1、子宮頸癌診斷分期及治療概論主講：張廷彰林口長庚醫院婦癌科主任時間：2005年5月14日 地點：臺大醫學院基礎醫學大樓五樓508講堂子宮頸癌治療團隊n婦癌科n放射診斷科n放射腫瘤科n核子醫學科n解剖病理科n個案管理師子宮頸癌申報TCDB分類n子宮頸原位癌(CIN III,CIS)n侵襲性子宮頸癌子宮頸癌的診斷n目視或陰道鏡檢查n子宮頸切片 n子宮頸錐狀手術 n麻醉下的內診檢查(examination under anesthesia)n影像檢查n膀胱鏡檢查(cystoscopy)n直腸鏡檢查(proctoscopy)n靜脈腎盂攝影(intravenous pyelography,IVP)n腫瘤指
2、標(SCC-Ag CEA)子宮頸癌的診斷n組織病理分類qSquamous cell carcinoma 80-85%qAdeno-carcinoma 15%qAdenosquamous carcinoma 3-5%q其它 clear cell carcinoma,endometrioid adenocarcinoma,undifferentiated carcinoma,neuroendocrine tumor,small cell carcinoma n分化 q分化良好(grade 1)q分化中度(grade 2)q分化不良或未分化(grade 3)q分化無法評估(grade x)子宮頸癌的
3、分期n國際婦產科聯盟(FIGO)1994年分期系統為主q大部份以理學檢查為依據n僅使用 chest X-ray、barium enema 等影像檢查做為分期的參考 nFIGO分期的侵襲性檢查限制陰道鏡、子宮頸切片、子宮頸錐狀手術、膀胱鏡及直腸鏡等nlymphangiography、MRI、CT，對於治療的規劃可能有所幫助，但檢查的結果並不影響既有的分期子宮頸癌的分期子宮頸癌的治療n早期的子宮頸癌，以手術治療為主 n較晚期者則以放射線治療為主 n接受同時合併放射線及cisplatin化學治療 n根治性手術後的輔助治療 n單純式子宮切除後意外發現有子宮頸侵襲癌 子宮頸癌的治療流程子宮頸癌的治療流程
4、子宮頸癌的治療流程子宮頸癌的治療流程子宮頸癌的治療流程THANK YOUSUCCESS2022-10-815可编辑癌症診療資料庫申報手冊說明手術方式n10 Local tumor destruction,NOSq11 Photodynamic therapy(PDT)q12 Electrocautery;fulguration q13 Cryosurgery q14 Laserq15 Loop Electrocautery Excision Procedure q16 Laser ablationq17 Thermal ablationNo specimen sent to pathology
5、 from surgical events 1017.癌症診療資料庫申報手冊說明手術方式n20 Local tumor excision,NOSq26 Excisional biopsy,NOSq27 Cone biopsyq24 Cone biopsy WITH gross excision of lesionq29 Trachelectomy;removal of cervical stump;cervicectomy Any combination of 20,24,26,27 or 29 WITHn21 Electrocauteryn22 Cryosurgeryn23 Laser ab
6、lation or excisionq25 Dilatation and curettage;endocervical curettage(for in situ only)q28 Loop electrocautery excision procedure(LEEP)Specimen sent to pathology from surgical events 2029.癌症診療資料庫申報手冊說明手術方式n30 Total hysterectomy(simple,pan-)WITHOUT removal of tubes Total hysterectomy removes both the
7、 corpus and cervix uteri and may also include a portion of vaginal cuff.n40 Total hysterectomy(simple,pan-)WITH removal of tubes and/or ovaryTotal hysterectomy removes both the corpus and cervix uteri and may also include a portion of vaginal cuff.子宮頸旁韌帶子宮薦韌帶截斷主韌帶截斷將輸尿管與子宮頸旁組織分離骨盆腔淋巴結分佈癌症診療資料庫申報手冊說明
8、手術方式n50 Modified radical or extended hysterectomy;radical hysterectomy;extended radical hysterectomyq51 Modified radical hysterectomyq52 Extended hysterectomyq53 Radical hysterectomy;Wertheim procedureq54 Extended radical hysterectomyn60 Hysterectomy,NOS,WITH or WITHOUT removal of tubes and ovariesq
9、61 WITHOUT removal of tubes and ovariesq62 WITH removal of tubes and ovaries 癌症診療資料庫申報手冊說明手術方式n70 Pelvic exenteration q71 Anterior exenteration q72 Posterior exenteration q73 Total exenterationq74 Extended exenteration n90 Surgery,NOS n99 Unknown if surgery performed;death certificate ONLY 病歷閱讀方向n先看
10、婦產科初診病歷n影像學檢查報告n出院病歷摘要n手術紀錄單n門診紀錄單n放射治療科會診單、治療紀錄單n病理報告n團隊會議記錄27写在最后写在最后成功的基础在于好的学习习惯成功的基础在于好的学习习惯The foundation of success lies in good habits谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal
