Cervical cancer is the third most common cancer worldwide and occurs in the cervix of the uterus. Every year in India, over 122,000 women are diagnosed with cervical cancer and nearly 67,000 die from the disease. The main cause is human papillomavirus (HPV). Diagnosis is carried out through procedures like Pap smear tests and treatments include chemotherapy, radiation therapy, surgery, and immunotherapy. Prevention focuses on HPV vaccination, screening, and healthy lifestyle habits.

1. cervical
Cancer
Presentedby: Dr. Pallavi Pathania

2. Cervical cancer
Magnitude of the problem
• Cervical cancer is the third most common cancer worldwide.
• 500,00 new cases are identified each year.
• 80% of the new cases occur in developing countries.
• At least 200,000 women die of cervical cancer each year.
• About 15% of cervical cancer are diagnosed in women over age 65
years.

3. Cervical cancer
• Few women under the age of 20 years are diagnosed
with cervical cancer.
• Cervical cancer is easily accessible to early diagnosis
and treatment which can drastically reduce the
mortality.
• More importantly, to a large extent cervical cancer is a
preventable disease.

4. CERVICAL CANCER
 Cancer in the cervix of the uterus is called
cervical cancer.
 Cells changes from normal to pre-
cancerous and then to cancerous state .
 It is due to abnormal growth of cells that
have the ability to invade or spread to
other parts of the body.
Cervical cancer

5. Cervical cancer
• High proportion of women are diagnosed at an advanced
stage due to:
Lack of knowledge among women of the relevance of symptoms.
Fatalistic attitude towards cancer and possibility of being cured.
Lack of availability of health care in rural areas.
Low priority of women’s health issues.

6. Continued……
 Low socio-economical status of the women.
 Poor hygienic health practices.
 Negligency towards maintenance of own health.

7. Cervix is the opening of the
uterus (womb) into the vagina.
Two type of cells present:
1)Squamous
2)Glandular
 Cervical cancer tends to occur
where the two cells type meets

8. Cervical Cancer
• Cervical cancer is a type
of cancer that occurs in the cells
of the cervix — the lower part of
the uterus that connects to the
vagina.

11. SQUAMOUS CELL
CARCINOMA
ADENO
CARCINOMA

13. INCIDENCE

14. • Cervical cancer is the 3rd most common cancer
worldwide.
• Every year in India 1,22,844 women are diagnosed
with cervical cancer and 67,477 dies from the
disease. Cancer of the cervix has been the most
important cancer among women in past two
decades.
• In the hilly Districts of Himachal Pradesh, cervical
cancer is a major public health problem since it
ranks as the number one female cancer as per the
annual report of Regional Cancer Centre.

35. FEVER

39. • History collection - excessive discharge
from vagina, burning sensation, pelvic pain,
bleeding.
• Physical examination - pelvic
examination, recto-vaginal examination.
• Lab test - Complete Blood Count(CBC)
• PAP test - papanicolaou test is method of
cervical screening
• CT – Scan (Computed tomography)
• MRI ( Magnetic Resonance Imaging)
• PET (Positron Emission Tomography)

40. Per-vaginal examination is done manually through
vaginal passage so as to examine the internal pelvic
organs.

42. PAP SMEAR TEST
 Pap smear testing is done to take sample of the cancerous cells in the cervix which helps to
diagnose presence and growh of HPV infection.
 Who should get the Pap test done?
 As per the international recommendation, the eligible age of screening is 21 years.
 When is the test conducted?
- The test is conducted during the days of the month when the women is not menstruating.
 Preparation for Pap Smear Test:-
• Following should be avoided 48 hours before the test:
- Sexual intercourse
- Douching of vagina
- Vaginal medications
-Vaginal contraceptives like creams/jellies

43. Continued….
Course of Pap Smear Test :-
- This test is recommended to be carried out annually to reduce risk of
HPV infection.
- If you had prior negative results of the pap test then below 30 years the
test surely be repeated in every 3 years interval.
- And for the women below 65 years of age are recommended to be
tested every 5 years intervals if had a prior 2-3 results of the test
negative.

44. BARRIERS TO CERVICAL SCREENING
PRIVACY
CONCERNS
LOW SOCIO-
ECONOMIC STATUS
IGNORANCE
TOWARDS
OWN
HEALTH
FEAR OF
SURGICAL
PROCEDURES
FAMILIAL ISSUES

47. OTHER INVESTIGATING STUDIES
CT
SCAN MRI
CYTOGR-
AM
BARRIUM
X-RAY

48. 1) C.T. Scan

49.  CT SCAN (Computed tomography)
• A CT Scan also known as Computed Tomography scan makes
use of computer processed combinations of many x-ray
measurements taken from the different angles to produce cross-
sectional images of specific areas of a scanned object, allowing
the user to see inside the object without cutting.
• It further generates a three-dimensional volume of the inside of
the object from a large series of two –dimensional radiographic
images taken around a single axis of rotation.

50. 2) MAGNETIC RESONANCE IMAGING (MRI)

51.  MAGNETIC RESONACE IMAGING
(MRI)
• Magnetic resonance imaging also known as MRI Scan is a medical
imaging technique used to form pictures of the anatomical and
physiological processes of the body.
• MRI scanners use strong magnetic fields, magnetic field gradients, and
radiowaves to generate images of the organs in the body.
• MRI does not involves x-rays or the use of ionizing radiations which
distinguishes them from CT Scans.

52. 3) CYTOGRAM
The graphical output of a hematology analyser that is
used to assist with the identification of cellular
abnormalities.

53. 4) Barium-X Ray

54. MANAGEMENT OF CERVICAL CANCER
MEDICAL-
MANAGEMENT
PHARMACOLOGICAL
NON-
PHARMACOLOGICAL
SURGICAL –
MANAGEMENT
INVASIVE
PROCEDURES AND
SURGERIES
OTHERS
SUPPORTIVE
THERAPY
REHABILITATIVE
SERVICES
HOSPICE CARE
PALLIATIVE CARE

55. 1. MEDICAL MANAGEMENT
A) SYMPTOMATIC MANAGEMENT
B) CHEMOTHERAPY
C) RADIATION THERAPY
D) IMMUNOTHERAPY

56. 1) PHARMACOLOGICAL TREATMENT
A) SYMPTOMATIC MANAGEMENT
• Irregular bleeding-hormonal pills(contraceptive pills)
• Anemia-blood transfusion, recombinant human
erythropoetin
• Pain-analgesics (diclofenac)
• Weight loss-high protein diet
• Fever-paracetamol(acetaminophen)

57. B) CHEMOTHERAPY

58.  Chemotherapy drugs
Chemotherapy uses toxic drugs to destroy cancer cells.
Commonly used drugs to treat cervicl cancer:-
a)Cisplatin (platinol)
b)Fluorouracil (adrucil, efudex)
 Administration of drugs
-These drugs are oftn used in combination in addition to radiation
-The drugs are administered intravenously, through injections, pills, implants or
chemo pods.

59.  Chemotherapy procedure
• The dose of all chemotherapeutic agents vary from patient to
patient. The dose is calculated keeping in view the various
factors age, sex, body surface area, stage of disease, type of
cancer, hepatic and renal status of the patient.
 Aim of treatment
a)Cure
b)Control
c)Palliation
d)Adjuvant
e)Neoadjuvant

60. Continued…..
HOW TO PREPARE FOR CHEMOTHERAPY ?
 Before the therapy is begun a series of test is conducted to determine if
the patient is healthy for chemotherapys or not.
 The side effects of the therapy is already explained to the patient and
the family members.
 A support group is recommended to help the patient to remain
optimistic.
 Schedules are already set by the health professionals and cycles of doses
are pre-decided.

61. 2) NON- PHARMACOLOGICAL TREATMENT
A) RADIATION THERAPY

62. RADIATION THERAPY
• Also called as radiotherapy, x-ray therapy, irradiation.
• Radiation therapy is the use of certain type of energy (called
ionizing radiation) to kill cancer cells and shrink tumors.
• These destroy cells called the ‘target tissues’.
• Radiation may come from a machine outside the body near
cancer cells (external beam radiation therapy) , or it may
come from radioactive material placed in the body near cancer
cells (internal radiation therapy).

63. TYPES OF RADIATION THERAPY

64. B) IMMUNOTHERAPY

65. IMMUNOTHERAPY
• Immunotherapy is also known as biotherapy, biological response
modifier therapy, biological therapy.
• It describe the use of biological agents to activate, boost, or restore the
ability of the immune system to fight cancer, infections, and other
diseases.
• It consists of -:
a) Monoclonal antibodies(rituximab, herceptin etc)
b) Interferons
c) Interleukins
d) Colony stimulating factors( CSFs)(example-epogen)
e) Tumor necrosis factors(TNFs)

67. 1) LASER SURGERY

68. LASER SURGERY ( Light Amplification By
Stimulated Emission of Radiation ).
• It is a type of surgery that uses a laser (in contrast to
using a scalpel) to cut tissues.
• Highly focussed and powerful beam of light energy which
can be used for very precise surgical work.
• It is used to cut through tissues(without using a scalpel )
and to vaporize (burn or destroy) cancerous cells.

69. 2) LOOP ELECTROSURGICAL EXCISION
PROCESS (LEEP)

70. LOOP ELECTROSURGICAL EXCISION
PROCESS
• The loop electrosurgical excision procedure is one of
the most commonly used approaches to treat high
grade cervical dysplasia.
• A small electrical wire loop is used to remove
abnormal cells from the cervix.

71. 3) CRYOSURGERY

72. CRYOSURGERY
• Cryosurgery uses a liquid nitrogen spray or a very cold
probe to freeze and kill abnormal cells.
• A scan is used to guide the probe into the cancer and
watch the freezing of the cells.
• This limits damage to nearby healthy tissues.

73. 4) HYSTERECTOMY

74. HYSTERECTOMY
• A Hysterectomy is an operation to remove a women’s
uterus.
• It may also involves removal of cervix, ovaries, fallopian
tubes, and other surrounding structures.
• Usually performed by a gynecologist, a hysterectomy may
be total or partial.
• It is the most commonly performed gynecological surgical
procedure.

76. Avoidance of early marriages and pregnancy

77. IMPROVE MENSTRUAL HYGIENE

78. FOLLOWHEALTHY DIETARY PATTERN

79. IMPROVE GENITAL
HYGIENE

80. AVOID SMOKING

81. REGULAR CERVICAL SCREENING

82. Prevention

84. HPV VACCINATION : THE BASIS OF
CANCER CONTROL

85. HPV VACCINES
• FIRST INTRODUCED IN 2006
• HPV 16 AND 18 CAUSE 70% OF CERVICAL CANCERS.
• ALL HPV VACCINES PREVENT HPV 16 AND HPV 18
INFECTION.
• GIVE STRONGER AND PROLONGED PROTECTION THAN
NATURAL INFECTION.
• TWO FDA(FOOD AND DRUGS ASSOCIATION) VACCINES
AVAILABLE IN INDIA
a) CERVARIX
b) GARDASIL

86. HPV VACCINES DOSES
• 3 INJECTIONS I/M OVER 6 MONTHS
• MOST EFFECTIVE WHEN GIVEN BEFORE PERSON IS
SEXUALLY ACTIVE
• INDIAN ACADEMY OF PEDIATRICS HAS INCLUDED IN ITS
SCHEDULE:-
2 DOSES – (9-14 YEARS FEMALES)
3 DOSES – (>15 YRS, IMMUNOCOMPROMISED)
FOR 2 DOSES MINIMUM INTERVAL 6 MONTHS
FOR 3 DOSES – 0,1/2 OR 6 MONTHS

88. EFFICACY OF HPV VACCINES
• 100% PROTECTION
• PROTECTION LASTS FOR8-9 YEARS

89. IS IT COST EFFECTIVE?
• INDIA APPROVED THE TWO HPV VACCINES IN 2008 AND THEY
HAVE BEEN AVAILABLE IN THE PRIVATE MEDICAL SECTOR.
• HOWEVER THE VACCINES ARE EXPENSIVE.
• PRICED AT BETWEEN RS 2000-3000 FOR A SINGLE DOSE.
• THE GOVERNMENT HAS BEEN CONSIDERING INTRODUCING
THE VACCINES INTO THE PUBLIC HEALTH PROGRAMME,WHICH
WOULD ALLOW WOMEN AND GIRLS FROM POOR
HOUSEHOLDS TO ACCESS THEM.

90. • Cervical Cancer - cancer in the cervix of the uterus is called cervical cancer. Cells changes from normal to
pre cancer and then to cancer. It is due to abnormal growth of cells that have an ability to invade or spread
to the other part of body.
• Incidence - Every year in India, 122,844 women are diagnosed with cervical cancer and 67,477 dies from
the disease. Cancer of the cervix has been the most important cancer among women in past two decades.
• Causes - The main causative agent that causes cervical cancer remains Human Papilloma Virus (HPV).
• Other factors are unhygienic conditions,unprotected sex,sexual intercourse with multiple partners,low
socioeconomic status.
• Sign and symptoms - unusual vaginal bleeding, pelvic pain,weight loss, etc.
• Diagnosis - It is carried out through various invasive and non-invasive procedures and imaging studies.
• Treatment – the treatment is based on primary, secondary and tertiary level of health care.
 Primary prevention – vaccination administration
 Secondary prevention – early screening and treatment
 Tertiary prevention – rehabilitative services