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CANCER OF THE CERVIX


Very common malignancy but the incidence is decreasing
  • Papanicolaou (Pap) smear is a main reason why there is a decreasing incidence
  • Histology is usually of squamous type
  • Associated with the following risk factors:
    1. multiple sexual partners
    2. early age at first sexual intercourse
    3. human papillomavirus types 16, 18 , 31 and 33: most women with human papillomavirus infection, however, do not develop cancer
    4. sex with high risk males: husband with cancer of the penis
    5. deficiency of vitamins A and C
    6. oral contraceptives
    7. immune deficiency syndromes
    8. oral contraceptives
    9. pelvic irradiation
    10. smoking


SYMPTOMS AND SIGNS
  • vaginal bleeding
  • painful intercourse
  • bleeding after intercourse
  • postmenopausal bleeding
  • foul smelling vaginal discharge
  • weight loss
  • bone pain
  • obstruction of the ureters
  • lymph node enlargement

LABORATORY INVESTIGATIONS

  • full history and physical examination
  • bimanual pelvic examination
  • full blood count and electrolytes
  • speculum examination
  • colposcopy: suspicious areas must be biopsied
  • endocervical curettage
  • excisional biopsy ( cone biopsy)
  • chest x-ray
  • CAT scan of the pelvis
  • Intravenous pyelogram
  • Proctoscopy: allows direct inspection of the rectum
  • Cystoscopy:

Treatment

- CIN ( cervical intraepithelial neoplasia ) and CIS ( carcinoma in situ):
    any of the following procedures may be performed

  • electrocoagulation diathermy
  • cryosurgery
  • carbon dioxide laser treatment
  • loop electrodiathermy excision procedure
  • cone biopsy
  • all stage I lesions are confined to the cervix but the subtypes have varying degrees of involvement measured in millimeters

Stage I CKC or total abdominal hysterectomy
Stages Ia2, Ib and IIa Radiation or radical hysterectomy
IIb advanced disease Radiation

- radiation therapy and radical hysterectomy have comparable 5 year survival and     complications
- chemotherapy may be used in the following situations:
    a) palliation of advanced disease
    b) as a radiosensitizer e.g hydroxyurea
    c) combined chemotherapy (5FU plus cisplatin) and radiation therapy prolong         survival in patients who have locally advanced disease
- in patients with recurrent disease, symptoms attributable to the organ system     involved
- pelvic exenteration is done in patients with central pelvic recurrence and this involves     the removal of the bladder, rectum, vagina, uterus and cervix with reconstruction
- Chemotherapy may also be used for palliation