Cervical carcinoma is the second most common cancer in women globally, with over 16 cases reported per 100,000 women each year. It arises from the cells of the cervix uteri. Human papillomavirus (HPV) infection is the primary risk factor. Symptoms may include abnormal bleeding or discharge. Diagnosis involves history, physical exam, Pap smear, colposcopy, and biopsy. Staging uses the FIGO system and treatment options depend on stage, including LEEP, hysterectomy, chemotherapy, and radiation. Regular screening through Pap smears and HPV testing can help prevent cervical cancer by detecting pre-cancerous lesions.

1. SAMIA SHAHEEN
08-166
CERVICAL CARCINOMA

2. Cervical carcinoma
 Definition
Malignant neoplasm
arising from the cells of
cervix uteri.

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. Anatomy of cervix
 Lowest part of uterus
 1 inch in length
 Anatomical divisions

5. Histology
 Stratified squamous
epithelium
 Simple columnar
epithelium
 SQUAMOCLOMNAR
JUNCTION
 Nabothian cysts

6. Types
 squamous cell carcinoma (about 80-85%)
 adenocarcinoma (about 15%)
 adenosquamous carcinoma
 small cell carcinoma
 neuroendocrine tumour
 glassy cell carcinoma
 villoglandular adenocarcinoma

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. 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. 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. Diagnosis
 History and physical examination
 Papanicolaou smear/liquid based cytology
 HPV-DNA testing
 Colposcopy: endocervical curettage
 Per rectal examination
 Biopsy

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. Pap smear: conventional
method
 Cytologic preparation of
exfoliated cells from
cervical transformation
zone
 Procedure
 speculum insertion
 scrap by brush
 microscopy

13. Liquid based cytology
 Collection of cells : same
 Spatula broken into
preservative containing
glass vial
 Centrifuge
 Microscopy
 HPV-DNA testing

14. Colposcopy
 Binocular, magnifies 5-
20 times
 See abnormal vessels
 Apply 3-5% acetic acid
 See whitish areas
 Can also do
endocervical curettage

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. Grading: BATHESDA SYSTEM
 LSIL
 CIN I
 HSIL
 CIN II
 CIN III
 DOES NOT MEAN THE
STAGING

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. FIGO Staging system
STAGE IA STAGE IB

19. FIGO system: cont
STAGE II

20. FIGO system: cont
STAGE IIIA STAGE IIIB

21. FIGO system: cont
STAGE IVA STAGE IVB

22. Treatment
 Depends upon
 Stage of tumor
 Size
 Age and general health
 Desire to have children

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. 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. Palliative treatment
 At the advanced stage disease
 Pain free and comfort
 Expert nursing

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. 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. 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. THANK YOU