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Cervical Cancer

Cervical Cancer

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Cervical Cancer

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  1. Cervical Cancer Amal El Sayed

  2. Introduction • Theoretically, cervical caner is a preventable disease if women have regular Pap smear. • The availability of HPV vaccine shoulder markedly decrease cancer of the cervix.

  3. Etiology • HPV Virus Type 16, 18 • Screening is by Pap test. Sample both endo and exocervix • Risk factors: • Young age at first coitus (<20 yr) • Multiple sexual partners • Sexual partner with multiple sexual partners • Young age at first pregnancy • High Parity • Lower socioeconomic status • Smoking

  4. Symptoms of Cancer of the Cervix • Post coital bleeding • Intermenstrual bleeding • Persistent vaginal discharge • Pelvic Pain

  5. Examination • Physical exam is normal • Weight loss in advanced disease • Pelvic exam: • Exophytic lesions • Ulcerative lesions • Lesions bleed on touch

  6. Pathological Features • Squamous cell carcinoma (commonest) • Adenocarcinoma • Adenoquamous carcinoma

  7. Modes of Spread • Local spread • Lymphatic spread • Blood Spread

  8. Staging • Specimen Adequacy: • Satisfactory for evaluation (note presence/absence of endocervical/transformation zone component) • Unsatisfactory for evaluation (specify reason) • Specimen rejected/not processed (specify reason) • Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality (specify reason)

  9. General Categorization (Optional) • Negative for intraepithelial lesion of malignancy • Epithelial cell abnormality • Other

  10. Interpretation/Result • Negative for Intraepithelial Lesion or Malignancy: • Organisms (e.g. Trichomonasvaginalis) • Reactive cellular changes associated with inflammation (includes typical repair), radiation, intrauterine contraceptive device • Antrophy

  11. Epithelial Cell Abnormalities • Squamous Cell • Atypical squamous cells of undetermined significance (ASCUS) cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H) • Low-grade squamous intraepithelial lesion (LSIL) encompassing: human papiloma virus/mild dysplasia/cervical intraepithelial neoplasia (CIN I) HSIL encompassing: moderate and severe dysplasia carcinoma in situ; CIN II and CIN III • Squamous cell carcinoma

  12. Epithelial Cell Abnormalities (Continued) • Glandular Cell • Atypical glandular cells (AGC) (specify endocervical endometrial, or not otherwise specified) • Atypical glandular cells, favor neoplastic (specify enodcervical or not otherwise specified) • Endocervicaladenocarcinoma in situ (AIS) • Adenocarcinoma 3. Other • For example, endometrial cells in a woman ≥40 years of age

  13. Treatment According to Stage • Stage IaMicroinvasion: Cone biopsy  Total abdominal hysterectomy • Stage Ib: Radial hysterectomy and bilateral lymphadenectomy • Stage IIa: Surgery or radiation • Stage IIb: Radiation • Stage III: Radiation • Stage IV: Radiation

  14. Staging is done by EUA: • Cytoscopy • Proctoscopy • IVP • CXR

  15. Thank You