1、* Dr.Xiaohua Wu 1Standard Treatment Optionsfor Cervical Cancer FIGO: Staging classifications and clinical practice guidelines of Cervical cancerNational Cancer Institute M.D. Anderson Cancer CenterPractical Gynecologic Oncology 4th Edition* Dr.Xiaohua Wu 2Cancers of the Female Reproductive Tract:Wor
2、ldwide Statistics11. Ferlay et al. GLOBOCAN 2000 IARC, WHO 2001 (www.dep.iarc.fr) Cancer New Cases DeathsCervical 470,000 230,000Endometrial 189,000 45,000Ovarian 192,000 114,000USANorthern EuropeSouthern Europe23,80010,00010,20015,6007,2006,200* Dr.Xiaohua Wu 31974-2000上海市居民妇科肿瘤发病率上海市肿瘤研究流行病研究室年报告*
3、 Dr.Xiaohua Wu 4* Dr.Xiaohua Wu 5* Dr.Xiaohua Wu 6Treatment Option Overview n Five randomized phase III trials have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy,1-6 while 1 trial examining this regimen demonstrated no benefit.7n The risk o
4、f death from cervical cancer was decreased by 30% to 50% by concurrent chemoradiation. n Based on these results, strong consideration should be given to the incorporation of concurrent cisplatin- based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervic
5、al cancer.1-8* Dr.Xiaohua Wu 7Treatment Option Overviewn Surgery and radiation therapy are equally effective for early-stage small-volume disease.9 n Younger patients may benefit from surgery in regard to ovarian preservation and avoidance of vaginal atrophy and stenosis. n Patterns of care studies
6、clearly demonstrate the negative prognostic effect of increasing tumor volume. n Therefore, treatment may vary within each stage as currently defined by FIGO, and will depend on tumor bulk and spread pattern.10 * Dr.Xiaohua Wu 8Treatment Option Overviewn Therapy of patients with cancer of the cervic
7、al stump is effective, yielding results comparable to those seen in patients with an intact uterus.11 n During pregnancy, no therapy is warranted for preinvasive lesions of the cervix, including carcinoma in situ, although expert colposcopy is recommended to exclude invasive cancer. n Treatment of i
8、nvasive cervical cancer during pregnancy depends on the stage of the cancer and gestational age at diagnosis.* Dr.Xiaohua Wu 9宫颈癌分期 :临床诊断分期q 有经验的医师、在麻醉下进行检查q 后来的发现不能改变已经确定的期别q 触诊、视诊、阴道镜、宫颈管诊刮术 (ECC)、宫腔镜、膀胱镜、直肠镜、静脉尿路造影、以及骨骼和肺部 x线检查q 膀胱和直肠怀疑病灶须经活检并有组织学证实q 淋巴管造影、动脉造影、静脉造影、剖腹探查术、超声探查、 CT扫描和磁共振（ MRI）等，故不能作为改变期别的根据q 对扫描检查怀疑的淋巴结行细针穿刺，能帮助制定治疗计划* Dr.Xiaohua Wu 10宫颈癌分期 :手术治疗后病理分期q 手术 -病理检查切除的标本结果，是最确切诊断肿瘤侵犯范围q 这些结果不能改变临床分期，但可将这些结果记录在疾病的病理分期法则中， TNM分期正是符合情况q 首次诊断时确定分期，而且不能更改，即使在复发时也是如此q 只有在临床分期的准则严格执行时，才有可能比较各个临床单位和不同治疗方式的结果
