Cervical

Cancer
Group 2
I Ketut Panji Mahartha (2208611007)
Susanti (2208611008)
I Putu Indra Sagita (2208611009)
Christina Melani (2208611010)
Gede Hary Putra Astawan (2208611011)
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 Outline
● Section I Epidemiology and Etiology
● Section II Symptoms and Signs Cervical Cancer
● Section III Laboratory Data
● Section IV Stage of Cervical Cancer
● Section V Pathophysiology and Therapy Guidelines
● Section VI Therapy Output
● Section VII Special Attention on Medicine Therapy
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 Section 01 Epidemiology cervical cancer In worldwide...
Cases

The most commonly diagnosed cancer in 28

countries and the leading cause of cancer death in
42 countries, the vast majority of which are in
Sub-Saharan Africa and South Eastern Asia. The
259000 highest regional incidence and mortality rates are
311000 seen in Africa. In relative terms, the rates are
7−10 times lower in North America, Australia,
New Zealand, and Western Asia (Saudi Arabia
and Iraq)
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Deaths Recover
 Section 01 Epidemiology cervical cancer In Indonesia...
Cases
● Cervical cancer ranks as the 2nd most frequent
cancer among women in Indonesia and the
2nd most frequent cancer among women
between 15 and 44 years of age.
● According to current estimates from the
15630 Indonesian Ministry of Health, the number of
women new cervical cancer patients ranged
21003 from 90-100 cases per 100,000 population and
every year there are 40 thousand cases of
cervical cancer (Indonesian Ministry of
Health, 2011).
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Deaths Recover
 Section 01 Etiology Other things can increase your risk of cervical
cancer:
cervical cancer • Having HIV (the virus that causes AIDS) or
another condition that makes it hard for your
human papilloma virus body to fight off health problems.
(HPV)
• Smoking.

• Using birth control pills for a long time (five

or more years).

• Having given birth to three or more children.

• Having several sexual partners

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 Symptoms and Signs Cervical

02 Cancer
In studies are located at south Africa was to explore patient
expressed cervical cancer-related signs and symptoms:
● Vaginal bleeding, including bleeding during or after sex, periods
or after the menopause
● Fatigue
● Abdomal pain
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 Table 2.1. Explorated data related sign and sympthon cervical cancer
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 Section 03 Laboratory Data
Screening test Confirmatory test

● HPV DNA test ● Biopsy

● Visual inspection with acetic acid (VIA)
● Conventional cytology (Pap smear)
● Liquidbased cytology (LBC)

● Cone biopsy
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 Section 03 Laboratory Data
Health history and physical exam
● Checking blood pressure, heart rate,
breathing rate, and body temperature
● Checking the organs in your abdomen,
including your liver and stomach
● Performing a pelvic examination to check
the size and position of your cervix and
uterus.
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Blood test
● Complete blood count (CBC): Red blood
cell count, white blood cell count, platelets.
● Blood chemistry profile: Urea and
electrolytes (sodium, potassium, chloride
and bicarbonate)
● Liver function tests: ALT, AST, ALP,
gamma GT
 Section 03 Laboratory Data
Staging Test

● Imaging tests: X-ray, CT, MRI, Positron

CT, MRI, PET Scan
Emission Tomography (PET), Transvaginal
ultrasound
● Visual examination of the bladder and
rectum
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Transvaginal Ultrasound
 Stage of Cervical Cancer

04 There are four main stages in The FIGO system: I, II, III, and IV. The
following information is used to stage the cancer in the FIGO system:
● The size or extent/depth of the tumor
● Whether any lymph nodes have cancer
● Whether the cancer has spread to the liver, lungs, and/or bone
(metastasized)
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 Stage I
STAGE IA1
The cancer is 3 mm or smaller

STAGE IA2
The cancer between 3 and 5 mm
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 Stage I
STAGE IB1
The cancer is larger than 5 mm but smaller than 2 cm

STAGE IB2
The cancer between 2 and 4 cm

STAGE IB3
The cancer is larger than 4 cm
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 Stage II
STAGE IIA1
The cancer is 4 cm or smaller

STAGE IIA2
The cancer is larger than 4 cm

STAGE IIB
The cancer has grown into the fat and connective
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tissue that surrounds the cervix and uterus

 Stage III
STAGE IIIA
The cancer has grown into the lower third of the vagina

STAGE IIIB
The cancer has grown into the pelvic wall and/or has caused kidney swelling or
dysfunction

STAGE IIIC
The cancer in lymph nodes near the cervix and/or in lymph
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nodes in the abdomen, called the para-aortic lymph nodes

 Stage IV
STAGE IVA
The cancer has spread to nearby organs, such as the bladder or rectum

STAGE IVB
The cancer is metastatic. It has spread to the liver, lungs, abdomen, bone, or other
distant sites or lymph nodes
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 Section 05 Pathophysiology of cervical cancer
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 Section 05 Pathophysiology of cervical cancer
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 Section 05 Therapy Guidelines of cervical
cancer
Surgery is often the
primary treatment
Cone biopsy
for early-stage
cervical cancer

Surgery Trachelectomy

RT uses high- Hysterectomy

energy waves
similar to x-rays to
kill cancer cells EBRT
Therapy Radiation
Therapy
Brachytherapy
ST is treatment with If cisplatin is
substances in the Cisplatin expected to be too
bloodstream, reaching
harsh or cannot be
and affecting cells Chemotherapy given for other
Systemic
Carboplatin reasons, using
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Therapy carboplatin
Immunotherapy
 Section 05 Therapy Guidelines of cervical
cancer No LVSI Cone biopsy

Fertility Sparing Trachelectomy +

lymphadenectomy
With LVSI
Cone biopsy +
Stage IA1 lymphadenectomy

No LVSI Cone biopsy

Non Fertility
Sparing Hysterectomy +
lymphadenectomy
With LVSI
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EBRT +
brachytherapy
 Section 05 Therapy Guidelines of cervical
cancer
Cone biopsy +
lymphadenectomy
Fertility Sparing
Trachelectomy +
lymphadenectomy
Stage IA2
EBRT +
brachytherapy
Non Fertility
Sparing
Hysterectomy +
lymphadenectomy
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 Section 05 Therapy Guidelines of cervical
cancer

Trachelectomy +
Fertility Sparing
lymphadenectomy

Stage IB1 dan IB2

EBRT + brachytherapy
+ chemotherapy
Non Fertility Sparing
Hysterectomy +
lymphadenectomy
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 Section 05 Therapy Guidelines of cervical
cancer
Hysterectomy +
lymphadenectomy

EBRT + brachytherapy +
Stage IB3 dan IIA2
chemotherapy

EBRT + chemotherapy +
brachytherapy + selective
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completion hysterectomy
 Section 05 Therapy Guidelines of cervical
cancer

Hysterectomy +
lymphadenectomy ±
para-aortic
lymphadenectomy
Stage IIA1
EBRT + brachytherapy +
chemotherapy
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 Section 05 Therapy Guidelines of cervical
cancer

EBRT + brachytherapy
Stage IIB, III, IVA
+ chemotherapy
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 Section 05 Therapy Guidelines of cervical
cancer
Resection ±
individualized EBRT

Local ablative therapies

Local treatment
± individualized EBRT

Individualized EBRT ±
Stage IVB
systemic therapy

Non local treatment Systemic therapy

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 Section 05 Therapy Guidelines of cervical
cancer
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(NCCN, 2022)
 Therapy Output

06 The desired therapeutic goals of cervical cancer treatment:

● Primary tumor mass
● Reduce the risk of surgical complications
● Improve quality of life patients
● Improve patient survival
(Gangireddy, 2022) .
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 Section 07 Special Attention on Medicine Therapy
Managing Cervical Cancer in Pregnant
Women
If the patient wishes to maintain the pregnancy,
most treatments will occur after delivery. Patients
should be informed in advance that to avoid delivery
complications caused by cervical dilation (such as
haemorrhage)
If the patient does not wish to maintain the
pregnancy, surgarical and radiotherapy
(with/without chemotherapy). In this case, the patient
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Managing cervical cancer in women
living with HIV
CD4 count is a key element of care for
women living with HIV. CD4 be needed to
monitor the patient’s immune status
throughout treatment. If the CD4 count is or
becomes low during therapy, she may be
started on antiretroviral therapy, which may
delay treatment to allow for recovery of her
immune system (WHO, 2014).

needs to be informed that treatment will cause loss of

the fetus (WHO, 2014).
Thank you!
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