子宫内膜癌

title: 分类.
title: 恶性上皮细胞肿瘤.
content: 大多数上皮组织癌症称之为恶性上皮细胞肿瘤(英语:carcinoma,也通常称之为腺癌),是指链接子宫内膜和子宫内膜腺体的上皮组织细胞病变而形成。在组织学上,有很多子宫内膜癌的子类,但主要归类为两种:I类和II类,取决于癌症的临床特征和发病机制。  第一类(I类)子宫内膜癌通常病发于停经期前妇女,常病发于白人妇女,经常有子宫内膜过度增厚(子宫内膜增生)和分泌过高的雌性激素而不能和黄体酮保持平衡。I类子宫内膜癌通常是低度癌症,很少侵入到子宫壁(子宫肌层),而这种子宫内膜样的类型有比较好的预后。在子宫内膜癌中,癌症细胞的生长仍然和正常子宫内膜细胞生长模式相似。  第二类(II类)子宫内膜癌通常病发于老年、停经期后的妇女,常病发于非裔美国人,这类肿瘤和分泌过高的雌性激素无关。II类子宫内膜癌通常是高度癌症,并侵入到子宫壁(子宫肌层),包括子宫乳头状浆液性癌或子宫内膜透明细胞癌类型,其预后比较差。
title: 恶性结缔细胞肿瘤.
content: 和子宫内膜癌不同,罕见的子宫内膜间质肉瘤(英语:endometrial stromal sarcomas)是一类病发于子宫内膜的非腺结缔组织的癌症。子宫肉瘤,正式名为苗勒管混合瘤,是一类罕见的子宫癌症,同时有腺部和肉瘤的癌症细胞显现,这类癌症细胞的原发机制仍然不明。
title: 诊断.
title: 临床评估.
content: 无症状的妇女在定期检查中无法发现子宫内膜癌,而这种疾病在早期是高治愈的。在骨盆检查中,子宫内膜会显示正常,特别是在疾病早期。当疾病恶化后,子宫和附件组织的大小、形状和一致性会产生变化。
title: 病理学.
content: 组织学下的子宫内膜癌呈高度分化。最常见的是分化良好型子宫内膜样腺癌,由大量、小型、密集分布的腺体组成,伴有不同程度的核异型、核分裂和成层;它常有子宫内膜增生的情况。通过透明基质入侵情况可以判定,弗兰克腺癌(英语:Frank adenocarcinoma)可能与典型增生不同。随着癌症病情加重,癌症可能会渗入子宫肌层。其他子类的子宫内膜癌很难发现,比如子宫乳头状浆液性癌和透明细胞癌。
title: 其他评估.
content: 被查出患有子宫内膜癌的患者可能会采取电脑断层扫描去评估癌症的扩散情况。术前评估应当包括完整的病历和身体检查、盆腔检查、肛门检查(包括粪便检查)、胸腔X光、全血计数、血象检查、肝功能试验。如果粪便检查呈阳性、或者患者有病症,医师会推荐进行结肠镜检查,因为致病原因可能是子宫内膜癌,也可能是结肠癌。此外,肿瘤标记物CA-125的检测,也可以帮助医师预测肿瘤恶化情况。
title: 分级.
content: 根据2009年国际妇产科联盟(英语:International Federation of Gynecology and Obstetrics)的癌症分级系统显示,子宫内膜癌的分级情况如下:
title: 治疗.
content: 首选的治疗措施是手术。手术措施应当包括腹膜液的细胞学抽样、腹腔探查、可疑淋巴管的触诊和活检、腹部全子宫切除术、双侧输卵管-卵巢切除术。此外,对于高危型肿瘤情况(比如病理学三期的浆液性或透明性肿瘤、肿瘤入侵超过一半以上的子宫肌层、或者侵入子宫颈或子宫附件情况),淋巴切除术或者盆腔、直肠旁淋巴结切除术有时也会被采用。有时,会需要进行大网膜切除术。  通常会推荐医师采取剖腹子宫切除术超过经阴道子宫切除术,因为前者可以帮助手术医师检查和进行腹腔清洗,并检查其他癌症症状和情况。  对于第I和第II期患者,医院可能会采取手术结合放射疗法,以减少肿瘤复发危险。在一些病例中,对于第III期和第IV期的患者,医师可能会考虑化学疗法,通常采用的单独化疗或联合化疗方式包括有阿霉素、卡铂、顺铂、5-氟脲嘧啶、阿霉素等。采用孕素和抗雌激素的激素疗法也被用于治疗子宫内膜间质肉瘤。  一类名为赫塞汀的抗体药物,通常用于治疗乳腺癌(产生过量的HER2/neu蛋白),也可以治疗一类过量产生HER2/neu蛋白的子宫乳头状浆液性癌II期患者;不过赫塞汀被证实有严重的心脏毒性,需要谨慎使用。
title: 预后.
title: 存活率.
content: 子宫内膜癌在合适治疗后,五年存活率是80%。超过75%的女性患者在肿瘤分期第1和2期中,有最好的预后。以下是国际妇产科联盟公布的五年存活率:
title: 复发率.
content: 早期子宫内膜癌的复发率是3%至17%,取决于主要和辅助的治疗方法。大多数复发情况(70%)发生于最初的三年中。
title: 生活质量.
content: 超过80%的子宫内膜癌治愈者平均都有2至3种合并症;数据显示肥胖对子宫内膜癌治愈者有负面影响。  子宫内膜癌治愈者采用超过其他人群更多的医疗检查,它与对疾病复发的恐惧有关,数据显示这种担心在治愈后的十年中未曾减少。  对子宫内膜癌治愈者的研究显示出,治愈者满意度(通过获取关于疾病和治疗的信息)可以提高了生活治疗,并减轻抑郁、消减焦虑。通过治愈者接受信息的途径(纸质或口头)研究显示,治愈者当接受到更多治疗和疾病信息后,她们的满意度越高。美国医学研究所和荷兰健康委员会推荐采用“生存保健计划”(英语:Survivorship Care Plan),其包括患者接受治疗措施总结,并还有后续检查建议、后遗症的处理、及健康提高策略。
title: 流行病学.
content: 在美国和一些西方国家,子宫内膜癌是妇科生殖道肿瘤中最常见的癌症。每年,每10万妇女中就有15-25位子宫内膜癌患者,它常见于55岁至65岁的妇女,很少有40岁以下的患者。从流行病学意义上,子宫内膜癌有两类 I类发生于围绝经期妇女伴发雌激素过多症;II类发生于子宫内膜萎缩患者。

Summary: 子宫内膜癌(英语:endometrial cancer),指的是源自子宫内膜的癌症。其病因是由于细胞异常的生长,并且具备了能够侵袭或扩散到身体其他部位的能力。最常见的初始症状为非经期阴道出血。其他可能出现的症状包括解尿疼痛、性交疼痛,或骨盆痛。子宫内膜癌最常发生在更年期之后。

Endometrial cancer: Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause. Approximately 40% of cases are related to obesity. Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes. Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and a progestogen in combination, as in most birth control pills, decreases the risk. Between two and five percent of cases are related to genes inherited from the parents. Endometrial cancer is sometimes loosely referred to as "uterine cancer", although it is distinct from other forms of uterine cancer such as cervical cancer, uterine sarcoma, and trophoblastic disease. The most frequent type of endometrial cancer is endometrioid carcinoma, which accounts for more than 80% of cases. Endometrial cancer is commonly diagnosed by endometrial biopsy or by taking samples during a procedure known as dilation and curettage. A pap smear is not typically sufficient to show endometrial cancer. Regular screening in those at normal risk is not called for. The leading treatment option for endometrial cancer is abdominal hysterectomy (the total removal by surgery of the uterus), together with removal of the fallopian tubes and ovaries on both sides, called a bilateral salpingo-oophorectomy. In more advanced cases, radiation therapy, chemotherapy or hormone therapy may also be recommended. If the disease is diagnosed at an early stage, the outcome is favorable, and the overall five-year survival rate in the United States is greater than 80%. In 2012, endometrial cancers newly occurred in 320,000 women and caused 76,000 deaths. This makes it the third most common cause of death in cancers which only affect women, behind ovarian and cervical cancer. It is more common in the developed world and is the most common cancer of the female reproductive tract in developed countries. Rates of endometrial cancer have risen in a number of countries between the 1980s and 2010. This is believed to be due to the increasing number of elderly people and increasing rates of obesity.