CANCER CERVIX A PREVENTABLE CANCER Dr NEETA DHABHAI Sr Consultant. – Gynaecologist Member Expert - Indian Cancer Winners’ Association

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

www.winovercancer.com

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.


Incidence of Cancer Incidence of Cancer CervixCervix


Cancer of Uterine CervixCancer of Uterine Cervix


> 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


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)


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


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)


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)


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


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


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


How to prevent Cancer How to prevent Cancer CervixCervix


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


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


• 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


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.


Treatment

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


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.


HPV Vaccine


Are HPV vaccines safe?Are HPV vaccines safe?


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


3 DOSES

0, 2MTHS 6MTHS

INTRAMUSCULAR

DOSE, METHOD OF DOSE, METHOD OF ADMINISTRATION AND ADMINISTRATION AND

USAGEUSAGE


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


Thank YouThank You

For Your CommentsFor Your Comments

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CANCER CERVIX A PREVENTABLE CANCER Dr NEETA DHABHAI Sr Consultant. – Gynaecologist Member Expert - Indian Cancer Winners’ Association