Cancer of the Cervix Max Brinsmead MB BS PhD March 2014
Ca Cx – Symptoms Watery PV discharge Becomes bloody Intermenstrual bleeding (postcoital) Pain =Parametrial tissue involvement Bowel or Bladder symptoms = a late sign Fistula Urine or feculent material Peak incidence 45 – 55 years of age
Ca Cx - Staging Microinvasive =through basement membrane but <5mm Stage 1 = confined to cervix Stage 2 = parametrial involvement Stage 3 = to the side wall of the pelvis Stage 4 = Bladder, bowel or distant metastases
Ca Cx – Preparation for Rx Team approach Gynae oncologist Radiotherapist Oncology Nurse Social worker/Counsellor Assess fitness for surgery Evaluate extent of disease Will require EUA Surgery or Radiotherapy?
Ca Cx – Treatment Options Radiotherapy Older patient Unfit for surgery Advanced disease Affects Bladder & Bowel Causes vaginal stenosis And premature menopause through damage to ovaries Surgery Age <45 years Can leave ovaries Ureters are vulnerable Bleeding & Abscess common Adjuvant XRT possible Pelvic exenteration for recurrence sometimes
Ca Cx - Prognosis Microinvasive % “cured” Stage 1B85 -90% Stage % Stage 330 – 40% Stage 410 – 20% Adenocarcinoma worse And now >10% of Ca Cx are AdenoCa Results from surgery slightly better
Ca Cx – Follow Up Pap smears Examine Watch for distant metastases The main dilemma is what to do when recurrence is detected Chemotherapy with Cysplatin is adjuvant ?role in palliation Monoclonal anti-VEGF is promising
Ca Cx – In Pregnancy The dilemma is the fetus Ignore in the 1 st trimester Proceed with surgery or XRT Wait for fetal viability after 24 w Realistically >30w Caesarean delivery better
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