Cervical Cancer (1) (1)

CERVICAL CANCER
INTRODUCTION
• Cervical cancer starts in the cells lining the cervix_x0002_the lower part
of the uterus (womb). The cervix connects the body of the uterus (the
upper part where a fetus grows) to the vagina (birth canal).
• Cancer starts when cells in thebody begin to grow out of control.All

women are at risk for cervical cancer. It occurs most often in women
over age 30 Long-lasting infection with certain types of human
papillomavirus (HPV)is the main cause of cervical cancer.
• When cervical cancer is found early, it is highly treatable and associated

with long survival and good quality of life. The advisory committee on
Immunization practices recommended routine use of the HPV vaccine in
boys 11 to 12 years old, as well as catch up vaccination in adolescent
boys and men aged 13 to 21 years.
DEFINITION
Cervical cancer is the uncontrolled growth of

abnormal cells in the lining of the cervix. The
cervix is part of the female reproductive
system and is located in the lower part of the
womb, forming the opening from the womb to
the vagina.
• The transformation zone is the area of the cervix where the
TRANSFORMATION ZONE columnar epithelium has been replaced and /or is being
replace by the metaplastic squamous epithelium.
• With the naked eye one can identify the inner border of the
transformation zone by tracing the squamocolumnar junction
and outer border by locating the distal most nabothian cysts (if
present) or crypt openings (usually visible under
magnification).
• After menopause, and through old age, the cervix shrinks with
the decreasing levels of oestrogens. Consequently, the
transformation zone may move partially, and later fully, into
the endocervical canal. Almost the cervical neoplasia occurs in
this zone, close to the squamocolumnar junction.
ETIOLOGY AND RISK FACTOR Herpes
Human papillomavirus infection (HPV) Socio Economic Factors
Immune system deficiency Oral contraceptives
Age Exposure to diethylstilbestrol (DES)

SIGN AND SYMPTOMS
Abnormal pain and bleeding
Urination discomfort
Genital warts
Abnormal discharge
SIGN AND SYMPTOMS
Lack of urinary control Anemia
Unusually heavy and long Pain during sex Weight loss & Pain
menstrual periods
STAGES STAGE 0 : Abnormal cells are found only in the first layer of the
cells lining the cervix.
STAGE 1 : The cancer is found only in the tissues of the cervix
STAGE 2 : The tumor has spread beyond the cervix to the

vagina and tissues next to the cervix
STAGE 3 : The cancer has spread throughout the pelvic area
STAGE 4 : The cancer has spread beyond the pelvic area to

nearby organs such as the bladder or rectum. The tumor may
also have spread to the lung, liver or bones
DIAGNOSTIC EVALUATION
Bimanual pelvic examination and sterile Human papilloma virus test
speculum examination (HPV typing test)
VIA (visual inspection with acidic acid) Colposcopy
Papanicolaou test (Pap

Biopsy
test).
X-ray Positron emission tomography
(PET) or PET-CT scan
Computed tomography
(CT or CAT) scan
Molecular testing of the tumor
Magnetic resonance imaging

Cystoscopy
Sigmoidoscopy
MANAGEMENT
The treatment of cervical cancer depends on several factors,
including the type and stage of cancer, possible side effects,
and the patient's preferences and overall health.
SURGERY RADIATION THERAPY SYSTEMATIC THERAPY

SURGERY Bilateral salpingo-oophorectomy
Conization
Loop electrosurgical excision procedure

Radical trachelectomy
Hysterectomy Exenteration
RADIATION THERAPY
• Radiation therapy is the use of high- energy x-rays or
other particles to destroy cancer cells. Radiation therapy
may be given alone, before surgery, or instead of surgery
to shrink the tumor.
SYSTEMATIC THERAPY
Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given
through the bloodstream to reach cancer cells throughout the body. Common ways to give systemic
therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule
that is swallowed (orally).
Chemotherapy Targeted therapy Immunotherapy

PREVENTION 1. Primary
prevention: reduce the risk
of Human Papillomavirus infection
 HPV vaccination begins for girls aged 9-13

years, before they become sexually active.
 Two Human Papillomavirus vaccines are
there - a bivalent and a quadrivalent
vaccine.
 The quadrivalent vaccine -100% protection
against types 16 and 18, cause 70% of all
cervical cancers.
•
Vaccination Recommended
• Girls and boys - 9 to 11years old, and for • For teens and young adults (ages 15 – 26) its
older kids who aren’t yet vaccinated. given in three shots over a 6- month period.
• For kids and teens ages 9- 14, the HPV
vaccine is given in shots over a 6 – 12 • People with weak immune systems also get
months period. 3 shots, including those 9 – 14 years old.
Who Can Get HPV Vaccination and
Who Cannot
Cost per dose
Rs. 4000
Rs. 3927
Rs.10,850
HPV vaccine Safety and Effectiveness
PREVENTION
2. Secondary prevention: screening 3. Tertiary prevention: treatment
for and treating pre- cancer of invasive cervical cancer
Early detection, by screening all women in the The goal of tertiary prevention is to decrease
target age group (30-49 years) followed by the number of deaths due to cervical cancer.
treatment of detected precancerous lesions Women suspected of having invasive cervical
can prevent the majority of cervical cancers. cancer should be referred to facilities that
Cervical cancer screening should be an offer cancer diagnosis and treatment.
essential part of a woman's routine health • Appropriate treatment in early stage of
care. It detects pre-cancer and cancer among cancer can result in cure. In advanced
women who have no symptoms and may feel stage of cancer treatment and palliative
perfectly healthy. Important aspect of care can improve quality of life, control
screening is that both precancerous lesions symptoms and minimize pain suffering.
and early cervical cancers can be treated very
successfully at this stage.
Five key messages by WORLD HEALTH ORGANISATION
All women aged 30-49

There are tests to detect early
changes in the cervix (known as years should be
pre-cancers) that may lead to screened for cervical
cancer if not treated. cancer at least once.
Cervical cancer is a There is a vaccine for girls

disease that can be There are safe and
that can help prevent
prevented. effective treatments for
cervical cancer.
these early changes.
THANK YOU ！

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CERVICAL CANCER

• Cancer starts when cells in thebody begin to grow out of control.All

• When cervical cancer is found early, it is highly treatable and associated

Cervical cancer is the uncontrolled growth of

Human papillomavirus infection (HPV) Socio Economic Factors

Immune system deficiency Oral contraceptives

Age Exposure to diethylstilbestrol (DES)

STAGE 1 : The cancer is found only in the tissues of the cervix

STAGE 2 : The tumor has spread beyond the cervix to the

STAGE 3 : The cancer has spread throughout the pelvic area

STAGE 4 : The cancer has spread beyond the pelvic area to

VIA (visual inspection with acidic acid) Colposcopy

Papanicolaou test (Pap

Molecular testing of the tumor

Magnetic resonance imaging

including the type and stage of cancer, possible side effects,

and the patient's preferences and overall health.

SURGERY RADIATION THERAPY SYSTEMATIC THERAPY

Loop electrosurgical excision procedure

Chemotherapy Targeted therapy Immunotherapy

 HPV vaccination begins for girls aged 9-13

All women aged 30-49

Cervical cancer is a There is a vaccine for girls

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