子宫内膜癌的诊疗FIGO指南

Platform of diagnosis for cervical diseases
Pap smear
TBS classification
TCT
HPV
Colposcopy--biopsy
LEEP
Colposcopy 阴道镜
Conization 宫颈锥切
Differential Diagnosis
High Risk Factors
HR-HPV Use of oral contraceptives Smoking Multiple sexual partners History of herpes infection History of STD
Human Papillomavirus , HPV 人乳头瘤状病毒
(CCCR) Radical Trachelectomy
人乳头瘤状病毒 广泛全子宫切除术 放射治疗 化学治疗 新辅助化疗
同步放化疗
宫颈根治术
Female Reproductive Anatomy
Transformation Zone
Cervical Cancer 子宫颈癌
World report: Account for 1/3 female malignancies New cases: 529 800 Death: 275 100 85% developing country
Low risk HPV（LR-HPV） non-carcinogenic HPV HPV 6,11,42,43,44,54,61,70,72,81 LSIL
Precursors
CIN: 宫颈上皮内瘤样病变 CIN I：mild dysplasia，1/3 CIN II：moderate dysplasia，1/3-2/3 CIN III：severe dysplasia
CIS(carcinoma in situ) 原位癌
CIN
Histological Types
Squamous carcinoma 80-85% Adenocaricinoma 15-20% Endometrial carcinoma Clear cell carcinoma Adenosquamous 3-5% Undifferentiated carcinoma
Symptoms
Asymptomatic Abnormal pap smear Watery, blood-tinged vaginal discharge Post-coital bleeding Pelvic pain
Diagnosis
History Physical examination Cytology (pap smear, TCT, HPV) Biopsy (colposcopy) Conization Imaging
Key words
Human Papillomavirus (HPV) Radical Hysterectomy (RH) Radiotherapy (RT) Chemotherapy (CT) Neoadjuvant chemotherapy
(NACT) Concurrent chemo-radiotherapy
The 4th most common cause of death from malignancy in women.
流行病学
新发病例数
死亡病例数
Cervical cancer progression
HPV infection CINs Carcinoma in situ Cervical cancer
Cervicitis Cervical polyps Benign cervical tumor:myoma
From：2003年WHO女性生殖器官肿瘤
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Spread pattern
Local tumor extension most common
Lymphatic pelvic and para-aortic
Hematogenous dissemination uncommon
FIGO stage
1972： Harald zur Hausen
1995： High-risk HPV by International Agency for Research on Cancer，IARC
90% cervical cancer with HPV i来自百度文库fection
HPV
High risk HPV（HR-HPV） oncogenic HPV HPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82 HSIL, Cervical cancer
10-15yrs
Cervical tumorigenesis
Progression Host immunity Environmental factors Genetics: oncogene E6, E7 tumor suppresor gnen p53, Rb
Regression
Cervical Tumor 宫颈肿瘤
Xin LU
Obstetrics and Gynecology Hospital Fudan University
Contents
CIN HPV Histology Pathology Diagnosis Treatment
Cervical Cancer General information Pathology Spread pattern FIGO staging Clinical signs Diagnosis and differential diagnosis Principle for treatment Prevention