1. Cervical carcinoma – trends and treatments
Miss Kathryn Hillaby MD MRCOG
Consultant Gynaecological Oncologist, Colposcopy Lead for Gloucestershire

2. Cervical Carcinoma – where are we now?
Total cases in England in 2008 = 2,369
Mortality = 753 women in 2008
1 yr relative survival rate = 86%
5 yr relative survival rate = 68%

3. Cervical carcinoma Peak incidence 35-39
Incidence rates have halved in UK in last 20 yrs
Linked to HPV and smoking

4. Cervical carcinoma
Number of cases highest in those aged 25-49, these women represent over half of all diagnoses
Rates peak in women in early 30’s, gradually reduce in 40’s and rise again in women in 70’s and early 80’s
Both incidence and mortality worse in deprived areas
Cervical cancer is worse in older women – 1 yr survival in those aged is 96% compared with 52% in those aged 80 or older

5. Cervical Carcinoma

6. Cervical carcinoma
Incidence and mortality rates have fallen considerably over past 20 yrs
Incidence rates have almost halved (16.2 to 8.3 per 100,000 female population)
Mortality rates reduced by 2/3 (from 6.4 to 2.2 per 100,000 female population)
Incidence fell sharply following introduction of Cervical screening programme

7. Cervical carcinoma HOWEVER:
Reduction in incidence has levelled off in recent years
Between 1998 and 2008 incidence in women aged increased by 77%

8. Worldwide
Cervical carcinoma 12th most common cancer in women, and 5th most deadly
In young women is 2nd most common carcinoma
80% occurs in developing countries
Kills 250,000 women per year

9. Map of incidence by Cancer Network, 2004-2008

10. Map of mortality by Cancer Network, 2004-2008

11. Cervical carcinoma

12. Cervical carcinoma Colposcopy – apply acetic acid to cervix
Biospy or LLETZ -
Squamous cell carcinoma (85%)
Adenocarcinoma (15%)

13. Colposcopy

14. Cervical carcinoma staging
Staging is clinical
FIGO staging
Based on EUA, cystoscopy +/- sigmoidoscopy
Does NOT include MRI
In UK investigations include MRI pelvis and CT chest/abdo/pelvis

15. Cervical carcinoma
Investigations – CT and MRI
EUA and cystoscopy

16. Stage 1 disease
Stage 1A
Stage 1A1 = <3mm depth of invasion and <7mm wide
Stage 1A2 = 3-5mm depth of invasion and <7mm wide
Treatment = LLETZ

17. Stage 1 disease Stage 1B = any tumour which is visible
Stage 1B1 = <4cm
Stage 1B2 = >4cm
Confined to cervix
Treatment = surgical for 1B1
Chemo Radiotherapy for 1B2

18. Stage 2 disease
Stage 2 = invades beyond uterus, but not to pelvic sidewall or lower 1/3 of vagina
Stage 2A – spread into the top of the vagina
2A1 = <4cm
2A2 = >4cm

19. Stage 2 disease
Stage 2B – spread into parametrium

20. Stage 3 disease
Tumour extends to pelvic sidewall and/or involves lower 1/3 of vagina and/or causes hydronephrosis
Stage 3A – Cancer has spread to lower 1/3 of vagina, but not to pelvic sidewall

21. Stage 3 disease Stage 3B disease
Spread to pelvic sidewall and / or hydronephrosis

22. Stage 4
Carcinoma has extended beyond true pelvis or has involved mucosa of bladder or rectum
Stage 4a – spread of growth to adjacent organ

23. Stage 4 disease
Stage 4B – spread to distant organs

24. Staging and treatment Surgical in women up to stage 1b1
Chemotherapy (cisplatin) with radiotherapy in women with disease > stage 1b1

28. Cervical carcinoma
36 cases Stage 1B1 and above per year Gloucestershire, Herefordshire and S Worcestershire
Stage 1b1 or less managed surgically
Stage 1b2 and above managed with chemo-radiotherapy
Survival rates >85% in women <40yrs

29. How can we tackle this? Reduce incidence by screening
Treatment – of CIN to stop progression to cervical cancer
Early detection of cervical carcinoma
Adequate treatment

30. Cervical screening programme
Cervical screening programme saves 4500 lives per year in UK
Cervical screening prevents up to 3,900 cases of cervical cancer per year in the UK

31. Cervical screening programme
Early detection can prevent 75% cervical cancers
Currently between 77-83% women attend for screening
2007/ % women 25-34yrs did not attend for smears

32. What happened?
statistics show that the number of women of all ages having cervical screening has increased to 3.7 million compared with 3.4 million last year, an increase of 10.5 per cent (around 353,000).
Those within the 25 to 64 age range have risen to 3.6 million from 3.2 million last year, an 11.9 per cent increase (around 384,000).
The majority of this increase is for women aged 25 to 49. It is thought to be due to the publicity surrounding the illness and death of Jade Goody.

33. Take home messages Cervical screening programme works
Prevents 70% cases cervical carcinoma
Saves 4500 women per year
Only works if women attend for smear
HPV vaccine prevents 70% cases cervical cancer
Uptake currently disappointing