Cervical cancer is a major health problem, especially in developing countries like India. It is caused by certain strains of the human papillomavirus (HPV). Regular Pap screening can detect precancerous cell changes early when treatment is most effective. The HPV vaccine, when administered before sexual debut, can prevent HPV infection and thus most cervical cancers. Together, vaccination and screening can end cervical cancer as a major public health problem.

1. Cervical cancer
Prepared by
DR.RAVICHANDRAVARMAS

3. WHAT IS CANCER?

4.  CANCER IS AN ABNORMAL AND AN EXCESSIVE GROWTH
OF CELLS WHICH ARE INCAPABLE OF DOING NORMAL
PHYSIOLOGICAL FUNCTION
 Cancer is one of the most common diseases in the world:
 1 in 4 deaths are due to cancer
 Lung cancer is the most common cancer of men in world
but oral cancer in india
 Breast cancer is the most common cancer of women but
cervical cancer in india

5. WHAT IS THE FEMALE RE
PRODUCTIVE TRACT ?
 Vulva
 Vagina
 Cervix
 Uterus
 Fallopian tubes
 Ovaries

7. WHAT IS THE CERVIX ?
 Opening of the
uterus (womb) into
the vagina
 Cancer that affecting
Cervix is called
cervical cancer

8. Global Cervical Cancer Incidence,
2012

9. Global Cervical Cancer Mortality, 2012

10. How does cancer develops

11. CERVICAL CANCER
EVERY YEAR
WORLD WIDE - 5 LAKH
INDIA - 1.2 LAKH
30-40% OF TOTAL INDIAN
POPULATION AT RISK FOR CERVICAL
CANCER

12. How common is HPV?
Most men and women who have
had sex have been exposed to HPV
More than 75% of sexually active
women have been exposed to
HPV by age 18-22

13. If I have HPV, does it mean I will
get cancer?
NO!
In most cases HPV infection will
go away
Only women with persistent HPV
(where the virus does not go
away) are at risk for cervical
cancer

14. WHO IS AT RISK ?
 EARLY MARRIAGE
 YOUNG AGE AT FIRST PREGNANCY
 SHORT INTEVAL BETWEEN PREGNANCY
 POOR NUTRITION
 POOR HYGEINE
 WOMEN WITH STD
 WOMEN WITH MULTIPLE SEXUAL PARTNER
 HUSBAND WITH MULTIPLE SEXUAL PARTNER
 SMOKING

15. How do I lower my risk?
 Delay onset of sexual activity or remain
abstine
 Do not smoke
 Maintain a healthy diet and lifestyle
 Practice safe sex. Condoms decrease the
chance of HPV exposure.
 If eligible, consider getting the vaccine
that prevents most cervical cancers.
 Get your Pap test and HPV testing as
recommended by your health care
provider.

16. SYMPTOMATOLOGY
ASYMPTOMATIC IN EARLY STAGES
BLEEDING
- POST COITAL
- INTERMENSTRUAL
- POST MENOPAUSAL
VAGINAL DISCHARGE
PAIN
RECTAL / URINARY SYMPTOM

17. WHAT CAUSES CERVICAL CANCER
?
The central cause of cervical cancer is
human papillomavirus or HPV:
 HPV is transmitted through sexual contact
 The HPV detected today could have been
acquired years ago
 There are many different types of HPV that
can infect the cervix, vagina and vulva
 ‘Low-risk’ types may cause genital warts
 ‘High-risk’ types may cause precancer and cancer of the
cervix
• Most women who are infected with HPV will
never have any symptoms

18.  CERVICAL CANCER IS THE CANCER
AFFECTING THE CERVIX OF THE UTERUS
 2ND MOST COMMON CAUSE OF CANCER
DEATH IN THE WORLD AND 1ST CAUSE IS
THE BREAST CANCER

19.  BUT IN THE DEVELOPING COUNTRIES
LIKE INDIA CERVICAL CANCER IS THE 1ST
CAUSE OF DEATH

20. Cancers that can be prevented or detected early by screening account for at
least 50% of all new cancer cases.
Cancer Facts & Figures 2009
Prevention & Early Detection

21. How we can prevent?
1.Vaccination
2.Regular pap smear screening

22. Vaccination
 human papilloma vaccine

25. Prophylactic HPV Vaccine
Approved for Adolescent Girls
Vaccine HPV Types FDA approved Age range
Bivalent 16/18 2009 10-25* yrs
Quadrivalent 6/11/16/18 2006 9-26* yrs
*Routine vaccination for 11-12 year old females

26. Bivalent vaccine is called cervarix and a
quadrivalent vaccine guardasil
Three doses of guardasil given
intramuscular route at 0,2months and
6months
Single dose of guardasil cost about
2500rupees

28. Screening

29. CERVICAL CANCER – IDEAL FOR
SCREENING
CERVIX EASILY ACCESSIBLE FOR
EXAMINATION
LONG LATENT PRECANCEROUS PHASE
NATURAL HISTORY KNOWN

30. What is a Pap test?
 Cells are collected from the surface of
your cervix by a doctor
 These cells are then checked under a
microscope for any abnormalities
 If abnormal (or precancerous) cells
are found, they can be treated before
they turn into cancer
 Cervical cancer can be found in the
early stages, when it is easier to treat

31. PAP SMEAR
 Papanicolaou test –
exfoliative cytology
test
 cells collected are
from normally
shedding epithelium
.
◦ collected using
spatulas or brushes.
◦ Specimen is fixed,
stained and studied
for morphology under
microscope.

32. SAMPLING INSTRUMENTS
 AYRE’S SPATULA

33. SpreadingSpread the material collected on the
spatula / cervix brush evenly over the
slide with a painting action and single
smooth stroke motion using both sides

34. Finding early cell changes
Normal cervical cells Precancer
cells

35. 30-64 Years21-29 Years<21 Years
No routine
Pap smear
Pap Smear Guidelines: 2009
American College of Obstetrics and
Gynecology
Pap smear every 3
years
..if patient has had
3 or more normal
Pap results in a
row, no abnormal
test results in 10
years, and lacks
other risk factors.**History of cervical cancer or DES in utero, HIV positive,
immunosuppression, or other risk factors for acquiring
STDs.
Bi-annual
Pap smear
ACOG Practice Bulletin No. 109. Obstet Gynecol. 2009;114:1409-20.
≥65 Years
Consider
discontinuing Pap
smear at 65 or 70
years
..if patient has had
3 or more normal
Pap results in a
row, no abnormal
test results in 10
years, and lacks
other risk factors.*

36. Most cervical cancer can be
prevented
 Cervical cancer is very rare in women
who get regular Pap tests

37. Creating messages to improve
women’s awareness:
 Target messages
to reach women at
highest risk of
cervical cancer
(generally aged 30
- 50).
 Involve women in
creating prevention
messages and
programs.

38. Barriers to women’s
participation in screening:
 Little understanding of cervical cancer
 Limited understanding of female reproductive organs
and associated diseases
 Lack of access to services
 Shame and fear of a vaginal exam
 Fear of death from cancer
 Lack of trust in health care system
 Lack of community and family support
 Concept of “preventive care” is foreign

39. Common misconceptions about
cervical cancer:
 People often do not know that it is preventable
 Belief that screening involves STI/HIV screening
 Belief that a positive/abnormal Pap smear result
means a woman will die
 Research found that:
◦ In South Africa and Kenya, women often think a
positive screening test means they have HIV
◦ In Mexico, women fear that treatment will leave
them sexually disabled

40. Places to reach women:
 Local women’s groups
 Community centers
 Women’s workplaces
 Places of worship
 Health facilities
 Women’s homes
 Schools (parent’s
groups)
 Markets

42. What We Do – Save Lives
Helping peoplestay well
Byeducatingthem on stepstheycantaketoprevent cancerandfindit early
Helping peopleget well
Byproviding accurateandtimely informational,emotional,andpracticalsupport
services
Funding cancerresearch
Tofurtherunderstandits causes,determinehowbest toprevent it, anddiscovernew
waysto cureit.
Fighting backagainstcancer
Bysupportingthe indian CancerSocietyandthosein yourlife whoareaffectedby
cancer,youcanjoin us in creating aworldwithmorebirthdays!

43. We can End Cervical Cancer
Policy Makers
Vaccination
Screening

44. Questions?