CARCINOMA OF

CERVIX

INVASIVE CARCINOMA OF

CERVIX

• Definition

• Epidemiology

Atiology

• Early exposure to sexual intercourse before 20 years of age

• Multiple sexual partners

• A male partner with multiple previous sexual partners

• Smoking

• Persistent infection by high risk papillomavirus HPV (Hr Specially HPV 16, 18)

Pathology

• Irregular vaginal bleeding

• Postcoital bleeding

• Pain (less common)

• Edema (in advanced stage)

Clinical Feature

• Cervical biopsy

• Metastatic work up, once the diagnosis of

invasive carcinoma is made, then we can do

pelvic examination, chest-x-ray, intravenous

pyelogram, cystoscopy and sigmoidoscopy

• Imaging Studies: CT, MRI

Diagnostic Tests

Staging of Cervical Carcinoma • Stage O : CIS• Stage I : Spread limited to cervix• Ia1 : Invasion is < 3 mm deep• Ia2 : Invasion is > Ia1 but < 5 mm deep • Ib : Invasion is > 5 mm deep• Stage IIa : Involves upper 2/3 of vagina• IIb : Invasion of parametrium• Stage III : Carcinoma extending the pelvic sidewall and lower

1/3 of vagina• IIIa : Involves lower 1/3 of vagina• IIIb : Extends to the pelvic sidewalls• Stage IV : Ca spread far away from cervix• IVa : Involves bladder or rectum• IVb : Distant metastasis

Management

Specific by Stage

• Ia1 : Total simple hysterectomy

• Ia2 : Radical hysterectomy. It includes removal of

cervix, upper 3rd of vagina, uterus and

parametrical tissue

• Ib or IIa : Radical hysterectomy or radiation therapy and pelvic node disection

• IIb, III or IV: Radiation therapy and chemotherapy.

Follow Up

• All Patients: patients with invasive cervical cancershould follow up with a pap smear every 3months for 2 years after treatment and thenevery 6 months for the subsequent 3 years.

• Local Reoccurrence: Patient having localreoccurrence should be treated with radiationtherapy.

• Distant Metastasis: In these case patient shouldbe treated with chemotherapy e.g. cisplatinum.

Invasive Carcinoma in Pregnancy

Complication of Surgery

• Anesthetic complication and haemorrhage

• Post operative, chest, wound and urinary tract

infection

• Urological complication include atonic bladder

• Obturator nerve damage may occur

• Thromboembolism

Complication of Radiotherapy

• Premature menopause due to radiationinduced ovarian.

• Urinary complication: haemorrhagic cystitis,urinary frequency, contracted bladder, chronichaematuria, ureteric stricture and fistula.

• Bowel Complication: Chronic diarrhea,proctocolitis, rectal stricture

• Avascular necrosis of femoral head.