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Cervical Cancer - Coggle Diagram
Cervical Cancer
Screening
There are 3 different types of screening recommended by the WHO
HPV DNA testing for high-risk HPV types
Visual inspection with Acetic Acid (VIA)
Conventional (Pap) test and liquid-based cytology (LBC)
Cost effective
Sensitive
Specific
Detects early dysplasia
Increased diagnosis of preinvasive cancers
Screening is recommended regularly for women aged 30 and onwards
Screening is performed earlier for high risk individuals (i.e. HIV positive)
Epidemiology
4th most common cancer among women globally
~570,000 new cases in 2018
~311,000 deaths globally in 2018
90% of which occur in low and middle income countries
Most cases in women <50yrs
Declining mortality rates
Classifications
TNM Staging
Tumour size
Spread of disease within the pelvis
Spread of disease to distant organs
FIGO Staging
Stage 1
Confined to the uterus
Stage 2
Invades beyond the uterus
Stage 3
Extends to pelvic wall
Involves lower thid or vagina
Stage 4
Invades mucosa of bladder or rectum
Histology
Squamous cell carcinoma
80-90% of cervical cancers
Adenocarcinoma
10-20% of cervical cancers
Worse prognosis
High rate of distant metastasis
Adenosquamous carcinomas
3-5% of cervical cancers
Other histologies
Melanoma
Clear cell carcinoma
Neuroendocrine
Treatment
Radiotherapy
Chemotherapy
Platinum-containing regimens
Cisplatin
Carboplatin
Paclitaxel (Taxol)
Gemcitabine
Topotecan
Side effects
Surgery
Total abdominal hysterectomy
Radical trachelectomy
Palliative Care
For pre-invasive cancers:
Cryotherapy
Laser therapy
Prevention
HPV Vaccination
There are vaccines that protect against both HPV 16 and 18
Quadrivalent
Bivalent
Nonavelent
The WHO recommends vaccination for girls between ages 9 and 14 years
Etiology
HPV 16 & 18
6x more likely to get cervical cancer, compared to women without HIV
Immunosuppression
Persistent HPV infections and a more rapid progression
Simultaneous infection with other STDs
Parity and young age at first birth
Tobacco smoking
Oral contraceptives
Obesity
Low socioeconomic status
Symptoms
Early stage symptoms include:
Irregular blood spotting/light bleeding between periods
Postmenopausal bleeding
Bleeding after sexual intercourse
Increased vaginal discharge
Late stage/more severe symptoms include:
Persistent back, leg and/or pelvic pain
Weight loss, fatigue, loss of appetite
Foul-smell discharge and vaginal discomfort
Swelling of leg or both lower extremities
Painful urination
Hematuria
Hematochezia
Prognostic Factors
Staging
Age
Race
Socioeconomic status
Tumour size
Tumour location
Lymph node involvement
Diagnosis
Histopathologic examination
Imaging studies
Chest X-ray
MRI or CT scan
PET-CT
Cystoscopy or proctoscopy
Barriers
Lack of access
To screening
For treatment
Socioeconomic challenges
Inadequate service providers
Lack of basic equipment
Inadequate funding for cervical cancer programs
WHO Initiatives
Global strategy to eliminate cervical cancer (Goals by 2030)
90% of girls fully vaccinated with HPV vaccine by age 15yrs
70% of women screened by 35yrs of age
And screened again by 45yrs of age
90% of women diagnosed with cervical disease to receive treatment