Carcinoma of Cervix

Carcinoma of Cervix
Omar Azmat
Final Year
MBBS

WORLDWIDE, 2nd most common cancer in women, after carcinoma breast!
Etiology
Etiology of cervical cancer is not clearly known but its relationship with sexual activity is clearly understood….thus it is more commmon in,
v Married women
v Women having their first sexual intercourse under 20yrs
v Those who have had multiple sexual partners. (6 more partners, resulting in a 14 fold increased risk)Men previously married to women with the cancer, puts his new wife at an increased risk (2.7 fold)Increased risk in women whose male partner has multiple sexual partners.
Women who smoke are at a higher risk. (12 yrs smoking, increasing risk by 12.7 fold)
Human Papilloma Virus (HPV)….causing warts in the genital tract is known for its association with cervical carcinoma. Group 1 (type 6, 11, 31, 35, 42, 50) >>> low grade CIN. Group2 (types 16, 18, 33)>>>high grade CIN.
Pathology
90% Malignancies>> Squamous Cell Carcinoma
Remaining 10%--adenocarcinoma, endometrioid, Clear Cell, mucinous and Papillary Cell Ca.
How does the Disease progress………..CIN Microinvasive Carcinoma (depth £ 5mm, width £ 7mm but pushing through the B. membrane)…>
Invasive Disease (Polypoid growth / ulcer on the cervix)
Spread
Predominantly spreads by…….”Direct Invasion” OR way of “Lymphatics”

Blood borne spread occurs in poorly differentiated tumours!
Tumour invading locally….
Lymphatics: Metastasizes to “obturator”, “external and internal iliac nodes”……>>> drain into ParaAortics L.Nodes.Blood borne spread: Common sites: liver, lungs, bones.

How Does a woman present…
Carcinoma cervix is a disease of the elderly. (50-70 yrs) Carcinoma Cervix presents at an early stage.
Abnormal Vaginal bleeding is the most common complaint!!
Pain is a complaint of advanced disease. Foul smelling vaginal discharge which may be blood stained (advanced disease) Symptoms due to advanced disease also include: Hematuria, Tenesmus, bleeding per rectum, Fistulas, Edema of the lower extremities.
Examining the patient
GPE: Evaluate for anemia and palpate supraclavicular and inguinal areas for enlarged lymph nodes.
Abdominal Examination: Aimed at…abdominopelvic mass, enlargement of liver/ kidney.
Speculum Examination would provide visual evidence of the disease extent. Bimanual Examination: Carcinoma feels hard, friable, irregular & enlarged.Rectal Examination, to exclude involvement.
Investigate..
To assess effects on other systems:
FBC, Urea, Creatinine, Electrolytes, LFTs, IV-pyelography, CXR
Understaning the extent of the disease (optional): abdominopelvic US, CT-scan, MRI & lymphangiography.
Staging
Based on:
Findings of clinical examination & Routine investigations!

For accurate staging, the clinical findings should be confirmed on “Examination Under Anesthesia”
Stage 0 …..Cervical Intraepithelial neoplasia (CIN), ca-in-situ
Stage ICarcinoma confined to the cervixOn basis of invasion and size, further classified into: Ia, Ia1, Ia2, Ib, Ib1, Ib2
Stage II Extending beyond the cervix into upper two-thirds of vagina (IIa), into the parametrium (IIb)(not reaching the pelvic side walls)
Stage III: Carcinoma involving the lower third of the vagina (IIIa) and/ or extending into the pelvic side walls (IIIb)
Stage IVa: Carcinoma involving the mucosa of the bladder, rectum or extending beyond the true pelvisStage IVb: Distant Organ Involvement
Thank you