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1、CERVICALCANCER...Diagnosis＆TreatmentCERVICALCANCER...ThemostcommonmalignancyingynecologicaloncologyIncidence:7.8/100,000Mortality:2.7/100,000Diagnosis:biopsyMainmodalityoftreatment:surgeryandradiationGoaloftreatment:cure,exceptstage4bSpecialCase38yrs,G3/P
2、1,nurseC/O:postcoitalbleedingfor2monthsMenstruationregularwith30dayscycleand5daysduration.Abnormaldischargewithbadsmell.LMP:12daysagoPapsmear:squamouscellcancerPV:Vulva:Normal,Vaginal:yellowishdischargewithbloodystained,Cervix:growthwithulcerationandconta
3、ctbleeding.Uterus:N/S,mobile.Parametrium:thickeningnottopelvicsidewallonbothsideCERVICALCANCER…..Howcanwemakeadiagnosis?Howcanweevaluatethepatient?Howcanwemanagethepatient?Howshouldweexplaintothepatient?Canwepreventcervicalcancer?Howcanwemakeadiagnosis?SY
4、MPTOMSAbnormalvaginalbleedingpostcoitalbleeding*contactbleedingAbnormalvaginaldischargeAsymptomatic,justabnormalpapsmearSYMPTOMSTheclassicsymptomisintermittent,painlessmetrorragiaorspottingonlypostcoitallyorafterdouching.Probablythefirstsymptomofearlycanc
5、erofthecervixisathin,watery,blood-tingedvaginaldischargethatfrequentlygoesunrecognizedbythepatients.Asthemaligancyenlarges,thebleedingepisodesbecomeheavierandmorefrequent,andtheylastlonger.SYMPTOMSLatesymptomorindicatorsofmoreadvanceddiseaseincludethedeve
6、lopmentofpainreferredtotheflankorleg.Manypatientsc/odysuria,hematuriaorrectalbleedingorobstipationresultingfrombladderorrectalinvasion.Distantmetastasisandpersistentedemaofoneorbothlowerextremitiesasaresultoflymphaticandvenousblockagebyextensivepelvicwall
7、diseasearelatemanifestationofprimarydiseaseandfrequentmanifestationsofrecurrentdisease.Howcanwemakeadiagnosis?SIGNSVagina:mucous,fornixCervix:erosiongrowthulcerationbarrel-shapedUterus:size,mobilityParamet:thickeningGrossappearenceThreecategoriesofgrossle
8、sionshavetraditionallybeendescribed.Themostcommonistheexophyticlesion,whichusuallyarisesontheectocervixandoftergrowstoformalarge,friable,polypoidmass,arisesontheendocervicalcanal,creatingbarrel-shapedlesion.Littlevi
