Cervical cancer

Prepared by
DR.RAVICHANDRA VARMA S
WHAT IS CANCER?
 CANCER IS AN ABNORMAL AND AN
EXCESSIVE GROWTH OF CELLS WHICH
ARE INCAPABLE OF DOING NORMAL
PHYSIOLOGICAL FUNCTION
WHAT IS THE FEMALE RE
PRODUCTIVE TRACT ?

 Vulva

 Vagina

 Cervix

 Uterus

 Fallopian tubes

 Ovaries
WHAT IS THE CERVIX ?

 Opening of the
uterus (womb) into
the vagina

 Cancer that affecting

Cervix is called
cervical cancer
 The central cause of cervical cancer is
human papillomavirus or HPV:
 HPV is transmitted through sexual contact
 The HPV detected today could have been
acquired years ago
 There are many different types of HPV that
can infect the cervix, vagina and vulva
 ‘Low-risk’ types may cause genital warts
 ‘High-risk’ types may cause precancer and cancer of the
cervix
• Most women who are infected with HPV will
never have any symptoms

WHAT CAUSES CERVICAL CANCER

?
 CERVICAL CANCER IS THE CANCER
AFFECTING THE CERVIX OF THE UTERUS
 2ND MOST COMMON CAUSE OF CANCER
DEATH IN THE WORLD AND 1ST CAUSE IS
THE BREAST CANCER
How common is HPV?
 Most men and women who have
had sex have been exposed to HPV

 More than 75% of sexually active

women have been exposed to
HPV by age 18-22
If I have HPV, does it mean I will
get cancer?
 NO!

 In most cases HPV infection will

go away

 Only women with persistent HPV

(where the virus does not go
away) are at risk for cervical
cancer
 EARLY MARRIAGE
 YOUNG AGE AT FIRST PREGNANCY
 SHORT INTEVAL BETWEEN PREGNANCY
 POOR NUTRITION
 POOR HYGEINE
 WOMEN WITH STD
 WOMEN WITH MULTIPLE SEXUAL PARTNER
 HUSBAND WITH MULTIPLE SEXUAL PARTNER
 SMOKING

WHO IS AT RISK ?
How do I lower my risk?
 Delay onset of sexual activity or remain
abstine
 Do not smoke
 Maintain a healthy diet and lifestyle
 Practice safe sex. Condoms decrease the
chance of HPV exposure.
 If eligible, consider getting the vaccine
that prevents most cervical cancers.
 Get your Pap test and HPV testing as
recommended by your health care
provider.
SYMPTOMATOLOGY

 ASYMPTOMATIC IN EARLY STAGES

 BLEEDING
- POST COITAL
- INTERMENSTRUAL
- POST MENOPAUSAL
 VAGINAL DISCHARGE
 PAIN
 RECTAL / URINARY SYMPTOM
Prevention & Early Detection

Cancers that can be prevented or detected early by

screening account for at least 50% of all new cancer
cases.

Cancer Facts & Figures 2009

How we can prevent?
1.Vaccination

2.Regular pap smear screening

Vaccination

 human papilloma vaccine

 Prophylactic HPV Vaccine
Approved for Adolescent Girls

Vaccine HPV Types FDA approved Age range

Bivalent 16/18 2009 10-25* yrs

Quadrivalent 6/11/16/18 2006 9-26* yrs

*Routine vaccination for 11-12 year old females

Three doses of vaccine given intramuscular
route at 0,2months and 6months
Screening
 CERVICAL CANCER – IDEAL FOR
SCREENING
 CERVIX EASILY ACCESSIBLE FOR
EXAMINATION

 LONG LATENT PRECANCEROUS PHASE

 NATURAL HISTORY KNOWN

What is a Pap test?
 Cells are collected from the surface of
your cervix by a doctor
 These cells are then checked under a
microscope for any abnormalities
 If abnormal (or precancerous) cells
are found, they can be treated before
they turn into cancer
 Cervical cancer can be found in the
early stages, when it is easier to treat
 Papanicolaou test –
exfoliative cytology
test
 cells collected are
from normally
shedding epithelium
.
◦ collected using
spatulas or brushes.
◦ Specimen is fixed,
stained and studied
for morphology under
microscope.

PAP SMEAR
 AYRE’S SPATULA

SAMPLING INSTRUMENTS
 Spreading
Spread the material collected on the
spatula / cervix brush evenly over the
slide with a painting action and single
smooth stroke motion using both sides
Finding early cell changes
Normal cervical cells Precancer
cells
 Pap Smear Guidelines: 2009
American College of Obstetrics and
Gynecology

<21 Years 21-29 Years 30-64 Years ≥65 Years

Pap smear every 3

Consider
No routine Bi-annual years
discontinuing Pap
Pap smear Pap smear smear at 65 or 70
..if patient has had years
3 or more normal
Pap results in a row,
no abnormal test ..if patient has had
results in 10 years, 3 or more normal
and lacks other risk Pap results in a row,
*History
of cervical cancer or DES in utero, HIV factors.* no abnormal test
positive, immunosuppression, or other risk factors results in 10 years,
for acquiring STDs. and lacks other risk
factors.*

ACOG Practice Bulletin No. 109. Obstet Gynecol. 2009;114:1409-20.

Most cervical cancer can be
prevented


 Cervical cancer is very rare in women

who get regular Pap tests
Barriers to women’s
participation in screening:

 Little understanding of cervical cancer

 Limited understanding of female reproductive organs
and associated diseases
 Lack of access to services
 Shame and fear of a vaginal exam
 Fear of death from cancer
 Lack of trust in health care system
 Lack of community and family support
 Concept of “preventive care” is foreign
Common misconceptions about
cervical cancer:
 People often do not know that it is preventable
 Belief that screening involves STI/HIV screening
 Belief that a positive/abnormal Pap smear result
means a woman will die
 Research found that:
◦ In South Africa and Kenya, women often think a
positive screening test means they have HIV
◦ In Mexico, women fear that treatment will leave
them sexually disabled
What We Do – Save Lives
Helping people stay well
By educating them on steps they can take to prevent
cancer and find it early

Helping people get well

By providing accurate and timely informational, emotional,
and practical support services

Funding cancer research

To further understand its causes, determine how best to
prevent it, and discover new ways to cure it.

Fighting back against cancer

By supporting the indian Cancer Society and those in your
life who are affected by cancer, you can join us in creating
a world with more birthdays!
We can End Cervical Cancer

Policy Makers
Vaccination
Screening
Questions?