Cancer of cervix, causes, risk factors, diagnostic tests its management

1. CANCER OF CERVIX
AND ITS MANAGEMENT
PRESENTED BY
KANCHAN MEHRA
M.SC NURSING 2ND YEAR

2. INTRODUCTION
• Cervical cancer constitute 13% of all cancers in women globally.
• It is the second most common cancer in women worldwide but the
most common cancer in India and other developing countries.
• Human papilloma virus (HPV) has been identified as the causative
agent in most cases.
• The disease is preventable by screening, early diagnosis and
treatment .

3. DEFINITION
Cervical cancer is a type of cancer that occurs in the cells of the
cervix mostly the lower part of the uterus that connects to the
vagina.

4. INCIDENCE
• 1 in 6000 live births.
• Most frequently diagnosed cancer in pregnancy
• Some 80% of cases detected in pregnancy are diagnosed in the
first or second trimester.
• The disease usually squamous cell carcinoma although upto
40% of cases now reported are adenoma carcinomas

5. RISK FACTORS
• Multiple sexual partners: The greater number of sexual
partners — and the greater partner's number of sexual partners
— the greater chance of acquiring HPV.
• Early sexual activity.
• Sexually transmitted infections (STIs)
• A weakened immune system

6. • Smoking. Smoking is associated with squamous cell cervical cancer.
• Exposure to miscarriage prevention drug. If mother took a drug
called diethylstilbestrol (DES) while pregnant in the 1950s, person
may have an increased risk of a certain type of cervical cancer called
clear cell adenocarcinoma.
• Prior history of human papilloma virus
• Family history of cervical cancer

7. PATHOGENESIS OF CERVICAL
CANCER BY STAGING
Stage I a : Preclinical invasive carcinoma that can be diagnosed only by
means of microscopy
-Stage Ib : A clinically visible lesion that is confined to the cervix uteri
-Stage Ib1: Primary tumor not greater than 4 cm in diameter.
-Stage Ib2: Primary tumor greater than 4 cm in diameter.

8. • Stage IIa : Spread into the upper two thirds of the vagina
without parametrial invasion
-Stage IIb : Extension into the parametrium but not into the
pelvic sidewall

9. • Stage IIIa : Extension into lower one third of the vagina,
without spread to the pelvic sidewall
-Stage IIIb : Extension into the pelvic sidewall and/or invasion of
the ureter

10. • Stage IVa : Extension of the tumor into the mucosa of the
bladder or rectum
• Stage IVb : Spread of the tumor beyond the true pelvis and/or
by metastasis into distant organs

11. SYMPTOMS OF CERVICAL CANCER
• Early-stage there is no signs or symptoms.
• Advanced cervical cancer Signs and symptoms include:
-Vaginal bleeding after intercourse
-Watery, bloody vaginal discharge that may be heavy and
have a foul odor
-Pelvic pain or pain during intercourse

12. DIAGNOSIS
• ASYMPTOMATIC CASES
- Cytologic screening of all pregnant mothers is a routine during
antenatal checkup.
- Cases showing dyskaryotic smear are subjected to colposcopic directed
biopsy.

13. • SYMPTOMATIC CASES:
- In cases of bleeding during pregnancy or early months simulating
threatened abortion
- Or in the later months causes APH, the cervix should be inspected
through a speculum at the earliest. If doubt arises, a biopsy from
the site of lesion confirms the diagnosis

14. Exfoliative cytology
• Pap test: The Papanicolaou test is a method of cervical screening used to
detect potentially precancerous and cancerous processes in the cervix or
colon.
• Cells scraped from the opening of the cervix are examined under a
microscope

16. Endocervical scrape cytology by endocervical brush or curettage:
cytology became the standard screening test for cervical cancer and
premalignant cervical lesions with the introduction of the Papanicolaou
(Pap) smear

17. Liquid-based cytology: Smeared plastic (not wooden) spatula is
placed in a liquid fixative (buffered methanol solution) instead of
smearing on a slide. Liquid Based Cytology (LBC) is a new
technique for collecting cytological samples in order to detect
cervical cancer.

18. • Speculoscopy: Uses a special disposable low-intensity blue-white
magnifying device or loupe (Speculite) is used to examine the cervix
for cancerous or pre-cancerous lesions.

19. • Spectroscopy: Cervical impedance or fluorescence spec-
troscopy is specific and sensitive, and provides instant results
unlike Pap smears. It is a noninvasive technique which probes
the tissue morphology and biochemical composition.

20. • Magnoscope has a magnifying lens built in source. It magnifies
cells five times and enables visualization of punctuation and
mosaics. It is portable and useful in rural areas. Therefore, it is
introduced in a few centres in India.

21. • Microspectrophotometry is also able to distinguish between
benign and malignant cells

22. Colposcopy: Colposcopy is a medical diagnostic procedure to
examine an illuminated, magnified view of the cervix as well as
the vagina and vulva
.

23. Cervicography: It is useful when a colposcopist is not available for
spot evaluation. A photograph of the entire external os is taken with a
35-mm camera after application of 5% acetic acid and sent to the
colposcopist for selecting areas for biopsy. Because of 50%
specificity and sensitivity, this technique is not cost-effective.

24. Cone biopsy
Cervical conization refers to an excision of a cone-shaped sample of
tissue from the mucous membrane of the cervix. Conization may be used
either for diagnostic purposes as part of a biopsy, or for therapeutic
purposes to remove pre-cancerous cells.

25. Tests that may be performed to determine whether cancer has spread
include:
Cystoscopy or proctoscopy to check to see if cancer has spread to the
urethra or bladder and rectum
.

26. • Computed tomography scan (CT), which combines multiple
X-rays to provide three-dimensional clarity and show various
types of tissue, including blood vessels

27. • Magnetic resonance imaging (MRI), using magnets and radio
waves provide three-dimensional body images. It may also be used
to determine if a tumor is benign or malignant.
• Positron emission tomography scan (PET), called a PET scan. A
PET scan is an imaging test that can help reveal how your tissues
and organs are functioning. A small amount of radioactive material
is necessary to show this activity.

28. EFFECTS OF PREGNANCY ON
CARCINOMA CERVIX
The malignant process remains unaffected. There may be a rapid
spread following vaginal delivery and induced abortion.
EFFECTS OF CARCINOMA ON PREGNANCY:
• There is increased incidence of:
(1) Abortion
(2) Premature labor

29. (3) Secondary cervical dystocia
(4) Injury to the cervix and lower segment leading to traumatic PPH.
(5) Uterine sepsis.

30. PREVENTION
To reduce the risk of cervical cancer:
• Administering HPV vaccine
• Routine Pap test - Most medical organizations suggest
beginning routine Pap tests at age 21 and repeating them
every few years.

31. • Practice safe sex
• Limit the habit of smoking

32. MANAGEMENT OF CA CERVIX
• Different types of management are available for patients
with cervical cancer.
• Some management are standard (the currently used treatment), and
some are being tested in clinical trials.
• When clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard
treatment.

33. Standard treatment are used
A. Surgery: Surgery (removing the cancer in an operation) is
sometimes used to treat cervical cancer. The following surgical
procedures may be used:

34. • Conization: A procedure to remove a cone-shaped piece
of tissue from the cervix and cervical canal. A pathologist views the
tissue under a microscope to look for cancer cells. Conization may be
used to diagnose or treat a cervical condition. This procedure is also
called a cone biopsy.

35. Conization may be done using one of the following procedures:
• Cold-knife conization: A surgical procedure that uses a scalpel (sharp
knife) to remove abnormal tissue or cancer.
• Loop electrosurgical excision procedure (LEEP): A surgical procedure
that uses electrical current passed through a thin wire loop as a knife to
remove abnormal tissue or cancer.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow
beam of intense light) as a knife to make bloodless cuts in tissue or to
remove a surface lesion such as a tumor.

36. B) Total hysterectomy:
Surgery to remove the uterus, including the cervix. If the uterus and
cervix are taken out through the vagina, the operation is called
a vaginal hysterectomy.
• If the uterus and cervix are taken out through a large incision (cut) in
the abdomen, the operation is called a total abdominal hysterectomy.
• If the uterus and cervix are taken out through a small incision in the
abdomen using a laparoscope, the operation is called a
total laparoscopic hysterectomy.

38. • Radical hysterectomy: Surgery to remove the uterus, cervix,
part of the vagina, and a wide area of ligaments and tissues
around these organs. The ovaries, fallopian tubes, or
nearby lymph nodes may also be removed.
• Radical trachelectomy: Surgery to remove the cervix, nearby tissue
and lymph nodes, and the upper part of the vagina. The uterus and
ovaries are not removed.

39. • Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and
both fallopian tubes.

40. Pelvic exenteration: Surgery to remove the lower colon, rectum,
and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also
removed. Artificial openings (stoma) are made for urine and stool to flow
from the body to a collection bag. Plastic surgery may be needed to make
an artificial vagina after this operation.

41. Radiation therapy adjuvant with
chemotherapy by staging
Radiation theray is a cancer treatment that uses high-energy x-rays or
other types of radiation to kill cancer cells.There are two types of
radiation therapy:
• External radiation therapy uses a machine outside the body to send
radiation toward the cancer. Certain ways of giving radiation therapy
can help keep radiation from damaging nearby healthy tissue.
• Internal radiation therapy uses a radioactive substance sealed in
needles, seeds, wires, or catheters that are placed directly into or near
the cancer.

42. Stage I
• A simple hysterectomy may be an option if the cancer shows no
lymphovascular invasion and the edges of the biopsy have no cancer
cells.
• If the cancer has grown into blood or lymph vessels, patient might
need external beam radiation to the pelvis followed by brachytherapy
is used.

43. Stage II
• External beam radiation therapy (EBRT) to the pelvis plus
brachytherapy
• Radical hysterectomy with removal of pelvic lymph nodes
• - If lymph nodes have cancer cells, radiation may still be an option if
the tumor is large.

44. Stages III
Treatment options
• Chemoradiation: The chemo may be cisplatin, carboplatin, or
cisplatin plus fluorouracil. The radiation therapy includes both
external beam radiation and brachytherapy.

45. Stage IV
At this stage, the cancer has spread out of the pelvis to other areas of the
body. Stage IV cervical cancer is not usually considered curable.
-Treatment options include radiation therapy with or without chemo to try
to slow the growth of the cancer or help relieve symptoms .

46. Most standard chemo regimens include –
• Cisplatin or carboplatin) along with another drug such as paclitaxel
(Taxol), gemcitabine (Gemzar), or topotecan.
• The targeted drug bevacizumab (Avastin) may be added to
chemotherapy

47. SUMMARY
At the end of the Presentation CA Cervix and its management can
be helpful for students to know the problem of CA Cervix and its
management and understand the definition, incidence, etiology,
risk factors, pathogenesis, types, symptoms, diagnosis, effects,
prevention, and management of CA Cervix.

48. ABSTRACT
G Narayana, Suchitra Jyothi, 2017 was conducted a cross-sectional study on
Knowledge, attitude, and practice toward cervical cancer among women
attending Obstetrics and Gynecology Department in South India. 403 women
were included as sample by convenient sampling method and using interview,
pre-validated Knowledge, attitude, and practice questionnaire on cervical
cancer. The result showed that most of (74.6%) the respondents had heard about
cervical cancer and majority of them are heard from media (41.6%) and friends
(20.5%). Most women knew symptoms (64.2%), risk factors (62.7%),
screening methods (76.9%), and preventive measures (61.7%) for cervical
cancer. More than half of the women (252; 62.5%) having positive attitude
toward screening.Thus the study concluded that although women are having
good knowledge, positive attitude toward cervical cancer screening and
prevention still there is a gap to transform it into practice. There is a need for
more educational programs to connect identified knowledge slits and uplift of
regular practice of cervical cancer screening.

49. BIBLIOGRAPHY
• Freaser Diane M., Cooper Margaret A. Myles Textbook for Midwives. 15th Edition India, Churchill Livingstone
Elsevier Publisher : 2009.Pp- 323-325
• Seshadri lakshmi. Essentials of gynecology.1st Edition India. Wolters kluwer Publisher Pvt. Ltd: 2011.Pp- 387-
390
• Littleton Lynna Y., Engebbretson Joan C. Maternity nursing care. 1st Edition India.Thomson Delmar Learning
corporation .Pp- 154-155
• Bhaskar Nima. Midwifery and Obstetrical Nursing. 2nd .Edition. India. EMMESS Medical Publisher: 2017. .Pp
-408
• G Narayana, Suchitra Jyothi , Knowledge, attitude, and practice toward cervical cancer among women
attending Obstetrics and Gynecology Department: A cross-sectional, hospital-based survey in South India ,
Indian Journal of Cancer[Internet]Volume 54 | Issue 2 | April–June 2017, Pp- 481-487 [cited on 28 feb 2020].
Online available at http://www.indianjcancer.com

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