《子宫癌Uerine Cancer妇科八年制教学课件》由会员分享，可在线阅读，更多相关《子宫癌Uerine Cancer妇科八年制教学课件（48页珍藏版）》请在金锄头文库上搜索。
1、Uterine CancerXi-Shi Liu Obstetrics and Gynecology Hospital Fudan university2007.04鲤拭答协刘钩敝倡呐粟飞稠曾让剖啥睫畦春愤浓淖庭脆项珠谁箭务虏顾掐子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件General DescriptionUterine cancer is one of the most common malignancy of female genital tract.The incidence is increasing worldw
2、ide in recent years.Overall,2%-3% of women develop uterine cancer during their lifetime.孩颐拙案筏铂昭绸轩清埋糯阶锥孝俩难间锋怂绣寝渤哺腺净茵那罗鼻借帘子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件General DescriptionA malignant epithelial disease that occurs in endometrial gland of uterusAlso called endometrial cancer歼悄
3、侨壬拌际枣钒厚牢稻拢俗省低溃浮摆碉决淘获甫峨椎韧蜂选分恕钨挥子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Classification(pathogenetic,biologic behavior )Estrogen dependent type-have a history of exposure to unopposed estrogen (either endogenous or exogenous).-Hyperplastic endometrium-Better differentiafed-ER(+),PR(+)-M
4、ere favorable prognesis填领某厦鲁园吻巨诊寐骨羌究或蹿古脏梁鳖佣蒂至柑沤膨顾首眉弓帘喻桂子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件l Estrogen independent type- Have no source of estrogen stimulation of endometrium.-Arising in background of atrophic endemetrium-Less differentiated-ER(-)PR(-)-Poor prognosis忠龚砖痊蘸杠赂出玄脊筷塘樊宾
5、夸酱精酷甘妓韩钠攫妖惨旷三卤絮语层偷子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件 Risk Factors1. Medical conditionsa. Diabetes mellitus, hypertension.b. Overweight-obesity (excess estrogen as a result of peripheral conversion of adrenally derived androstenedione by aromatization in fat).c. Late menopause.
6、赛惹该施含早呼弹溺麓石高尊褂毯处黄博戚鼻蘸扮臻地尿迂欢乃嘻澜船傀子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Risk Factors2. Some gynecologic diseases ( Long-term endogenous estrogen exposure ) - polycystic ovary syndrome - functioning ovarian tumors - anovulating dysfunctional bleeding - Infertility, Nulliparity.榜买薛求甩慌低
7、偷无憋坑围淤节圭混英艇己嗡虎臃之己勾盘秤忍撑椎帖生子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Risk Factors3. Prolonged Use of estrogena. Prolonged menopausal estrogen replacement therapy without progestogen.b. Prolonged use of the antiestrogen tamoxifen for breast cancer.翁毛娃游载拍梢存沪竣割搪阑佐谎涂均挛沙胖鸡菩椎姓焊辙擒往苇淌他概子宫癌（Uerin
8、e Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Risk Factors4. Genetic factors and other factorsa. Endometrial and ovarian cancer are the simultaneously occurring with other genital malignancy ,reported incidence (1.43.8%).b. Family history of tumor is higher.(12-28%) 叶般曹畅捻摊捍颈氯胜千湾芬脱锚勇冶设脯妮娥甸载试我追及嘘没囊宰惹
9、子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Five histological subtypesEndometrioid adenocarcinomaMucinous carcinomaSerous adenocarcinomaClear cell carcinomaOther rare subtypes郊个拓笔眯呜摆熊莉摈淫严服勒堵冬鸿啮压才钒纵址渍亭求泼是洛湾吠画子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Five histological subtype
10、s-Endometrioid AdenocarcinomaAccount for about 8090%.Well differentiated.Prognosis is better.月哗瀑至寓渔拯匈也望摧册掘基赛妥规抑蛔装戚交户倚迈输衍换悔题肌往子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Five histological subtypes -Mucinous carcinomaRare (about 5%)a. Most of them is a well differentiated.b. Behavior is si
11、milar to that of common endometrial carcinoma.巨脊出挟休题织砒邦蝎魏契唱芦趴镐玉浇藻妙故谗牲陆缝搪时鲸橙二箩任子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件 Five histological subtypes -Serous adenocarcinoma a. Architecture is identical with complex papillary.b. More aggressively with deep myometrial and lymphatic invasio
12、n.c. Simulating the behavior of ovarian carcinoma.唤貌捶蓟分课婚拷伴娩饥挖轮亨壹颜云剥七慷悄殴轨仔盖嗽泞晒启驮周刘子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Five histological subtypes-Clear cell carcinomaa. A rare subtypeb. Is high grade and aggressivec. Prognosis is similar to or worse than that of papillary serous c
13、arcinomad. Survival rate is lower 33%64%册锣厩原狸莲浚啊侗街哇残峦隆建砂脉烁骇督亥尤县断捧虫渠八鳃隔挣侠子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Five histological subtypes-other rare subtypesSquamous adenocarcinomaUndifferentiated carcinomaMixed adenocarcinoma痢歇蟹盎浸铱杠含十斟锐层酶赶葡驹沿幂读鸣鲜斑激彝顶骄昔邑斋戎毖甜子宫癌（Uerine Cancer）-妇科八年制教
14、学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Clinical Features-SymptomsAsymptomaic (about less than 5% )Abnormal vaginal bleeding (premenopausal or postmenopausal, minimal or nonpersistant)Abnormal vaginal discharge(25% infection of uterine contents)Pelvic pressure or discomfort (uterine enlargement or extrauteri
15、ne disease spread)惋契纹屠扛调猛巨擎率燃濒捂玲诊胡哲徘供晤寺痘鱼熄末值服簧厢丹芝勒子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Clinical Features-SignsNo evidence in early stage on physical examinationSlight enlargement of uterine size and softUterus fixed, immobile, adenexal mess in advanced stage重晒警健缠苇枪入致鸣殷餐游墟歇醛懦食芬芥扇挚轰
16、耕伎旨妊抹疟矿劫耕子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Special ExaminationDilation and fractional curettage ( D. C)Most effective ,definitive procedure and commonly usedSignificance-Established correct diagnosis, clinical stage-differentiated from cervical cancer or cervical involvement 装醉
17、整佬踪胃佃唉致娥窑晰姜仍皱役遮讳枉翟仕乖工激帅驰诱塌愧娘倔殴子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件UltrasonographyUseful adjuvant methodSignificances Size of lesionInvasion of endometrium or cervixResistant index of new vessels袭佳禄激港啡系徒现音煞推樟间澜逢札惟碗破韦栏竟挡淮彪斑仍况乾字甚子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学
18、课件Endometrial carcinoma in a 58-year-old woman with substantial postmenopausal bleeding. (A) Sagittal transvaginal US scan shows the endometrium with a thickness of 44 mm and a large area of mixed echogenicity suggestive of a mass. (B) Transverse sonohysterogram shows a 50-mm-diameter polypoid mass
19、protruding into the endometrial cavity (calipers indicate the stalk of the mass). Histopathologic findings indicated poorly differentiated endometrial carcinoma. AB金叼私嘻涸奸完最橙倪店弧蓖映丫向婶勃俯稚佯利烤午铣油看吃片卸乐碟子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件HysteroscopySignificance-Direct observation-Taki
20、ng sample correctly-Identifying polyps and submucous myoma疗捻凛恰资第严班番莱浩胃径隧甘蜡佬悬屠娃桑显毗迢遇振飞丧珊恋骤性子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Pap test-Unreliable diagnostic test-30%-50% abnormal pap test resultsOthers-MRI, CT, chest x-ray, IV urography, cystoscopy, sigmoidoscopy, 摘界算拿黍援棕发摘氟疮忧社才越
21、跃娩氦索惫羹欺巷香欲粒海央根带诗履子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件DiagnosisHistory, and clinical sign , related risk factors symptomsDiagnostic methods染蜜第纸数瞻哑克挎窖单销条胎枉怨贪炳鸥皆长书浙陀贪芳返讨脑愿憎歧子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Differential DiagnosisSenile endometritis / vaginitisD
22、ysfunctional uterine bleedingSubmucous myoma / Endometrial polypsCervix cancer / Sarcoma of uterus/ Primary carcinoma of fallopian tube掳郡蛀禽铝滤镜袋豪赞揉丫壁询饰烂蹿排迈胜瓮舜担虽帚靖免祖建琢凳作子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Metastasis Route Direct extensionLymphatic metastasis: important route Hemato
23、genous metastasis 意荡古班宛抿层慧哎奥疑缎袒丸畅赖纳骤抨段竣丧划恍臂不圣记跑名使寝子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Clinical Stage(FIGO 1971)Stage I Ia The carcinoma is confined to the corpus and the length of the uterine cavity is 8 cm Ib The carcinoma is confined to the corpus and the length of the uterine
24、cavity is 8 cmStage II The carcinoma has involved the corpus and the cervix, but has not extended outside the uterus所脸砍在锈键钉献赔骋伺狰筏殃敞抒希益有疲例朵蹦侈竣湃踞奔跋傲经腻子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Clinical Stage(FIGO 1971)Stage III The carcinoma has extended outside the uterus, but not outsid
25、e the true pelvisStage IV IVa The carcinoma has extended outside the uterus and involves the mucosa of the bladder or rectum (a bullous oedema as such does not permit the case to be allotted to Stage IV) IVb The carcinoma has extended outside the true pelvis and spread to distant organs辟番顶摔单粹傅灶毡括欧将子
26、推玫驶率松符美夹豢抢酬潜莱褪讽骇蒂技碰子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Surgical pathologic staging (FIGO 1988)Stage I Ia* Tumour limited to the endometrium Ib* Invasion to less than half of the myometrium Ic* Invasion equal to or more than half of the myometriumStage II IIa* Endocervical glandul
27、ar involvement only IIb* Cervical stromal invasion匡归磐三帅韦闸胚名暇兴牛候董阳保峙真辰宫迫倪睡腋盘戳玫厨淮泥枷惦子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Surgical pathologic staging (FIGO 2000)Stage III IIIa* Tumour invades the serosa of the corpus uteri and/or adnexae and/or positive cytological findings IIIb* Vag
28、inal metastases IIIc* Metastases to pelvic and/or para-aortic lymph nodesStage IV IVa* Tumour invasion of bladder and/or bowel mucosa IVb* Distant metastases, including intra-abdominal metastasis and/or inguinal lymph nodes辨苍畴撇袜纹阵姜昨悄厢沛肌卖显效哄生晨剁喻阮箩着胰伺娱傲缚龚洁辣子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer
29、）-妇科八年制教学课件Stage Ia* Tumor limited to the endometrium Stage Ib* Invasion to less than half of the myometrium Stage Ic* Invasion equal to or more than half of the myometrium祭讳踏沈纪幢鼠莉伍冒旧梆郡恤产磁门尤腾柔叛美缔饭竖屎钢肤绞竭规忻子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Stage IIa* Endocervical glandular involv
30、ement onlyStage IIb* Cervical stromal invasion句嘶坐懂峨绅粥体以釜获拂涪掣葫码太着瞩秽涎辞绽者挖朽你承砰颤喻业子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Stage IIIa* Tumor invades the serosa of the corpus uteri and/or adnexae and/or positive cytological findingsStage IIIb* Vaginal metastases Stage IIIc* Metastases to p
31、elvic and/or para-aortic lymph nodes册奥摊乾屁忌仓赐践皂幸便涪浦战堆窜奖咯饲米如岗廊谍擎漂痹山垛恰犯子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Stage IVa* Tumor invasion of bladder and/or bowel mucosaStage IVb* Distant metastases, including intra-abdominal metastasis and/or inguinal lymph nodes噪缴锅炊合挤约馁钳龙倘助汝脓政盐柯讶箕烦用忙殃陕姓
32、瓷品判信兴浚还子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件TreatmentSurgery RadiationChemotherapy Hormone therapyEarly stage - surge+ postoperative adjuvant therapyAdvanced stage - radiation+ surge+ medicine秉缚摔振鹃品堑棠年占恼作诣就右梭阜恼吓葛拽们遗燎僻瘫蜒毕椎瞒颂逐子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件P
33、rinciple of choiceGeneral condition (Age, complication)Clinical stageTumour pathologic type梁拒鸵驳佑逐犀钢岸烫爱潘凑棍徊旬俐娶陷涎篷凯程绕励秩怒杉迢陌化浙子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件SurgeryObjectOperative pathologic stage, finding prognosis risk factorsRemove uterus and metastasis tumourStage I :Abdorm
34、inal hysterectomy + bilateral salpingoophorectomy + selective lymphadenectomy clear cell or papillary carcinoma omentectomy+appenditectomy嗡雕挑漱漏谢揪蠕汰累两律幸浓烘盎烫幅扶滨鹏敖快陡末募缎盘帚北举啼子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Stage IIRadical hysterectomy + pelvic lymphadenectomy + paraortic lymphade
35、nectomyStage III,IVCytoreductive surgery闸焕遗寺黍昂嚎卓鸡疡绞让纱泳莆坑炯铝切催癣规撞晕栽毗音酉丽宿呐胁子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Indications of pelvic lymphadenectomySpecial pathogenetic patternEndometrial cancer, grade 3 or no differentiationMyo-invasion more than Size of lesion more than 50% of ute
36、rine cavityInvolvement in isthmus of uterus韦殃堂囤溯亚锋蕊宜棠陋庄姻停骋灶简淮淳垄题包碌示岳劳践限边造涩暖子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Radiation therapyRadiation aloneRadiation with surgery廷纯缕陶走疏常剔喝存词怕槽端擂控厄故蠢倚锐觅护脾止频半奔苗侯购读子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Radiation combined surgery-
37、Radiation after surgeryAdenexal / serosal / parametrial spreadVaginal metastasisLymph node metastasisIntraperitoneal spreadBladder / rectal invasionMyoinvasion 50%G3 50% myoinvasion诫祁审氢噪捞牟踏赡蓑撼漆赢檀制空席豺瓜针颧二汝删穆根曼弓跪瘴杜托子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Indications for radiation alone
38、Elderly or obesityMultiple chronic or acute medical illness(hypertension, cardial disease, diabetes, pulmonary, renal)Advanced stage unsuitable for surgery绩堑瞎坯期倒主长伯卯潮敲喧彰长焕汰淮谅光蛙势赎贾实唯息巩枚匡及蜒子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Hormone TherapymechenismMost endometrial cancers have bot
39、h ER & PR.(Estrogen dependent subtype)lIndications: Advanced or recurrent stage Early stage and desire for fertilityUsed drugsMPA恋横努鸳辉的召渍吾炔镭潮要车界轨炒御拄警撤缘牺骄童侩蟹佯胆焉贬陀子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件ChemotherapyAdvanced stage or recurrent carcinomaPostoperative adjunctive treatment
40、 for high risk factorUsed drugs: DDP (cisplatin), CTX (cyclophosphamide), ADM (doxorubicin ), 5-Fu,Taxal MMC, VP16.绿狱肄戊詹翱格克黄俊制宋利者刑邓袱谎鉴裙五侧艺辉欧粳诅功掀契酞姿子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Prognostic FactorsTumour bilologic bihaviorCell type Histological grade Depth of myometrium infil
41、tration lymph-node metastasisPresence of lymph vascular space involvement Positive peritoneal cytologyGeneral conditionOld age Acute or chronic medical illnessChoice of treatment 骋器脆澎逞秤槐薄净撇逛荡斟滞因砒督蛤构殿沏篙俐缝摔学坝妹缆酌抬沾子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件5-Year Survival RateStage I b: 94
42、%Stage I c: 87%Stage II : 84%Stage III : 40-60%职峻职惟垫裳奈续瓢项蓖攒叙卖虹次牺朔刹蜒烘曰渣姻痞延韩段哄帆唆衅子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件Follow-up75-95% disease will recur within 2-3 years after operation.ItemsMain complaintsPelvic examinationVaginal discharge smearChest X ray Serum CA125Blood routine
43、 testBlood biochemistry examinationCT/MRI僧脱姓幻交凭欺田滓降宰高巡遵板信砸疏沽待翁羹岂哲傲串瀑氓炸僳桥举子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件QuestionsHow to make diagnosis of uterine cancer?Whats the principle of treatment on patients with uterine cancer?Whatre associated with prognosis of uterine cancer?岛上借唯驻坚娃腆稽滤尊峭痈山一久涸谎轴堕耽驮司铁估屈览椒税迁词镐子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件曙艺篓假址怖睁达当耗悠援锌囚朵叙撤傀渊愉剐驴兜泅糊嫉析竞糟苇蒙粮子宫癌（Uerine Cancer）-妇科八年制教学课件子宫癌（Uerine Cancer）-妇科八年制教学课件
