扬州大学：《妇产科学》课程教学课件（PPT讲稿）33 宫颈癌的诊断与治疗 CERVICAL CANCER Diagnosis ＆Treatment

CERVICAL CANCERDiagnosis&Treatment

CERVICAL CANCER. Diagnosis ＆ Treatment

CERVICAL CANCER..Themost common malignancy in gynecologicaloncologyIncidence:7.8/100000Mortality:2.7/100,000Diagnosis:biopsyMain modality of treatment: surgery and radiationGoal oftreatment: cure, except stage 4b

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 radiation Goal of treatment: cure, except stage 4b

Special Case38yrs,G3/P1,nurseC/O:postcoitalbleedingfor2monthsMenstruationregular with30dayscycle and5daysduration.Abnormal discharge with bad smell.LMP:12daysagoPapsmear:squamouscell cancerPV:Vulva :Normal,Vaginal:yellowishdischarge withbloody stainedCervix:growth with ulceration and contact bleedingUterus:N/S,mobileParametrium:thickening nottopelvic sidewall onboth side

Special Case 38 yrs, G3/P1, nurse C/O: postcoital bleeding for 2 months Menstruation regular with 30 days cycle 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

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?Canweprevent cervicalcancer?

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?

How can we make a diagnosis?SYMPTOMSAbnormal vaginalbleeding postcoitalbleeding*contactbleedingAbnormal vaginal dischargeAsymptomatic,just abnormal papsmear

How can we make a diagnosis? SYMPTOMS Abnormal vaginal bleeding postcoital bleeding* contact bleeding Abnormal vaginal discharge Asymptomatic, just abnormal pap smear

SYMPTOMSThe classic symptom is intermittent, painlessmetrorragia or spotting only postcoitally or afterdouching.Probably the first symptom of early cancer of thecervix is a thin, watery, blood-tinged vaginaldischarge that frequently goes unrecognized by thepatients.As the maligancy enlarges, the bleeding episodesbecome heavier and more frequent, and they lastlonger

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. As the maligancy enlarges, the bleeding episodes become heavier and more frequent, and they last longer

SYMPTOMSLate symptom or indicators of more advanced diseaseinclude the development of pain referred to the flank or legMany patients c/o dysuria, hematuria or rectal bleeding orobstipation resulting from bladder or rectal invasion.Distant metastasis and persistent edema of one or both lowerextremities as a result of lymphatic and venous blockage byextensive pelvic wall disease are late manifestation ofprimary disease and frequent manifestations of recurrentdisease

SYMPTOMS Late symptom or indicators of more advanced disease include the development of pain referred to the flank or leg. 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

How can we make a diagnosis?SIGNSVagina:mucous,fornixCervix:erosiongrowthulcerationbarrel-shapedUterus:size,mobilityParamet:thickening

How can we make a diagnosis? SIGNS Vagina: mucous, fornix Cervix: erosion growth ulceration barrel-shaped Uterus: size, mobility Paramet: thickening

Gross appearenceThree categories of gross lesions havetraditionally beendescribed.The most common is the exophytic lesion, which usuallyarises on the ectocervix and oftergrows to form a largefriable,polypoid mass, arises on the endocervical canal,creating barrel-shaped lesion.Little visible ulceration or exophytic mass like a stone-hardcervix that regresses slowly with radiation therapy.Ulcerative tumor,usually erodes a portion of the cervix orreplacing the cervix,erodes a portion of the upper vaginalvault with alarge crate

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. 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