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Cervical carcinoma

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obstetrics & gynecology,

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Cervical carcinoma

  1. 1. SAMIA SHAHEEN 08-166 CERVICAL CARCINOMA
  2. 2. Cervical carcinoma  Definition Malignant neoplasm arising from the cells of cervix uteri.
  3. 3. Epidemiology  Second most common cancer in women.  Third most common cause of death among women.  16 per 100,000 cases reported globally every year.  80% cases from developing countries.  Pakistan:19.5 cases per 1lac population (WHO 2008)
  4. 4. Anatomy of cervix  Lowest part of uterus  1 inch in length  Anatomical divisions
  5. 5. Histology  Stratified squamous epithelium  Simple columnar epithelium  SQUAMOCLOMNAR JUNCTION  Nabothian cysts
  6. 6. Types  squamous cell carcinoma (about 80-85%)  adenocarcinoma (about 15%)  adenosquamous carcinoma  small cell carcinoma  neuroendocrine tumour  glassy cell carcinoma  villoglandular adenocarcinoma
  7. 7. Risk factors  Human Papillomavirus (HPV) Infection  Family History of Cervical Cancer  Age  Sexual and Reproductive History  Socioeconomic Status  Smoking  HIV Infection  In Utero DES Exposure  Long-term use of oral contraceptives
  8. 8. Human Papillomavirus  Small, circular, double stranded DNA genome.  150-200 types of HPV known  15 are classified as high- risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82)  Infects rapidly dividing cells at squamocolumnar junction  Oncogenes:E6 and E7
  9. 9. Symptoms  Asymptomatic  Postcoital bleed  Intermenstrual bleed  Postmenopausal bleed  Malodorous vaginal discharge  Urinary frequency, retention  Sciatic pain  Swelling of lower extremity(s)  Urinary/fecal incontinence  Bone fractures
  10. 10. Diagnosis  History and physical examination  Papanicolaou smear/liquid based cytology  HPV-DNA testing  Colposcopy: endocervical curettage  Per rectal examination  Biopsy
  11. 11. Diagnosis  History and physical examination Risk factors, past illness, treatments, signs of health and disease, lumps and swellings.  Pelvic examination Bimanual pelvic examination
  12. 12. Pap smear: conventional method  Cytologic preparation of exfoliated cells from cervical transformation zone  Procedure  speculum insertion  scrap by brush  microscopy
  13. 13. Liquid based cytology  Collection of cells : same  Spatula broken into preservative containing glass vial  Centrifuge  Microscopy  HPV-DNA testing
  14. 14. Colposcopy  Binocular, magnifies 5- 20 times  See abnormal vessels  Apply 3-5% acetic acid  See whitish areas  Can also do endocervical curettage
  15. 15. Biopsy  When abnormal cells are found on cytology  Simple biopsy  Small amount of tissue removed in doctor’s office  Cone biopsy  Cone of tissue removed, need to visit hospital
  16. 16. Grading: BATHESDA SYSTEM  LSIL  CIN I  HSIL  CIN II  CIN III  DOES NOT MEAN THE STAGING
  17. 17. Staging  Inspection and palpation  Colposcopy  Hysteroscopy  X-Ray chest and skeleton  Abdominal ultrasound  Intravenous urography  MRI  PET scan  LEEP and conization  Results viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.
  18. 18. FIGO Staging system STAGE IA STAGE IB
  19. 19. FIGO system: cont STAGE II
  20. 20. FIGO system: cont STAGE IIIA STAGE IIIB
  21. 21. FIGO system: cont STAGE IVA STAGE IVB
  22. 22. Treatment  Depends upon  Stage of tumor  Size  Age and general health  Desire to have children
  23. 23. Treatment  Stage I  IA1: LEEP or cone biopsy,trachelectomy  IA2: hystrectomy,remove lymph nodes as well  Stage IB1 and Stage IIA  Wertheim hysterectomy, radiation therapy  Stage IIB –IVA  Chemo radiotherapy followed by hysterectomy  Recurrence  Pelvic externation
  24. 24. Treatment during pregnancy  Depends on the time of diagnosis  1st trimester: external irradiation, abortion, internal irradiation and chemotherapy  Last trimester:hysterotomy or caesarean section followed by radical hysterectomy
  25. 25. Palliative treatment  At the advanced stage disease  Pain free and comfort  Expert nursing
  26. 26. Prognosis  Depends on volume and stage of the disease  5 year survival rate  Stage I: 80% -90%  Stage II: 60% -75%  Stage III: 30%-40%  Stage IV: 15%
  27. 27. Screening and prevention  Types of screening  Conventional cytology  Liquid-based monolayer cytology  Human papillomavirus testing  Testing in resource-poor areas  Visual inspection to detect pre-cancer or cancer
  28. 28. Prevention  HPV vaccination  Quit smoking  Limitation of sexual partners  Barrier methods of contraception  Regular Pap smears  Diet with anti oxidants: vita A, vit B12, vit C, vit E, beta carotene.
  29. 29. THANK YOU

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