Cervical tumor
Cervical intraepithelial
neoplasia(CIN)
Introduction
A group of precancerous lesion closely associated with
the cervical cancer,which reflect the continuous process
of the development of the cervical cancer.
1.CIN caused by virus infection rarely develop cervical
cancer
2.CIN caused by multifactors may develop cervical
cancer.
3.TBS diagnosing system by NCI
(1).atypical squamous cells,ABC.
(2).low-grade squamous intraepithelial lesion,LSIL.
(3).high-grade squamous intraepithelial lesion,HSIL.
LSIL means CIN I,rarely develop cervical cancer.
HSIL menas CIN II and III,may develop cervical cancer.
Etiology
? HPV(human papillomaviruses) infection
? Epidemiologic risk factors for CIN:
1,multiple sexual partners
2,high-risk sexual partner
3,early onset of sexual activity(<16)
4,a history of STDs(especially,HPV infection)
5,cigarette smoking
6,immunodeficiency
7,long-tem oral contraceptive pill use
Cervical Histological Specialty
(i).primal squamo-columnar junction
(ii).physiologic squamo-columnar junction
(iii).transformation zone
(iv).squamous metaplasia
(v).squamous epithelization
Pathology
Cervical intraepithelial neoplasia(CIN)
degree I,ie,mild dysplasia,
heterotype cells occupy lower 1/3 layer
degree II,ie,moderate dysplasia,
heterotype cells occupy the lower 2/3 layer
degree III,ie,severe dysplasia and carcinoma in situ,
heterotype cells occupy whole layer
Clinical findings
?Usually no symptoms or signs
?Early detection is extremely important
Diagnosis
?Repeated cervical ctyology--TCT
?Colposcopic examination
?Biopsy— the most reliable method to
make diagnosis
诊断,CIN I级
诊断,CIN I级
诊断,CIN II级
诊断,CIN II级
诊断,宫颈原位癌
诊断,宫颈原位癌
Treatment
? CINI:Cryotherapy can be used in small,limited
lesions,with an effective rate of 95%.For
lesions involving vagina or glands,laser
ablation is used with an effective rate of 93%.
? CINII:Cryotherapy(94% effective rate),laser
ablation(92% effective rate) or cone excision
can be used according to the range of lesion
? CINIII:Hysterectomy is recommended,Cone
excision is used in young patients when
infertility is desired.
Cervical cancer
Introduction
?The most common gynecologic cancers
?Usually occurs between 35~39 and
60~64.The average age at diagnosis of
patients with cervical cancer is 52.2
years old.
Etiology
i.early marriage,early sexual activity and
delivery,deranged sexual activity,poor
economy and multipara
ii.the women who has sexual activity with high-
risk man
iii.virus infection through sexual activity,such
as herpes simplex virus II type,human
papilloma virus and cytomegalovirus
Histological genesis and development
Most cervical cancer occurs on the transformation zone.
Unmature metaplastic squamous cells metabolize acti-
vely,and may develop cervical cancer under the stimu-
Lation of some factor
Pathology
I,squamous carcinoma:
account for 80%~85% of cervical cancer
(1)macro examination:
There is no obvious difference among CIN,microscopic
invasive cancer and early stage of invasive cancer
(a).exogenic cancer:the most common type
(b).endogenous cancer
(c).ulcer type cancer
(d).cervical canal type cancer
(2)microscopic examination
(a).microscopic invasive cancer,tear-drop or
serrate cancer cell group growing through basal
membrane
(b).invasive cervical cancer,invasiveness of
stroma is beyond the microscopic invasive
cancer,and according to the cellular differentiation it
is divided into 3 degrees:
degree I:cornified large cell type,mitosis<2/HP
degree II:uncornified large cell type,mitosis 2~4/HP
degree III:small cell type,mitosis>4/HP
2,adenocarcinoma,account for 15% of cervical Ca,
(1).macro examination:
originate from cervical canal,invade canal wall and
paracervical tissue,protrude the external OS,focus
appearance,cervical appearance
(2).microscopic examination
(a).mucous adenocarcinoma,origination,polyp
protruding in gland cavity,stratified epithelium,nuclear
atypia and mitosis is obvious
(b).malignant cervical adenoma,also called
microdeviation adenocarcinoma,tumor cell,gland,tumor
epiderm,deeply invasion
(c).squamoadenocarcinoma:origination,resulting
from,close combination,transformation
Metastatic path
i,direct spreading,the most common
way,exogenic type,cervical canal type
ii,lymphatic metastasis,tumor embolus in
lymphatic space,the first group of LN,the
second group of LN
iii,blood metastasis,extremely less
Clinical stage:adopting FIGO(2000) stage
Stage I cancer focus is located in the cervix
Ia invasiveness can only be seen under microscope,the depth
of stroma invading≤5mm,width ≤ 7mm
Ia1 the depth of stroma invading ≤ 3mm,,width≤7mm
Ia2 the depth of stroma invading >3mm,≤5mm,width ≤ 7mm
Ib clinically seen cancer focus is located in the cervix,superficial
invasive cancer can be seen,preclinical focus range is beyond
the stage Ia
Ib1 clinical cancer volume ≤ 4cm
Ib2 clinical cancer volume>4cm
Stage II cancer focus is beyond cervix but not reach pelvic
wall,involving vagina but not reach the low 1/3
IIa cancer chiefly spread to vagina,
no obvious paracervical infiltration
IIb cancer chiefly spread to paracervical tissue,
Stage III cancer focus reach low 1/3 of vagina and /or
pelvic wall,there may be hydronephrosis or
unfunctional kidney
IIIa chiefly spread to vagina and reach low 1/3
IIIb chiefly spread to paracervical tissue and reach pelvic
wall or there is hydronephrosis or unfunctional kidney
Stage IV the cancer spread beyond the true pelvis or
infiltrate the mucosa of rectum or bladder
IVa infiltrating the mucosa of rectum or bladder
IVb spreading beyond the true pelvis
Clinical manifestation
symptoms:at early stage,cervical canal cancer
(i).vaginal bleeding:
young patients manifest contacting bleeding,senile
patient,exogenic cancer,endogenous cancer
(ii).vaginal discharge:
white or bloody discharge,purulent or ricewater-like
discharge
(iii).symptoms of late stage cancer:
depending upon the infiltrating range,in severe
case,at end stage
Clinical manifestation
body signs
(i).at CIN,microinvasive and early invasive cancer
(ii).with the further development of invasive cancer there
will be
i).exogenic type,
ii)endogenous type,
iii)late stage,
iv)neighbor infiltration
Diagnosis
i.cervical smear for cytologic examination
ii.iodine test
iii.nitrogen molecular laser tumor intrinsic
fluorescence
iv.colposcopy
v.biopsy of cervix and cervical canal:the most
reliable method to make diagnosis
vi.cervical conization
Differential diagnosis
cervical erosion,
cervical polyp,
cervical TB,
cervical papilloma
endometriosis
Management
(i).surgical treatment:indication Ia~Ⅱ b early stage
Ia1,total hysterectomy,If ovary is normal,
ovary should be reserved.
Ia2-Ⅱ b (early stage), radical hysterectomy with
pelvic lymphadenectomy,If ovary is
normal,ovary should be reserved.
(ii).radiotherapy:
intracavity irradiation,extrinsic irradiation
Indication,Ⅱ b late stage,III,IV;
can not endure operation
Management
(iii).comprehensive treatment of operation
and radiotherapy,
Preoperation radiation:locally advanced cervical
cancer
Postoperation radiation:If there is lymph nodes,
or parametrail involvement
(iv).chemotherapy:
Indication,late stage or recurrent cervical
cancer,
Prognosis
? associated with clinical stage,
pathologic type and treating method.
? chief cause of death at late stage
1,Uremia
2,Hemorrhage
3,Infection
4,Cachexia
Prophylaxis
I popularization of cancer prevention knowledge,
sugesting late marriage,less birth and sexual health
education
II.the screening and mass treatment of cervical cancer
should be made regularly
III.treating moderate and severe cervical erosion
actively,CIN should be diagnosis and treated early to
stop the development of cervical cancer
Follow up
The first follow up is in 1 month after
discharge,then once a time every 2~3 month
within 1 year.in the second year once a time
every 3~6 month.during 3~5 years after
discharge once a time each year,The
contents of the follow up include clinical
examination,regular chest X-ray and blood
RT
Cervical intraepithelial
neoplasia(CIN)
Introduction
A group of precancerous lesion closely associated with
the cervical cancer,which reflect the continuous process
of the development of the cervical cancer.
1.CIN caused by virus infection rarely develop cervical
cancer
2.CIN caused by multifactors may develop cervical
cancer.
3.TBS diagnosing system by NCI
(1).atypical squamous cells,ABC.
(2).low-grade squamous intraepithelial lesion,LSIL.
(3).high-grade squamous intraepithelial lesion,HSIL.
LSIL means CIN I,rarely develop cervical cancer.
HSIL menas CIN II and III,may develop cervical cancer.
Etiology
? HPV(human papillomaviruses) infection
? Epidemiologic risk factors for CIN:
1,multiple sexual partners
2,high-risk sexual partner
3,early onset of sexual activity(<16)
4,a history of STDs(especially,HPV infection)
5,cigarette smoking
6,immunodeficiency
7,long-tem oral contraceptive pill use
Cervical Histological Specialty
(i).primal squamo-columnar junction
(ii).physiologic squamo-columnar junction
(iii).transformation zone
(iv).squamous metaplasia
(v).squamous epithelization
Pathology
Cervical intraepithelial neoplasia(CIN)
degree I,ie,mild dysplasia,
heterotype cells occupy lower 1/3 layer
degree II,ie,moderate dysplasia,
heterotype cells occupy the lower 2/3 layer
degree III,ie,severe dysplasia and carcinoma in situ,
heterotype cells occupy whole layer
Clinical findings
?Usually no symptoms or signs
?Early detection is extremely important
Diagnosis
?Repeated cervical ctyology--TCT
?Colposcopic examination
?Biopsy— the most reliable method to
make diagnosis
诊断,CIN I级
诊断,CIN I级
诊断,CIN II级
诊断,CIN II级
诊断,宫颈原位癌
诊断,宫颈原位癌
Treatment
? CINI:Cryotherapy can be used in small,limited
lesions,with an effective rate of 95%.For
lesions involving vagina or glands,laser
ablation is used with an effective rate of 93%.
? CINII:Cryotherapy(94% effective rate),laser
ablation(92% effective rate) or cone excision
can be used according to the range of lesion
? CINIII:Hysterectomy is recommended,Cone
excision is used in young patients when
infertility is desired.
Cervical cancer
Introduction
?The most common gynecologic cancers
?Usually occurs between 35~39 and
60~64.The average age at diagnosis of
patients with cervical cancer is 52.2
years old.
Etiology
i.early marriage,early sexual activity and
delivery,deranged sexual activity,poor
economy and multipara
ii.the women who has sexual activity with high-
risk man
iii.virus infection through sexual activity,such
as herpes simplex virus II type,human
papilloma virus and cytomegalovirus
Histological genesis and development
Most cervical cancer occurs on the transformation zone.
Unmature metaplastic squamous cells metabolize acti-
vely,and may develop cervical cancer under the stimu-
Lation of some factor
Pathology
I,squamous carcinoma:
account for 80%~85% of cervical cancer
(1)macro examination:
There is no obvious difference among CIN,microscopic
invasive cancer and early stage of invasive cancer
(a).exogenic cancer:the most common type
(b).endogenous cancer
(c).ulcer type cancer
(d).cervical canal type cancer
(2)microscopic examination
(a).microscopic invasive cancer,tear-drop or
serrate cancer cell group growing through basal
membrane
(b).invasive cervical cancer,invasiveness of
stroma is beyond the microscopic invasive
cancer,and according to the cellular differentiation it
is divided into 3 degrees:
degree I:cornified large cell type,mitosis<2/HP
degree II:uncornified large cell type,mitosis 2~4/HP
degree III:small cell type,mitosis>4/HP
2,adenocarcinoma,account for 15% of cervical Ca,
(1).macro examination:
originate from cervical canal,invade canal wall and
paracervical tissue,protrude the external OS,focus
appearance,cervical appearance
(2).microscopic examination
(a).mucous adenocarcinoma,origination,polyp
protruding in gland cavity,stratified epithelium,nuclear
atypia and mitosis is obvious
(b).malignant cervical adenoma,also called
microdeviation adenocarcinoma,tumor cell,gland,tumor
epiderm,deeply invasion
(c).squamoadenocarcinoma:origination,resulting
from,close combination,transformation
Metastatic path
i,direct spreading,the most common
way,exogenic type,cervical canal type
ii,lymphatic metastasis,tumor embolus in
lymphatic space,the first group of LN,the
second group of LN
iii,blood metastasis,extremely less
Clinical stage:adopting FIGO(2000) stage
Stage I cancer focus is located in the cervix
Ia invasiveness can only be seen under microscope,the depth
of stroma invading≤5mm,width ≤ 7mm
Ia1 the depth of stroma invading ≤ 3mm,,width≤7mm
Ia2 the depth of stroma invading >3mm,≤5mm,width ≤ 7mm
Ib clinically seen cancer focus is located in the cervix,superficial
invasive cancer can be seen,preclinical focus range is beyond
the stage Ia
Ib1 clinical cancer volume ≤ 4cm
Ib2 clinical cancer volume>4cm
Stage II cancer focus is beyond cervix but not reach pelvic
wall,involving vagina but not reach the low 1/3
IIa cancer chiefly spread to vagina,
no obvious paracervical infiltration
IIb cancer chiefly spread to paracervical tissue,
Stage III cancer focus reach low 1/3 of vagina and /or
pelvic wall,there may be hydronephrosis or
unfunctional kidney
IIIa chiefly spread to vagina and reach low 1/3
IIIb chiefly spread to paracervical tissue and reach pelvic
wall or there is hydronephrosis or unfunctional kidney
Stage IV the cancer spread beyond the true pelvis or
infiltrate the mucosa of rectum or bladder
IVa infiltrating the mucosa of rectum or bladder
IVb spreading beyond the true pelvis
Clinical manifestation
symptoms:at early stage,cervical canal cancer
(i).vaginal bleeding:
young patients manifest contacting bleeding,senile
patient,exogenic cancer,endogenous cancer
(ii).vaginal discharge:
white or bloody discharge,purulent or ricewater-like
discharge
(iii).symptoms of late stage cancer:
depending upon the infiltrating range,in severe
case,at end stage
Clinical manifestation
body signs
(i).at CIN,microinvasive and early invasive cancer
(ii).with the further development of invasive cancer there
will be
i).exogenic type,
ii)endogenous type,
iii)late stage,
iv)neighbor infiltration
Diagnosis
i.cervical smear for cytologic examination
ii.iodine test
iii.nitrogen molecular laser tumor intrinsic
fluorescence
iv.colposcopy
v.biopsy of cervix and cervical canal:the most
reliable method to make diagnosis
vi.cervical conization
Differential diagnosis
cervical erosion,
cervical polyp,
cervical TB,
cervical papilloma
endometriosis
Management
(i).surgical treatment:indication Ia~Ⅱ b early stage
Ia1,total hysterectomy,If ovary is normal,
ovary should be reserved.
Ia2-Ⅱ b (early stage), radical hysterectomy with
pelvic lymphadenectomy,If ovary is
normal,ovary should be reserved.
(ii).radiotherapy:
intracavity irradiation,extrinsic irradiation
Indication,Ⅱ b late stage,III,IV;
can not endure operation
Management
(iii).comprehensive treatment of operation
and radiotherapy,
Preoperation radiation:locally advanced cervical
cancer
Postoperation radiation:If there is lymph nodes,
or parametrail involvement
(iv).chemotherapy:
Indication,late stage or recurrent cervical
cancer,
Prognosis
? associated with clinical stage,
pathologic type and treating method.
? chief cause of death at late stage
1,Uremia
2,Hemorrhage
3,Infection
4,Cachexia
Prophylaxis
I popularization of cancer prevention knowledge,
sugesting late marriage,less birth and sexual health
education
II.the screening and mass treatment of cervical cancer
should be made regularly
III.treating moderate and severe cervical erosion
actively,CIN should be diagnosis and treated early to
stop the development of cervical cancer
Follow up
The first follow up is in 1 month after
discharge,then once a time every 2~3 month
within 1 year.in the second year once a time
every 3~6 month.during 3~5 years after
discharge once a time each year,The
contents of the follow up include clinical
examination,regular chest X-ray and blood
RT
