cervix cancer power point with slides

5/10/2018 Cervix Cancer Power Point With Slides - slidepdf.com

http://slidepdf.com/reader/full/cervix-cancer-power-point-with-slides 1/41

Cervix Cancer

Prevention and Early Detection



Obtaining CME CreditThis activity is accredited for up to 1 hour

of AMA PRA Category 1 credit. To

obtain CME credit for this module,complete the evaluation and return with$10 to TMA/POEP, 401 West 15th

Street, Austin, TX 78701-1680.



Objectives After completion of this module, the physician

will be able to:

1. Identify women at risk for cervix cancer.2. Describe the probable etiologic factors that

contribute to the development of cervix cancer.

3. Explain why cervix cancer is suitable forscreening.

4. Describe the screening procedure for cervixcancer.



Objectives (continued) After completion of this module, the physician

will be able to:

5. Describe the reporting system(s) used for Papsmear.

6. Describe the recommendations for evaluationand follow-up of women with abnormal Pap

test results.7. Encourage women to be screened for cervix

cancer.



Cervix Cancer: A Global Problem It is the second most common cancer

site in women worldwide.

It is the most common cancer site andcause of cancer death in women inmany developing countries.

Women with cervical cancer die at ayounger age than those with any othernon-childhood cancer.



Incidence Rates of Cervix

Cancer in the United States14.2

11.9

10.1

8.7 8.4 8.88.4

7.8

0

24

6

8

1012

14

16

1973 1980 1985 1991

Rates per 100,000

Age-adjusted to1970 U.S. std. Pop.

21-year trend (females only)

Source: SEER Cancer Statistics Review, 1973-1994.



Mortality Rates for Cervix

Cancer in Texas

Counties with mortality rate above5 per 100,000

Counties with Mortality rate above 2per 100,000 but less than 5 per 100,000

Counties with mortality rate lowerthan 2 per 100,000



Relationships Between Age, Ethnicity,

and Incidence of Cervix Cancer

0

51015202530

354045

1 5 - 1 9

2 5 - 2 9

3 5 - 3 9

4 5 - 4 9

5 5 - 5 9

6 5 - 6 9

7 5 - 7 9

8 5 +

Age at diagnosis

Black

White

Source: Herrero, Rolando. Journal of the National Cancer Institute Monographs , No. 21:3, 1996.

Age-specific rate1988-1992



Cervical Cancer Among Blacks

and Whites

0

2

4

6

8

10

12

14

1 9 7 3 7 5 7 7 7 9 8 1 8 3 8 5 8 7 8 9 9 1

Year of death

M o r t a l i t y r

a t e

Black

White

Source: Herrero, Rolando. Journal of the National Cancer Institute Monographs , No. 21:3, 1996



Incidence of Invasive and

Pre-invasive Cervix Cancer

0

10

20

30

40

50

60

70

1975 1980 1985 1990 1995

Invasive

Carcinoma in situ

Rates are per 100,000

and age-adjusted to the1970 U.S. standard

Source: SEER Registry



Risk Factors for Cervix Cancer No prior smear screening

History of cervical dysplasia or genital warts

Young age at first coitus

Multiple sex partners

High-risk male partner (e.g., multiple female

partners) Sexually transmitted diseases

Cigarette smoking

Increasing age



The Normal Cervix



The Human Papillomavirus

(HPV) and Cervix CancerHPV 16 and 18

E6 protein E7 protein

+ +

p53 retinoblastomatumor suppressor tumor suppressor

gene product gene product

increased cellular proliferation



Promoters of Cervix Cancer Smoking

Diet

Immunosuppression



Screening for Cervix CancerCervix cancer is a disease suitable for screening

because it meets the following criteria:

It’s a common disease.

It has serious consequences.

It has a detectable, asymptomatic phase.

Early detection and treatment decreasemorbidity and mortality.

The screening test is acceptable to patients,safe, and affordable.



Benefits of the Papanicolaou Smear Sensitivity: 50-70%

Specificity: 30-50%

Inexpensive

Minimal risk and discomfort to the patient



The Papanicolaou Smear:

False Negative ResultsWhy do false negative results occur?

Inadequate smear technique/sample Improper laboratory preparation/evaluation

Failure of health care provider to properlyinterpret and manage an abnormal result

Failure of the patient to comply withrecommendations for evaluation and treatment

Invasive cancer at the time of initial evaluation



Cervix Cancer Screening:

Recommendations for Frequency Annually after the patient is sexually active or

age 18 until negative x3; then at the

discretion of the physician and patient basedupon a consideration of risk factors.

The American College of Obstetricians and Gynecologist



Cervix Cancer Screening:

Current Controversies How often should Pap tests be

performed?

Should a woman who has had ahysterectomy continue to have periodicPap tests?

When should the Pap test be repeatedif endocervical cells are not present?

Should Pap tests be performed inpatients older than age 60?



Pathology of Cervical Dysplasia



The 1988 Bethesda SystemReporting Cervical Cytologic Diagnosis

Statement about the adequacy of the specimen

General categorization of the diagnosis

Descriptive diagnosis

JAMA 267:1892, 1989.



The 1988 Bethesda System

(continued)Descriptive Diagnosis

Infection

Reactive and reparative changes

Epithelial cell abnormalities

Nonepithelial malignant neoplasm (specify)

Hormonal evaluation (vaginal smear only)

Other




(continued)Epithelial Cell Abnormalities: Squamous Cells

Atypical squamous cells of undeterminedsignificance (recommended follow-upspecified)

Squamous intraepithelial lesion (SIL) Low grade SIL: HPV changes and/or CIN I

High grade SIL: CIN II, CIN III, or CIS

Squamous cell carcinoma




(continued)Epithelial Cell Abnormalities: Glandualr Cells

Presence of endometrial cells

Out of phase in a menstruating woman In a postmenopausal woman

No menstrual history available

Atypical glandular cell of undetermined

significance (recommended follow-upspecified) Endometrial

Endocervical

Not otherwise specified




(continued)Epithelial Cell Abnormalities: Glandular

Cells (continued)

Adenocarcinoma (probable site of origin specified)

Other epithelial malignant neoplasm: specify



Follow-up of Abnormal

Papanicolaou SmearsColposcopy: Magnified Inspection of

the Cervix

Identifies the area of abnormality for biopsy

Defines the extent of the cervical lesion

Delineates the areas of greatest abnormality



Evaluation of the Abnormal

Papanicolaou SmearCOLPOSCOPY

Satisfactory Unsatisfactory

(entire lesion seen) (lesion extends intoendocervical canal)

Biopsy lesion Biopsy any visible lesionEndocervical curettage

Histological Confirmation



Evaluation of the Abnormal

Papanicolaou SmearTREATMENT OF CERVICAL DYSPLASIA

Lesion confined Lesion extends intoto ectocervix endocervical canal

Cervical biopsies revealmicroinvasion

Ablation of Excision of T-zone

excision of T-zone



Treatment of Cervix DysplasiaTreatment Modality

Destructive Methods Cryotherapy

Laser ablation

Excision Cervical conization

LEEP

Cure Rate (5-year)Overall

85-95%

85-95%

>90%

>90%



Evaluation of the Patient with

Cervix CanerHistologic confirmation of cervix cancer

by biopsy, followed by:

HIV test

Staging examination

Metastatic survey

Treatment planning



Evaluation of the Patient with

Cervix Cancer Staging examination

Complete physical and pelvic examination

Palpation of the lymph node-bearing areas

Cystoscopy/proctoscopy for advanced cancers

Metastatic survey Radiograph of the chest

IVP and barium enema or computerizedtomography of pelvis and abdomen

Treatment planning Surgery for selected Stage I lesions

Radiation therapy for all others



Post Treatment SurveillanceExams: Palpation of the node-bearing areas, Pelvic, Pap

Year Frequency0-2 every 3-4 months

2-4 every 6 months

5+ annually



Five Year Survival of Cervix

Cancer by Stage of Disease100%

85%

66%

39%

11%0%

20%

40%

60%

80%

100%

Stage 0 Stage I Stage II Stage III Stage IV



Role of the Primary Care Physician

in Preventing Cervix Cancer Identify patients who should be

screened

Educate patients regarding theimportance and timing of Pap smears

Conduct Pap smears properly

Follow up abnormal Pap smear results



Barriers to Screening Embarrassment, unpleasantness

Lack of knowledge of recommended

screening interval

Financial barriers

Lack of knowledge concerning theimportance of screening



SummaryCervix cancer is highly preventable

Pap smear screening

Treatment of precursor lesions (dysplasia)

Follow-up of abnormal Pap smear results is critical

Colposcopically-directed biopsies

Histologic evaluation and correlation with the Papsmear

Definitive therapy



Reading List1. American College of Obstetricians and Gynecologists.Recommendations on Frequency of Pap Test Screening. ACOG Committee Opinion 152. Washington, DC: ACOG, 1995.

2. Anderson GH, et al. Organisation and results of the cervical

cytology screening programme in British Columbia, 1955-85,British Medical Journal (Clin Res Ed) 296(6627):975-8, 1988.

3. Broder S. The Bethesda System for reporting cervical/vaginalcytologic diagnoses: report of the 1991 Bethesda workshop.Journal of the American Medical Association 267:1892, 1992.

4. Burack RC, et al. How reminders given to patients andphysicians affected pap smear use in a health maintenanceorganization: results of a randomized controlled trail. Cancer 82(12):2391-400, 1998.



Reading List (continued)5. Creasman WT, et al. Early invasive carcinoma of the cervix (3

to 5 mm invasion): risk factors and prognosis. A GynecologicOncology Group study. Am J Obstet Gynecol 178(1 Pt 1):62-5, 1998.

6. Devesa SS, et al. Recent trends in cervix uteri cancer. CancerNov. 15; 64(10):2184-90, 1989.

7. Eaker ED, et al. Cervical cancer screening among women withand without hysterectomies. Obstet Gynecol 91(4):551-5,1998.

8. Frame PS, et al. Determinants of cancer screening frequency;the example of screening for cervical cancer. J AM Board Fam Pract 11(2):87-95, 1998.

9. Hopman EH, et al. Positive predictive rate of colposcopicexamination of the cervix uteri: an overview of literature.Obstet Gynecol Surv 53(2):97-106, 1998.



Reading List (continued)10. Lobell M, et al. Barriers to cancer screening in Mexican-

American women. Mayo Clin Proc 73(4):301-8, 1998.

11. Ollayos CW. Update on the Papanicolaou smear: new issues

for the 1990s. Mil Med 162(8):521-3, 1997.12. Paskett ED, et al. Clinic-based interventions to promote

breast and cervical cancer screening. Prev Med 27(1):120-8,1998.

13. Peters RK, et al. Risk Factors for invasive cervical cancer

among Latinas and non-Latinas in Los Angeles County.Journal of the National Cancer Institute 77(5):1063-77, 1986.



Other POEP CME Modules Breast Cancer (and in interactive CD-ROM)

Cancer in Special Populations

Colorectal Cancer Head and Neck Caner

Lung Cancer

Nutrition and Cancer Risk Reduction

Prostate Cancer

Skin Cancer

Surveillance of Cancer Patients

To order these modules in spiral bound or 35mm slide format, contactPOEP at [email protected] or call 800-880-1300, ext. 1672.

mailto:[email protected]

mailto:[email protected]



EvaluationTo obtain CME credit for this module,

complete the online evaluation and

return with $10 to TMA/POEP, 401 West15th Street, Austin, TX 78701-1680.

Return to POEP online CME

http://texmed.org/has/prs/pop/cmepp/cervixeval.asp

http://www.texmed.org/has/prs/pop/cmepp/pocme.asp

http://www.texmed.org/has/prs/pop/cmepp/pocme.asp

http://texmed.org/has/prs/pop/cmepp/cervixeval.asp

cervix cancer power point with slides

Documents