Cervical Cancer
Cervical Cancer
Cervical Cancer
CIN I.
CIN II.
CIN III.
CIS .
Results:
• Normal (negative) smear: with no dyskaryosis
at all-women having negative smears are
assured and advised for annual smear later.
• Abnormal (positive) smear: with variable
degrees of dyskaryosis: mild, moderate or
severe.
Cont.diagnosis :
2.Colposcopy
• The cervix is first examined
for abnormal vessel patterns
• premalignant and malignant
lesions of the cervix
abnormal findings includes:
1-Leukoplakia: white lesions without
adding acetic acid.
2-Aceto white lesions: white lesions
on adding acetic acid.
3- Abnormal blood vessels:
punctate,mosaicism,cork
skrew,spagetti like.
:Cont.diagnosis
2.Colposcopy
Findings may be:
-Normal colposcopy.
-Abnormal colposcopy.
-Unsatisfactory colposcopy: can't visualize
T-zone.
:Cont.diagnosis
3.Schiller's iodine test
Normal, mature squamous epithelium contains
abundant glycogen that stains dark brown with
iodine, and the test involves the application of
Lugol's iodine solution to the ectocervix.
Results:
• Negative: The normal squamous epithelium
will stain dark brown
• Positive: Abnormal squamous epithelium will
not.
:Cont.diagnosis
4.Cervical biopsy
Cone Biopsy:
Conization is both a diagnostic and therapeutic
procedure
Indicated in:
• Unsatisfactory colposcopy/+ve ECC
• Multifocal lesion
• Suspicion of microinvasion
• Discrepancy between Pap smear, colposcopy and biopsy.
Treatment of CIN
• CIN has the potential to be an invasive
malignancy but does not have malignant
properties so treatment involves completely
removing the abnormal epithelium. This can be
done either by an excisional technique or by
destroying the abnormal epithelium.
,(:Treatment of CIN (cont
Ablative therapy is appropriate when the following
conditions exist:
• There is no evidence of microinvasive or
invasive cancer on cytology, colposcopy,
• endocervical curettage, or biopsy.
• The lesion is located on the ectocervix and can
be seen entirely.
• There is no involvement of the endocervix with
high-grade dysplasia as determined by
• colposcopy and endocervical curettage.
,(:Treatment of CIN (cont
• Cryotherapy
• Laser Ablation
• Loop Electrosurgical Excision
• Conization
• Hysterectomy
:Invasive Cervical cancer
• Cervical cancer is the second most common
malignancy in women worldwide.
• Internationally, 500,000 new cases are
diagnosed each year.
• Cervical cancer is more common in Hispanic,
African American, and Native American women
than in white women.
• Cervical cancers usually affect women 40 – 50
years old, but it may be diagnosed in any
reproductive-aged woman.
Causes & Risk factors
• HPV infection
• Lack of regular Pap tests
• Smoking
• Weakened immune system
• Sexual history
• Using birth control pills for a long time:
• Having many children
• DES (diethylstilbestrol) in utero exposure
Having an HPV infection or other risk factors does not mean that
a woman will develop cervical cancer. Most women who have
risk factors for cervical cancer never develop it.
Clinical
Symptoms:
• Clinically, the first symptom is abnormal vaginal
bleeding, usually postcoital.
• Vaginal discomfort, malodorous discharge, and
dysuria are common.
• tumor growth:
constipation, fistula, and ureteral obstruction frequency, dysuria and
hematuria, leg edema, pain, and hydronephrosis, back aches
Somatic pain Deeply seated pelvic pain, loin pain
• Pelviabdominal mass
Clinical
• Signs:
General:
• Cachexia in advanced cases
• Ureamia if the ureter is compressed
• Leg edema suggests lymphatic/vascular obstruction from tumor.
Abdominal:
• Kidneys may be enlarged if hydronephrosis occurred,
Pelviabdominal mass may be felt in case of pyometria with tender
uterus & high fever.
• If the disease involves the liver, hepatomegaly may develop.
•
Clinical
Vaginal:
• LYMPHATIC SPREAD
• DIRECT IMPLANTATION
into lower part of vagina or vulva may occur during operation
Workup
• Cytology - cervical smears
• Colposcopy
• Schiller's test
• In the UK, HPV vaccines are licensed for boys aged 9–15 & they
have been FDA approved for use in males age 9 to 26 for
prevention of genital warts and precancerous lesions caused by
HPV.
Mechanism of action
• The latest generation of preventive HPV vaccines is
based on hollow virus-like particles assembled from
recombinant HPV coat proteins. The vaccines target the
two most common high-risk HPVs, types 16 and 18.
Together, these two HPV types currently cause about 70
percent of all cervical cancer. Gardasil also targets HPV
types 6 and 11, which together currently cause about 90
percent of all cases of genital warts.
• Gardasil and Cervarix are designed to elicit virus-
neutralizing antibody responses that prevent initial
infection with the HPV types represented in the vaccine.
:Administration
• The vaccine should be delivered through a
series of three intra-muscular injections over a
six-month period. The second and third doses
should be given two and six months after the
first dose.
• The vaccine can be administered at the same
visit as other age-appropriate vaccines.
• Providers should consider a 15-minute waiting
period for vaccine recipients following
vaccination.
,(:Preventive measures (cont
C. Others
• Male circumcision
• Penile hygiene
• Use of condoms to prevent STDs
Active treatment
The treatment of cervical cancer varies with the
stage of the disease:
• For early invasive cancer, surgery is the
treatment of choice.
• In more advanced cases, radiation combined
with chemotherapy is the current standard of
care.
• In patients with disseminated disease,
chemotherapy or radiation provides symptom
palliation.
:Surgical treatment
i. Extended hysterectomy
• It's indicated in stage I A. It involves removal of the uterus – adnexa –
upper vagina – parametrium & pelvic lymph nodes all in one mass.