THERESA LOWRY-LEHNENRGN, BSC (HON’S) NURSING SCIENCE (SPECIALIST PRACTITIONER), PGCC, DIP COUNSELLING,

DIP ADV PSYCHOTHERAPY, BSC (HON’S) CLINICAL SCIENCE, PGCE (QTS), H. DIP. ED, MED, PHD STUDENT HEALTH PSYCHOLOGY

Cervical CancerThe Importance of Cervical Screening and Vaccination

Cancer CellsCancer begins in cells, the building blocks that make up tissues. Tissues make

up the organs of the body.

• Normal cells grow and divide to form new cells as the body needs them.When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form

when the body does not need them, and old or

damaged cells do not die as they should.

• The buildup of extra cells often forms a mass of tissue called a growth or tumor.

• Changes to the DNA of a cell (mutations) lead to cellular damage

• Mutations enable cancer cells to divide continuously, without the need for normal signals.

• In some cancers the unchecked growth results in a mass, called a tumor. Cancerous cells may invade other parts of the body interfering with normal body functions.

Cancer Cells

Cancer Although cancer is often referred

to as if it were a single disease, it is really a diverse group of diseases that affects many different organs and cell types.

The likelihood of developing any particular cancer depends on an individual’s genetics, environment, and lifestyle.

The occurrence of some cancers may be prevented or reduced by wise lifestyle choices.

Cancer TypesThe main types of cancer include:

• Carcinoma Cancer that begins in the skin or in tissues that line or cover internal organs.

• Sarcoma Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

• Leukemia Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.

• Lymphoma and myeloma

Cancers that begin in the cells of the immune system.

• Central nervous system cancers

Cancers that begin in the tissues of the brain and spinal cord.

Cervical Cancer

• Cervical Cancer is the second most common cancer among women worldwide.

• Over 500,000 women worldwide die of cervical cancer annually.

• Approximately every 47 minutes a woman is diagnosed with cervical cancer.

Cervical CancerCe

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Cancer CellsCe

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r Growths on the cervix can be benign or malignant. Benign growths are not cancer. They are not as harmful as malignant growths (cancer).

Benign growths (polyps, cysts):• are rarely a threat to life• don’t invade the tissues around them

Malignant growths (cervical cancer): • may be a threat to life• can invade nearby tissues and organs• can spread to other parts of the body

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cer How does cervical cancer start?

The spread of cancer is called metastasis.

The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which

branch into all the tissues of the body.

Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby

tissues.

Risk FactorsCe

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r • HPV infection: Sexually

transmitted virus

HPV infections are very common. Most men and women who are sexually active have been exposed to HPV. Over 85% of men and women have been infected with HPV at some time in their lives, but most infections clear up on their own. More than 75% of sexually active women have been exposed to HPV by age 18-22. Some types of HPV can cause changes to cells in the cervix. If these changes are found early, cervical cancer can be prevented by removing or killing the changed cells before they can become cancer cells.

• Lack of regular Cervical Smear tests:

Cervical cancer is more common among women who don’t have regular smear tests. The smear test screens for abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer.

• Family History• Smoking:

Heredity/ GeneticsSmoking cigarettes increases the risk of cervical cancer.

• Weakened immune system:

The body’s natural defense system: Infection or taking drugs that suppress the immune system increases the risk of cervical cancer.

Risk FactorsCe

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r • Using birth control pills for a long time:

Using birth control pills for a long time (5 or more years) may slightly increase the risk of cervical cancer. However, the risk decreases quickly when women stop using birth control pills.

• Having many children:

Studies suggest that giving birth to many children (5 or more) may slightly increase the risk of cervical cancer among women with HPV infection.

• DES (diethylstilbestrol):

DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women between 1940 and 1971. (It is no longer given to pregnant women)

Having a HPV infection or other risk factors does not mean that a woman will develop cervical cancer. Most women who have risk factors never develop it. Women who have never been sexually active and who have not had the HPV virus can also develop cervical cancer

About 80% of Womenwill be infected with HPV in their lifetime

HPV and Cervical Cancer

Source: Gynecologic Cancer Foundation

About 7% of Women have an abnormal smear test

HPV and Cervical Cancer

SymptomsCe

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Early cervical cancers usually don’t cause symptoms. When the cancer grows larger, women may notice one or more of these symptoms.Infections or other health problems may also cause these symptoms. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Abnormal vaginal bleeding—Bleeding that occurs between regular menstrual periods—Bleeding after sexual intercourse, douching, or a pelvic exam—Menstrual periods that last longer and are heavier than before—Bleeding after going through menopause.

Increased vaginal discharge—Pelvic pain—Pain during sex

How cervical smear tests help prevent cervical cancer

• Routine cervical screening (smear tests) detects abnormal cervical cells before they have a chance to turn into cancer.

• Cervical cancer is a disease that develops quite slowly and begins with a pre-cancerous condition known as dysplasia.

• Dysplasia is easily detected in a routine smear and is completely treatable.

• Cervical cancer is a malignant tumour deriving from cells of the cervix.

• Detecting and treating abnormal cervical cells early can almost always prevent cervical cancer from developing.

Between 60% and 80% of women diagnosed with cervical cancer had not had a smear test within 5 years of their diagnosis.

What Is a Cervical Smear Test?A cervical smear test is a simple procedure which involves gently scraping some cells from the surface of the cervix and putting them on a slide. The cells are then examined under a microscope in the laboratory to see if they are normal.Pre and early cancerous changes in the cervix can be detected by the smear.Pre-cancers and very early cervical cancers are nearly 100% curable, so early and regular screening tests can prevent nearly all deaths from cervical cancer

Detection and DiagnosisCe

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r Women can help reduce their risk of cervical cancer by having regular smear tests. A cervical smear test is a simple test used to look at cervical cells. Smear tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

Finding and treating abnormal cells can prevent most cervical cancer. Also, the cervical smear test can help find cancer early, when treatment is more likely to be effective.

For most women, the smear test is not painful. It’s carried out in a doctor’s surgery or clinic. The nurse or doctor scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes.

Most often, abnormal cells found by a smear test are not cancerous. The same sample of cells may be tested for HPV infection.

Detection and DiagnosisCe

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r If abnormal cervical smear or HPV results are found other tests will be carried out to make a diagnosis:

Colposcopy: A colposcope is used to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. A colposcopy is usually done in the doctor’s office or clinic.

Biopsy: Biopsy under local anesthesia and pathologists then check the tissue under a microscope for abnormal cells.Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.Endo-cervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

Diagnosis

CERVICAL SMEAR

COLPOSCOPY

CERVICAL BIOPSY

COLPOSCOPY

A visual examination of the surface of the cervix using a colposcope- an instrument with magnifying lenses and a light.If abnormalities are seen, a tissue sample (biopsy) may be taken and sent for evaluation.

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

Biopsy

Grades of DysplasiaNormalCIN 1 = Mild dysplasiaCIN 2 = Moderate dysplasiaCIN 3 = Severe dysplasia

Treatment options for CINTreatments include:• LEEP• Laser• Cryotherapy• Cone Biopsy• Hysterectomy may

be recommended (rarely)

SURGICAL MANAGEMENT

–Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells.

–LEEP (loop electrosurgical excision procedure) - a wire loop which has an electric current cuts through tissue removing cells from the mouth of the cervix.

Cryotherapy

Hysterectomy

StagingCe

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r If the biopsy detects cancer, the extent (stage) of the disease needs to be identified to choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease..

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• Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix.

• Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall.

• Stage III: The tumor extends to the lower part of the vagina.It may also have invaded the pelvic wall.If the tumor blocks the flow of urine, one or both kidneys may not be working well.

• Stage IV: The tumor invades the bladder or rectum. Or the cancer has spread to other parts of the body.

• Recurrent cancer:

The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

Staging

Treatment for Cervical CancerCe

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r Women with cervical cancer have treatment options.

The options are

SurgeryRadiation TherapyChemotherapy or a combination of methods.

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether the woman wishes to become pregnant someday.

Cancer treatments often damage healthy cells and tissues, so side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

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cer Surgery is an option for women with Stage I or II cervical cancer.

The surgeon removes tissue that may contain cancer cells:

Radical Trachelectomy:

Removal of the cervix, part of the vagina, and the lymph nodes in the pelvis.Recommended for a small number of women with small tumors who may want to try to get pregnant in the future.

Total Hysterectomy:

Removal of the cervix and uterus.

Radical Hysterectomy:

Removal of the cervix, some tissue around the cervix, the uterus, and part of the vagina.

Fallopian Tubes and Ovaries:

The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.

Lymph Nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

Surgery

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Radiation therapy (radiotherapy) is an option for women with any stage of cervical cancer. • Early stages of cervical cancer can be treated with radiation therapy instead of surgery.

• It may also be used after surgery to destroy any cancer cells that remain in the area.

• Cancer that extends beyond the cervix may have radiation therapy and chemotherapy.

• Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

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cer Doctors use two types of radiation therapy to treat cervical

cancer. Some women receive both types:

External Radiation Therapy:

A large machine directs radiation at the pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. External radiation usually takes place 5 days a week for several weeks. Each treatment takes only a few minutes.

Internal Radiation Therapy:

A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. The patient may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and the patient can go home afterwards. Once the radioactive substance is removed, no radioactivity is left in the body. Internal radiation may be repeated two or more times over several weeks.

Radiation Therapy

ChemotherapyCe

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r For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy.However depending on the type of cancer chemotherapy can also be used alone.

Chemotherapy uses drugs to kill cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing.

The drugs for cervical cancer are usually given through a vein (intravenous). prevents cancer cells from dividing and growingChemotherapy can take place at a clinic, at the doctor’s surgery, or sometimes at home.

Some women need to stay in the hospital during treatment.

ChemotherapyCe

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r The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

Blood cells: Chemotherapy lowers the levels of healthy blood cells, and the patient is more susceptible to infections, bruise or bleed easily, feel very weak and tired. Blood tests will check for low levels of blood cells. If levels are low, chemotherapy may be stopped for a while or the dose of drug reduced. There are also medicines to help the body make new blood cells.

Cells in hair roots:

Chemotherapy may cause hair loss. It will grow back, but it may change in color and texture.

Cells that line the digestive tract:

Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhoea, or mouth and lip sores.

Follow-up Care

Regular checkups after treatment for cervical cancer are important. Checkups help ensure that any changes in health are noted and treated.

Doctor’s will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups include a physical exam, cervical smear tests, bloods and chest x-rays.

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Prevention is better than cure

• To be most effective, the HPV vaccine should be given before a female has any type of sexual contact with another person. It is given in a series of 3 doses within 6 months.

• Recommendations for each age group: • Girls ages 11 to 12

The vaccine should be given to girls ages 11 to 12 and as early as age 9.

• Girls ages 13 to 18 Girls ages 13 to 18 who have not yet started the vaccine series or who have started but have not completed the series should be vaccinated.

• Young women ages 19 to 26 Some authorities recommend vaccination of women ages 19 to 26, but the American Cancer Society experts believed that there was not enough evidence of the benefit to recommend vaccinating all women in this age group.

• It is recommended that women ages 19 to 26 talk to their doctors about whether to get the vaccine based on their risk of previous HPV exposure and potential benefit from the vaccine

HPV VaccineWho should be vaccinated and when?