子宮惡性腫瘤的診斷羅婭紅

子宮惡性腫瘤的診斷羅婭紅第一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital2

子宮惡性腫瘤的流行病學(xué)現(xiàn)狀

Epidemiology

of

Uterine

Malignant

Neoplasm子宮惡性腫瘤包括子宮頸癌、子宮內(nèi)膜癌、滋養(yǎng)細(xì)

胞惡性腫瘤、子宮肉瘤等Uterine

malignant

neoplasm

includes

cervical

carcinoma,

endometrial

carcinoma,

uterine

sarcoma

and

malignant

trophoblastic

tumor,

etc.第二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital3nnnn全球婦女惡性腫瘤發(fā)病率的第三位

The

No.

3

female

malignant

tumor

in

the

world我國(guó)婦科惡性腫瘤發(fā)病率的前兩位

The

top

two

common

female

cancer

in

China女性惡性腫瘤死亡率的第二位

The

second

mortality

in

female

malignant

tumor

in

China每年約有3萬(wàn)名婦女死于宮頸癌

About

30,000

females

died

子宮頸癌Cervical

Carcinoma第三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital4nnn全球婦女惡性腫瘤發(fā)病率的第四位The

fourth

most

common

female

cancer

in

the

world每年的平均病例數(shù)是30

年前的40

倍之多The

yearly

average

number

of

endometrial

carcinoma

is

nearlyfourty

times

as

much

as

those

30

years

ago隨著我國(guó)婦女內(nèi)分泌代謝性疾病的增加，子宮內(nèi)膜癌呈對(duì)數(shù)速度增長(zhǎng)With

endocrinopathy

morbidity

rising,

the

number

of

endometrialcarcinoma

is

increasing

according

to

logarithm

fashion

子宮內(nèi)膜癌Endometrial

carcinoma第四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital5nnn占子宮惡性腫瘤的2

%

–

4

%

Accounting

for

2

–

4

%

of

all

uterine

malignancies占生殖道惡性腫瘤的1%

Accounting

for

1%

of

all

malignancies

in

female

reproductive

tract臨床罕見(jiàn)、惡性程度較高

A

very

rare

and

high

malignancy

in

female

reproductive

tract

子宮肉瘤Uterine

sarcoma第五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital6子宮惡性腫瘤的臨床檢查方法

Clinical

examination

of

uterine

malignant

neoplasm第六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital7

臨床檢查

Clinical

examinationp普通婦科檢查：簡(jiǎn)單，但具有明顯的局限性

Gynecological

examination

:

simple

&

limitedp分期具有主觀性：34％－39％的患者分期錯(cuò)誤

Subjectivity

on

its

staging:

34%-39%

of

incorrect

stagingp不能全面評(píng)價(jià)腫瘤侵犯深度和盆腔淋巴結(jié)轉(zhuǎn)移

Difficult

to

identify

invasive

extent

and

lymph

node

metastases第七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital8

臨床檢查-細(xì)胞學(xué)檢查Clinical

examination-Exfoliative

cytologic

examination

n檢測(cè)來(lái)源于子宮內(nèi)膜、子宮頸的惡性細(xì)胞

Finding

malignant

cells

from

cervix

and

uterine

endometrium

n為子宮惡性腫瘤的診斷診斷提供直接依據(jù)

Providing

direct

diagnosis

for

uterine

malignant

neoplasm

n為子宮微生物感染提供診斷依據(jù)

Finding

foundation

for

uterine

microbial

infection

n在腫瘤的分期上無(wú)明顯價(jià)值

No

value

on

its

staging第八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital9

臨床檢查-陰道宮腔鏡Clinical

examination--

hysteroscopynnn對(duì)子宮可疑病變進(jìn)行定位活檢Biopsy

for

suspected

lesion明顯提高子宮體、頸部早期癌的診斷率Higher

diagnostic

rate

of

uterine

and

cervical

cancer不能客觀評(píng)價(jià)腫瘤侵犯深度和盆腔淋巴結(jié)轉(zhuǎn)移Unable

to

evaluate

invasive

extent

and

lymphnodes

metastasisaccurately第九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital10

影像學(xué)方法-超聲檢查Medical

image

examination-Ultrasonographyppp

對(duì)子宮可疑病變進(jìn)行定位活檢The

most

common

screen

on

uterine

malignant

tumor

經(jīng)腹超聲在分期上應(yīng)用價(jià)值較小Trans-abdominal

ultrasound

with

few

value

on

staging

陰式超聲可明顯提高子宮惡性腫瘤的分期，

其陽(yáng)性、陰性預(yù)測(cè)值分別約62％和92％

Improving

staging

by

trans-vagina

ultrasound

with

62%

for

positive

predictive

value

and

92%

for

negative

predictive

value第十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital11

影像學(xué)方法-

CT檢查Medical

image

examination-CTnnn平掃CT：子宮惡性腫瘤與子宮壁密度相似，難以顯示癌腫的浸潤(rùn)深度和范圍Non-CE

CT:

difficult

to

show

tumor

invasive

depth

and

extent

becauseof

similar

intensity

between

uterine

tissues

&

malignant

tissuesCT增強(qiáng)：子宮惡性腫瘤顯示有局限性Showing

uterine

disease

with

some

limitations

by

CE

CTCT評(píng)價(jià)宮旁浸潤(rùn)假陽(yáng)性較高，準(zhǔn)確度僅33％－58％Accuracy

is

33％－58％

on

evaluating

parametrical

invasion

by

CTbecause

of

a

high

false-positive

error第十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital12

影像學(xué)方法-

MRMedical

image

examination--MRInn上世紀(jì)80年代，MRI出現(xiàn)并應(yīng)用于子宮腫瘤的診斷

MRI

used

in

uterine

diagnosis

in

the

last

80's當(dāng)時(shí)，成像時(shí)間長(zhǎng)、圖像易受呼吸、血管搏動(dòng)和腸蠕動(dòng)的影響、磁場(chǎng)強(qiáng)度低等缺點(diǎn)使其應(yīng)用受限At

that

time,

longer

imaging

time

&

imaging

quality

easily

disturbed

bybreath,

vessel

pause,

bowel

movement,

low

magnetic

field

strengt,

etc.These

disadvantages

limited

its

application第十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital13nn隨著MRI場(chǎng)強(qiáng)、梯度切換率的提高和多通道高密相控陣線圈的應(yīng)用，使應(yīng)用MRI技術(shù)對(duì)子宮惡性腫瘤進(jìn)行準(zhǔn)確診斷和客觀評(píng)價(jià)成為可能With

high-magnetic

MR

scanner,high-gradient

switch

ratio

andmultiple

phased

array

coils,

it

is

possible

to

diagnose

uterinemalignacy

accurately

and

evaluate

it

objectively

by

MRIMRI因其極高的軟組織分辨力，能夠清晰顯示子宮的組織結(jié)構(gòu)和信號(hào)的細(xì)微變化，近而準(zhǔn)確評(píng)價(jià)子宮惡性腫瘤的大小和范圍Clearly

displaying

uterine

layers,

signal

changes,

tumor

size

andextent

on

MRI

image

because

of

it

high

soft

tissue

resolution第十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital14nn腫瘤分期達(dá)到Ⅰb期以上，MRI的評(píng)價(jià)準(zhǔn)確性、陽(yáng)性和陰性預(yù)測(cè)值分別可達(dá)81％－

95%、100％、90%Above

IB

staging,

accuracy,

positive

predictive

value

and

negativepredictive

value

of

MRI

evaluation

:

81%-95%,100%

and

90%在顯示子宮惡性腫瘤宮旁浸潤(rùn)和淋巴結(jié)轉(zhuǎn)移等方面，其敏感度、特異度均較高High

sensitivity

and

specificity

in

showing

parametrical

invasion

andlympnode

metastasis

from

uterine

malignant

neoplasm

on

MRI第十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital15

影像學(xué)方法-

PETCT檢查Medical

image

examination-PEC/CTnnn是評(píng)價(jià)子宮腫瘤良惡性的最佳影像方法之一One

of

the

best

evaluations

on

uterine

malignancy對(duì)腫瘤及周圍淋巴結(jié)轉(zhuǎn)移進(jìn)行客觀評(píng)價(jià)，其特異性高，陽(yáng)性預(yù)測(cè)值約75%-100%Objective

view

on

tumor

and

lymph

node

metastasis

with

75%-100%

positive

predictive

value昂貴的價(jià)格制約了其廣泛應(yīng)用Application

limited

by

expensive

costing第十五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital16MRI在子宮惡性腫瘤診斷上的價(jià)值

Diagnostic

Value

of

MRI

in

Uterine

Malignant

Neoplasm第十六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital17MRI成像的優(yōu)勢(shì)

Advantage

of

MRInnnn無(wú)損傷和輻射性

No

injury

and

radiation高的軟組織分辨力和極高的敏感度

High

soft

tissue

resolution

and

sensitivityMRI三維成像使病灶定位更準(zhǔn)確

3D

images

with

high

accuracy

in

lesions檢出子宮多灶性病變以及評(píng)價(jià)侵犯的范圍、周圍淋巴結(jié)轉(zhuǎn)移區(qū)域有明顯價(jià)值Identifying

multiple

lesions,invasive

extending

and

lymph

nodemetastasis第十七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital18nn動(dòng)態(tài)增強(qiáng)檢查可了解病變的血流灌注情況,有助于病變性質(zhì)的評(píng)價(jià)Exploring

perfusion

&

evaluation

of

tumors

by

DCT為準(zhǔn)確分期和臨床治療方案的制定提供可靠依據(jù)Providing

accurate

staging

and

therapy

planning第十八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital19

子宮MRI檢查的適應(yīng)癥Indications

of

uterine

MRI

examinationnnnnn檢出子宮隱匿性病灶、囊性病灶及多灶性病變

Detecting

occult,

cystic

and

multiple

lesions評(píng)價(jià)子宮惡性腫瘤的浸潤(rùn)范圍和淋巴結(jié)轉(zhuǎn)移

Evaluating

invasive

extent

and

lympnode

metastasis評(píng)價(jià)子宮惡性腫瘤的新輔助治療療效

Evaluateing

therapy

effect確定手術(shù)適應(yīng)癥

Determining

surgical

indications監(jiān)測(cè)子宮惡性腫瘤的術(shù)后復(fù)發(fā)

Monitoring

post-surgical

recurrence第十九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital20子宮惡性腫瘤的MRI診斷、分期

Diagnosing

and

Staging

of

Uterine

Malignant

Neoplasm

by

MRI第二十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital21（一）子宮內(nèi)膜癌

Endometrial

Carcinoma第二十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital22

子宮內(nèi)膜癌的臨床特征Clinical

Characters

of

Endometrial

Carcinomann

臨床表現(xiàn)：絕經(jīng)后婦女陰道不規(guī)則流血、

惡臭液體及爛肉,下腹疼痛、消瘦和貧血

Clinical

manifestations:

postmenopausal

women

with

irregular

vaginal

bleeding,

foul

liquid,necrotic

tissue,

abdominal

pain,

weight

loss

and

anemia

好發(fā)部位：子宮底和體后壁Occurrence

sites:

the

posterior

wall

of

uterus

and

its

bottom第二十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital23擴(kuò)散方式The

spreading

ways???直接播散Direct

spreading淋巴轉(zhuǎn)移Lymph

node

metastasis血行轉(zhuǎn)移Hematogenous

metastasis第二十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital24

子宮內(nèi)膜癌的MRI特征

MRI

Characters

of

Endometrial

Carcinoma病變局限于內(nèi)膜Lesions

confined

in

endometrialnnnT1WI：癌腫信號(hào)稍低于內(nèi)膜或與肌層信號(hào)一致T1WI:

endometrial

carcinoma

signal

is

slightly

lower

than

theendometrial

signal

or

same

as

the

myometrial

signalT2WI：內(nèi)膜局限/彌漫增厚，呈稍高信號(hào)

T2WI:

hyper-signal

in

limitations

/

diffuse

thickening

endometrial病變不強(qiáng)化或輕度強(qiáng)化，低于肌層Slightly

or

no

enhanced

contrast

with

a

signal

lower

than

myometrial第二十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital25病變侵入肌層Invading

myometrialnnn癌腫呈菜花狀、息肉狀突入宮腔lesions

with

cauliflower-like

mass

in

the

uterine

cavityT2WI:低信號(hào)的結(jié)合帶內(nèi)出現(xiàn)高信號(hào)T2WI:

hyper-signal

in

lower

junctional

zone增強(qiáng)時(shí):肌層病變與內(nèi)膜病變均呈低信號(hào)，強(qiáng)化的結(jié)合帶不完整CE:

lesion

with

low

signals

in

both

myometrial

and

endometriallayers,

showing

incompletely

enhanced

changes

in

the

junctionalzone第二十五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital26深肌層受侵Deep

myometrial

invasionnn子宮各層結(jié)構(gòu)消失,

局部肌層出現(xiàn)不規(guī)則低信號(hào)病灶，肌層變薄

Disappearance

uterine

layers

with

focused,

irregular

low-signallesions

in

myometrium

&

thinning

myometrium子宮增大,

盆腔內(nèi)組織器官?gòu)V泛受侵

Enlarged

uterus,

diffusion

involvement

in

pelvic

tissues

&

organs第二十六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital27nnnnⅠa:腫瘤僅局限于子宮內(nèi)膜Ⅰa

:Tumor

confined

in

endometriumⅠb:子宮肌層受侵小于1/2Ⅰb:

invaded

myometrial

less

than

1/2Ⅰc:子宮肌層受侵大于1/2Ⅰc:

invased

myometrial

more

than1/2Ⅱa:宮頸內(nèi)膜受侵Ⅱa:

invasion

into

cervical

endometrial

子宮內(nèi)膜癌的臨床分期

Staging

of

Endometrial

Carcinoma采用國(guó)際婦產(chǎn)科聯(lián)盟分期標(biāo)準(zhǔn)From

International

Federation

of

Gynecology

and

Obstetrics,

FIGO第二十七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital28nnnnnn

Ⅱb:腫瘤侵犯到宮頸基質(zhì)外

Ⅱb:

invasion

into

cervical

stromal

outside

Ⅲa:附件受侵或穿出漿膜/腹腔積液細(xì)胞學(xué)(＋)

Ⅲa:

out

of

the

annex

or

serosal

invasion/peritoneal

fluid

cytology

(+)

Ⅲb:陰道擴(kuò)散

Ⅲb:

the

spread

of

the

vagina

Ⅲc:盆腔或主動(dòng)脈周圍淋巴結(jié)轉(zhuǎn)移

Ⅲc:

pelvic

lymph

node

metastasis

around

the

aorta

Ⅳa期:膀胱或直腸受侵Ⅳa:

involvement

of

bladder

or

rectum

Ⅳb期:遠(yuǎn)處轉(zhuǎn)移或腹部、腹股溝淋巴結(jié)轉(zhuǎn)移

Ⅳb:

distant

metastasis

or

the

abdomen,

groin

lymphnode

metastasis第二十八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital29第二十九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital30第三十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六肌層受侵小于

Cancer

Institute

and2009-8-7Hospital31

子宮內(nèi)膜癌Ib

期

55歲--StageⅠb

endometrial

carcinoma

in

a

55-year-old

woman

T2WIT1WIT2WI

1/2

LiaoningInvaded

myometrial

less

than

1/2第三十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六Invased

myometrial

more

than1/2T2WI

2009-8-7T1WI

32

子宮內(nèi)膜癌Ic期

40歲--Stage

Ic

endometrial

carcinoma

in

a

40-year-old

woman

CE:

T1WICE:

T1WI

肌層受侵大于1/2

Liaoning

Cancer

Institute

and

Hospital第三十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六Liaoning

Cancer

Institute

and

Hospital33

2009-8-7Copyright

?

2007

by

the

American

Roentgen

Ray

Society

子宮內(nèi)膜癌IIa期

78歲----Stage

IIa

endometrial

carcinoma

in

a

78-year-old

woman宮頸內(nèi)膜受侵

Invasion

into

cervical

endometrialSala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587T2WIT2WI第三十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital34

子宮內(nèi)膜癌Ⅲa期----Stage

Ⅲa

endometrial

carcinoma雙側(cè)卵巢受侵tumor

invading

the

ovaries

T2WIT2WI第三十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六Liaoning

Cancer

Institute

and

Hospital35

子宮內(nèi)膜癌Ⅲb期

----Stage

Ⅲb

endometrial

carcinoma肌層受侵大于1/2伴陰道擴(kuò)散Deep

invasion

>50%

of

the

myometrialthickness

of

endometrial

carcinoma(arrow).The

spread

of

the

vagina2009-8-7T2WI第三十五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital36Riccardo

et.al

子宮內(nèi)膜癌Ⅲc期

----Stage

Ⅲc

endometrial

carcinoma肌層受侵大于1/2伴閉孔內(nèi)淋巴結(jié)轉(zhuǎn)移Deep

invasion

>50%

of

the

myometrialthickness

of

endometrial

carcinoma

(arrow)and

internal

obturator

lymph

node

metastasis

T2WIRadiology

2004

18

(

10).1148第三十六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital37

T2WI直腸受侵Involvement

of

rectumT2WI

子宮內(nèi)膜癌Ⅳa期----Stage

Ⅳa

endometrial

carcinomaT2WIT1WI第三十七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital38Jpn

Clinica

lRadol

50（11）1514-1515Involvement

of

bladder

子宮內(nèi)膜癌Ⅳa期

----Stage

Ⅳa

endometrial

carcinoma

T2WI

T2WI膀胱受侵第三十八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital39

子宮內(nèi)膜癌Ⅳb期

----Stage

Ⅳb

endometrial

carcinoma宮頸受侵、腹部多發(fā)轉(zhuǎn)移Invasion

into

cervical

and

abdomenmetastasis第三十九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital40（二）子宮頸癌

Cervical

carcinoma第四十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital41nnn病因:尚不清，可能與婦女性生活、生育史、生殖道病毒或細(xì)菌感染、性病、種族、地理和營(yíng)養(yǎng)狀況等相關(guān)Etiology:

not

clearly,

maybe

related

with

sexual

life,

reproductive

history,reproductive

tract

virus

or

bacterial

infection,

sexually

transmitteddiseases,

race,

geography

and

nutrition腫瘤來(lái)源:95%為宮頸鱗狀上皮；5%為宮頸管腺上皮Oncology

resource

:

95%

from

cervical

squamous

cell;

5%

from

thecervical

epithelium好發(fā)部位：鱗狀上皮和柱狀上皮間的移行區(qū)Ocurrence

site:

transitional

zone

between

squamous

epithelium

andcolumnar

epithelium

子宮頸癌的臨床特征Clinical

Characters

of

Cervical

Carcinoma第四十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital42nn臨床表現(xiàn)：陰道出血是主要征象，可以是自然出血或接觸性出血，合并感染時(shí)白帶增多Clinical

:

the

main

symptom

:

vaginal

bleeding

with

natural

or

contactbleeding,

white

discharge

infection擴(kuò)散方式：深部浸潤(rùn)、直接蔓延、淋巴轉(zhuǎn)移，血行轉(zhuǎn)移少The

spreading:

deep

infiltration,

direct

spreading,

lymph

nodemetastasis,

hematogenous

metastasis第四十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六43nⅠ期：限于宮頸

Stage

Ⅰ

–

confined

to

the

cervix

?Ⅰa:早期鏡下浸潤(rùn)

Ⅰa

-

Diagnosed

only

by

microscopy;

no

visible

lesions??Ⅰa1期:微灶浸潤(rùn)深度小于3mm,寬度小于7mm

Ⅰa1

-

stromal

invasion

less

than

3

mm

in

depth

and

7

mm

or

less

in

horizontal

spreadⅠa2期:融合性浸潤(rùn)，深度在3-5mm，寬度＜7mm

Ⅰa2

-

stromal

invasion

between

3

and

5

mm

with

horizontal

spread

of

7

mm

or

less

Liaoning

Cancer

Institute

and2009-8-7

Hospital

子宮頸癌的臨床分期

Staging

of

Cervical

Carcinoma采用國(guó)際婦產(chǎn)科聯(lián)盟分期標(biāo)準(zhǔn)From

International

Federation

of

Gynecology

and

Obstetrics,

FIGO第四十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital44???Ⅰb期：浸潤(rùn)深度>5mm，寬度>7mmⅠb

-

visible

lesion

or

a

microscopic

lesion

with

more

than

5

mm

ofdepth

or

horizontal

spread

of

more

than

7

mmⅠb1期：病灶可視最大徑<40mmⅠb1

-

visible

lesion

4

cm

or

less

in

greatest

dimensionⅠb2期：病灶可視最大徑>40mmⅠb2

-

visible

lesion

more

than

4

cmn

Ⅱ期：癌灶超越宮頸Stage

Ⅱ

–

involved

in

cervix??Ⅱa:癌腫未達(dá)到骨盆壁，累及陰道上部2/3

Ⅱa

–

no

parametrial

invasion,

but

involved

in

upper

2/3

of

vaginaⅡb:宮頸旁組織浸潤(rùn)

Ⅱb

-

parametrial

invasion第四十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital45n

Ⅲ期：癌腫累及陰道下1/3和/或達(dá)到骨盆壁Stage

III

-

extends

to

pelvic

wall

or

lower

third

of

the

vagina??

Ⅲa期：癌腫累及陰道下1/3

Ⅲa

-

involves

lower

1/3

of

vagina

Ⅲb期：骨盆壁累和/或腎盂積水或無(wú)功能腎ⅢB

-

extends

to

pelvic

wall

and/or

causes

hydronephrosis

or

non-

functioning

kidneynⅣ期：癌腫累及真骨盆以外部分或累及膀胱或直腸(Ⅳa)，到達(dá)遠(yuǎn)處器官(Ⅳb)??Ⅳa

-

invades

mucosa

of

bladder

or

rectum

and/or

extends

beyond

truepelvisⅣb

-

distant

metastasis第四十五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital46第四十六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital47第四十七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital48/best-practi...第四十八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital49http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100

-39842007000300014&tlng=en&lng=en&nrm=iso第四十九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital50nnnMRI軸位上顯示為類圓形和不規(guī)則形分葉腫塊MRI:

a

round,

irregular-shaped

and

lobulated

mass

on

axial

MRI矢狀位顯示宮頸增大為桶狀，宮頸管腔消失Enlarged

cervix

with

barrel

shape

on

sgaiggtal

imagingT1WI呈等信號(hào)，T2WI呈高信號(hào)the

disappearance

of

cervical

cannel

iso-signal

on

T1WI;

hyper-signal

on

T2WI

子宮頸癌的MRI特征

MRI

Characters

of

Cervical

Carcinoma癌腫的MRI表現(xiàn)MRI

Characters

of

lesion第五十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital51nnT2WI:癌腫與正常宮頸基質(zhì)低信號(hào)及宮旁脂肪間隙有良好對(duì)比

T2WI:

good

contrast

between

the

tumor

and

normal

cervicalstroma

with

low

signal

&

parametrial

space增強(qiáng)動(dòng)態(tài)掃描，T1WI癌腫早期強(qiáng)化，可清晰顯示病灶的形態(tài)、邊界和宮頸基質(zhì)受侵犯的深度CE:

obviously

showing

enhanced

tumor

with

shape

and

rimand

the

depth

of

cervical

stromal

invasion第五十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital52癌腫侵犯深度的MRI評(píng)價(jià)Tumor

invasion

depth:

evaluation

by

MRInn局限于粘膜內(nèi)：浸潤(rùn)深度＜5mm，T1WI與T2WI呈中等信號(hào)，與正常粘膜接近;增強(qiáng)掃描可依據(jù)早期強(qiáng)化的癌腫清晰顯示病灶的邊緣及其浸潤(rùn)的深度Confined

in

mucosa:

the

invasion

depth

<5mm;

iso-signal

on

T1WI

andT2WI,

showing

similar

signal

with

nearly

normal

mucosa

and

enhancedlesion

with

clear

rim

and

invasive

depth

on

contrast-enhanced

image病變侵犯基質(zhì)：T2WI低信號(hào)的基質(zhì)環(huán)被癌腫高信號(hào)部分或完全取代時(shí)，即使外緣光整，也提示基質(zhì)受侵Invaded

stroma

by

lesion:

hypo-signal

on

T2WI

replaced

by

tumor

as

asmooth

rim,

demonstrating

a

complete

or

partial

damage

in

cervicalstroma第五十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital53nn病變侵犯宮體：T2WI子宮體增大，低信號(hào)的結(jié)合帶被高信號(hào)的癌腫組織取代/內(nèi)外帶顯著不規(guī)則Invaded

uterine

corpus

by

lesion:

enlarged

uterus

corpus

on

T2WI,junctional

zone

replaced

by

hyper-signal

of

tumor,

showingirregular

changes

on

hypo-signal

of

inner

and

latter

zone病變侵犯宮旁：T1WI雙側(cè)宮旁不對(duì)稱，宮頸外緣不規(guī)則，低信號(hào)的宮旁組織出現(xiàn)稍高信號(hào)腫塊；增強(qiáng)后，腫塊明顯強(qiáng)化T1WI:invaded

uterine

corpus

by

lesion,

showing

unsymmetricalparametrial

changes

and

irregular

rim

on

cervix

with

hyper-signalmass

with

clear

enhancement

in

hypo-signal

parametrial

tissue第五十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital54

子宮頸癌Ib期

36歲----Stage

Ⅰb

cervical

carcinoma

in

a

36-year-old

woman

T2WI浸潤(rùn)深度>5mm，寬度>7mmStromal

invasion

more

than5

mm

in

depth

and

morethan7

mm

in

horizontal

spreadT1WIT2WI第五十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital55浸潤(rùn)深度>5mm，寬度>7mmStromal

invasion

more

than5

mm

in

depth

and

morethan7

mm

in

horizontal

spread

子宮頸癌Ib期----Stage

Ⅰb

cervical

carcinoma

T2WIT2WI第五十五頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital56

子宮頸癌Ⅱa期

34歲----Stage

Ⅱa

cervical

carcinoma

in

a

34-year-old

womanT2WIT2WIT2WIT1WI癌腫累及陰道上部2/3involved

in

upper

2/3

ofvagina第五十六頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital57

子宮頸癌Ⅱb期

47歲----Stage

Ⅱb

cervical

carcinoma

in

a

47-year-old

woman宮頸旁組織浸潤(rùn)parametrial

invasionT2WI

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587第五十七頁(yè)，共七十一頁(yè)，編輯于2023年，星期六58

子宮頸癌Ⅱb期----Stage

Ⅱb

cervical

carcinoma宮頸旁組織浸潤(rùn)parametrial

invasion

2009-8-7T2WIT2WI

T2WILiaoning

Cancer

Institute

and

HospitalT2WI第五十八頁(yè)，共七十一頁(yè)，編輯于2023年，星期六Liaoning

Cancer

Institute

and

Hospital59

2009-8-7Copyright

?

2007

by

the

American

Roentgen

Ray

Society

子宮頸癌IIb期

42歲--Stage

IIb

cervical

cancer

in

42-year-old

woman

T2WI宮頸旁組織浸潤(rùn)parametrial

invasion

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587第五十九頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital60

子宮頸癌IIIa期

45歲

--Stage

Ⅲa

cervical

cancer

in

45-year-old

woman

T2WI累及陰道下1/3extends

to

the

lower

1/3

of

vagina

T2WI第六十頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital61

子宮頸癌IVa期

39歲--Stage

Ⅳa

cervical

cancer

in

39-year-old

woman

T2WI累及直腸extends

to

rectum

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587第六十一頁(yè)，共七十一頁(yè)，編輯于2023年，星期六Liaoning

Cancer

Institute

and

Hospital62

2009-8-7Copyright

?

2007

by

the

American

Roentgen

Ray

Society

子宮頸癌IVa期--Stage

Ⅳa

cervical

cancer累及膀胱extends

to

rectum

and

bladder

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587第六十二頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital63（三）子宮肉瘤

Uterine

Sarcoma第六十三頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital64nnn病因：尚不清Etiology:

unclear腫瘤來(lái)源:子宮平滑肌、子宮內(nèi)膜間質(zhì)、血管、纖維組織Oncology

Source:

uterine

smooth

muscle,

endometrial

stromal,

vascular,fibrous

tissues病理分類：子宮平滑肌肉瘤、子宮內(nèi)膜間質(zhì)肉瘤、混合型同源mullerian肉瘤、混合型異源mullerian肉瘤Pathological

classification:

uterine

leiomyosarcoma,

endometrial

stromalsarcoma,

homologous

mixed

mullerian

sarcoma,

mixed

mullerianheterologous

sarcoma

子宮肉瘤的臨床特征Clinical

Characters

of

Uterine

Sarcoma第六十四頁(yè)，共七十一頁(yè)，編輯于2023年，星期六2009-8-7Liaoning

Cancer

Institute

and

Hospital65臨床表現(xiàn)Clinical

manifestationsnnnn最常見(jiàn)癥狀不規(guī)則陰道出血Common

symptoms--

irregular

vaginal

bleeding腫瘤生長(zhǎng)過(guò)快、過(guò)度膨脹或瘤內(nèi)出血壞死Excessive

tumor

growth,

excessive

swelling

or

bleeding

andnecrosis腹痛及腫瘤的壓迫癥狀Symptoms

of

oppression

and

pain觸及腹部包塊Palpable

abdominal