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1、 Copyright National Comprehensive Cancer Network 2009. All rights reserved. “NCCN”, the NCCN logo, and “National Comprehensive Cancer Network” are registered trademarks of the National Comprehensive Cancer Network. The Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Cervical Cancer
2、Guideline 2009 is the Chinese adapted version of NCCN Clinical Practice Guidelines in Oncology-Cervical Cancer Guideline, V.1.2009 as permitted and endorsed by NCCN. It is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field.The original
3、 guideline and Chinese edition are both available at: http:/www.nccn.org. To view the most recent and complete version of the guideline, go online to www.nccn.org. These Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of th
4、e NCCN.These Guidelines are a work in progress that will be refined as often as new significant data becomes available. The NCCN Guidelines are a statement of consensus of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any N
5、CCN guideline is expected to use independent medical judgment in the context of individual clinical circumstance to determine any patients care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims
6、 any responsibility for their application or use in any way.This publication should not be used for commercial purpose. It is provided for free to Chinese medical professions with the support of the unrestrictive educational grant of GlaxoSmithKline (China) Investment Co. Ltd. which exerts no influe
7、nce to the formation of the Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Cervical Cancer Guideline 2009.NCCN 肿瘤学临床实践指南(中国版) 2009年 第一版 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without
8、the express written permission of NCCN. The Chinese edition 2009 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the
9、most recent and complete version of this or any other guideline, visit www.nccn.org.宫颈癌NCCN宫颈癌专家组成员* Benjamin E.Greer, MD/Co-Chair Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance* Wui-Jin Koh, MD/Co-Chair Fred Hutchinson Cancer Research Center/Seattle Cancer Care AllianceNadeem A
10、bu-Rustum, MD Memorial Sloan-Kettering Cancer CenterMichael A. Bookman, MD Fox Chase Cancer CenterRobert E. Bristow, MD The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsSusana M. Campos, MD Dana-Farber / Brigham and Womens Cancer Center Kathleen R. Cho, MD University of Michigan Compreh
11、ensive Cancer CenterLarry Copeland, MD Arthur G. James Cancer Hospital 70:209-262. Copyright 2000. 无论肿瘤来源于上皮或腺体，自基底膜向下测量，间质浸润深度不得超 过5 mm。浸润深度的定义为邻近最表面的上皮乳头的上皮间质交界到肿 瘤浸润最深处的距离。脉管间隙受侵（静脉或淋巴管），不影响分期。FIGO分期0 IIAIA1IA2IBIB1 IB2 IIIIA IIB III手术-病理发现 原发肿瘤无法评估 无原发肿瘤证据 原位癌（浸润前期癌） 宫颈肿瘤局限于子宫（侵犯宫体可以不予 考虑） 仅在显微镜
12、下可见的浸润癌。所有肉眼可见 的病灶即使是表浅的浸润都归为 IB/T1b期。 间质浸润深度3.0 mm，水平浸润范围7.0 mm 间质浸润深度3.0 mm，但不超过5.0 mm，水平浸润范围 7.0 mm 局限于宫颈的临床可见病灶，或是镜下肿瘤 的病变范围大于IA2/T1a2期 最大直径4.0 cm的临床可见病灶 最大直径4.0 cm的临床可见病灶肿瘤已经超出子宫，但未达盆壁，或累及 阴道但未达阴道下1/3 无宫旁组织浸润 有宫旁组织浸润 肿瘤侵及盆壁和/或侵及阴道下1/3和/或导致 肾盂积水或无功能肾TNM分类TX T0 Tis T1T1aT1a1T1a2T1bT1b1 T1b2 T2T2a
13、 T2b T3IIIA IIIB IVAIVB肿瘤侵及阴道下1/3，未侵及盆壁 肿瘤侵及盆壁和/或导致肾盂积水或无功能肾 肿瘤侵及膀胱或直肠粘膜，和/或超出真骨盆。 粘膜的泡样水肿不足以作为诊断T4期的依据 远处转移T3a T3b T4M1ST-1NCCN 肿瘤学临床实践指南(中国版) 2009年 第一版 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without
14、the express written permission of NCCN. The Chinese edition 2009 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the
15、most recent and complete version of this or any other guideline, visit www.nccn.org.宫颈癌讨论概述美国2007年预计将有大约11,150例新发宫颈癌患者，并且将有3,670例患者死亡1。虽然西班牙/拉丁裔女性的宫颈癌发病率仍居高不下，但美国其他各个种族人群女性宫颈癌的发病率都在下降2,3。尽管如此，宫颈癌仍然是威胁全世界女性健康的主要问题。2002年全球宫颈癌发病人数为493,243例，每年死亡人数为273,505例。宫颈癌是世界范围内女性最常见的第三大肿瘤4,5，78%的病例发生于发展中国家，在那里宫颈癌是女
16、性肿瘤致死的第二位原因。发达国家宫颈癌发病率和死亡率的实质性下降归功于有效的宫颈癌筛查。人乳头瘤病毒（HPV）的持续感染被认为是宫颈癌发病最重要的原因。人群中HPV的感染率和宫颈癌的发病率相关。在宫颈癌高发病率的国家，慢性HPV感染率为10%20%，而在低发病率国家，感染率只有5%10%4。针对HPV的免疫接种使用Gardasil，该产品已于2006年由美国食品和药品管理局（FDA）批准上市可以预防某些亚型的HPV持续感染，因而被期待用来预防HPV感染引起的女性肿瘤（见“针对HPV的免疫接种”）6-9。其他与宫颈癌有关的流行病学危险因素包括吸烟史、经产、使用避孕药、性交年龄过早、多个性伴侣、性传播疾病史以及长期免疫力低下。严格来讲，NCCN临床实践指南并不能涵盖所有可能的临床情况，也无意取代好的临床判断以及个体化治疗措施。在制定本指南的过程中，宫颈癌专家组成员讨论了许多一般规律之外的情况。诊断和全面评估NCCN指南主要讨论了宫颈鳞
