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AYMAN SHEHATALecturer Ob/Gyn
2015
What do you know about cervical cancer?
Incidence
• 4-6 % of female genital cancers.• Age 40-60 and may be young 30s
Important points about cervical cancer
• It is rising in young women.• There are 450,000 cases of cervical cancer/year.• There are 300,000 death/year.• It is the fourth most common cancer (breast, lung, and
stomach).• It is a preventable disease (screening programme-cervical
smear).• The surgical treatment is mainly for early stage.
Precancerous lesions
• cervical dysplasia• cervical intraepithelial neoplasia (CIN)• squamous intraepithelial lesion (SIL)• atypical glandular cells• Polyps• Warts• Cysts
Grades of CIN
CIN is graded according the proportion of epithelium occupied by the abnormal cells.
• CIN 1 (mild dysplasia):
- One-third or less is occupied by the abnormal cells.
- Progress to (CIS) in 6%.
- Regressed or disappeared in 62%,
Grades of CIN
• CIN 2(modrate dysplasia):- Between 1/3-2/3 of the epithelium is occupied by the abnormal
cells. - Become invasive in 13%.• CIN 3 (severe dysplasia):- The whole thickness of the squamous epithelium is occupied
by the abnormal cells.- It is regarded as carcinoma-in-situ (CIS).- It could arise as CIN 3 or progress from CIN 1or CIN 2.- Become invasive in 29%.
HPV
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
Diagnosis
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.
Cytology Histology
calposcopy
INVESTIGATIONS
Mild Dysplasia Severe Dysplasia
Sq. cell Crs.
•LEEP
Acetic acid test
A. Colposcopic image of a CIN III lesion with dense acetowhite changes, coarse mosaic (long arrow), and punctuation (short arrow).
B. Colposcopic image of a CIN III lesion with dense acetowhite changes and sharp margins.
A B
Schiller iodine test
Biopsy types
Pathology (Gross )
• 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.
SPREAD:Direct Lymphatic Dissemination
(late) - Uteruq. - Vagina.- Parametrium. - Bladder and rectum.
A- primary node: parametrial.Paracervical.Vesicovaginal.Rectovaginal.Hypogastric.Obturator and external iliac
B-Secondary nodes:Common iliacSacralVaginalParaaorticInguinal.
- parametrial spread causes obstruction of the ureters, many deaths occur due to uraemia.- Obstruction to the cervical canal results in pyometria.