Cervical cancer

cervical cancer is the worlds most leading cause for the death of women. so knowledge regarding that disease will help us to prevent that disease to some extent.

1. CERVICAL CANCER DR HEM NATH SUBEDI II YEAR OBGYN COMSTH

2. 55 YEARS P5L5, SECOND MARRIAGE TO EX ARMY HAD POSTMENOPAUSAL BLEEDING WITH FOUL SMELLING VAGINAL DISCHARGE FOR 6 MONTHS,ON PV EXAMINATION THERE IS A GROWTH. WHAT COULD BE DIAGNOSIS?

3. CONTENTS INTRODUCTION INCIDENCE ETIOLOGY PATHOLOGY CLINICAL FEATURES PATTERN OF SPREAD STAGING DIAGNOSIS MANAGEMENT

4. INTRODUCTION Worldwide, cervical carcinoma continues to be a significant health care problem. In developing countries, where health care resources are limited, cervical carcinoma is the second most frequent cause of cancer death in women.

5. INCIDENCE GENITAL CANCER IN DC DUTTA TEXT BOOK OF GYNECOLOGY , 6TH EDITION, NEW DELHI PP334

6. SECOND MOST COMMON IN DEVELOPING COUNTRY THIRD MOST COMMON IN DEVELOPED ONES. SCREENING PROGRAM HPV VACCINATION : Gardasil ( quadravalant ), Cervarix (bivalent) ALMOST 30% OF CERVICAL CANCER OCCURS IN WOMEN WHO HAD NEVER GONE THROUGH THE SCREENING PROGRAM. THIS PERCENTAGE APPROACH TO 60% IN DEVELOPING COUNTRY. THE PEAK INCIDENCE IS BIMODAL .

7. AETIOLOGY AGE -35-39 AND 60-64 YEARS . RACE SOCIOECONOMIC STATUS LOW SOCIOECONOMIC STATUS COITUS Multiple sex partners EARLY AGE OF COITUS AND FREQUENT COITUS CHILD BEARING ESTROGEN CERVICAL IRRITATION AND INFECTION HPV high risk types16,18,31,33,45 HPV low risk types PREDISPOSING HISTOLOGICAL STATUS CIN II, CIN III AND CARCINOMA IN SITU

8. PATHOLOGY Histopathologic Types • Cervical intraephithelial neoplasia , Grade III • Squamous cell carcinoma in situ • Squamous cell carcinoma – Keratinising – Non- Keratinising – Verrucous • Adenocarcinoma in situ • Adenocarcinoma in situ, endocervical type • Endometrioid adenocarcinoma • Clear cell adenocarcinoma • Adenosquamous carcinoma • Adenoid cystic carcinoma • Small cell carcinoma • Undifferentiated carcinoma

9. CLINICAL FEATURES VAGINAL BLEEDING SPECIALLY POSTCOITAL BLEEDING POSTMENOPAUSAL BLEEDING WITH ADVANCE DISEASE MALODOROUS VAGINAL DISCHARGE WT LOSS OBSTRUCTIVE UROPATHIES GROWTH OF THE MASS

10. PATTERN OF SPREAD DIRECT INVASION INTO THE CERVICAL STROMA, CORPUS ,VAGINA AND PARAMETRIUM LYMPATHIC METASTASIS BLOOD-BOURNE METASTASIS INTRAPERITONEAL IMPLANTATION

11. STAGING GENITAL CANCER IN DC DUTTA TEXT BOOK OF GYNECOLOGY , 6TH EDITION, NEW DELHI PP334

12. STAGING

13. STAGING

14. STAGING

15. DIFFERENTIAL DIAGNOSIS The growth needs to be differentiated from: Cervical tuberculosis . Syphilitic ulcer . Cervical ectopy . Products of conception in incomplete abortion. Fibroid polyp .

16. DIAGNOSIS History Clinical Features Investigation Lab investigation Colposcopic finding Tissue biopsy Chest –x ray CT scan MRI Scan Lymphography

17. COMPLICATIONS The following complications may occur sooner or later, as the lesion progresses. ™ Hemorrhage. ™ Frequent attacks of ureteric pain, due to pyelitis and pyelonephritis and hydronephrosis . ™ Pyometra — specially with endocervical variety. ™ Vesicovaginal fistula. ™ Rectovaginal fistula

18. Causes of death Uremia Hemorrhage Sepsis Cachexia Metastasis

19. MANAGEMENT Preventive Primary prevention Secondary prevention Curative Primary surgery Primary radiotherapy Chemotherapy Combination therapy

20. Prevention Primary prevention Identifying high risk male and female HPV vaccine Use of condom Removal of cervix during surgery Secondary prevention By doing screening program Down staging program of WHO

21. CURATIVE Primary surgery Primary radiotherapy Chemotherapy Combination therapy

22. SURGERY HYSTERECTOMY RADICAL HYSTERECTOMY EXTRAFACIAL MODIFIED RADICAL RADICAL EXTENSIVE PELVIC EXCENTRATION LAPROSCOPIC RADICAL HYSTERECTOMY ROBOTIC LAPAROSCOPIC HYSTERECTOMY

23. Radical Hysterectomy Rutledge has defined five classes of hysterectomy in cases of malignancy, depending on the extent of resection. Class I – Extrafascial hysterectomy with bilateral salpingo-oophorectomy Class II – Modified radical hysterectomy which is the original Wertheim hysterectomy. In this the medial half of the cardinal and uterosacral ligaments are also removed as well as those pelvic lymph nodes which are enlarged. Class III – Radical hysterectomy. This is the modified Wertheim’s operation as described by Meigs . It includes complete pelvic lymph node dissection, removal of almost the whole of the cardinal and uterosacral ligaments and the upper one-third of the vagina. Class IV – Extended radical hysterectomy. This includes removal of the periureteral tissue, superior vesical artery and up to three-fourths of the vagina. Class V – Partial exenteration . This is rarely performed. Here portions of the distal ureter and bladder are also dissected.

24. PRIMARY RADIOTHERAPY TELETHERAPY FOR LARGE TUMOR To SHRINKK THE TUMOR BRACHYTHERAPY FOR SMALLER ONES

25. CHEMORADIATION Cisplatin Carboplatin Vincristine Hydroxyuria Tepotetan Note : best result with cisplatin with radiotherapy

26. Palliative care At last symptomatic treatment Analgesic Chemotherapy Diet Rest

27. IMPORTANT QUESTIONS WHAT ARE THE RISK FACTORS FOR THE DEVELOPMENT OF CERVICAL CARCINOMA IN FEMALE DEFINE HPV AND ITS SIGNIFICANCE FOR CERVICAL CANCER FOR STAGE IA 1 BEST MODALITIES OF TREATMENT IS HYSTERECTOMY CONE BIOPSY RADIOTHERAPY CHEMOTHERAPY VIRUS CAUSING CERVICAL CANCER HPV CMV VERICELLA RUBELLA

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