Cervical Cancer

1. ECHO India
ECHO India Cervical Cancer Prevention, Detection, Awareness and
Advocacy Capacity Building ECHO for Nurses
Moving Knowledge, Not People

2. Introduction
Childhood cervical cancer and vaginal cancer are very rare
types of cancer. Cervical cancer forms in the cells of the
cervix, and vaginal cancer forms in the cells of the vagina.
The cervix is the lower, narrow end of the uterus (the hollow,
pear-shaped organ where a fetus grows). The cervix leads
from the uterus to the vagina (birth canal). The vagina is the
canal leading from the cervix to the outside of the body. At
birth, a baby passes out of the body through the vagina

5. Symptoms
The most common symptom of cervical cancer and vaginal
cancer in children is bleeding from the vagina. Other
conditions may also cause vaginal bleeding. If child has
vaginal bleeding, it is important to tell their doctor/nurse. The
doctor will ask when it started and how often it occurs as a
first step in making a diagnosis.

6. Tests to diagnose
Child has symptoms that suggest vaginal or cervical cancer, find out if
they are due to cancer or another condition. They may ask about
child’s personal and family medical history and do a physical exam.
Depending on child’s symptoms and medical history and the results of
their physical exam, may recommend more tests to find out if your
child has vaginal or cervical cancer, and if so, its extent (stage). The
results of tests and procedures done to diagnose vaginal and cervical
cancer are used to help make decisions about treatment.

7. The following tests and procedures may be used to
diagnose and stage childhood cervical cancer or vaginal
cancer:
Pap test
The Pap test (also called a Pap smear or cervical cytology)
collects cervical cells from the surface of the cervix and
vagina using a soft, narrow brush or tiny spatula. The cells
are viewed under a microscope to find out if they are
abnormal.

9. Biopsy
Transvaginal needle biopsy is the removal of tissue using a
needle that is guided by ultrasound. A pathologist views the
tissue under a microscope to check for signs of cancer.

11. Serum tumor marker test
Serum tumor markers are substances found in the blood that
are either made by vaginal or cervical cancer cells or that
the body makes in response to vaginal or cervical cancer.
For this test, a sample of blood is checked in the lab to
measure the amounts of certain substances released into
the blood by organs, tissues, or tumor cells in the body.

13. Ultrasound
An ultrasound uses high-energy sound waves (ultrasound),
which bounce off internal tissues or organs in the pelvis and
make echoes. The echoes form a picture of body tissues
called a sonogram.

15. Magnetic resonance imaging (MRI)
MRI uses a magnet and radio waves to make a series of detailed
pictures of areas inside the body, such as the pelvis. The pictures are
made by a computer. This procedure is also called nuclear magnetic
resonance imaging.

17. CT scan (CAT scan)
A CT scan is a procedure that makes a series of detailed pictures of
areas inside the body, such as the pelvis, taken from different angles.
The pictures are made by a computer linked to an x-ray machine. This
procedure is also called computed tomography, computerized
tomography, or computerized axial tomography

18. CT scan vaginal cancer

19. Getting a second opinion
Some people may want to get a second opinion to confirm their child’s cervical or
vaginal cancer diagnosis and treatment plan. If choose to seek a second opinion, get
important medical test results and reports from the first doctor to share with the
second doctor. The second doctor will review the pathology report, slides, and scans
before giving a recommendation. The doctor who gives the second opinion may
agree with the first doctor, suggest changes or another approach, or provide more
information about your child’s cancer.

20. Stages
Cancer stage describes the extent of cancer in the body, such as the
size of the tumor, whether it has spread, and how far it has spread
from where it first formed. It is important to know the stage of the
cervical or vaginal cancer to plan the best treatment.

21. There are several staging systems for cancer that describe
the extent of the cancer. The International Federation of
Gynecology and Obstetrics (FIGO) staging system is used
for cervical and vaginal cancers. child’s cancer described by
this staging system in the pathology report. Based on the
FIGO results, a stage is assigned to the cancer, ranging
from stage I, stage II, stage III, or stage IV (may also be
written as stage 1, stage 2, stage 3, or stage 4). child’s
doctor may describe it as one of these stages.

24. Recurrent cervical cancer or vaginal
cancer
Recurrent cancer is cancer that has come back after it has been
treated. Cervical or vaginal cancer may come back in the cervix or
vagina or as metastatic tumors in other parts of the body. Tests will be
done to help determine where the cancer has returned in the body, if it
has spread, and how far. The type of treatment that child will have for
recurrent cancer will depend on how far it has spread.

25. Types of treatment for childhood
cervical and vaginal cancer
There are different types of treatment for children and
adolescents with cervical cancer or vaginal cancer. cancer
care team will work together to decide treatment. Many
factors will be considered, such as your child’s overall health
and whether the cancer is newly diagnosed or has come
back.

26. A pediatric oncologist, a doctor who specializes in treating children with
cancer, will oversee treatment. The pediatric oncologist works with other
pediatric health professionals who are experts in treating children with
cancer and who specialize in certain areas of medicine. This may include
the following specialists and others:

27. Pediatrician
Pediatric surgeon
Gynecologist
Pediatric nurse specialist
Rehabilitation specialist
Social worker
Psychologist
Fertility specialist

28. Child’s treatment plan will include information about the
cancer, the goals of treatment, treatment options, and the
possible side effects. It will be helpful to talk with child’s
cancer care team before treatment begins about what to
expect.
A cervical cancer diagnosis can raise concerns about
whether treatment will affect child’s fertility.

29. Surgery
Surgery is used to remove as much cancer as possible from
the cervix or vagina. If cancer cells remain after surgery or
cancer has spread to the lymph nodes, more treatment may
be needed.

30. Types of surgeries for cervical
cancer

31. Surgery for vaginal cancer

32. Radiation therapy
Radiation therapy uses high-energy x-rays or other types
of radiation to kill cancer cells or keep them from growing.
Cervical cancer and vaginal cancer are sometimes treated
with external beam radiation therapy. This type of radiation
therapy uses a machine outside the body to send radiation
toward the area of the body with cancer. Radiation therapy
may be given alone or with other types of treatment, such as
chemotherapy.

34. Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop
the growth of cancer cells, either by killing the cells or by
stopping them from dividing. Chemotherapy for vaginal
cancer or cervical cancer is injected into a vein. When given
this way, the drugs enter the bloodstream to reach cancer
cells throughout the body.

35. It is not known if chemotherapy is an effective treatment for
childhood cervical cancer or vaginal cancer, although drugs
commonly used to treat these cancers in adults, such
as carboplatin and paclitaxel, may be used.

37. Clinical trials
A treatment clinical trial is a research study meant to help improve
current treatments or obtain information on new treatments for patients
with cancer. For some patients, taking part in a clinical trial may be an
option.

38. Treatment of newly diagnosed
childhood cervical cancer and vaginal
cancer
Treatment of newly diagnosed cervical cancer and vaginal cancer in children may
include:
Surgery will be done to remove as much of the cancer as possible, followed by
radiation therapy, if cancer cells remain after surgery or cancer has spread to the
lymph nodes.
Chemotherapy may also be used, but it is not yet known how well this treatment
works.
Sometimes childhood cervical cancer and vaginal cancer can recur (come back) after
treatment. If your child is diagnosed with a recurrent cervical cancer or vaginal
cancer, child's doctor will work to plan treatment.

39. Side effects of treatment
Side effects from cancer treatment that begin after treatment
and continue for months or years are called late effects.
Physical problems, such as problems with fertility, may be a
late effect of treatment.
Some late effects may be treated or controlled. It is
important to talk with child's doctors about the possible late
effects caused by some treatments

40. Follow-up testing
Some of the tests that were done to diagnose the cancer
may be repeated to see how well the treatment is working.
Decisions about whether to continue, change, or stop
treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time
after treatment has ended. The results of these tests can
show if child's condition has changed or if the cancer has
recurred (come back). These tests are sometimes called
follow-up tests or check-ups.

41. Coping and support
When a child has cancer, every member of the family needs
support. Honest and calm conversations build trust as talk
with child and their siblings. Taking care of yourself during
this difficult time is also important. Reach out to your child’s
treatment team and to people in your family and community
for support

42. Related researches
Common warts could indicate cervical cancer susceptibility,
as both are caused by human papillomavirus (HPV).
Eczema was also investigated, as atopic eczema has been
negatively associated with warts, but non-atopic eczema
may be associated with compromised host defences, as
observed in patients with HIV, suggesting increased
susceptibility to HPV infection and cervical cancer. ‘Cervical
cancer’ was self-reported during an interview by 87 of 7594
women members of two longitudinal British birth cohorts.
The accuracy of the diagnoses

43. limited by lack of confirmation using medical records. Odds
ratios are adjusted for common warts and eczema in
childhood; and cigarette smoking, number of cohabiting
partners and social class in early adult life. The odds ratios
of warts and eczema with cervical cancer are 2.50 (95%
confidence interval 1.14–5.47) and 3.27 (1.95–5.49),
respectively. The association of eczema with cervical cancer
is independent of hay fever as a marker of atopy, suggesting
the importance of non-atopic eczema. Both heavier smoking
compared with non-smoking and

44. four or more cohabiting partners compared with one/none
have odds ratios for cervical cancer of 8.26 (4.25–15.10)
and 4.89 (1.39–17.18), respectively. Common warts in
childhood may indicate cervical cancer susceptibility; this
and the relationship with eczema deserves investigation.

45. Materials and methods
The data are from two British longitudinal birth cohort
studies: the National Child Development Study (NCDS) and
the 1970 British Cohort Study (BCS70), which follow
everyone in Great Britain born in the weeks 3–9 April 1958
and 5–11 March 1970, respectively (Ekinsmyth et al,
1992; Ferri, 1993; Bynner et al, 1998). Each study is based
on approximately 16 000 individuals followed from birth to 42
or 30 years in NCDS and BCS70, respectively (Ekinsmyth et
al, 1992; Ferri, 1993; Bynner et al, 1998). After exclusion of
males and those with

46. incomplete data, some 3654 and 3941 were available for analysis in
NCDS and BCS70, respectively. Response rates varied by sweep and
have been reported in detail elsewhere (Ekinsmyth et al, 1992; Ferri,
1993; Bynner et al, 1998). Totals of 11 419 (5795 female) and 11 261
(5790 female) cohort members participated in data collection sweep at
ages 42/30 years in NCDS and BCS70, respectively. Despite greater
loss from more disadvantaged groups, the cohorts are largely
representative (Ferri, 1993; Bynner et al, 1998). However, in the data
used here, the proportion of females from a family in social class V (the
most disadvantaged) at birth declined from 8.5 to 7.3% and 5.0 to
4.0% in NCDS and BCS70, respectively.

47. Response rates varied by sweep and have been reported in detail
elsewhere (Ekinsmyth et al, 1992; Ferri, 1993; Bynner et al, 1998).
Totals of 11 419 (5795 female) and 11 261 (5790 female) cohort
members participated in data collection sweep at ages 42/30 years in
NCDS and BCS70, respectively. Despite greater loss from more
disadvantaged groups, the cohorts are largely representative (Ferri,
1993; Bynner et al, 1998). However, in the data used here, the
proportion of females from a family in social class V (the most
disadvantaged) at birth declined from 8.5 to 7.3% and 5.0 to 4.0% in
NCDS and BCS70, respectively.

48. In summary, the following data were used (and collected at these
ages). NCDS: eczema and common warts (11 and 16 years);
diagnosis of any cancer, hay fever and smoking (16 years); social
class and cohabiting partners (33 years); and cervical cancer after age
17 years (42 years). BCS70: eczema (5 and 10 years); diagnosis of
any cancer and hay fever (10 years); smoking, social class, cohabiting
partners and cervical cancer after age 11 years (30 years).

49. A diagnosis of ‘cervical cancer’ was reported during interviews at ages
42 years in NCDS and 30 years in BCS70. Eczema and common warts
(on arms and legs) were identified in NCDS by medical examination
conducted by a local authority medical officer at 11 and 16 years. As
warts were assessed by a medical examination at two time points,
rather than record review, the estimates of prevalence for warts may
be conservative, but a positive record is likely to be accurate. Hay
fever was recorded at age 16 years in NCDS. In BCS70, eczema at
age 5 years was identified by health visitor interviews with parents and
medical records. At age 10 years,

50. community medical officers and school nurses recorded a diagnosis of
eczema during a medical examination. Hay fever was recorded at age
10 years in BCS70. A history of chronic disease, including cancer, was
recorded from review of medical records at ages 16 years and 10
years in NCDS and BCS70, respectively.
Cigarette smoking was reported in NCDS at age 16 years by a self-
completed questionnaire. Number of cigarettes smoked was
dichotomised into under three or three and more packets of 20 per
week. In BCS70, smoking history was recorded by interview at age 30
years and dichotomised into less than a packet of 20 or at least a
packet of 20 cigarettes smoked per

51. day. The number of cohabiting partners to date was recorded during
interviews at ages 33 and 30 years for NCDS and BCS70,
respectively. Social class using the Registrar General's classification
was based on current or most recent job at ages 33 and 30 years for
NCDS and BCS70, respectively. The social class measure was divided
into three groups: non-manual, manual and class not ascertained.

52. Statistical analysis
Women with cancer of any type by age 16 years in NCDS or
10 years in BCS70 were excluded (one woman in BCS70).
Cervical cancer was the dependent variable in multiple
logistic regression using SPSS (Norusis, 1989). Adjustment
was made for the susceptibility measures and potential
confounding factors, modelled as series of binary dummy
variables. Additional analysis adjusted for hay fever.

53. A combined analysis of both cohorts required modification of some
variables for comparability. As common warts were only assessed in
NCDS, the wart status for all those in BCS70 was set as not known.
This also introduced an adjustment for cohort and thus age at follow-
up. Cigarette smoking was recoded so that never-smokers were in the
no smoking category; ex-smokers, occasional smokers and those
smoking less than three packets per week at 16 years or less than one
packet per day at 30 years were classified as moderate smokers; the
other smokers were combined in a heavy smoker category. In
examining the association of single factors with cervical cancer without
adjustment for potential confounding, adjustment was made for cohort
(and thus age) using a dummy variable for cohort.

54. Results
Common warts and eczema at ages 11 or 16 years were
statistically significantly associated with cervical cancer. If
common warts and eczema are combined into a single
variable, those with either common warts or eczema

55. Table 1 The risk of cervical cancer between ages 17 and 42 years in
the 1958 birth cohort (NCDS)

56. Table 2 The risk of cervical cancer between ages 11 and 30 years in
the 1970 birth cohort (BCS70)

57. Table 3 The risk of cervical cancer in the 1958 (NCDS) and 1970
(BCS70) birth cohorts combined

58. Conclusion
As common warts were not assessed in BCS70, the estimates for their
association with cervical cancer are unaltered by combining the two
cohorts. The precision of the estimates for eczema is improved and
indicates a robust positive relationship with subsequent cervical
cancerThe collapsing of categories necessary to combine the cohorts,
accounts for the reduction in odds ratios for cervical cancer in some
smoking groups, although this positive association remains highly
statistically significant. Number of cohabiting partners remains
significantly positively associated with cervical cancer after adjustment
for the potential confounding factors. A slight reduction in the impact of
adjusting for smoking on the association between number of cohabiting
partners and cervical cancer is due to the collapsed smoking
categories.

59. The increased statistical power of the combined model reveals a
statistically significant association between manual social class and
cervical cancer, but this was eliminated by adjustment for the potential
confounding factors. Hay fever was not significantly associated with
cervical cancer in the combined analysis, with an odds ratio of 1.04
(0.50–2.17), P=0.922 and is not a confounding factor.

60. Referances-
https://www.cancer.gov/types/cervical/childhood-cervical-
vaginal-
cancer#:~:text=Childhood%20cervical%20cancer%20and%2
0vaginal,organ%20where%20a%20fetus%20grows).
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.126
10
https://my.clevelandclinic.org/health/diseases/15579-vaginal-
cancer

61. https://www.nejm.org/doi/full/10.1056/NEJMoa2030391
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12610

62. Thank You!