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Transcript of Ppt CA Cervical
8/13/2019 Ppt CA Cervical
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CERVICAL CANCERSupervisor :
dr. Pim Gonta, Sp.OG
Presented by :
Marcella Haryanto 2011-061-146
Pauline Octaviani 2011-061-147
Maria Clarissa W. 2011-061-151Ian Suryadi 2012-061-079
Inez Ayuwibowo 2012-061-083
Department Of Obstetric And Gynecology
Medical Faculty Of Atma Jaya University2013
Topic List
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INCIDENCE RISK
Worldwide, ranks 2nd
among all malignancies
for women
In 2002 493,000 new
cases & 274,000 †
Developing countries
83% of reported casesannually.
Economically
advantaged countries
only 3.6 % of newcancers.
The median age at
diagnosis : 40-59 years.
Human papillomavirus
(HPV), serotype 16
which is sexually transmitted.
Early coitarche, multiple
sexual partners, and
increased parity
Intercourse at age <16 y.o Multiparitas
Multiple partners
Cigarette smoking
The greatest risk forcervical cancer is the lack
of regular Pap smear
screening.
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Patophysiology
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SpreadTumor can advance◦ Locally◦ Exophitic
Ectocervix into vagina◦ Endophitic
Endocervix into stroma
◦ Infiltrative
Ulcerative lesion is common with necrosis May invade surrounding organs
◦ Following lymphatic drainage
◦ Hematogenous
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Lymphatic
pattern of
spread
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Histologic Classification
Squamous cell
carcinoma
Most common 85 % of all
subtype
Adenocarcinoma Endocervical
Endometrioid
Minimal deviation
Papillary villoglandular
Serous adenocarcinoma
Mixed cervical
carcinoma
Clear cell carcinoma
Adenosquamous carcinoma
Glassy cell carcinoma
Adenoid Cystic, Adenoid basalepithelioma
Neuroendocrine tumor
of cervix
Large cell neuroendocrine,
Small cell carcinoma
Sarcoma cervix Mali nant
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Clinical Manifestation
EARLY -> Asymptomatic
COMMON: Bleeding (postcoital, metrorrhagia,
menorrhagia) Vaginal discomfort Malodorous discharge
Leucorrhea
LATE -> Based on metastasis
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Diagnosis
Anamnesis
RiskFactor + Manifestation
PhysicalExamination Cervical inspection,
palpation, LymphNodes, Rectal Touche
Px ◦ Biopsy (gold standard)
◦ Colposcopy / Gynescopy
/ Pap Smear/ Endocervixcurretage
◦ Roentgen / CT scan/pielograph metastasis
◦ Tumor Marker (CEA, CA
125, SCC)
PAP SMEAR Test issuggested:
1. Coitarche -> THREE
TIMES a year
2. Screening -> ONCE ayear
3. High Risk -> ONCE a
year
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STAGING FIGO (1)
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STAGING FIGO (2)
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American Joint Committee on
Cancer (AJCC) Conversion
Stage Tumor Node Metastasis 0 Tis N0 M0
IA1 T1a1 N0 M0
IA2 T1a2 N0 M0
IB1 T1b1 N0 M0
IIA T2a N0 M0
IIB T2b N0 M0
IIIA T3a N0 M0
IIIB T1 N1 M0
- T2 N1 M0
- T3a N1 M0
- T3b Any N M0
IVA T4 Any N M0
IVB Any T Any N M1
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Treatment Prevention
Depends on the
stage :
- Surgery
- Radiotherapy
- Chemotherapy
HPV vaccines(Gardasil®,Cerv
arix®)
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Treatment
Stage 0 (CIS) : cryosurgery, laser ablation Stage IA :
◦ Stage IA1 (w.o LVSI) : cervical conization, simple
hysterectomy, intracavitary brachytherapy
◦
Stage IA1 (w. LVSI) – IA2: modified radicalhysterectomy and pelvic lymphadenectomy,
intracavitary brachytherapy
◦ Stage IB – IIA : radical hysterectomy with pelvic
lymphadenectomy.
◦ Stage IIB – IVA : external beam radiation and
brachytherapy, and chemoradiation with cisplatin
◦ Stage IVB : palliative care pelvic radiation and
systemic chemotherapy
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Prognosis
Cervical cancer survival rates accordingto stage
*DATA FROM http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-survival
Stage 5-year survival rate
0 93%
IA 93%
IB 80%
IIA 63%
IIB 58%
IIIA 35%
IIIB 32%
IVA 16%
IVB 15%
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Follow Up- Following radiotherapy :
- Pelvic examination : tumor expected to regress up to
3 mo. after therapy. If disease progresses locally
pelvic exenteration
- Examine lymph nodes at neck, supraclavicular,
infraclavicular, axillary and inguinal.- Pap smear every 3 mo. for 2 years, then every 6 mo.
for 3 years.
- Following surgery :
- After radical hysterectomy, 80% of recurrence aredetected within 2 years.
- In first 2 years, patient should do check up every 3
months. In third to fifth year, check up every 6
months, and then every a year.
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THANK
YOU