gynecology; cervical cancer

1. CERVICAL CANCER

2. Cervical cancer is a malignant tumour
deriving from cells of the "cervix
uteri", which is the lower part, the
"neck" of the womb, the female
reproductive organ.
Cells change from normal to pre-
cancer (dysplasia) and then to cancer.
Mainly occurs in the transitional zone.

4. WORLDWIDE MORBIDITY
Cervical cancer is the fourth most common
cancer in women, and the seventh overall, with
an estimated 528,000 new cases in 2012. As
with liver cancer, a large majority (around 85%)
of the global burden occurs in the less
developed regions, where it accounts for almost
12% of all female cancers. High-risk regions,
with estimated ASRs over 30 per 100,000,
include Eastern Africa (42.7), Melanesia (33.3),
Southern (31.5) and Middle (30.6) Africa. Rates
are lowest in Australia/New Zealand (5.5) and

5. WORLDWIDE MORTALITY
There were an estimated 266,000 deaths from
cervical cancer worldwide in 2012, accounting
for 7.5% of all female cancer deaths. Almost
nine out of ten (87%) cervical cancer deaths
occur in the less developed regions. Mortality
varies 18-fold between the different regions of
the world, with rates ranging from less than 2
per 100,000 in Western Asia, Western Europe
and Australia/New Zealand to more than 20 per
100,000 in Melanesia (20.6), Middle (22.2) and
Eastern (27.6) Africa.

6. I N C I D E N C E

7. M O R T A L I T Y

8. RISK FACTORS

9. Human Papillomavirus
Infection with the common human
papillomavirus (HPV) is a cause of
approximately 90% of all cervical cancers.
About half of the sexually transmitted
HPVs are associated with cervical cancer.

10. IF I HAVE HPV, DOES IT MEAN I WILL
GET CANCER?
No! Most people get HPV infection, but very few get cervical cancer
In most cases, HPV infection goes away on its own
Sometimes, the HPV infection does not go away after many years.
This type is called “persistent”. It can lead to cervical cancer

11. Lack of regular Pap Smear tests: Cervical cancer is more common
among women who don’t have regular Pap tests. The Pap test helps
doctors find abnormal cells. Removing or killing the abnormal cells
usually prevents cervical cancer.
• Smoking: Among women who are infected with HPV, smoking
cigarettes slightly increases the risk of cervical cancer.
• Weakened immune system: the body’s natural defense system):
Infection with HIV (the virus that causes AIDS) or taking drugs that
suppress the immune system increases the risk of cervical cancer.
• Sexual history: Women who have had many sexual partners have a
higher risk of developing cervical cancer. Also, a woman who has had
sex with a man who has had many sexual partners may be at higher
risk of developing cervical cancer. In both cases, the risk of
developing cervical cancer is higher because these women have a
higher risk of HPV infection. Also, a woman is at a higher risk if she
began having sexual relations before the age of 18

12. • Using birth control pills for a long time: Using birth
control pills for a long time (5 or more years) may
slightly increase the risk of cervical cancer among
women with HPV infection. However, the risk decreases
quickly when women stop using birth control pills.
• Having many children: Studies suggest that giving
birth to many children (5 or more) may slightly
increase the risk of cervical cancer among women with
HPV infection.
• DES (diethylstilbestrol): 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 in the United States between about 1940 and
1971. (It is no longer given to pregnant women.)
Having an HPV infection or other risk factors does not
mean that a woman will develop cervical cancer. Most

13. CERVICAL CANCER IN
NIGERIA

14. NUMBER OF CANCER CASES BY
AGE GROUP & GENDER(ICR, 1960-
69) 7
14

15. AGE DISTRIBUTION OF
CANCERS IN LUTH;
2007(MORBID ANATOMY,
LUTH)
15

16. 16

17. DISTRIBUTION OF CANCERS SEEN AT THE MORBID ANATOMY
DEPARTMENT IN LUTH (2007)
17

18. It is the 2nd most common cancer in Nigerian women
and the most common female genital cancer
constituting a major cause of mortality among
Nigerian females in their most productive years.
It was the commonest cancer reported from Ibadan,
Eruwa, Zaria, Jos, Benin and Calabar and in the early
years, 2nd to breast in Enugu and Ife-Ijesha.
A steady increase was reported by Babarinsa et al in
Ibadan in between 1975-1995 which was
attributed to poor screening facilities, and lack of
organized national screening programme.
18

19. Recent data shows that it has however
been overtaken by breast cancer; except in
Kano where it was reported as the most
common cancer in both sexes ; In Jos, it is
the most common female cancer.
On the other hand, incidence of other
gynae cancers such as choriocarcinoma
and endometrial has reduced drastically.
19

20. The age range is between 17-80yrs with peak in
the 5th decade.
Patients are multiparous with average parity of
5.6-6.5.
Multiple marriages, late presentation are common
and majority of the patients have not had Pap
smear done before.
Squamous cell carcinoma is the most common
(90-91%) histological type while adenocarcinoma
represents 2.4% to 5.1%.
20

21. HPV is a necessary cause of cervical cancer
being present in 99.9% of cases.
In a study of 233 cases of cervix cancer
from Lagos, HPV 16 and 18 were present in
65.2%.
This supports data that effective vaccination
against these 2 types will reduce the cervical
burden in Nigeria.
It gladdens the heart to know that the
Federal Ministry of Health has already given
license to bring in vaccines
21

22. Institution of organized screening
programs to detect the pre-cancerous
stage has reduced the mortality and
morbidity of this cancer in developed
countries. This can also be done in Nigeria
with strong commitment
A cheaper method by using VIA has been
reported to be acceptable and effective.
22

23. PREVENTION

24. DIET AND CANCER
1. Avoid food and drinks that are high in sugar
2. Eat more plant-based foods of a variety of vegetables, fruits, whole
grains, peas, beans, lentils.
3. Limit processed meats and red meats
4. Avoid alcohol
5. Limit the use of salty foods and foods processed with salt
(sodium).
6. Avoid using supplements for cancer prevention. .
7. Phytonutrients and antioxidants.

25. VACCINATION
Two HPV vaccines licensed for use to protect against the virus
types that cause most cervical cancer tumors, and one
protects against genital warts. Approximately 70% of cervical
cancerous tumors are caused by HPV viral types 16 or 18, and
about 90% of genital warts are caused by viral types 6 and 11.
The bivalent HPV2 vaccine (Cervarix, GlaxoSmithKline)
protects against two oncogenic types (HPV 16 and 18).
The quadrivalent HPV4 vaccine (Gardasil, Merck) protects
against two oncogenic types (HPV 16 and 18) and two non-
oncogenic types (HPV 6 and 11). Thus, prophylactic
immunization could prevent many tumors, warts, and genital
cancers; reduce treatment costs; prevent distressing

26. SCREENING

27. INCIDENCE
RATE OF ALL
CANCERS IN
GEORGIA

28. PREVALENCE
RATE OF ALL
CANCERS IN
GEORGIA

29. INCIDENCE
RATE OF
CERVICAL
CANCER IN
GEORGIA

30. PREVALENCE
RATE OF
CERVICAL
CANCER IN
GEORGIA

31. AGE-SPECIFIC
INCIDENCE
RATE

32. PIE CHART FOR CERVICAL CANCER
STAGES AT THE DIAGNOSIS IN 2006
11%
39%
23%
25%
2%
2006
Stage 1 Stage 2 Stage 3 Stage 4 Unknown

33. PIE CHART FOR CERVICAL CANCER
STAGES AT THE DIAGNOSIS IN 2007
11%
35%
27%
24%
3%
2007
Stage 1 Stage 2 Stage 3 Stage 4 Unkown

34. PIE CHART FOR CERVICAL CANCER
STAGES AT THE DIAGNOSIS IN 2008
12%
36%
22%
25%
5%
2008
Stage 1 Stage 2 Stage 3 Stage 4 Unkown

35. PIE CHART FOR CERVICAL CANCER
STAGES AT THE DIAGNOSIS IN 2009
10.7, 11%
25.3, 25%
29.5, 29%
30.6, 31%
3.9, 4%
2009
Stage 1 Stage 2 Stage 3 Stage 4 Unkown