《妇产科学》课程授课教案（讲义）子宫内膜癌 Endometrial Carcinoma

EndometrialCarcinoma 子宫内膜癌、一、教学目的及重点：2．了解子宫内膜癌的发病相关因素3．熟悉子宫内膜癌的病理类型。4.掌握子宫内膜癌的临床表现和诊断。5、熟悉子宫内膜癌的处理。二、教学方法：紧密结合临床实际，提问式讲解教材并举例说明。三、教学重点和难点：1、子宫内膜癌的处理。2、子宫内膜癌的临床表现和诊断。四、教学内容：EndometrialCarcinoma 子宫内膜癌carcinoma of corpus uteri 子宫体癌1 of 3 common malignant tumors of female reproductive systemEpidemiology（流行病学）age 58 -- 6175% postmenopause25% pre-menopause(5% < age 40)Risk factors1. Estrogen-dependent

Endometrial Carcinoma 子宫内膜癌 1. 一、教学目的及重点： 2. 了解子宫内膜癌的发病相关因素。 3. 熟悉子宫内膜癌的病理类型。 4. 掌握子宫内膜癌的临床表现和诊断。 5、熟悉子宫内膜癌的处理。 二、教学方法：紧密结合临床实际,提问式讲解教材并举例说明。 三、教学重点和难点: 1、子宫内膜癌的处理。 2、子宫内膜癌的临床表现和诊断。 四、教学内容: Endometrial Carcinoma 子宫内膜癌 carcinoma of corpus uteri 子宫体癌 1 of 3 common malignant tumors of female reproductive system Epidemiology（流行病学） age 58 - 61 75% postmenopause 25% pre-menopause ( 5% < age 40 ) Risk factors 1. Estrogen-dependent

(1) Exogenous estrogen stimulationestrogen replacement therapy (ERT)Tamoxifen(它莫西芬)(2)Endogenousestrogen stimulationpolyeystic ovary syndrome (PCOS)ovarian granulosa cell tumorRisk factors2. Diabetes,Obesity ，Hypertension3 Genetics factor(20%)family historyEnd ometrial HyperplasiaSimple (cystic) hyperplasia 1%Complex (adenomatous) hyperplasia 3%Atypical hyperplasia 1/3 PathologyGross PathologyDiffuse esionsFocal lesionsHistological types1.Endometriod adenocarcinoma（内膜样腺癌）2.Adenocarcinoma with squmous differentiation（腺癌伴鳞状上皮分化）4~5%

(1) Exogenous estrogen stimulation estrogen replacement therapy (ERT) Tamoxifen(它莫西芬) (2) Endogenous estrogen stimulation polycystic ovary syndrome (PCOS) ovarian granulosa cell tumor Risk factors 2. Diabetes， Obesity ，Hypertension 3. Genetics factor family history ( 20% ) Endometrial Hyperplasia Simple (cystic) hyperplasia 1% Complex (adenomatous) hyperplasia 3% Atypical hyperplasia 1/3 Pathology Gross Pathology Diffuse lesions Focal lesions Histological types 1.Endometriod adenocarcinoma （内膜样腺癌） 2.Adenocarcinoma with squmous differentiation （腺癌伴鳞状上皮分化） 4~5%

(1）adenoacanthoma 腺棘皮癌（腺癌+正常鳞状上皮）(2）adenosqumous carcinoma 腺鳞瘤（腺癌+鳞癌）Histological types3.Otheruncommon types 10~15%Serous carcinoma（浆液性癌）（透明细胞癌）Clear-cell carcinomaMixedtypes（混合型）Spread PattermsDirect extension（直接蔓延）Lymphatic spread（淋巴转移）（血行播散）Hematogenous spreadStagingClinical Staging（临床分期）Surgically pathological staging（手术病理分期）Clnical FindingsSymptomsVaginal beeding （阴道流血）postmenopausal bleding（绝经后阴道流血）

(1) adenoacanthoma 腺棘皮癌 ( 腺癌 +正常鳞状上皮 ) (2) adenosqumous carcinoma 腺鳞癌 ( 腺癌+鳞癌 ) Histological types 3. Other uncommon types 10~15% Serous carcinoma （浆液性癌） Clear-cell carcinoma （透明细胞癌） Mixed types（混合型） Spread Patterns Direct extension（直接蔓延） Lymphatic spread（淋巴转移） Hematogenous spread （血行播散） Staging Clinical Staging（临床分期） Surgically pathological staging （手术病理分期 ） Clinical Findings Symptoms Vaginal bleeding（阴道流血） postmenopausal bleeding （绝经后阴道流血）

Vaginal discharge（阴道排液）Gynecologic examination(妇科检查)Uterine enlargement UltrasonographyEndometrial thickness ≥5mmFractional dilation and curettage ( D&℃)DiagnosisVaginal beedingUterine enlargement Endometrial thickness ≥ 5mmendometrial sample（D&c)Differentiation DiagnosisDysfunctional uterine bleeding(功能失调性子宫出血)Cervical cancerTreatment（首选手术）1. OperationStage Itotal abdominal hysterectomy经腹全子切除）+bilateralsalpingo-0ophorectomy双侧输卵管卵巢切除StagelIradical hysterectomy广泛子宫切除+lymphanodesampling淋巴结取样（pelvic,paraaortic盆腔淋巴结及腹主动脉淋巴结）Treatment2. Radiation therapy

Vaginal discharge (阴道排液） Gynecologic examination (妇科检查) Uterine enlargement Ultrasonography Endometrial thickness ≧5mm Fractional dilation and curettage（ D & C ） Diagnosis Vaginal bleeding Uterine enlargement Endometrial thickness ≧5mm endometrial sample （ D & C ） Differentiation Diagnosis Dysfunctional uterine bleeding (功能失调性子宫出血) Cervical cancer Treatment 1. Operation （首选手术） Stage I total abdominal hysterectomy 经 腹 全 子 切 除 ） +bilateral salpingo-oophorectomy 双侧输卵管卵巢切除 Stage II radical hysterectomy 广泛子宫切除 + lymphanode sampling 淋巴结取样( pelvic, paraaortic 盆腔淋巴结及腹主动脉淋 巴结 ) Treatment 2. Radiation therapy

(放射治疗)3.High efficiency progestin（高效孕激素）五、复习思考题1、子宫内膜癌的病理类型？2、子宫内膜癌的临床表现和诊断？3、子宫内膜癌的处理？

(放射治疗） 3. High efficiency progestin （高效孕激素） 五、复习思考题 1、子宫内膜癌的病理类型？ 2、子宫内膜癌的临床表现和诊断？ 3、子宫内膜癌的处理？