlying cause（潜在原 因） of cervical cancer since 1996
– NIH Consensus Conference on Cervical Cancer, 1996 – World Health Organization/European Research Organization on
How can we make a diagnosis?
• SIGNS（体征）
• Vulva（外阴） • Vagina（阴道）: mucous（粘液）, fornix（穹窿） • Cervix（宫颈）: erosion（糜烂）、growth（增生）、
ulceration（溃疡）、barrel-shaped（桶状）
• How can it occur? etiology（病因） • How can we make a diagnosis（诊断）? • How can we evaluate（评估） the patient? • How can we manage（治疗） the patient? • How should we explain to the patient? • Can we prevent（预防） cervical cancer?
Colposcopy and directed biopsy
• The cervix is painted with 3% acetic acid solution（醋酸溶液） to enhance surface alterations and vascular changes.
• The colposcope evaluation is considered adequate or satisfactory if the complete T zone and full extent of the lesions is visualized（直观的）.
Cervical cancer
45, 51, 52, 56, 58, 59, 68, 73, 82 Anal and other cancers
HPV Infections: Summary
• Most people are infected by HPV at some time • Immune system usually clears HPV, but not to all infector • Persistent low-risk HPV can lead to genital warts • Persistent high-risk HPV can lead to pre-cancer
Genital Infection and Neoplasia, 1996
• 德国人哈拉尔德·楚尔·豪森 因发现人乳头状瘤病毒（ＨＰＶ）是导致 宫颈癌的病原体，获得2008年诺贝尔生理学或医学奖
Common HPV Types and their effects
HPV Types
Low-Risk
• The most common malignancy（恶性肿瘤） in gynecological oncology
• Incidence（发病率）: 7.8/100,000 （我国每年新发11万例） • Mortality（死亡率）: 2.7/100,000 • Usually occurs between 35~39 and 60~64.The average
How can we evaluate the patient?
宫颈（？）癌（？）期
• Histologic type • Stage • general condition
How can we evaluate the patient?
Histologic type（组织类型）:
• Squmous cell carcinoma ( 鳞癌，SCC) 80%
• Uterus（宫体）: size（大小）, mobility（活动性） • Parametrium（宫旁组织）: thickening（增厚）
Байду номын сангаас
Gross appearance（大体观）
Four types:
(a).exogenous cancer: the most common type（外生型） (b).endogenous cancer（内生型） (c).ulcer type cancer（溃疡型） (d).anabrotic type cancer（糜烂型）
iii. blood metastasis血道转移: extremely less
common iliac lymph nodes internal iliac lymph nodes external iliac lymph nodes
obturator lymph nodes
How can we evaluate the patient?
age at diagnosis of patients with cervical cancer is 52.2 years old.
Normal cervix
Cervical polyp
Acute cervicitis
Erosion of cervix
Cervical cancer
CERVICAL CANCER…..
HPV 6, 11, 40, 42, 43, 44,
54, 61, 70, 72, 81
Lead to:
Benign cervical changes
Genital warts
High-Risk
HPV 16, 18, Precancer cervical changes
31, 33, 35, 39,
·
Cervical Cancer
Cervical cancer
• Etiology （病因） : HPV • Diagnosis （诊断） : biopsy, stage • Theraphy （治疗） : surgery and radiation • Prevention （预防）
CERVICAL CANCER...
• Stage（FIGO）:
• Pelvic examination骨盆检查, Rectovaginal examination 直肠阴道检查, Intravenous pyelography (IVP)， ultrasonography or CT
• Staging is clinical, but can use IVP and CT
组织病理学是诊断的金标准！
• TCT is the most common and effective screening
method.
Normal
Cervicitis
Squamous Cell Carcinoma
（鳞状细胞癌）
TCT results
ASCUS: atypical squamous cells of undetermined
significance（意义不明确的非典型鳞状细胞）
LSIL/HSIL: low-grade/High-grade squamous
intraepithelial lesion（低度/高度鳞状上皮内病变）
AGUS: atypical glandular cell of undetermined
significance （意义不明确的非典型腺细胞）.
Squamous cell carcinoma 鳞癌
Adenocarcinoma 腺癌
How can we make a diagnosis?
• TCT is only a screening test! • Definitive diagnosis of
cervical cancer requires a BIOPSY!
SCC： Squamous Cell Carcinoma
Colposcopy Examination
TCT is only a screening test. A definitive diagnosis requires inspection（视诊） of a well-visualized（直观） cervix with a colposcope.
• Areas of abnormality（white epithelium（白色上皮）, mosaicism（嵌合体）, and punctation（斑点）） are selectively punch biopsied（打孔活检）.
Cone biopsy
• Indications for cone biopsy
Long persistence of HPV can lead to cancer
HPV
How can we make a diagnosis?
SYMPTOMS（症状）
• Abnormal vaginal bleeding: postcoital bleeding*（同房后阴道流血）、contact bleeding （接触性出血）
外生型
糜烂型
溃疡型
内生型
宫颈癌类型
宫颈鳞癌—外生型（菜花型）
宫颈鳞癌—溃疡型（空洞型）
How can we make a diagnosis?
CLINICAL TESTS:
• Thin-prep cytologic test （液基薄层细胞学检测， TCT）
• Colposcopy and target biopsy（阴道镜及镜下活检） • Endocervical curettage (颈管骚刮术，ECC) • Cone biopsy（锥切） • Biopsy（活检）
Human Papillomavirus (HPV) 人乳头瘤病毒
• Long known to cause warts （疣）
• Over 200 types identified
• Most benign, but 15-20 can cause cancers
• Very common
– 20,000,000 curr ent cases in US – 6,200,000 new cases annually – 80% of women have HPV by age 50 – 50% of college students are infected
1.The lesion cannot be fully visualized . 2.The ECC is positive. 3.There is significant discrepancy（偏差） between the TCT and biopsy. 4.A biopsy reveals microinvasive squamous cell carcinoma （微小鳞状上皮细胞癌） 5.A biopsy reveals adenocarcinoma in situ（原位癌）
• Abnormal vaginal discharge（异常阴道分泌物）
SYMPTOMS
• pain referred to the flank or leg • bladder or rectal invasion ：dysuria（排尿困难）,
hematuria（血尿） ,rectal bleeding（直肠出 血） ,obstipation（顽固性便秘） • lymphatic and venous blockage :persistent edema（水肿）
• Adenocacinoma（腺癌）
15%-20%
• Others （其他）
5%-10%
Metastatic path （转移途径）
i. direct spreading直接蔓延: the most common way, exogenic type, cervical canal type
ii. lymphatic metastasis淋巴转移: tumor embolus （癌栓） in lymphatic space
HPV & Cervical Cancer
• HPV recognized as the underlying cause（潜在原 因） of cervical cancer since 1996
– NIH Consensus Conference on Cervical Cancer, 1996 – World Health Organization/European Research Organization on
How can we make a diagnosis?
• SIGNS（体征）
• Vulva（外阴） • Vagina（阴道）: mucous（粘液）, fornix（穹窿） • Cervix（宫颈）: erosion（糜烂）、growth（增生）、
ulceration（溃疡）、barrel-shaped（桶状）
• How can it occur? etiology（病因） • How can we make a diagnosis（诊断）? • How can we evaluate（评估） the patient? • How can we manage（治疗） the patient? • How should we explain to the patient? • Can we prevent（预防） cervical cancer?
Colposcopy and directed biopsy
• The cervix is painted with 3% acetic acid solution（醋酸溶液） to enhance surface alterations and vascular changes.
• The colposcope evaluation is considered adequate or satisfactory if the complete T zone and full extent of the lesions is visualized（直观的）.
Cervical cancer
45, 51, 52, 56, 58, 59, 68, 73, 82 Anal and other cancers
HPV Infections: Summary
• Most people are infected by HPV at some time • Immune system usually clears HPV, but not to all infector • Persistent low-risk HPV can lead to genital warts • Persistent high-risk HPV can lead to pre-cancer
Genital Infection and Neoplasia, 1996
• 德国人哈拉尔德·楚尔·豪森 因发现人乳头状瘤病毒（ＨＰＶ）是导致 宫颈癌的病原体，获得2008年诺贝尔生理学或医学奖
Common HPV Types and their effects
HPV Types
Low-Risk
• The most common malignancy（恶性肿瘤） in gynecological oncology
• Incidence（发病率）: 7.8/100,000 （我国每年新发11万例） • Mortality（死亡率）: 2.7/100,000 • Usually occurs between 35~39 and 60~64.The average
How can we evaluate the patient?
宫颈（？）癌（？）期
• Histologic type • Stage • general condition
How can we evaluate the patient?
Histologic type（组织类型）:
• Squmous cell carcinoma ( 鳞癌，SCC) 80%
• Uterus（宫体）: size（大小）, mobility（活动性） • Parametrium（宫旁组织）: thickening（增厚）
Байду номын сангаас
Gross appearance（大体观）
Four types:
(a).exogenous cancer: the most common type（外生型） (b).endogenous cancer（内生型） (c).ulcer type cancer（溃疡型） (d).anabrotic type cancer（糜烂型）
iii. blood metastasis血道转移: extremely less
common iliac lymph nodes internal iliac lymph nodes external iliac lymph nodes
obturator lymph nodes
How can we evaluate the patient?