Download Invasive cervical cancer

Invasive cervical cancer
Background
• Most common cancer of women in Africa,
most common gynaecologic cancer, most
common cancer of black and coloured
women in SA
• Probably always preventable: follows on
SIL lesions and share epidemiology
• Half of patients present in late stages
• 80% squamous Ca, 20% adenocarcinoma
Clinical
• Ages: 45-60 (range 20-100!!)
• Symptoms: none / + smear / BLEEDING /
discharge. Pain is a LATE complaint
• Signs: normal to cachectic. Paraneoplastic
syndromes common: excessive anaemia,
fever, cachexia
• On cervix: ulcer / exophytic / endophytic
growth
Spread
• 1 Direct: vagina, uterus then parametria
then adjacent organs: bladder, rectum,
vulva
• 2 Lymphatic: pelvic nodes then para-aortic
• 3 Hematogenous: late and rare: bone,
lungs, liver
Staging
• Necessary to diagnose extent of cancer, to
decide on appropriate therapy, to suggest
prognosis
• Staging is clinical but utilises special tests:
– FBC, U&E, LFT, urine MCS
– X ray chest
– Ultrasound of bladder, ureters, upper
abdomen and kidneys
– Can do CT, MRI, Cystoscopy if needed
Staging system
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IA: invisible, diagnosed on cone or LLETZ
IB: Visible: <4cm = IBi, >4cm = IBii
IIA: Cx + upper 2/3 of vagina
IIB: Cx + parametria not to pelvic sidewall
IIIA: Cx + entire vagina (lower 1/3)
IIIB: Cx + parametria to pelvic sidewall
IVA: pelvic organs: bladder, rectum
IVB: distant organs
Treatment options
• Stage IA: LLETZ or cone is sufficient
• Stage IB: RHND: radical hysterectomy and
pelvic node dissection
• Stage II, III: Radical radiotherapy to pelvis
with added chemotherapy
• Stage IV: chemotherapy plus pelvic
irradiation
Outcomes
• Success of treatment is determined by
stage, size, type, nodal status and general
condition of patient including HIV status
• Prognosis: 5year survival rates:
– IA: =/- 100%
– IB: - nodes: 85-90%; + nodes: 60-70%
– II: 50-60%
– III: 35-40%
– IV: <10%
Control of disease
• Screening for precursors and treatment of
HSIL
• Early detection of invasive CaCx
• Correct treatment per stage
• Education education education
Palliative care
• Reasons for death: uraemia, bleeding,
infection, general cachexia, HIV,
metastases
• When we cannot cure we still care
• Cannot re-operate radically in most cases,
cannot re-irradiate radically, can
sometimes offer chemotherapy
• Can relieve pain, look after normal needs,
help, talk: at home, hospital, hospice