Cervical cancer is the fourth most common cancer among women globally, with over 600,000 new cases and 342,000 deaths in 2020. Nearly all new cases and deaths occur in low- and middle-income countries. In Pakistan, over 5,000 women are diagnosed with cervical cancer each year and around 3,200 die from the disease, making it the third most frequent cancer among women. Persistent infection with high-risk strains of the human papillomavirus (HPV) is the main cause of cervical cancer. Regular Pap smear screening can help detect pre-cancerous lesions early to prevent the development of invasive cervical cancer. Vaccination against HPV also helps prevent infection and subsequent cervical cancer development.

1. CERVICAL CANCER
KANWAL SAFEER
ROLL NO: 39

2. EPIDEMIOLOGY
&
GLOBAL:
Cervical cancer is the fourth most common cancer among
women globally, with an estimated 604 000 new cases and
342 000 deaths in 2020.
About 90% of the new cases and deaths worldwide in 2020
occurred in low- and middle-income countries
PAKISTAN:
Every year 5008 women are diagnosed with cervical cancer
and 3197 die from the disease.
Cervical cancer ranks as the 3rd most frequent cancer among
women in Pakistan and the 2nd most frequent cancer among
women between 15 and 44 years of age..

3. EITIOLOGY:
PERSISTENT, HIGH RISK
HUMAN PAPILLOMA
VIRUS (HPV)INFECTION
IS THE CAUSE.
TRANSMITTED VIA
SEXUAL INTERCOURSE

4. RISK FACTORS:
Early
intercourse and
early childbirth
Multiple sexual
partners
High parity
Low
socioeconomic
status
STDs- HIV Smoking OCPs

5. PATHOPHYSIO
LOGY:
HPV persists in transformation zone TZ
Triggers oncogenic process
Integrates into basal epithelial cells
Immortalization and rapid turnover
CIN 1, CIN 2 & CIN 3
Malignant disease of cervix

7. TYPES
Squamous cell carcinoma
More common
Ectocervix
Adenocarcinoma
Less common
Arises from endocervix

8. SIGN AND SYMPTOMS:
Asymptomatic
Post-coital
bleeding (PCB)*
Intermenstrual
bleeding (IMB)
Post-
menopausal
bleeding (PMB)
Pelvic pain Incontinence Renal failure

9. EXAMINTION:
PER VAGINAL EXAMINATION:
Hard on palpation
Bleeding on touch
PER SPECULUM EXAMINATION:
Exophytic
Ulcerative
COLPOSCOPY:
Acetic acid- whitish area
Iodine-stain brown

10. INVESTIGATIONS:
Pap smear
Liquid
based
cytology
HPV DNA
testing
Colposcopy

11. Cervical cancer as visualized on per speculum
examination

12. COLPOSCOPY; using acetic acid

13. STAGING OF CA:
FIGO
CLASSIFICATION:

14. STAGING;FIGO CLASSIFICATION:

15. TREATMENT:
CERVICAL INTRA-EPITHELIAL NEOPLASIA:
•Large loop excision of transformation zone (LLETZ)
•Cone biopsy
CARCINOMA CERVIX:
Pre-clinical lesions
Clinically invasive lesions

16. Pre-clinical
lesions
CIN
Cone biopsy
LLETZ
STAGE 1A
Local
excision

17. CLINICALLY INVASIVE STAGE 1B-4
STAGE 1B
FAMILY COMPLETE:
Radical hysterectomy with
bilateral pelvic node dissection
FAMILY NOT COMPLETE:
Radical trachelectomy
with pelvic node
dissection
STAGE 2-4
Radiotherapy plus chemotherapy

19. PREVENTION:

20. VACCINATION:
HTTP://SOGP.ORG/GUIDELINES
GARDASIL 9
CERVARIX GARDASIL

21. SCREENING:
*Regular Pap Smears / Liquid based cytology
(LBC) or VIA screening should start after 3 to 5 yrs
of marriage at 3 to 5 yearly intervals. VIA training
should be mandatory
*By the age of 35 years at least one Pap
Smear/LBC/ HPV Testing or VIA screening should
be done
*Stop doing Pap smears at 65 years age if
previous smears have been normal, and no other
risk factors are present.
HTTP://SOGP.ORG/GUIDELINES

22. THANK YOU!