, ,

, ,

, 2010



....................................................................4

A.......................................................................5
A.1. ...................................................................................5
A.2. (- 10- ).........................................................................................5
A.3. ........................................................................................................5
A.4. ...............................................................................................................6
A.5. : 2010...................................................................................6
A.6. : 2014.....................................................................................................6
A.7. , ...........................................6
A.8. , , .........................9
A.9. .............................................................................................................9
A.9.1. .................................................................................................10

. , ...........................12
. (
:
: )

. ....................................................................12
..........................................................................................................12
.1
:...............................................................................14
.2. ......................................16
.2.2. , (CIN 1)
..................................................................................................................18
.2.3. ,
(CIN 1)- .......................................................................19
....................................................................................................................................20
.2.5. (CIN 2, CIN 3)
.................................................................................................................21
.2.6. (AGC) ............22
.3.
.............................................................................................................................................................23
.3.1. ,
CIN 1 ........................................................................23
.
.............................................................23
...........................................................23
.3.2. CIN 2, CIN 3 ...............24
.3.3.
CIN 1 ...............................................25
.4. ....................26
.4.1. CIN 2, 3 (AIS)- .....................................................27
: ,
.........27
.5. ............................................28
.5.1. : IA1 IA2 ................................28
.5.2. : I1 II < 4 c...29
.5.3. : I2 IIA > 4c ..............30
.5.4. II-III .............................31
.5.5. IVA .........................................................32
.5.6 IV ...............................33
.6. ,
....................................................................................................................34
.7. .................................................35

. , .............................36
.1. ......................................................................................36

.1.1. 10- ....................................................................36

.1.2. -O-3...................................................................38
.1.4. .............................................42
.1.5. TNM....................................................................................................................42
.2. ..............................................................................................................45
.3. .............................................................................................46
.3.1. - ..................................................................................46
.3.2. ...............................................................................46
.4. ( ) ............................................................49
.4.1 .
.....................................................................................................................................50
.4.2. .................................................................51
.4.3. .................................................................................................52
.4.4. ( ).......................................52
.4.5. . 53
.5. , ........53
.5.1. , ................................................................................53
.5.2. , .................54
.5.3. , ................................................................55
.5.4. ..............................................................................56
.5.5. ..............................................................................................56
.5.6.
, ...............................................................................................56
.5.7. ...........................................................................................................58
.5.8. ..............................................................................................................66
.5.9. .............................................................................................67

........................................................................69
1. ...........................69
2. ...............................................73
3. ..............................................75
4. ( ), ,
, (
, )...................85
5. ...........................................87
6. ( )..........................89
7. , ..................................................91
8. ..................................................................................................93
9. ..............................................................95
10. ...................................................................................................98
11. , ................................99
12. CIN (LEEP)..................102
13. CIN ..........................................................104
14. ....................106
...........................106
15. ................................................................................108
16. ....................................................108
..........................................................................................................................................................108

17.
GOG ............................................................................109
I

........................................109
...............................................................................110

ASC-H
ASCUS

LEEP
LSIL

HSIL
-FIC

CIN 1
CIN 2
CIN 3

TNM

-

-


(Adenocarcinoma in situ)







, (IEC)




-

I
II
III




TNM (UICC) (T = , N =
, M =
)



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(UICC -Union Internationale
Contre le Cancer)





(GOG)

(FIGO)

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,




5

A.4.
1.
2.
,

3.

4. ,
,
5. , , ,

6. ,

A.5. : 2010
A.6. : 2014
A.7. ,

, PhD

, MPH, PhD

,
-
-

: 976-99173326,
: 976-11-458189
-: canceravir@yahoo.com
-
: 99198808,
: 976-11-458189
-: drbaigal@yahoo.com
- ,

: 976-99190750
-: buyanjargal@yahoo.com
-
: 976-99018213
: 976-11-458189
-: ganaasub@yahoo.com


: 976-70101024
: 976-326863
-: elena.maximenco@ncdi-epos.mn

, MD, PhD

, PhD

, PhD

, MPH, PhD

, PhD

,
- ,
, -
,
, , ,

Elffors HSRC A, Kullvgen 4A, 13553 Tyres
Sweden
Phone +46 76 245 87 97; +46 8 519 712 46
-: elffors.hsrc@glocalnet.net

: 976-70101024
: 976-326863
-: sonin.sodov@ncdi-epos.mn
,
: 976-99020031
-: mchoijiljav@yahoo.com
,
-
: 976-11-450712
: 976-11-458189
-: navchaa@cancer-center.gov.mn
- ,
VIII
: 976-99156217, 976-70121024
: 976-70121023
-: n.oyunbileg@mca.mn


: 976-70101024
: 976-326863
-: oyunbileg.shagdarsuren@ncdi-epos.mn
- , ,

: 976-88828899
: 976-11-458189
-: cancer_oyun@yahoo.com
- , ,

: 976-99187566, 976-11-306255
: 976-11-458189
-: purevsureng@cancer-center.gov.mn


: 976-99036773

-
: 976-99077929
: 976-11-458189
-: uranchimeg_ts@cancer-center.gov.mn

, MD, MD, MSc, FRCS(C)

, PhD

, PhD

,

-
: 976-99046668
: 976-11-458189

,
.
Juravinski Cancer Centre, 699 Concession Street,
Hamilton, Ontario, Canada, L8V 5C2
Phone 905 389-5688, Fax 905 575-6343
-: Laurie.elit@jcc.hhsc.ca
,

VIII
: 976-88069895, 976-70121024
: 976-70121023
-: e_jargal@mca.mn
- , ,

: 976-99083695, 976-11-459784
: 976-11-458189
-: cancer_enkh@yahoo.com
,
-
: 976-99142160
: 976-11-458189
-: erdenetuya_ya@yahoo.com

-

(2010 8- 31)


(2010 9- 14)

(2010 9- 13)
-

(2010 11- 12-

10/10)
-

(2010 12- 01-
020/034)

.

.
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.

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2000-2008 8% .
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10


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15

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.

ASC

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12

ASC

,

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CIN /

CIN /

CIN
.
(18-32 )

12

.

16

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(ASC-H)

CIN
( )

CIN-

2-3

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CIN

*
.
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.

17

.2.2. , (CIN 1)

CIN/

6- 12

ASC

-

-
-

CIN/

CIN
.

* ,
.

18

.2.3. ,
(CIN 1)-

ASC

4-6 .

ASC

19

.2.4. - (ASC-US)

( ,

)

( )

. ( 1
)

ASC

4
6 .

ASC

20

.2.5. (CIN 2, CIN 3)

CIN

CIN 1

CIN 2, 3

CIN ( )

CIN
.

CIN 1

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( ,

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.

>CIN 1

CIN

,

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:- * ,
.

21

.2.6. (AGC)

(
)

35-

AGC-NOS

AGC -
AIS

,
(
)

CIN AIS

CIN

4-6

4
.

ASC
HSIL

LSIL
GC

22

.3.

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,
CIN 1

/
./

6,12

12

ASC



.

CIN

CIN

CIN 1; CIN 2,3

CIN

.

.

.
CIN 1
.

23

.3.2. CIN 2, CIN 3

.

:
-

- .

4-6 ,
4-6 .

ASC
( .)

CIN 2, 3
. .

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.
.

24

.3.3.
CIN 1

, .
.

25

.4.

CIN 1

CIN 2-3

6
2

,
,
.

,
,

9-12

.
.

3
.

9-12

.

26

.4.1. CIN 2, 3 (AIS)-

CIN 2,3

HSIL (CIN 2 CIN 3)

: ,
.

27

.5.
.5.1. : IA1 IA2

IA1

IA2

IA1 IA2
CIN3

+
(A : 75-80 )

,
.

28

.5.2. : I1 II
< 4 c
,

.
I1
IIA < 4c

.

,
.

,
.

()

,

.

+ ,

.

+/- (

) +
(A : 80-85 )

29

.5.3. : I2 IIA > 4c

I2 IIA >4c

,
.

+/-
(
) +
(A : 80-85 )
+,
.

+
.

+ +,
.
-
,
.

30

.5.4. II-III

, .
IIB - IIIB

+
(A 85 ) ,
.

+
(A 85 ) ,
.

31

.5.5. IVA
IVA

/
/
/

.

32

.5.6 IV
IV

( )

( )

2c

33

.6. ,


.

,
- LSIL, HSIL

>3

/ ./

(
)

<3

2, 3

, .

8


.

6

.

/ ./
34

.7.

30-60

3
.

II .

CIN 2,CIN 3

,
.

35

. ,
.1.
2001
.

(CIN) ( .1.3. .1:4 ).
-
. (.1 ).
- (.1.6.
).

.1.1. 10-

1990 5-
43-
, - 1994 .
2007 .
1893
. 1948
, 6
. 1967 -
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,
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6-
.
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N86

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()

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36

N87

: ( D06.- )

N87.0
[CIN], I
N87.1
[CIN], II
N87.2 ,

[CIN], III
: )
N87.9 ,
D06

[CIN], III

( D03.5 )
:
( N87.2 )
:

D06.0
D06.1
D06.7
D06.9 ,
C53

C53.0
C53.1
C53.8
C53.9 ,

37

.1.2. -O-3
() - -3 (ICD-O-3) -
() , , ,
. -
(1951) 1976 .
(3-) 2000 . , -9
-10
.
--3- , ,
.

, , , ,
.
.1.3.
,
(
) .

. 1968
(CIN) .
,
. .
1990
.
. CIN 2 3-
HSIL . 2001
(ASC-US),

(ASC-H) .
ASC-H
.
2001 .
( A.8 ).

38

 : ,
;

( )

( )

CIN

II

III

ASC-US
ASC-H
LSIL

III

HSIL

CIN 1
.
CIN 2

III

HSIL

CIN 3

IV

HSIL

CIN 3

CIN: ;
LSIL: ;
HSIL: ;
ASC-US: - ;
ASC-H : -
* 2001 c ,
CIN .

39


2001
.

( ),


- (
, ,
)
- ......( )
- / ( )
-
, ...... ( )

- (-)
- : (: 40 )
- : (
)

40


(-)
(

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:
- (Trichomonas vaginalis)
-
-
-
- (herpes simplex)
( ).
:
- ( )
-
-
-
-

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)
-

-
- (ASC-US)
- HSIL (ASC-H)
- LSIL ( : / /CIN 1)
-HSIL ( : , ;
CIN 2 CIN 3)
-
-

-
- ( )
- ( )
- ( )
-
- ,
- ,
- ()
-
-
-
-
- ()
, : ()
41


, .

,
.

.1.4.
CIN .
(- )
. :
(85%).

( )
( )
( )


: ( )
:




( )





(, , c,
)

.1.5. TNM
,
.

.

TNM .
, . T
, N , M
.
(I, II, III, IV )

/ .
1943- 1952 TNM-
(UICC)
. (FIGO)
.
42

 (AJCC) TNM
. 1987 (UICC, AJCC) TNM .
- TNM
. 2014
TNM .
TNM/FIGO
- (T)
TX:
T0:
T1/I: (
)
T1/IA: .
T1/I .
5 ,
7 . ,
.
T11/I1: 3 , 7
T12/IA2: 3 - 5 - ,
7
T1/I: ,
T1/IA2
T11/I1: 4
T12/I2: 4 -
T2/II:
1/3
T2/IIA:
T2/IIB:
T3/III: 1/3- , ,

T3/IIIA: 1/3-
T3/III: , ,

T4/IVA: , ,
( T4
)
(N)
NX:
N0:
N1:
(M)
MX:
M0:
M1/IVB:

43

.1.6. FIGO
.
.
FIGO TNM . FIGO- 2009
TNM .
: FIGO (2009)
I

).

IA

.
1B . ,
5.0 , 7.0 . -
.

IA1

<3.0 , 7.0
.

IA2

3.0- , 5.0 - , 7.0 -

.

IB

(preclinical cancers) 1A .

IB1

4.0c

IB2

> 4.0c

II

; 1/3-
.

IIA1

4.0c ,
2/3- .

IIA2

> 4.0c
2/3-

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III

, ,
, 1/3-
; , .

IIIA

, 1/3 .

IIIB

, , ,
.

IV

, ,
.

.

IVA

. ,
.

IVB

44


TNM / UICC

FIGO

Tis

N0

M0

IA1

T1a1

N0

M0

IA2

T1a2

N0

M0

IB1

T1b1

N0

M0

IB2

T1b2

N0

M0

IIA

T2a

N0

M0

IIB

T2b

N0

M0

IIIA

IVA

T3a
T1
T2
T3a
T3b
T4

N0
N1
N1
N1
N
N

M0
M0
M0
M0
M0
M0

IVB

M1

IIIB

(N)

NX
N0
N1

(M)

MX
M0
M1

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70%- . - 31, 44, 45
.
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45

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16 18 70% . .
, 100 (FDA
) .
,
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.
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.

46

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47

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48

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49

(-VIA) .

,
,
. . CIN 2
50% , 97%-
. 2-4
,
. 3 .
(-VIA) ,
(3-5%) .

. -
.
41%, 95%. 35-45

.
- (90%)
5-8 .
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51

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60 , 3
, .

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.

()

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.

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.
.
52


.
.
.

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.
(
7 11- ).

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.

. ASCUS 6
. ASC-H, LSIL, HSIL
.

.
4-6 . -
.
3-5%- , 5-15
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. ,
- . CIN 2, 3 ,
, ,
.

.
,
.

2-4 .
6
.

.5. ,

.5.1. ,

. .
53


. , .
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2.

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54

 . ,
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.
.5.2.3.
(5-15 ),
.
.
(3-5%) .
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:

AIS (), ASC-H, LSIL, HSIL
(2 ,
6 ) (ASCUS,
CIN 1)

-
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.

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,
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( ,
).

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. 40-


. 10%-
, .
.

.5.3. ,
.5.3.1.
, .
2001 (.1.3.
). .
- .

55

.5.3.2.
,
. 10%-
, .
, . .

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,
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. :
SIL
.
. : LSIL, CIN 3
CIN 3 ,
.

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,
(k)
()

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,

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. CIN 2 CIN 3 ,
.
.
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.
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-20C .
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,
.
2 - 3 -

(2,5 c)
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- .
CIN

56

,

3
.

.
.5.6.3.

CIN

1 c- .

,
, , , ,

, .
, , ,
, ,

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.5.6.4.

,
(
1,5 c )
,
.
,

,

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. 14
(9%) .
.
. ( ,
) ,
.

57

 3.

6
.

CIN 3

.

9%

.5.7.
.5.7.1.
,
, ,
.
.
.5.7.2.
( ,
, )

. , , ,
, . CIN 2
CIN 3 100% .
CIN 2, 3-
. , , ,
, .
(
, ),
.
.

58

 4.

6
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108

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5
6
7
8
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5
6
7
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22
23
25
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8
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2
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1.9
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26 x 1.9 x 1.7 = 84
GOG <40 .

109


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112