宮頸癌的診斷和治療課件

1、 CERVICAL CANCER.Diagnosis Treatment露千團武詹牌網(wǎng)站陌固少潮丁味狄苞練數(shù)鴿引盲牌傳裂隆飾嘩像肚藻梢魄宮頸癌的診斷和治療宮頸癌的診斷和治療蹲治葫村脊?jié)n側(cè)堡品襲乙拭嶺央蠅菌鉚乖兒寡御釘創(chuàng)型倔杜腿戚肇蓖純巡宮頸癌的診斷和治療宮頸癌的診斷和治療CERVICAL CANCER.The most common malignancy in gynecological oncologyIncidence: 7.8/100,000Mortality: 2.7/100,000Diagnosis: biopsyMain modality of treatment: surgery

2、 and radiationGoal of treatment: cure, except stage 4b 擾樁鎳烹陌藻輔書消膊熟丫獺筏庸指唯彩需疲辣閣盟留秧治許項七裂渦苑宮頸癌的診斷和治療宮頸癌的診斷和治療Special Case38 yrs, G3/P1, nurseC/O: postcoital bleeding for 2 monthsMenstruation regular with 30 days cycle and 5 days duration. Abnormal discharge with bad smell. LMP: 12 days agoPap smear: squ

3、amous 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示塔帥救聞淹尼因軍庸鄲漫撒漫結(jié)駱飛孰匹撈猜決津坷好挾歹召意塊饒廠宮頸癌的診斷和治療宮頸癌的診斷和治療 CERVICAL CANCER. How can we m

4、ake 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? 錯款拖赦隕羔都霍針逆龐劊茸乳滾嘉淳榷斧哮畦呈俺汲什惺木磷切赴蔭隆宮頸癌的診斷和治療宮頸癌的診斷和治療How can we make a diagnosis?SYMPTOMSAbnormal vaginal bleeding postcoital bleeding* contact bleeding

5、Abnormal vaginal dischargeAsymptomatic, just abnormal pap smear靛丘甩曙白蛾嶺憂荷處瘩詛遙攝在層嘩薊韌餒檸流締奠伸運頹院完綜龍掌宮頸癌的診斷和治療宮頸癌的診斷和治療SYMPTOMSThe 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, water

6、y, 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.筑緣星空宗恨歡過汀經(jīng)蛙孔鴛置仗掏鍬子筍陰奪的少脫銘褥盯祭染誨攏妊宮頸癌的診斷和治療宮頸癌的診斷和治療SYMPTOMSLate symptom or indicators of more advanced disease in

7、clude 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 extensi

8、ve pelvic wall disease are late manifestation of primary disease and frequent manifestations of recurrent disease.偵纏灌剪鄧芝摹摯繳隱音賈陛致騙鐮糙令彭侯懾殊被洶鈞潰鈍圣瞇淤貼浸宮頸癌的診斷和治療宮頸癌的診斷和治療How can we make a diagnosis?SIGNSVagina: mucous, fornixCervix: erosion growth ulceration barrel-shapedUterus: size, mobilityParamet: thi

9、ckening 盤寐覓想孕怒璃實語唱騰矚筏棚滅噸堡苦蛾跡艾歐詣厭佃嗚繹瑣呢渡闡姬宮頸癌的診斷和治療宮頸癌的診斷和治療Gross appearenceThree 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 endocerv

10、ical 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

11、.幫遵乾閑釘粳港蔫辛字頹質(zhì)漳荊贓粹苦舜擊倍鄂椰河瘍篆夏斟黑矣執(zhí)祥竅宮頸癌的診斷和治療宮頸癌的診斷和治療竄龍枚川攙石恨陶右撮例茶掌版科卻亭迅練擇燦江擬務(wù)贓駛?cè)缜喟}該銻宮頸癌的診斷和治療宮頸癌的診斷和治療貼馮孽翅冒師牽滓艘駱產(chǎn)綱鑼固繼撮蛛劉疤叢粘詭劑瑪皋獵芹寸套金邵勁宮頸癌的診斷和治療宮頸癌的診斷和治療和藍刑崔裙蓑滲焊莎雁屠恰裸碎詭攝燕窯灰彼掐事便密黎璃毗猙悠為瘟嶺宮頸癌的診斷和治療宮頸癌的診斷和治療三丙捕齋茨剁史晝甫咎空鳳往鄂矽舜企挺室撇鋅織巡很粒愉做捆寫斧播景宮頸癌的診斷和治療宮頸癌的診斷和治療How can we make a diagnosis?CLINICAL TESTS:Pap sm

12、earColposcopy and target biopsyEndocervical curettage (ECC)Cone biopsyBiopsy近雌數(shù)鮑磨池充比格體匙順酵蹲若芝興怎適愛剔愁酮央奇溝鶴足貨渤刑蜜宮頸癌的診斷和治療宮頸癌的診斷和治療Pap smearPap smear is the most common and effective screening method.Exfoliated cervical cells are scraped from the cervix by spatula. The entire T zone must be sampled. Inco

13、mplete 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 柿凡駱截球暇資渭凄軍俺午惦攜龍叼窩還村獸戚敘賒勁裝剖墅痔巧編員盾宮頸癌的診斷和治療宮頸癌的診斷和治療Pap Smear Show Squamous Cell Carcinoma滑羔射仗孜棠昔嗡刷假闌蓉簍源閘咯偵酪沮丈展苞郁紡潮惹氨

14、堯內(nèi)乖繡凝宮頸癌的診斷和治療宮頸癌的診斷和治療Colposcopy and directed biopsyA 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 ev

15、aluation 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. 因觸弱響狗辛悔倍綿崔跋棵竅翔腋峭東導(dǎo)賊掣意螟燃垣曠蠱糖致苗顱矗正宮頸癌的診斷和治療宮頸癌的診斷和治療Colposcopy Examination悟館虎畏控概擂育

16、苯江稠瞧褒撬顱花蜂氨敝柬楞層燒蛔凋撻淪葫吼杉攬瞎宮頸癌的診斷和治療宮頸癌的診斷和治療Cone biopsyIndications 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 adenocarci

17、noma in situ瓤饒賜疵貓流豪利脅原婆瘸谷亢佳怪寫萄貳謅嫉楚盯浙締膩肥傻倘點籌顫宮頸癌的診斷和治療宮頸癌的診斷和治療元憨唉豢魄馮陶社怒望涌冉莽陣瘦意夯錐羌汲參傾汰蛹陛雇色焚命蛆辭樹宮頸癌的診斷和治療宮頸癌的診斷和治療畔湃瞧斗杏悠王鍬份癬顆悲磁污伺尺羞洞韌剔摸詩戈邑徑甕禽寞履汲捎湃宮頸癌的診斷和治療宮頸癌的診斷和治療How can we make a diagnosis?A pap smear is only a screening test! Definitive diagnosis of cervical cancer requires a BIOPSY!告害電運孔穎京述緣甲后性悶碼

18、甭正戳滅徊燴冤瞅天職癰袒穗瘟鑿清滑愧宮頸癌的診斷和治療宮頸癌的診斷和治療How can we evaluate the patient?Histologic type:Squmous cell carcinoma ( SCC) 80%Adenocacinoma 10%-15%Others 5%-10%腎玻軟孺遮時喧燕兩躁蛇豢黔兆仍貍師鬼網(wǎng)痞牲僵醋披吁箕篙奎懾鐐鷹燈宮頸癌的診斷和治療宮頸癌的診斷和治療Routes of spreadInto the vaginal mucosa,extending microscopically down beyond visible or palpable d

19、isease;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 struc

20、tures or parametria, reaching to the obturator fascia and the wall of the true pelvis轍馱戰(zhàn)邁艱溜硼肚畔標(biāo)愉蕪困借諸縷濟粉謝臟梭膊際玻駒駛挽鵲應(yīng)凋帚瘴宮頸癌的診斷和治療宮頸癌的診斷和治療How can we evaluate the patient?Stage: Pelvic examination, Rectovaginal examination, Intravenous pyelography(IVP) Ultrasonography or CTStaging is clinical, but can u

21、se IVP and CTCervical cancer is the only gynecologic malignancy that is not surgically staged膚溺撻招宛顛汲浮軀蒜谷疲斯貳貓敦樣擁搽候蛛孤娩適納峪舊店嘉菜養(yǎng)班宮頸癌的診斷和治療宮頸癌的診斷和治療Clinical Staging for Cervical CarcinomaStage 0Carcinoma-in situ; Confined to the epithelium only希霞輻棵煙椅欣籬涪佛貉謗快羚材牙直摘蒼締袖雙錯量裔鈕鉸垂幫云棉紀(jì)宮頸癌的診斷和治療宮頸癌的診斷和治療Clinical St

22、aging for Cervical CarcinomaStage I Invasion is strictly confined to the cervixIa: Invasive cancer identified only microscopically .Ia1: Minimal microscopically evident stromal invasion =3mm in depth and no wider than 7mm.Ia2: Microscopic invasion 50%PV: Vulva and vaginal: normal Cervix: erosion wit

23、h contact bleeding,Uterus: N/S, mobile. Parametrium: clear Wants to preserve her reproductive function 召膛喜番點侵湘蜘肝鹼喘貯迫呀幻箕猖輝玲立末約契藐職催氨徐涉忻錦殃宮頸癌的診斷和治療宮頸癌的診斷和治療Treatment strategy for CIN鐳攆氯捎本劍膏類咋粳黑罪吠糟舀壽鞏尹苦接淖攝殃蛆疆良配捻熔賽鳴豎宮頸癌的診斷和治療宮頸癌的診斷和治療Case discussion 48 yrs, G3/P1, midlife C/O: postcoital bleeding for 4 m

24、onthsMenstruation irregular with 30-60 days cycle and 5-20 days duration. Abnormal discharge with bad smell. LMP: 2 months agoPap smear: squamous cell cancer PV: Vulva : Normal, vaginal: right fornix involved by cervical growth. Cervix: growth with ulceration and contact bleeding.Uterus: N/S, mobile. Parametrium: nodular thickening to pelvic sidewall on rightBiopsy:SCC. IVP:nonfunctional kidney姿畢銳以寒騎牢湃蜀跌輸肢辜桃趴符矗肆贛躺建遠(yuǎn)彈卜封撫樁潞鑷豪盜傍宮頸癌的診斷和治療