Cervical Cancer The Importance of Cervical Screening and Vaccination

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1 Cervical Cancer The Importance of Cervical Screening and Vaccination Cancer Cells Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. Normal cells grow and divide to form new cells as the body needs them.when normal cells grow old or get damaged, they die, and new cells take their place. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Cancer of the cervix typically originates from a dysplastic or premalignant lesion previously present at the active squamocolumnar junction. The transformation from mild dysplastic to invasive carcinoma generally occurs slowly within several years, although the rate of this process varies widely u Cervical Cancer is the second most common cancer among women worldwide. u Over 500,000 women worldwide die of cervical cancer annually.

2 Estimated number of cases and incidence of cervical cancer However, u Cervical cancer is the easiest gynecologic cancer to prevent. Routine cervical screening (smear tests) detects abnormal cervical cells before they have a chance to turn into cancer. Cervical cancer is a disease that develops quite slowly and begins with a precancerous condition known as dysplasia. Dysplasia is easily detected in a routine smear and is completely treatable. u Two screening tests can help prevent cervical cancer or find it early:

3 The Pap smear looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes. Most often, abnormal cells found by a smear test are not cancerous. The same sample of cells may be tested for HPV infection. Abnormal Cervix? Growths on the cervix can be benign or malignant. Benign growths are not cancer. They are not as harmful as malignant growths (cancer). Benign growths (polyps, cysts): are rarely a threat to life don t invade the tissues around them Malignant growths (cervical cancer): may be a threat to life can invade nearby tissues and organs can spread to other parts of the body

4 Risk Factors

5 HPV and Cervical Cancer

6 Symptoms Early cervical cancers usually don t cause symptoms. When the cancer grows larger, women may notice one or more of these symptoms. Infections or other health problems may also cause these symptoms. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible. Abnormal vaginal bleeding Bleeding that occurs between regular menstrual periods Bleeding after sexual intercourse, douching, or a pelvic exam Menstrual periods that last longer and are heavier than before Bleeding after going through menopause. Increased vaginal discharge Pelvic pain Pain during sex How cervical smear tests help prevent cervical cancer Routine cervical screening (smear tests) detects abnormal cervical cells before they have a chance to turn into cancer. Cervical cancer is a disease that develops quite slowly and begins with a precancerous condition known as dysplasia. Dysplasia is easily detected in a routine smear and is completely treatable. Cervical cancer is a malignant tumour deriving from cells of the cervix. Detecting and treating abnormal cervical cells early can almost always prevent cervical cancer from developing.

7 What Is a Cervical Smear Test? A cervical smear test is a simple procedure which involves gently scraping some cells from the surface of the cervix and putting them on a slide. The cells are then examined under a microscope in the laboratory to see if they are normal. Pre and early cancerous changes in the cervix can be detected by the smear. Pre-cancers and very early cervical cancers are nearly 100% curable, so early and regular screening tests can prevent nearly all deaths from cervical cancer Detection and Diagnosis Women can help reduce their risk of cervical cancer by having regular smear tests. A cervical smear test is a simple test used to look at cervical cells. Smear tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

8 Finding and treating abnormal cells can prevent most cervical cancer. Also, the cervical smear test can help find cancer early, when treatment is more likely to be effective. For most women, the smear test is not painful. It s carried out in a doctor s surgery or clinic. The nurse or doctor scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a smear test are not cancerous. The same sample of cells may be tested for HPV infection. Detection and Diagnosis If abnormal cervical smear or HPV results are found other tests will be carried out to make a diagnosis: Colposcopy: A colposcope is used to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. A colposcopy is usually done in the doctor s office or clinic. Biopsy: Biopsy under local anesthesia and pathologists then check the tissue under a microscope for abnormal cells. Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue. LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue. Endo-cervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette. Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

9 Ø CERVICAL SMEAR Ø COLPOSCOPY Ø CERVICAL BIOPSY COLPOSCOPY

10 A visual examination of the surface of the cervix using a colposcope- an instrument with magnifying lenses and a light. If abnormalities are seen, a tissue sample (biopsy) may be taken and sent for evaluation. Grades of Dysplasia Normal CIN 1 = Mild dysplasia CIN 2 = Moderate dysplasia CIN 3 = Severe dysplasia

11 Treatment options for CIN Treatments include: LEEP Laser Cryotherapy Cone Biopsy Hysterectomy may be recommended (rarely) SURGICAL MANAGEMENT Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells. LEEP (loop electrosurgical excision procedure) - a wire loop which has an electric current cuts through tissue removing cells from the mouth of the cervix. Cryotherapy

12 Hysterectomy

13 Staging If the biopsy detects cancer, the extent (stage) of the disease needs to be identified to choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it s treated as cervical cancer, not lung cancer. Doctors call the new tumor distant or metastatic disease.. Treatment for Cervical Cancer Women with cervical cancer have treatment options.

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17 Follow-up Care Regular checkups after treatment for cervical cancer are important. Checkups help ensure that any changes in health are noted and treated. Doctor s will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups include a physical exam, cervical smear tests, bloods and chest x-rays. HPV Vaccine Who should be vaccinated and when? Of the >100 types of HPV, only 15 are known to cause cancer. Immunization against the high-risk types (16 and 18) can reduce HPV infection and the cancer that may result To be most effective, the HPV vaccine should be given before a female has any type of sexual contact with another person. It is given in a series of 3 doses within 6 months. There are 2 types of vaccine in the market currently. The recommended age for vaccination are 9-26 years old. PREVENTION IS BETTER THAN CURE