It is important to emphasize that most (perhaps all) invasive cervical squamous cell carcinoma arise from precursor epithilial changes referred to as CIN. However, not all cases of CIN progress to invasive cancer, and indeed many persist without change or even regress.
CINI Regression 50-60% Persistence 30% Progression to CIN III 20% Progression to invasive cancer 1-5% CINIII Regression 33% Progression 6-74%
流行病学 CIN 高峰年龄 30y ，癌高峰年龄 50y Risk factors –Early age at first intercourse –Multiple sexual partners –A male partner with multiple previous sexual partners –Persistent infection by “High-risk” HPV –Others
The Death of Eva Peron Eva Peron ("Evita"), wife of Argentina's left-wing dictator Juan Peron, died in January 1952 of cervical cancer.
宫颈癌分期 (FIGO,1985) 0 Preinvasive carcinoma Ⅰ Carcinoma strictly confined to the cervix Ⅱ Carcinoma that extends beyond the cervix, but does not extend into the pelvic wall Ⅲ Carcinoma that has extended into the pelvic sidewall Ⅳ Carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum
五年生存率 Stage 0 100% Stage I 90% Stage II 82% Stage III 35% Stage IV 10%
Factors Relative risk Well-Established influences Geographic factors Varies Age Increase after 30y Family history First-degree relative with BC 1.2-3.0 Menstrual history Age at menarche<12y 1.3 Age at menopause>55y 1.5-2.0 Pregnancy First live birth 25-29yo 1.5 First live birth >30yo 1.9 First live birth >35yo 2.0-3.0 Nulliparous 3.0
Factors Relative risk Well-Established influences Benign breast disease Proliferative disease 1.9 Proliferative disease with atypical hyperplasia 4.4 Lobular carcinoma in situ 6.9-12.0 Less Well-Established influences Exogenous estrogens Oral contraceptives Obesity High-fat diet Alcohol consumption Cigarette smoking
导管内原位癌 DCIS 常伴坏死和钙化 ( 乳腺摄片 ) 97% long term survival 1/2 low-grade DCIS (left alone) turns invasive at the same site (Cancer 103: 2481, 2005). Architectural patterns of DCIS – 粉刺癌 Comedo subtype –Solid, cribriform, papillary
Van Nuys grading-and-treatment scheme for non-infiltrating ductal carcinoma: (Lancet 345: 1154, 1995) 1: No necrosis (lumpectomy, skip the radiation) 2: Necrosis but no ugly nuclei (lumpectomy, maybe radiation) 3: Ugly nuclei (lumpectomy-radiation or mastectomy)
A distinctive proliferation of tame- looking cells filling the ductules of one or more lobules Signet-ring cells are common The lobules are expanded but not distorted Does not form masses Usually bilateral 1/3 turns invasive 小叶原位癌 LCIS