Invasive carcinoma of the cervix is caused by persistent HPV infection and early sexual activity. Symptoms include irregular bleeding and pain. Diagnosis involves cervical biopsy and imaging tests. Cancer is staged based on extent of spread from I to IV. Treatment depends on stage and includes surgery such as hysterectomy for early stages and radiation and chemotherapy for later stages. Follow up involves regular pap smears to check for recurrence or metastasis which are treated with additional radiation or chemotherapy. Complications can arise from treatment procedures.

1. CARCINOMA
OF
CERVIX

2. INVASIVE CARCINOMA
OF
CERVIX
• Definition
• Epidemiology

3. Atiology
• Early exposure to sexual intercourse before 20
years of age
• Multiple sexual partners
• A male partner with multiple previous sexual
partners
• Smoking
• Persistent infection by high risk papilloma
virus HPV (Hr Specially HPV 16, 18)

4. Pathology

5. • Irregular vaginal bleeding
• Postcoital bleeding
• Pain (less common)
• Edema (in advanced stage)
Clinical Feature

6. • Cervical biopsy
• Metastatic work up, once the diagnosis of
invasive carcinoma is made, then we can do
pelvic examination, chest-x-ray, intravenous
pyelogram, cystoscopy and sigmoidoscopy
• Imaging Studies: CT, MRI
Diagnostic Tests

7. Staging of Cervical Carcinoma
• Stage O : CIS
• Stage I : Spread limited to cervix
• Ia1 : Invasion is < 3 mm deep
• Ia2 : Invasion is > Ia1 but < 5 mm deep
• Ib : Invasion is > 5 mm deep
• Stage IIa : Involves upper 2/3 of vagina
• IIb : Invasion of parametrium
• Stage III : Carcinoma extending the pelvic sidewall and lower
1/3 of vagina
• IIIa : Involves lower 1/3 of vagina
• IIIb : Extends to the pelvic sidewalls
• Stage IV : Ca spread far away from cervix
• IVa : Involves bladder or rectum
• IVb : Distant metastasis

8. Management

9. Specific by Stage
• Ia1 : Total simple hysterectomy
• Ia2 : Radical hysterectomy. It includes removal of
cervix, upper 3rd of vagina, uterus and
parametrical tissue
• Ib or IIa : Radical hysterectomy or radiation
therapy and pelvic node disection
• IIb, III or IV: Radiation therapy and chemotherapy.

10. Follow Up
• All Patients: patients with invasive cervical cancer
should follow up with a pap smear every 3
months for 2 years after treatment and then
every 6 months for the subsequent 3 years.
• Local Reoccurrence: Patient having local
reoccurrence should be treated with radiation
therapy.
• Distant Metastasis: In these case patient should
be treated with chemotherapy e.g. cisplatinum.

11. Invasive Carcinoma in Pregnancy

12. Complication of Surgery
• Anesthetic complication and haemorrhage
• Post operative, chest, wound and urinary tract
infection
• Urological complication include atonic bladder
• Obturator nerve damage may occur
• Thromboembolism

13. Complication of Radiotherapy
• Premature menopause due to radiation
induced ovarian.
• Urinary complication: haemorrhagic cystitis,
urinary frequency, contracted bladder, chronic
haematuria, ureteric stricture and fistula.
• Bowel Complication: Chronic diarrhea,
proctocolitis, rectal stricture
• Avascular necrosis of femoral head.