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1、CervicalTumor宫颈肿瘤XinLUObstetricsandGynecologyHospital FudanUniversityContentsCINHPVHistologyPathologyDiagnosisTreatmentCervicalCancerGeneralinformationPathologySpreadpatternFIGOstagingClinicalsignsDiagnosisanddifferentialdiagnosisPrinciplefortreatmentPreventionKeywordsHumanPapillomavirus(H
2、PV)RadicalHysterectomy(RH)Radiotherapy(RT)Chemotherapy(CT)Neoadjuvantchemotherapy(NACT)Concurrentchemo-radiotherapy(CCCR)RadicalTrachelectomy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FemaleReproductiveAnatomyTransformationZoneCervicalCancer子宫颈癌Worldreport:Accountfor1/3femalemalignanciesNewcase
3、s:529800Death:27510085%developingcountryThe4thmostcommoncauseofdeathfrommalignancyinwomen.流行病学新发病例数死亡病例数CervicalcancerprogressionHPVinfectionCINs10-15yrsCarcinomainsituCervicalcancerCervicaltumorigenesisProgressionHostimmunityEnvironmentalfactorsGenetics:oncogeneE6,E7tumorsuppresorgnenp53,
4、RbRegressionHighRiskFactorsHR-HPVUseoforalcontraceptivesSmokingMultiplesexualpartnersHistoryofherpesinfectionHistoryofSTDHumanPapillomavirus,HPV人乳头瘤状病毒1972：HaraldzurHausen1995：High-riskHPVbyInternationalAgencyforResearchonCancer，IARC90%cervicalcancerwithHPVinfectionHPVHighriskHPV（HR-HPV）on
5、cogenicHPVHPV16,18,31,33,35,39,45,51,52,56,58,59,68,73,82HSIL,CervicalcancerLowriskHPV（LR-HPV）non-carcinogenicHPVHPV6,11,42,43,44,54,61,70,72,81LSILPrecursorsCIN:宫颈上皮内瘤样病变CINI：milddysplasia，1/3CINII：moderatedysplasia，1/3-2/3CINIII：severedysplasiaCIS(carcinomainsitu)原位癌CINHistologicalTypesS
6、quamouscarcinoma80-85%Adenocaricinoma15-20%EndometrialcarcinomaClearcellcarcinomaAdenosquamous3-5%UndifferentiatedcarcinomaFrom：2003年WHO女性生殖器官肿瘤SpreadpatternLocaltumorextensionmostcommonLymphaticpelvicandpara-aorticHematogenousdisseminationuncommonFIGOstageSymptomsAsymptomaticAbnormalpaps
7、mearWatery,blood-tingedvaginaldischargePost-coitalbleedingPelvicpainDiagnosisHistoryPhysicalexaminationCytology(papsmear,TCT,HPV)Biopsy(colposcopy)ConizationImagingPlatformofdiagnosisforcervicaldiseasesPapsmearTBSclassificationTCTHPVColposcopy--biopsyLEEPColpo
