Ppt CA Cervical

8/13/2019 Ppt CA Cervical

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CERVICAL CANCERSupervisor :

dr. Pim Gonta, Sp.OG

Presented by :

Marcella Haryanto 2011-061-146

Pauline Octaviani 2011-061-147

Maria Clarissa W. 2011-061-151Ian Suryadi 2012-061-079

Inez Ayuwibowo 2012-061-083

Department Of Obstetric And Gynecology

Medical Faculty Of Atma Jaya University2013

Topic List



INCIDENCE RISK

Worldwide, ranks 2nd

among all malignancies

for women

In 2002 493,000 new

cases & 274,000 †

Developing countries

83% of reported casesannually.

Economically

advantaged countries

only 3.6 % of newcancers.

The median age at

diagnosis : 40-59 years.

Human papillomavirus

(HPV), serotype 16

which is sexually transmitted.

Early coitarche, multiple

sexual partners, and

increased parity

Intercourse at age <16 y.o Multiparitas

Multiple partners

Cigarette smoking

The greatest risk forcervical cancer is the lack

of regular Pap smear

screening.



Patophysiology



SpreadTumor can advance◦ Locally◦ Exophitic

Ectocervix into vagina◦ Endophitic

Endocervix into stroma

◦ Infiltrative

Ulcerative lesion is common with necrosis May invade surrounding organs

◦ Following lymphatic drainage

◦ Hematogenous



Lymphatic

pattern of

spread



Histologic Classification

Squamous cell

carcinoma

Most common 85 % of all

subtype

Adenocarcinoma Endocervical

Endometrioid

Minimal deviation

Papillary villoglandular

Serous adenocarcinoma

Mixed cervical

carcinoma

Clear cell carcinoma

Adenosquamous carcinoma

Glassy cell carcinoma

Adenoid Cystic, Adenoid basalepithelioma

Neuroendocrine tumor

of cervix

Large cell neuroendocrine,

Small cell carcinoma

Sarcoma cervix Mali nant



Clinical Manifestation

EARLY -> Asymptomatic

COMMON: Bleeding (postcoital, metrorrhagia,

menorrhagia) Vaginal discomfort Malodorous discharge

Leucorrhea

LATE -> Based on metastasis



Diagnosis

Anamnesis

RiskFactor + Manifestation

PhysicalExamination Cervical inspection,

palpation, LymphNodes, Rectal Touche

Px ◦ Biopsy (gold standard)

◦ Colposcopy / Gynescopy

/ Pap Smear/ Endocervixcurretage

◦ Roentgen / CT scan/pielograph metastasis

◦ Tumor Marker (CEA, CA

125, SCC)

PAP SMEAR Test issuggested:

1. Coitarche -> THREE

TIMES a year

2. Screening -> ONCE ayear

3. High Risk -> ONCE a

year



STAGING FIGO (1)



STAGING FIGO (2)



American Joint Committee on

Cancer (AJCC) Conversion

Stage Tumor Node Metastasis 0 Tis N0 M0

IA1 T1a1 N0 M0

IA2 T1a2 N0 M0

IB1 T1b1 N0 M0

IIA T2a N0 M0

IIB T2b N0 M0

IIIA T3a N0 M0

IIIB T1 N1 M0

- T2 N1 M0

- T3a N1 M0

- T3b Any N M0

IVA T4 Any N M0

IVB Any T Any N M1



Treatment Prevention

Depends on the

stage :

- Surgery

- Radiotherapy

- Chemotherapy

HPV vaccines(Gardasil®,Cerv

arix®)



Treatment

Stage 0 (CIS) : cryosurgery, laser ablation Stage IA :

◦ Stage IA1 (w.o LVSI) : cervical conization, simple

hysterectomy, intracavitary brachytherapy

◦

Stage IA1 (w. LVSI) – IA2: modified radicalhysterectomy and pelvic lymphadenectomy,

intracavitary brachytherapy

◦ Stage IB – IIA : radical hysterectomy with pelvic

lymphadenectomy.

◦ Stage IIB – IVA : external beam radiation and

brachytherapy, and chemoradiation with cisplatin

◦ Stage IVB : palliative care pelvic radiation and

systemic chemotherapy



Prognosis

Cervical cancer survival rates accordingto stage

*DATA FROM http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-survival

Stage 5-year survival rate

0 93%

IA 93%

IB 80%

IIA 63%

IIB 58%

IIIA 35%

IIIB 32%

IVA 16%

IVB 15%

http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-survival









Follow Up- Following radiotherapy :

- Pelvic examination : tumor expected to regress up to

3 mo. after therapy. If disease progresses locally

pelvic exenteration

- Examine lymph nodes at neck, supraclavicular,

infraclavicular, axillary and inguinal.- Pap smear every 3 mo. for 2 years, then every 6 mo.

for 3 years.

- Following surgery :

- After radical hysterectomy, 80% of recurrence aredetected within 2 years.

- In first 2 years, patient should do check up every 3

months. In third to fifth year, check up every 6

months, and then every a year.



THANK

YOU

Ppt CA Cervical

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