子宫颈癌英文论文

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MycoplasmaMycoplasma is a genus of bacteria that lack a cell wall. Because they lack a cell wall, they are unaffected by some antibiotics such as penicillin or other beta-lactam antibiotics that target cell wall synthesis. They can be parasitic or saprotrophic. Several species are pathogenic in humans, including M. pneumoniae, which is an important cause of atypical pneumonia and other respiratory disorders, and M. genitalium, which is believed to be involved in pelvic inflammatory diseases. They may cause or contribute to some genus Mycoplasma is one of several genera within the class Mollicutes. Mollicutes are bacteria which have small genomes, lack a cell wall and have a low GC-content (18-40 mol%). There are over 100 recognized species of the genus Mycoplasma. Their genome size ranges from - megabase-pairs. Mollicutes are parasites or commensals of humans, animals (including insects), and plants; the genus Mycoplasma is by definition restricted to vertebrate hosts. Cholesterol is required for the growth of species of the genus Mycoplasma as well as certain other genera of mollicutes. Their optimum growth temperature is often the temperature of their host if warmbodied (. 37 degrees Celsius in humans) or ambient temperature if the host is unable to regulate its own internal temperature. Analysis of 16S ribosomal RNA sequences as well as gene content strongly suggest that the mollicutes, including the mycoplasmas, are closely related to either the Lactobacillus or the Clostridium branch of the phylogenetic tree (Firmicutes sensu stricto).Mycoplasmas are often found in research laboratories as contaminants in cell culture. Mycoplasmal cell culture contamination occurs due to contamination from individuals or contaminated cell culture medium ingredients. The Mycoplasma cell is usually smaller than 1 µm and they are therefore difficult to detect with a conventional microscope. Mycoplasmas may induce cellular changes, including chromosome aborations, changes in metabolism and cell growth. Severe mycoplasma infections may destroy a cell line. Detection techniques include PCR, plating on sensitive agar and staining with a DNA stain including DAPI or bacteria of the genus Mycoplasma (trivial name: mycoplasmas) and their close relatives are largely characterized by lack of a cell wall. Despite this, the shapes of these cells often conform to one of several possibilities with varying degrees of intricacy. For example, the members of the genus Spiroplasma assume an elongated helical shape without the aid of a rigid structural cell envelope. These cell shapes presumably contribute to the ability of mycoplasmas to thrive in their respective environments. M. pneumoniae cells possess an extension, the so-called 'tip-structure', protruding from the coccoid cell body. This structure is involved in adhesion to host cells, in movement along solid surfaces (gliding motility), and in cell division. M. pneumoniae cells are of small size and pleomorphic, but with a rough shape in longitudinal cross-section resembling that of a round-bottomed are unusual among bacteria in that most require sterols for the stability of their cytoplasmic membrane. Sterols are acquired from the environment, usually as cholesterol from the animal host. Mycoplasmas also generally possess a relatively small genome of megabases, which results in drastically reduced biosynthetic capabilities and explains their dependence on a host. Additionally they use an alternate genetic code where the codon UGA is encoding for the amino acid tryptophan instead of the usual opal stop 1898 Nocard and Roux reported the cultivation of the causative agent of contagious bovine pleuropneumonia (CBPP), which was at that time a grave and widespread disease in cattle herds. Today the disease is still endemic in Africa and Southern Europe. The disease is caused by M. mycoides subsp. mycoides SC (small-colony type), and the work of Nocard and Roux represented the first isolation of a mycoplasma species. Cultiviation was, and still is difficult because of the complex growth requirements. These researchers succeeded by inoculating a semi-permeable pouch of sterile medium with pulmonary fluid from an infected animal and depositing this pouch intraperitoneally into a live rabbit. After fifteen to twenty days, the fluid inside of the recovered pouch was opaque, indicating the growth of a microorganism. Opacitiy of the fluid was not seen in the control. This turbid broth could then be used to inoculate a second and third round and subsequently introduced into a healthy animal, causing disease. However, this did not work if the material was heated, indicating a biological agent at work. Uninoculated media in the pouch, after removal from the rabbit, could be used to grow the organism in vitro, demonstrating the possibility of cell-free cultivation and ruling out viral causes, although this was not fully appreciated at the time (Nocard and Roux, 1890). The name Mycoplasma, from the Greek mykes (fungus) and plasma (formed), was proposed in the 1950’s, replacing the term pleuropneumonia-like organisms (PPLO) referring to organisms similar to the causative agent of CBPP (Edward and Freundt, 1956). It was later found that the fungus-like growth pattern of M. mycoides is unique to that confusion about mycoplasmas and virus would surface again 50 years later when Eaton and colleagues cultured the causative agent of human primary atypical pneumonia (PAP) or 'walking pneumonia.' This agent could be grown in chicken embryos and passed through a filter that excluded normal bacteria. However, it could not be observed by high magnification light microscopy, and it caused a pneumonia that could not be treated with the antimicrobials sulphonamides and penicillin (Eaton, et al., 1945a). Eaton did consider the possibility that the disease was caused by a mycoplasma, but the agent did not grow on the standard PPLO media of the time. These observations led to the conclusion that the causative agent of PAP is a virus. Researchers at that time showed that the cultured agent could induce disease in experimentally infected cotton rats and hamsters. In spite of controversy whether the researchers had truly isolated the causative agent of PAP (based largely on the unusual immunological response of patients with PAP), in retrospect their evidence along with that of colleagues and competitors appears to have been quite conclusive (Marmion, 1990). In the early 1960's, there were reports linking Eaton's Agent to the PPLOs or mycoplasmas, well known then as parasites of cattle and rodents, due to sensitivity to antimicrobial compounds (. organic gold salt) (Marmion and Goodburn, 1961). The ability to grow Eaton's Agent, now known as Mycoplasma pneumoniae, in cell free media allowed an explosion of research into what had overnight become the most medically important mycoplasma and what was to become the most studied advances in molecular biology and genomics have brought the genetically simple mycoplasmas, particularly M. pneumoniae and its close relative M. genitalium, to a larger audience. The second published complete bacterial genome sequence was that of M. genitalium, which has one of the smallest genomes of free-living organisms (Fraser, et al., 1995). The M. pneumoniae genome sequence was published soon afterwards and was the first genome sequence determined by primer walking of a cosmid library instead of the whole-genome shotgun method (Himmelerich, et al., 1996). Mycoplasma genomics and proteomics continue in efforts to understand the so-called minimal cell (Hutchison and Montague, 2002), catalog the entire protein content of a cell (Regula, et al., 2000), and generally continue to take advantage of the small genome of these organisms to understand broad biological have also been exploring an association between mycoplasma and cancer. Despite a number of interesting studies, this cancer bacteria association hasn't been clearly established, and has yet to be fully elucidated (Ning and Shou, 2004), (Tsai, et al., 1995).The medical and agricultural importance of members of the genus Mycoplasma and related genera has led to the extensive cataloging of many of these organisms by culture, serology, and small subunit rRNA gene and whole genome sequencing. A recent focus in the sub-discipline of molecular phylogenetics has both clarified and confused certain aspects of the organization of the class Mollicutes, and while a truce of sorts has been reached, the area is still somewhat of a moving target (Johansson and Pettersson, 2002).The name mollicutes is derived from the Latin mollis (soft) and cutes (skin), and all of these bacteria do lack a cell wall and the genetic capability to synthesize peptidoglycan. While the trivial name 'mycoplasmas' has commonly denoted all members of this class, this usage is somewhat imprecise and will not be used as such here. Despite the lack of a cell wall, Mycoplasma and relatives have been classified in the phylum Firmicutes consisting of low G+C Gram-positive bacteria such as Clostridium, Lactobacillus, and Streptococcus based on 16S rRNA gene analysis. The cultured members of Mollicutes are currently arranged into four orders: Acholeplasmatales, Anaeroplasmatales, Entomoplasmatales, and Mycoplasmatales. The order Mycoplasmatales contains a single family, Mycoplasmataceae, which contains two genera: Mycoplasma and Ureaplasma. Historically, the description of a bacterium lacking a cell wall was sufficient to classify it to the genus Mycoplasma and as such it is the oldest and largest genus of the class with about half of the class' species (107 validly described) each usually limited to a specific host and with many hosts harboring more than one species, some pathogenic and some commensal. In later studies, many of these species were found to be phylogenetically distributed among at least three separate orders. A limiting criterion for inclusion within the genus Mycoplasma is that the organism have a vertebrate host. In fact, the type species, M. mycoides , along with other significant mycoplasma species like M. capricolum, is evolutionarily more closely related to the genus Spiroplasma in the order Entomoplasmatales than to the other members of the Mycoplasma genus. This and other discrepancies will likely remain unresolved because of the extreme confusion that change could engender among the medical and agricultural communities. The remaining species in the genus Mycoplasma are divided into two non-taxonomic groups, hominis and pneumoniae, based on 16S rRNA gene sequences. The hominis group contains the phylogenetic clusters of M. bovis, M. pulmonis, and M. hominis, among others. The pneumoniae group contains the clusters of M. muris, M. fastidiosum, U. urealyticum, the currently unculturable haemotrophic mollicutes, informally referred to as haemoplasmas (recently transferred from the genera Haemobartonella and Eperythrozoon), and the M. pneumoniae cluster. This cluster contains the species (and the usual or likely host) M. alvi (bovine), M. amphoriforme (human), M. gallisepticum (avian), M. genitalium (human), M. imitans (avian), M. pirum (uncertain/human), M. testudinis (tortoises), and M. pneumoniae (human). Most if not all of these species share some otherwise unique characteristics including an attachment organelle, homologs of the M. pneumoniae cytadherence-accessory proteins, and specialized modifications of the cell-division detailed analysis of the 16S rRNA genes from the order Mollicutes by Maniloff has given rise to a view of the evolution of these bacteria that includes an estimate of the time-scale for the emergence of some groups or features (Maniloff, 2002). This analysis suggests that about 600 million years ago (MYA), late in the Proterozoic era, Mollicutes branched away from the low G+C Gram-positive ancestor of the streptococci, losing their cell wall. At this time on Earth, molecular oxygen was present in the atmosphere at 1%, and the fossil record shows that multicellular marine animals had recently spread in the Cambrian explosion. One hundred million years later the requirement for sterols in the cytoplasmic membrane evolved along with the change to the alternate genetic code. Also, the ancestor of the genera Spiroplasma and Entomoplasma (primarily plant and insect pathogens) and Mycoplasma emerged at this time and would itself diverge into the Spiroplasma-Entomoplasma and Mycoplasma lineages approximately 100 million years after that. This diversity coincided with the origin of land plants 500 MYA. It appears that the calculated rate of evolution for the Mycoplasma group increased several fold about 190 MYA, soon after the appearance of vertebrates, while the Spiroplasma-Entomoplasma ancestor continued to evolve at the previously shared slower rate until about 100 MYA, when angiosperms and their associated pollinating insects appeared. Then the evolution rate of these bacteria appears to have also increased significantly. This is an attractive hypothesis, but while it tracks the emergence of several of the unusual characteristics of Mycoplasma and related organisms, it does not address the selective pressures driving their evolution, except perhaps the widespread close association of a parasite with a specific host. The advantages of a reduced genome, cell wall-less structure, and alternate genetic code remain murky.

中外医学家联合研制出了一项可在两个半小时左右快速筛查宫颈癌的技术。9月22日出版的最新一期英国《柳叶刀—肿瘤学》（The Lancet Oncology）杂志，发表了这项研究成果。 这项名为HPV快速筛查法（careHPV）的技术与现在普遍使用的两种宫颈癌检测法相比，能够更加快速而准确地捕捉到由人乳头状瘤病毒（HPV）导致的宫颈癌及癌前病变。 该研究项目临床试验的负责人、中国医学科学院肿瘤研究所乔友林教授说：“临床检测结果显示，这项技术的假阴性率为10%，假阳性率为16%，接近发达国家和地区普遍使用的杂交捕获二代（HC2）技术，比较令人满意。” 在美国比尔／梅林达?盖茨基金会的资助下，流行病学家乔友林和他的研究团队与美国卫生科技推广研究所（PATH）和德国凯杰公司（QIAGEN）合作，历经5年，研究成功了这项筛查技术。 与目前通常使用的巴氏涂片和液基细胞学技术相比，HPV快速检测技术实验设施简单，操作容易。乔友林说：“乡村卫生员经过基本训练，就能很好地掌握这个技术，而且，可以在没有水电的情况下操作。”他率领研究团队在山西襄垣县和武乡县，采用三种方法——HPV快速筛查法（careHPV），醋酸染色后观察（VIA）法，以及杂交捕获二代技术检测（HC2）法对2388名30－54岁妇女进行了对比检测。 结果表明，HPV快速筛查技术，识别宫颈癌与高度病变的敏感度和特异度，都大大优于醋酸染色后观察法，并与杂交捕获二代技术的检测准确度相差不大。 这项技术在中国应用获得成功，改写了宫颈癌生化检测技术的历史。“它的准确度与杂交捕获二代（HC2）技术相差甚小，但费用却比它少10倍，”乔友林说。 作为一种面向低收入国家和地区的宫颈癌预防的实用方法，HPV快速筛查技术拥有广阔的前景。 HPV病毒几乎在所有子宫颈癌病例中都存在，是引发子宫颈癌的元凶。在妇科恶性肿瘤中，子宫颈癌是仅次于乳腺癌的威胁妇女健康的第二杀手。全球每年大约有47万妇女罹患宫颈癌，中国约有10万，其中70%是农村妇女。著名艺人梅艳芳和李媛媛，都不幸死于这一疾病。 自巴氏涂片1941年问世以来，宫颈癌早期病变检出率增加，全球宫颈癌发病率下降了80%。但是，在发展中国家广泛推行该技术却比较困难。 乔友林说，“首先，它需要建立高标准的细胞学检查系统，以及培养训练有素、能准确阅读巴氏涂片的细胞学技术人员，这两方面所需的费用都相当可观。”另外，巴氏涂片的敏感度并不令人满意，假阴性率约可高达40%。 从理论上讲，液基细胞学加杂交捕获二代的HPV检测技术是最佳检测方法，其假阴性率为2%，假阳率为15%。“唯一的问题是，做一次这样的检测需要花费500多元人民币，即便是对大城市的工薪阶层妇女也太高了。它只适合深圳等高收入城市，”乔友林说。目前，醋酸染色观察法是贫困地区宫颈癌筛查的主要模式。这个检测只需要10元人民币，但效果不尽如人意。他说，“如果妇科医生不熟练，或没有接受良好的培训，肉眼观察的假阴性和假阳性率可以高达40%和20%。” 尽管国际上研究开发的预防宫颈癌的疫苗已在很多国家和地区获准上市，但是，疫苗只能预防70%左右的宫颈癌，而且对已经感染HPV病毒的妇女不起作用。 因此，HPV病毒的检测对防治宫颈癌仍然至关重要。研究出经济、准确、安全、有效的宫颈癌筛查方法也因此成为学术界和国际社会关注的焦点。“如果妇女一生中能做一次，作到早诊早治疗，那么，宫颈癌的发病率和死亡率可望下降三分之一，”美国卫生科技推广研究所的约翰·瑟拉斯（John Sellors）博士说。

概述 宫颈癌（cervical cancer）又称宫颈浸润癌（invasive carcinoma of cervix uteri），是最常见的妇科恶性肿瘤。患者年龄分布呈双峰状，35-39岁和60-64岁；平均分布年龄为岁。由于宫颈癌有较长癌前病变阶段，因此宫颈细胞学检查可使宫颈癌得到早期诊断与早期治疗。近40年国内外均已普遍开展宫颈脱落细胞学筛查，宫颈癌的发病率明显下降，死亡率也随之不断下降。 病因和发病机制 一、与性生活、婚姻、妊娠的关系性生活过早（指18岁前即有性生活）的妇女，其宫颈癌的发病率较18岁以后开始性生活的要高4倍。若妇女性生活开始早，有患有梅毒、淋病等性传播疾病，则其宫颈癌的发病率将较正常妇女高6倍。已证实若妇女与多个男子发生性关系，其发生宫颈癌的机会较多。这可能是青春期前的妇女，下生殖道尚未成熟，对致癌因素的刺激比较敏感，若较早开始性生活，一旦被某些细菌或病毒感染后，容易引发癌症。 二、外源因素*人宫颈癌发病率低，研究其原因可能与*人的风俗是男婴出生后需切除包皮有关。但也有认为在未切除包皮的*人群中，妇女患宫颈癌者也少见。目前尚缺乏实验资料证实包皮切除能减少宫颈癌的发生，虽然Nahmos曾从男子的包皮垢中分离出HSV-2型病毒。 Singer（1976）等曾提出精子头部所含的组蛋白和精蛋白是一种致癌因素，可作用于宫颈化生细胞的DNA细丝。Coppelson及Reid等认为成年妇女特别在妊娠期，鳞化活跃的宫颈上皮最容易恶变，这可能与DNA病毒有关。当然精子本身在特殊情况下也会对宫颈起诱变作用，这些新的假设尚待进一步证实。 三、内分泌因素性激素是否会促进宫颈癌的发生也是多年来研究的问题。动物实验用雌激素诱导小鼠发生鳞癌已获得成功，但在人体用外源性雌激素诱发宫颈癌尚未获得确实证据。 四、性传播性疾病60年代以前认为梅毒患者的宫颈癌发生率高，但至今尚未找到梅毒引起宫颈癌的直接证据。滴虫性阴道炎常与宫颈癌前病变或宫颈癌并存。Parfen等发现宫颈不典型增生合并滴虫性阴道炎者，其转化为浸润癌的机会增加，并已成功地用滴虫感染动物，诱发出宫颈癌。但两者都为性传播疾病，可以并存，且宫颈不典型增生患者的阴道酸碱度常偏于碱化，有利于滴虫生长，故不能证实滴虫感染可诱发宫颈癌。 五、病毒感染引起女性下生殖道感染的病毒种类很多，研究病毒感染与宫颈癌发生的关系已有数十年的历史，至今认为有3种病毒可能与宫颈癌的发生有关：单纯疱疹Ⅱ型病毒感染（HSV-2）；人*状瘤病毒（human paliloma virus， HPV）；人具细胞病毒（heman cytomegalovirus， HCMV）。 六、真菌感染与其他因素临床上已观察到宫颈炎与宫颈癌的发生有密切关系。宫颈糜烂是一个重要的危险因素，因为宫颈癌最常发生于经产妇，多发生在宫颈糜烂区及撕裂部分。真菌是宫颈炎、宫颈糜烂的诱发因素之一，其除有致癌作用外，还可以产生致癌性毒素，可与二级胺、亚硝酸盐等合成致癌性亚硝酸。 宫颈癌多发生在社会经济地位低下的妇女，可能是由于营养不足影响宫颈粘液的防御能力。此外，不同地区不同的生活习惯也可能影响宫颈癌的发病率。妇女免疫功能低下、不良精神因素、吸烟等都可能与宫颈癌的发生有关，吸烟者患宫颈癌的机会要比不吸烟者增加2倍。 病理改变 一、鳞状细胞癌宫颈癌以鳞状上皮细胞癌为主，约占90％～95％。 （一）巨检在发展为浸润癌前，肉眼观察无特殊异常，或类似一般宫颈糜烂。随着浸润癌的出现，宫颈可表现以下四种类型： 1．外生型：又称增生型或菜花型。由息肉样或*状隆起，继而发展向阴道内突出的大小不等的菜花状赘生物，质脆易出血。 2．内生型：又称浸润型。癌组织宫颈深部组织浸润、宫颈肥大而硬，但表面仍光滑或仅有浅表溃疡。 3．溃疡型：不论外生型或内生型进一步发展后，癌组织坏死脱落，形成溃疡，甚至整个子宫颈为一大空洞所替代，因常有继发性感染，故有恶臭的分泌物排出。子宫颈癌尤其是腺癌也可向颈管内生长，使子宫颈成桶状增大，这也是内生型的一种。 4．颈管型：环绕宫颈外口表面有粗糙的颗粒状糜烂区，或有不规则的溃破面、触及易出血。 （二）镜查 1．不典型增生： 不典型增生表现为底层细胞增生，底层细胞不但增生，而且有细胞排列紊乱及细胞核增大、浓染、染色质分布不均等核异质改变。不典型增生可分为轻、中及重度。 ①轻度不典型增生（间变I级）：上皮细胞排列稍紊乱，细胞轻度异型性，异型上皮占据上皮层的下三分之一。 ②中度不典型增生（间变Ⅱ级）：上皮细胞排列紊乱，异型性明显，异型上皮占据上皮层的下三分之二。 ③重度非典型增生（间变Ⅲ级）：几乎全部上皮极性紊乱或极性消失，细胞显著异型性和原位癌已不易区别。 2．原位癌： 原位癌（CIS）又称上皮内癌。上皮全层极性消失，细胞显著异型，核大，深染，染色质分布不均，有核分裂相。但病变仍限于上皮层内，未穿透基底膜，无间质浸润。异型细胞还可沿着宫颈腺腔开口进入移行带区的宫颈腺体，致使腺体原有的柱状细胞为多层异型鳞状细胞所替代，但腺体基底膜仍保持完整，这种情况称为宫颈原位癌累及腺体。 3．镜下早期浸润癌： 镜下早期浸润癌在原位癌基础上，偶然可发现有癌细胞小团已穿破基底膜，似泪滴状侵入基底膜附近的间质中，浸润的深度不超过5mm，宽不超过7mm，也无癌灶互相融合现象，也无侵犯间质内脉管迹象时，临床上无特征。 4．鳞状上皮浸润癌： 当癌细胞穿透上皮基底膜，侵犯间质深度超过5mm，称为鳞状上皮浸润癌。在间质内可出现树枝状、条索状，弥漫状或团块状癌巢。根据病理切片，癌细胞分化程度可以分为三级： ①I级：分化好。癌巢中有相当数量的角化现象，可见明显的癌珠。 ②Ⅱ级：中等分化（达宫颈中层细胞的分化程度），癌巢中无明显角化现象。 ③Ⅲ级：未分化的小细胞（相当于宫颈底层的未分化细胞）。 二、腺癌 腺癌仅占5％～10％。 （一）巨检来自宫颈管，并浸润宫颈管壁。当癌灶长至一定程度即突向宫颈外口，常侵犯宫旁组织。癌灶呈*状、芽状、溃疡或浸润型。病灶向宫颈管内生长，宫颈外观可完全正常，但宫颈管膨大如桶状。 （二）镜查 1、粘液腺癌： 最常见。来源于宫颈粘膜柱状粘液细胞，镜下见腺体结构，腺腔内有*状突起，腺上皮增生为多层，细胞低矮，异型性明显，见核分列相，细胞内含粘液。 2、宫颈恶性腺瘤： 又称微偏的腺瘤。肿瘤细胞貌似良性，腺体由柱状上皮覆盖，细胞无异型性，表皮为正常宫颈管粘膜腺体，腺体多，形态多样，大小不一，常含点状突起，浸润宫颈壁深层，常伴有淋巴结转移。 3、鳞腺癌来源于宫颈粘膜柱状下细胞，占3%-5%，同时含腺癌和鳞癌两种成分。是储备细胞同时向腺细胞和鳞状细胞分化发展而成。两种上皮性癌在同一部位紧密结合，有时可见一种上皮癌过渡到另一种癌。 三、 播散与转移宫颈原位癌发展为浸润癌平均病程为5～20年。一旦发展到浸润癌则可较快播散，其主要转移途径是直接蔓延和淋巴转移，血行播散较少见，但是晚期病例可以几种情况同时存在。 （一）直接蔓延为最常见的播散方式。癌瘤自宫颈向下浸润，穹窿最容易受累。由于前穹窿浅，所以侵犯阴道前壁早于阴道后壁。一旦穹窿受累癌瘤就可以迅速向阴道播散，有时呈间隔或跳跃式播散。向上蔓延可侵犯宫体，此种情况出现较晚。由于宫旁组织较疏松，淋巴管丰富，很易受累。癌瘤由宫颈两侧沿宫旁组织和主韧带蔓延，向后沿宫颈骶韧带蔓延，以片状、条索样、结节或团状形成转移灶。往往与淋巴结转移同时出现。癌瘤向前侵犯膀胱，向后侵犯直肠。 临床上肿瘤浸润常与为症同时存在，需全身抗炎处理后方可鉴别，因此盆腔检查时，组织增厚不一定是癌浸润，只有当宫旁组织硬、形成结节、团块、弹性消失或粗条索样时，方可诊为是癌浸润。 （二）淋巴结转移是宫颈癌主要转移途径。癌瘤沿宫颈旁组织中的小淋巴管转移到闭孔区经髂内、髂外血管区淋巴结再转移到髂总淋巴结。癌瘤亦可盆腔淋巴到达腹主动脉周围淋巴结甚至上行达锁骨上淋巴结或逆行转移至腹股沟区淋巴结，此种情况多见于晚期病例。癌瘤可沿宫颈骶韧带内的淋巴管转移至骶前淋巴结。当癌瘤浸润到阴道下1/3或外阴时，沿淋巴向转移到腹股沟淋巴结。 淋巴结转移的发生率与临床分期的情况成比例增加，即随着临床期别的增高而上升。但在临床上发现有的早期病例就出现淋巴结转移，也有部分晚期病例并无淋巴结转移的情况，可能与自身的淋巴免疫功能有关。 （三）血行播散比较少见。一旦血行播散就形成远处转移灶，常见的转移部位是肺脏、肝脏、骨骼和脑，此种情况多发生于晚期宫颈癌病例，多见于小细胞型鳞癌。