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In Europe and America, the incidence has fallen considerably due to the
4. SEXUAL HISTORY:
(a) Low risk of the dx. among women of fanatical religions group – viz.
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(i) Early coitache – before 20th birthday – 50% excess of
cases.
1981).
other agents.
implicated.
2
- Human papilloma virus (HPV) types 16, 18 and 33, while types 6, 11,31,
- Herpes simplex hominis type II has a possible link but this has not been
status.
surveillance.
PATHOLOGY
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(a) Large cell keratinizing.
The relatively low mitotic rate in these tumours renders them rather
epithelial cells.
(d) Endometrioid
(iii) Mixed
(a) Adeno-squamous
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(b) Glassy cell
excavation is frequent.
important.
SPREAD
nodes; Internal iliac nodes; common iliac nodes; sacral nodes and
Para-aortic nodes.
differentiated tumours and the higher stages. Most common sites are
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COMPLICATIONS
pyonephrosis.
5. uraemia
6. haemorrhage
7. cachexia
CAUSES OF DEATH
CLINICAL FEATURES
Symptomatic:
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• Bleeding: irregular intermenstrual bleeding and recur in
(i) Cachexia
ureteric colic.
PHYSICAL SIGNS
lymph nodes and palpation of the abdomen for enlarged liver and
kidneys.
furgating.
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Bimanual examination may reveal a hard, friable, irregular, enlarged
cervix which becomes fixed as the tumour spreads into the parametra.
FBC, serum E/U/Cr, serum calcium and uric acid, LFT, IVU, CXR
and ECG (all those with stage 1b disease or worse, should have a
A smear (Pap) may be taken from the cervix for cytology and a
disease).
radiotherapist.
are performed.
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Cystoscopy is also performed if the dx appears locally advanced.
punch biopsy.
(ii) & (iii) CT and Abdomino-pelvic USS – may be used to estimate size
nodes.
PROGNOSTIC FACTORS
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1. CLINICAL FACTORS
barrel-shaped form.
2. HISTOPATHOLOGY
Stage 1B – 12-20%
Stage 2B – 16-36%
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STAGING OF CARCINOMA OF THE CERVIX UTERI (FIGO 1995)
STAGE DEFINITION
Stage 0 Carcinoma is Situ, intraepithelial carcinoma
Stage 1 Cervical carcinoma confined to the cervix extension to the corpus
should be disregarded.
,,1A Invasive Ca. diagnosed microscopically only.
width of 7mm.
,, 1B Clinical lesions confined to the cervix or preclinical lesions greater
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Stage III Extends to the pelvic wall or involves the lower third of the vagina
sidewall.
IIIB Tumour extends to the pelvic sidewall or causes hydrophrosis in
non-functioning kidney.
Stage IV Carcinoma extends beyond the true pelvis or has clinically
TREATMENT
1. Stage 1A1:
Cervical conisation
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2. Stage 1A2: Extended (Class II) abdominal hysterectomy with
hysterectomy
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tissues as well as pelvic and para-aortic lymphadenectomy – medial
half of both cardinal and uterosacral ligaments are removed with the
that the ureters receives from the proximal uterine artery. The main
cancer with depth of invasion > 3mm but < 5mm, with areas of
origin at the anterior division of the internal iliac artery and wide
pelvic side wall respectively. This is usually done for stages 1B1 or
the cervix.
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Class IV – the ureters are completely dissected from their
radiotherapy.
OTHERS:
ensure that the pelvis is not filled with distended loops of bowel –
clean the bowel of faecal matter. This help to make the patients first
particularly smokers.
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- Epidural anaesthetic is a valuable adjunct to the G.A; reducing
blood loss and causing some constriction of the bowel, which thus
analgesia.
COMPLICATIONS OF SURGERY
1. Anaesthetic complications
3. Bladder injury:
(i) Fistula
4. Ureters:
(i) Hydro-ureter
(iii) Stenosis
(iv) Fistula
5. Retroperitoneal space:
(a) Haematoma
(c) Infection
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(d) Thrombosis
rectal dystunction.
- Monitor vital signs (i.e. Temp, blood press, pulse and resp
rate).
- Antibiotic course
removed.
Follow-up
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- To evaluate results, provide reassurance and to give
1-2 year and then 3-4 months visits for 3rd and 4th years.
exenteration
continent pouch.
colostomy.
colostomy is avoided
RADIOTHERAPY
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- Involves application of cesium – 137 to treat the local dx
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In Brachytherapy – In Manchester system, 6600 - 7600cGy were
insertion.
Complications:
- Radiation dermatitis
- Radiation menopanse
apareunia
- Urinary fistulae
- Faecal fistulae
- Intestinal obstruction
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ADVANTAGES OF PRIMARY SURGICAL Rx OVER PRIMARY
RADIATION Rx
radiotherapy
also easier.
used
CHEMOTHERAPY
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- Surgery is the only modalities that can cure but
operation.
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- Radical hysterectomy, upper vaginectomy and pelvic
4500CGY in 5 weeks
HAEMORRHAGE
overlooked.
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