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Cervical Cancer

Cervix
Lower part of the uterus  Connects the body of the uterus to the vagina (birth canal)

Source: American Cancer Society

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Cervical Cancer   Begins in the lining of the cervix Cells change from normal to pre-cancer (dysplasia) and then to cancer Source: American Cancer Society .

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Three Types  Squamous cell Carcinomas – Cancer of flat epithelial cell – 80% to 90%  Adenocarcinomas – Cancer arising from glandular epithelium – 10% .20%  Mixed carcinoma – Features both types Source: American Cancer Society .

20% at the age of 65 or over.520 new cases in the U. Rarely occurs in women younger than 20 Noninvasive is four times more common 74% decrease in deaths between 1955 and 1992 in the U.Statistics         10.900 will die 50% are diagnosed between ages 35 and 55.S. Death rate continuous to decline by 2% a year Source: American Cancer Society . this year 3.S.

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Lifetime Probability of Developing Cancer. http://srab.cancer. Version 5. by Site. 2003. US.gov/devcan . 1998-2000 Site All sites Breast Lung & bronchus Colon & rectum Uterine corpus Non-Hodgkin lymphoma Ovary Pancreas Melanoma Urinary bladder Uterine cervix Risk 1 in 3 1 in 7 1 in 17 1 in 18 1 in 38 1 in 57 1 in 59 1 in 83 1 in 82 1 in 91 1 in 128 Source:DevCan: Probability of Developing or Dying of Cancer Software. Women. NCI.1 Statistical Research and Applications Branch.

Signs and Symptoms      Vaginal bleeding Menstrual bleeding is longer and heavier than usual Bleeding after menopause or increased vaginal discharge Bleeding following intercourse or pelvic exam Pain during intercourse Source: American Cancer Society .

HPV 45 – 50% are caused by HPV 16 AND 18 Sexual behavior Smoking HIV infection Chlamydia infection Diet Oral contraceptives Multiple pregnancies Low socioeconomic status Diethylstilbestrol (DES) Family history Source: American Cancer Society . HPV 33. HPV 18.Risk Factors            Human papillomavirus infection (HPV) – Primary factor – HPV 16. HPV 31.

– Have test annually Source: American Cancer Society .Prevention  Avoiding the risk factors – Especially HPV – Help for low-income women (NBCCEDP)  Having the Pap Test – 3 years after first vaginal intercourse or by age 21.

– Can detect epithelial cell abnormalities  Atypical squamous cells  Squamous intraepithelial lesions  Squamous cell carcinoma (likely to be invasive) Source: American Cancer Society .Diagnosis  Cervical Cytology (Pap Test) – Cells are removed from the cervix and examined under the microscope.

– Cervical Biopsies  Colposcopic biopsy – removal of small section of the abnormal area of the surface.  Cone biopsy – cone-shaped piece of tissue is removed from the cervix .Diagnosis  Additional testing – Colposcopy  Cervix is viewed through a colposcope and the surface of the cervix can be seen close and clear.  Endocervical curettage – removing some tissue lining from the endocervical canal.

Cancer has spread to the lower part of the vagina. Source: American Cancer Society . Cancer has spread to nearby organs. but has not spread.Staging  FIGO System – – – – – Stage Stage Stage Stage Stage 0 1 2 3 4 (International Federation Of Gynecology and Obstetrics)  Has five stages – 0 to 4 Carcinoma in situ Invaded cervix. not leaving pelvic area. Has spread to nearby areas. metastasis.

Survival Rate   5-year survival rate is 92% for earliest stage 71% for all stages combined Source: American Cancer Society .

upper part of the vagina.Treatment  Surgery   Radiation – Preinvasive cervical cancer  Cryosurgery  Laser surgery  Conization – Invasive cervical cancer  Simple hysterectomy – Removal of the body of the uterus and cervix. surrounding tissue. and lymph nodes from the cervix. Chemotherapy .  Radical hysterectomy and pelvic lymph node dissection – Removal of entire uterus.

Weirtheim .

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What’s new in cervical cancer research and treatment?     HPV test HPV vaccine Radical trachelectomy procedure Other clinical trials Source: American Cancer Society .

Pap Smear Technique Video .

Padded Stirrups Soft. padded stirrups  Oven mitts  Socks  Battle dressings  .

Inspect Spread labia  Discharge  Ulcers  Growths  .

Anatomy .

Vaginal Speculum .

Warm Speculum Warm water  Not too hot  Lubricates speculum  Don’t use K-Y. Surgilube or Vaseline to lubricate speculum  .

Insert Speculum Spread labia  Keep labia apart  Blades remain closed until fully inserted  .

Squamo-Columnar Junction Junction of pink cervical skin and red endocervical canal  Inherently unstable  Key portion of the cervix to sample  Most likely site of dysplasia  .

Ayers Spatula Concave end to fit the cervix  Convex end for vaginal wall and vaginal pool scrapings  .

Sample Cervix Use concave end  Rotate 360 degrees  Don’t use too much force (bleeding. pain)  Don’t use too little force (inadequate sample)  .

Cytobrush Insert ~ 2 cm (until brush is fully inside canal)  Rotate only 180 degrees (otherwise will cause bleeding)  .

Make Pap Smear As thin as possible  Properly labeled  .

Spray with Fixative Within 10-15 seconds  Allow to fully dry before packaging  Cytologic Fixative (hairspray works acceptably also)  .

“Normal” Pap Smear Negative for intraepithelial lesion or malignancy  Other non-neoplastic findings  – Reactive cellular changes – Glandular cells status post hysterectomy – Atrophy  Other – Endometrial cells (women  40 yrs) .

 Atypical squamous cells Epithelial Cell Abnormalities: Squamous – ASC-US: undetermined significance – ASC-H: cannot exclude HSIL LSIL: low grade (CIN 1)  HSIL: high grade (CIN 2 .3)  Squamous cell carcinoma  .

endometrial or glandular cells (NOS)  Atypical endocervical or glandular .Epithelial Cell Abnormalities: Glandular Atypical endocervical. endometrial or extrauterine  .favor neoplastic  Endocervical adenocarcinoma in situ  Adenocarcinoma: endocervical.

SIL and CIN .