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 II |
Involvement of the upper two thirds of the vagina
|
| Stage III |
|
| Stage IV |
|
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 Question
- 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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