小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 异常阴道出血
- 性交后出血
- 骨盆或背部疼痛
- 性交痛
- 宫颈肿物
- 宫颈出血
其他诊断因素
- 黏液样或脓性白带
- 膀胱、肾脏或肠梗阻
- 骨痛
危险因素
- 人类乳头状瘤病毒 (HPV) 感染
- 年龄组
- HIV 感染
- 过早性生活（小于18岁）
- 多名性伴侣
- 吸烟
- 免疫抑制
- STI 病史
- 口服避孕药的使用
- 多产
- 未做过包皮环切的男性伴侣
- 微量元素性营养不良
- 血清叶酸低水平
- 维生素C和E低水平
- 饮酒
- 低等社会经济状况
诊断性检查
首要检查
- 阴道检查或窥具检查
- 阴道镜检查
- 活检
- 人乳头瘤病毒（HP）检测
需考虑的检查
- 全血细胞计数 (FBC）
- 肾功能检查
- 肝功能检查
- 胸部 X 线检查
- 静脉肾盂造影
- 肾脏超声
- 钡灌肠
- 乙状结肠镜检查
- 膀胱镜检查
- 盆腔 MRI
- 全身PET检查
- 全身PET/CT检查
- 胸部/腹部/骨盆CT与静脉/口服造影剂
新兴检查
- p16 和 Ki67 生物标志物的表达
治疗流程
非妊娠女性 IA1 期病变：微小浸润性病变
非妊娠 IA2 或 IB1 期：早期宫颈癌
非妊娠IB2-IIA期：早期宫颈癌
非妊娠IIB-IVA期：局部晚期宫颈癌
非妊娠IVB期：疾病转移
非妊娠：局部或区域性复发性疾病
妊娠：任何期别
撰稿人
作者
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
利益声明
RTP reports receiving personal fees from AbbVie, Clovis Oncology, Janssen Oncology (J&J), NewLink Genetics, Sutro Biopharma, Tesaro Inc., and Vascular Biogenics Ltd, research funding provided to the institution for clinical trials from Array BioPharma Inc., AstraZeneca., Genentech, Inc., Regeneron, and Sanofi-Aventis US LLC, and personal fees and research funding provided to the institution for clinical trials from AstraZeneca, Eisai Inc./Merck & Co., Tesaro Inc., Genentech/Roche, Inc., and Vascular Biogenics Ltd, during the conduct of the study. RTP is an author of a number of references cited in this topic.
Andrea L. Russo, MD
Director
Gynecologic Radiation Oncology
Associate Clinical Director
Department of Radiation Oncology
Massachusetts General Hospital
Boston
MA
利益声明
ALR declares that she has no competing interests.
鸣谢
Dr Richard T. Penson and Dr Andrea L. Russo would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who is sadly deceased, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
利益声明
NSH and AHR declare that they have no competing interests.
同行评议者
Tracilyn Hall, MD
Assistant Professor of Gynecologic Oncology
Dan L Duncan Comprehensive Cancer Center
Baylor College of Medicine Houston
Houston
TX
利益声明
TH declares that she has no competing interests.
Linda Yang, MD
Fellow
Minimally Invasive Gynecologic Surgery
Magee Women's Hospital
University of Pittsburgh Medical Center
PA
利益声明
LY declares that she has no competing interests.
Deirdre Lyons, MB, BCh, BAO, MRCOG
Consultant in Obstetrics & Gynaecology
Lead Clinician in Colposcopy
Imperial College Healthcare NHS Trust
London
UK
利益声明
DL declares that she has no competing interests.
鉴别诊断
- 人类乳头状瘤病毒 (HPV) 感染
- 盆腔感染
- 纳氏囊肿
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