(Microsoft PowerPoint - \(CHI\) HPV & cervical cancer \261`\250\243\260\374\244k\264c\251\312\270~\275F -Macau 2013)

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悠助马
4 years ago
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1 常見的婦女惡性腫瘤子宮頸癌 / HPV 1

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3 女性一生感染 HPV 的機會率為 50% 1 HPV 病毒感染十分普遍, 超過半數有性行為的男女都曾感染 HPV 3

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7 HPV 病毒可引起子宮頸細胞病變受感染後, 人體的免疫力或能將病毒清除, 但無法自癒的持續感染者,HPV 病毒會令子宮頸細胞產生病變有機會在數年至十數年間惡化成子宮頸癌, 並可能擴散至身體其他地方 ( 如陰道骨盤等 ) HPV-16 及 HPV-18 醫學數據顯示 18 引致七成的子宮頸癌 HPV-6 及 HPV 引致九成的生殖器官濕疣 ( 椰菜花 ) 7

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9 HPV Related Disease Annual new cases (world figure) 9

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11 本港子宮頸癌 2007 年發病率及死亡率 11

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13 預防 HPV 引發的相關疾病及子宮頸癌 : 1. 定期接受抹片檢查 : 25 歲開始性行為後定期接受抹片檢查, 有助發現病變並及早作治療, 防止子宮頸癌形成 13 13

14 陰道鏡檢查儀器 14

15 正常子宮頸 15

16 子宮頸癌前病變第一度第二度第三度 16

17 子宮頸癌 17

18 手術治療如 HPV 感染引致高度癌前病變, 女士可能需要接受手術治療, 去除細胞異變組織 : 子宮頸圓錐切除術子宮頸電圈切除術 (LEEP) 激光療法液體氮冷凍療法等 18

19 激光療法 19

20 子宮頸電環切除後 20

21 冷凍療法後 21

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23 疫苗注射市面有四合一及二合一疫苗 3 injections within 6 months 四合一疫苗為例, 可助預防引致子宮頸癌外陰癌陰道癌及生殖器官濕疣的陰道癌及生殖器官濕疣的 HPV 病毒常見副作用一般為注射部位疼痛腫脹腫脹瘙癢紅斑及發燒, 均為輕微 23

24 Influence on fetus Published study 13 reported that For women who had prior cervical loop excision although no significant increase in neonatal morbidity was noted slight increase in preterm delivery low birth weight babies As for the fetus, the virus laid at mother s cervix can possibly infect the infant s throat during natural delivery causing wart formation, fortunately this rarely occurs 13 Obstetric Outcomes after Conservative Treatment for Intraepithelial or Early Invasive Cervical Lesions: Systematic Review and Meta-analysis. Kyrgiou et al. Lancet Feb 11;367(9509): Review. 24

25 Influence on pregnant women The medical sector suggests that women with CIN2 or 3 should receive treatment promptly in order to reduce the risk of cervical cancer Nevertheless, the procedure may induce certain risks to pregnant woman or the fetus In most cases, the treatment will be delayed to 3 months after giving birth yet this may bring psychological stress to the mother 25

26 Cervical Cancer effect on pregnancy CIN and early cervical cancer are difficult to spot, thus patients may miss the best time for treatment When cervical cancer eventually develops patients may need to have removal of her womb In cases of advance cervical cancer, radiotheraphyand chemotheraphy will also be needed results in infertility 26

27 Case Sharing Case 1 : Mrs. Ho 2 years ago, she was discovered with CIN3 and then received LEEP treatment to remove the abnormal tissue Later, she was pregnant again. As her cervix was cut short in the last surgery, there was a possibility that the remaining cervix could not support the weight of fetus and result in preterm delivery Doctor suggested her to receive another surgery to temporary tighten the cervix, to reduce the prenatal risk Since there was potential risk to receive any surgery during pregnancy, Mrs. Ho decided not to undergo any surgery. Fortunately, she gave birth to a healthy baby at term 27

28 Case Sharing Case 2 : Mrs. Chan A year ago, shewas found to have CIN in a pre-marriage checkup Her doctor suggested her to have Colposcopyand LEEP treatment In the view that the treatment might reduce the pregnancy rate, Mrs. Chan declined the suggestion Until recently, sheis found pregnant. However the pap smear result shows that the CIN still persists Yet surgery is not appropriate for her, she can only wait until her child is born 28

29 Get well prepared before pregnancy --Vaccination Take HPV Quadrivalent Vaccine, for instance Covers four HPV-types which account for cervical, vulvar, and vaginal cancers and genital warts Studies have shown that the quadrivalentvaccine provides cross-protection against other HPV types such as 31, 33, 52, and 59in prevention of cervical cancer and genital diseases Regarding safety of the vaccine, common side effects reported are injection site pain, swelling, erythema, pruritus and fever. Most reactions are mild 29

30 Get well prepared before pregnancy --Vaccination Vaccination provides the optimal protection before a woman is sexually active The quadrivalentvaccine covers HPV Types 6, 11, 16 and 18, a woman will still be protected from the remaining HPV-types, even though she was infected with one or more of the covered types Since woman at different ages may get cervical cancer, irrespective of future pregnancy, they should take action to protect themselves from the disease 30

31 Suggestion Protecting the uterus should be the first and foremost task before any planning to have a baby Get vaccinated + Regular pap smear screening = the best protection to a woman + in the best interest of their offspring and partner 31

32 防癌方法 32

33 Frequently Asked Questions Which is the best age to vaccinate? Which is the Vaccine of choice, Gardasil (quadrivalent) or Cervarix (bivalent)? Is HPV DNA testing required before vaccination? Is vaccination for male indicated? Is booster dose required & when? Is it worth vaccinating women who already has other HPV type infection? 33

124 第十三期 Conflicts in the Takeover of the Land in Taiwan after the Sino-Japanese War A Case in the Change of the Japanese Names of the Taiwanese Peopl

123 戰後初期臺灣土地接收的糾紛以更改日式姓名的臺人遭遇為例 124 第十三期 Conflicts in the Takeover of the Land in Taiwan after the Sino-Japanese War A Case in the Change of the Japanese Names of the Taiwanese People Abstract By Ho Fung-jiao