Cervical Cancer

Reduced in industrial countries,

Still a major problem in developing world

10% of all cancers in women

Prof. Anwar Sultana

Professor of Gynae and Obs
Mercy Teaching Hospital
INCIDENCE

Every year 30 to 40 % new cases / 100000 population arises

Age distribution is bimodal

 30 to 40 years and again > 55 years

ETIOLOGY

 Promiscuity early age at first sex

 Human Papiloma Virus (HPV)
 Smoking
Impaired immune response and reduced level of
anti-bodies against type-16/18
 OCP
 Not clear
Immunal deficiency
Six fold increase risk in HIV infected patients
Two fold increase risk in transplant surgery
Human Papiloma Virus (HPV)

 Human Papiloma Virus (HPV)

 Double stranded DNA virus
 Eight genes
 Six early (E1 , 2, 4, 5, 6, 7)
 Two late (L1, L2)
 HIGH RISK HPV
16, 18, 31, 33, 35, 45, 51, 52, 58, 59, 68, 22
 LOW RISK
16-11, 40, 42, 43, 44, 54, 61, 80, 81, 72
HPV VACCINATION

 Bivalent (Cervirax)
 targeting 16 and 18
 Quadrivalent
 Targeting 6, 11, 16 and 18
 Vaccination program in UK
 Routine vaccination of 12 to 13 years old girls is
(Cervirax)
 Three doses 0.5 ml injection 0,2,6 month for and
five years
PATHOLOGY

Depends upon the presence of tissue

 Ecto Cervix
 Sqamus cell; Sqamus Cell Carcinoma
 Endo Cervix
 Columnar cells; Adeno carcinoma
 Morphology
 Endophitic
 Exophitic
Types
SPREAD

 Direct
 ( Parametrum, vagina, corpus,
bladder and rectum
 Lymphatic
 (external and internal iliac,
obturator lymph Nodes,
presacral, iliac and paraaotic
lymph nodes)
 Heamotagenous
 liver & Lungs)
CLINICAL PRESENTATION

 Asymptomatic
 Abnormal cervix
 Suspicious smear
 Loop excision biopsy
CLINICAL PRESENTATION
 Symptomatic
 Post coital bleeding
 Irregular bleeding
 Post menopausal bleeding
 Excessive foul smelling vaginal discharge
 Pelvic pain
 Loin pain secondarily to uretaric obstruction and renal failure
 Sciatic pain due to nerve compression
 Fistula formation
 Renal failure
DIAGNOSES
 History
 Examination
 GPE
 PA
 PV , P/S
▪ Speculum Examination
▪ Vaginal Walls Cervix, Growth, and its extension to vagina
 EUA – Biopsy Cervix & staging
 Inspection bleeding on touch, growth and its biopsy
 Staging of tumors
 Extensiontion vaginal wall parametrium, and all vaginal fornices
 Rectal examination
 Peripheral lymph nodes
 Cystoscopy
 Proctosigmoidoscopy
 IVU
 CT
 MRI
 PET SCAN
COMBINED APROACH or MULTI
DISCIPLINARY PLAN
 Gynaecological oncologist
 Clinical oncologist
 Medical oncologist
 Radiologist
 Pathologist
 Nursing staff
STAGING

Depends on
 Clinical Finding
 Microscopic Examination
 Histological type and differentiation
 Pattern of Invasion
 Presence of lympho vascular surface invasion
STAGE 1
 The carcinoma is strictly confined to the
cervix (extension to the corpus would be
disregarded)
STAGE 2
 Cervical carcinoma invades beyond the
uterus, but not to the pelvic wall or to the
lower third of the vagina
 Without parametrial invasion
 Clinically visible lesion < 4.0cm in greatest
dimension
 Clinically visible lesion > 4.0cm in greatest
dimension
 With obvious parametrial invasion
STAGE 3
 The tumour extends to the pelvic wall and/or
involves lower third of the vagina and/or
causes hydronephrosis or non-functioning
kidney
STAGE 4

 The carcinoma has extended beyond the true

pelvis or has involved (biopsy proven) the
mucosa of the bladder or rectum. A bullous
oedema, as such, does not permit a case to
be allotted to stage IV
Q-1
 A 64 year old para5 attending OPD with history of foul smelling
discharge for the last four month. The discharge has become
blood stained for the last fifteen days. She has used many local
medicine but no response

Which examination should a medical officer shall perform for

diagnosis?

 A) PV
 B) Ultrasound Pelvis
 C) PS
 D) CT Pelvis
 E) MRI Pelvis
Q-2

 In the above mentioned scenario what is the

most probable diagnosis?

 A) Vaginitis
 B) Prolpase
 C) Polyp
 D) CA cervix
 E) CA Endometrium
Q-3

 How will you confirm the diagnosis?

 A) CT
 B) MRI
 C) Ultrasound
 D) High Vaginal Swap
 E) EUA Biopsy