(Parkin D.M,et al Bulletin of the WHO.1984,62:163-183) 459400 Total 15700 44000 47200 31300 36900 131500 71600 9700 70300 1200 105100 354300 North America Latin America Europe Soviet Union Africa China Indea Japan Asia （ Other Areas ） Australia/New Zealand Advanced Areas Developing Aeras New Cases Area
Infection From Time of First Sexual Intercourse From Winer RL, Lee S-K, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003;157:218–226. Reprinted with the permission of Oxford University Press. 0 0.2 0.4 0.6 0.8 1 Months Since First Intercourse Cumulative Incidence of HPV Infection
*Mantle-Haenszel estimates adjusted for age only 1. La Vecchia C, Franceschi S, DeCarli A, et al. Cancer . 1986;58:935 – 941. Age at First Intercourse (Years) (n=206) (n=327)
9,710 new cases of cervical cancer 1 330,000 new cases of high-grade cervical dysplasia (CIN 2/3) 2 1.4 million new cases of low-grade cervical dysplasia (CIN 1) 2 1 million new cases of genital warts 3 Incidence of HPV infection, CIN and Cervical Cancer in USA
At colposcopy, the original or native squamous epithelium appears gray and homogeneous. The columnar epithelium appears red and grapelike. The transformation zone can be identified by the presence of gland openings that are not covered by the squamous metaplasia and by the paler color of the metaplastic epithelium compared with the original squamous epithelium.Normal blood vessels branch like a tree.
General physical examination such as weight loss, enlarged inguinal lymph nodes, edema of the legs, ascites, pleural effusion, or hepatomegaly.
Pelvic examination I n early cervical cancer may reveal a cervix that appears normal, especially if the lesion is endocervical. Visible disease may take several forms: ulcerative, exophytic, granular, or necrotic . The lesion may involve the upper potion of the vagina. The cervix may be distorted or completely replaced by tumor.
Rectovaginal examination E ssential to determine the extent of involvement. The degree of cervical expansion and spread to the parametria are much more easily deteced with a finger in the rectum, as is extension into the uterosacral ligaments.
Direct invasion cervical stroma, vagina, and parametrium.
Lymphatic spread pelvic and then paraaortic lymph nodes
Hematogenous spread such as lungs, liver, and bone
The International Federation of Gynecology and Obstetrics(FIGO) staging of cervical carcinoma Spread to distant organs. IVb Spread of the growth to adjacent organs. IVa 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 IV Extension onto the pelvic wall and /or hydronephrosis or nonfunctioning kidney. IIIb Tumor involves lower third of the vagina with no extension to the pelvic wall. IIIa The carcinoma has extended to the pelvic wall. On rectal examination there is no cancer-free space between the tumor and the pelvic wall. The tumor involves the lower third of the vagina. All cases with hydroeprosis or nonfunctioning kidney should be included, unless they are known to be due to another cause. III Obvious parametrial involvement. IIb No obvious parametrial involvement. IIa The carcinoma extends beyond the cervix but has not extended to the pelvic wall or to the lower third of the vagina. II Clinical lesions greater than 4 cm in size Ib2 Clinical lesions not greater than 4 cm in size Ib1 Clinical lesions confined to the cervix or preclinical lesions greater than stage Ia Ib Measured invasion of stroma greater than 3 mm and not greater than 5 mm and width not greater than 7 mm Ia2 Measured invasion of stroma not greater than 3 mm in depth and 7 mm in width Ia1 Invasive cancer is identified only microscopically. All grossslesions even with superficial invasion are Ib cancer. Invasion is limited to a measured stromal invasion, with a maximal depth 5 mm and a horizontal extension of not more than 7 mm Ia The carcinoma is strictly confined to the cervix I Carcinoma in situ, intraepithelial carcinoma 0 Range Stage