Cervical cancer PowerPoint Presentation

Slide 1 -

Cervical cancer

Slide 2 -

Introduction Cancer of the cervix is the most common female genital cancer in developing countries every year about 500,000 women , acquire the disease and 75% are from frame developing countries. About 300,000 women also die from the disease annually and of these 75% are from developing countries

Slide 3 -

ppt slide no 3 content not found

Slide 4 -

Finland which has an advanced population based screening program has one of the lowest rates in the world.

Slide 5 -

Incidence 4-6 % of female genital cancers.

Slide 6 -

Age 40-50 years old

Slide 7 -

Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Risk factors and aetiology Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of Coitus at young age: <16 years old increased risk by 50% Number of sexual partners: 6 sexual partners or more increase risk by 14.2 folds. Smoking Smoking for> 12 years increase the risk by 12.7 folds. Male related risk factors: number of the partners previous sexual relationships is relevant . cervical cancer risk increased if partners has penile cancer (circumcision) Previous wife with cervical cancer. Previous CIN Poor uptake of screening program. Long term use of the contraceptive pill increase the risk due to increasing exposure to seminal fluids. Barrier method decrease the risk (condan) Immuno suppresion risk increased with immuno suppressed renal transplant patients and in HIV positive women. HPV (Human papilloma virus ) infection mainly 16,18 the main aetiological is infection with subtypes of HPV (16,18) Low socioecomic class of

Slide 8 -

ppt slide no 8 content not found

Slide 9 -

ppt slide no 9 content not found

Slide 10 -

Type of patient: Multiparous. Low socioeconomic class. Poor hygiene. Prostitutes. Low incidence in Muslims and Jews.

Slide 11 -

Predisposing factors: Cervical dysplasia. (Cervical intraepithelial neoplasia) CIN III / CARCINOMA IN SITU THE LESION PROCEEDS THE INVASION BY 10-12 YEARS

Slide 12 -

ppt slide no 12 content not found

Slide 13 -

ppt slide no 13 content not found

Slide 14 -

ppt slide no 14 content not found

Slide 15 -

ppt slide no 15 content not found

Slide 16 -

ppt slide no 16 content not found

Slide 17 -

Symptoms:

Slide 18 -

Pathology type Squamous cell carcinoma- 90%. Adenocarcinoma- 10%.

Slide 19 -

Types of growth Exophytic: is like cauliflower filling up the vaginal vualt. Endophytic: it appears as hard mass with a good deal of induration. Ulcerative: an ulcer in the cervix.

Slide 20 -

DIAGNOSIS 1- History. Many women are a symptomatic . Presented with abnormal routine cx smear Complain of abnormal vaginal bleeding I M bleeding post coital bleeding perimenopausal bleeding postmenopausal bleeding blood stain vaginal discharge

Slide 21 -

2- Examination: Mainly vaginal examination using cuscu’s speculem nothing is found in early stage . Mass ,ulcerating fungating in the cervix P/V P/R is very helful.

Slide 22 -

Cytology Histology calposcopy

Slide 23 -

ppt slide no 23 content not found

Slide 24 -

Preoperative evaluation Review her history. General examination: Anaemia. Lymphadenopathy-Supraclavicular LN. Renal area. Liver or any palpable mass. Oedema. Laboratory tests: CBC, LFT, RFT, Urine analysis. Tumour markers. Chest X- ray, abdominal X- ray, IVU. CAT, MRI, if necessary. Ultrasound. Lymphography, if necessary.

Slide 25 -

Staging Best to follow FIGO system. Examination under anaesthesia. Bimanual palpation. P/V, P/R. Cervical biopsy, uterine biopsy. Cystoscopy, Proctoscopy, if necessary.

Slide 26 -

ppt slide no 26 content not found

Slide 27 -

STAGES OF CANCER CERVIX Once cancer cervix is found (diagnosed), more tests will be done to find out if the cancer cells have spread to other parts of the body. This testing is called staging. TO PLAN TREATMENT, A DOCTOR NEEDS TO KNOW THE STAGE OF THE DISEASE.

Slide 28 -

ppt slide no 28 content not found

Slide 29 -

ppt slide no 29 content not found

Slide 30 -

ppt slide no 30 content not found

Slide 31 -

ppt slide no 31 content not found

Slide 32 -

ppt slide no 32 content not found

Slide 33 -

SPREAD:

Slide 34 -

DIFFERENTIAL DIAGNOSIS Cervical ectropion. Cervical tuberculosis. Cervical syphilis, Schistosomiasis, and Choriocarcinoma are rare causes.

Slide 35 -

TREATMENT Surgical. Radiotherapy. Radiotherapy & Surgery. Radiotherapy and Chemotherapy followed by Surgery. Palliative treatment.

Slide 36 -

The choice of treatment will depend on Fitness of the patients Age of the patients Stage of disease. Type of lesion Experience and the resources avalible.

Slide 37 -

Surgical procedure The classic surgical procedure is the wertheim’s hystrectomy for stage Ib,IIa, and some cases of IIb in young and fat patient

Slide 38 -

ppt slide no 38 content not found

Slide 39 -

Werthemeim’s hystrectomy Total abdominal hystrectomy including the parametrium. Pelvic lymphadenectomy 3 cm vaginal cuff The original operation conserved the ovaries ,since squamouss cell carcinoma does not spread dirctly to the ovaries. Oophorectomy should be performed in cases of adenocarcinoma as there is 5-10% of ovarian metastosis

Slide 40 -

Surgery offers several advantage It allows presentation of the ovaries (radiotherapy will destroythem). There is better chance of preserving sexual function. (vaginal stonosis occur in up 85% of irradiates. Psychological feeling of removing the disease from the body . More accute staging and prognsis

Slide 41 -

COMPLICATIONS OF SURGERY Haemorrhage: primary or secondary. Injury to the bladder, uerters. Bladder dysfunction. Fistula. Lymphocele. Shortening of the vagina.

Slide 42 -

INDICATIONS OF P/O XRT FOLLOWING WERTHEIM’S HYSTERECTOMY (STAGE I , IIa): Positive pelvic lymph nodes. Tumour close to resection margins and/or parametrial extension.

Slide 43 -

Radiotherapy Stage IIb and III Radical Radiotherapy External irradiation (Teletherapy). Intracavitary radiation (Brachytherapy). In some cases of stage IIa or b radio and chemotherapy to be given then followed by simple hysterectomy -------

Slide 44 -

Palliative therapy For stage IV – individualized therapy. Some suitable for palliative XRT ( usually intracavitary Caesium). Some suitable for extensive surgery. Some suitable for chemotherapy. Good nursing care. Analgesia-must be used in sufficient amount to ----- pain (Codein sulfate, Pethidine, Morphine, Diamorphine). Antiemetic if necessary. IV drip, entral, and parentral feeding. Urinary Catheterization. Other measures for symptom relief.

Slide 45 -

PROGNOSIS Depends on: Age of the patient. Fitness of the patient. Stage of the disease. Type of the tumour. Adequacy of treatment.

Slide 46 -

THE OVERALL 5 YEARS SURVIVAL FOLLOWING THERAPY: Stage I -------80% Stage II-------50-60% Stage III-------30-40% Stage IV-------4%

Slide 47 -

MANAGEMENT OF RECURRENT DISEASE 1. Local recurrence: Radiation – if not used. Pelvic exenturation. 2. Distant disease Chemotherapy.

Slide 48 -

Follow up policy On completion of treatment all patients are given a vaginal dilator to use until vaginal mucosa healed, this prevents vaginal stenosis. Premenopausal patients commenced on HRT: post hysterectomy-Extraderm skin patches 50 meg twice weekly. No hysterectomy- Cycloprogyn 1mg daily. The patient to be seen 1/12 post-treatment. 3 monthly for 2 years. 4 monthly for 3rd year. 6 monthly until 5years. Then yearly all her life. Patients with stage I and II disease treated with radical radiotherapy will be assessed by EUA approximately 3 months after completing treatment.

Slide 49 -

Objective Cancer of the cervix is still quite common, reduction in incidence depends on the quality of the screening program.

Slide 50 -

The aetiology appears to be multifactorial the prime oncogenic agent is probably [HPV-16,18]. Clinical presentation is with inermenstrul,postcoital, postmenospausal bleeding or following abnormal cytology. Tumour spreads locally to involve the uterus bladder , vagina, parametrium, ureters, rectum and bone.

Slide 51 -

Spread also to the internal and external iliac , obdurater and common iliac nodes then to para- aortic nodes. Blood borne metastasis spread to liver, lung and bone occur . Microinvasion squamous tumour carry a good prognosis allowing conservative treatment initially if required.

Slide 52 -

Early invasive squamous cell disease (stage Ib,IIa and in some cases of IIb) may be treated by either a wertheimes hysterectomy or radiotherapy as first line treatment. Advanced stage (IIb, III,IV) treated by radio or chemotherapy.

Slide 53 -

Glandular tumours (adenocarcinomas) are not detectable by screening are associated with skip lesions and require radical surgery.