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CA CERVIX
Drs Muhammad Yahya SpFRS Apt
 Epidemilogy
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 Prevalensi 468.000 kasus baru setiap tahunnya

didunia angka kematian : 233.000 pada tahun 2000
(Tortolero-Luna G et al., 2004 )
 41 kasus baru dan 20 kasus kematian setiap hari di
Indonesia (Rasjidi I et al.,2007)
 Di Dr. Soetomo menduduki peringkat ke-1 (2008-
2010)  mayoritas stadium lanjut
 Epidemilogy
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 Affects 16 per 100,000 women per year and dies

about 9 per 100,000 per year in world Population.
 Every year 452,000 new cases of cervical cancer
are detected, according to World Health
Organization.
 More than 2000 new cases being detected each
year in Nepal
 Sign and Symptoms
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 Vaginal bleeding
 Menstrual bleeding is longer and heavierthan usual
 Bleeding after menopause or increasedvaginal
discharge
 Bleeding following intercourse or pelvicexam
 Pain during intercouse
 Risk Faktor
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 Human Papilloma virus infection (HPV) – Primary factor

 HPV 16, HPV 18, HPV 31, HPV 33, HPV 45 
 50% are caused by HPV 16 AND 18
 Sexual behavior/ multiple sex partner.
 Smoking
 HIV infection /Immunocompromised state
 Chlamydia infection
 Oral contraceptives
 Multiple pregnancies
 Riwayat keluarga Ca Cervix
 Cervix
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 Cervix :erbuat dari 2 bagian yang berbda

 Dekat dg Uterus : Endocervix dilapisi sel glandular
 Dekat dg Vagina : Ectocerix, dilapisi sel squamous
 Ca Cervix
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 Pertumbuhan sel yang abnormal dimulai dari sel-

sel yang melapisi serviks - bagian bawah rahim
(rahim). Ini kadang-kadang disebut serviks uterus.
Janin tumbuh di dalam tubuh rahim (bagian atas).
 Kedua bag sel bertemu pada zona transitional (yg
berubah krn bertambah usia dan saat melahirkan)
 Peubahan cell pad zona transitional
 Normal  pre-cancer (dysplasia)  cancer
 Types of cervical cancer
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 squamous cell carcinomas.

 Berkembang dari eoo cerix
 adenocarcinomas.
 Berasal dari sel glandular penghasil mucus/lendir di
endocervix
 adenosquamous carcinomas or mixed carcinomas.
 Kurang umum
cervical intraepithelial neoplasia (CIN),
squamous intraepithelial lesion (SIL)
 Role of HPV in Cervical Servix
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 HPV causes the production of two proteins known

as E6 and E7.
 When these proteins are produced, they turn off
some tumor suppressor genes.
 This may allow the cervical lining cells to grow
uncontrollably, which in some cases will lead to
cancer
 Contribution of OCP in Cervical
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Cervix
 Association of cervical cancer with oral
contraceptive use is likely to be indirect
 The hormones in oral contraceptives may change
the susceptibility of cervical cells to HPV infection,
affect their ability to clear the infection, or make it
easier for HPV infection to cause changes that
progress to cervical cancer.
Deteksi Dini …(1)
Pap test
screening test for cervical cancer. It looks for

abnormal cells on your cervix that could turn into

cancer over time. That way, problems can be
found and treated before they ever turn into
cancer. All women should start getting regular
Pap tests at age 21.
Alternatif lain Tes PAP Smear : metode IVA

(Inspeksi Visual dg As Acetat

Deteksi Dini …(2)
HPV test
It looks for the virus that can cause abnormal cells

on your cervix. For women ages 30 and older, the

HPV test can be used along with the Pap test. This is
called HPV co-testing. Screening tests can find early
problems before they become cancer. That way,
problems can be found and removed before they ever
become cancer.
Deteksi Dini …(3)
 Getting the HPV test with the Pap test at the same
time can safely increase screening intervals up to 5
years for women who do not have HPV and have a
normal Pap test result even if they have new sexual
partners.

 Even without the HPV test, women who have

several normal Pap tests only need a Pap test every
3 years !
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Pra Kanker … (1)
 Prakanker = Displasia Serviks
 Ketika hasil tes Pap Smear (+)
 Digambarkan dengan Ssquomous Intraepitel
Lesion (SIL)
 Low grade (LSIL)
 High grade (HSIL)
 Mungkin kanker (ganas)
Pra Kanker … (2)
 Jika hasil tes PAP Smear kurang baik . Dokter akan
menyarankan tes HPV , digambarkan dengan CIN
(Cervical Intraepitel Neoplasma)
 CIN I : Displasia ringan
 CIN II : hingga displasia ditandai
 CIN III : Displasia berat hingga prakanker
 Diagnosis ..(1)
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 Cervical Cytology (Pap Test):

 Cells are removed from the cervix and examined under
the microscope.
 Can detect epithelial cell abnormalities
 Atypical squamous cells
 Squamous intraepithelial lesions
 Squamous cell carcinoma (likely to be invasive)
 Diagnosis ..(2)
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 Colposcopy:
 Cervix is viewed through a colposcope and the surface of
the cervix can be seen close and clear.
 Cervical Biopsies:
 Colposcopic biopsy
 removal of small section of the abnormal area of the surface.
 Endocervical curettage
 removing some tissue lining from the endocervical canal.
 Cone biopsy
 cone-shaped piece of tissue is removed from the cervix
 Type of Cervical Cancer
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 Squamous cell carcinomas (75 - 80 %)

 Large cell, keratinizing
 Large cell, nonkeratinizing
 Small cell (not neuroendocrine)
 Verrucous carcinoma
 Adenocarcinomas (17 %)
 Adenoma malignum
 Mucinous
 Papillary
 Endometrioid
 Clear cell
 Adenoid cystic
 Adenosquamous (6 %)
 Staging of Cervical Cancer ..(1)
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FIGO Primary Tumor

Stage I Carcinoma c onfined to cervix
Stage IA1 Stromal invasion upto 3mm in depth &  7mm in width

Stage IA2 Stromal invasion 3-5 mm in depth &  7mm in width

Stage IB Clinical lesions confined to the cervix or pre-clinical lesions

>stage IA2
Stage IB1 Lesions  4 cm
Stage IB2 Lesions > 4 cm
 Staging of Cervical Cancer ..(2)
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FIGO Primary Tumor

Stage II Involvement of upper 2/3rd of vagina
Stage IIA1 Lesions  4 cm
Stage IIA2 Lesions > 4 cm
Stage IIB Involvement of medial parametrium

Stage Involvement of medial parametrium

IIIIA
Stage IIIB Involvement of para upto LPW/HN
Stage IVA Bladder &/or bowel involvement
Stage IVB Distant metastasis
 Ca Cervix

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 Prevention
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 Avoiding the risk factors

 Especially HPV
 Long term use of OCP
 Having the Pap Test
 3 years after first vaginal intercourse or by age 21
years.
 Have test annually
 Use physical barrier for safe sex
 Treatment / Management
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 Surgery
 Pre invasive cervical cancer
 Cryosurgery
 Laser surgery
 Conization
 Invasive cervical cancer
 Simple hysterectomy
 Removal of the body of the uterus and cervix.
 Radical hysterectomy and pelvic lymph node dissection
 Removal of entire uterus, surrounding tissue , upper part of the vagina, and
lymph nodes from the cervix.
 Radiation
 Chemotherapy
 Follow up after treatment.
 Chemotherapy
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 Stage IA1 and IA2

 Surgery (radikal histerektomi)

 Stage IB1/IIA1 or IB2/IIA2 (4-6 cm) and IIB

 Surgery

 Adjuvant EBRT/Chemoradiation (while waiting cisplatin 50 mg/m2)

 Stage IB2, IIA2 (>6 cm)

 3-4 x Cisp 50 mg/m2

 3 x Pacli-Carbo
 Paclitaxel 175 mg/m2 – Carboplatin (AUC = 6)
 Follow up / 2x Cisplatin 75 mg/m2
 Stage III & IV
 Cisplatin 50 mg/m2

 Radiatioan
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 Pap test results is the Bethesda System (TBS).
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 Negative for intraepithelial lesion or malignancy

 This category means that no signs of cancer, pre-
cancer, or other significant
 Epithelial cell abnormalities
 Other malignant neoplasms.
 Epithelial cell abnormalities
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 Squamous cell abnormalities
 Atypical squamous cells (ASCs)
 Atypical squamous cells of uncertain significance (ASC-US)
 Atypical squamous cells where high-grade squamous
intraepithelial lesion (HSIL) can’t be excluded (ASC-H)
 Squamous intraepithelial lesions (SILs)
 low-grade SIL (LSIL)
 high-grade SIL (HSIL)

 Squamous cell carcinoma: 

 Glandular cell abnormalities
 Atypical glandular cells
 Adenocarcinoma: