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treatment and prevention for cervcal cancer

treatment and prevention for cervcal cancer


Cervical carcinoma:

•Cervical carcinoma is the malignant

neoplasm of the cervix. Almost all cases of cervical carcinoma originate in the transformation zone from the ectocervical or endocervical mucosa

The cervix is divided into an ectocervix which is lined by squamous epithelium and endocervix which is lined by columnar epithelium. Almost all cases of cervical carcinoma originate in the transformation zone from the endocervical or ectocervical mucosa



It is now recognized that cervical cancer is a long-term outcome of persistent infection of the lower genital tract by high-risk HPV types,

HPV is thus termed the “necessary” cause of cervical cancer.

HPV types 16 and 18 account for 71% of cases HPV types 31, 33, 45, 52 and 58 accounts for another 19% of cases.

Risk factors

  • Early first intercouse: 2x risk if first intercourse at <14yrs compared to 20yrs.
  • Race: 2x in black as compared to whites.
  • Being HIV positive: 5x increased risk
  • Smoking cigarette.
  • Family history.
  • Parity: para 7 with full term has 4x increase risk compared to para 2 has 2x increase risk.
  • Multiple sexual partner or having sex with someone who has multiple sexual partners.
  • DES Exposure-enlarge transformation zone at the cervix.
  • • COCs-Hormone contained promote proliferation of cell make it vulnerable to mutation.
  • Lower social economic status: limited access to screening.

Clinical features


  • Asymptomatic at early stage.
  • Abnormal vaginal bleeding-post coital, spotting, intermenstrual bleeding.
  • •Serosanguineous or yellowish discharge, at times foul smelling in advanced or necrotic cancer.
  • •Pelvic pain: from locally advanced disease.
  • Extension to pelvic wall may cause sciatic pain or back pain associated with hydronephrosis
  • •Lumboscral back pain due to metastatic involvement of iliac and Para-aortic lymph nodes that extend to lumbosacral nerve roots.
  • Haematuria following bladder invasion by advance stage of disease
  • Pain during sex(dyspareunia)
  • Pain during urination(dysuria).

Clinical features

Physical examination:

  • Small shallow ulcer or crater.
  • •Exophytic cervical mass that bleeds on touch (most commonly)
  • •Bimanual examination: firm indurated barrel shaped cervix

Differential diagnosis

  • Chronic cervicitis
  • Endometrial carcinoma
  • Endometrial hyperplasia
  • Cervical polyps


  • Biopsy: for histology
  • Complete blood cell count: to rule out anemia, infections
  • Urinalysis: Haematuria.
  • HIV Test
  • Renal function test.
  • Liver function tests
  • CXR for possible pulmonary metastasis.
  • Abdominalpelvic Utrasund: metastasis in the liver, lymphnode or hydronephrosis


Pre-referral treatment: Largely supportive

  • •Correct anemia with hematenics + BT
  • •Anaelgesics for pain management
  • •Oxygen if dyspnoeic

Specific treatment: Depends on clinical stage

  • •Surgery
  • •Radiotherapy
  • •Chemotherapy


  • Hemorrhage.
  • Frequent attacks of ureteric pain, due to pyelitis, pyelonephritis and hydronephrosis.
  • Pyometra: specially with endocervical variety.
  • Vesicovaginal fistula.
  • Rectovaginal fistula (rare)

Follow up

35% of Patients with Invasive Cervical Cancer are estimated to have persistent or recurrent disease. Most of these (85%) within 3 years of the initial treatment.

Evaluations include Pelvic Examinations, Careful Palpation of nodal groups, Pap Smears, and Radiologic Imaging.


Primary prevention:

  • Vaccination against HPV:
  • Only works before HPV infection. Targeted to girls and women of 9 to 26yrs of age
  • Avoid risks e.g sex at early age
  • .Condom use

Secondary prevention:

  • •Awareness: linkage between HPV and cervical cancer.
  • •Screening
  • Papanicolaus test(pap smear)
  • Visual inspection-Acetic Acid or Lugols Iodine (Schillers test).
  • Colposcopy

by drdonya