2. ο Carcinoma cervix is commonest malignancy
in the female genital tract.
ο Second common cancer in female body
following Breast cancer.
ο In USA it is less common and India it is highly
prevalent.
ο Every year 500,000 new cases are occurring
in the world.
3.
4. ο Papanicolaou β For cervical Screening
ο Colposcope β Sir Hans Hinselmann
ο Wertheimβ s Radical hysterectomy
ο Schautaβs Radical Hysterectomy
ο Mitraβs Radical Hysterectomy
ο Meigβs Radical Hysterectomy
ο Rutledgeβs types Hysterectomies
5. ο Human Papilloma Virus infection is
responsible for Carcinoma cervix.
ο 16,18,31 and 33 are common strains that
affect cancer cervix.
ο Herpes simplex Type II, HIV, Cytomegalo virus
and Chlamydial infections are associated
infections.
6. ο Other contributing factors are
ο Early coitus
ο Early marriage
ο Early Pregnancy
ο Multiple pregnancies
ο Multiple partners
7. ο Tobacco users/ smokers
ο Oral contraceptive pill users
ο Bad hygiene
ο Circumcision β a protective factor
ο Poverty
ο Low socioeconomic status
11. 1. Direct β to vagina, parametrium
2. Lymphatic β to the lymph nodes β
Parametrial, obturator, internal, external
and common iliac
ο Rarely β left supraclavicular lymph node
[ Virchowβs]
1. Haematogenous β Liver, Lung, Brain, Bones
12. ο Post coital bleeding
ο Irregular bleeding
ο Postmenopausal bleeding
ο Foul smelling discharge
ο Pain lower abdomen and back
ο Dyspareunia
ο Depending on site of metastasis may present
with Jaundice, haemoptysis, bone pain,
incontinence of urine and faces etc.
13. ο Per Speculum Examination - Cancer Cervix
present as a Friable cauliflower growth or
Indurated growth or Ulcerative form.
ο Bleeds on touch
ο May Look Normal
ο Per Vaginal Examination: Bleeds on touch, fixed
uterus
ο Per Rectal eam β Parametrial involvement
ο Rectovaginal eamination: Involvement of
rectovaginal septum and rectal mucosa
14. ο Clinical Staging - FIGO
ο Stage 0 β CIN I, II, III, Carcinoma in-situ
ο Stage I - Micro-invasive Cancer [ occult ]
ο Stage II - Overt cancer
ο Stage III β Spreads to Pelvic wall
ο Stage IV β Bladder and Rectal Mucosa and
distant metastasis
15.
16.
17.
18.
19.
20.
21. ο IV A β Bladder and rectal involvement
ο IV B β Distant Metastasis
24. ο Stage I A I β Conisation, Hysterectomy
ο Stage IA II β Modified Radical Hysterectomy
ο Stage 1B - Radical Hysterectomy [ or Primary
radiotherapy ]
ο Stage II A β Radical Hysterectomy
ο Stage II B to Stage IV β Radiotherapy +_
Chemotherapy
ο Stage IV B - Chemotherapy
25. ο Structures to be removed are
ο Uterus and cervix
ο Bilateral parametrium
ο Bilateral adnexa
ο Upper 1/3 of vagina
ο B/L cardinal and utero-sacral ligaments
ο Sentinel, Parametrial, Internal, obturator,
external, common iliac and para-aortic
lymphnodes.
27. ο For all advanced cancer cervix and few bulky
early stage cancers it is indicated.
ο 2 types:
ο 1. External or Tele Cobalt Radiotherapy
ο 2. Brachy or Interstitial therapy. β Three
techniques are used
ο A] Paris
ο B] Manchester and Modified Manchester
ο C] Stockholm techniques
28.
29. ο Early β loss of appetite, skin changes,
cystitis, loose motions
ο Late β Stenosis of urethra, vagina, bowel,
fistulae
30. ο Prognosis depends on Clinical staging, Tumor
volume, Vaginal involvement and Lymphnodal
involvement.
5 year survival rate
ο Stage 1 - 80 - 90%
ο Stage II - 50 - 65%
ο Stage III β 35%
ο Stage IV β 15%
31. ο Indications:
ο Advanced,
ο Inoperable,
ο Recurrent disease β
ο To reduce the volume of the growth
ο As Neoadjuvant chemotherapy β CIPLATINUM,
IFOFAMIDE or PACLITAEL
ο Concurrent Chemotherapy along with
radiotherapy