SAMIA SHAHEEN

08-166

CERVICAL CARCINOMA

Cervical carcinoma

Definition

Malignant neoplasm

arising from the cells of

cervix uteri.

Epidemiology

Second most common cancer in women.

Third most common cause of death among women.

16 per 100,000 cases reported globally every year.

80% cases from developing countries.

Pakistan:19.5 cases per 1lac population (WHO 2008)

Anatomy of cervix

Lowest part of uterus

1 inch in length

Anatomical divisions

Histology

Stratified squamous

epithelium

Simple columnar

epithelium

SQUAMOCLOMNAR

JUNCTION

Nabothian cysts

Types

squamous cell carcinoma (about 80-85%)

adenocarcinoma (about 15%)

adenosquamous carcinoma

small cell carcinoma

neuroendocrine tumour

glassy cell carcinoma

villoglandular adenocarcinoma

Risk factors

Human Papillomavirus (HPV) Infection

Family History of Cervical Cancer

Age

Sexual and Reproductive History

Socioeconomic Status

Smoking

HIV Infection

In Utero DES Exposure

Long-term use of oral contraceptives

Human Papillomavirus

Small, circular, double

stranded DNA genome.

150-200 types of HPV

known

15 are classified as high-

risk types (16, 18, 31,

33, 35, 39, 45, 51, 52,

56, 58, 59, 68, 73, and

82)

Infects rapidly dividing

cells at squamocolumnar

junction

Oncogenes:E6 and E7

Symptoms

Asymptomatic

Postcoital bleed

Intermenstrual bleed

Postmenopausal bleed

Malodorous vaginal discharge

Urinary frequency, retention

Sciatic pain

Swelling of lower extremity(s)

Urinary/fecal incontinence

Bone fractures

Diagnosis

History and physical examination

Papanicolaou smear/liquid based cytology

HPV-DNA testing

Colposcopy: endocervical curettage

Per rectal examination

Biopsy

Diagnosis

History and physical

examination

Risk factors, past

illness, treatments, signs

of health and disease,

lumps and swellings.

Pelvic examination

Bimanual pelvic

examination

Pap smear: conventional

method

Cytologic preparation of

exfoliated cells from

cervical transformation

zone

Procedure

speculum insertion

scrap by brush

microscopy

Liquid based cytology

Collection of cells : same

Spatula broken into

preservative containing

glass vial

Centrifuge

Microscopy

HPV-DNA testing

Colposcopy

Binocular, magnifies 5-

20 times

See abnormal vessels

Apply 3-5% acetic acid

See whitish areas

Can also do

endocervical curettage

Biopsy

When abnormal cells are found on cytology

Simple biopsy

Small amount of tissue removed in doctor’s office

Cone biopsy

Cone of tissue removed, need to visit hospital

Grading: BATHESDA SYSTEM

LSIL

CIN I

HSIL

CIN II

CIN III

DOES NOT MEAN THE

STAGING

Staging

Inspection and palpation

Colposcopy

Hysteroscopy

X-Ray chest and skeleton

Abdominal ultrasound

Intravenous urography

MRI

PET scan

LEEP and conization

Results viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.

FIGO Staging system

STAGE IA STAGE IB

FIGO system: cont

STAGE II

FIGO system: cont

STAGE IIIA STAGE IIIB

FIGO system: cont

STAGE IVA STAGE IVB

Treatment

Depends upon

Stage of tumor

Size

Age and general health

Desire to have children

Treatment

Stage I

IA1: LEEP or cone biopsy,trachelectomy

IA2: hystrectomy,remove lymph nodes as well

Stage IB1 and Stage IIA

Wertheim hysterectomy, radiation therapy

Stage IIB –IVA

Chemo radiotherapy followed by hysterectomy

Recurrence

Pelvic externation

Treatment during pregnancy

Depends on the time of diagnosis

1st trimester: external irradiation, abortion, internal

irradiation and chemotherapy

Last trimester:hysterotomy or caesarean section

followed by radical hysterectomy

Palliative treatment

At the advanced stage disease

Pain free and comfort

Expert nursing

Prognosis

Depends on volume and stage of the disease

5 year survival rate

Stage I: 80% -90%

Stage II: 60% -75%

Stage III: 30%-40%

Stage IV: 15%

Screening and prevention

Types of screening

Conventional cytology

Liquid-based monolayer cytology

Human papillomavirus testing

Testing in resource-poor areas

Visual inspection to detect pre-cancer or cancer

Prevention

HPV vaccination

Quit smoking

Limitation of sexual partners

Barrier methods of contraception

Regular Pap smears

Diet with anti oxidants: vita A, vit B12, vit C, vit E, beta

carotene.

THANK YOU