Carcinoma Of Cervix – At A Glance

Carcinoma cervix is the second most common Gynecological cancer.

Risk Factors Of Carcinoma Cervix

  1. Early age of marriage
  2. Early pregnancy
  3. Frequent child births
  4. Low socio-economic conditions
  5. Multiple sexual partners
  6. Sexual transmitted diseases
  7. Infection by HPV
  8. Husband whose previous wife had died of cervical malignancy
  9. Immunosuppression

Prevention Of Carcinoma Cervix
A. Primary prevention

  1. Prophylactic vaccination
    • a. Cervarix
      • Dose : 0 month, 1 month, 6 months after first dose
    • b. Gardasil
  2. Health education
  3. Raising the age of marriage
  4. Delay child birth
  5. Improvement of female education
  6. Empowerment of women
  7. Maintain personal hygiene
  8. Removal of cervix during hysterectomy as a routine for benign lesion

B. Secondary prevention

  1. It is done by screening procedures

Methods Of Screening CA cervix

  1. VIA : Visual inspection of cervix with acetic acid
  2. PAP smear
  3. Colposcopy
  4. HPV DNA antibody test
  5. Schiller’s test

Complications Of Carcinoma Cervix

  1. Excessive haemorrhage
  2. Frequent attacks of ureteric pain, due to pyelitis and pyelonephritis and hydronephrosis
  3. Renal failure due to ureteric involvement leading to hydroureter and hydronephrosis
  4. Pyometra
  5. Vesicovaginal fistula
  6. Rectovaginal fistula

Cause Of Death In CA Cervix

  1. Uremia
  2. Haemorrhage
  3. Sepsis (Localized pelvic or generalized peritonitis)
  4. Cachexia
  5. Metastasis into distant organs

Differential Diagnosis Of CA Cervix

  1. Cervical tuberculosis
  2. Syphilitic ulcer
  3. Cervical ectopy
  4. Products of conception in incomplete abortion
  5. Fibroid polyp

Management Of Carcinoma Cervix

A. Patient profile

  1. Multiparous women
  2. In pre-menopausal age group
  3. Previous history of postcoital or intermenstrual bleeding

B. Clinical features

  1. Foul smelling brownish watery discharge per-vagina
  2. Irregular per-vaginal bleeding
  3. Post-coital bleeding
  4. Intermenopausal bleeding
  5. Pelvic pain / Backache
    • Due to metastasis
    • Pelvic pain : Involvement of uterosacral ligaments
    • Backache : Neural involvement (Sacral plexus)
  6. Leg edema
    • Due to progressive obstruction of lymphatics and/or iliofemoral veins by the tumor
  7. Bladder symptoms (Frequency & urgency of  micturition, dysuria, hematuria, incontinence)
    • Due to bladder involvement
  8. Rectal involvement (Diarrhea, rectal pain, bleeding per rectum or rectovaginal fistula)
  9. Ureteral obstruction
    • Due to progressive growth of tumor laterally, may cause frequent pyelonephritis

B. On Examination
a. On general examination

  1. Anaemic
  2. Anorexia
  3. Loss of weight
  4. Odema

b. On per-abdominal examination

  1. NAD

c. On per-vaginal examination

  1. Ulcerated / cauliflower like growth
  2. Bleeds on touch

d. On speculum examination

  1. Ulcerated / cauliflower like growth
  2. Bleeds on touch
  3. Cervix is replaced by growth

e. Bimanual examination

  1. Cervix is enlarged, friable & bleeds on touch
  2. Involvement of fornices
  3. Involvement of parametrial tissues

e. On rectal examination

  1. In malignancy : Induration is nodular

C. Investigations

  1. Examination under anaesthesia with cervical biopsy for histopathology (Confirmatory test)
  2. Intravenous pyelography (To detect ureteric involvement)
  3. Cystoscopy (To exclude bladder involvement)
  4. Sigmoidoscopy (To exclude rectal involvement)

D. Treatment
a. General measures

  1. Nutritional support
  2. Correction of anaemia if necessary
  3. Prophylactic antibiotics are given
  4. Analgesics to relieve pain

b. Up to stage IIA

  1. Primary surgery : Wertheim’s hysterectomy
  2. Primary radiotherapy : Brachytherapy / Teletherapy

c. Beyond stage IIA

  1. Concomitant radiochemotherapy (Radiotherapy is done along with Chemotherapy)

E. Follow up

  • 3 months interval for 1 year
  • 6 months interval for next 1 year
  • Then yearly afterwards
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