Premalignant & malignant

disease of cervix

Premalignant disease of
cervix
introduction

Epidemiology
& etiology

Pathophysiol
ogy

Cytology:
cervical
smears

HPV vaccines

Colposcopy

Treatment of
CIN

Malignant disease of cervix

Clinical
presentation

Pathophysiol
ogy

Investigation
&
importance
of staging

Treatment

Clinical presentation
Many pateints are asymptomatic as cancer has been
diagnosed as incidental finding after loop biopsy of cervix
for pre-invasive disease
Most cervical cancers are firable, vascular massess on
cervic are likely to produce number of complaints eg postcoital bleeding, intermenstrual bleeding, post-menopausal
bleeding & blood-stained vaginal discharge
- should undergo full history & abdominal pelvic exam
including visualization of cervix
In advanced disease (stages 3-4), patients may experience
number od distressing symptoms including pain (malignant
infiltration of spinal cord), incontinence (d/t vesicovaginal
fistulae), anaemia (chronic vaginal bledding) & renal failure
(ureteric blockage)

Assessment
Initial clinical asent of patients maybe
unrevealing as disease is often locally not
visible, een in advanced disease
Pelvic & speculum usually clinches the diagnosis
as there is often cervical mass which bleeds in
cintact and if advanced disease, hardness &
fixity of tissues
Biopsy of outpatient should be taken
Diagnsois can be missed as some tumours are
endophytic rather than exophytic (less clinically
revealing)

Pathophysiology
70% of cervical cancer are sq cell Ca with
adenoca making up most of remainder
Tumours are locally infiltrative in pelvic
area, but also spread via lymphatics and in
late stages via blood vessels
Tumours can grow through cervix to reach
parametria (anatomical area lateral to
cervix), bladder, vagina & rectum
Metastases: pelvic (iliac & obturator), paraaortic nodes, liver & lungs

Investigation & imprtance of staging

Stage

Description

5-year survival rate

(%)

Carcinoma confined to cervix

- 1a: microscopic invasive cancer. All gross lesions, even
with superficial invasion, are stage 1b cancers. Depth of
measure stromal invasion are <5mm and no wider than
7mm
- 1a1: depth of invasion <3mm and wide <7mm
- 1a2: deth of invasion 3<5 mm and wide <7mm
- 1b: confined to cervix or preclinical lesions greater than
1a
- 1b1: clinical lesions size <4cm
- Ab2: clinical lesions size >4cm

83

Carcinoma extending beyond cervix & involving vagina (not

lower third) &or infiltrating parametrium (not reaching
pelvic sidewall)
- 2a: involving vagina
- 2b: involving parametrium

65

Carcinoma involving lower third of vagina and/or extending

to pelvic sidewall
- 3a: involve lower third of vagina
- 3b: extending to pelvic wall and/or hydropnephrosis or
non-functioning kidney d/t ureteric obstruction caused

36

Investigation
Staging : FIGO staging
Biopsy is crucial to confirm malignancy &
assess the tumour type
MRIof abdomen and pelvis will assess the
local spread of disease in cervix & will detect
enlarged lymph nodes in pelvis area
CXR to exclude lung metases
Rectovaginal exam : size of disease, fixity &
vaginal involvement
Cystoscopy to eliminate bladder involvement