CERVICAL CANCER
Feb 2008
• 3rd most common frequent malignancy of lower female genital tract after Endometrial CA
• 2nd most frequent cause of death after Ovarian CA
• Peak incidence - 30's
• most common cause of cancer death in the world where Pap tests are not available
Cervical Intraepithelial Neoplasia
• Premalignant change in the cervical epithelium.
• Cells have altered nuclei that have at least some features of a neoplastic process.
• Squamo-columnar Junction - important landmark where neoplastic change develops in the cervix.
- a premalignant change in the cervical epithelium.
CIN 1 (mild dysplasia)- is of little or no clinical consequense as it is usually a result of a transient human papillomavirus infection only.
- Low-Grade Squamous Intraepithelial Lesion(LGSIL)
CIN 2 ( moderate dysplasia)- if the cellular changes is more extensive and include ½ to 2/3 of the thickness of the epithelium
- High-Grade Squamous Intraepithelial Lesion(HGSIL)
CIN 3 ( severe dysplasia / CIS)- full- thickness cellular changes
- HGSIL
Risk Factors
• HPV infection
• Early intercourse
• Multiple sex partners
• Early marriage
• Early pregnancy
• Prostitution
• Male factors
• STD infection
• Alteration in immune function
• Socioeconomic status, race
• Family history
• Cigarette smoking
• OCP
• Vitamin A and C deficiency
• Radiation
• Intrauterine DES exposure
Signs and Symptoms
• Early stages of cervical CA maybe completely asymptomatic.
• Vaginal bleeding, contact bleeding, vaginal mass, dyspareunia.
• Vaginal discharge
• Loss of appetite, wt loss, pelvic pain, back pain, leg pain, swollen leg, heavy bleeding, leaking of urine or feces, bone fracture.
Diagnosis
• Biopsy - confirmation of the diagnosis
• Colposcopy - aided by acetic acid solution ( to highlight cells on the surface of the cervix
• LEEP - Loop Electrical Excision Procedure
• Conization
Categories
I .Squamous Cell CA (85 - 90%)
large cell
small cell
