Obstetric gynecology cervical cancer.pptx

Gyn

1. CASE OF cervical cancer BY D r medhat ghanem

2. A 50-year-old G5P5 woman complains of postcoital spotting over the past 6 months. Most recently, she complains of a malodorous vaginal discharge. She states that she has had syphilis in the past. Her deliveries were all vaginal and uncomplicated. She has smoked 1 pack per day for 20 years. On examination, her blood pressure is 100/80 mm Hg, temperature is 99°F (37.2°C), and heart rate is 80 beats per minute. Her heart and lung examinations are within normal limits. The abdomen reveals no masses, ascites , or tenderness. Her back examination shows right costovertebral angle tenderness (CVAT). The pelvic examination reveals normal external female genitalia. The speculum examination reveals a 3-cm exophytic lesion on the anterior lip of the cervix. No other masses are palpated. Her right leg is more swollen than her left leg. » What is your next step? » What is the most likely diagnosis? » What is the best treatment for this condition?

3. HISTORY AGE : 50-year-old COMPLAIN: Vaginal spotting after intercourse and malodorous vaginal discharge over the past 6 months, OBESTATRIC HISTORY : G5P5 Her deliveries were all vaginal and uncomplicated. MENSTRUAL HISTORY : not provided MEDICAL HISTORY :not provided Contraceptive history:not provided Date of the last smear not provided Smoking history She has smoked 1 pack per day for 20 years.

4. GENERAL EXAMINATION BP 100l80 mmgh WEIGHT? temperature is 99°F (37.2°C), heart rate is 80 beats per minute Her heart and lung examinations are within normal limits Her right leg is more swollen than her left leg.

5. Examination . The abdomen reveals no masses, ascites , or tenderness . Herback examination shows right costovertebral angle tenderness (CVAT). The pelvic examination reveals normal external female genitalia . The speculum examination reveals a 3-cm exophytic lesion on the anterior lip of the cervix.

6. Examination General look: cachexia ? BMI Lymphadenopathy Local Examination : Picture of the 1ry Local spread 1 . Vaginal spread. 2. Examine mobility . 2 . PR examination .. 3. Infection Fistula ( UB or rectum ) .

7. investigation To confirm the diagnosis : • Biopsy & histopathological examination . To certify spread Examination under anesthesia Intravenous pyelogram Chest radiograph Barium enema or proctoscopy Cystoscopy MRI Abdomen and pelvis. multislice CT scans of chest, abdomen and pelvis. Cystoscopy and sigmoidoscopy should not be routinely performed for staging purposes . If imaging cannot exclude bladder or bowel involvement , cystoscopy and sigmoidoscopy should be used for staging. Ultrasound, IVU and lymphangiography are not recommended for staging.

8. complication • Uraemia . Fistulae (VVF or rectovaginal fistula) Obstruction of cervical canal by malignancy ® pyometra or haematometra or pyo-haematometera or pyophesometra ( gas forming organism ) .

9. Management Risk factor : Early age of coitus Sexually transmitted diseases Early childbearing Low socioeconomic status Human papillomavirus HIV infection Cigarette smoking Multiple sexual partners

10. Staging Staging of cervical cancer is based on examination under anaesthesia (EUA) by an experienced clinician. The EUA should include a combined rectovaginal examination to assess parametrial and vaginal extension, cystoscopy and sigmoidoscopy . A chest X-ray (CXR) should be performed to examine for lung metastases or pleural effusion.

11. staging FIGO staging of cancer of the cervix uteri (2018) I The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded) IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mma IA1 Measured stromal invasion <3 mm in depth IA2 Measured stromal invasion ≥3 mm and <5 mm in depth IB Invasive carcinoma with measured deepest invasion ≥5 mm (greater than Stage IA), lesion limited to the cervix uterib IB1 Invasive carcinoma ≥5 mm depth of stromal invasion, and <2 cm in greatest dimension IB2 Invasive carcinoma ≥2 cm and <4 cm in greatest dimension IB3 Invasive carcinoma ≥4 cm in greatest dimension I I The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall IIA Involvement limited to the upper two-thirds of the vagina without parametrial involvement IIA1 Invasive carcinoma <4 cm in greatest dimension IIA2 Invasive carcinoma ≥4 cm in greatest dimension IIB With parametrial involvement but not up to the pelvic wall

12. staging III The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para -aortic lymph nodesc IIIA The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall IIIB Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause) IIIC Involvement of pelvic and/or para -aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c IIIC1 Pelvic lymph node metastasis only IIIC2 Para-aortic IV The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) 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 adjacent pelvic organs IVB Spread to distant organs

13. treatment Cervical cancer is typically treated with either radical hysterectomy if early ( small tumor ) invasive cancer is found or radiation therapy if advanced disease is found. However, in younger women who desire children, radical trachelectomy ( removal of the cervix and upper vagina while leaving the uterus) can be performed .

14. treatment Ia1 LLETZ) or a cone biopsy as the incidence of positive lymph nodes is less than 1% + Careful cytological and colposcopic follow- up.If the excision margins are involved then further local excision or a simple hysterectomy. 1a2 lymphadenectomy is advisable on the basis of the 5% risk of metastases, the cervical component may alternatively be treated by simple hysterectomy or either LLETZ or cone biopsy in selected women who wish to preserve fertility. Ib A radical hysterectomy and pelvic lymphadenectomy or radical radiotherapy Women requesting fertility conservation should be offered radical trachelectomy and pelvic lymph node dissection, providing the tumour diameter is less than 2 cm and no lymphatic-vascular space invasion is present. Ib1 Radical surgery is recommended for FIGO IB1 disease if there are no contraindications to surgery. A radical trachelectomy and pelvic lymphadenectomy if suitable to conserve fertility IIb - Iva Radiotherapy is the primary mode of treatment, combined with platinumbased chemotherapy , unless the patient is medically unfit . Ivb radiotherapy may be particularly useful for symptom control, especially vaginal bleeding

15. prognosis Cervical cancer 5-year survival relative to stage Stage 5-year survival (%) LN I 79 15% II 47 30% III 22 50% IV 7