宫颈癌的诊断和治疗.ppt

Colposcopy Examination
Cone biopsy
Indications for cone biopsy
1.The lesion cannot be fully visualized . 2.The ECC is posituve 3.There is significant discrepancy between the Pap smear and biopsy. 4.A biopsy reveals microinvasive squamous cell carcinoma 5.A biopsy reveals adenocarcinoma in situ
Exfoliated cervical cells are scraped from the cervix by spatula. The entire T zone must be sampled. Incomplete sampling could produce a false-negative smear. The endocervical canal is also sampled with a swab or cytobrush. Cells are fixed immediately to avoid air-drying cytologic artifacts
How can we make a diagnosis?
SIGNS Vagina: mucous, fornix Cervix: erosion growth ulceration barrel-shaped Uterus: size, mobility Paramet: thickening
Gross appearence
How can we make a diagnosis?
A pap smear is only a screening test! Definitive diagnosis of cervical cancer requires a BIOPSY!
How can we evaluate the patient?
Special Case
38 yrs, G3/P1, nurse C/O: postcoital bleeding for 2 months Menstruation regular with 30 days cycle and 5 days duration. Abnormal discharge with bad smell. LMP: 12 days ago Pap smear: squamous cell cancer PV: Vulva : Normal, Vaginal: yellowish discharge with bloody stained, Cervix: growth with ulceration and contact bleeding. Uterus: N/S, mobile. Parametrium: thickening not to pelvic sidewall on both side
CERVICAL CANCER...
源自文库Diagnosis
＆
Treatment
CERVICAL CANCER...
The most common malignancy in gynecological oncology Incidence: 7.8/100,000 Mortality: 2.7/100,000 Diagnosis: biopsy Main modality of treatment: surgery and radiation Goal of treatment: cure, except stage 4b
Clinical Staging for Cervical Carcinoma
Stage 0
Carcinoma-in situ; Confined to the epithelium only
Clinical Staging for Cervical Carcinoma
Pap Smear Show Squamous Cell Carcinoma
Colposcopy and directed biopsy
A pap smear is only a screening test. A definitive diagnosis requires inspection of a well-visualized cervix with a colposcope. The cervix is painted with 3% acetic acid solution 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. Areas of abnormality(e.g., White epithelium, mosaicism, and punctation) are selectively punch biopsied.
How can we evaluate the patient?
Stage: Pelvic examination, Rectovaginal examination, Intravenous pyelography(IVP) Ultrasonography or CT Staging is clinical, but can use IVP and CT Cervical cancer is the only gynecologic malignancy that is not surgically staged
Histologic type:
Squmous cell carcinoma ( SCC) 80%
Adenocacinoma
10%-15%
Others
5%-10%
Routes of spread
Into the vaginal mucosa,extending microscopically down beyond visible or palpable disease; Into the myometrium of the low uterine segment and corpus, particularlly with lesions arising from the endocervix. Into the paracervical lymphatics and from there to the most common involved lymph nbodes ( the obturator; hypogastric,and external iliac nodes). Direct extesion into adjacent structures or parametria, reaching to the obturator fascia and the wall of the true pelvis
Three categories of gross lesions have traditionally been described.
The most common is the exophytic lesion, which usually arises on the ectocervix and ofter grows to form a large, friable,polypoid mass, arises on the endocervical canal, creating barrel-shaped lesion. Little visible ulceration or exophytic mass like a stone-hard cervix that regresses slowly with radiation therapy. Ulcerative tumor,usually erodes a portion of the cervix or replacing the cervix , erodes a portion of the upper vaginal vault with a large crate.
How can we make a diagnosis?
SYMPTOMS Abnormal vaginal bleeding postcoital bleeding* contact bleeding Abnormal vaginal discharge Asymptomatic, just abnormal pap smear
SYMPTOMS
The classic symptom is intermittent, painless metrorragia or spotting only postcoitally or after douching. Probably the first symptom of early cancer of the cervix is a thin, watery, blood-tinged vaginal discharge that frequently goes unrecognized by the patients. As the maligancy enlarges, the bleeding episodes become heavier and more frequent, and they last longer.
CERVICAL CANCER…..
How can we make a diagnosis? How can we evaluate the patient? How can we manage the patient? How should we explain to the patient? Can we prevent cervical cancer?
How can we make a diagnosis?
CLINICAL TESTS: Pap smear Colposcopy and target biopsy Endocervical curettage (ECC) Cone biopsy Biopsy
Pap smear
Pap smear is the most common and effective screening method.
SYMPTOMS
Late symptom or indicators of more advanced disease include the development of pain referred to the flank or leg. Many patients c/o dysuria, hematuria or rectal bleeding or obstipation resulting from bladder or rectal invasion. Distant metastasis and persistent edema of one or both lower extremities as a result of lymphatic and venous blockage by extensive pelvic wall disease are late manifestation of primary disease and frequent manifestations of recurrent disease.