CMT06210: Apprenticeship in

Obstetrics and Gynecology

Session 3: Cervical Carcinoma
Total Session time 120 minutes

CMT 06210: Apprenticeship in Obstetrics

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and Gynaecology
 Learning tasks
At the end of this session, students are expected to
be able to:
•Explain aetiology/risk factors of cervical carcinoma
•Outline epidemiology of cervical carcinoma
•Explain clinical features of cervical carcinoma
•Establish diagnosis/ provisional and differential
diagnosis of cervical carcinoma
•Provide pre-referral treatment of cervical carcinoma
•Provide follow-up services of cervical carcinoma
•Provide control and preventive measures of cervical
carcinoma

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and Gynaecology
 Activity: Brainstorming

• What is Cervical carcinoma?

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and Gynaecology
 Definition
Cervical carcinoma:
•Cervical carcinoma is the malignant
neoplasm of the cervix.
•Almost all cases of cervical carcinoma
originate in the transformation zone from the
ectocervical or endocervical mucosa

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and Gynaecology
 Definition cont…
• The cervix is divided into an
ectocervix which is lined by
squamous epithelium and
endocervix which is lined by
columnar epithelium.
• Almost all cases of cervical
carcinoma originate in the
transformation zone from the
endocervical or ectocervical
mucosa

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and Gynaecology
 Epidemiology
• Cervical cancer is the 3rd most common
malignancy in women worldwide.
• More frequent in developing in comparison
to to developed countries,
• Cervical cancer is the 2nd most common
cause of cancer-related deaths in women in
developing countries
• Most common cancer among females in
Tanzania
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and Gynaecology
 Etiology
• It is now recognized that cervical cancer is a
long-term outcome of persistent infection of
the lower genital tract by high-risk HPV types,
• HPV is thus termed the “necessary” cause of
cervical cancer.
• HPV types 16 and18 account for 71% of cases
• HPV types 31, 33, 45, 52 and 58 accounts for
another 19% of cases.
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and Gynaecology
 Risk factors
• Early first intercouse: 2x risk if first
intercourse at <14yrs compared to 20yrs.
• Race: 2x in black as compared to whites.
• Being HIV positive: 5x increased risk
• Smoking cigarette.
• Family history.
• Parity: para 7 with full term has 4x increase
risk compared to para 2 has 2x increase risk.
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and Gynaecology
 Risk factors cont….
• Multiple sexual partner or having sex with
someone who has multiple sexual partners.
• DES Exposure-enlarge transformation zone at
the cervix.
• COCs-Hormone contained promote
proliferation of cell make it vulnerable to
mutation.
• Lower social economic status: limited access to
screening.
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and Gynaecology
 Activity: Brainstorming

• What are clinical features of Cervical

carcinoma?

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and Gynaecology
 Clinical features
History:
•Asymptomatic at early stage.
•Abnormal vaginal bleeding-post coital, spotting,
intermenstrual bleeding.
•Serosanguineous or yellowish discharge, at times
foul smelling in advanced or necrotic cancer.
•Pelvic pain: from locally advanced disease.
•Extension to pelvic wall may cause sciatic pain or
back pain associated with hydronephrosis

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 Clinical features cont…
History cont…
•Lumboscral back pain due to metastatic
involvement of iliac and Para-aortic lymph
nodes that extend to lumbosacral nerve roots.
•Haematuria following bladder invasion by
advance stage of disease
•Pain during sex(dyspareunia)
•Pain during urination(dysuria).
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and Gynaecology
 Clinical features cont…
Physical examination:
•Small shallow ulcer or
crater.
•Exophytic cervical mass
that bleeds on touch (most
commonly)
•Bimanual examination:
firm indurated barrel-
shaped cervix

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and Gynaecology
 Differential diagnosis

• Chronic cervicitis
• Endometrial carcinoma
• Endometrial hyperplasia
• Cervical polyps

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and Gynaecology
 Investigations
• Biopsy: for histology
• Complete blood cell count: to rule out anemia, infections
• Urinalysis: Haematuria.
• HIV Test
• Renal function test.
• Liver function tests
• CXR for possible pulmonary metastasis.
• Abdominalpelvic Utrasund: metastasis in the liver,
lymphnode or hydronephrosis

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and Gynaecology
 Treatment
Pre-referral treatment: Largely supportive
•Correct anemia with hematenics ± BT
•Anaelgesics for pain management
•Oxygen if dyspnoeic

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 Treatment cont…
Specific treatment: Depends on clinical stage
•Surgery
•Radiotherapy
•Chemotherapy

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 Complications
• Hemorrhage.
• ™Frequent attacks of ureteric pain, due to
pyelitis, pyelonephritis and hydronephrosis.
• ™ Pyometra: specially with endocervical
variety.
• ™ Vesicovaginal fistula.
• ™ Rectovaginal fistula (rare)

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and Gynaecology
 Follow up
• 35% of Patients with Invasive Cervical Cancer
are estimated to have persistent or recurrent
disease. Most of these (85%) within 3 years of
the initial treatment.
• Evaluations include Pelvic Examinations,
Careful Palpation of nodal groups, Pap
Smears, and Radiologic Imaging.

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and Gynaecology
 Prevention
Primary prevention:
•Vaccination against HPV:
Only works before HPV infection.
Targeted to girls and women of 9 to 26yrs of age
•Avoid risks e.g sex at early age
•Condom use

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and Gynaecology
 Prevention cont…
Secondary prevention:
•Awareness: linkage between HPV and cervical
cancer.
•Screening
Papanicolaus test(pap smear)
Visual inspection-Acetic Acid or Lugols Iodine
(Schillers test).
Colposcopy..

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and Gynaecology
 Key points
• Cervical cancer is a malignant tumor of the
cervix
• It is the commonest malignancy among women
in Tanzania.
• HPV infection is termed as a “necessary factor”
for development of cervical cancer
• Risk factors for cervical cancer includes sex at
early age, smoking, black race, high parity, e.t.c
• Prevention involves vaccination against HPV,
avoidance of risks and screening
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 Review questions
1. What is Cervical carcinoma?
2. Outline the risk factors for cervical
carcinoma.
3. What are the clinical presentation of
Cervical carcinoma?
4. Outline the management of Cervical
carcinoma.

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and Gynaecology
 Assignment
• Describe the clinical staging of cervical
carcinoma

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 References
• D.C Dutta. Textbook of Gynecology. 6th edition
• https://emedicine.medscape.com//article/954252
• Obstetric and Gynaecology, six ed. Samantha
pfeifer
• Willium gynaecology 2008
• ACOG practice bulletin. Diagnosis and treatment. Of
cervical cancer number 35 May 2011..
• Frederic A, Kristel V, Michael H et al, Gynecologic
cancers in pregnancy: Guideline of an International
Consesus meeting; Int Jour of Gyn Cancer 2009;19;
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