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CANCER CERVIXCANCER CERVIXA PREVENTABLE CANCERA PREVENTABLE CANCER
Dr NEETA DHABHAIDr NEETA DHABHAISr Consultant. – GynaecologistSr Consultant. – Gynaecologist
Member Expert - Indian Cancer Member Expert - Indian Cancer Winners’ AssociationWinners’ Association
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Anatomy of female pelvisAnatomy of female pelvis
The cervix is the lower part of The cervix is the lower part of
the uterus. It extends into the the uterus. It extends into the
vagina. Of all gynecologic vagina. Of all gynecologic
cancers, cervical cancer is the cancers, cervical cancer is the
second most common among all second most common among all
women and the most common women and the most common
among younger women. It among younger women. It
usually affects women aged 35 to usually affects women aged 35 to
55, but it can affect women as 55, but it can affect women as
young as 20.young as 20.
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Incidence of Cancer Incidence of Cancer CervixCervix
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Cancer of Uterine CervixCancer of Uterine Cervix
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> 200 women die every day
Every 7 minutes a women dies
8 women die every hourCervical Cancer :
India
This ‘Cause’ need to be taken up by multiple stake holders.
Cervical Cancer in India
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Indian scenarioIndian scenario
Commonest cancer in women in IndiaCommonest cancer in women in India
Major cause of deaths in women due to cancerMajor cause of deaths in women due to cancer
Usually diagnosed at advanced stageUsually diagnosed at advanced stage
No National programNo National program
Uniformly low incidence of cervical screening in Uniformly low incidence of cervical screening in India (6% in rich & 4% in poor)India (6% in rich & 4% in poor)
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HIGH-RISKHIGH-RISK FACTORS FACTORS
Women with a history that includes:Women with a history that includes: Lower socioeconomic statusLower socioeconomic status Multiple sexual partnersMultiple sexual partners Early onset of sexual activity (at or before age 17)Early onset of sexual activity (at or before age 17) Multiple pregnancies and poor birth spacingMultiple pregnancies and poor birth spacing
Woman with current or former history :Woman with current or former history : Human papillomavirus infections- type 16,18,31,35Human papillomavirus infections- type 16,18,31,35 HIVHIV
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HIGH-RISK FACTORS-OthersHIGH-RISK FACTORS-Others
Women with medical histories which include:Women with medical histories which include: ImmunosupressionImmunosupression Smoking Smoking Oral contraceptivesOral contraceptives Substance abuse, including alcoholSubstance abuse, including alcohol Lack of screening (women who have had Pap smears at Lack of screening (women who have had Pap smears at
least every 3 years have 1/10 the risk of invasive disease least every 3 years have 1/10 the risk of invasive disease than women who have never had one)than women who have never had one)
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HPV 16
HPV 18
HPV 6
HPV 11
Cancer causing Types Non-cancer causing types
• >75% of Cervical Cancer• ~50% of Vaginal & Vulvar Cancer
90% of Anogenital warts
HPV is a necessary cause of cervical cancer - 99.7%
HPV
Human Papilloma Virus (HPV)
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Changes in Cervical Changes in Cervical Epithelium by HPV Epithelium by HPV
InfectionInfectionNormal CervixNormal Cervix HPV Infection / CIN* 1HPV Infection / CIN* 1 CIN 2 / CIN 3 /CIN 2 / CIN 3 /
Cervical CancerCervical Cancer
*CIN = cervical intraepithelial neoplasia www.winovercancer.com
Natural History of HPV & Natural History of HPV & Cervical CancerCervical Cancer
NormalCervix
HPV Infection Pre-cancer Cancer
Infection Progression Invasion
RegressionClearance
PersistencPersistencee
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HPV Infection
Low Grade
Lesions
High Grade
Lesions
Invasive Cancer
0–1 Year 0–5 Years 1–20 Years
HPV Infection may clear
Facts about HPV Infection
Facts about HPV Infection
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Diagnosis of Cancer Diagnosis of Cancer Cervix Cervix
History & Physical exam:History & Physical exam: No symptomsNo symptoms Irregular Bleeding PVIrregular Bleeding PV Vaginal discharge (foul Vaginal discharge (foul
smelling, blood stained)smelling, blood stained) Post coital spottingPost coital spotting Cervical growthCervical growth
If no visible growthIf no visible growth PAP smear PAP smear ColposcopyColposcopy Endocervical curettageEndocervical curettage
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How to prevent Cancer How to prevent Cancer CervixCervix
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MOST IMPORTANT METHOD MOST IMPORTANT METHOD FOR FOR
PREVENTION AND EARLY PREVENTION AND EARLY DETECTION DETECTION
OF CANCER CERVIX IS BY OF CANCER CERVIX IS BY
CERVICAL SCREENING WITH CERVICAL SCREENING WITH PAP’S PAP’S
SMEARSMEAR
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Pap smear - guidelinesPap smear - guidelinesTarget groupTarget group - - All women aged 18-70 yrs who have ever had sexAll women aged 18-70 yrs who have ever had sex
Timing of Initial Screening -Timing of Initial Screening - Initial screening at age of 21 years or within 3 years of sexual activityInitial screening at age of 21 years or within 3 years of sexual activity
Screening intervalScreening 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.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 ScreeningWhen 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 - 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. abnormal in the last 10 years.
- Post Hysterectomy - Post Hysterectomy
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• For women at high risk of HPV, the HPV test can be done at the same time as a Pap test.
Screening Test for HPV
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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?Are HPV vaccines safe?
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Vaccine Profile: Side Effects
Side EffectsSide Effects QuadrivalentQuadrivalent BivalentBivalent
Local: Pain at inj. SiteLocal: Pain at inj. Site
( mild to moderate)( mild to moderate)83%83% 90%90%
Local: Swelling and Local: Swelling and erythemaerythema
25%25% 40%40%
FeverFever 4%4% 12%12%
No serious vaccine related adverse effects with both vaccine
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3 DOSES
0, 2MTHS 6MTHS
INTRAMUSCULAR
DOSE, METHOD OF DOSE, METHOD OF ADMINISTRATION AND ADMINISTRATION AND
USAGEUSAGE
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Cancer Cervix IS PREVENTABLE ,Cancer Cervix IS PREVENTABLE ,
IF Detected EARLY!!!!!!!!!IF Detected EARLY!!!!!!!!!
THANK YOUTHANK YOUwww.winovercancer.com
HPV is a necessary cause of cervical cancer – HPV is a necessary cause of cervical cancer – 99.7%99.7%
Induction of Induction of neutralising antibodiesneutralising antibodies by vaccination is critical for by vaccination is critical for protectionprotection
HPV 16 & 18 cause HPV 16 & 18 cause ~75%~75%** of cervical cancer cases while HPV 6 & 11 of cervical cancer cases while HPV 6 & 11 cause cause ~90%~90% genital warts genital warts
27%27% of the world burden of Cervical Cancer is seen in India. of the world burden of Cervical Cancer is seen in India.
Every Every 7 minutes7 minutes a woman dies in India due to cervical cancer a woman dies in India due to cervical cancer
Cervical Cancer is usually diagnosed in Cervical Cancer is usually diagnosed in late stageslate stages in India. in India.
Cervical cancer screening is recommended in women Cervical cancer screening is recommended in women >30yrs>30yrs
Vaccination between 9-26yrs Vaccination between 9-26yrs can be an effective strategy to help can be an effective strategy to help reduce this huge disease burden.reduce this huge disease burden.
* India
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Thank YouThank You
For Your CommentsFor Your Comments
icanwinassociation.blogspot.comicanwinassociation.blogspot.comicanwinassociation@gmail.comicanwinassociation@gmail.comwww.winovercancer.comwww.winovercancer.com