obstetrics & gynecology,

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