Professional Documents
Culture Documents
Cervical Cancer Screening
Cervical Cancer Screening
-Dr.MEETA AGRAWAL,
Obs & Gynae., Bhopal
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For you & your daughter …..a
wonderful gift
Guard Yourself means
Protect yourself
very special programme
to prevent cervical cancer.
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where is cervix in woman?
CERVIX
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Cervical Cancer – Disease Burden
8 and
2. X. Castellsagué, S. de Sanjose, T. Aguado, K. S. Louie, L. Bruni, J.Muñoz, M. Diaz, K. Irwin, M. Gacic, O. Beauvais, G. Albero, E. Ferrer, S. Byrne, F. X. Bosch. HPV
Cervical Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Available at: www.who.int/hpvcentre
Human Papillomavirus (HPV)
HPV 16 HPV 6
HPV 18 HPV 11
1.Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 2. Wiley DJ, Douglas J, Beutner K, et al. Clin Infect Dis. 2002;35(suppl 2):S210–S224. 3. Muñoz N, Bosch FX, Castellsagué X, et al. Int J
Cancer. 2004;111:278–285. Reprinted from J Virol. 1994;68:4503–4505 with permission from the American Society for Microbiology Journals Department. 4. Walboomers JM, Jacobs MV, Manos MM, et al. J 9
Pathol. 1999;189:12–19. 5. X. Castellsagué, S. de Sanjose, T. Aguado, K. S. Louie, L. Bruni, J.Muñoz, M. Diaz, K. Irwin, M. Gacic, O. Beauvais, G. Albero, E. Ferrer, S. Byrne,F. X. Bosch. HPV and Cervical
Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Available at: www.who.int/hpvcentre
Anogenital Disease: cervix, vulva, vagina, anus, penis
Condylomata accuminatum
Squamous intraepithelial neoplasia
Cancer
Head/Neck Disease:
Mouth, tongue, tonsils
Sinuses
Oropharangeal
Respiratory mucosa (children; type 6, 11)
Cancer: usually HPV 16
Cofactors: Smoking, Alcohol
5 – 10 years to develop cancer from time of infection
Progression Invasion
Normal Infection HPV
Cervix Pre-cancer Cancer
Infection
Clearance Regression
CIN (CERVICAL INTRAEPITHELIAL NEOPLASIA)
as Seen in Colposcopy
Colposcopy findings confirmed by histology1
CIN 1 CIN 2 CIN 3
Photo courtesy of Dr. J. Monsonego Photo courtesy of Dr. J. Monsonego From IARC, 2003.4
1. Wright TC Jr, Cox JT, Massad LS, et al, for the ASCCP-Sponsored Consensus Congress. JAMA. 2002;287:2120–2129. 2. Bonnez W. In: Richman DD,
Whitley RJ, Hayden FJ, eds. Washington, DC: American Society for Microbiology Press; 2002:557–596. 3. Canadian Cancer Society. Cervical Cancer: What
you need to know. Available at: http://www.cancer.ca/vgn/images/portal/cit_86751114/63/40/151140772cw_library_wyntk_cervical_en.pdf. Accessed March 13,
2006. 4. Reprinted with permission from Sellors JW, Sankaranarayanan R, eds. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia. A Beginner’s
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Manual. Lyon, France: International Agency for Research on Cancer; 2003.
How HPV infection can occur?
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Cervical cancer screening
• Chronic pain
• distension
• loss of weight
• Heavy prolong bleeding ,before or during
menopausal age
• Post menopausal bleeding-important
• Cervical polyp
• tumor during or before menopause age
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Is it possible
to get
protection
against
cervical cancer?
Early Vaccination
Screening strategies
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What is the use of screening
program?
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Visual Inspection
VIA
Community low
VILI
resource
Pap Smear settings
Conventional
LBC
HPV DNA Testing
Cervicography
Pap Net Still Experimental
Polar Probe
Population USPSTF ACS/ASCCP/ASCP
Younger Recommends against screening. Women should not be screened regardless of the age
than 21 of sexual initiation or other risk factors. ?
Grade: D recommendation.
years
21–29 years Recommends screening with cytology Screening with cytology alone every 3 years is
every 3 years. recommended.
Grade: A recommendation.
30–65 years Recommends screening with cytology Screening with cytology and HPV testing (“co-
every 3 years or for women who want testing”) every 5 years (preferred) or cytology alone
to lengthen the screening interval, every 3 years (acceptable) is recommended.
screening with a combination of
cytology and HPV testing every 5
years.
Grade: A recommendation.
Population USPSTF ACS/ASCCP/ASCP
Older than 65 Recommends against screening Women with evidence of adequate negative prior
years women who have had adequate prior screening and no history of CIN2+ within the last 20
screening and are not otherwise at years should not be screened. Screening should not
high risk for cervical cancer. be resumed for any reason, even if a woman reports
having a new sexual partner.
Grade: D recommendation.
After Recommends against screening in Women of any age following a hysterectomy with
hysterectomy women who have had a removal of the cervix who have no history of
hysterectomy with removal of the CIN2+ should not be screened for vaginal cancer.
cervix and who do not have a Evidence of adequate negative prior screening is not
history of a high-grade precancerous required. Screening should not be resumed for any
lesion (i.e. CIN 2 or 3) or cervical reason, including if a woman reports having a new
cancer. sexual partner.
Grade: D recommendation
HPV Women who have been vaccinated Recommended screening practices should not change
vaccinated should continue to be screened on the basis of HPV vaccination status.
PAP Smear
PAP smear sampling of cervix involves scraping of
cervical surface and a portion of non visualised
cervical canal using various sampling devices
disasters “prevention is better than cure’-
holds true for cervical cancer
This can be achieved by regular health
check up and regular pap smear test
Pap- smear is cancer screening which is easy
,painless and reliable method in which the
discharge from vagina is taken on slide and
sent for examination for presence of
abnormal cells
Routine pap smear has reduced ca cx by 75%
in developed world
Repeat pap is advised if it shows abnormal
cells & than advised colposcopy & biopsy.
It can give early diagnosis of cancer before
its sets in and hence early treatment can
avoid disease
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Significance of Pap smear
Detect precancerous & invasive cancer cervix cases in
early stages
Transformation zone -
- Area of squamous metaplasia
- Area between original and new SCJ
Transformation zone
Transformation Zone -TZ
Exposure of TZ to carcinogens begins the process of
intraepithelial neoplasia
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How to take a Pap Smear ?
Spatula is rotated through 360 degrees
maintaining contact with ectocervix
This test can use the same sample of cells taken for the Pap test.
A positive HPV test does not mean that a woman has cancer.
To see if a woman with a borderline Pap test result
(one that shows unusual cells but not dysplasia)
needs additional tests.
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Colposcopy
• Magnified visual examination of uterine cervix by a low
power ,stereoscopic microscope with a powerful light
source to help in diagnosis of cervical neoplasia .
• Key ingradients –observations of features of cervical
epithelium after application of normal saline , 3-5% dilute
acetic acid and Lugol’s iodine solution .
•
INDICATIONS OF COLPOSCOPY
• Squamous or glandular cell abnormalities
• Persistence of inflammatory cells despite adequate tt
• Presence of keratinized cells .
• VIA +ve and VILLI+ve
• Evaluation of HPV +ve women .
• Postcoital ,postmenopausal bleeding .
• Unhealthy cervix .
• Treatment and monitoring of women with CIN
• Anogenital condylomas ,VIN and VAIN.
• DES exposure in utero.
Colposcopy - Objectives
Determines the presence of invasive cancer
Hyperkeratosis ( Leukoplakia)
CIN (CERVICAL INTRAEPITHELIAL NEOPLASIA)
as Seen in Colposcopy
Colposcopy findings confirmed by histology1
CIN 1 CIN 2 CIN 3
Photo courtesy of Dr. J. Monsonego Photo courtesy of Dr. J. Monsonego From IARC, 2003.4
1. Wright TC Jr, Cox JT, Massad LS, et al, for the ASCCP-Sponsored Consensus Congress. JAMA. 2002;287:2120–2129. 2. Bonnez W. In: Richman DD,
Whitley RJ, Hayden FJ, eds. Washington, DC: American Society for Microbiology Press; 2002:557–596. 3. Canadian Cancer Society. Cervical Cancer: What
you need to know. Available at: http://www.cancer.ca/vgn/images/portal/cit_86751114/63/40/151140772cw_library_wyntk_cervical_en.pdf. Accessed March 13,
2006. 4. Reprinted with permission from Sellors JW, Sankaranarayanan R, eds. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia. A Beginner’s
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Manual. Lyon, France: International Agency for Research on Cancer; 2003.
Geographic satellite lesion
Early invasive cancer: note the raised irregular mosaics with umbilication (a), breaking
mosaics (b), surface irregularity & the atypical vessels after the application of 5% AA
Inflammatory lesions of the
Uterine Cervix
CERVERIX
[Human Papillomavirus Bivalent
(Types 16 and 18)
Vaccine 0.5ml prefilled syringe]
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09-2009-GRD-2008-AP-(IN)-1601-SS
HPV Vaccines- made by
recombinant DNA technology
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INDICATION
FOR Gardasil
For the prevention of
Cervical Cancer
Vulvar/ Vaginal Precancers
Cervical Dysplasia
Genital Warts
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When we can give this vaccine?
This vaccine can be given to any
girl above 9 years. Recommended
for women of 9-45 years age group
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Gardasil Approvals: 156 countries
Caribbean & Central America: Europe:
North America:
Germany Cyprus Ireland
Costa Rica Trinidad France Czech Republic Latvia
Puerto Rico El Salvador UK Denmark Lithuania
USA
Guatemala Honduras Spain Estonia Luxembourg
Canada
Curaçao Nicaragua Italy Finland Malta
Mexico
Bermuda Panama Austria Greece Netherlands
Bahamas Cayman Islands Belgium Hungary Norway
Barbados Aruba Bulgaria Iceland Poland
Jamaica Dominican Republic Portugal Romania Slovakia Asia Pacific:
Slovenia Sweden Serbia
40 Montenegro Switzerland Liechtenstein
Turkey Croatia Bosnia Australia
South America:
3 Russia
Georgia
Macedonia Belarus Indonesia
Brazil Bolivia Korea
Argentina Uruguay Taiwan
Peru Ecuador 16 13 Hong Kong
Colombia Chile 26 Singapore
New Zealand
8 Macau
Malaysia
Middle East & Africa: Philippines
Thailand
Gabon Congo Kinshasa India
Israel C.A.R. Vietnam
Morocco Mauritius
Kenya Kuwait
Mauritania UAE
Guinea Eq. Ethiopia
Uganda Togo
Malawi Congo Brazzaville
Jordan Egypt
Cote d’Ivoire Burkina Faso
Chad Bahrain
Saudi Arabia Botswana 75
South Africa Cameroon
Is this vaccine is using with another
developing country?
Yes, this vaccine is available in 156 country.
till date 200 million doses already used
within 9 years of time.
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Preventing aspects-lifestyle change
Social change –avoid early marriages
Multiparity_ role of family planning
Avoid multiple partners
Use of condom to avoid STD,and HPV diseases
Improve nutrition and personal hygiene
Prevents smoking ,alcoholism ,etc
Regular exercise
Health awareness-health check up
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To produce a Cancer Free Society
Screening and identification of High Risk groups
Education – Think of Cervical Cancer as an
extension of STD
Behavioral changes
Limit number of sexual partners
Delay initial age of sexual intercourse
Avoid STD – Use of Condoms/ Spermicidals;
Avoid Smoking
HPV Vaccines to be promoted at the right age
Lets fight against cancer
…..join hands……
…..take preventive measures…….
…..update yourself…..
…..take care…..
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