Cervical cancer Advancedstage cervical cancers are mainly diagnosed

Cervical cancer Advanced-stage cervical cancers are mainly diagnosed in women who remain largely unscreened. The survival of women with cervical cancer is directly determined by the extent of disease at the time of diagnosis. The performance of regular Pap smears has played a major role in decreasing the incidence of cervical cancer worldwide.

Early Detection

Early detection strategies 1. Screening : pap smear To detect cancer before symptoms appear Target: asymptomatic group 2. Early detection : To detect cancer as soon as symptoms appear Target: warning signs , high risk group

การดำเนนโรค Months Time Normal epithelium Progression* HPV infection koilocytosis CIN 1 Low-grade squamous intraepithelial lesion (ASCUS/LSIL) CIN 2 CIN 3 Years Invasive carcinoma High-grade squamous intraepithelial lesion (HSIL) Regression * With increasing probability of viral DNA integration. CIN = cervical intraepithelial neoplasia; ASCUS = atypical squamous cells of undetermined significance. pap Burd EM. Clin Microbiol Rev 2003; 16: 1– 17; Solomon D, et al. JAMA 2002; 287: 2114 – 2119.

National Cervical Cancer Screening Program ระยะท 1 ปงบประมาณ 2548 - 2552 ระยะท 2 ปงบประมาณ 2553 - 2557

ผลงานการคดกรอง Pap Smear แยกตามเขตสขภาพ 1 2 3 4 5 6 7 8 9 10 11 12 จำนวนการคดกร อง คดเปนรอยละ ประชากรเป าหมาย ทงหมด รายใหม ด 997, 745 963, 880 571, 247 96. 61 57. 25 588, 200 450, 204 288, 979 76. 54 49. 13 492, 740 408, 253 265, 963 82. 85 53. 98 749, 085 477, 496 337, 583 63. 74 45. 07 775, 080 702, 814 512, 388 90. 68 66. 11 894, 220 610, 715 441, 182 68. 3 49. 34 858, 330 748, 618 505, 602 87. 22 58. 91 997, 115 957, 012 577, 148 95. 98 57. 88 1, 139, 970 934, 878 646, 345 82. 01 56. 70 741, 915 639, 237 465, 844 86. 16 62. 79 717, 055 307, 157 228, 292 42. 84 31. 84 626, 385 436, 962 324, 178 69. 76 51. 75

ผลงานการคดกรอง Pap Smear แยกตามเขตสขภาพ ปงบประมาณ 2558 เขตสขภาพ ประชากรเปาหมาย 1 2 3 4 5 6 7 8 9 10 11 12 ผลงานรวมทงป ระเทศ 199, 549 117, 640 98, 548 149, 817 155, 016 178, 844 171, 666 199, 423 227, 994 148, 383 143, 411 125, 277 1, 915, 568 ผลการคดกรอง จำนวน รอยละ 132, 878 66. 59 65, 496 55. 67 53, 294 54. 08 76, 082 50. 78 138, 850 89. 57 61, 307 34. 28 158, 286 92. 21 198, 237 99. 41 172, 888 75. 83 111, 879 75. 40 51, 497 35. 91 61, 822 49. 35 1, 282, 516 66. 95

Training on cervical cancer screening

Incidence of cervical cancer and Breast cancer /100, 000 ASR

Cancer in Thailand VI, 2004 -2006

Cancer in Thailand VII, 2007 -2009

Cancer in Thailand VIII, 2010 -2012

DIAGNOSTIC WORK-UP Once the diagnosis of cervical cancer is established by histology. The patient should be staged using the FIGO staging. Clinical staging. Early Diagnosis Early Treatment

Modality of treatment 1. Surgery 2. Concurrent chemoradiotherapy 3. Chemotherapy 4. Palliative treatment

Surgery Current standard of practice for patients with stage I cervical cancer Laparotomy or Laparoscopic surgery New technic: -Nerve sparing technic-decrease bladder dysfunction -Fertility sparing surgery: trachelectomy -SLN Mapping

Concurrent chemoradiotherapy Current standard of practice for patients with locally advanced-stage cervical cancer. The chemotherapy agent of choice is platinum (cisplatin, carboplatin) as radiosensitizer. Concurrent chemoradiotherapy is used both for primary treatment and for post-hysterectomy women with high risk factors. NEW TECHNIC RT

Chemotherapy For patients who develop distant metastasis. Rarely curable The role of chemotherapy is palliation, primary objective to relieve symptoms and improve quality of life.

5 -year Survival Rate Stage I 90 -97 % Stage II 65 -70 % Stage III 39 -41 % Stage IV 10 -20 % Berek&Hacker Gynecologic Oncology 5 th edition

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