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Cervical Cancer

CERVICAL CANCER

¡Ø¿øÀÎ
- À§Çè ¿äÀÎ : Á¶±â¿¡ ½ÃÀÛµÈ ¼ºÀû Ȱµ¿, ´Ù¼öÀÇ ¼Í±³ »ó´ëÀÚ, ³²¼º ¿äÀÎ, HPV °¨¿°

¡ØSymptoms
- vaginal bleeding(M/C) : postcoital bleeding , irregular or postmenopausal bleeding
Ç÷¾×ÀÌ ¼¯ÀÎ Áú ºÐºñ¹°
- ¾ÇÃ뼺 Áú ºÐºñ¹°
- º´º¯ÀÌ ÁøÇàµÈ °æ¿ì °ñ¹ÝÅë, ÆíÃø¼º ´Ù¸® ºÎÁ¾, ¿ä°ü Æó¼â

¡ØPhysical examination
- supracalvicular and groin lymph nodes : ÀüÀÌ ¿©ºÎ ÆÄ¾Ç
- speculum : À°¾ÈÀ¸·Î º¸¾ÒÀ» ¶§ Áú¿¡µµ ¹øÁ³´ÂÁö È®ÀÎ
- rectal exam : Àڱà °æºÎÀÇ °ß°í¼º, Å©±â¸¦ Æò°¡
- Àڱà °æºÎ µÚÂÊÀÇ nodularity´Â parametrial extension ½Ã»ç

¡ØÁø´ÜÀ§ÇÑ °Ë»ç
- screening : PAP
- punch Bx.
- Conization : ¹Ì¼¼Ä§À±ÀÇ ¹üÀ§ Á¤È®È÷ ¾Ë±â À§Çؼ­
- Colposcopy(PAP¿¡¼­ Ãʱâ ħÀ±¼º ¾Ï Àǽɵdzª À°¾È»ó Á¤»óÀÎ °æ¿ì)
: ºñÁ¤»óÀû Ç÷°ü, ºÒ±ÔÄ¢ÇÑ Ç¥¸é À±°û °ú »óÇÇÀÇ ¼Õ½Ç, »ö±ò º¯È­ ÀÖÀ¸¸é ħÀ± ÀǽÉ
: Adenocarcinoma : ¼Ò°ßÀÌ Æ¯ÀÌÀûÀÌÁö ¾Ê¾Æ¼­ Àڱðæ°ü ¼ÒÆÄ¼ú ½ÃÇà ÇÊ¿ä

¡Øº´¸®
- Microinvasive cervical squamous carcinoma
: ¿øÃß»ý°ËÀÌ Ä§À±ÀÇ ¹üÀ§ È®½ÇÈ÷ ¾Ë±â À§ÇØ ÇÊ¿äÇÔ
3mmÀÌÇÏÀÇ Ä§À±À̸é FIGO stage Ia1
3-5mmÀÇ Ä§À±À̰ųª ¿·À¸·Î 7mm ¹Ì¸¸À̸é FIGO stage Ia2
- Invasive cervical cancer
¨çSquamous cell carcinoma(M/C-85~90%)
Á¾·ù : large cell keratinizing /large cell nonkeratinizing / small cell types
¨èAdenocarcinomas(10%Á¤µµ)
20~30´ë ÀþÀº ¿©¼º¿¡ ¸¹À½
30~50%¿¡¼­ squamous neoplasia°¡ °üÂûµÊ
PAP·Î ã±â ¾î·Á¿ò -> conizationÀÌ Áø´ÜÀ§ÇØ ÇÊ¿ä
¨éSarcoma
¾Ö³ª ÀþÀº ¼ºÀο¡¼­ ³ªÅ¸³ª´Â Å»ý¼º Ⱦ¹®±Ù À°Á¾
¨êMalignant melanoma(rare)

¡ØStaging
stage0
Carcinoma in situ. intraepitheliaal carcinoma
stage¥°
Invasive cancer with tumor strictly confined to the cervix.

IA



IA1
Tumor has penetrated an area less than 3 mm deep and less than 7 mm wide. preclinical carcinoma(Çö¹Ì°æÀ¸·Î¸¸ º¸ÀÓ)


IA2
Tumor has penetrated an area 3 to 5 mm deep and less than 7 mm wide.

IB
This stage includes tumors that can be seen without a microscope. It also includes tumors that cannot be seen without a microscope but that are more than 7 mm wide and have penetrated more than 5 mm of connective cervical tissue.


IB1
Tumor that is no bigger than 4 cm


IB2
Tumor that is bigger than 4 cm Tumor has spread to organs and tissues outside the cervix but is still limited to the pelvic area.
stage¥±
Invasive cancer with tumor extending beyond the cervix and/or the upper two-thirds of the vagina, but not onto the pelvic wall.

¥±A
Tumor has spread beyond the cervix to the upper part of the vagina.

¥±B
Tumor has spread to the tissue next to the cervix.(parametruim)
stage¥²
Invasive cancer with tumor spreading to the lower third of the vagina or onto the pelvic wall; tumor may be blocking the flow of urine from the kidneys to the bladder.

¥²A
Tumor has spread to the lower third of the vagina.

¥²B
Tumor has spread to the pelvic wall and/or blocks the flow of urine from the kidneys to the bladder.
stage¥³
Invasive cancer with tumor spreading to other parts of the body. This is the most advanced stage of cervical cancer.

¥³A
Tumor has spread to organs located near the cervix, such as the bladder or rectum.

¥³B
Tumor has spread to parts of the body far from the cervix


¡Østagingng work up(¹ØÁÙÀ» Çʼö °Ë»ç)
- CXR
- Cystoscopy
- Proctoscopy
- IVP
- Barium enema
- Computed tomography (CT scan)
- Magnetic resonance imaging (MRI)

¡Ø ÀüÆÄ ¾ç»ó
- ÀڱðæºÎ °£Áú, Àڱà üºÎ, Áú°ú Àڱùæ°áÇÕ Á¶Á÷À¸·Î Á÷Á¢ ħÀ±
- ¸²ÇÁ¼º ÀüÀÌÀÇ ºñÀ²stage¥°
stage¥±
stage¥²
stage¥³
15~20%
25~40%
>50%
50~80%


- Ç÷Ç༺ ÀüÀÌ
- º¹°­³» ÆÄ±Þ
¡Ø Treatment(surgery, radiotherapy)
- II a ¹Ì¸¸¿¡¼­¸¸ ¼ö¼ú ´Üµ¶ ¿ä¹ýÀÌ °¡´É
¡àSurgical therapy
¼ö¼úÀÇ Á¾·ù
Type ¥°
Simple hysterectomy
Type II
Modified radical hysterectomy : medial one-half of the cardinal and uterosacral ligaments
Type III
Radical hysterectomy : includes a pelvic lymph node dissection, along with removal of most of the uterosacral and cardinal ligaments and the upper one-third of the vagina
Type IV
Extended radical hysterectomy : periureteral tissue, superior vesicle artery, and up to three-fourths of the vagina are removed
TypeV
Partial exenteration : portions of the distal ureter and bladder are resected

¡àComplications of radical hysterectomy
Acute complications


blood loss
ureterovaginal fistula
vesicovaginal fistula
pulmonary embolus
small-bowel obstruction
febrile morbidity
most often pulmonary
pelvic cellulitis
urinary tract infection

Subacute complications
bladder dysfunction
Lymphocyst

Chronic complications
Bladder hypotonia (or atony)3%
Ureteral stricture(uncommon)

¡à¼ö¼úÈÄ »ýÁ¸À²
stage1bÀÌÇÏÀÎ °æ¿ì : 85~90%
stage2a : 75%
¡à¼ö¼ú »ç¸ÁÀÇ °¡Àå ÈçÇÑ ¿øÀÎÀº Æóµ¿¸Æ »öÀüÁõ

¡à¹æ»ç¼± Ä¡·á : Àڱà °æºÎ¾ÏÀÇ ¸ðµç º´±â¿¡¼­ ½ÃÇà °¡´É
- ¹Ì¼¼ ħÀ±¾ÏÀÇ Ä¡·á¿¡´Â 4000~5000cGyÁ¶»ç
- ÀÓ»óÁõ»ó ÀÖÀ¸¸é 6000cGy
- ÇÕº´Áõ : perforation, fever, nausea, frequency, hematuria, hematochezia
¸¸¼º ÇÕº´Áõ : proctosigmoiditis, fistular, stricture
- CCRT : cisplatin°ú ÇÔ²² RTÇÏ¸é ´Üµ¶Ä¡·áº¸´Ù ¼ºÀû ³´´Ù

¡àneoadjuvant chemotherapy
- 2bÀÌ»óÀÇ È¯ÀÚ¿¡¼­ ¼ö¼ú °¡´ÉÇÏ°Ô ÇØ¼­ ¼ö¼úÇϱ⵵ ÇÔ
- LN ÀüÀÌÀ² ³·Ãã
- Àç¹ß·ü ³·Ãã, 5³â »ýÁ¸À² ¿Ã¸²