AYMAN SHEHATALecturer Ob/Gyn

2015

What do you know about cervical cancer?

Incidence

• 4-6 % of female genital cancers.• Age 40-60 and may be young 30s

Important points about cervical cancer

• It is rising in young women.• There are 450,000 cases of cervical cancer/year.• There are 300,000 death/year.• It is the fourth most common cancer (breast, lung, and

stomach).• It is a preventable disease (screening programme-cervical

smear).• The surgical treatment is mainly for early stage.

Precancerous lesions

• cervical dysplasia• cervical intraepithelial neoplasia (CIN)• squamous intraepithelial lesion (SIL)• atypical glandular cells• Polyps• Warts• Cysts

Grades of CIN

CIN is graded according the proportion of epithelium occupied by the abnormal cells.

• CIN 1 (mild dysplasia):

- One-third or less is occupied by the abnormal cells.

- Progress to (CIS) in 6%.

- Regressed or disappeared in 62%,

Grades of CIN

• CIN 2(modrate dysplasia):- Between 1/3-2/3 of the epithelium is occupied by the abnormal

cells. - Become invasive in 13%.• CIN 3 (severe dysplasia):- The whole thickness of the squamous epithelium is occupied

by the abnormal cells.- It is regarded as carcinoma-in-situ (CIS).- It could arise as CIN 3 or progress from CIN 1or CIN 2.- Become invasive in 29%.

HPV

DIAGNOSIS

1- History.• Many women are a symptomatic .• Presented with abnormal routine cx smear• Complain of abnormal vaginal bleeding• I M bleeding• post coital bleeding• perimenopausal bleeding• postmenopausal bleeding• blood stain vaginal discharge

Diagnosis

2- Examination:• Mainly vaginal examination using cuscu’s

speculem nothing is found in early stage .• Mass ,ulcerating fungating in the cervix• P/V P/R is very helful.

Cytology Histology

calposcopy

INVESTIGATIONS

Mild Dysplasia Severe Dysplasia

Sq. cell Crs.

•LEEP

Acetic acid test

A. Colposcopic image of a CIN III lesion with dense acetowhite changes, coarse mosaic (long arrow), and punctuation (short arrow).

B. Colposcopic image of a CIN III lesion with dense acetowhite changes and sharp margins.

A B

Schiller iodine test

Biopsy types

Pathology (Gross )

• Exophytic: is like cauliflower filling up the vaginal vualt.

• Endophytic: it appears as hard mass with a good deal of induration.

• Ulcerative: an ulcer in the cervix.

SPREAD:Direct Lymphatic Dissemination

(late) - Uteruq. - Vagina.- Parametrium. - Bladder and rectum.

A- primary node: parametrial.Paracervical.Vesicovaginal.Rectovaginal.Hypogastric.Obturator and external iliac

B-Secondary nodes:Common iliacSacralVaginalParaaorticInguinal.

- parametrial spread causes obstruction of the ureters, many deaths occur due to uraemia.- Obstruction to the cervical canal results in pyometria.