CERVIX Cancer

What is Cervix Cancer?

Cervix
Cervix is the lower end of thewomb (uterus).
It is at the top of the vagina and about 1 inch
long.

Cancer
is a class of diseases characterized by out-ofcontrol cell growth

Epidemiology

Cervical cancer is the third most common

malignancy in women worldwide.
Is the second most common cause of
cancer-related deaths in women in
developing countries but is not even among
the top 10 causes in developed countries.
Cervical cancer may be diagnosed in any
woman of reproductive age.
Indeed, rates of cervical adenocarcinoma
have been increasing in women under 40
years of age.

Risk Factors

Beginning sexual intercourse at 16 years or younger;

Having a history of multiple sexual partners
Being diagnosed with genital HPV infections,
Chlamydia infections, or other sexually transmitted
disease;
Having sex with an uncircumcised male;
Being diagnosed with a previous precancerous
cervical lesion (cervical dysplasia).
Women who have had many children and
Long-term users of oral contraceptives (5 or more
years)

Sign and Symptoms

EARLY symptoms of
established cervical
cancer are:

Vaginal discharge
this varies greatly in
amount and can be
intermittent or
continuous.
Bleeding
this can be spontaneous
but may occur after sex,
micturition or defecation,
in the early stages.
Vaginal discomfort/urinary
symptoms.

Signs in early-stage
cervical cancer

White or red patches on

the cervix.

Rectal examination

As the disease progresses,

it can lead to an abnormal
appearance of the cervix
and vagina, due to erosion,
ulcer or tumour.
reveal a mass or bleeding
due to erosion.

Bimanual palpation

reveal pelvic
bulkiness/masses due to
pelvic spread.

Investigations

Premenopausal women presenting with abnormal

vaginal bleeding should be tested for Chlamydia
trachomatis

Colposcopy - allows examination of the visible

cervix, usually including the transformation zone:

The cervix is first cleaned with acetic acid.

The cervix can then be inspected, biopsied and

treated if necessary.

Cone biopsy may be undertaken.

Positron emission tomography (PET) is also being

used increasingly for staging.

CT and/or MRI scanning of the pelvis and abdomen

are often used to stage disease, along with relevant
biopsies.

Examination under anaesthesia is often undertaken

with abdominal, vaginal and rectal examination,
with or without colposcopy, hysteroscopy,
cystoscopy and sigmoidoscopy. Biopsies are taken
as necessary.

Staging

Treatment and Management

Stage 0 (carcinoma in
situ)

For squamous cell carcinoma in situ include cryosurgery, laser

surgery, loop electrosurgical excision procedure (LEEP/LEETZ),
and cold knife conization.

For women who wish to have children, treatment with a cone

biopsy may be an option After the woman has finished having
children, a hysterectomy is recommended.

For adenocarcinoma in situ, hysterectomy is usually

recommended.

Treatment and Management

Stage IA-1
Women who want to maintain fertility are often treated first with a cone
biopsy to remove the cancer. If the edges of the cone dont contain cancer
cells (negative margins) watched closely without further treatment as
long as the cancer doesnt come back.
If the edges of the cone biopsy have cancer cells (positive margins)
treated with a repeat cone biopsy or a radical trachelectomy (removed of
the cervix and upper vagina)
Radical trachelectomy id preferred if the cancer shows lymphovascular
invasion.
If the cancer has invaded the blood vessels or lymph vessels
(lymphovascular invasion), you might need a radical hysterectomy along
with removal of the pelvic lymph nodes.

Treatment and Management

Stage IA-2
Women who want to maintain fertility, the main treatment is radical
trachelectomy with removal of pelvic lymph nodes (pelvic lymph node
dissection). Another option is cone biopsy
Women who dont want to maintain fertility have 2 main options:
Radical hysterectomy along with removal of lymph nodes in the pelvis
(pelvic lymph node dissection)
External beam radiation therapy to the pelvis plus Brachytheraphy
If the cancer has spread to the tissues next to the uterus (called the
parametria) or to any lymph nodes, radiation therapy is usually
recommended. Often chemotherapy (Cisplatin) will be given with
radiation therapy.

Treatment and Management

Stage IB1 and IIA1
The standard treatment is a radical hysterectomy with removal of
lymph nodes in the pelvis (pelvic lymphnode dissection).
Radical trachelectomy may be recommended instead of a radical
hysterectomy if the patient still wants to be able to have children.
Another option is to treat with radiation using both brachytherapy and
external beam radiation therapy Chemoteraphy + Radiation.
Stage IB2 and IIA2
The standard treatment is chemo + radiation teraphy The chemo may
be cisplatin or cisplatin plus fluorouracil.
The radiation therapy includes both external beam radiation and
brachytherapy.
Some doctors recommend radiation given with chemotherapy (first option)

Treatment and Management

Stage IIB, III and IVA
Radiation therapy given with chemo (concurrent chemoradiation) is the
recommended treatment. The chemo is either cisplatin or cisplatin plus
fluorouracil (5-FU).
The radiation includes both external beam radiation and brachytherapy.
Stage IVB
At this stage, the cancer has spread out of the pelvis to other areas
of the body. Stage IVB cervical cancer is not usually considered curable.
Treatment options include the radiation therapy to relieve the
symptoms of cancer that has spread to the areas near the cervix or to
distant sites (such as the lungs or bone)
Most standard regimens use a platinum compound (such as cisplatin or
carboplatin) along with another drug such as paclitaxel (Taxol),
gemcitabine (Gemzar), or topotecan. The targeted drugs bevacizumab

Treatment and Management

Outlook

The chances of living for at least five years

after being diagnosed with cervical cancer
are:

stage 1 80-99%

stage 2 60-90%

stage 3 30-50%

stage 4 20%