Pujol H, Prade M
Bull Cancer. 1979;66(5):503-14.
Invasive epithelioma of the uterine cervix spreads in two different ways. Locally, tumour involves progressively upon neighbouring structures (vagina parametrium, uterine corpus, bladder, rectum). Regionally, lymphatic dissemination occur preociously moving towards the nodes of the pelvic wall. Local extension can be appreciated by clinical examination which determines the clinical staging of cervical cancer. It does not take sufficiently into account the volume of the tumour which is a principal factor in lymphatic dissemination. Nodal metastases essentially localise in the external iliac chain (obturateur group), from there spreading to the common iliac or latero aortic nodes which may, under exceptionnal circumstances be involved primarily. The incidence of latero-aortic metastases has recently been high-lighted by pre-treatment staging laparotomy. Besides lymphatic metastases, systematic metastases via a venous spread are rare. They indicate a late diagnosis or therapy failure with pelvic relapse. The therapeutic effort in cancer of the uterine cervix, at the present time, ought to be found on loco-regional treatment using either radiotherapy or surgery.
子宫颈浸润性上皮瘤以两种不同方式扩散。在局部，肿瘤逐渐累及邻近结构（阴道、子宫旁组织、子宫体、膀胱、直肠）。在区域上，淋巴扩散较早发生，转移至盆腔壁淋巴结。通过临床检查可了解局部扩展情况，这决定了宫颈癌的临床分期。但临床检查没有充分考虑肿瘤体积，而肿瘤体积是淋巴扩散的主要因素。淋巴结转移主要定位于髂外淋巴结链（闭孔组），从那里扩散至髂总或腹主动脉旁淋巴结，在特殊情况下，后者可能首先受累。近期术前分期剖腹术突出了腹主动脉旁转移的发生率。除淋巴转移外，通过静脉扩散的全身转移很少见。它们提示诊断延迟或治疗失败伴盆腔复发。目前，子宫颈癌的治疗应侧重于采用放疗或手术的局部区域治疗。
