Carcinoma of the uterus 子宫肿瘤,Department of Obstetrics and Gynecology妇 产 科Zhang Wei张 蔚,Endometrial carcinoma 子宫内膜癌,Cervical tumors 宫颈肿瘤,Cervical intraepithelial neoplasia (CIN)宫颈上皮内瘤样变 Cervical cancer 宫颈癌,Carcinoma of the uterus 子宫肿瘤,Cervical intraepithelial neoplasia (CIN)宫颈上皮内瘤样变,Definition：Cervical intraepithelial neoplasia (CIN) is a premalignant condition of the cervix. It is usually asymptomatic and is detected by routine cytological screening. The degree of severity is graded CIN、to CIN ,定义:宫颈上皮内瘤样变是宫颈组织的癌前病变。一般没有症状,通常在常规的细胞学筛查时发现。根据严重程度分为CIN、CIN、CIN,TBS types,atypical squamous cells (ASC)不典型鳞状上皮Low-grade squamous intraepithelial lesion (LSIL)轻度鳞状上皮内病变High-grade squamous intraepithelial lesion (HSIL) 重度鳞状上皮内病变,Aetiology,The area of previously exposed columnar epithelium that undergoes squamous metaplasia is known as the transformation zone (TZ),病因学,原始鳞柱交接部和生理鳞柱交接部间的区域称为移行带,It is the predilection site of cervical carcinoma,移行带为宫颈癌好发部位,Ectropion and transformation of the transformation zone 移行带区的外翻和转化,transformation mechanism转化机制,squamous metaplasia 鳞状上皮化生squamous epithelization鳞状上皮化,The risk factors for CIN and cervical carcinomaCIN和宫颈肿瘤的危险因素,Young age at first intercourse初次性生活的年龄过小,Number of sexual partners性伙伴的数目,Smoking 吸烟,Poor uptake of screening programme 筛查过少,Long-term use of the contraceptive pill长期服用避孕药,Exposure to tumor promoters has a greater influence on immature cells不成熟的细胞暴露于致癌因素会对其产生很大的影响,Increases the risk of cervical cancer four-fold; the risk remains elevated in ex-smokers 吸烟的妇女患宫颈癌的危险性会提高4倍；曾经吸烟的妇女患宫颈癌的危险性仍然存在,Pill takers do not necessarily use barrier methods - increasing exposure to seminal fluids 服用药物而没有使用屏障的方法，会增加精液的刺激,Male-related risk factors与男性相关的危险因素,The number of the partners previous sexual relationships is relevant 与以前性伙伴的数目有关,Cervical cancer risk increased if partner has penile cancer 性伙伴患阴茎癌会增加患宫颈癌的危险性,Cervical cancer risk increased if partners previous sexual contact had cervical cancer 性伙伴的前性伴患宫颈癌也会增加患宫颈癌的危险性,Immunosuppressant 免疫抑制,Risk increased with immune suppressed renal transplant patients, and in HIV-positive women 免疫抑制、肾移植、HIV阳性妇女患宫颈癌危险性增加,HPV infection HPV感染,Mainly subtype 16 主要是16型,Screening for CIN is based on a cervical smear - sampling surface cells from the cervix with a spatula筛查CIN可以利用宫颈表皮细胞涂片,Screening(筛查),To obtain a complete diagnosis the triage of cytology, colposcopy and histological biopsy are needed, as smears are often under reported,要想达到完整的细胞学分类诊断需要阴道镜和活检，因为细胞涂片常常取决于报告人的经验,Cytology,细胞学,dyskaryosis is a cytological termIt describes features of individual cells such as size and staining of nuclei and the amount of cytoplasm,细胞核异常是细胞学特点。表现为各个细胞核的大小、染色和细胞质的数量的改变,Mild dyskaryosis,轻度核异常,Moderate dyskaryosis,Severe dyskaryosis,中度核异常,重度核异常,Normal-sized nucleus,Mild nuclear abnormalities,Nucleus larger than normalbut 50% of cell,Nucleus irregular,细胞大小正常,轻度核异常,细胞核大于细胞的50,胞核不规则,Cell border rounded,细胞边界变圆,Angular cell borders,细胞边界有角,Histology,组织学,Dysplasia is a histological term. It requires a full-thickness biopsy for diagnosis. Carcinoma-in-situ and CINare more or less synonymous. The basement membrane remains intact,组织学检查发现分化异常。需要取表皮全层活组织检查诊断，原位癌和CIN在某种程度上是相同的，都没有突破基底膜,CIN,CIN,CIN,Upper 2/3 of epithelium exhibits,reasonable differentiation,2/3以上的上皮组织分化正常,Upper 1/2 of epithelium welldifferentiated,1/2以上的上皮组织分化正常,Maturation confined tosuperficial 1/3 (or absent),分化成熟的组织局限于表皮1/3或没有,Colposcopy（阴道镜检查）,In dysplastic tissue the normal pattern of blood vessels becomes distorted and punctation and mosaicism are seen,在异常的组织中可以看到正常结构的血管变得弯曲、极细的点、血管网围绕的镶嵌现象（镶嵌的白色或黄色的上皮块）,Colposcope 阴道镜,Abnormal tissue stains white with acetic acid but will not take up the brown iodine stain. Studying the vessel patterns and staining reactions, a colposcopist gauges the degree of CIN present,异常的组织（醋酸染色白色）不会被碘溶液染成棕色，根据血管的模式和染色反应，用阴道镜可以较精确地估计CIN的程度,CIN,CIN,CIN,Local treatment 局部治疗,loop diathermy环形电热疗法,running an electric current through a thin loop of varying size and shape 电流可以通过不同大小和形状的细环,cold coagulation 冷凝法,carbon dioxide laser 二氧化碳激光器,cone biopsy锥切,Loop diathermy apparatus 环形透热电疗仪,The process of cone biopsy 锥切的过程,Loop Electrosurgical Excision Procedure (LEEP),Cervical carcinoma 宫颈肿瘤,normal cervix,Cervical carcinoma,rough and uneven in surface,smooth,凸凹不平,宫颈癌,正常宫颈,光滑,Epidemiology 流行病学,cancer of the cervix is the second most common malignancy in women after breast cancer - 77% of cases occur in developing countries,在发展中国家，宫颈癌的发病率位于妇女恶性肿瘤的第二位，仅次于乳腺癌（77）,Risk factors危险因素,The main aetiological agent is infection with certain subtypes of human papilloma virus (HPV),主要的病原学因素是感染了人乳头瘤病毒的某一亚型,HPV subtype 16 appears to be the main oncological agent HPV16是肿瘤学的主要原因,Only 5% of cytologically normal women细胞学正常的妇女中HPV16阳性占5 Up to 50% of smears containing CIN在涂片异常含CIN 中HPV16阳性占50 Over 90% of invasive cervical cancer浸润性宫颈癌中90以上患者HPV16阳性,