carcinoma cervix

Dr.Chaduvula Suresh Babu
Professor
Department of Obstetrics & Gynaecology
GIMsR
Visakhapatnam, AP, India

 Carcinoma cervix is commonest malignancy
in the female genital tract.
 Second common cancer in female body
following Breast cancer.
 In USA it is less common and India it is highly
prevalent.
 Every year 500,000 new cases are occurring
in the world.

 Papanicolaou – For cervical Screening
 Colposcope – Sir Hans Hinselmann
 Wertheim’ s Radical hysterectomy
 Schauta’s Radical Hysterectomy
 Mitra’s Radical Hysterectomy
 Meig’s Radical Hysterectomy
 Rutledge’s types Hysterectomies

 Human Papilloma Virus infection is
responsible for Carcinoma cervix.
 16,18,31 and 33 are common strains that
affect cancer cervix.
 Herpes simplex Type II, HIV, Cytomegalo virus
and Chlamydial infections are associated
infections.

 Other contributing factors are
 Early coitus
 Early marriage
 Early Pregnancy
 Multiple pregnancies
 Multiple partners

 Tobacco users/ smokers
 Oral contraceptive pill users
 Bad hygiene
 Circumcision – a protective factor
 Poverty
 Low socioeconomic status

 1.Squamous cell carcinoma – 80-90% -
Keratinizing and non-keratinizing types
 2. Adenocarcinoma – 10%
 3.Adenoquamou carcinoma – 1%
 4. Rare – melanoma - <1 %

1. Direct – to vagina, parametrium
2. Lymphatic – to the lymph nodes –
Parametrial, obturator, internal, external
and common iliac
 Rarely – left supraclavicular lymph node
[ Virchow’s]
1. Haematogenous – Liver, Lung, Brain, Bones

 Post coital bleeding
 Irregular bleeding
 Postmenopausal bleeding
 Foul smelling discharge
 Pain lower abdomen and back
 Dyspareunia
 Depending on site of metastasis may present
with Jaundice, haemoptysis, bone pain,
incontinence of urine and faces etc.

 Per Speculum Examination - Cancer Cervix
present as a Friable cauliflower growth or
Indurated growth or Ulcerative form.
 Bleeds on touch
 May Look Normal
 Per Vaginal Examination: Bleeds on touch, fixed
uterus
 Per Rectal eam – Parametrial involvement
 Rectovaginal eamination: Involvement of
rectovaginal septum and rectal mucosa

 Clinical Staging - FIGO
 Stage 0 – CIN I, II, III, Carcinoma in-situ
 Stage I - Micro-invasive Cancer [ occult ]
 Stage II - Overt cancer
 Stage III – Spreads to Pelvic wall
 Stage IV – Bladder and Rectal Mucosa and
distant metastasis

 IV A – Bladder and rectal involvement
 IV B – Distant Metastasis

1. Pap smear
2. Cervical punch biopsy
3. Colposcopy guided biopsy
4. Endo-cervical curettage
5. TLC,LFT,KFT, Hg%
6. Ultrasound, CT Scan, MRI, PET scan
7. Cystoscope, Proctoscope
8. X-ray chest

 Stage I A I – Conisation, Hysterectomy
 Stage IA II – Modified Radical Hysterectomy
 Stage 1B - Radical Hysterectomy [ or Primary
radiotherapy ]
 Stage II A – Radical Hysterectomy
 Stage II B to Stage IV – Radiotherapy +_
Chemotherapy
 Stage IV B - Chemotherapy

 Structures to be removed are
 Uterus and cervix
 Bilateral parametrium
 Bilateral adnexa
 Upper 1/3 of vagina
 B/L cardinal and utero-sacral ligaments
 Sentinel, Parametrial, Internal, obturator,
external, common iliac and para-aortic
lymphnodes.

 Haemorrhage
 Ureteric Injury
 Lympho-cyst
 Urinary retention

 For all advanced cancer cervix and few bulky
early stage cancers it is indicated.
 2 types:
 1. External or Tele Cobalt Radiotherapy
 2. Brachy or Interstitial therapy. – Three
techniques are used
 A] Paris
 B] Manchester and Modified Manchester
 C] Stockholm techniques

 Early – loss of appetite, skin changes,
cystitis, loose motions
 Late – Stenosis of urethra, vagina, bowel,
fistulae

 Prognosis depends on Clinical staging, Tumor
volume, Vaginal involvement and Lymphnodal
involvement.
5 year survival rate
 Stage 1 - 80 - 90%
 Stage II - 50 - 65%
 Stage III – 35%
 Stage IV – 15%

 Indications:
 Advanced,
 Inoperable,
 Recurrent disease –
 To reduce the volume of the growth
 As Neoadjuvant chemotherapy – CIPLATINUM,
IFOFAMIDE or PACLITAEL
 Concurrent Chemotherapy along with
radiotherapy

 Renal Failure
 Cachexia

carcinoma cervix

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carcinoma cervix