Miss Kathryn Hillaby MD MRCOGConsultant Gynaecological Oncologist,

Colposcopy Lead for Gloucestershire

Cervical Carcinoma – where are we now?

Total cases in England in 2008 = 2,369Mortality = 753 women in 20081 yr relative survival rate = 86%5 yr relative survival rate = 68%

Cervical carcinomaPeak incidence 35-

39Incidence rates

have halved in UK in last 20 yrs

Linked to HPV and smoking

Cervical carcinomaNumber 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

Cervical carcinomaIncidence and mortality rates have fallen

considerably over past 20 yrsIncidence 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 carcinomaHOWEVER: Reduction in incidence has levelled off in

recent yearsBetween 1998 and 2008 incidence in women

aged 25-29 increased by 77%

WorldwideCervical carcinoma 12th most common cancer

in women, and 5th most deadlyIn young women is 2nd most common

carcinoma80% occurs in developing countriesKills 250,000 women per year

Map of incidence by Cancer Network, 2004-2008

Map of mortality by Cancer Network, 2004-2008

Cervical carcinoma

Cervical carcinomaColposcopy – apply acetic acid to cervixBiospy or LLETZ - Squamous cell carcinoma (85%)Adenocarcinoma (15%)

Colposcopy

Cervical carcinoma staging

Staging is clinicalFIGO staging Based on EUA, cystoscopy +/- sigmoidoscopyDoes NOT include MRIIn UK investigations include MRI pelvis and

CT chest/abdo/pelvis

Cervical carcinomaInvestigations – CT

and MRIEUA and cystoscopy

Stage 1 diseaseStage 1AStage 1A1 = <3mm

depth of invasion and <7mm wide

Stage 1A2 = 3-5mm depth of invasion and <7mm wide

Treatment = LLETZ

Stage 1 diseaseStage 1B = any

tumour which is visible

Stage 1B1 = <4cmStage 1B2 = >4cmConfined to cervixTreatment =

surgical for 1B1Chemo Radiotherapy

for 1B2

Stage 2 diseaseStage 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 = <4cm2A2 = >4cm

Stage 2 diseaseStage 2B – spread

into parametrium

Stage 3 diseaseTumour 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 diseaseStage 3B diseaseSpread to pelvic

sidewall and / or hydronephrosis

Stage 4Carcinoma has

extended beyond true pelvis or has involved mucosa of bladder or rectum

Stage 4a – spread of growth to adjacent organ

Stage 4 diseaseStage 4B – spread to

distant organs

Staging and treatmentSurgical in women up to stage 1b1Chemotherapy (cisplatin) with radiotherapy

in women with disease > stage 1b1

Cervical carcinoma36 cases Stage 1B1 and above per year

Gloucestershire, Herefordshire and S Worcestershire

Stage 1b1 or less managed surgicallyStage 1b2 and above managed with chemo-

radiotherapySurvival rates >85% in women <40yrs

How can we tackle this?

Reduce incidence by screeningTreatment – of CIN to stop progression to

cervical cancerEarly detection of cervical carcinoma Adequate treatment

Cervical screening programmeCervical screening programme saves 4500

lives per year in UKCervical screening prevents up to 3,900

cases of cervical cancer per year in the UK

Cervical screening programme

Early detection can prevent 75% cervical cancersCurrently between 77-83% women attend for

screening2007/2008 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 messagesCervical screening programme worksPrevents 70% cases cervical carcinomaSaves 4500 women per yearOnly works if women attend for smearHPV vaccine prevents 70% cases cervical

cancerUptake currently disappointing