CERV ICAL CANC ER

SHARMA 11408047.
4/29/12

PRESENTED BY:
SWAGATA REG.NO:

INTRODUCTION

COMPRISES APPROXIMATELY 12% OF TOTAL CANCER IN WOMAN WORLD WIDE. SEXUALLY TRANSMITTED DISEASE. IT IS MALIGNANT NEOPLASM OF CERVICAL AREA OF WOMAN.

4/29/12

FEMALE REPRODUCTIVE SYSTEM HAS FOLLOWING ORGANS

CERVIX

1. 2. 3. 4.

uterus fallopian tubes vagina ovaries.

Cervix is the lowest part of uterus

.

4/29/12

PREVALENCE

83% of cervical cancer cases are seen in DEVELOPING COUNTRIES including south-east Asia, southcentral Asia, Latin America, the Caribbean, sub-Saharan Africa 50% of the cases are diagnosed between the age 35 and 55 years. Rarely occur under the age of 20years.
4/29/12

20% of the cases diagnosed above

no data less than 2.4 2.4-4.8 4.8-7.2 7.2-9.6 9.6-12 12-14.4 14.4-16.8 16.8-19.2 19.2-21.6 21.6-24 24-26.4 more than 26.4

Age-standardized death from cervical cancer per 100,000inhabitants in 2004

4/29/12

HISTORY
400 BCE - Hippocrates: cervical cancer incurable 1925 - Hinselmann: invented colposcope 1928 - Papanicolaou: developed Papanicolaou technique 1941 - Papanicolaou and Trout: Pap smear screening 1946 - Ayer: Aylesbury spatula to scrape the cervix, collecting sample 4/29/12

TYPES OF CERVICAL CANCER

squamous cell carcinoma(about 90% in India) adenocarcinoma (about 15% of cervical cancers in the UK) adenosquamous carcinoma small cell carcinoma

4/29/12

International Federation of Gynecology and Obstetrics(FIGO) staging system. Stage 0 In situ carcinoma. Stage I Confined to cervix
v v v v v

STAGES OF CANCER

Stage IA Stage IA1 Stage IA2 Stage IB

4/29/12

STAGES OF CANCER(CONTD)
Stage III- Spread to the lower portion of the vagina, possibly to the pelvic wall, also.
v

Stage IIIA Stage IIIB Stage IV- Cancer has spread to

4/29/12

SYMPTOMS

At early stage, NO SYMPTOM is observed. AT ADVANCED STAGEVaginal bleeding Contact bleeding Any bleeding after menopause.

Abnormal vaginal bleeding between periods, after intercourse, or after menopause

ADDITIONAL SYMPTOMS-

Loss of appetite, weight loss, fatigue, pelvic pain, back pain, single swollen leg, leaking of urine and 4/29/12 faeces from vagina.

CAUSES
Human Papillioma Virus(HPV)- primary cause of cancer. Additional causes may be

Smoking HIV infection Hormonal contraception Dietary factors Family history 4/29/12

More than 150 types

Human papilioma virus(HPV)

. 15 types are high risk types 3 types are probable high risk types Type 16 and 18 causes about 70% of cervical cancer 4/29/12 cases.

TYPES OF HPV:
Disease Plantar warts Common warts Flat warts Genital warts Cervical cancer HPV Type 1, 2, 4 1, 2, 4, 26, 27, 29, 41, 57 3, 10, 27, 28, 41, 49 6, 11, 30, 40-45, 51, 54

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 Precancerous changes 16, 18, 34, 39, 42, 55 Laryngeal papillomas 6, 11, 30
4/29/12

Genome
Some of the HPV "early" genes, such as E6 and E7, are known to act as oncogenes that promote tumor growth . E6-AP(E6Associated Protein) binds ubiquitin to the p53 protein, thereby triggering its degradation.

4/29/12

4/29/12

Hereditary effect

The genes may play a role to lead HPV infection into cancer. The hereditary liability of the disease showed shared genes (heritability) explain 27% (95% CI 26%-29%) of the total variation. Genes related to cervical cancer: FHIT(3p1321.1), HLA-DBQA (6p21.3), HLA-DRB1(6p21.3).
4/29/12

ESTROGEN LEVEL AS RISK FACTOR

Analysis of HPV E6/E7 transgenic mouse models has also indicated a contribution of estrogen to the genesis, persistence and continued development of cervical cancer. The tumour suppressor BRCA1 is reported to repress estrogeninduced transcriptional activity of the estrogen receptor, and E6 and E7 interact directly with BRCA1 and antagonise its repressor ability . 4/29/12

DIAGNOSIS
Pap smear

Most widely followed screening process. Cytological screening process. Pap smear screening every 35 years with appropriate follow-up can reduce cervical cancer incidence by up to 80%. It can also find noncancerous conditions, such as infection and inflammation Sensitivity is less(relatively high false negative resutls)

4/29/12

4/29/12

Normal and abnormal cells

Normal cells cancerous cells 4/29/12

abnormal

Colposcopy:

If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy.The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see.

. Cone Biopsy
A cone biopsy is surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal. Cone biopsy may be 4/29/12

4/29/12

The abnormal cells can be removed by three ways. 1) Surgical scalpel. 2)LEEP (Loop electrosurgical excision procedure) 3)Carbon dioxide laser.

Endocervical curettage (ECC)

It is a procedure where scrape the mucous membrane of the endocervical canal. This procedure obtains a small tissue sample, which is then sent to a 4/29/12 pathology lab to be examined for

MOLECULAR DETECHTION

HPV DNA detection is more sensitive that cytology but its specificity is lower, since most HPV infections are transient. . The marker combinations at the level of RNA or protein has the potential to predict disease status more precisely than the detection of markers in isolation. Detection of viral oncogene E6/E7 transcripts, which is the marker of the productive infection, is a promising tool for follow-up of HPV DNA-positive women The detection of p16INK4a over-expression, as an indirect test of E6/E7 expression, is used for 4/29/12 confirmation of cervical neoplasia. But the

TREATMENT

Hysterectomy:

Removal of the whole uterus including part of the vagina. Microinvasive cancer (stage IA) is usually treated by hysterectomy.

Trachelectomy:

For patients who want to preserve their fertility. attempts to surgically remove the cancer while preserving the ovaries and uterus.
4/29/12

Radiation therapy:
External beam radiotherapy to the pelvis. Patients treated with surgery who have high risk features found on pathological examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.

On June 15, 2006, the US Food and Drug Administration approved the use of a 4/29/12 combination of two chemotherapy drugs,

PREVENTION

Pap smear screening every 35 years with appropriate follow-up can reduce cervical cancer incidence by up to 80%.
Two vaccines are available to prevent infection by some HPV types: 1)Gardasil, marketed by Merck, and

Vaccines

2)Cervarix, marketed by GlaxoSmithKline 4/29/12

Both vaccines are delivered in three shots over six months. vaccine is recommended primarily for those women not yet having been exposed to HPV . Recommended to have girls aged 10-14 years vaccinated with the three dose HPV vaccine The Centers for Disease Control and Prevention states that male condom use 4/29/12 may reduce the risk for genital

Condoms

Microbicides

At the 2010 International Papillomavirus Conference indicate that a carrageenanbased personal lubricant called Carraguard is effective for preventing HPV infection in women. Commercially available carrageenanbased products, such as Divine No 9, Bioglide and Oceanus Carrageenan, may likewise be effective for preventing HPV infection. Consists of repeating galactose units and 3,6 anhydrogalactose (3,6-AG).

4/29/12

THANK YOU

4/29/12