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[子宫颈腺癌:诊断与治疗的特殊性]

[Adenocarcinoma of the uterine cervix: particularities in diagnosis and treatment].

作者信息

Vandenbroucke L, Robert A-L, Lavoué V, Foucher F, Henno S, Levêque J

机构信息

Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France.

出版信息

J Gynecol Obstet Biol Reprod (Paris). 2013 May;42(3):207-16. doi: 10.1016/j.jgyn.2012.07.003. Epub 2012 Aug 23.

Abstract

INTRODUCTION

The adenocarcinoma of the uterine cervix accounts for 10 to 20% of the premalignant and malignant lesions and is different from the cervical intraepithelial neoplasia and invasive squamous cell carcinoma.

MATERIALS AND METHODS

Recent literature review (from 1985 to 2012) based on the literature available.

RESULTS AND DISCUSSION

Adenocarcinoma in situ is an induced HPV lesion (role of HPV 18) of the glandular epithelium: its preferential endocervical situation explains the difficulties in the diagnosis and follow-up after conservative treatment. If the hysterectomy remains the gold standard for treatment, the conservative treatments (resection in sano of the lesions with margins of more than 1cm, meticulous study of the operative specimen, compliance with the follow-up) are possible in the young patients who desire to preserve their fertility. The invasive adenocarcinoma is characterized by a more difficult diagnosis because of its endocervical development, and a prognosis less favorable when compared to squamous cell carcinoma with a greater frequency of the lymphatic node involvement and metastatic diffusion. Its treatment must take into account the particular gravity of the factors of worse prognosis (FIGO stage, tumor size, lymphatic node spreading, adenosquamous histological subtype) in particular in the advanced stages and includes beside the surgery, radiotherapy and chemotherapy.

摘要

引言

子宫颈腺癌占癌前和恶性病变的10%至20%,与宫颈上皮内瘤变和浸润性鳞状细胞癌不同。

材料与方法

基于现有文献进行近期文献回顾(1985年至2012年)。

结果与讨论

原位腺癌是腺上皮的一种由人乳头瘤病毒诱导的病变(人乳头瘤病毒18型的作用):其好发于宫颈管内的情况解释了保守治疗后诊断和随访的困难。如果子宫切除术仍然是治疗的金标准,对于希望保留生育能力的年轻患者,保守治疗(切除病变组织且切缘超过1厘米,仔细研究手术标本,遵守随访)是可行的。浸润性腺癌的特点是由于其在宫颈管内发展,诊断更为困难,与鳞状细胞癌相比预后较差,淋巴结受累和转移扩散的频率更高。其治疗必须考虑到预后较差因素(国际妇产科联盟分期、肿瘤大小、淋巴结转移、腺鳞组织学亚型)的特殊严重性,特别是在晚期,除手术外还包括放疗和化疗。

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