Carcinoma Cervix | Medical Science Optional Notes for UPSC PDF Download

Carcinoma Cervix-Etiopathogenesis

• Human Papilloma virus infection
• Sexually transmitted infections
• Coitus before 18 years of age
• Multiple sex partners
• Multiparity
• Poor personal hygiene
• Poor socioeconomic status
• Smoking
• Immunosuppressed individuals
• Women on OCP, Progesterone therapy for long time are predisposed to adenocarcinom< of endocervix.
• In utero exposure to DES

"HPV is central to the development of cervical neoplasia.
HPV - DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas.”

There are 13 high-risk HPV subtypes; two of the high-risk subtypes, 16 (Most common) and 18 are found in up to 62% of cervical carcinomas.
HPV - 16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, 68 are associated with Ca Cervix.

Diagnosis

• Pap smear

To reduce false negative reporting with pap smear

• Endocervical scrape cytology
• HPV testing
• Liquid based cytology

If Pap smear facility is not available

• VIA (visual inspection of acetowhite areas)

Other tests

• Colposcopy
• Cone biopsy (both diagnostic and therapeutic)
• CT
• Chest X Ray
• PET CT
• Basic lab tests

Carcinoma Cervix-Staging (FIGO guidelines)

• Stage I:
  • The cancer is confined strictly to the cervix.
  • Substages IA1 and IA2 are based on the depth and extension of invasion.
• Stage II:
  • Cervical carcinoma extends beyond the uterus but does not reach the pelvic wall or lower third of the vagina.
• Stage III:
  • Tumor extends to the pelvic wall and/or involves the lower third of the vagina.
  • It may cause hydronephrosis (kidney swelling) or a nonfunctioning kidney.
• Stage IV:
  • Carcinoma extends beyond the true pelvis.
  • Involvement of the mucosa of the bladder or rectum is confirmed by biopsy.
• Substage IA:
  • Invasive carcinoma diagnosed by microscopy.
  • Depth of invasion < or = 5 mm and largest extension > or = 7 mm.
  • Further divided into IA1 and IA2 based on specific measurements.
• Substage IB:
  • Clinically visible lesions limited to the cervix.
  • Further divided into IB1 and IB2 based on lesion size.
• Stage IIA:
  • Cervical lesion without parametrial invasion.
  • Substages IIA1 and IIA2 based on lesion size.
• Stage IIB:
  • Cervical lesion with obvious parametrial invasion.
• Stage IIIA:
  • Tumor involves the lower third of the vagina with no extension to the pelvic wall.
• Stage IIIB:
  • Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney.
• Stage IVA:
  • Spread of the growth to adjacent organs.
• Stage IVB:
  • Spread to distant organs.

Carcinoma Cervix-Stage I Management

Stage I: The carcinoma is strictly confined to the cervix