CERVICAL CANCER
INCIDENCE
AGE
44-55 peak
Rare before 20
GEOGRAPHY
Developing > Developed
PREDISPOSING FACTORS
Early onset sexual activity
Mutiple sexual partners
Immunsuppression
Smoking
May influence epithelial resistance to virus
Oral contraceptives
use of barrier methods
HPV 16, 18, 33
Young at 1st pregnancy
metaplasia most active
Parity
Low social status
HISTOLOGY
Majority squamous cell (75%)
From squamo columnar juction
less common are adeno ca + adenosquamous ca
PATHOLOGY
PRE-INVASIVE --> INVASIVE
20yrs for CIN to reach invasive Ca
10yrs for Microinvasive to reach invasive Ca
Untreated 20-30% CIN3--> invasive Ca
STAGING
Histological
0-CIN3 (Carcinoma in situ)
IA- MIcroinvasive Ca
Clinical
IB invasive,confined to cervix
IIA invasion into upper1/3 vagina
IIB extension to parenchyma,NOTpelvic side walls
IIIA extension to lower 1/3 vagina
IIIB extension to pelvic side walls
IVA tumour involving bladder and rectum
IVB mets
SCREENING
Smear test
Liquid based cytology
Less inadequate samples
Spatula & slides
Sensitivity 85-95%
Recomend Every 3-5 years
women aged 25-64
60% dx ca have NOT been screened
PROGNOSIS 5yr
Stage I 80%
Stage II 60%
Stage III 30%
Stage IV 10%
TREATMENT
SURGICAL
Radical hsyerectomy
Local ablative Tx if stage 0
Cone excision IA
RADIOTHERAPY
Cervical Ca radiosensitive
CHEMOTHERAPY
Not 1st choice
CLINICAL FEATURES
80=90% Postcoital/intermenstrual bleeding
Blood stained dicsharge
ADVANCED DISEASE
Heavy bleeding
Offensive discharge
Pain
Urinary/faecal incontinence
leg swelling
Uraemia
ureteric obstruction/fistukae formation
Ulcer
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