常见妇科恶性肿瘤的诊治.ppt

梅艳芳 李媛媛 很久以后... 谢 谢！ * * 宫颈癌是最常见的女性生殖道恶性肿瘤，多年来科学家不断探究其病因 * 1.150年前，发现修女中宫颈癌极罕见，性混乱与婚产情况与宫颈癌有关；2.60年代报道妇女血中抗HSV-2抗体明显增高，有人提出HSV－2可能是宫颈癌的病因，但缺乏分子学支持，在肿瘤组织中也未检测出HSV DNA，所以此概念逐渐改变；3.从较落后的方法到PCR技术；4.世界各国的大量研究使人们的认识日渐统一：HPV感染是宫颈上皮内瘤变＆宫颈癌发生的必要因素，无论是实验室亦或流行病学证据均证实了这一观点。 * HPV是一种环状双链结构的DNA病毒，由8000个碱基对组成，是一种没有包被的病毒颗粒。其基因结构中包含6个早期转录单位E1、E2、E4－E7，2个晚期转录区L1、L2，E6和E7是病毒癌基因，参与宿主细胞的病毒基因表达和复制，并调控这些活动；它们所编码的蛋白可诱导细胞增殖和转化；参与细胞周期调控：E6与P53、E7与PRb结合，导致这两种抑癌基因失活，使细胞无限制生长。L1、L2 编码膜壳蛋白，可诱导机体产生对HPV 的抗体－疫苗预防 * 粘膜型：口咽、食道、结膜、气道（罕见） ； 皮肤型： 疣状病变。 根据HPV与癌瘤的关系，感染肛门生殖器的HPV可分类为高危型和低危型 * Slide 7: Genital HPV types are divided into low and high-risk types on the basis of their relatedness and their ability (or lack of it) to cause cervical and other lower genital tract cancers. HPV 6 and 11 are responsible for approximately 90% of the exophytic condylomata of the external genitalia, vagina, and cervix as well as most recurrent respiratory papillomatosis, and for less than 15% of low-grade lesions of the cervical transformation zone. Mixed infections with both low-risk and high-risk viruses occur in 2% to 25% of women with CIN. HPVs 42, 43, and 44 are related to HPVs 6 and 11 on both the nucleotide level and in their common lack of association with cervical cancer. These types have been found in only a small proportion of low-grade lesions of the vulva, cervix, and penis. Of 1000 cervical cancers evaluated worldwide, only a single cervical cancer tested positive for a low-risk viral type. Other low-risk types, such as HPVs 53, 61, 70, and 71, are primarily associated with low-grade squamous intraepithelial lesions throughout the lower genital tract. The oncogenic risk of high-risk HPV types has been delineated by their close association with human tumors and by their ability to immortalize normal cells. The relative risk for many of these genital HPVs for CIN 3 and cervical cancer has been well delineated. Approximately 8 HPV types are involved in over 95% of cervical cancer cases. HPV 16 and