1、EndometrialCarcinoEndometrialCarcinomama子宫内膜癌子宫内膜癌corpus uteri子宫体cervix 子宫颈Structure of uterusendometriummyometriumSerous layer EndometrialCarcinoma子宫内膜癌2Prevalencefourth most malignancy in women（女女性恶性肿瘤中第四位性恶性肿瘤中第四位）ranks third in the malignant tumors of female reproductive system（女性生殖女性生殖系统恶性肿瘤中第系
2、统恶性肿瘤中第3位位）EndometrialCarcinoma子宫内膜癌3Epidemiology 55-69 years 75%postmenopausal 绝经后绝经后 25%pre-menopausal 绝经前绝经前 (5%50%EndometrialCarcinoma子宫内膜癌14Serous Clear-cell EndometrialCarcinoma子宫内膜癌15Spread Patterns转移方式转移方式 Direct extension（直接蔓延）（直接蔓延）Lymphatic spread（淋巴转移）（淋巴转移）Hematogenous spread（血行播散）（血行播散
3、）Transtubal passage of exfoliated cells （脱落细胞经输卵管转移）（脱落细胞经输卵管转移）EndometrialCarcinoma子宫内膜癌16Direct extensionCervical involvement宫颈受累宫颈受累Myometrium invasion肌层浸润肌层浸润EndometrialCarcinoma子宫内膜癌17Clinical Findings Vaginal bleeding（阴道流血阴道流血）Esp.postmenopausal bleeding （绝经后阴道流血绝经后阴道流血）Uterine enlargementEndo
4、metrialCarcinoma子宫内膜癌19Diagnosis1.Fractional dilation and curretage （分段诊刮）（分段诊刮）扩张棒扩张棒刮匙刮匙EndometrialCarcinoma子宫内膜癌20Diagnosis-Fractional dilation&currettage12Establish the diagnosisHelp identify cervical involvementLimit Missed diagnosis False positive cervical involvement EndometrialCarcinoma子宫内膜癌
5、21Endometrial SamplerDiagnosis-Endometrial sampling*Simple,non-traumatic procedure.*Moldability permits easy insertion into a markedly anteverted(前屈前屈)or retroverted(后屈后屈)uterus.*No cervical dilation necessary in most cases.*Less discomfort,bleeding,tissue abrasion than D&C method.EndometrialCarcino
6、ma子宫内膜癌22 Normal endometriumHyperplasiaHyperplasia with atypiaEndometrial carcinomaDiagnosis-endometrial cytologyEndometrialCarcinoma子宫内膜癌23Diagnosis-endometrial assessment sonographicallyNormal endometrium stripe正常子宫内膜线正常子宫内膜线5mmEndometrialCarcinoma子宫内膜癌24Diagnosis-hysteroscopyEndometrial Carcinoma
7、Simple hyperplasiaComplex hyperplasiaNormal endometriumAtrophic endometriumEndometrialCarcinoma子宫内膜癌25Normal endometriumEMCa IaEMCa IbEMCa IIDiagnosis-MRIEndometrialCarcinoma子宫内膜癌26Differentiation DiagnosisCervical Cancer postcoital bleedingEndometrialCarcinoma子宫内膜癌27Staging Clinical Staging（临床分期）（临
8、床分期）pre-treatment evaluation Surgically pathological staging （手术病理分期）（手术病理分期）EndometrialCarcinoma子宫内膜癌28Clinical Staging Stage Characteristics_ I Confined to the corpus（限于宫体）（限于宫体）IA Uterine cavity8cmIB Uterine cavity 8cmII Involvement of cervix（宫颈受累）（宫颈受累）_EndometrialCarcinoma子宫内膜癌29Stage Character
9、istics_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_EndometrialCarcinoma子宫内膜癌30Surgical-pathological staging Stage Characteristics_ IA limited to the endometrium 限于内膜限于内膜 IB Invasion 1/2 th
10、e myometrium 肌层浸润肌层浸润1/2 the myometrium 肌层浸润肌层浸润1/2 IIA Endocervical gland involvement only IIB Cervical stromal invasion_EndometrialCarcinoma子宫内膜癌31Stage Characteristics_IIIA Tumor invades serous and/or adnexes,and/or positive peritoneal cytologyIIIB Vaginal metastasesIIIC Metastases to pelvic and/
11、or paraaortic lymph nodesIVA Tumor invasion of bladder and/or rectumIVB Distant metastases,including intra-abdominal and/or inguinal nodes_EndometrialCarcinoma子宫内膜癌32Treatment 1.operation Stage 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)EndometrialCarcinoma子宫内膜癌332.radiation therapy3.chemotherapyEndometrialCarcinoma子宫内膜癌34EndometrialCarcinoma子宫内膜癌35
