Cancer of the Cervix

Max Brinsmead MB BS PhDMarch 2014

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?

Ca Cx – Treatment Options 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 - 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 Monoclonal anti-VEGF is promising

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

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