宫颈鳞状细胞癌
Cervical Squamous Cell Carcinoma
作者信息
Jain Manisha A., Limaiem Faten
机构信息
MUHS, Nashik
University of Tunis El Manar, Tunis Faculty of Medicine
出版信息
Cervical cancer is a cancer of the female reproductive system that originates in the cervix. It is the fourth leading cause of cancer in women after breast, lung, and colorectal cancer. It is easily preventable, owing to the universal application of Papanicolaou smear screening that has resulted in the early detection of pre-cancerous lesions, which can be removed before they progress to invasive cancer. However, it is still a common genital cancer encountered in clinical practice in women of low and middle-income countries (LMICs) due to a lack of extensive screening. Cervical cancers are often squamous-cell carcinomas that arise from infection with high-risk Human Papilloma Virus (HPV) serotype-16 and 18. along with fallopian tubes, the body of the uterus, and the upper third of the vagina, are all derived from the paramesonephric duct. The cervix is the lowermost cylindrical part of the uterus in females, measuring about 2.5 cm in length. The interior cavity of the cervix is called the cervical canal. The cervical canal communicates above with the cavity of the body of the uterus through the internal os and below with the vaginal cavity through the external os. The lower part of the cervix projects into the anterior vaginal wall, which divides it into a supravaginal part and a vaginal part. The supravaginal part is related anteriorly to the bladder, posteriorly to the rectovaginal pouch (containing intestines) and rectum, and on either side to the ureter and uterine artery embedded in the parametrium. The space between the vaginal part of the cervix and the vagina forms the vaginal fornices. The cervix is composed mainly of fibroelastic connective tissue. It can be divided into endocervix, cervical transformation zone, and ectocervix. The endocervix comprises simple columnar epithelium, which produces mucus, and the ectocervix comprises non-keratinized stratified squamous epithelium. The cervical transformation zone, or the squamocolumnar junction, represents the zone where the endocervix's columnar epithelium changes to the ectocervix's squamous epithelium. Cervical cancer mostly originates from this region. Uterine artery. External iliac, internal iliac, obturator, and sacral lymph nodes. Sympathetic from T12 - L2 (contraction and vasoconstriction); parasympathetic from S2 - S4 (vasodilation); and viscerosensory fibers (pain sensations) pass along parasympathetic nerves. Cervical cancer incidence has dramatically declined in regions where screening programs have been implemented. About 70 percent of the current burden of cervical cancer comes from the low-socioeconomic areas where screening programs are not well-established. Cervical cancer is most common in females who have multiple sexual partners and do not use condoms. High-risk sexual practices result in infection by the HPV. HPV integrates its DNA into the basal cells of the columnar junction (in the cervix's transformation zone), which results in the production of proteins (E6 and E7) that eventually cause dysplasia. Dysplasia of the cervical epithelium is also called cervical intraepithelial neoplasia(CIN). While CIN can progress to cervical cancer, regression can take place. Rates of progression to cancer vary in different studies. CIN does not necessarily develop in all women who get infected with HPV. The immune system clears off most of the HPV infection. The risk of CIN increases with the type of HPV (HPV 6 and 11 are low-risk types, whereas 16 and 18 are high-risk types), duration of infection, environmental factors like smoking, and immunosuppression in the patient. Fortunately, vaccination against HPV is available, which immunizes against several HPV types linked with cervical cancer, including HPV 16. As compared to other gynecological cancers, cervical cancer occurs in younger women. The mean age of diagnosis of cervical cancer is about 49 years. Most of these women are diagnosed with early-stage cancer and cured, though they might have to carry the burden of potential treatment-related side effects (eg, infertility). The majority of the women who are cervical cancer survivors are diagnosed with early-stage or locally advanced cancer. The median survival of women diagnosed with metastatic or recurrent cervical cancer is generally less than 2 years. The most common areas of metastases from cervical cancer are the lymph nodes, liver, lungs, and bones.
宫颈癌是一种起源于子宫颈的女性生殖系统癌症。它是继乳腺癌、肺癌和结直肠癌之后女性癌症的第四大主要病因。由于巴氏涂片筛查的广泛应用,能够早期发现癌前病变,且这些病变在发展为浸润性癌症之前即可切除,所以宫颈癌很容易预防。然而,由于缺乏广泛筛查,在低收入和中等收入国家(LMICs)的临床实践中,宫颈癌仍是常见的妇科癌症。宫颈癌通常是由高危型人乳头瘤病毒(HPV)16型和18型感染引起的鳞状细胞癌。输卵管、子宫体和阴道上三分之一部分均源自副中肾管。子宫颈是女性子宫最下端的圆柱形部分,长约2.5厘米。子宫颈的内腔称为宫颈管。宫颈管通过内口与子宫体腔相通,通过外口与阴道腔相通。子宫颈的下部突入阴道前壁,将其分为阴道上部和阴道部。阴道上部前方与膀胱相邻,后方与直肠子宫陷凹(含肠管)和直肠相邻,两侧与包埋在子宫旁组织中的输尿管和子宫动脉相邻。子宫颈阴道部与阴道之间的间隙形成阴道穹窿。子宫颈主要由纤维弹性结缔组织构成。它可分为子宫颈内膜、宫颈转化区和子宫颈外膜。子宫颈内膜由产生黏液的单层柱状上皮组成,子宫颈外膜由未角化的复层鳞状上皮组成。宫颈转化区,即鳞柱交界,是子宫颈内膜柱状上皮转变为子宫颈外膜鳞状上皮的区域。宫颈癌大多起源于该区域。子宫动脉、髂外动脉、髂内动脉、闭孔动脉和骶淋巴结。交感神经来自T12 - L2(收缩和血管收缩);副交感神经来自S2 - S4(血管舒张);内脏感觉纤维(痛觉)沿副交感神经传导。在实施筛查计划的地区,宫颈癌发病率已大幅下降。目前约70%的宫颈癌负担来自筛查计划不完善的低社会经济地区。宫颈癌在有多个性伴侣且不使用避孕套的女性中最为常见。高危性行为会导致HPV感染。HPV将其DNA整合到柱状交界(宫颈转化区)的基底细胞中,导致产生蛋白质(E6和E7),最终引起发育异常。宫颈上皮发育异常也称为宫颈上皮内瘤变(CIN)。虽然CIN可发展为宫颈癌,但也可能发生消退。不同研究中发展为癌症的发生率有所不同。并非所有感染HPV的女性都会发生CIN。免疫系统可清除大多数HPV感染。CIN的风险会因HPV类型(HPV 6和11为低危型,而16和18为高危型)、感染持续时间、吸烟等环境因素以及患者的免疫抑制情况而增加。幸运的是,有针对HPV的疫苗,可预防多种与宫颈癌相关的HPV类型,包括HPV 16。与其他妇科癌症相比,宫颈癌多见于年轻女性。宫颈癌的平均诊断年龄约为49岁。这些女性大多被诊断为早期癌症并治愈,不过她们可能要承受潜在的治疗相关副作用(如不孕)。大多数宫颈癌幸存者被诊断为早期或局部晚期癌症。被诊断为转移性或复发性宫颈癌的女性的中位生存期通常不到2年。宫颈癌最常见的转移部位是淋巴结、肝脏、肺和骨骼。
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