Cervical cancer is a significant health issue, particularly in developing countries, where it is the second most common cause of cancer-related deaths among women. Key risk factors include age, low socioeconomic status, HPV infection, and sexual behavior. Management options encompass prevention through vaccination and screening, as well as various treatment modalities such as surgery, radiotherapy, and chemotherapy.

1. CERVICAL CANCER
DR HEM NATH SUBEDI
II YEAR
OBGYN
COMSTH

2. • 55 YEARS P5L5, SECOND MARRIAGE TO EX
ARMY HAD POSTMENOPAUSAL BLEEDING
WITH FOUL SMELLING VAGINAL DISCHARGE
FOR 6 MONTHS,ON PV EXAMINATION THERE
IS A GROWTH.
• WHAT COULD BE DIAGNOSIS?

3. CONTENTS
• INTRODUCTION
• INCIDENCE
• ETIOLOGY
• PATHOLOGY
• CLINICAL FEATURES
• PATTERN OF SPREAD
• STAGING
• DIAGNOSIS
• MANAGEMENT

4. INTRODUCTION
• Worldwide, cervical carcinoma continues to
be a significant health care problem.
• In developing countries, where health care
resources are limited, cervical carcinoma is
the second most frequent cause of cancer
death in women.

5. INCIDENCE
GENITAL CANCER IN DC DUTTA TEXT BOOK OF GYNECOLOGY , 6TH EDITION, NEW DELHI PP334

6. • SECOND MOST COMMON IN DEVELOPING COUNTRY
• THIRD MOST COMMON IN DEVELOPED ONES.
• SCREENING PROGRAM
• HPV VACCINATION : Gardasil( quadravalant), Cervarix (bivalent)
• ALMOST 30% OF CERVICAL CANCER OCCURS IN WOMEN WHO HAD NEVER GONE
THROUGH THE SCREENING PROGRAM.
• THIS PERCENTAGE APPROACH TO 60% IN DEVELOPING COUNTRY.
• THE PEAK INCIDENCE IS BIMODAL .

7. AETIOLOGY
• AGE
-35-39 AND 60-64 YEARS .
• RACE
• SOCIOECONOMIC STATUS
– LOW SOCIOECONOMIC STATUS
• COITUS
– Multiple sex partners
– EARLY AGE OF COITUS AND FREQUENT COITUS
• CHILD BEARING
• ESTROGEN
• CERVICAL IRRITATION AND INFECTION
– HPV high risk types16,18,31,33,45
– HPV low risk types
• PREDISPOSING HISTOLOGICAL STATUS
– CIN II, CIN III AND CARCINOMA IN SITU

8. PATHOLOGY
Histopathologic Types
• Cervical intraephithelial neoplasia,
Grade III
• Squamous cell carcinoma in situ
• Squamous cell carcinoma
– Keratinising
– Non-Keratinising
– Verrucous
• Adenocarcinoma in situ
• Adenocarcinoma in situ, endocervical
type
• Endometrioid adenocarcinoma
• Clear cell adenocarcinoma
• Adenosquamous carcinoma
• Adenoid cystic carcinoma
• Small cell carcinoma
• Undifferentiated carcinoma

9. CLINICAL FEATURES
• VAGINAL BLEEDING SPECIALLY POSTCOITAL
BLEEDING
• POSTMENOPAUSAL BLEEDING
• WITH ADVANCE DISEASE
– MALODOROUS VAGINAL DISCHARGE
– WT LOSS
– OBSTRUCTIVE UROPATHIES
– GROWTH OF THE MASS

10. PATTERN OF SPREAD
1. DIRECT INVASION INTO
THE CERVICAL STROMA,
CORPUS ,VAGINA AND
PARAMETRIUM
2. LYMPATHIC METASTASIS
3. BLOOD-BOURNE
METASTASIS
4. INTRAPERITONEAL
IMPLANTATION

11. STAGING
GENITAL CANCER IN DC DUTTA TEXT BOOK OF GYNECOLOGY , 6TH EDITION, NEW DELHI PP334

12. STAGING

13. STAGING

14. STAGING

15. DIFFERENTIAL DIAGNOSIS
The growth needs to be differentiated from:
• Cervical tuberculosis .
• Syphilitic ulcer .
• Cervical ectopy.
• Products of conception in incomplete
abortion.
• Fibroid polyp .

16. DIAGNOSIS
• History
• Clinical Features
• Investigation
– Lab investigation
– Colposcopic finding
– Tissue biopsy
– Chest –x ray
– CT scan
– MRI Scan
– Lymphography

17. COMPLICATIONS
• The following complications may occur sooner
or later, as the lesion progresses.
– ™Hemorrhage.
– ™Frequent attacks of ureteric pain, due to pyelitis
and pyelonephritis and hydronephrosis.
– ™Pyometra — specially with endocervical variety.
– ™Vesicovaginal fistula.
– ™Rectovaginal fistula

18. Causes of death
• Uremia
• Hemorrhage
• Sepsis
• Cachexia
• Metastasis

19. MANAGEMENT
• Preventive
– Primary prevention
– Secondary prevention
• Curative
– Primary surgery
– Primary radiotherapy
– Chemotherapy
– Combination therapy

20. Prevention
• Primary prevention
– Identifying high risk male and female
– HPV vaccine
– Use of condom
– Removal of cervix during surgery
• Secondary prevention
– By doing screening program
– Down staging program of WHO

21. CURATIVE
– Primary surgery
– Primary radiotherapy
– Chemotherapy
– Combination therapy

23. SURGERY
• HYSTERECTOMY
• RADICAL HYSTERECTOMY
– EXTRAFACIAL
– MODIFIED RADICAL
– RADICAL
– EXTENSIVE
– PELVIC EXCENTRATION
• LAPROSCOPIC RADICAL HYSTERECTOMY
• ROBOTIC LAPAROSCOPIC HYSTERECTOMY

24. Radical Hysterectomy
Rutledge has defined five classes of hysterectomy in cases of malignancy,
depending on the extent of resection.
Class I – Extrafascial hysterectomy with bilateral salpingo-oophorectomy
Class II – Modified radical hysterectomy which is the original Wertheim
hysterectomy. In this the medial half of the cardinal and uterosacral
ligaments are also removed as well as those pelvic lymph nodes which are
enlarged.
Class III – Radical hysterectomy. This is the modified Wertheim’s operation as
described by Meigs. It includes complete pelvic lymph node dissection,
removal of almost the whole of the cardinal and uterosacral ligaments and
the upper one-third of the vagina.
Class IV – Extended radical hysterectomy. This includes removal of the
periureteral tissue, superior vesical artery and up to three-fourths of the
vagina.
Class V – Partial exenteration. This is rarely performed. Here portions of the
distal ureter and bladder are also dissected.

26. PRIMARY RADIOTHERAPY
• TELETHERAPY
– FOR LARGE TUMOR
– To SHRINKK THE TUMOR
• BRACHYTHERAPY
– FOR SMALLER ONES

28. CHEMORADIATION
• Cisplatin
• Carboplatin
• Vincristine
• Hydroxyuria
• Tepotetan
• Note : best result with cisplatin with
radiotherapy

29. Palliative care
• At last symptomatic treatment
• Analgesic
• Chemotherapy
• Diet
• Rest

30. IMPORTANT QUESTIONS
1. WHAT ARE THE RISK FACTORS FOR THE
DEVELOPMENT OF CERVICAL CARCINOMA IN FEMALE
2. DEFINE HPV AND ITS SIGNIFICANCE FOR CERVICAL
CANCER
3. FOR STAGE IA 1 BEST MODALITIES OF TREATMENT IS
1. HYSTERECTOMY
2. CONE BIOPSY
3. RADIOTHERAPY
4. CHEMOTHERAPY
4. VIRUS CAUSING CERVICAL CANCER
A. HPV
B. CMV
C. VERICELLA
D. RUBELLA

31. THANK YOU
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