Cervical carcinoma trends and treatments
Download
1 / 33

Cervical carcinoma – trends and treatments - PowerPoint PPT Presentation


  • 89 Views
  • Uploaded on

Cervical carcinoma – trends and treatments. Miss Kathryn Hillaby MD MRCOG Consultant Gynaecological Oncologist, Colposcopy Lead for Gloucestershire. Cervical Carcinoma – where are we now?. Total cases in England in 2008 = 2,369 Mortality = 753 women in 2008 1 yr relative survival rate = 86%

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Cervical carcinoma – trends and treatments' - tybalt


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Cervical carcinoma trends and treatments

Cervical carcinoma – trends and treatments

Miss Kathryn Hillaby MD MRCOG

Consultant Gynaecological Oncologist, Colposcopy Lead for Gloucestershire


Cervical carcinoma where are we now
Cervical Carcinoma – where are we now?

  • Total cases in England in 2008 = 2,369

  • Mortality = 753 women in 2008

  • 1 yr relative survival rate = 86%

  • 5 yr relative survival rate = 68%


Cervical carcinoma
Cervical carcinoma

Peak incidence 35-39

Incidence rates have halved in UK in last 20 yrs

Linked to HPV and smoking


Cervical carcinoma1
Cervical carcinoma

  • Number of cases highest in those aged 25-49, these women represent over half of all diagnoses

  • Rates peak in women in early 30’s, gradually reduce in 40’s and rise again in women in 70’s and early 80’s

  • Both incidence and mortality worse in deprived areas

  • Cervical cancer is worse in older women – 1 yr survival in those aged 15-39 is 96% compared with 52% in those aged 80 or older



Cervical carcinoma3
Cervical carcinoma

  • Incidence and mortality rates have fallen considerably over past 20 yrs

  • Incidence rates have almost halved (16.2 to 8.3 per 100,000 female population)

  • Mortality rates reduced by 2/3 (from 6.4 to 2.2 per 100,000 female population)

  • Incidence fell sharply following introduction of Cervical screening programme


Cervical carcinoma4
Cervical carcinoma

  • HOWEVER:

  • Reduction in incidence has levelled off in recent years

  • Between 1998 and 2008 incidence in women aged 25-29 increased by 77%


Worldwide
Worldwide

  • Cervical carcinoma 12th most common cancer in women, and 5th most deadly

  • In young women is 2nd most common carcinoma

  • 80% occurs in developing countries

  • Kills 250,000 women per year





Cervical carcinoma6
Cervical carcinoma

  • Colposcopy – apply acetic acid to cervix

  • Biospy or LLETZ -

  • Squamous cell carcinoma (85%)

  • Adenocarcinoma (15%)



Cervical carcinoma staging
Cervical carcinoma staging

Staging is clinical

FIGO staging

Based on EUA, cystoscopy +/- sigmoidoscopy

Does NOT include MRI

In UK investigations include MRI pelvis and CT chest/abdo/pelvis


Cervical carcinoma7
Cervical carcinoma

Investigations – CT and MRI

EUA and cystoscopy


Stage 1 disease
Stage 1 disease

  • Stage 1A

  • Stage 1A1 = <3mm depth of invasion and <7mm wide

  • Stage 1A2 = 3-5mm depth of invasion and <7mm wide

  • Treatment = LLETZ


Stage 1 disease1
Stage 1 disease

  • Stage 1B = any tumour which is visible

  • Stage 1B1 = <4cm

  • Stage 1B2 = >4cm

  • Confined to cervix

  • Treatment = surgical for 1B1

  • Chemo Radiotherapy for 1B2


Stage 2 disease
Stage 2 disease

  • Stage 2 = invades beyond uterus, but not to pelvic sidewall or lower 1/3 of vagina

  • Stage 2A – spread into the top of the vagina

  • 2A1 = <4cm

  • 2A2 = >4cm


Stage 2 disease1
Stage 2 disease

  • Stage 2B – spread into parametrium


Stage 3 disease
Stage 3 disease

  • Tumour extends to pelvic sidewall and/or involves lower 1/3 of vagina and/or causes hydronephrosis

  • Stage 3A – Cancer has spread to lower 1/3 of vagina, but not to pelvic sidewall


Stage 3 disease1
Stage 3 disease

  • Stage 3B disease

  • Spread to pelvic sidewall and / or hydronephrosis


Stage 4
Stage 4

  • Carcinoma has extended beyond true pelvis or has involved mucosa of bladder or rectum

  • Stage 4a – spread of growth to adjacent organ


Stage 4 disease
Stage 4 disease

  • Stage 4B – spread to distant organs


Staging and treatment
Staging and treatment

  • Surgical in women up to stage 1b1

  • Chemotherapy (cisplatin) with radiotherapy in women with disease > stage 1b1


Cervical carcinoma8
Cervical carcinoma

36 cases Stage 1B1 and above per year Gloucestershire, Herefordshire and S Worcestershire

Stage 1b1 or less managed surgically

Stage 1b2 and above managed with chemo-radiotherapy

Survival rates >85% in women <40yrs


How can we tackle this
How can we tackle this?

Reduce incidence by screening

Treatment – of CIN to stop progression to cervical cancer

Early detection of cervical carcinoma

Adequate treatment


Cervical screening programme
Cervical screening programme

Cervical screening programme saves 4500 lives per year in UK

Cervical screening prevents up to 3,900 cases of cervical cancer per year in the UK


Cervical screening programme1
Cervical screening programme

Early detection can prevent 75% cervical cancers

Currently between 77-83% women attend for screening

2007/2008 43% women 25-34yrs did not attend for smears


What happened
What happened?

  • 2008-2009 statistics show that the number of women of all ages having cervical screening has increased to 3.7 million compared with 3.4 million last year, an increase of 10.5 per cent (around 353,000).

  • Those within the 25 to 64 age range have risen to 3.6 million from 3.2 million last year, an 11.9 per cent increase (around 384,000).

  • The majority of this increase is for women aged 25 to 49. It is thought to be due to the publicity surrounding the illness and death of Jade Goody.


Take home messages
Take home messages

  • Cervical screening programme works

  • Prevents 70% cases cervical carcinoma

  • Saves 4500 women per year

  • Only works if women attend for smear

  • HPV vaccine prevents 70% cases cervical cancer

  • Uptake currently disappointing


ad