Transcript Cervical carcinoma – trends and treatments

Miss Kathryn Hillaby MD MRCOG
Consultant Gynaecological Oncologist, Colposcopy
Lead for Gloucestershire
Cervical Carcinoma – where are we
now?
 Total cases in England in 2008 = 2,369
 Mortality = 753 women in 2008
 1 yr relative survival rate = 86%
 5 yr relative survival rate = 68%
Cervical carcinoma
 Peak incidence 35-39
 Incidence rates have
halved in UK in last 20
yrs
 Linked to HPV and
smoking
Cervical carcinoma
 Number 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
Cervical Carcinoma
Number of deaths and age-specific mortality rates, cervical
cancer, UK, 2008
140
14
100
10
Age at death
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
0
45-49
0
40-44
2
35-39
20
30-34
4
25-29
40
20-24
6
15-19
60
10-14
8
5-9
80
Rate per 100,000
12
Female deaths
Female rates
0-4
Number of deaths
120
Cervical carcinoma
 Incidence and mortality rates have fallen considerably
over past 20 yrs
 Incidence 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
Cervical carcinoma
 HOWEVER:
 Reduction in incidence has levelled off in recent years
 Between 1998 and 2008 incidence in women aged 25-
29 increased by 77%
Worldwide
 Cervical carcinoma 12th most common cancer in
women, and 5th most deadly
 In young women is 2nd most common carcinoma
 80% occurs in developing countries
 Kills 250,000 women per year
Map of incidence by Cancer Network, 2004-2008
Map of mortality by Cancer Network, 2004-2008
Cervical carcinoma
Cervical carcinoma
 Colposcopy – apply acetic acid to cervix
 Biospy or LLETZ  Squamous cell carcinoma (85%)
 Adenocarcinoma (15%)
Colposcopy
Cervical carcinoma staging
 Staging is clinical
 FIGO staging
 Based on EUA, cystoscopy +/- sigmoidoscopy
 Does NOT include MRI
 In UK investigations include MRI pelvis and CT
chest/abdo/pelvis
Cervical carcinoma
 Investigations – CT and
MRI
 EUA and cystoscopy
Stage 1 disease
 Stage 1A
 Stage 1A1 = <3mm depth
of invasion and <7mm
wide
 Stage 1A2 = 3-5mm
depth of invasion and
<7mm wide
 Treatment = LLETZ
Stage 1 disease
 Stage 1B = any tumour
which is visible
 Stage 1B1 = <4cm
 Stage 1B2 = >4cm
 Confined to cervix
 Treatment = surgical for
1B1
 Chemo Radiotherapy for
1B2
Stage 2 disease
 Stage 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 = <4cm
 2A2 = >4cm
Stage 2 disease
 Stage 2B – spread into
parametrium
Stage 3 disease
 Tumour 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
Stage 3 disease
 Stage 3B disease
 Spread to pelvic sidewall
and / or hydronephrosis
Stage 4
 Carcinoma has extended
beyond true pelvis or has
involved mucosa of
bladder or rectum
 Stage 4a – spread of
growth to adjacent organ
Stage 4 disease
 Stage 4B – spread to
distant organs
Staging and treatment
 Surgical in women up to stage 1b1
 Chemotherapy (cisplatin) with radiotherapy in women
with disease > stage 1b1
Cervical carcinoma
 36 cases Stage 1B1 and above per year Gloucestershire,
Herefordshire and S Worcestershire
 Stage 1b1 or less managed surgically
 Stage 1b2 and above managed with chemoradiotherapy
 Survival rates >85% in women <40yrs
How can we tackle this?
 Reduce incidence by screening
 Treatment – of CIN to stop progression to cervical
cancer
 Early detection of cervical carcinoma
 Adequate treatment
Cervical screening programme
 Cervical screening programme saves 4500 lives per
year in UK
 Cervical screening prevents up to 3,900 cases of
cervical cancer per year in the UK
Cervical screening programme
 Early detection can prevent 75% cervical cancers
 Currently between 77-83% women attend for
screening
 2007/2008 43% women 25-34yrs did not attend for
smears
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.
Take home messages
 Cervical screening programme works
 Prevents 70% cases cervical carcinoma
 Saves 4500 women per year
 Only works if women attend for smear
 HPV vaccine prevents 70% cases cervical cancer
 Uptake currently disappointing