1、Endometrial Carcinoma 子宫内膜癌,carcinoma of corpus uteri 子宫体癌,corpus uteri子宫体,cervix 子宫颈,Structure of uterus,endometrium,myometrium,Serous layer,Prevalencefourth most malignancy in women （女性恶性肿瘤中第四位）ranks third in the malignant tumors of female reproductive system（女性生殖系统恶性肿瘤中第3位）,Epidemiology,55-69 yea
2、rs 75% postmenopausal 绝经后25% pre-menopausal 绝经前( 5% 40years ),Risk factors *unopposed estrogen exposureendogenous ovarian granulosa cell tumorexogenous estrogen treatment *obesity hypertension endometrial cancer triaddiabetes 子宫内膜癌三联症 *anovulation cycles 无排卵月经,Days,Proliferative phase,secretory phas
3、e,mense,ovary,endometrium,estrogen,estrogen/progestrone,ovulation,Effect of estrogen/ progesterone function upon endometrium,Endometrial Hyperplasia and Endometrial Cancer,Simple hyperplasia with nuclear atypia without Complex hyperplasiawith nuclear atypia without ,Simple hyperplasia Complex hyperp
4、lasia 单纯增生过长 复杂性增生过长,Nuclear Atypia (核异型性）,Nuclear enlargement 核增大 Increase in nuclear/cytoplasm ratio 核/浆比例增大 Prominent nucleoli 核仁明显 Coarse abundant chromatin 染色体粗大,Risk of Hyperplasia to Endometrial Carcinoma,_ Types of Hyperplasia Progressing to Cancer (%) _ Simple(cystic) without atypia 1 Compl
5、ex(adenomatous) without atypia 3 Simple with atypia 8 Complex with atypia 29 _,hyperplasia with nuclear atypia is considered the pre-malignant diseases,Pathology,Diffuse lesions,Focal lesion,Histological types,typeI estrogen-dependent Endometrioid adenocarcinoma （宫内膜样腺癌）8090% , G1 typeII estrogen-in
6、dependenthigh-grade endometrioid cancer ,G2/3papillary serous carcinomaclear cell carcinoma,Cell differentiation （细胞分化）,G1（I级）: fairly good differentiation分化较好 G2（II级）: moderate differentiation中等分化 G3（III级）: poor differentiation分化差,G1,G2,G3,With solid component 5% 5-50% 50%,Serous ,Clear-cell ,Sprea
7、d Patterns 转移方式,Direct extension（直接蔓延） Lymphatic spread（淋巴转移） Hematogenous spread （血行播散） Transtubal passage of exfoliated cells（脱落细胞经输卵管转移）,Direct extension,Cervical involvement 宫颈受累,Myometrium invasion 肌层浸润,Lymphatic spreading,Pelvic lymph node, 盆腔淋巴结，PLN Para-aortic lymph node, 腹主动脉旁淋巴结，PAN,Clinic
8、al Findings,Vaginal bleeding（阴道流血） Esp. postmenopausal bleeding（绝经后阴道流血）Uterine enlargement,Diagnosis,1.Fractional dilation and curretage（分段诊刮）,扩张棒,刮匙,Diagnosis- Fractional dilation & currettage,1,2,Establish the diagnosis Help identify cervical involvement,Limit Missed diagnosisFalse positive cervi
9、cal involvement,Endometrial Sampler,Diagnosis-Endometrial sampling,*Simple, non-traumatic procedure.*Moldability permits easy insertion into a markedly anteverted(前屈) or retroverted (后屈)uterus. *No cervical dilation necessary in most cases. *Less discomfort, bleeding, tissue abrasion than D & C meth
10、od.,Normal endometrium,Hyperplasia,Hyperplasia with atypia,Endometrial carcinoma,Diagnosis- endometrial cytology,Diagnosis- endometrial assessment sonographically,Normal endometrium stripe 正常子宫内膜线,5mm,Diagnosis- hysteroscopy,Endometrial Carcinoma,Simple hyperplasia,Complex hyperplasia,Normal endomet
11、rium,Atrophic endometrium,Normal endometrium,EMCa Ia,EMCa Ib,EMCa II,Diagnosis-MRI,Differentiation Diagnosis,Cervical Cancerpostcoital bleeding,Staging,Clinical Staging（临床分期）pre-treatment evaluationSurgically pathological staging（手术病理分期）,Clinical Staging,Stage Characteristics _I Confined to the corp
12、us（限于宫体） IA Uterine cavity8cm IB Uterine cavity 8cm II Involvement of cervix（宫颈受累） _,Stage Characteristics _ III Extends outside the uterus but not outside the true pelvis, may involve parametrium IV Extends outside the true pelvis or involves the bladder or rectum _,Surgical-pathological staging,St
13、age Characteristics _IA limited to the endometrium 限于内膜IB Invasion 1/2 the myometrium 肌层浸润1/2 IIA Endocervical gland involvement onlyIIB Cervical stromal invasion _,Stage Characteristics _ IIIA Tumor invades serous and/or adnexes,and/or positive peritoneal cytology IIIB Vaginal metastases IIIC Metas
14、tases to pelvic and/or paraaorticlymph nodes IVA Tumor invasion of bladder and/or rectum IVB Distant metastases, including intra-abdominal and/or inguinal nodes _,Treatment,1. operationStage 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+ lymphonode sampling 淋巴结取样( pelvic, paraaortic 盆腔淋巴结及腹主动脉淋巴结 ),2. radiation therapy3. chemotherapy,Thanks,
