????(Carcimoma of Cervix uteri)

1

• ????,?,40?,??????????,???????????,?????,??????,?
  ??,????????
• ??????,?????

2
????(Carcimoma of Cervix uteri)

• ?????????????????,?????????????????????????????80?
  ??????????????461?,???20????????????13.15?,????1/3
  ????70????????????,?????70????????,???????????5.3?
  ?

3

• ?????????????????????????,????????????????????????
  ?????????????????????????????????,????????????????
  ??????????????????????,???????????,???????????????
  ??(Muir 1987)?

4

• ????????????????,??????????????????,??????,??????,
  ???????????????
• ?40???????????????????????,???????????????????????
  ?

5
????(Etiology)

• ??????????????????????????????
• ???
• ????????????????18????????20???,??????????????,
  ??????????????,????????????,???????????,??????????
  ????????????,?????18????,?25???????13.3??

6

• ????
• ???????????????????????????????????????????,?
  ???13??????(110.38/10?),??7???????(377.52/10?)??
  ??????????????????????????
• ??????????
• ????????????????????????,?????????????????????
  ????????
• ?????????????????????????????????????????????????
  ??????36??

7

• ?????? Centain infection with virus
• ??????????????????
• ???????II?(herpes simplex virusII H.S.V-2)
• ????????(human papplloma virus HPV)
• ???????(human Cytomegalovirus HCMV)
• HSV-2???????????????????????,?????????,??????HSV-2
  ???????80??,??????14.1457.14?
• HPV?????????????,?????????,?????????????,?????????
  ???????
• ??????????,???????????????,?????????????????????

8
??????????Histohogic Development of Cervical
Cancer

• 1.???????
• physiclogic change of the cervical
  epithelium
  ??????????????????????,??????????????,????????????
  ,??????????????????(Primitive squimv-columnar
  junction ?Physiologic squimv-columnar junction)?
• ?????????,???????????????????????,????????????????
  ??????????????????????????????????????

9

• ?????????????????????????????(transformation
  zone),??????????

10

• ????E2 ???????????????????????,????????,???,??
  ????,??E ?
• ????E2 ????????E2??,????????

11

• ??????????,?????????????????,??????
• 1).??????Squamous metaplasia
• ?????????????,?????????????????(?????PH??4.55.5,?
  ?,??PH?7.07.5,?PH?5.56.5,PHgt7.0??,??),?????????
  ???????????,??????????,????????,??????????????????
  ???????????,?????????(?????????)?

12

• 2).?????Squamous epithelazation
• ???????????????????????,??????????????????????????
  ????

13

• 2.?????????
• Development of cervical carcer
• ???????????,??????????,????????,?????????????
  ????????????????
• ?????????????,????,???,???,?????
• ???????????????cervical dysplasia
• ???????????????????????,??????????????????,???????
  ??????????????????(III?)
• ??(I?)mild (grade I)?????????1/3
• ??(II?)moderate(gradeII)?????????2/3
• ??(III?)severe (gradeIII)???????????(?1/3)?

14

• ????????????????,?????????????,????????
• ????????(carcinoma in situ)
• CIS???????????,???????,?????,???????(??1932??Brod
  ers ????)?
• 60????????????????????????????????????????,???????
  ????????,????????,??,Richart?1967????????????????
  ??????(Cervical intraepithelial neoplasia
  CIN)?????????????????,??????????????????,?????????
  ???????

15

• ??????CIN???????
• CIN I ?mild dysplasia ???????
• CIN II?moderate dysplasia ???????
• CIN III?severe dysplasia CIS ?????
• ???????????????,????,????,???????????,???????????1
  015,??75??????(??????????)?

16

• ??
• ??????,??????,????????
• ???????,???????
• CIN ??????

17
???? Pathology

• ???????????????9095,????510,???????????,????
  ???????????
• 1.?? Gross appearance
• ???????????????????????,?????????,???????,????
  ?????????

18

• 1).Exophytic growth ????????????,???????,????????
  ,????,???,????????????
• 2).Enduphytic growth ????????????????,??????,????
  ?,???????
• 3).Ulcerative ?????????????,?????,?????????,?????
  ?
• 4).?????????????,??????,??????,??????

19

• 2.?? Microscopic Examination
• 1).???????Microinvasive Carcinoma
• ????????????????,????,????????,???????????????
  ,????????,????????????
• ????????????????????1mm?
• ?????????????????????5mm,?????7mm?

20

• 2).????? invasive carcinoma
• ??????????????????????,???????????5mm??,???7mm???
  ??????????????
• ???????????,?????????
• I ?,????,????,5????68.3?
• III ?,????????,???,5??????20?
• ????????????????,????510,???????????,????

21
?????? Routes of the spread

• ??1.???? Direct extension
• 2.???? Lymphatic metastasis
• 3.???? Blood vessel teransport
• ??????????????????????????????????????????????,???
  ???,??????,???????
• ??????????????,?????????
• ???????????????????,?????????????????????,????????
  ?????
• ??????????,?????????????????????????,?????????

22
?????? Clinical staging

• ??????????????,??????,????????????????????,???,???
  ??????FIGO????????AJCC???????UICC,????????????????
  1991???????????????(????????)???????????????

23

• ?????????

24

• ????????
• 1. ??????????????????? ?,???????????????
• 2. ??????????????????? ????,??,???????????
  ?????????????,???? III ??
• 3. ??????????????????? ??????,??????????? I
  ?? II ??,????? III ??

25
??????Clinical Characteristics

• 1. Symptomy ??
• ????????????,1585?,?????50???,3040??????????
  ?????????,??????,??????,?????????????????,????????
  ?????????

26

• 1).???? Vaginal bleeding
• ???????? Cuntact bleeding
• ????????????????,?????,???????,??????????,???????
  ????,????????????????
• ?????????????,??????
• ?????????,??,?????????

27

• 2).????Abnormal vaginal discharge
  ??????,?????,?????????,?????
• Watery Serous Purulent
• 3).8085?????????????,???????????,?????????,????
  ?????????,???????????,????????????????????????????
  ???
• ?????????? ???? ????
• 4).????????????????????

28

• 2.Signs ??
• ??????,??????,????????
• ?CIN???????????????,?????????????????,??????,????
  ?????????????????????????,????????????????????????
  ???????,??????????????,????????,??,???????????????
  ??,???????????

29
???? Diagnosis

• ?????????,????,?????????????????????
• 1.?????????Vaginal Smear Syudies
  (Papanicolaou Smear)
• ???????1847?,?????????????,???1864????????????????
  ,?????????,??????????,????,?????????1890??????????
  ?????????1928???????????????????,??1944??????????,
  ?????????????,???????

30

• ???????1951??????????,??????????????????????,?????
  ?????,?????,????????,???????,?????????????????????
  ???????????,???????????

31

• ??? V ?
• Grade I Normal cells
• Grade II Usually indicting inflammatory
• Grade III A more serious degree of cellular
  abnormal ,usually indicating need
  for biopsy
• Grade IV Distinctly abnormal cells ,possibly
  malignant and definitely requoiring
  biopsy
• Grade V Malignant cells

32

• 2.???Schiller test
• ?????1938?,???????????????????????????????????
  ???,????????????????????,?????????????,???????????
  ????,???????,???????????,????????,????????

33

• 3.?????Colposcopy
• 1925??????,????????????,???????,???????,??????
  ???????????,????????

34

• 4.????Cervical Biopsy(???)
• ????????????????????????,?????????????,???????
  ?3?6?9?12???4????????,??????????????
• (?? III ???)

35

• 5.?????Conization of the Cervix
• ?????????,????,???????????????????????,??????,
  ????????,?????????
• 6.?????????????
• ??MJ?????????,? ??????????????????????????????
  ?????,??????

36
?????? Differential Diagnosis

• 1. Cervical polyp or erosion
• 2. Cervical tubeculosis
• 3. Condylma (??)
• 4. Abortion of a cervical pregnancy
• 5. Metastasized Carcinoma of the Corpus, Biopsy
  may help to diagnosis

37
???? Treatment

• ??????gt III ??,?????????,????????????
• 1.?????????
• CIN I ???????
• CIN II ????????????????CIN III
  ?????????,??????? ????,????????

38

• 2.??????
• Ia????????????
• 3.???
• ??????????????????????
• ?????IbIIa,???????????????
• ?????????,??????????
• ??????????????,?????,????????????
• ???????,?????

39

• 4.???????????
• ????????????????????
• ????????,????????
• ?????????????
• Ia????????????????????????
• IbIIa?????,???????????????,????????????
• ?????????,???????,????????????????

40

• ???????????????
• ??????????????????????????????????????????????,???
  ????????????,?????????????????????????????????????
  ,???????????1827?,??????,??????,?????????????
• ?????????????????
• ??????????????????

41

• ???????????

42

• ??
• ???????????????
• ????
• ???????????
• ?????????
• ???
• ????????

43
??

• ??????
• ????
• ??
• ????