CERVICAL CANCER

INTRODUCTION
Cervical cancer is one of the

most common cancers in

women worldwide.
Is the 2nd leadingcauses of

deathin females in Mexico.

Starts as precancerous

condition called cervical

dysplasia or Cervical
intraepithelial neoplasia
(CIN).
Mortality rate: 40%
25- 69 years.

CLASSIC RISK FACTORS FOR

CERVICAL CANCER
Early first age of sexual contact

Multiple sexual partners

Human papillomavirus Infection

(HPV 16,18,31,33,35,45,56)

Smoking (RR 4-13)

Multiple sexually transmitted diseases

Immunocompromised (HIV)

Lower socio-economic class

Long-term use of oral contraceptives
Multiple pregnancies
Family history is not a risk factor

CERVICAL CANCER
Infection with Human

papillomavirus is a cause of
approximately 90% of all cervical
cancers.
Most cervical cancers begin in

the cells in the transformation

zone (Squamocolumnar junction)
The main types of cervical

cancers are squamous cell

carcinoma (80-85%)
Adenocarcinoma (15%)
Melanoma, sarcoma, lymphoma

(2%)

SYMPTOMS
Early stages
Asymptomatic
Vaginal bleeding between periods, after

intercourse, after menopause

Foul smelling, yellowish discharge

Late stages
Back pain
Lethargy
Nausea/vomiting
Most symptoms attributable to renal failure

from ureteral obstruction

CERVICAL CYTOLOGY
(PAP TEST, PAP SMEAR)
Can detect epithelial cell

abnormalities :
Atypical Squamous Cell

Undeterminated Significance

Squamous intraepithelial
lesions

Squamous cell carcinoma.

Pap Smear should be

done ONCE A YEAR, after
they start havingsexual
intercourse.

COLPOSCOPY &

BIOPSIES

Main indication:
Pap test with abnormal cells

+ NOT visible tumour.

If tumour visible Biopsy.

Cervical Biopsies:

Colposcopic biopsy

Endocervical curettage

Cone biopsy

GOLD STANDARD BIOPSY.

SPREAD OR DISSEMINATION
Direct
extension

Hematogen
ous Spread

Lymphatic
embolizatio
n

FIGO STAGING

STAGE-BASED TREATMENT

STAGE 0 TREATMENT
Carcinoma in situ (stage 0) is treated with local ablative

or excisional measures such ascryosurgery, laser

ablation, and loop excision;
Surgical removal is preferred

STAGE 1A1 TREATMENT

The treatment of choice for stage IA1 disease is surgery.
Total hysterectomy, radical hysterectomy, and conization

are accepted procedures

STAGE IA2, IB, OR IIA

Combined external beam radiation with brachytherapy

and radical hysterectomy with bilateral pelvic

lymphadenectomy for patients with stage IB or IIA
disease.
Radical vaginal trachelectomy with pelvic lymph node

dissection is appropriate for fertility preservation in

women with stage IA2 disease and those with stage IB1
disease whose lesions are 2 cm or smaller

STAGE IIB, III, OR IVA

Cisplatin-based chemotherapy with radiation is the

standard of care.

STAGE IVB AND RECURRENT

CANCER
Individualized therapy is used on a palliative basis; radiation

therapy is used alone for control of bleeding and pain;

systemic chemotherapy is used for disseminated disease

IMMUNIZATION
Evidence suggests that HPV vaccines prevent HPV

infection.[
The following 2 HPV vaccines are approved by the FDA:
Gardasil :

Cervarix :

SURVIVAL RATES