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Cancer of the Cervix. Max Brinsmead PhD FRANZCOG May 2011. Ca Cx – Symptoms. Watery PV discharge Becomes bloody Intermenstrual bleeding (postcoital) Pain =Parametrial tissue involvement Bowel or Bladder symptoms = a late sign Fistula Urine or feculent material
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Cancer of the Cervix Max Brinsmead PhD FRANZCOG May 2011
Ca Cx – Symptoms • Watery PV discharge • Becomes bloody • Intermenstrual bleeding (postcoital) • Pain • =Parametrial tissue involvement • Bowel or Bladder symptoms • = a late sign • Fistula • Urine or feculent material • Peak incidence 45 – 55 years of age
Ca Cx - Staging • Microinvasive • =through basement membrane but <5mm • Stage 1 • = confined to cervix • Stage 2 • = parametrial involvement • Stage 3 • = to the side wall of the pelvis • Stage 4 • = Bladder, bowel or distant metastases
Ca Cx – Preparation for Rx • Team approach • Gynae oncologist • Radiotherapist • Oncology Nurse • Social worker/Counsellor • Assess fitness for surgery • Evaluate extent of disease • Will require EUA • Surgery or Radiotherapy?
Radiotherapy Older patient Unfit for surgery Advanced disease Affects Bladder & Bowel Causes vaginal stenosis And premature menopause through damage to ovaries Surgery Age <45 years Can leave ovaries Ureters are vulnerable Bleeding & Abscess common Adjuvant XRT possible Pelvic exenteration for recurrence sometimes Ca Cx – Treatment Options
Ca Cx - Prognosis • Microinvasive 95- 100% “cured” • Stage 1B 85 -90% • Stage 2 70 -75% • Stage 3 30 – 40% • Stage 4 10 – 20% • Adenocarcinoma worse • And now >10% of Ca Cx are AdenoCa • Results from surgery slightly better
Ca Cx – Follow Up • Pap smears • Examine • Watch for distant metastases • The main dilemma is what to do when recurrence is detected • Chemotherapy with Cysplatin is adjuvant ?role in palliation
Ca Cx – In Pregnancy • The dilemma is the fetus • Ignore in the 1st trimester • Proceed with surgery or XRT • Wait for fetal viability after 24 w • Realistically >30w • Caesarean delivery better
Ca Cx – Burden of Illness in PNG • Required 203 admissions at PMGH in 2010 • This was 82% of all admissions for gynaecological malignancy • Only 12 patients were deemed suitable for attempted therapy by Wertheim Hysterectomy