Cervical cancer is one of the malignant cancer among gynecologic cases.

1. Cervical Cancer
BY Shimelis Tadesse
Lecturer of Midwifery at Mattu
University, Ethiopia
2022
10/17/2023 1

2. Definition
• Cervical cancer occurs when abnormal cells
on the cervix grow out of control
• Squamous cell in the carcinoma of the cervix
develops from precursor lesions of the cervix
called:
• cervical intraepithelial neoplasia (CIN),
previously called cervical dysplasia which is
premalignant lesions of the cervix
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3. Epidemiology
• 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
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4. Clinical Significance
• Approximately 3 percent of all invasive cervical
cancers occur during pregnancy.
• Cervical cancer is the most common gynecologic
malignancy associated with pregnancy, occurring
in approximately 1 per 2,200 pregnancies.
• Therefore all pregnant patients should be
evaluated on their initial obstetric visit with
visualization of the cervix and cervical cytology,
including an endocervical brush
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5. Etiology
• Human papilloma virus (HPV)
• But it is a necessary, not a sufficient cause of
cervical cancer; host, behavioral and
environmental factors, may facilitate cancer
development
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6. • More than 130 HPV types have been
identified
• High oncogenic risk-types 16, 18, 31, 33, 35,
45,56.
• Low oncogenic risk-types 6, 11, 42, 43.
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7. Risk factors
• Infection with human papilloma virus
• Early age of first sexual intercourse
• Multiple sexual partners (unprotected)
• Multiparity
• Smoking
• Age ≥35 to <45
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8. Signs and symptoms
• Very often asymptomatic in early stages
• Abnormal vaginal bleeding
• Post coital bleeding
• Exclude cervix cancer in any post menopausal
bleeding
• Foul smelling vaginal discharge
• Symptoms of metasis
• Hydronephrosis and renal failure
• Lesions infiltrating the cervix
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9. Complication
• Anemia, Cachexia, Pain
• Hematuria and dysuria
• Ureteral obstruction and renal failure
• Oedema of legs
• Bowel invasion: Diarrhea, Tenesmus,rectal
bleeding
• Sepsis
• Metastasis
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10. Investigations
• Pre-cervical cancer screening test assessment
should include information and counseling,
informed consent, a social and clinical history,
and a physical examination.
• Cytology
• Conventional (Pap smear) and
• Liquid-based
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11. • HPV DNA test
• Visual inspection
• Acetic acid (VIA) or
• Lugol’s iodine (VILI)-Schiller test
• Colposcopy
• Biopsy
• CBC
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12. • ESR
• Reneral function
• Intavenous pyelography
• X-rays: CXR, skeletal X-rays, CT-scan
• MRI lymphatic metastasis
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13. Staging
• Stage 0: Carcinoma in situ
• Stage Ia1: Stromal invasion <3 mm
(microinvasive)
• Stage Ia2: stromal invasion 3-5 mm
• Stage Ib1: Stromal invasion >5 mm, or gross
cervical lesion <4cm
• Stage Ib2: gross cervical lesion > 4 cm
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14. • Stage IIa: extending to upper 2/3 vagina
• Stage IIIa: Extending to lower 1/3 vagina
• Stage IIIb: Extending into parametrium to
pelvic sidewall or hydronephrosis
• Stage IVa: extending to bladder/ bowel
mucosa
• Stage IVb: distant metastasis
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15. Managment
• Principle of treatment
– Provide general supportive care, e.g., correction of
anemia
– Undertake examination under anesthesia for
staging, biopsy
– Provide supportive treatment, surgery, and or
radio therapy according to staging
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16. • General measures
– It is important to clinically assess the extent of
disease prior to the onset of treatment
– Surgery can be utilized in early stage- disease Ia1-
IIa
– Radiotherapy+/- chemotherapy can be utilized in
all stages I-IV
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17. • Cryotherapy
• Acts on the principle of crystallizing the
intracellular water at temperature of –
90°C
• It uses either nitrous oxide or carbon
dioxide.
• This method is ideal for minor degree and
localized CIN lesions.
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18. • Cold coagulation destroys cervical tissue at a
temperature of 100–120°C.
• It does not need any anesthesia.
• Depth of tissue destruction is about 4 mm.
• Electrodiathermy destroys cervical tissue up
to a depth of 8–10 mm using a unipolar
needle electrode.
• It is done under general anesthesia.
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19. • Laser ablation –Carbon dioxide laser through
colposcopic guidance—can destroy the
epithelium by vaporization up to a depth of 7
mm.
• The method is of choice when CIN extends
onto the vaginal fornices.
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20. • Loop electrosurgical excision – uses a small
fine wire loop attached to an electrosurgical
generator to excise the tissue of interest
• Cold knife conization – excision of a cone
shaped portion of the cervix using a scalpel
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21. • Surgery(Hysterectomy) or radiotherapy or
combination of two and / or Chemotherapy
• abdominal or vaginal hysterectomy- Stage
IA1 Disease
• Either radical hysterectomy and pelvic
lymphadenectomy -Stage IA2 to IIA
• primary radiation with concomitant
chemotherapy.- Stage IA2 to IIA & Stage IIB
to IVA
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22. –chemotherapeutic agents & Palliative radiation
/ resection- Stage IVB) and Persistent or
Recurrent Disease
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23. • Prognosis --5 year survival figures
• Stage 1: 75%
• Stage 2: 55%
• Stage 3: 30%
• Stage 4: 7%
• Overall: 50-60%
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24. Recommendations
• Health education should be an integral part of
comprehensive cervical cancer control
• Cytology is recommended for large-scale
cervical cancer screening programs, if
sufficient resources exist.
• New programs should start screening women
aged 30 years or more, and include younger
women only when the highest-risk group has
been covered.
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25. • Appropriate policies and legislation should be
created and implemented to tackle the main
risk factors (early marriage, multiple sexual
partnerships, use of condoms)
• Trearment of invasive cancer (radiotherapy,
surgery, chemotherapy)
• Psychologic and financial support in advanced
stage of cervical cancer
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26. • If a woman can be screened only once in her
lifetime, the best age is between 35 and 45
years
• For women over 50 years, a five-year
screening interval is appropriate
• In the age group 25-49 years, a three-year
interval can be considered if resources are
available
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27. • Screening is not necessary for women over 65
years, provided the last two previous smears
were negative
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28. Prevention
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