1. Cervical Dysplasia and Cervical Cancer Qu Quanxin [email_address] Tianjin First Central Hospital

5. LCR E6 E7 E1 E2 E4 E5 L2 L1

6. HPV HPV infection via wounds in epithelium

7. 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

8. *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. Cervical Intraepithelial Neoplasia

10. 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

12. Before puberty After puberty and reproductive period child-bearing period Peri-menopausal period menopausal period

14. Normal ASCUS LSIL HSIL

15. Conventional Pap Smear Decrease Sensitivity

16. Liquid-based Cytology HPV infection and endocrine change

17. The Liquid-based Cytology

18. CIN 1 CIN2 CIN3 LSIL HSIL Normal or benign disease Carcinoma in situ Early invasive carcinoma CIN Pathology Cytology

21. Squamous epithelial Columnar epithelial Squamous epithelial Columnar epithelial (iodine test)

25. Cervical carcinoma

29. Normal Pre-Invasive Cancer Invasive Cancer Pre-Invasive Cancer Invasive Cancer

30. Natural History of Cerical Carcinogenesis

33. Cervical squmous carcinoma

34. Cervical squmous carcinoma

35. Cervical squmous carcinoma

38. Cervical squmous carcinoma

39. Cervical squmous carcinoma

40. Cervical adenocarcinoma

41. Cervical adenocarcinoma

43. 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