The document discusses cervical cancer, including that it occurs in the cervix and is caused by HPV infection. It notes that over 2000 new cases are detected in Nepal each year. The main types are squamous cell carcinoma and adenocarcinoma. Risk factors include HPV, multiple sex partners, smoking, and HIV/AIDS. Symptoms can include abnormal bleeding. Screening includes Pap tests and colposcopy with biopsies for diagnosis. Treatment options are surgery, radiation, and chemotherapy, with follow up after treatment. Prevention includes avoiding risk factors and regular Pap screening.

1. Presentation On
Cervical Cancer

2. 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.

3.  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.

6.  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

7.  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.

8.  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

9.  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.

10. Vaginal bleeding
Menstrual bleeding is longer and heavier
than usual
Bleeding after menopause or increased
vaginal
discharge
Bleeding following intercourse or pelvic
exam

11.  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)

12.  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

14.  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.

15.  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.

16. Together It Is Possible