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Orals Obgyne Cervical Cancer

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Krista P. Aguinaldo
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44 views1 page

Orals Obgyne Cervical Cancer

Uploaded by

Krista P. Aguinaldo
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Obstetrics and Gynecology  Excision or curative radiation therapy if there is no spread

Cervical Cancer to parametria or beyond


 Cervical cancer is usually a squamous cell carcinoma caused by  Radiation therapy and chemotherapy if there is spread to
HPV infection less often, it is an adenocarcinoma parametria or beyond
 Cervical cancer is the 3rd most common gynecologic cancer and  Chemotherapy for metastatic and recurrent cancer
the 8th most common cancer among women in the US. CIN and squamous cell carcinoma stage IA1
 Mean age at diagnosis is about 50, but the cancer can occur as  Cone biopsy with LEEP, laser, or cold knife is usually
early as age 20. sufficient treatment. Hysterectomy is done for stage IA1 cancer if
 Cervical cancer results from cervical intraepithelial neoplasia there are adverse prognostic factors (nonsquamous histology or
(CIN), which appears to be caused by infection with human lymphatic or vascular invasion).
papillomavirus (HPV) type 16, 18, 31, 33, 35, or 39 Stages IA2 to IIA
 Radical hysterectomy and pelvic lymphadenectomy alone (stages
Risk factors for cervical cancer include: IA2 to IB1) or a radical hysterectomy and pelvic lymphadenectomy
 Younger age at first intercourse with possible combined chemotherapy and pelvic radiation
 A high lifetime number of sex partners (stages IB2 to IIA).
 Intercourse with men whose previous partners had Stages IIB to IVA
cervical cancer  Radiation therapy plus chemotherapy (cisplatin) is more
 Other factors such as cigarette smoking and suitable as primary therapy. Surgical staging should be considered
immunodeficiency also appear to contribute. to determine whether para-aortic lymph nodes are involved and
thus whether extended-field radiation therapy is indicated; a
Pathology retroperitoneal approach is used.
CIN is graded as 1 (mild cervical dysplasia), 2 (moderate dysplasia), Stage IVB and recurrent cancer
or 3 (severe dysplasia and carcinoma in situ).  Chemotherapy is the primary treatment, but only 15 to 25% of
patients respond to it and only briefly. Cisplatin is the most active
Symptoms and Signs drug and the current standard, but adding topotecan appears to
 CIN is usually asymptomatic. Early cervical cancer can be improve overall response and survival. 
asymptomatic. The first symptom is usually irregular vaginal Prevention
bleeding, which is most often postcoital but may occur Pap tests
spontaneously between menses. Routine cervical Pap tests are recommended every 2 yr for women
 Larger cancers are more likely to bleed spontaneously and may aged 21 to 30. The Pap test and HPV test should be done
cause a foul-smelling vaginal discharge or pelvic pain. simultaneously beginning at age 30. If results of both are negative,
 More widespread cancer may cause obstructive uropathy, back the screening interval should be extended to every 3 to 5 yr. Testing
pain, and leg swelling due to venous or lymphatic obstruction; continues until age 65.
pelvic examination may detect an exophytic necrotic tumor in the HPV vaccine
cervix. Preventive vaccines that target HPV subtypes 16, 18, and sometimes
6 and 11 are available. These subtypes are the ones most commonly
Diagnosis associated with cervical intraepithelial lesions, genital warts, and
Papanicolaou (Pap) test cervical cancer. The vaccines aim to prevent cervical cancer but do
Biopsy not treat it. Three doses are given over 6 months.
Clinical staging, usually by biopsy, pelvic examination, and chest x-
ray
Cervical cancer may be diagnosed during a routine gynecologic
examination. It is considered in women with
 Visible cervical lesions
 Abnormal routine Pap test results
 Abnormal vaginal bleeding

Staging
 If the stage is > IB1, CT or MRI of the abdomen and pelvis is
typically done to identify metastases, although results are not Stag
Description
used for staging. e

 PET with CT (PET/CT) is being used more commonly to check for I Carcinoma confined to the uterus (including to the corpus)
IA Carcinoma diagnosed only by microscopy, with invasion of stroma ≤ 5 mm in depth and largest extension ≤ 7 mm in
spread beyond the cervix width)*
Prognosis IA1 Measured invasion of stroma ≤ 3 mm in depth and ≤ 7 mm in width

In squamous cell carcinoma, distant metastases usually occur only IA2 Measured invasion of stroma > 3 mm and ≤ 5 mm in depth and ≤ 7 mm in width

when the cancer is advanced or recurrent. The 5-yr survival rates are IB Clinically visible lesions confined to the cervix or microscopic lesions larger than those in stage IA2
IB1 Clinically visible lesions ≤ 4 cm
as follows:

IB2 Clinically visible lesions > 4 cm
Stage I: 80 to 90% II Extension beyond the cervix but not to the pelvic wall or to the lower third of the vagina
 Stage II: 60 to 75% IIA No obvious parametrial involvement
 Stage III: 30 to 40% IIA1 Clinically visible lesion ≤ 4.0 cm in greatest dimension

 Stage IV: 0 to 15% IIA2 Clinically visible lesion > 4.0 cm in greatest dimension
IIB Parametrial involvement
III Extension to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or a
Treatment nonfunctioning kidney
IIIA Extension to lower third of the vagina but not to the pelvic wall
IIIB Extension to the pelvic wall, hydronephrosis, or a nonfunctioning kidney
IV Extension beyond the true pelvis or clinical involvement of the bladder or rectal mucosa (bullous edema does not
signify stage IV)
IVA Invades mucosa of bladder or rectum and/or extends beyond true pelvis
IVB Spread to distant organs (including peritoneal spread)

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