PRACTICAL PATHOLOGY 1- Cervical Carcinoma, Ovarian Cysts and Tumours
Cervical carcinoma – trends and treatments
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Miss Kathryn Hillaby MD MRCOGConsultant Gynaecological Oncologist,
Colposcopy Lead for Gloucestershire
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Cervical Carcinoma – where are we now?
Total cases in England in 2008 = 2,369Mortality = 753 women in 20081 yr relative survival rate = 86%5 yr relative survival rate = 68%
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Cervical carcinomaPeak incidence 35-
39Incidence rates
have halved in UK in last 20 yrs
Linked to HPV and smoking
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Cervical carcinomaNumber of cases highest in those aged 25-
49, these women represent over half of all diagnoses
Rates peak in women in early 30’s, gradually reduce in 40’s and rise again in women in 70’s and early 80’s
Both incidence and mortality worse in deprived areas
Cervical cancer is worse in older women – 1 yr survival in those aged 15-39 is 96% compared with 52% in those aged 80 or older
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Cervical Carcinoma
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Cervical carcinomaIncidence and mortality rates have fallen
considerably over past 20 yrsIncidence rates have almost halved (16.2 to
8.3 per 100,000 female population)Mortality rates reduced by 2/3 (from 6.4 to
2.2 per 100,000 female population)Incidence fell sharply following introduction
of Cervical screening programme
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Cervical carcinomaHOWEVER: Reduction in incidence has levelled off in
recent yearsBetween 1998 and 2008 incidence in women
aged 25-29 increased by 77%
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WorldwideCervical carcinoma 12th most common cancer
in women, and 5th most deadlyIn young women is 2nd most common
carcinoma80% occurs in developing countriesKills 250,000 women per year
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Map of incidence by Cancer Network, 2004-2008
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Map of mortality by Cancer Network, 2004-2008
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Cervical carcinoma
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Cervical carcinomaColposcopy – apply acetic acid to cervixBiospy or LLETZ - Squamous cell carcinoma (85%)Adenocarcinoma (15%)
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Colposcopy
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Cervical carcinoma staging
Staging is clinicalFIGO staging Based on EUA, cystoscopy +/- sigmoidoscopyDoes NOT include MRIIn UK investigations include MRI pelvis and
CT chest/abdo/pelvis
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Cervical carcinomaInvestigations – CT
and MRIEUA and cystoscopy
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Stage 1 diseaseStage 1AStage 1A1 = <3mm
depth of invasion and <7mm wide
Stage 1A2 = 3-5mm depth of invasion and <7mm wide
Treatment = LLETZ
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Stage 1 diseaseStage 1B = any
tumour which is visible
Stage 1B1 = <4cmStage 1B2 = >4cmConfined to cervixTreatment =
surgical for 1B1Chemo Radiotherapy
for 1B2
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Stage 2 diseaseStage 2 = invades
beyond uterus, but not to pelvic sidewall or lower 1/3 of vagina
Stage 2A – spread into the top of the vagina
2A1 = <4cm2A2 = >4cm
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Stage 2 diseaseStage 2B – spread
into parametrium
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Stage 3 diseaseTumour extends to
pelvic sidewall and/or involves lower 1/3 of vagina and/or causes hydronephrosis
Stage 3A – Cancer has spread to lower 1/3 of vagina, but not to pelvic sidewall
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Stage 3 diseaseStage 3B diseaseSpread to pelvic
sidewall and / or hydronephrosis
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Stage 4Carcinoma has
extended beyond true pelvis or has involved mucosa of bladder or rectum
Stage 4a – spread of growth to adjacent organ
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Stage 4 diseaseStage 4B – spread to
distant organs
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Staging and treatmentSurgical in women up to stage 1b1Chemotherapy (cisplatin) with radiotherapy
in women with disease > stage 1b1
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Cervical carcinoma36 cases Stage 1B1 and above per year
Gloucestershire, Herefordshire and S Worcestershire
Stage 1b1 or less managed surgicallyStage 1b2 and above managed with chemo-
radiotherapySurvival rates >85% in women <40yrs
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How can we tackle this?
Reduce incidence by screeningTreatment – of CIN to stop progression to
cervical cancerEarly detection of cervical carcinoma Adequate treatment
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Cervical screening programmeCervical screening programme saves 4500
lives per year in UKCervical screening prevents up to 3,900
cases of cervical cancer per year in the UK
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Cervical screening programme
Early detection can prevent 75% cervical cancersCurrently between 77-83% women attend for
screening2007/2008 43% women 25-34yrs did not attend
for smears
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What happened?2008-2009 statistics show
that the number of women of all ages having cervical screening has increased to 3.7 million compared with 3.4 million last year, an increase of 10.5 per cent (around 353,000).
Those within the 25 to 64 age range have risen to 3.6 million from 3.2 million last year, an 11.9 per cent increase (around 384,000).
The majority of this increase is for women aged 25 to 49. It is thought to be due to the publicity surrounding the illness and death of Jade Goody.
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Take home messagesCervical screening programme worksPrevents 70% cases cervical carcinomaSaves 4500 women per yearOnly works if women attend for smearHPV vaccine prevents 70% cases cervical
cancerUptake currently disappointing