宫颈癌的诊断和治疗

Areas of abnormality(e.g., White epithelium, mosaicism, and punctation) are selectively punch biopsied.
Colposcopy Examination
Cone biopsy
Indications for cone biopsy
Direct extesion into adjacent structures or parametria, reaching to the obturator fascia and the wall of the true pelvis
How can we evaluate the patient?
How can we make a diagnosis?
CLINICAL TESTS: Pap smear Colposcopy and target biopsy Endocervical curettage (ECC) Cone biopsy Biopsy
Pap smear
and 5 days duration. Abnormal discharge with bad smell. LMP: 12 days ago Pap smear: squamous 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
Stage: Pelvic examination, Rectovaginal examination, Intravenous pyelography(IVP) Ultrasonography or CT
Staging is clinical, but can use IVP and CT Cervical cancer is the only gynecologic
As the maligancy enlarges, the bleeding episodes become heavier and more frequent, and they last longer.
SYMPTOMS
Late symptom or indicators of more advanced disease include the development of pain referred to the flank or leg.
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 adenocarcinoma in situ
How can we make a diagnosis?
A pap smear is only a screening test!
Definitive diagnosis of cervical cancer requires a BIOPSY!
How can we evaluate the patient?
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.
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).
malignancy that is not surgically staged
radiation Goal of treatment: cure, except stage 4b
Special Case
38 yrs, G3/P1, nurse C/O: postcoital bleeding for 2 months Menstruation regular with 30 days cycle
Histologic type:
Squmous cell carcinoma ( SCC) 80%
Adenocacinoma
10%-15%

Others
5%-10%
Routes of spread
Into the vaginal mucosa,extending microscopically down beyond visible or palpable disease;
How can we make a diagnosis?
SIGNS Vagina: mucous,
fornix Cervix:
erosion growth ulceration barrel-shaped Uterus: size, mobility Paramet: thickening
CERVICAL CANCER…..
How can we make 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?
SYMPTOMS
The 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, watery, blood-tinged vaginal discharge that frequently goes unrecognized by the patients.
Pap 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. Incomplete sampling could produce a false-negative smear.
Colposcopy and directed biopsy
A pap smear is only a screening test. A definitive diagnosis requires inspection of a well-visualized cervix with a colposcope.
Gross appearence
Three 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 endocervical canal, creating barrel-shaped lesion.
CERVICAL CANCER...
Diagnosis
＆
Treatment
CERVICAL CANCER...
The most common malignancy in gynecological oncology
Incidence: 7.8/100,000 Mortality: 2.7/100,000 Diagnosis: biopsy Main modality of treatment: surgery and
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 extensive pelvic wall disease are late manifestation of primary disease and frequent manifestations of recurrent disease.