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CARCINOMA CERVIX

RISK FACTORS:

Age of first pregnancy less than 20 years & Multiparity with poor birth spacing.
Early intercourse, poor personal hygiene & Multiple sexual partners
STD: HPV-16 (high risk), 18 (commonly leads to adeno Ca), HPV-6 (Verrucous Ca.), HSV 2, HIV.
99.7% of Ca. cervix is associated with HPV.
Other type of HPV which are associated with cervical Ca: HPV 18, 31, 45, 51, 52 and 53
OCPs & Progestogens usage over 8 years period can cause Adeno carcinoma of the endocervb( (double the risk).
DES exposure in childhood.
Low socio economic status, Smoking, alcohol, drug abuse, immunocompromised

SYMPTOMS:

Arises from: Squamo-columnar junction
Earliest symptom: Post-coital bleeding

As the cancer progresses, symptoms may include:

Unusual vaginal discharge
Vaginal bleeding between periods
Bleeding after menopause
Pyometra
Bleeding or pain during sex
MC site: Ectocervix
Lymph nodes affected: Obturator, hypogastric and external iliac
Time taken for conversion of CIN to invasive Ca: 10 years
MC type: Squamous cell Ca
100% cure rates are seen in: CIS
Uremia: altered sensorium and is having hiccups
MC cause of death: Renal failure
Ca cervix can be prevented by screening

International Federation of Gynecology and Obstetrics Cervical Cancer Staging:

Stage 0	Carcinoma-in-situ
Stage I	Confined to the cervix Stage IA1: Measured stromal invasion( Stage IA2:Measured stromal invasion of >3.0 mm but 70 mm) Stage IB1: Clinically visible lesion Stage IB2: Clinically visible lesion >4.0 cm
Stage II	Involvement of the upper two thirds of the vagina Stage II A: without parametrial involvement (A) II A1:Clinically visible lesion II A2: Clinically visible lesion >4.0 cm Stage II B: with parametrial involvement (B)
Stage III	A. Involvement of the lower third of the vagina B. Involvement of a parametria to the sidewall or obstruction of one or both ureters on imaging
Stage IV	A. Local involvement of the bladder or rectum B. Distant metastases

INVESTIGATION:

Best method for diagnosing: Cervical biopsy

Investigations used for staging of cervical carcinoma according to FIGO are:

Mandatory for staging:

Speculum, vaginal and rectal examination
Abdominal ultrasound
Intravenous urography (pyelography).
Colposcopic study of the vagina and vaginal formices

Supplementary for staging:

Cystoscopy
Proctoscopy
Cone biopsy
Endocervical curettage or smear
Chest X ray
Exfoliative cytology
Skeletal X ray or bone scan
Cystoscopic examination of bladder and urethra
Proctosigmoidoscopic study
Barium enema
Elevated CA-125
Electrocardiographic studies
Pulmonary function studies

Exam Important

Intravenous pyelography, Cystoscopy & Proctoscopy investigations are used in FIGO staging of carcinoma cervix
A case of carcinoma cervix is found in altered sensorium and is having hiccups, likely cause is uremia
CA cervix is Common at squamocolumnar junction
Post coital bleeding is a common symptom of CA cervix
HPV 16 and 18 are associated with high risk of carcinogenesis
In Carcinoma of cervix lymphatics drain to Hypogastric , External iliac & Obturator lymph nodes
Adenocarcinoma cervix is associated with HPV 16, 18 & 51
Post coital bleeding would be the earliest symptom of Ca cervix
Carcinoma cervix involving upper 2/3 of vagina without parametrial involvement are classed as IIA
Carcinoma cervix is the Commonest cause of pyometra
Ca cervix can be prevented by screening
Complication, which results in mortality, in carcinoma cervix is Renal failure
Carcinoma cervix involving upper 2/3rd of vagina. The stage would be Stage II a
Risk factor of CA cervix Smoking

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CARCINOMA CERVIX