Carcinoma cervix by Dr roman
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Transcript of Carcinoma cervix by Dr roman
CARCINOMA OF
CERVIX
INVASIVE CARCINOMA OF
CERVIX
• Definition
• Epidemiology
Atiology
• Early exposure to sexual intercourse before 20 years of age
• Multiple sexual partners
• A male partner with multiple previous sexual partners
• Smoking
• Persistent infection by high risk papillomavirus HPV (Hr Specially HPV 16, 18)
Pathology
• Irregular vaginal bleeding
• Postcoital bleeding
• Pain (less common)
• Edema (in advanced stage)
Clinical Feature
• Cervical biopsy
• Metastatic work up, once the diagnosis of
invasive carcinoma is made, then we can do
pelvic examination, chest-x-ray, intravenous
pyelogram, cystoscopy and sigmoidoscopy
• Imaging Studies: CT, MRI
Diagnostic Tests
Staging of Cervical Carcinoma • Stage O : CIS• Stage I : Spread limited to cervix• Ia1 : Invasion is < 3 mm deep• Ia2 : Invasion is > Ia1 but < 5 mm deep • Ib : Invasion is > 5 mm deep• Stage IIa : Involves upper 2/3 of vagina• IIb : Invasion of parametrium• Stage III : Carcinoma extending the pelvic sidewall and lower
1/3 of vagina• IIIa : Involves lower 1/3 of vagina• IIIb : Extends to the pelvic sidewalls• Stage IV : Ca spread far away from cervix• IVa : Involves bladder or rectum• IVb : Distant metastasis
Management
Specific by Stage
• Ia1 : Total simple hysterectomy
• Ia2 : Radical hysterectomy. It includes removal of
cervix, upper 3rd of vagina, uterus and
parametrical tissue
• Ib or IIa : Radical hysterectomy or radiation therapy and pelvic node disection
• IIb, III or IV: Radiation therapy and chemotherapy.
Follow Up
• All Patients: patients with invasive cervical cancershould follow up with a pap smear every 3months for 2 years after treatment and thenevery 6 months for the subsequent 3 years.
• Local Reoccurrence: Patient having localreoccurrence should be treated with radiationtherapy.
• Distant Metastasis: In these case patient shouldbe treated with chemotherapy e.g. cisplatinum.
Invasive Carcinoma in Pregnancy
Complication of Surgery
• Anesthetic complication and haemorrhage
• Post operative, chest, wound and urinary tract
infection
• Urological complication include atonic bladder
• Obturator nerve damage may occur
• Thromboembolism
Complication of Radiotherapy
• Premature menopause due to radiationinduced ovarian.
• Urinary complication: haemorrhagic cystitis,urinary frequency, contracted bladder, chronichaematuria, ureteric stricture and fistula.
• Bowel Complication: Chronic diarrhea,proctocolitis, rectal stricture
• Avascular necrosis of femoral head.