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Carcinoma cervix
- 1. 45 YEARS MULTIPAROUSFEMALE COMPLAINS OF DISCHARGE PER VAGINA Evaluate the patient. Write the differential diagnosis Investigation and management of carcinoma cervix
- 2. HISTORY OF PRESENTILLNESS DURATION AMOUNT COLOUR ODOUR ASSOCIATED SYMPTOMS MALE PARTNER
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- 6. Objectives At the endof the session the student should be able to elicit sign and symptoms of carcinoma cervix To understand the staging of cervix. To outline the management of carcinoma cervix.
- 7. Symptoms and Signs irregularvaginal bleeding vaginal discharge with an unpleasant odor. watery vaginal discharge. vaginal discharge tinged with blood. pelvic or back pain. pain during sex. problems urinating. problems defecating
- 8. Invasive Carcinoma Stage ICarcinoma strictly confined to the cervix (extension to the corpus should be disregarded). Stage Ia Preclinical carcinomas of the cervix microscopy. Ia1 Lesion with ≤3 mm invasion. Ia2 The upper limit of the measurement should show a depth of invasion of >3–5 mm taken from the base of the epithelium either surface or glandular, from which it originates, and a second dimension, the horizontal spread, must not exceed 7 mm. Larger lesions should be staged as Ib.
- 9. Stage IbLesions invasive > 5 mm. Ib1 Lesion ≤4 cm. Ib2 Lesions >4 cm.
- 10. Stage IIThe carcinoma extends beyond the cervix but has not extended onto the wall. The carcinoma involves the vagina, but not the lower one third. IIa No obvious parametrial involvement. IIb Obvious parametrial involvement.
- 11. Stage IIIThe carcinoma has extended onto the pelvic wall. On rectal examination, there is no cancer-free space between the tumor and the pelvic wall. The tumor involves the lower one third of the vagina. All cases with hydronephrosis or nonfunctioning kidney. III a No extension to the pelvic wall. III b Extension onto the pelvic wall and/or hydronephrosis or nonfunctioning kidney.
- 12. Stage IVThe carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV. Iva Spread to the growth to adjacent organs. Ivb Spread to distant organs.
- 13. STAGING STAGE 1 a–DIAGNOSED MICROSCOPY 1- < OR= 3MM 2- >3-5 MM(DEPTH), 7MM(HORIZONTAL) b - > 5MM 1 - <4 CM 2 - >4 CM
- 14. CONT.. STAGE II (EXTENDS BEYONDCERVIX BUT HAS NOT EXTENDED ON TO THE WALL) a – NO OBVIOUS PARAMETRIAL INVOLVMENT b - OBVIOUS PARAMETRIAL INVOLVMENT
- 15. CONT STAGE III (CARCINOMA HASEXTENDED ON TO THE WALL) - a – NO EXTENSION TO PELVIC WALL b - EXTENSION TO PELVIC WALL AND/OR HYDRONEPHROSIS OR NON FUNCTIONING KIDNEY
- 16. CONT STAGE IV (CARCINOMA HASEXTENDED BEYOND THE TRUE PELVIS AND CLINICALLY INVOLVED THE RECTAL OR BLADDER MUCOSA) a – SPREAD TO ADJACENT ORGANS b – SPREAD TO DISTANT ORGANS
- 17. DIFERENTIAL DIOGNOSIS…… CERVICITIS CERVICAL EROSION ULCER TUBERCULAR VIRAL SYPHYLITIC FIBROID POLYP PRODUCT OF CONCEPTION IN INCOMPLETE ABORTION CARCINOMA CERVIX
- 18. DOWN STAGING DETECTION OFTHE DISEASE IN AN EARLIER STAGE WHEN STILL CURABLE,BY NURSE AND OTHER NONMEDICAL HEALTH WORKERS USING A SIMPLE SPECULUM FOR VISUAL INSPECTION OF THE CERVIX
- 19. INVESTIGATIONS….. HISTOPATHOLOGICAL HAEMATOLOGICAL BIOCHEMICAL RADIOLOGICAL X-RAY CHEST IVP PROCTOSCOPY CYSTOSCOPY
- 20. MANAGEMENT STAGE I- Ia1-- TAH Ia2–MODIFIED RADICALHYSTERECTOMY Ib – WERTHEIM HYSTERECTOMY
- 21. CONT……. STAGE II RADIOTHERAPY RADICAL SURGERY RADIOTHERAPYFOLLOWED BY RADICAL SURGERY RADICAL SURGERY FOLLOWED BY RADIOTHERAPY STAGE III RADIOTHERAPY,CHEMOTHERAPY STAGE IV PALLIATIVE RADIOTHERAPY, ULTRARADICAL SURGERY, CHEMOTHERAPY
- 22. FOLLOW UP 3 MONTHSFOR FIRST 2 YEARS 6 MONTHS FOR NEXT 2 YEARS AFTER THAT ANNUALLY
- 23. Self directed learning Papsmear Squamo-columnar junction Transformation Zone Risk factors for Ca Cervix Histopathological type of Ca Cervix
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