cervical cancer screening / evaluation / treatment
TRANSCRIPT
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: [email protected] site: www.nccc-online.org
Gynecologic Cancer Foundation401 N. Michigan Avenue
Suite 2200Chicago, IL 60611
800-444-4441
www.wcn.org/[email protected]