The Dept. OB/GY of the first hospital of Xi’an Jiao Tong university The Dept. OB/GY of the first hospital of Xi’an Jiao Tong university Cervical carcinoma

Etiology Sexual activity HPV infection-16,18 types. Tobacco use Oral contraceptive pill Herpes simplex infection High-risk men etc

General considerations Dichotomy of its incidence in developed and developing countries Average age at diagnosis 51 years Model of a “controllable ” cancer 5-year survival for stage I >91%, stage IIA, stage IIIA, IV are 83%, 45%, 14%

Transformation zone

Pathology Squamous carcinoma: 80-95% Adenocarcinoma: 15% Adenosquamous carcinoma: 3-5%

Ectophytic growth endophytic growth Ulcerating growth Endocervial growth Gross pathology

Route for metastasis Direct extension Lymphatic metastasis (the more advanced local disease, the greater likelihood of distant metastases) Blood-borne metastases

Clinical FIGO Staging Stage II Strictly confined to cervix IA. Microscopically diagnosed preclinical lesion, stromal invasion with depth <5.0 mm and width < 7.0mm. IA1 Stromal invasion no greater than 3.0 mm and no wider than 7.0 mm IA2 Stromal invasion > 3 mm and < 5 mm, horizontal invasion < 7 mm IB Clinical lesions confined to cervix or preclinical lesions greater than stage IA. IB1 Clinical lesion no longer than 4.0 cm in size IB2 Clinical lesion greater than 4.0 cm in size Stage II II Extension beyond cervix but not to pelvic wall. Involves vagina, but not the lower third. IIA Involves vagina, but not lower third. No obvious extension to parametrium. IIB Involves vagina, but not lower third. Obvious parametrial involvement. Stage III III Extension to pelvic wall. On rectal exam, no cancer-free space between tumor and pelvic wall. Involves lower third of vagina. IIIA No extension to pelvic side wall. IIIB Extension to pelvic side wall. Stage IVIV Extension beyond true pelvis, involvement of bladder or rectal mucosa.

Clinical findings Clinical Finding: ⒉ Signs Gross inspection ⒈ Symptoms ： ① Vaginal bleeding ② Vaginal discharge ③ Pain ④ Involvement of adjacent organs ⑤ Cachexia Early stage: postcoital bleeding Mid and end stage ： blood stained leukorrhea, spotting, frank bleeding White or sanguineous Purulent Odorous Copious Unilateral, radiating Hip or thign Advanced stage ， Bladder involvement Frequency and difficulty in urination, bloody urine Painful bowel movement Diarrhea Rectal symptoms ectophytic endophytic ulcerating endocervical Signs of metastasis Frozen pelvis ： last stage Thickened Parametrial tissue No tumor-free space between cervix and pelvis Incarcerated uterus

① Pap smear ② Schiller test ③ Colposcopy and biopsy ④ Punch biopsy and ECC Laboratory examination Diagnostic procedures ⑤ Conization ⑥ Chest X-ray, IVP, lymphoangiography, cystoscopy, CBC, barium enema, chemistry

Differential diagnosis Chronic cervicitis Cervical TB Cervical papilloma Cervical metastasis of endometrial carcinoma

Treatment: operation, radiation therapy, chemotherapy Operation: IA-IIb I a1 : total hysterectomy or conization I a2- II b: radical hystrectomy+ pelvic lymphadenectomy Ovarian preservation for young women

Treatment: operation, radiation therapy, chemotherapy Radiation therapy I b- II b: poor surgical candidates Patients with more advanced diseases More extensive LN involvement High-dose external beam + intracavitary irradiation Ovarian function destroyed Complications: radiation cystitis and proctitis Preoperative or postoperative

1. Cisplatin based regimen. 2. Adjuvant treating modality to operation and radiation. 3. Systematic administration or radiographic interventional therapy Treatment: operation, radiation therapy, chemotherapy

regimens (squamous carcinoma) DDP 50mg/m 2 1d } 3W BIP BLM 15mg 1d IFO 1mg/m 2 1-5d DDP 50mg/m 2 1d PVB BLM 20mg 1-3d } 3W VCR 1mg/m 2 1d DDP 60mg/m 2 1d PAM MTX 30mg/m 2 1d } 3W ADM 50mg 1d

Prognosis Stage, LN invasion, tumor volumn, depth of cervical stromal invasion, pathologicla type 5-year survival for stage I >91%, stage IIA, stage IIIA, IV are 83%, 45%, 14% Uremia Hemorrhage Infection Cachexia Follow-up study

复习题 Cervical carcinoma is most likely to arise from A ． Squamous epithelium B ． Columnar epithelium C ． SCJ D ． Endocervical epithelium E ． Squamous epithelium undergoing hyperplasia

Colposcopy is best used for the diagnosis of : A Submucous myoma B Endometriosis C Endometrial carcinoma D Cervical carcinoma E Endometrial polyp

she ， 35y ， increased amount of vaginal discharge for 1 y ， occasional postcoital bleeding ， yellow vaginal discharge without odor, chronic pain in the lower back. Signs: cervical erosion II, granule, normal pelvis. Cervical cytology: ± she should receive which following procedure: A ． Repeat pap smear and cytological evaluation B ． Ioding test C ． Colposcopy + biopsy D ． Diagnostic curretage E ． Hysteroscopy

谢 谢 ！ Thanks!