Cervical CancerCervical Cancer

The Patients JourneyThe Patients Journey

Sarah BurtonSarah Burton

Cancer Care Cymru Cancer Care Cymru

Lead Gynae Oncology Nurse SpecialistLead Gynae Oncology Nurse Specialist

Patient attends Gynae Oncology Patient attends Gynae Oncology

Clinic at Llandough with a Clinic at Llandough with a

confirmed diagnosis of cervical confirmed diagnosis of cervical

cancer.cancer.

Types of Cervical CancerTypes of Cervical Cancer

��SquamousSquamous cell carcinoma (most common)cell carcinoma (most common)

Develops from the flat cells which cover the Develops from the flat cells which cover the

outer surface of the cervix and top of vagina.outer surface of the cervix and top of vagina.

��AdenocarcinomaAdenocarcinoma

From glandular cells which line the cervical From glandular cells which line the cervical

canal (canal (endoendo cervix).cervix).

Less Common TypesLess Common Types

��Adenosquamous CarcinomaAdenosquamous Carcinoma

��Clear Cell CarcinomaClear Cell Carcinoma

��Small Cell CarcinomaSmall Cell Carcinoma

These cancers are more aggressive with a These cancers are more aggressive with a

poorer prognosispoorer prognosis

Further InvestigationsFurther Investigations

��Blood testsBlood tests

��FBCFBC

��RLBRLB

��Cyfra 21Cyfra 21--11

��Chest xChest x--rayray

The above are carried out during the The above are carried out during the

outout--patient appointment.patient appointment.

Surgical StagingSurgical Staging

��EUA (Examination Under Anaesthetic)EUA (Examination Under Anaesthetic)

This is an examination of the vagina, cervix This is an examination of the vagina, cervix

and bladder.and bladder.

��MRI (Magnetic Resonance Imaging) of the MRI (Magnetic Resonance Imaging) of the

abdomen and pelvis.abdomen and pelvis.

Staging and GradingStaging and Grading

��Stage 1 Stage 1 Confined to cervix.Confined to cervix.

��Stage 2Stage 2 Extending to upper vagina Extending to upper vagina and/or parametrium.and/or parametrium.

��Stage 3Stage 3 Spread to lower vagina, pelvic Spread to lower vagina, pelvic lymph nodes, pelvic side wall lymph nodes, pelvic side wall and possible hydronephrosis.and possible hydronephrosis.

��Stage 4Stage 4 Spread to bladder, bowel and Spread to bladder, bowel and distant organs e.g. liver, lungs distant organs e.g. liver, lungs or bone.or bone.

GradingGrading

��Grade 1Grade 1 Well differentiatedWell differentiated

��Grade 2Grade 2 Moderately differentiatedModerately differentiated

��Grade 3Grade 3 Poorly differentiatedPoorly differentiated

TreatmentTreatment��SurgerySurgery Radical hysterectomy or Radical hysterectomy or

trachelectomy (only used in trachelectomy (only used in stage 1 disease).stage 1 disease).

��Chemo/Chemo/ RadiotherapyRadiotherapy

Can be used in all stages of Can be used in all stages of the disease.the disease.

��Radiotherapy OnlyRadiotherapy Only

This is used for frailer patients This is used for frailer patients or those over 70. or those over 70.

SurgerySurgery��Node negative clinical follow up only. Node negative clinical follow up only.

This is currently for 5 years.This is currently for 5 years.

��Node positive needs referral to Velindre for Node positive needs referral to Velindre for

chemo/RT or RT alone.chemo/RT or RT alone.

��Chemo/RT 5 weeks (25 fractions) external Chemo/RT 5 weeks (25 fractions) external

beam +/beam +/-- internal treatment.internal treatment.

��Weekly cisplatin for 5 doses.Weekly cisplatin for 5 doses.

��On completion clinical follow up every 3 On completion clinical follow up every 3

months for 1st year, every 6 months for 2nd months for 1st year, every 6 months for 2nd

year, then yearly to 5 years.year, then yearly to 5 years.

Thank YouThank You