cervical cancer screening / evaluation / treatment

Cervical CancerScreening· Evaluation·

Treatment

About this Presentation

This presentation is intended to help women take an active role in their health care. It does not replace the judgment of a health care professional in diagnosing and treating disease.

GCF Mission Statement

The mission of the Gynecologic Cancer Foundation (GCF) is to ensure public awareness of gynecologic cancer prevention, early diagnosis and proper treatment. In addition the Foundation supports research and training related to gynecologic cancers. GCF advances this mission by increasing public and private funds that aid in the development and implementation of programs to meet these goals.

GCF gratefully acknowledges the National Cervical Cancer Coalition (NCCC) for their support of this educational presentation. For more information on NCCC, call (800) 685-5531 or visit the Web site at www.nccc-online.org.

Information Hotline: (800) 444-4441

A list of specially trained gynecologic oncologists practicing in your local area can be received by phone, fax or mail

A directory of all GCF members practicing in the U.S. can also be mailed upon request

Free educational brochures on gynecologic health

Women’s Cancer Network: www.wcn.org Confidential

gynecologic (ovarian, endometrial, cervical) and breast cancer risk assessment

Comprehensive women’s cancer information including gynecologic, breast, lung and colon cancers

Links to other sources of cancer information

Cervical Cancer Screening and Prevention

New cancer diagnoses in the U.S.

2003 Statistics:

Breast 211,300 Uterus (womb) 40,100 Ovary 25,400 Cervix 12,200 Vulva 4,000

Source: American Cancer Society.

What is cervical cancer?

It is a cancer of the female reproductive tract

It is the most common cause of cancer death in the world where Pap tests are not available

It is the easiest gynecologic cancer to prevent through screening

What is the female reproductive tract? Vulva Vagina Cervix Uterus Fallopian tubes Ovaries

What is the cervix?

Opening of the uterus (womb) into the vagina

Two cell types present (squamous and glandular)

Cervical cancers tend to occur where the two cell types meet

Source: TAP Pharmaceuticals, “Female Reproductive Systems.”

How common is cervical cancer?

500,000 women worldwide die of cervical cancer annually

50-60 million women in the U.S. have a Pap test each year

3-5 million women in the U.S. have an abnormal result

12,200 new cervical cancers diagnosed in the U.S. per year

4,100 deaths from cervical cancer in the U.S. per year

Most cervical cancer can be prevented

What causes cervical cancer?

The central cause of cervical cancer is human papillomavirus or HPV:

HPV is sexually transmitted

The HPV detected today could have been acquired years ago

There are many different types of HPV• Low-risk types can cause warts • High-risk types can cause precancer and

cancer of the cervix

If I have HPV, does it mean I will get cancer? NO!

In most cases HPV goes away

Only women with persistent HPV (where the virus does not go away) are at risk for cervical cancer

How common is HPV?

Most men and women who have had sex have been exposed to HPV

More than 75% of sexually active women tested have been exposed to HPV by age 18-22

Who is at risk?

Women who have ever had sex

Women who have had more than one partner

Women whose partner (s) has had more than one sexual partner

Women with other sexually transmitted diseases

Who is at risk?

Women who do not have Pap tests

Women with immune problems Steroid medications Transplanted organs Chemotherapy HIV

Women who smoke

How do I lower my risk?

Delay onset of sexual activity

Know your sexual partner

Do not smoke

Maintain a healthy diet and lifestyle

Practice safe sex

Get your Pap test

What is a Pap test?

A test which collects cells from the surface of the cervix and looks for any abnormal cells

Abnormal cells can be treated before cervical cancer develops

When cancer is detected early, it is easier to treat

What a Pap test is NOT!

A pelvic exam

A test for ovarian or uterine cancer

A biopsy

When do I need my first Pap test?

Three years after the onset of sexual intercourse

No later than age 21

How often do I need a Pap test?

Every year until age 30

After age 30, if you have only had normal results, you may have them every two to three years after discussion with your physician and evaluation of your risk factors

I feel fine, so why do I need a Pap test? A Pap test can find treatable changes

of the cervix (precancer) before you have a symptom or notice a problem

Once a problem is symptomatic, it is harder to treat

Why do I need to keep getting tested? The test is not perfect

Changes (abnormalities) may occur since the last test

It may take many years for changes to develop or be detected

Your risk changes if you have new partners

What is the best time to have a Pap test? Schedule your Pap when you are not

having a menstrual period

It is best to abstain from intercourse and avoid use of tampons or douches for two days before your Pap test

What should I expect when I havea Pap test?

Feet are placed in stirrups (foot holders)

A speculum (thin duck-billed instrument) is inserted into vagina to see the cervix

You may have brief discomfort which is usually mild

You may have some spotting afterward

How do I find out about my Pap test results? You may ask to have a copy mailed to you

You may call for your results

If you have an abnormal result, it is extremely important to follow-up for the recommended testing

Even after a normal Pap test, it is still

important to report any symptoms of abnormal vaginal bleeding, discharge or pain to your doctor and call to be seen right away

Do I need a Pap test if I had a hysterectomy? If you had treatment for precancer or

cancer of the cervix, you may need a Pap test

If the cervix was left in place at the time of your hysterectomy, you will still need Pap tests

Preventive health care is still important even if you do not need a Pap test

Is there an age when I can stop having Pap tests?

The American Cancer Society recommends that screening stop at age 70, if three or more recent tests are normal, and there have been no abnormal results in the last 10 years.

What is new in screening and prevention? Liquid cytology-thin layer cytology

Combination of HPV test and Pap is now available for women 30 years of age and older

Pap test computer reviews

Vaccines for HPV currently being tested

Evaluation of the Abnormal Pap Test

and Treatment of Precancer

Abnormal Pap test – How common is it?

12,200

cancers

300,000 HSIL

1.25 million LSIL

2-3 million ASC

50-60 million women screened

What is an HPV test?

A test sometimes used to determine if you need further evaluation

Cells are collected just like a Pap test

It checks for high-risk HPV

What happens if I have an abnormal Pap test?

ASC-US management options: HPV testing Repeat Pap Colposcopy

ASC-H, LSIL, HSIL, AGC, AIS, cancer Colposcopy Possibly endometrial biopsy for AGC AIS / cancer: referral to gynecologic

oncologist

What is a colposcopy?

Colposcopy: Use of a magnifying

instrument Application of a

vinegar-like solution onto the cervix

See abnormalities that can’t be seen with the naked eye

Feels like getting a Pap test, but lasts longer

Source: This is a copyrighted image of the California Family Health Council, Inc. and may not be reproduced in any way without the expressed written permission of the California Family Health Council. California Department of Health Services "What You Should Know if your Pap Test is Abnormal"- Your Colposcopy Exam, Donna Bell Sanders (Education Programs Associates 1995; Campbell, CA).

What is a cervical biopsy?

Biopsy: Removal of a small

piece of tissue from the cervix

May feel like getting a Pap test or like a menstrual cramp that lasts a few seconds

Source: TAP Pharmaceuticals, “Female Reproductive Systems.”

Source: A. DeCherney and M. Pernoll, Current Obstetric and Gynecologic Diagnosis and Treatment (The McGraw-Hill Companies, Inc.) 586.

What does the biopsy result mean?

Mildly abnormal (CIN I) observation preferred

More abnormal (CIN II) treatment

Precancer (CIN III) treatment

Cancer Gynecologic oncology consultation

What are the treatment options for CIN? LEEP Laser Cryotherapy Cone Biopsy In special circumstances a

hysterectomy may be recommended

What can I expect after treatment for CIN? Estimates of cure range from 73-90%

with a single treatment The risk for invasive cancer following

treatment is about 1% Therefore, you still need to have

regular Pap tests Minimal, if any, impact on fertility

What you can do?

Take Control - Protect Yourself 1) Ask your doctor about an appropriate

Pap test screening interval for you2) Make sure that you get a Pap test at

the recommended time3) Find out how and when you will learn

about the results of your Pap test4) Follow-up! Don’t assume that no news

is good news

5) Do not smoke

Cervical Cancer

What are the symptoms of cervical cancer? Abnormal bleeding

Between periods With intercourse After menopause

Unusual vaginal discharge Other symptoms

Leg pain Pelvic pain Bleeding from the rectum or bladder

Some women have no symptoms

What should I do if I have just been diagnosed with cervical cancer?

Find a gynecologic oncologist Call 1-800-444-4441

Discuss treatment options Conization Hysterectomy Radical hysterectomy Radiation with chemotherapy

Ask about clinical trials (Gynecologic Oncology Group)

Other considerations Preserve your fertility Preserve your ovaries

Clinical staging of cervical cancer

Source: “FIGO Annual Report on The Results of Treatment in Gynaecological Cancer” Journal of Epidemiology and Biostatistics, (2001) vol. 6 no. 1, page 14.

What is a cervical conization?

Conization: • Removes a

cone-shaped piece of tissue

• Often allows for diagnosis and treatment

• Performed with local anesthesia in the office or under general anesthesia in the operating room

Source: TAP Pharmaceuticals, “Female Reproductive Systems.”

What is a radical hysterectomy?

Treatment option for early stage cancer

Not the same as the usual hysterectomy

Surgical removal of the uterus, cervix and upper vagina with the surrounding tissues

Lymph nodes are removed

Removal of the ovaries is not required

What is radiation with chemotherapy (chemoradiation)?

Standard of care for advanced cancer

Treatment requires: 1. External radiation 2. Internal radiation 3. Low dose chemotherapy given at

the same time

Cervical cancer: What is the chance of survival after treatment?

FIGO Stage 5-Year Survival

Stage I 81-96%

Stage II 65-87%

Stage III 35-50%

Stage IVA 15-20%

Re-establishing Wellness

Restoring wellness is a gradual process Some women find strength from:

Friends and family Support groups Spiritual work Counseling Exercise

The challenges and the journey are different for each woman with cervical cancer

How do I get my friends to have a Pap test? Tell her it doesn’t hurt

Offer her a ride

Offer help with child care

Help her get an appointment

Help her find the right health care provider

Empower her with information: Tell your friend about the importance of health prevention

Cervical Cancer Presentation ParticipantsGCF gratefully acknowledges the following individuals who contributed to this educational

presentation: Bobbie Gostout, M.D., EditorWendy Brewster, M.D.Karen CarlsonThomas Cox, M.D.Juan Felix, M.D.Hollis ForsterChristine Holschneider, M.D.Beth Karlan, M.D.Alan KayeHershel Lawson, M.D.Suzy Lockwood, R.N., M.S.N., Ph.D.

Saralyn Mark, M.D.F.J. Montz, M.D., K.M. (1955-2002)Mitchell Morris, M.D.Karl Podratz, M.D., Ph.D.Karen RiordanDebbie Saslow, Ph.D.Evelyn SchulmanAlice Spinelli, M.S.N., A.R.N.P.Joan Walker, M.D.Leslie Walton, M.D.Thomas Wright, Jr., M.D.

GCF Supporting Organization

This educational effort was undertaken by the Gynecologic Cancer Foundation with support from the National Cervical Cancer Coalition (NCCC). GCF gratefully acknowledges and thanks NCCC for its efforts related to cervical cancer public outreach.

For more information:National Cervical Cancer Coalition16501 Sherman WaySuite #110Van Nuys, CA 91406

Toll Free Hotline (800) 685-5531Phone: (818) 909-3849Fax: (818) 780-8199Email: info@nccc-online.orgWeb site: www.nccc-online.org

Gynecologic Cancer Foundation401 N. Michigan Avenue

Suite 2200Chicago, IL 60611

800-444-4441

www.wcn.org/gcfgcf@smithbucklin.com