oncology category

1. AYMAN SHEHATA
Lecturer Ob/Gyn
2015

5. What do you know about cervical
cancer?

6. Incidence
• 4-6 % of female genital cancers.
• Age 40-60 and may be young 30s

7. Important points about cervical cancer
• It is rising in young women.
• There are 450,000 cases of cervical cancer/year.
• There are 300,000 death/year.
• It is the fourth most common cancer (breast, lung, and
stomach).
• It is a preventable disease (screening programme-cervical
smear).
• The surgical treatment is mainly for early stage.

9. Precancerous lesions
• cervical dysplasia
• cervical intraepithelial neoplasia (CIN)
• squamous intraepithelial lesion (SIL)
• atypical glandular cells
• Polyps
• Warts
• Cysts

10. Grades of CIN
CIN is graded according the proportion of epithelium
occupied by the abnormal cells.
• CIN 1 (mild dysplasia):
- One-third or less is occupied by the abnormal cells.
- Progress to (CIS) in 6%.
- Regressed or disappeared in 62%,

11. Grades of CIN
• CIN 2(modrate dysplasia):
- Between 1/3-2/3 of the epithelium is occupied by the abnormal
cells.
- Become invasive in 13%.
• CIN 3 (severe dysplasia):
- The whole thickness of the squamous epithelium is occupied
by the abnormal cells.
- It is regarded as carcinoma-in-situ (CIS).
- It could arise as CIN 3 or progress from CIN 1or CIN 2.
- Become invasive in 29%.

13. HPV

15. HPV 16,18
Smoking Cervical cell Male factors
Infhibation of CX
cellp53 tumour
suppression gyne
Protection against
tumour
development lifted
Cancer develops

18. DIAGNOSIS
1- History.
• Many women are a symptomatic .
• Presented with abnormal routine cx smear
• Complain of abnormal vaginal bleeding
• I M bleeding
• post coital bleeding
• perimenopausal bleeding
• postmenopausal bleeding
• blood stain vaginal discharge

19. Diagnosis
2- Examination:
• Mainly vaginal examination using cuscu’s
speculem nothing is found in early stage .
• Mass ,ulcerating fungating in the cervix
• P/V P/R is very helful.

20. Cytology Histology
calposcopy
INVESTIGATIONS

25. Mild Dysplasia
Severe Dysplasia
Sq. cell Crs.

26. •LEEP

30. Acetic acid test

31. A. Colposcopic image of a CIN III lesion with dense acetowhite changes, coarse
mosaic (long arrow), and punctuation (short arrow).
B. Colposcopic image of a CIN III lesion with dense acetowhite changes and sharp
margins.
A B

35. Schiller iodine test

38. Biopsy types

40. Pathology (Gross )
• Exophytic: is like cauliflower filling up the
vaginal vualt.
• Endophytic: it appears as hard mass with a
good deal of induration.
• Ulcerative: an ulcer in the cervix.

42. SPREAD:
Direct Lymphatic Dissemination
(late)
- Uteruq.
- Vagina.
- Parametrium.
- Bladder and rectum.
A- primary node:
parametrial.
Paracervical.
Vesicovaginal.
Rectovaginal.
Hypogastric.
Obturator and external iliac
B-Secondary nodes:
Common iliac
Sacral
Vaginal
Paraaortic
Inguinal.
- parametrial spread
causes obstruction of the
ureters, many deaths occur
due to uraemia.
- Obstruction to the
cervical canal results in
pyometria.