cervical cancer. dr. swapna chaudhary m.s. (mum) consultant obstetrician & gynaecologist...
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Cervical Cancer
Cervical Cancer
Dr. Swapna Chaudhary M.S. (MUM)
Consultant Obstetrician & Gynaecologist
Infertility Specialist
Cervix
Cervix
• Cervix constitutes lower 1/3rd of uterus
Epidemiology
Epidemiology
• 5 lac new cases / year around world
Epidemiology
• 5 lac new cases / year around world• 80% in developing countries
Epidemiology
• 5 lac new cases / year around world• 80% in developing countries• Commonest gynecological malignancy in
India
Epidemiology
• 5 lac new cases / year around world• 80% in developing countries• Commonest gynecological malignancy in
India• 2nd is breast cancer
Risk Factors / Causes
Risk Factors / Causes
• Multiple sexual partners (> 1)
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse • Early childbearing / Multiparity
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse • Early childbearing / Multiparity• Prior STDs (HSV II, genital warts, vaginal infections)
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse • Early childbearing / Multiparity• Prior STDs (HSV II, genital warts, vaginal infections)• Cigarette Smoking
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse • Early childbearing / Multiparity• Prior STDs (HSV II, genital warts, vaginal infections)• Cigarette Smoking• Immunodeficiency
Risk Factors / Causes
• Multiple sexual partners (> 1)• Young age at marriage / first intercourse • Early childbearing / Multiparity• Prior STDs (HSV II, genital warts, vaginal infections)• Cigarette Smoking• Immunodeficiency• Human Papiloma Virus (HPV) – transforms normal cell
into malignant cells
Age Groups
Age Groups
• Cervical Intraepithelial Neoplasia (CIN) 35 years
Age Groups
• Cervical Intraepithelial Neoplasia (CIN) 35 years• Invasive Cervical Cancer 45 - 55
years
Symptoms
Symptoms
• CIN (dysplasia): Asymptomatic
Symptoms
• CIN (dysplasia): Asymptomatic• Invasive Cancer
1. No classic presentation
Symptoms
• CIN (dysplasia): Asymptomatic• Invasive Cancer
1. No classic presentation
2. Abnormal bleeding -- intercycle
-- post coital
-- post menopausal
Symptoms
• CIN (dysplasia): Asymptomatic• Invasive Cancer
1. No classic presentation
2. Abnormal bleeding -- intercycle
-- post coital
-- post menopausal
3. Foul smelling vaginal discharge
4. Chronic backache / pelvic pain
4. Chronic backache / pelvic pain
5. Late sign -- weight loss
-- mild fever
-- anemia
Dysplasia / CIN
Dysplasia / CIN• Precancerous stage
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
CIN
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
CIN
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
CIN
I mild
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
CIN
I II mild mod
Dysplasia / CIN• Precancerous stage• First series of changes leading to cancer• Age of presentation – 35 yrs
CIN
I II III mild mod severe
• 25 % patients progress from CIN 1 to CIN 3 in 2 yrs
• 25 % patients progress from CIN 1 to CIN 3 in 2 yrs
• 40 % patients of CIN 3 progress to Cancer over 10 – 15 yrs.
Pap Smears
Pap Smears
• Non invasive OPD procedure
Pap Smears
• Non invasive OPD procedure• No pain / no discomfort
Pap Smears
• Non invasive OPD procedure• No pain / no discomfort• No anesthesia required
When to Get Pap Smears
When to Get Pap Smears• ACOG Recommendations
When to Get Pap Smears• ACOG Recommendations
– 1st Pap Smear at age when patient becomes sexually active (or by age 18)
When to Get Pap Smears• ACOG Recommendations
– 1st Pap Smear at age when patient becomes sexually active (or by age 18)
– Yearly pap smears thereafter
When to Get Pap Smears• ACOG Recommendations
– 1st Pap Smear at age when patient becomes sexually active (or by age 18)
– Yearly pap smears thereafter• Others contend that monogamous women
with no history of abnormal pap smears can have them done every 3 years
When to Get Pap Smears• ACOG Recommendations
– 1st Pap Smear at age when patient becomes sexually active (or by age 18)
– Yearly pap smears thereafter• Others contend that monogamous women
with no history of abnormal pap smears can have them done every 3 years
• After 40 – yrly pap test for 3 yrs – if normal then 3 yrly.
• Routine screening can stop at age of 60 yrs provided….
• Routine screening can stop at age of 60 yrs provided
1.Previous 2 normal smears
• Routine screening can stop at age of 60 yrs provided
1.Previous 2 normal smears
2.No abnormal smear in last 10 yrs
• Routine screening can stop at age of 60 yrs provided
1.Previous 2 normal smears
2.No abnormal smear in last 10 yrs• Routine screening not required for
patients who had hysterectomy for benign disease (eg. Fibroid)
Performing Pap Smear
Performing Pap Smear
• Cervix visualised – superficial layer of cells in cervical canal taken on a spatula or swab stick – spread on a slide, fixed and stained with Papanicolou stain – examined under mircoscope
Performing Pap Smear
• Cervix visualised – superficial layer of cells in cervical canal taken on a spatula or swab stick – spread on a slide, fixed and stained with Papanicolou stain – examined under mircoscope
• If abnormal cells seen – patient referred for biopsy
Evaluating the Pap Smear
Evaluating the Pap Smear
• First, the smear is evaluated for adequacy of sample
Evaluating the Pap Smear
• First, the smear is evaluated for adequacy of sample
• Secondly the sample is categorized as “normal” or “other”
Evaluating the Pap Smear
• First, the smear is evaluated for adequacy of sample
• Secondly the sample is categorized as “normal” or “other”
• Lastly, all sample categorized as “other” are further specified as infection, inflammation, CIN or Cancer suspect
Evaluating the Pap Smear
• First, the smear is evaluated for adequacy of sample
• Secondly the sample is categorized as “normal” or “other”
• Lastly, all sample categorized as “other” are further specified as infection, inflammation, CIN or Cancer suspect (biopsy confirmation).
What to Inform Patients Prior to Obtaining Pap Smear
What to Inform Patients Prior to Obtaining Pap Smear
• No douching or usage of vaginal medications, lubricants, or spermicides within 2-3 days of exam (these products may hide abnormal cells)
What to Inform Patients Prior to Obtaining Pap Smear
• No douching or usage of vaginal medications, lubricants, or spermicides within 2-3 days of exam (these products may hide abnormal cells)
• Schedule Pap Smear between days 12-16 of menstrual cycle, if possible
What to Inform Patients Prior to Obtaining Pap Smear
• No douching or usage of vaginal medications, lubricants, or spermicides within 2-3 days of exam (these products may hide abnormal cells)
• Schedule Pap Smear between days 12-16 of menstrual cycle, if possible
• Abstain from intercourse 1-2 days prior to smear
Improving Access to Pap Smears
Improving Access to Pap Smears
• 50% of patients who die of cervical cancer have never had a Pap Smear
Improving Access to Pap Smears
• 50% of patients who die of cervical cancer have never had a Pap Smear
• Uninsured, older patients and those who live in rural areas have limited access to Pap Smears
Improving Access to Pap Smears
• 50% of patients who die of cervical cancer have never had a Pap Smear
• Uninsured, older patients and those who live in rural areas have limited access to Pap Smears
• These groups must be targeted to reduce rates of cervical cancer.
Treatment
Treatment
• Surgery for early stage 1
Treatment
• Surgery for early stage 1• Stage 2 onwards radiotherapy and / or
surgery
Prognosis
Prognosis
• CIN cure rate 95 – 100%
Prognosis
• CIN cure rate 95 – 100%• Stage 1 – after treatment – 5 yr survival
80%
Prognosis
• CIN cure rate 95 – 100%• Stage 1 – after treatment – 5 yr survival
80%• Decreased to 14 % for Stage 4
Thank you