cervical neoplasia

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Cervical Intraepithelial Neoplasia ,carcinoma of
cervix

• Vikas
• Roll. No. 47

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Cervical Intraepithelial Neoplasia ,carcinoma of
cervix

• Most common genital cancer
• Prevalence rate-2.3million annually (world)
• 13 to 24 lakhs per year in India
• Mortality due to Ca cervix is an indicator of
  health inequities
• India _ has the highest age standardized
  incidence of cervical cancer in South Asia

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Risk factors and Aetiology

• Early age , Multiple sexual partners
• Multiparity
• Poor (ses), hygiene
• HPV infection (16 ,18 ,31 ,33 )
• Women with STD ,HSV2 , HIV ,condylomata
• Alcohol Smoking
• Immunosuppressed ,age gt30yr.
• 8 yrs. Use of progestogens-adenocarcinoma-dyspla
  sia

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Pre-invasive cervical cancer STAGE 0 CIN
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Incidence of dysplasia appears to be10 yr.
earlier than carcinoma
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Diagnosis based on
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ThinPrep Pap Smear showing abnormal squamous
cells with HPV cytopathic effect (arrow),
consistent with LSIL.
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Koilocytes (arrows) in a cervical smear
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DIAGNOSIS...

• PAP as routine start at 21 yr. age
• treat if any inflammatory pathology
• 15 to 30 false negative- 3yr. -3 negative pap
• After age 50 incidence of CIN drops to 1
• Dry vagina ,poor shedding Oestrogen cream for
  10 days
• First Endocervical swab then ectocervical smear
• HPV testing alongwith pap
• Liquid based cytology-plastic spatula in methanol
  sol.-make thin monolayer
• Women with HSIL - must go for colposcopy biopsy
  of lesion
• Visual acetowhite area inspection
• Schillers test - lugols iodine

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colposcopy

• Locates the abnormal lesion
• Extent
• Biopsy
• Conservative surgery
• Follow-up

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Cone biopsy diagnostictherapeutic

• When squamocolumnar junction indrawn or not
  visible
• Wide cone excision of lesion and endocervical
  lining
• With cold-knife tech or LLETZ or NETZ or laser
  excision (less compl.)

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• AgNOR molecular marker (nucleolar organizer
  regions)
• DNA increase in number but get shrinked

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Treatment

• Mild (CIN I)-treat infection,follow-up every 3-6
  months
• CIN II and CIN III local destructive methods
• Cryosurgery( best tolerated) but discharge
• Electrocoagulation(700),8to 10 mm. deep
• Ablation 5mm deep tissue
• Excision LLETZ ,NETZ ,LEEP
• THERAPEUTIC CONIZATION
• Hysterectomy and vaginal cuff removal
• Prophylaxis via Gardasil

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Invasive cancer of Cervix

• Incidence is 20 to 35 per lakh women of age 35-65
• CC- of growth, ulcers, bleeding, leucorrhoeal
  discharge (blood stained)
• Irregular menses, postciotal bleeding
• Cervix growth bleed on touch
• Positive pap smear, schillers
• D/D-tubercular,syphilitic ulcer, sarcoma of cervix

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Diagnosis

• Histologically -1.welldifferentiated
• 2.ill differentiated
• Biopsy settels the diagnosis
• C-xray, ct , MRI ,
• FDG-PET gold standard
• Nodal involvement
• Hypercalcaemia

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Investigations

• Haemogram
• Urinalysis
• Fasting and pp blood glu.
• LFT
• KFT
• CYSTOSCOPY
• PROCTOSCOPY
• CHEST X-RAY
• SERUM electrolytes
• PET
• FDG-PET

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• CONE BIOPSY not during preg.
• Bleeding during pregnancy, women allowed a
  vaginal delivery if no invasive lesion
• Pergnancy does not alter biological nature of
  tumor

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Staging- Ca cervix (FIGO )
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treatment

• Stage 1a1- conization is therapeutic
• . Hysterectomy in elderly and parous
• Stage 1a2- vaginal trachelectomy laparoscopic
  lymphadenectomy, fertility conserving(if lesion
  is less than 2.cm.)
• Stage 1b and 2a-Wertheims hysterectomymeigs-obay
  ashi
• -schautas vaginal hysterectomy Mitra
  operation
• -taussigs extraperitoneal lymphadenectomy
• -laparoscopic lymphadenectomy
• Radiotherapy-carboplatin brachytherapy
• Radiotherapy (chemo)surgery 80-90 of cure rate
• Stage 2b- chemoradiation (3 month) surgery
• Stage 3 and 4- chemoradiotherapy improve survival
• Most recurrences related to lesion gt2.0 cm. size
  and with in 2 year
• In young women go for surgery