Carcinoma of Cervix

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Presentation Transcript

CARCINOMA OF CERVIX:

CARCINOMA OF CERVIX BY DR. SHABNAM NAZ MBBS, MCPS, FCPS ASSISTANT PROFESSOR GYNAE & OBS UNIT-I SMBBMU

Slide 3:

FEMALE GENITAL TRACT

Slide 4:

NORMAL CERVIX

INCIDENCE OF CA CERVIX :

INCIDENCE OF CA CERVIX Ca cervix is second most common female cancer world wide. In developed countries it constitutes 4 % of females malignancy with an annual incidence of 9.5 in 100,000 women. Death rate is 3.1 in 100, 000 annum have decline recently because of aggressive screening program.

TYPES OF CA CERVIX:

TYPES OF CA CERVIX According to invasion Non invansive (CIN) Invasive (Ca cervix) Histological type Squmous cell ca (95 %) columnar (5%) Rare (Adenosqumous, small cell, transitional, lymphoma, sarcoma) Clinical Ulcerative or Endophytic Polypoidal or Exophytic Or cauliflower

ETIOLOGY :

ETIOLOGY Age 35-50 years Parity 2-4 times more in married women Race Jews less common S.E.S poor S.E status

Slide 9:

Coitus Common in prostitutes (frequency of coitus,change of partner) Unknown in nuns Cervical irritation & infection Cervical trauma Chronic cervicitis Erosion Severe dysplasia HPV 16, 18, 33

CLINICAL FEATURES :

CLINICAL FEATURES Asymptomatic (+ ve pap smear) Irregular vaginal bleeding Post coital bleeding Foul smelling, blood staind vaginal discharge. symptoms of metastasis Pain :(Advance stage)

CLINICAL EXAMINATION:

CLINICAL EXAMINATION Early Stage Patient looking healthy No + ve findings Evaluate Anemia Jaundice Supraclavicular, inguinal lymph nodes P/A Liver enlargement Abdominal mass

Continue…..:

Continue….. P/S Visual evidence of CA cervix Look for change in cervix Cervix looks edematous, irregular & enlarged, P/V Cervix hard, friable, ulcearated, fixed, bleed to touch Fungating mass/ cauliflower In Advance Stage Spread to parametrium, vagina, uterus, bladder Rectal Examination exclude posterior extension

SPREAD:

SPREAD Local extension Down Vagina Up Uterus Laterally Para metrium & pelvic side wall Lymphatic Obturator, External iliac, Internal iliac Para- aortic Lymph nodes Rarely Inguinal & Supra clavicular lymph nodes

Slide 19:

LOCAL SPREAD

Slide 20:

LYMPHATIC SPREAD

continue……:

continue…… Blood borns Liver Lungs Bones

DIFFERENTIAL DIAGNOSIS :

DIFFERENTIAL DIAGNOSIS Cervical erosin Cervical ulcer Benign cervical growth

DIAGNOSIS:

DIAGNOSIS Mandatory investigations Full blood count Blood urea, creatinin, Electrolytes LFT I/V/U X Ray chest Optional investigations Abdomino pelvic U/S C.T MRI Lymphangiography

STAGING (FIGO staging) :

STAGING (FIGO staging) Staging (FIGO staging) Based on EUA & results of routine investigations EUA Proctoscopy Sigmoidoscopy Cystoscopy Cervical biopsy Curatings from uterine cavity & endocervix.

Slide 30:

STAGING OF CA CERVIX

PROPHYLAXIS OF CA CERVIX:

PROPHYLAXIS OF CA CERVIX Vaccination against HPV 16 & 18

TREATMENT:

TREATMENT Surgery Radiotherapy Surgery + Radiotherapy Radiotherapy + Surgery Stage I, II a ---- Surgery Stage II b to IV -----Radiotherapy /chemotherapy Supportive treatment

Continue…..:

Continue….. SURGERY Simple hysterectomy Wertheims Operations Schauta Amreich vaginal operation Supportive & palliative treatment 5 years survival is 30-40 of exentraction

Slide 34:

WERTHEIMS HYSTRECTOMY

continue……:

continue…… RADIOTHERAPY Radical pelvic radiotherapy with external beam x.ray treatment (Teletherapy) to the pelvis 20 fractions over 4 weeks Followed by brachytherapy Intra cavity treatment.

continue……:

continue…… in this vaginal delivery system is inserted under anesthesia & radiation delivered by a selectrom machine taking 12-18 hours The patient is awake during treatment & discomfort may be delivered by caudal block or sedation Some patient require second insertion 2-3 weeks after the 1 st.

Slide 37:

Acute diarrhea treated by low residual diet & imodium or codein. Long term S/E occurs in 5-10% include diarrhea, radiational cystitis, radrative proctitis (rectal bleeding) & vaginal stenousu

Slide 38:

RADIOTHERAPY

CAUSES OF DEATH IN CERVICAL CANCER:

CAUSES OF DEATH IN CERVICAL CANCER Uremia Haemorrhage Cachexia

5 years survival rate :

5 years survival rate

RECURRENT CA CERVIX:

RECURRENT CA CERVIX 30-70 of recurrence 60 % in 1st year 25 % in 2nd year Lymph node involved…increased risk of recurrence Faster recurrence worst prognosis 80 % die within 2 years

CA OF CERVICAL STUMP:

CA OF CERVICAL STUMP After subtotal hysterectomy Radiotherapy Brachytherapy is not possible then dose of teletherapy is increased