Theresa Lowry-Lehnen RGN, PGCC, Dip Counselling & Psychotherapy, BSc (Hon’s), MSc, - PowerPoint Presentation

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Theresa Lowry-LehnenRGN, PGCC, Dip Counselling & Psychotherapy, BSc (Hon’s), MSc, PGCE (QTS) Science, H. Dip. Ed, M.ED, PhD Health Psychology

Cervical Cancer

The Importance of Cervical Screening and HPV Vaccination

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Cancer Cells

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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

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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.

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Cancer Types

The 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.

Leukaemia

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.

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Cervical CancerCervical 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.

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Cervical CancerCervical Cancer

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Cancer Cells

Cervical Cancer

Growths on the cervix can be

benign

or

malignant

.

Benign growths are not cancer.

They are not as harmful as malignant growths (cancer).

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Cervical Cancer

How does cervical cancer start?

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Risk Factors

Cervical Cancer

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/

Genetics

Smoking 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.

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Risk Factors

Cervical Cancer

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

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About 80% of Women

will be infected with

HPV in their lifetime

HPV and Cervical Cancer

Source: Gynecologic Cancer Foundation

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About 7% of

Women have

an abnormal

smear test

HPV and Cervical Cancer

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Symptoms

Cervical Cancer

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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.

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What Is a Cervical Smear Test?A

cervical smear

test

is a simple procedure which involves

inserting a speculum into the vagina, opening it up and gently

scraping some cells from the

opening

of the

cervix. The

cells are

then

sent to a laboratory and examined

under a

microscope

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

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Detection and Diagnosis

Cervical Cancer

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Detection and Diagnosis

Cervical Cancer

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

.

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Diagnosis

CERVICAL SMEAR

COLPOSCOPY

CERVICAL BIOPSY

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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.

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

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Grades of Dysplasia

Normal

CIN 1 = Mild dysplasia

CIN 2 = Moderate dysplasia

CIN 3 = Severe dysplasia

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Treatment options for CIN

Treatments include:

LEEP

Laser

Cryotherapy

Cone Biopsy

Hysterectomy may be recommended (rarely)

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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.

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Cryotherapy

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Hysterectomy

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Staging

Cervical Cancer

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Cervical Cancer

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

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Treatment for Cervical Cancer

Cervical Cancer

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Cervical Cancer

Surgery

i

s 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

Cervical Cancer

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Cervical Cancer

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

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Chemotherapy

Cervical Cancer

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Chemotherapy

Cervical Cancer

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.

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Follow-up Care

Cervical Cancer

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Prevention is better than cure

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To be most effective, the HPV vaccine should be given before any type of sexual contact occurs with another person.Recommendations for each age group: Girls ages 11 to 13

The vaccine should be given to girls aged 11 to 13 and

the

HSE has offered the HPV vaccine to all girls in first year in second level schools since 2010 to protect them from cervical cancer in adulthood

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 Vaccine

Who should be vaccinated and when?