The Dept. OB/GY of the first hospital of Xi’aThe Dept. OB/GY of the first hospital of Xi’an Jiao Tong university n 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%

Tran

sformation

zon

e

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

Ectophytic growthendophytic growthUlcerating growthEndocervial growth

Gross p

athology

Route for metastasis Direct extension Lymphatic metastasis

(the more advanced local disease, the greater likelihood of distant metastases) Blood-borne metastases

Clinical FIGO StagingStage I I 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 IV IV Extension beyond true pelvis, involvement of bladder or rectal mucosa.

Clin

ical find

ings

Clinical Finding:

⒉Signs Gross inspection

⒈Symptoms ：①Vaginal bleeding②Vaginal discharge③Pain④Involvement of adjacent organs⑤Cachexia

Early stage: postcoital bleedingMid and end stage ： blood stained leukorrhea, spotting, frank bleeding

White or sanguineous PurulentOdorousCopious

Unilateral, radiatingHip or thignAdvanced stage ，

Bladder involvementFrequency and difficulty in urination, bloody urinePainful bowel movementDiarrheaRectal symptoms ectophytic

endophytic ulcerating endocervical

Signs of metastasis

Frozen pelvis ： last stageThickened Parametrial tissueNo tumor-free space between cervix and pelvisIncarcerated uterus

① Pap smear

② Schiller test

③ Colposcopy and biopsy

④ Punch biopsy and ECC

Laboratory examinationDiagn

ostic p

rocedu

res

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 Ia1: total hysterectomy or conization

Ia2- IIb: radical hystrectomy+ pelvic lymphadenectomy

Ovarian preservation for young women

Treatment: operation, radiation therapy, chemotherapy

Radiation therapy Ib- IIb: 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/m2 1d }3WBIP BLM 15mg 1d IFO 1mg/m2 1-5d

DDP 50mg/m2 1dPVB BLM 20mg 1-3d }3W VCR 1mg/m2 1d

DDP 60mg/m2 1dPAM MTX 30mg/m2 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

单

选

题

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

lasia

Colposcopy is best used for the diag

nosis 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!