2. Carcinoma of the Cervix
Dr Fulufhelo Tshivhula
Specialist Gynaecologist
Polokwane
62 Burger street

3. Introduction
In RSA cervix cancer is the second most common cancer killer to our women, following Breast cancer

4. The cervix is the lower, narrow part of the uterus (womb)
The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in a woman's lower abdomen, between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

5. Cervix - region connecting the uterus to the vagina;
Anatomy of the Female Reproductive System
Cervix - region connecting the uterus to the vagina;

6. Statistic
It is the leading cause of cancer deaths for South African women.
One in 35 women in South Africa will develop cervical cancer.
Although it is a preventable disease that is curable if detected in its early stages, more than South African women die every year from cervical cancer

7. Who is at Risk
Women
Women who begin having sexual intercourse before age 18
Many sexual partners increased risk for cervical cancer.
Smoking
Immunodeficiency ( HIV/AIDS)

8. Sexual History
Sexually transmitted virus, which may trigger cervical cancer.
Human papilloma virus (HPV),

9. HPV

12. Symptoms
Suffering
Severe Pain
Dying

13. Symptoms Early cervical cancers usually do not have symptoms.
When the cancer grows larger, women may notice one or more of these symptoms:

14. Symptoms
The most common symptom of cancer of the cervix is abnormal bleeding

15. Abnormal vaginal bleeding
Bleeding that occurs between regular menstrual periods
Bleeding after sexual intercourse, douching, or a pelvic exam
Menstrual periods that last longer and are heavier than before
Bleeding after going through menopause

16. Increased vaginal discharge
Fouls smelling discharge
Not responding to treatments

17. Late stage Symptoms
Pelvic pain
Pain during sex
Weight loss

18. Prevention
Regular pelvic exams and Pap testing can detect precancerous changes in the cervix

19. Primary Prevention Lifestyle changes
Postpone sexual activity to older age
Single partner
Use of condom
Stop smoking or never smoke
Vaccine

20. Cervarix. Gardasil Age catergory 12-26 years
Two vaccines
Cervarix.
Gardasil
Age catergory years

21. Aims: Detect and treat of precursors cell.
Secondary Prevention
Aims: Detect and treat of precursors cell.

22. Secondary Prevention
Screening
Pap Smears

23. What is a pap smear?
A pap smear is a quick, painless test used to detect early cell changes in the neck of the womb, which may later progress to cancer.
Cancer does not develop suddenly in the cells. There is a gradual change from normal, through various levels of abnormality, through pre-cancer and eventually to cancer.
The pap smear detects these along-the-way changes and indicates how far along that road a women has traveled.
Treatment can be given at an early stage and so prevent the later development of true cancer.

25. How often RSA ( DOH) programme : free three Pap smears per lifetime
Commencing at age 30 years with 10 years interval

26. First world Countries
Initially smear should be taken soon after commenscement of sexual activity.
Then annually

27. Where to go for a pap smear
Local clinic.
Hospitals
All Gp’s
All gynaecologist

28. How is a pap smear done?
An instrument is placed into the vagina (speculum)and cells are scraped off the surface of the cervix with a wooden spatula.
The cells are put onto a glass slide which is then sent to the laboratory for examination under a microscope.
Should abnormal cells be detected, the client will be referred for treatment .

31. Pap Test Results:
Normal (negative)—There are no signs of cancer or pre-cancer.
Atypical squamous cells of undetermined significance (ASC–US)—Changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection but may indicate precancer is present.
Squamous intraepithelial lesion (SIL)—Abnormal changes are seen in the cells that may be a sign of pre-cancer
LSIL almost always indicates that an HPV infection is present, but it also may indicate mild precancer changes.
LSIL is very common and usually goes away on its own without treatment.

32. Pap Test Results Worrying
HSIL indicates more serious changes.
Carcinoma in situ (CIS) is a severe form of HSIL. It is the result most likely to progress to cancer.
Atypical squamous cells, cannot exclude HSIL (ASC–H)—Changes in the cervical cells have been found. These changes are not clearly HSIL but could be. Further testing is needed.
Atypical glandular cells (AGC)—Cell changes are seen that suggest precancer of the upper part of the cervix or uterus.
Cancer—Abnormal cells may have spread deeper into the cervix or to other tissues.

34. What happens if Pap smear is abnormal?

35. Colposcopy
A colposcopy gives a better look at your cervix and allows to take a sample of tissue (called a biopsy) in a area view to be more abnormal.

36. Abnormal cells LSIL Ascus HSIL Cancer LLETZ Cone Biospy Laser
Cryotherapy
Hysterectomy

37. HPV in Man
Human papilloma virus (HPV) causes common warts, the small, white, beige or brown skin growths that can appear almost anywhere on the body and on the moist mucous membranes near the penis and anus
Genital warts

40. Treatment Podophylline Trichloroacetic acid Imiquimod ( Aldar)
Cautarazation
Laser
Cryotherapy

41. Unaffected Need to complete it sooner Back to yearly pap smear
Fertility
Unaffected
Need to complete it sooner
Back to yearly pap smear

42. Diagnosed by Biopsy Stage
Ca- Cervix
Diagnosed by Biopsy
Stage

46. Stage Early stages (IB1 and IIA less than 4 cm)
Advanced stage tumors (IIB-IVA) are treated

47. The cervix is the lower, narrow part of the uterus (womb)
The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in a woman's lower abdomen, between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

49. Treatment
Hysterectomy
Radiotherapy
Chemotherapy

51. Treatment
Early stages (I and IIA less than 4 cm) are treated with radical hysterectomy with removal of the lymph nodes.
Patients treated with surgery who have high risk features are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse.

52. Treatment
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and chemotherapy
Palliative care

53. Prognosis
The prognosis of cervical cancer depends upon the stage and type of cervical cancer and the tumor size.

54. Prognosis
With treatment, the 5-year relative survival rate for the earliest stage of invasive cervical cancer is 92%,
The overall (all stages combined) 5-year survival rate is about 72%.

55. Prognosis Only 25 to 35% of women with stage III cancer
15% or fewer of those with stage IV cancer are alive after 5 years.

56. Conclusion
Cervical cancer is the leading cause of deaths for South African women.
One in 35 women in South Africa will develop cervical cancer.
Lifestyle change
Vaccination
Pap smear
Annually Gynaecology check-up

59. Thanks