cervical cancer. cervix lower part of the uterus lower part of the uterus connects the body of the...

Cervical CancerCervical Cancer

CervixCervix Lower part of the Lower part of the

uterusuterus Connects the body of Connects the body of

the uterus to the the uterus to the vagina (birth canal)vagina (birth canal)

Source: American Cancer SocietySource: American Cancer Society

Cervical CancerCervical Cancer

Begins in the lining of the cervixBegins in the lining of the cervix

Cells change from normal to pre-Cells change from normal to pre-cancer (dysplasia) and then to cancer cancer (dysplasia) and then to cancer


Three TypesThree Types

Squamous cell CarcinomasSquamous cell Carcinomas– Cancer of flat epithelial cellCancer of flat epithelial cell– 80% to 90%80% to 90%

Adenocarcinomas Adenocarcinomas – Cancer arising from glandular epitheliumCancer arising from glandular epithelium– 10% - 20%10% - 20%

Mixed carcinomaMixed carcinoma – Features both typesFeatures both typesSource: American Cancer SocietySource: American Cancer Society

StatisticsStatistics 10,52010,520 new cases in the U.S. this year new cases in the U.S. this year 3,9003,900 will die will die 50%50% are diagnosed between ages 35 and 55. are diagnosed between ages 35 and 55. 20%20% at the age of 65 or over. at the age of 65 or over. Rarely occurs in women younger than 20Rarely occurs in women younger than 20 Noninvasive is four times more commonNoninvasive is four times more common 74%74% decrease in deaths between 1955 and decrease in deaths between 1955 and

1992 in the U.S.1992 in the U.S. Death rate continuous to decline by Death rate continuous to decline by 2%2% a year a year


Lifetime Probability of Developing Cancer, byLifetime Probability of Developing Cancer, by Site, Women, US, 1998-2000 Site, Women, US, 1998-2000

Site Risk

All sites 1 in 3Breast 1 in 7Lung & bronchus 1 in 17Colon & rectum 1 in 18Uterine corpus 1 in 38Non-Hodgkin lymphoma 1 in 57Ovary 1 in 59Pancreas 1 in 83 Melanoma 1 in 82Urinary bladder 1 in 91Uterine cervix 1 in 128

Source:DevCan: Probability of Developing or Dying of Cancer Software, Version 5.1 Statistical Research and Applications Branch, NCI, 2003. http://srab.cancer.gov/devcan

Signs and SymptomsSigns and Symptoms Vaginal bleedingVaginal bleeding

Menstrual bleeding is longer and heavier than usualMenstrual bleeding is longer and heavier than usual

Bleeding after menopause or increased vaginal Bleeding after menopause or increased vaginal dischargedischarge

Bleeding following intercourse or pelvic examBleeding following intercourse or pelvic exam

Pain during intercoursePain during intercourse


Risk FactorsRisk Factors Human papillomavirus infection (HPV) – Primary factorHuman papillomavirus infection (HPV) – Primary factor

– HPV 16, HPV 18, HPV 31, HPV 33, HPV 45HPV 16, HPV 18, HPV 31, HPV 33, HPV 45– 50% are caused by HPV 16 AND 1850% are caused by HPV 16 AND 18

Sexual behaviorSexual behavior SmokingSmoking HIV infectionHIV infection Chlamydia infectionChlamydia infection DietDiet Oral contraceptivesOral contraceptives Multiple pregnanciesMultiple pregnancies Low socioeconomic statusLow socioeconomic status Diethylstilbestrol (DES)Diethylstilbestrol (DES) Family historyFamily history


PreventionPrevention Avoiding the risk factorsAvoiding the risk factors

– Especially HPVEspecially HPV– Help for low-income women (NBCCEDP)Help for low-income women (NBCCEDP)

Having the Pap TestHaving the Pap Test– 3 years after first vaginal intercourse or by age 3 years after first vaginal intercourse or by age

21.21.– Have test annuallyHave test annually


DiagnosisDiagnosis Cervical Cytology (Pap Test)Cervical Cytology (Pap Test)

– Cells are removed from the cervix and Cells are removed from the cervix and examined under the microscope.examined under the microscope.

– Can detect epithelial cell abnormalitiesCan detect epithelial cell abnormalities Atypical squamous cellsAtypical squamous cells Squamous intraepithelial lesionsSquamous intraepithelial lesions Squamous cell carcinoma (likely to be Squamous cell carcinoma (likely to be

invasive)invasive)


DiagnosisDiagnosis

Additional testingAdditional testing– ColposcopyColposcopy

Cervix is viewed through a colposcope and Cervix is viewed through a colposcope and the surface of the cervix can be seen close the surface of the cervix can be seen close and clear.and clear.

– Cervical BiopsiesCervical Biopsies Colposcopic biopsyColposcopic biopsy – removal of small section – removal of small section

of the abnormal area of the surface.of the abnormal area of the surface. Endocervical curettageEndocervical curettage – removing some – removing some

tissue lining from the endocervical canal.tissue lining from the endocervical canal. Cone biopsyCone biopsy – cone-shaped piece of tissue is – cone-shaped piece of tissue is

removed from the cervixremoved from the cervix

StagingStaging FIGO System FIGO System (International Federation Of Gynecology and Obstetrics)(International Federation Of Gynecology and Obstetrics)

Has five stages – 0 to 4Has five stages – 0 to 4– Stage 0Stage 0 Carcinoma in situ Carcinoma in situ– Stage 1Stage 1 Invaded cervix, but has not spread. Invaded cervix, but has not spread.– Stage 2Stage 2 Has spread to nearby areas, not leaving pelvic Has spread to nearby areas, not leaving pelvic

area.area.– Stage 3Stage 3 Cancer has spread to the lower part of the Cancer has spread to the lower part of the

vagina.vagina.– Stage 4Stage 4 Cancer has spread to nearby organs; Cancer has spread to nearby organs;

metastasis. metastasis.


Survival RateSurvival Rate 5-year survival rate is 92% for earliest stage 5-year survival rate is 92% for earliest stage

71% for all stages combined71% for all stages combined


TreatmentTreatment SurgerySurgery

– Preinvasive cervical cancerPreinvasive cervical cancer CryosurgeryCryosurgery Laser surgeryLaser surgery ConizationConization

– Invasive cervical cancerInvasive cervical cancer Simple hysterectomySimple hysterectomy

– Removal of the body of the uterus and cervix.Removal of the body of the uterus and cervix. Radical hysterectomy and pelvic lymph node dissectionRadical hysterectomy and pelvic lymph node dissection

– Removal of entire uterus, surrounding tissue, upper part of Removal of entire uterus, surrounding tissue, upper part of the vagina, and lymph nodes from the cervix.the vagina, and lymph nodes from the cervix.

RadiationRadiation

ChemotherapyChemotherapy


What’s new in cervical cancer What’s new in cervical cancer research and treatment?research and treatment?

HPV testHPV test

HPV vaccineHPV vaccine

Radical trachelectomy procedureRadical trachelectomy procedure

Other clinical trialsOther clinical trials


Tata Memorial Hospital

Evidence Based Guidelines

Evidence Based TMH Guidelines - Feb 2003

STAGE Ib & IIa

Evidence Based TMH Guidelines - Feb 2003

STAGE Ib & IIa

Type III Hysterectomy

+

Pelvic Lymphadenectomy

Type III Hysterectomy

+

Pelvic Lymphadenectomy

IB1: Radical Radiation Therapy

IB2/IIA: Concomitant CT+RT

IB1: Radical Radiation Therapy

IB2/IIA: Concomitant CT+RT

Low riskLow risk Intermediate riskIntermediate risk High riskHigh risk

ObservationObservation Pelvic RadiationPelvic Radiation Concomitant

chemo radiation

Concomitant

chemo radiation

cervical cancer. cervix lower part of the uterus lower part of the uterus connects the body of the...

Documents

cancer source

american cancer society

cancer cells

cervical cancer slide

cancer software

precancer dysplasia

intercourse source

year source