Cervical Cancer Cancer in the cervix of the uterus is called cervical cancer. Cells change from normal to pre-cancer (dysplasia) and then to cancer Mainly occurs in the transitional zone.
Affects 16 per 100,000 women per year and dies about 9 per 100,000 per year in world Population. Every year 452,000 new cases of cervical cancer are detected, according to World Health Organization. More than 2000 new cases being detected each year in Nepal.
Squamous cell Carcinomas Cancer of flat epithelial cell 80% to 90% Adenocarcinoma Cancer arising from glandular epithelium 10% to 20% Mixed carcinoma Features both types
Human Papilloma virus infection (HPV) – Primary factor HPV 16, HPV 18, HPV 31, HPV 33, HPV 45 50% are caused by HPV 16 AND 18 Sexual behavior/ multiple sex partner. Smoking HIV infection /Immunocompromised state. Chlamydia infection Oral contraceptives Multiple pregnancies.
HPV causes the production of two proteins known as E6 and E7. When these proteins are produced, they turn off some tumor suppressor genes. This may allow the cervical lining cells to grow uncontrollably, which in some cases will lead to cancer
Association of cervical cancer with oral contraceptive use is likely to be indirect The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer.
Vaginal bleedingMenstrual bleeding is longer and heavierthan usualBleeding after menopause or increasedvaginal dischargeBleeding following intercourse or pelvicexam
Cervical Cytology (Pap Test): Cells are removed from the cervix and examined under the microscope. Can detect epithelial cell abnormalities • Atypical squamous cells • Squamous intraepithelial lesions • Squamous cell carcinoma (likely to be invasive)
Colposcopy: • Cervix is viewed through a colposcope and the surface of the cervix can be seen close and clear. Cervical Biopsies: • Colposcopic biopsy – removal of small section of the abnormal area of the surface. • Endocervical curettage – removing some tissue lining from the endocervical canal. • Cone biopsy – cone-shaped piece of tissue is removed from the cervix
Surgery Pre invasive cervical cancer • Cryosurgery • Laser surgery • Conization Invasive cervical cancer • Simple hysterectomy Removal of the body of the uterus and cervix. • Radical hysterectomy and pelvic lymph node dissection Removal of entire uterus, surrounding tissue , upper part of the vagina, and lymph nodes from the cervix. Radiation Chemotherapy Follow up after treatment.
Avoiding the risk factors Especially HPV Long term use of OCP Having the Pap Test 3 years after first vaginal intercourse or by age 21 years. Have test annually Use physical barrier for safe sex.