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Invasive cervical cancer

Invasive cervical cancer. Background. Most common cancer of women in Africa, most common gynaecologic cancer, most common cancer of black and coloured women in SA Probably always preventable: follows on SIL lesions and share epidemiology Half of patients present in late stages

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Invasive cervical cancer

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  1. Invasive cervical cancer

  2. Background • Most common cancer of women in Africa, most common gynaecologic cancer, most common cancer of black and coloured women in SA • Probably always preventable: follows on SIL lesions and share epidemiology • Half of patients present in late stages • 80% squamous Ca, 20% adenocarcinoma

  3. Clinical • Ages: 45-60 (range 20-100!!) • Symptoms: none / + smear / BLEEDING / discharge. Pain is a LATE complaint • Signs: normal to cachectic. Paraneoplastic syndromes common: excessive anaemia, fever, cachexia • On cervix: ulcer / exophytic / endophytic growth

  4. Spread • 1 Direct: vagina, uterus then parametria then adjacent organs: bladder, rectum, vulva • 2 Lymphatic: pelvic nodes then para-aortic • 3 Hematogenous: late and rare: bone, lungs, liver

  5. Staging • Necessary to diagnose extent of cancer, to decide on appropriate therapy, to suggest prognosis • Staging is clinical but utilises special tests: • FBC, U&E, LFT, urine MCS • X ray chest • Ultrasound of bladder, ureters, upper abdomen and kidneys • Can do CT, MRI, Cystoscopy if needed

  6. Staging system • IA: invisible, diagnosed on cone or LLETZ • IB: Visible: <4cm = IBi, >4cm = IBii • IIA: Cx + upper 2/3 of vagina • IIB: Cx + parametria not to pelvic sidewall • IIIA: Cx + entire vagina (lower 1/3) • IIIB: Cx + parametria to pelvic sidewall • IVA: pelvic organs: bladder, rectum • IVB: distant organs

  7. Treatment options • Stage IA: LLETZ or cone is sufficient • Stage IB: RHND: radical hysterectomy and pelvic node dissection • Stage II, III: Radical radiotherapy to pelvis with added chemotherapy • Stage IV: chemotherapy plus pelvic irradiation

  8. Outcomes • Success of treatment is determined by stage, size, type, nodal status and general condition of patient including HIV status • Prognosis: 5year survival rates: • IA: =/- 100% • IB: - nodes: 85-90%; + nodes: 60-70% • II: 50-60% • III: 35-40% • IV: <10%

  9. Control of disease • Screening for precursors and treatment of HSIL • Early detection of invasive CaCx • Correct treatment per stage • Education education education

  10. Palliative care • Reasons for death: uraemia, bleeding, infection, general cachexia, HIV, metastases • When we cannot cure we still care • Cannot re-operate radically in most cases, cannot re-irradiate radically, can sometimes offer chemotherapy • Can relieve pain, look after normal needs, help, talk: at home, hospital, hospice

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