Radiation Oncology, Chulolongkorn University : ¢éÍºè§ªÕé

Radiation Oncology Chulolongkorn University

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¡ÒÃ¼èÒµÑ´ÊÒÁÒÃ¶¡ÃÐ·Óä´éà©¾ÒÐÁÐàÃç§»Ò¡Á´ÅÙ¡·Õèà»ç¹ÃÐÂÐµé¹ æ (Early stage) à·èÒ¹Ñé¹ ¤×Í
ÍÂÙèã¹ÃÐÂÐâÃ¤äÁèà¡Ô¹ IB áÅÐ IIA áÅÐ»Ñ¨¨ØºÑ¹¹Õéã¹Ê¶ÒºÑ¹·ÕèÁÕà¤Ã×èÍ§Á×Í·Ò§ÃÑ§ÊÕÃÑ¡ÉÒ·ÕèÁÒµÃÒ°Ò¹
à¡×Íº¨ÐäÁèÃÑ¡ÉÒ¼Ùé»èÇÂ IIA ´éÇÂÇÔ¸Õ¡ÒÃ¼èÒµÑ´áÅéÇ áÅÐà¹×èÍ§¨Ò¡¡ÒÃÃÑ¡ÉÒ´éÇÂÃÑ§ÊÕÊÒÁÒÃ¶·Óä´éã¹¼Ùé»èÇÂ
·Ø¡ÃÐÂÐ¢Í§âÃ¤ ¹Í¡¨Ò¡¹ÕéÂÑ§¾ºÇèÒÁÐàÃç§»Ò¡Á´ÅÙ¡ÁÕ¡ÒÃµÍºÊ¹Í§µèÍ¡ÒÃÃÑ¡ÉÒ´éÇÂÃÑ§ÊÕ·Õè´Õ
(Radioresponsive tumor) ¼Å¢Í§¡ÒÃÃÑ¡ÉÒ¼Ùé»èÇÂÁÐàÃç§»Ò¡Á´ÅÙ¡·Õèà»ç¹ Early carcinoma ´éÇÂÃÑ§ÊÕ
äÁèáµ¡µèÒ§¡Ñ¹àÁ×èÍà·ÕÂº¡Ñº¡ÒÃ·Ó¼èÒµÑ´ ¤×Í ÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµËÅÑ§¡ÒÃÃÑ¡ÉÒ 5 »Õ ÃéÍÂÅÐ 85% 6,34
Stage Ia1 ËÃ×Í Early stromal invasion
¼Ùé»èÇÂ·Õè·Ó¼èÒµÑ´ Conization áÅéÇ¾ºÇèÒÁÐàÃç§ÅØ¡ÅÒÁ·ÐÅØªÑé¹ Basement membrane ÅÖ¡ £ 1 mm.
áÅÐäÁè¾ºÇèÒÁÕ Lymphatic vascular space invasion á¹Ð¹ÓãËéÃÑ¡ÉÒµèÍ´éÇÂ¡ÒÃ¼èÒµÑ´Á´ÅÙ¡ÍÍ¡·Ò§
Ë¹éÒ·éÍ§ (Total abdominal hysterectomy) áµè¶éÒÂÑ§ÁÕ¤ÇÒÁ»ÃÐÊ§¤ìµéÍ§¡ÒÃ¨ÐÁÕºØµÃÍÕ¡ ¡ÒÃ·Ó¼èÒµÑ´
conization ¡çÍÒ¨¨Ðà¾ÕÂ§¾Í áµèµéÍ§á¹èã¨ÇèÒ¢Íºà¢µ¢Í§à¹×éÍ¡ÃÇÂ·ÕèµÑ´ÍÍ¡ÁÒµéÍ§äÁè¾ºÇèÒÁÕà«ÅÅìÁÐàÃç§
»ÃÒ¡¯ÍÂÙè (Negative or Free margin)
Stage Ia2 "£ 5 mm. invasion"
- 1-3 mm invasion : ã¹ÀÒÇÐ¹Õé¾ºÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂä»ÂÑ§µèÍÁ¹éÓàËÅ×Í§¹éÍÂÁÒ¡¤×Í
¾ºä´éäÁèà¡Ô¹ÃéÍÂÅÐ 2 ¢Í§¼Ùé»èÇÂ ¡ÒÃÃÑ¡ÉÒàËÁ×Í¹¡Ñº¼Ùé»èÇÂã¹ÃÐÂÐ Ia1
- 1-3 mm invasion : áµè¶éÒ¾ºÁÕ Lymphatic-Vascular space invasion á¹Ð¹ÓãËé·Ó¡ÒÃ¼èÒµÑ´áÅÐàÍÒµèÍÁ¹éÓàËÅ×Í§ÍÍ¡ä»´éÇÂ (Type II Radical hysterectomy with pelvic nodes dissection)
- 3-5 mm invasion : ¼Ùé»èÇÂã¹¡ÅØèÁ¹Õé¾ºÇèÒÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§âÃ¤ä»·ÕèµèÍÁ¹éÓàËÅ×Í§
ä´éºèÍÂ¢Öé¹ ¾ºä´é¶Ö§ÃéÍÂÅÐ 4.8 ¡ÒÃÃÑ¡ÉÒá¹Ð¹ÓãËé·Ó¼èÒµÑ´áºº Type II-III Radical hysterectomy
with pelvic nodes dissection ¢Öé¹¡Ñº¢¹Ò´¢Í§ lesion ·Õè»Ò¡Á´ÅÙ¡
Stage Ib - IIa invasive cancer ¶éÒ¨ÐÃÑ¡ÉÒ´éÇÂ¡ÒÃ¼èÒµÑ´ ¨ÐµéÍ§à»ç¹ Type III Radical
hysterectomy with pelvic nodes dissection áÅÐ¤ÇÃ¨Ð»ÃÐàÁÔ¹ Periaortic nodal area ´éÇÂàÊÁÍ
â´Â·ÑèÇä»áÅéÇ ¡ÒÃ¨Ð·Ó Radical hysterectomy ¨ÐàËÁÒÐÊÁà©¾ÒÐ¼Ùé»èÇÂ·ÕèÁÕÊØ¢ÀÒ¾ÃèÒ§¡ÒÂ·Õèá¢ç§áÃ§
áÅÐäÁèÍéÇ¹ ¢¹Ò´¢Í§¡éÍ¹ÁÐàÃç§»Ò¡Á´ÅÙ¡¤ÇÃÁÕ¢¹Ò´àÅç¡¡ÇèÒ 4 «Á. ÁÔ©Ð¹Ñé¹ÍÒ¨¾ºÀÒÇÐá·Ã¡«éÍ¹
¨Ò¡¡ÒÃ¼èÒµÑ´ä´éºèÍÂ 36,37 àªè¹ ¡ÒÃàÊÕÂàÅ×Í´ ÍÑ¹µÃÒÂµèÍËÅÍ´äµ ¡ÃÐà¾ÒÐ»ÑÊÊÒÇÐ à»ç¹µé¹ ¹Í¡¨Ò¡¹Õé
¡ÒÃ¼èÒµÑ´¨ÐàËÁÒÐÊÁ¡Ñº¼Ùé»èÇÂ·ÕèÁÕà¹×éÍ§Í¡¢Í§Á´ÅÙ¡áÅÐÃÑ§ä¢èÃèÇÁ´éÇÂ »ÃÐÇÑµÔ¡ÒÃµÔ´àª×éÍáÅÐÁÕàÂ×èÍ¾Ñ§¼×´
ÂÖ´à¡ÒÐÅÓäÊéã¹ÍØé§àªÔ§¡ÃÒ¹ à»ç¹µé¹

µÒÃÒ§·Õè 4 Surgical Management of Early Invasive Cancer of the Cervix 3,30,35

Stage Ial	Early stromal Invasion (£ l mm)	Conization
Stage Ia2	1-3 mm Invasion No Lymph-vascular	Conization / Type I Hysterectomy
	with lymph-vascular	Type II Hysterectomy Possible Pelvic nodes dissection
	3-5 mm Invasion £ l cm width	Type II Hysterectomy with Pelvic lymphadenectomy
	> l cm width	Type III Hysterectomy with Pelvic lymphadenectomy
Stage Ib-IIa	> 5 mm Invasion and £ 3 cm diameter	Type III Hysterectomy with Pelvic lymphadenectomy

ª¹Ô´¢Í§¡ÒÃ¼èÒµÑ´ (Type of Hysterectomy)
Type I Hysterectomy = Simple extrafascial hysterectomy
Type II ËÃ×Í Modified Radical Hysterectomy = less extensive than a radical hysterectomy and
removes the medial half of the cardinal
ligaments and the uterosacral ligaments.
Wertheim’s original operation did not include
a pelvic lymph node dissection, but rather
selective remove only enlarged lymph nodes.
Type III ËÃ×Í Radical hysterectomy = The operation includes a pelvic lymph node
dissection along with removal of most of the
uterosacral and cardinal ligaments and the
upper one-third of the vagina

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Last modified on 25 October 1996