다음주 부터는 주로 부인과를 돌게 되었습니다. 아마 추석 지나고 수술이 굉장히 많을 것이라 예상이 됩니다만, 어떻게든 지나가겠죠! ㅎㅅㅎ Novak을 찾아봅시다~ novak
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Human papillomavirus (HPV) infection is the causal agent of cervical cancer.
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Screening programs are effective at decreasing the incidence of cervical cancer.
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Although the most common histologic type of cervical cancer is squamous, the relative and absolute incidence of adenocarcinoma is increasing.
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Cervical cancer is clinically staged, although modern radiographic modalities such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, or positon emission tomography (PET) may be beneficial for individual treatment planning. (치료계획으론 이용할 수 있으나 진단으로 영상학적 검사는 사용하지 않아요, sensitivity도 낮고 위양성율도 굉장히 높아요. 다만 a recent systematic review comparing CT scan(80%) with MRI has shown that MRI is significantly more sensitive with equivalent specificity)
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Treatment of cervical cancer is based on stage of disease. In general, early stage disease(Ia~IIa) can be treated with either radical surgery or radiation therapy. Advanced stage disease (IIb~IV) is best treated with chemoradiation.
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Vaginal cancer is a rare disease with many similarities to cervical cancer. Radiation therapy is the mainstay of treatment for most patients; however, select patients may be treated with radical surgery.
Cervical Cancer
2)There are numerous risk factors for cervical cancer: young age at first intercourse (<16 years), multiple sexual partners, cigarette smoking, race, high parity, and lower socioeconomic status.
3)The initiating event in cervical dysplasia and carcinogenesis is infection with HPV.
(A) Atypical vessels. The lesion on the anterior lip of the cervix exhibits large vessels running horizontal to the surface. The border is very distinct and the edge is raised. The lesion color is more yellow than white. Biopsy revealed invasive squamous carcinoma to a depth of 4 mm. Conization was consistent and radical hysterectomy found no evidence of disease spread. Patient is alive and well 17 years later.
<Sawaya, G, Smith-McCune, K, Glob. libr. women's med., (ISSN: 1756-2228) 2010; DOI 10.3843/GLOWM.10019>
(ii)Irregular Surface Contour
(iii)Color Tone
FIGO Staging of Carcinoma of the Cervix Uteri
<reference - Revised FIGO Staging System 유 희 석 | 아주의대 산부인과 | Hee Sug Ryu, MD>
Preinvasive Carcinoma
Stage 0 Carcinoma in situ, intraepithelial carcinoma (cases of stage 0 should not be included in any therapeutic statistics). 상피내암
Invasive Carcinoma
Stage I Carcinoma strictly confined to the cervix (extension to the corpus should be disregarded).
Stage Ia Preclinical carcinomas of the cervix, that is, those diagnosed only by microscopy.
Stage Ia1 Lesions with less than 3 mm invasion
Stage Ia2 Lesions detected microscopically that can be measured. The upper limit of the measurement should show a depth of invasion of 3~5 mm taken from the base of the epithelium, either surface or glandular, from which it originates, and a second dimension, the horizontal spread, must not exceed 7 mm. Larger lesions should be staged as Ib.
Stage Ib Lesions invasive > 5 mm.
Stage Ib1 Lesions < 4cm
Stage Ib2 Lesions > 4cm
Stage II The carcinoma extends beyond the cervix but has not extended onto the wall
The carcinoma involves the vagina, but not the lower one third
Stage IIa No obvious parametrial involvement
Stage IIb Obvious parametrial involvement
Stage III The carcinoma has extended onto the pelvic wall. On rectal examination, there is no
cancer-free space between the tumor and the pelvic wall. The tumor involves the lower one third of the vagina. All cases with hydronephrosis or nonfunctioning kidney.
Stage IIIa No extension to the pelvic wall.
Stage IIIb Extension onto the pelvic wall and/or hydronephrosis or nonfunctioning kidney
Stage IV The carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV.
Stage IVa Spread to the growth to adjacent organs.
Stage IVb Spread to distant organs.
*Special tip
자궁경부암의 병기설정에 있어서 몇 가지 논란거리가 있는데, 임상적 병기설정과 수술적 병기설정에 관한 것, 병기 IA1의 임상적 의의에 관한 것(4), 림프혈관 침윤에 대한 것, 림프절 전이상태에 관한 것(5),선암(adenocar-cinoma)의 병기설정에 대한 것 등이 대표적이다. 임상적 병기설정 방법은 최근 영상의학의 발달과 장비의 진보에도 불구하고 수술적 병기설정보다 부정확하다(6). 그러나 국소적으로 진행된 경우에서 수술
이 일차적 치료가 될 수 없고 또한 이러한 환자들은 의료자원이 충분하지않은 환경, 즉 개발도상국에서 많이 발생한다. 수술적 병기설정의 중요성을인정하지만 수술이 아닌 다른 치료방법과 같은 효과를 얻을 수 있는지 아직 확실하지 않다. 따라서 임상적 병기설정으로 지속하기로 결정되었다(Table 2).
<reference - Revised FIGO Staging System 유 희 석 | 아주의대 산부인과 | Hee Sug Ryu, MD>
<reference- Berek & Novak's gynecology. 14th edition>
그림이 짱이네요 ㅋㅋ
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