CANCER CERVIX by mikeholy

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									CANCER CERVIX
   A PREVENTABLE CANCER




      Dr NEETA DHABHAI
     Sr Consultant. – Gynaecologist

Member Expert - Indian Cancer Winners’
            Association
             www.winovercancer.com
Anatomy of female pelvis
                   The cervix is the lower part of the
                      uterus. It extends into the vagina.
                      Of all gynecologic cancers,
                      cervical cancer is the second most
                      common among all women and
                      the most common among
                      younger women. It usually affects
                      women aged 35 to 55, but it can
                      affect women as young as 20.




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Incidence of Cancer Cervix




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Cancer of Uterine Cervix




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        Cervical Cancer in India


                              > 200 women die every day

Cervical Cancer :                   8 women die every hour
      India

                          Every 7 minutes a women dies

 This ‘Cause’ need to be taken up by multiple stake holders.

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                Indian scenario
   Commonest cancer in women in India
   Major cause of deaths in women due to cancer
   Usually diagnosed at advanced stage
   No National program
   Uniformly low incidence of cervical screening in
    India (6% in rich & 4% in poor)



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           HIGH-RISK FACTORS

Women with a history that includes:
 Lower socioeconomic status

 Multiple sexual partners

 Early onset of sexual activity (at or before age 17)

 Multiple pregnancies and poor birth spacing



Woman with current or former history :
 Human papillomavirus infections- type 16,18,31,35

 HIV
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        HIGH-RISK FACTORS-Others
Women with medical histories which include:
 Immunosupression

 Smoking
   Oral contraceptives
   Substance abuse, including alcohol
   Lack of screening (women who have had Pap smears at
    least every 3 years have 1/10 the risk of invasive disease
    than women who have never had one)


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             Human Papilloma Virus (HPV)
   HPV is a necessary cause of cervical cancer - 99.7%


                                         HPV                Non-cancer causing types
      Cancer causing Types



           HPV 16                                                  HPV 6


           HPV 18                                                 HPV 11


    • >75% of Cervical Cancer
                                                            90% of Anogenital warts
• ~50% of Vaginal & Vulvar Cancer



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Changes in Cervical Epithelium by
         HPV Infection
           Normal Cervix                    HPV Infection / CIN* 1   CIN 2 / CIN 3 /
                                                                      Cervical Cancer




*CIN = cervical intraepithelial neoplasia
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         Natural History of HPV & Cervical
                       Cancer



                         Persistence

                                        Progression                Invasion
Normal    Infection         HPV
Cervix                                                Pre-cancer              Cancer
                          Infection
         Clearance                      Regression




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             Facts about HPV Infection
            Facts about HPV Infection


HPV Infection may clear

    0–1 Year           0–5 Years            1–20 Years



                Low                 High
  HPV                                             Invasive
                Grade               Grade
Infection                                          Cancer
                Lesions             Lesions



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       Diagnosis of Cancer Cervix
   History & Physical exam:
      No symptoms

      Irregular Bleeding PV

      Vaginal discharge (foul
        smelling, blood stained)
      Post coital spotting

      Cervical growth

   If no visible growth
      PAP smear

      Colposcopy

      Endocervical curettage
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How to prevent Cancer Cervix




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  MOST IMPORTANT METHOD FOR
PREVENTION AND EARLY DETECTION
   OF CANCER CERVIX IS BY
CERVICAL SCREENING WITH PAP’S
           SMEAR




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                  Pap smear - guidelines
   Target group - All women aged 18-70 yrs who have ever had sex

   Timing of Initial Screening -
       Initial screening at age of 21 years or within 3 years of sexual activity

   Screening interval –
   Yearly till the age of 30 then every 2 to 3 yearly if test results have been
normal for 3 years in a row.
   When to End Screening

        - After 70 yrs if test results have been normal for at least 3 years in a
row and no result has been abnormal in the last 10 years.

        - Post Hysterectomy



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Screening Test for HPV

•   For women at high risk of HPV, the HPV test
    can be done at the same time as a Pap test.




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    Colposcopy
•   Colposcopy is often done if
    results of a Papanicolaou
    (Pap) test are abnormal.

•   For colposcopy, cervix is
    inspected for signs of
    cancer. Often, a sample of
    tissue is removed for
    examination (biopsy).

•   Colposcopy alone (without
    biopsy) is painless and thus
    requires no anesthetic.
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           Treatment

•The    main    treatment    of
 gynecologic cancer is surgical
 removal of the tumor. Surgery
 may be followed by radiation
 therapy or chemotherapy.

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Prognosis
• Prognosis depends on the stage of the
 cancer.
• With treatment, 80 to 90% of women with
 stage I cancer and 50 to 65% of those
 with stage II cancer are alive 5 years
 after diagnosis.

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HPV Vaccine




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Are HPV vaccines safe?




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     Vaccine Profile: Side Effects

           Side Effects                 Quadrivalent               Bivalent

Local: Pain at inj. Site                       83%                  90%
( mild to moderate)
Local: Swelling and erythema                   25%                  40%
Fever                                           4%                  12%



    No serious vaccine related adverse effects with both vaccine


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      DOSE, METHOD OF
  ADMINISTRATION AND USAGE


3 DOSES
0, 2MTHS 6MTHS
INTRAMUSCULAR


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Cancer Cervix IS PREVENTABLE ,
    IF Detected EARLY!!!!!!!!!




                       THANK YOU
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         HPV is a necessary cause of cervical cancer – 99.7%

         Induction of neutralising antibodies by vaccination is critical for
          protection

         HPV 16 & 18 cause ~75%* of cervical cancer cases while HPV 6 & 11
          cause ~90% genital warts

         27% of the world burden of Cervical Cancer is seen in India.

         Every 7 minutes a woman dies in India due to cervical cancer

         Cervical Cancer is usually diagnosed in late stages in India.

         Cervical cancer screening is recommended in women >30yrs

         Vaccination between 9-26yrs can be an effective strategy to help reduce
          this huge disease burden.


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    * India
           Thank You


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