Transcript Carcinoma of the Cervix

Dr Fulufhelo Tshivhula
Specialist Gynaecologist
Polokwane
62 Burger street
015 291 4310
In RSA cervix cancer is the second
most common cancer killer to our
women, following Breast cancer
Anatomy of the Female Reproductive System
2.Cervix - region connecting the uterus to the vagina;
 It is the leading cause of cancer deaths for South African women.
One in 35 women in South Africa will develop cervical cancer.
Although it is a preventable disease that is curable if detected in its
early stages, more than 3 400 South African women die every year
from cervical cancer
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Women
Women who begin having sexual intercourse
before age 18
Many sexual partners increased risk for
cervical cancer.
Smoking
Immunodeficiency ( HIV/AIDS)
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Sexually transmitted virus, which may trigger
cervical cancer.
Human papilloma virus (HPV),
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Suffering
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Severe Pain
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Dying
Early
cervical cancers usually do not have
symptoms.
When
the cancer grows larger, women may
notice one or more of these symptoms:
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The most common symptom of cancer of the
cervix is abnormal bleeding
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Bleeding that occurs between regular menstrual periods
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Bleeding after sexual intercourse, douching, or a pelvic exam
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Menstrual periods that last longer and are heavier than before
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Bleeding after going through menopause
 Fouls
 Not
smelling discharge
responding to treatments
 Pelvic
 Pain
pain
during sex
 Weight
loss
Regular pelvic exams and Pap testing
can detect precancerous changes in the
cervix
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Lifestyle changes
Postpone sexual activity to older age
Single partner
Use of condom
Stop smoking or never smoke
Vaccine
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Cervarix.
Gardasil
Age
catergory 12-26 years
Aims: Detect and treat of precursors
cell.
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Screening
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Pap Smears
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A pap smear is a quick, painless test used to
detect early cell changes in the neck of the
womb, which may later progress to cancer.
Cancer does not develop suddenly in the cells.
There is a gradual change from normal, through
various levels of abnormality, through precancer and eventually to cancer.
The pap smear detects these along-the-way
changes and indicates how far along that road a
women has traveled.
Treatment can be given at an early stage and so
prevent the later development of true cancer.
RSA
( DOH) programme : free three Pap
smears per lifetime
Commencing at age 30 years with 10 years
interval
Initially
smear should be taken soon after
commenscement of sexual activity.
Then
annually
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Local clinic.
Hospitals
All Gp’s
All gynaecologist
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An instrument is placed into the vagina
(speculum)and cells are scraped off the surface
of the cervix with a wooden spatula.
The cells are put onto a glass slide which is
then sent to the laboratory for examination
under a microscope.
Should abnormal cells be detected, the client
will be referred for treatment .
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Normal (negative)—There are no signs of cancer or pre-cancer.
Atypical squamous cells of undetermined significance (ASC–US)—
Changes in the cervical cells have been found. The changes are
almost always a sign of an HPV infection but may indicate
precancer is present.
Squamous intraepithelial lesion (SIL)—Abnormal changes are seen in
the cells that may be a sign of pre-cancer
LSIL almost always indicates that an HPV infection is present, but
it also may indicate mild precancer changes.
LSIL is very common and usually goes away on its own without
treatment.
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HSIL indicates more serious changes.
Carcinoma in situ (CIS) is a severe form of HSIL. It is
the result most likely to progress to cancer.
Atypical squamous cells, cannot exclude HSIL (ASC–H)—
Changes in the cervical cells have been found. These
changes are not clearly HSIL but could be. Further
testing is needed.
Atypical glandular cells (AGC)—Cell changes are seen
that suggest precancer of the upper part of the cervix
or uterus.
Cancer—Abnormal cells may have spread deeper into
the cervix or to other tissues.
A colposcopy gives a better look at your cervix
and allows to take a sample of tissue (called a
biopsy) in a area view to be more abnormal.
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LSIL
Ascus
HSIL
Cancer
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LLETZ
Cone Biospy
Laser
Cryotherapy
Hysterectomy
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Human papilloma virus (HPV) causes common
warts, the small, white, beige or brown skin
growths that can appear almost anywhere on
the body and on the moist mucous membranes
near the penis and anus
Genital warts
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Podophylline
Trichloroacetic acid
Imiquimod ( Aldar)
Cautarazation
Laser
Cryotherapy
Unaffected
Need
to complete it sooner
Back to yearly pap smear
Diagnosed by Biopsy
Stage
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Early stages (IB1 and IIA less than 4 cm)
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Advanced stage tumors (IIB-IVA) are treated
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Hysterectomy
Radiotherapy
Chemotherapy
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Early stages (I and IIA less than 4 cm) are
treated with radical hysterectomy with
removal of the lymph nodes.
Patients treated with surgery who have high
risk features are given radiation therapy with
or without chemotherapy in order to reduce
the risk of relapse.
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Advanced stage tumors (IIB-IVA) are treated
with radiation therapy and chemotherapy
Palliative care
The prognosis of cervical cancer depends
upon the stage and type of cervical cancer
and the tumor size.
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With treatment, the 5-year relative survival
rate for the earliest stage of invasive cervical
cancer is 92%,
The overall (all stages combined) 5-year
survival rate is about 72%.
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Only 25 to 35% of women with stage III cancer
15% or fewer of those with stage IV cancer are
alive after 5 years.
Cervical
cancer is the leading cause
of deaths for South African women.
One in 35 women in South Africa will
develop cervical cancer.
Lifestyle change
Vaccination
Pap smear
Annually Gynaecology check-up