1. Cancer of the Cervix Max Brinsmead MB BS PhD March 2014

2. 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

3. 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

4. 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?

5. 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

6. Ca Cx - Prognosis  Microinvasive 95- 100% “cured”  Stage 1B85 -90%  Stage 270 -75%  Stage 330 – 40%  Stage 410 – 20%  Adenocarcinoma worse  And now >10% of Ca Cx are AdenoCa  Results from surgery slightly better

7. 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

8. 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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