Cervical Cancer. The Importance of Cervical Screening and Vaccination Programmes. Presented by Theresa Lowry-Lehnen. Nurse Practitioner and Lecturer.
RGN, BSC (HON’S) NURSING SCIENCE (SPECIALIST PRACTITIONER), PGCC, DIP COUNSELLING,
DIP ADV PSYCHOTHERAPY, BSC (HON’S) CLINICAL SCIENCE, PGCE (QTS), H. DIP. ED, MED,
PHD STUDENT HEALTH PSYCHOLOGY
The Importance of Cervical Screening and Vaccination
Cancer begins in
cells, the building
blocks that make
up tissues. Tissues
make up the
organs of the
• 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
wrong. New cells
form when the
body does not need
them, and old or
damaged cells do
not die as they
• The buildup of extra
cells often forms a
mass of tissue called a
growth or tumor.
• Changes to the DNA of a cell (mutations)
lead to cellular damage
• Mutations enable cancer cells to divide
continuously, without the need for normal
• In some cancers the unchecked growth
results in a mass, called a tumor.
Cancerous cells may invade other parts of
the body interfering with normal body
Although cancer is often referred
to as if it were a single disease, it
is really a diverse group of
diseases that affects many
different organs and cell types.
The likelihood of developing any
particular cancer depends on an
individual’s genetics, environment,
The occurrence of some cancers
may be prevented or reduced by
wise lifestyle choices.
Cancer TypesThe main types of cancer include:
• Carcinoma Cancer that begins in the skin or in tissues that line or cover
• Sarcoma Cancer that begins in bone, cartilage, fat, muscle, blood
vessels, or other connective or supportive tissue.
• Leukemia Cancer that starts in blood-forming tissue such as the bone
marrow and causes large numbers of abnormal blood cells to
be produced and enter the blood.
• Lymphoma and
Cancers that begin in the cells of the immune system.
• Central nervous
Cancers that begin in the tissues of the brain and spinal cord.
• Cervical Cancer is the
second most common
cancer among women
• Over 500,000 women
worldwide die of cervical
• Approximately every 47
minutes a woman is
diagnosed with cervical
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
CervicalCancer How does cervical cancer start?
The spread of cancer is called metastasis.
The cancer cells may attach to other tissues and grow to form new
tumors that may damage those tissues.
The cancer cells can spread by breaking away from the original
(primary) tumor. They enter blood vessels or lymph vessels, which
branch into all the tissues of the body.
Cervical cancer begins in cells on the surface of the cervix. Over time,
the cervical cancer can invade more deeply into the cervix and nearby
Risk FactorsCervicalCancer • HPV infection:
HPV infections are very common.
Most men and women who are sexually active have been
exposed to HPV. Over 85% of men and women have been
infected with HPV at some time in their lives, but most
infections clear up on their own. More than 75% of
sexually active women have been exposed to HPV by age
18-22. Some types of HPV can cause changes to cells in the
cervix. If these changes are found early, cervical cancer can
be prevented by removing or killing the changed cells
before they can become cancer cells.
• Lack of regular
Cervical cancer is more common among women who don’t
have regular smear tests. The smear test screens for
abnormal cells. Removing or killing the abnormal cells
usually prevents cervical cancer.
• Family History
Smoking cigarettes increases the risk of cervical cancer.
The body’s natural defense system: Infection or taking
drugs that suppress the immune system increases the risk
of cervical cancer.
Risk FactorsCervicalCancer • Using birth control
pills for a long
Using birth control pills for a long time (5 or more
years) may slightly increase the risk of cervical
cancer. However, the risk decreases quickly when
women stop using birth control pills.
• Having many
Studies suggest that giving birth to many children
(5 or more) may slightly increase the risk of
cervical cancer among women with HPV
DES may increase the risk of a rare form of
cervical cancer in daughters exposed to this drug
before birth. DES was given to some pregnant
women between 1940 and 1971.
(It is no longer given to pregnant women)
Having a HPV infection or other risk factors does not mean that a woman
will develop cervical cancer. Most women who have risk factors never
develop it. Women who have never been sexually active and who have
not had the HPV virus can also develop cervical cancer
About 80% of Women
will be infected with
HPV in their lifetime
HPV and Cervical Cancer
Source: Gynecologic Cancer Foundation
About 7% of
HPV and Cervical Cancer
Early cervical cancers
usually don’t cause
When the cancer grows
larger, women may notice
one or more of these
Infections or other health
problems may also cause
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
—Bleeding after sexual intercourse, douching, or a
—Menstrual periods that last longer and are
heavier than before
—Bleeding after going through menopause.
Increased vaginal discharge
—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 pre-cancerous condition known as dysplasia.
•Dysplasia is easily detected in a routine smear and is
•Cervical cancer is a malignant tumour deriving from cells of
•Detecting and treating abnormal cervical cells early can
almost always prevent cervical cancer from developing.
Between 60% and 80% of women diagnosed with cervical cancer had not had a smear
test within 5 years of their diagnosis.
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
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 DiagnosisCervicalCancer
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
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
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 DiagnosisCervicalCancer
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
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
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.
A visual examination of the
surface of the cervix using
a colposcope- an
magnifying lenses and a
If abnormalities are seen, a
tissue sample (biopsy)
may be taken and sent for
May feel like getting a smear test or like a
menstrual cramp that lasts a few seconds
Grades of Dysplasia
CIN 1 = Mild dysplasia
CIN 2 = Moderate dysplasia
CIN 3 = Severe dysplasia
Treatment options for CIN
• Cone Biopsy
• Hysterectomy may
–Laser surgery - a narrow beam of
intense light destroys cancerous and
–LEEP (loop electrosurgical excision
procedure) - a wire loop which has an
electric current cuts through tissue
removing cells from the mouth of the
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..
• Stage I: The tumor has invaded the cervix beneath the top layer of cells.
Cancer cells are found only in the cervix.
• Stage II: The tumor extends to the upper part of the vagina. It may
extend beyond the cervix into nearby tissues toward the pelvic
wall (the lining of the part of the body between the hips). The
tumor does not invade the lower third of the vagina or the
• Stage III: The tumor extends to the lower part of the vagina.
It may also have invaded the pelvic wall.
If the tumor blocks the flow of urine, one or both kidneys may
not be working well.
• Stage IV: The tumor invades the bladder or rectum.
Or the cancer has spread to other parts of the body.
The cancer was treated, but has returned after a period of time
during which it could not be detected. The cancer may show up
again in the cervix or in other parts of the body.
Treatment for Cervical CancerCervicalCancer
Women with cervical cancer have
The options are
or a combination of
The choice of treatment depends mainly on
the size of the tumor and whether the cancer
has spread. The treatment choice may also
depend on whether the woman wishes to
become pregnant someday.
Cancer treatments often damage healthy cells
and tissues, so side effects are common.
Side effects may not be the same for each
person, and they may change from one
treatment session to the next.
Surgery is an option for women with Stage I or II cervical cancer.
The surgeon removes tissue that may contain cancer cells:
Removal of the cervix, part of the vagina, and the lymph
nodes in the pelvis.
Recommended for a small number of women with small
tumors who may want to try to get pregnant in the future.
Removal of the cervix and uterus.
Removal of the cervix, some tissue around the cervix, the
uterus, and part of the vagina.
The surgeon may remove both fallopian tubes and ovaries.
This surgery is called a salpingo-oophorectomy.
The surgeon may remove the lymph nodes near the tumor
to see if they contain cancer.
If cancer cells have reached the lymph nodes, it means the
disease may have spread to other parts of the body.
Radiation therapy (radiotherapy) is an option
for women with any stage of cervical cancer.
• Early stages of cervical cancer can be treated with
radiation therapy instead of surgery.
• It may also be used after surgery to destroy any cancer
cells that remain in the area.
• Cancer that extends beyond the cervix may have
radiation therapy and chemotherapy.
• Radiation therapy uses high-energy rays to kill cancer
cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat cervical
cancer. Some women receive both types:
A large machine directs radiation at the pelvis or other tissues
where the cancer has spread. The treatment usually is given
in a hospital or clinic. External radiation usually takes place 5
days a week for several weeks.
Each treatment takes only a few minutes.
A thin tube is placed inside the vagina. A radioactive
substance is loaded into the tube. The patient may need to
stay in the hospital while the radioactive source is in place (up
to 3 days). Or the treatment session may last a few minutes,
and the patient can go home afterwards.
Once the radioactive substance is removed, no radioactivity is
left in the body. Internal radiation may be repeated two or
more times over several weeks.
For the treatment of cervical cancer, chemotherapy is usually
combined with radiation therapy.
However depending on the type of cancer chemotherapy can
also be used alone.
Chemotherapy uses drugs to kill cancer cells. Cytotoxic
medication prevents cancer cells from dividing and growing.
The drugs for cervical cancer are usually given through a vein
(intravenous). prevents cancer cells from dividing and growing
Chemotherapy can take place at a clinic, at the doctor’s
surgery, or sometimes at home.
Some women need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much.
Chemotherapy kills fast-growing cancer cells, but the drugs can also harm
normal cells that divide rapidly:
Chemotherapy lowers the levels of healthy blood cells,
and the patient is more susceptible to infections, bruise
or bleed easily, feel very weak and tired. Blood tests will
check for low levels of blood cells. If levels are low,
chemotherapy may be stopped for a while or the dose
of drug reduced. There are also medicines to help the
body make new blood cells.
Cells in hair
Chemotherapy may cause hair loss. It will grow back,
but it may change in color and texture.
Chemotherapy can cause a poor appetite, nausea and
vomiting, diarrhoea, or mouth and lip sores.
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.
• 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
• Recommendations for each age group:
• Girls ages 11 to 12
The vaccine should be given to girls ages 11 to 12 and as early as age 9.
• Girls ages 13 to 18
Girls ages 13 to 18 who have not yet started the vaccine series or who have
started but have not completed the series should be vaccinated.
• Young women ages 19 to 26
Some authorities recommend vaccination of women ages 19 to 26, but the
American Cancer Society experts believed that there was not enough evidence of
the benefit to recommend vaccinating all women in this age group.
• It is recommended that women ages 19 to 26 talk to their doctors about whether
to get the vaccine based on their risk of previous HPV exposure and potential
benefit from the vaccine
Who should be vaccinated and when?
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