大学精品课件:妇产科第22章第4节宫颈癌 双语 范江涛.ppt
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1、CERVICAL CANCER,子 宫 颈 癌,广西医科大学第一附属医院 妇科 范江涛,掌握宫颈癌临床表现和诊断、防治措施 熟悉宫颈癌病理和临床分期 了解宫颈癌流行病学及病因、癌组织发生与发展、转移的途径。,学习的目的和要求,overview,the second leading cause of cancer related deaths among women across the world 500,000 cases per year, and 250,000 deaths 80% of cases and deaths in developing countries 150,000
2、new cases accounting for 1/3 cases of the world, 80,000 died per year in China Cervical screening program decreased incidence of cervical cancer(CC) by 7% per year,etiology,Human PapillomaVirus (HPV) infection other risk factors,RISK FACTORS,Multiple sexual partners Early onset of sexual activity Lo
3、w socioeconomic status Long-term oral contraceptive use High parity cigarette smoking,HPV INFECTION,HPVs are major etiologic factor in the development of CIN and cervical cancer about 100% cervical cancer and 80% CIN are HPV positive Low-risk HPV: 6, 11, 42, 43, 44 and so on are associated to CINand
4、 condyloma (genital warts) High risk HPV: 14 types including HPV16, 18, 31, 33,35, 56, 58.CIN/ and cervical cancer,HPV16/18 accounts for 70% cases of cervical cancer HPV infection is temporary, disappearing within 12 months 10-15% will persistence,induced CIN,HPV INFECTION,Mechanisms of HPV inducing
5、 CC,HPV contains E6, E7 oncogenes, produced E6, E7 oncoproteins combined with P53 and RB proteins(tumor suppressor proteins), disabling cell cycle arrest and then result in host cell immortalization and malignant transformation.,HPV感染(human papilloma virus, 人乳头状瘤病毒): 90%以上的CIN有HPV感染,HPV感染后的挖空细胞,感染的早
6、期宫颈上皮细胞变成挖空细胞(koilocystosis) CIN:低危型6,11,31,35. CIN:高危型16,18,33.,(cervical intraepithelial neoplasia, CIN),宫颈上皮内瘤变,1、宫颈组织学特点:,子宫颈是一圆柱形组织,长约2.53cm。分为 宫颈阴道部:鳞状上皮 宫颈管部:柱状上皮,鳞-柱交接,组织发生和发展,宫颈复层鳞状上皮,正常宫颈,宫颈阴道部:为复层鳞状上皮 宫颈管部:柱状上皮,移行带区:在原始鳞-柱交接部和生理性鳞-柱交接部间所形成的区域称移行带区 鳞-柱交接部(squamoucolumnar junction,SCJ):宫颈鳞状
7、上皮与柱状上皮交接部,(鳞柱交界),原始鳞-柱交接部:胎儿期宫颈鳞状上皮与柱状上皮交接部 生理性原始鳞-柱交接部:随体内雌激素水平变化而移位的鳞-柱交接部,也称新鳞-柱交界,移行带区(Transformation Zone),鳞柱交接,移行带区(Transformation Zone),Squamo-columnar junction (SCJ),Squamo-columnar junction (SCJ) is the line along which the stratified squamous epithelium meets the columnar epithelium of th
8、e endocervix. This junction is generally within the canal before puberty period, easily visible during the reproductive years. Frequently there is eversion of the columnar epithelium (ectopy). During menopause the columnar epithelium ascends into the endocervical canal.,puberty,reproductive,menopaus
9、e,postmenopause,胎儿新生儿幼女期青春、生育期绝经期 原始 外移 内移 外移 内移,雌激素,为宫颈癌的好发部位 90%宫颈癌来源该区,移行带区形成的过程实际上是鳞状上皮替代柱状上皮的过程 替代的方式有二种: 1、鳞状上皮化生(squamous metaplasia) 2、鳞状上皮化(squamous epithelization),移行带区形成机制,a common process in the transformation zone. The gradurally replacement of columnar epithelium with the stratified sq
10、uamous epithelium due to the proliferation of reserve cells under the columnar cell layer, with the influence of the acid environment in vagina.,(Squamous Metaplasia),柱状上皮,储备细胞,复层鳞状细胞,鳞状上皮化生,化生并非不典型增生,宫颈阴道部鳞状上皮直接长入柱状上皮与其基底膜之间而替代柱状上皮,此上皮与正常的鳞状上皮相同。,(squamous epithelization),鳞状上皮化,90%宫颈癌起源于宫颈移行带,在移行带形
11、成过程当中,未成熟的化生鳞状上皮细胞,代谢活跃,在一些物质(如HPV、精子、精液组蛋白等)的刺激下,可发生细胞分化不良,排列紊乱,细胞核异常,有丝分裂增加,形成CIN浸润癌,Pathology of CIN,CIN I : cellular with mild dysplasia. The dysplasia cells are limited under 1/3 normal epithelial line. CIN II: cellular with moderate dysplasia. The dysplasia cells are limited under 1/32/3 norma
12、l epithelial line. CIN III: cellular with severe dysplasia as well as carcinoma in situ. The all of normal epithelial line is involved by dysplasia cells.,carcinoma in situ,Preinvasive malignancy limited to the epithelium without invasion of the basement membrane. CINIII encompasses the squamous car
13、cinoma in situ,CIN临床表现,无特殊症状,偶有阴道排液增多,可有宫颈接触性出血。妇检:宫颈可光滑,或见局部红斑、白色上皮或宫颈糜烂样改变,未见明显病灶。,CIN诊断,辅助检查 1.宫颈细胞学检查:筛查手段,特异性高,敏感性低; 2.高危型HPV-DNA检测:敏感性高,特异性低,可与细胞学联 合筛查,也可用于细胞学异常的分流; 3.阴道镜检查:当细胞学为ASC-US并高危型HPV阳性,或LSIL 及以上者,应行阴道镜检查。 4.子宫颈活组织检查:确诊最可靠方法。多点活检,阴道镜指 示下。必要时宫颈管内膜刮取(endocervical curettage,ECC),CIN的治疗,C
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