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Cervical cancer is one the most common cancers in women. You will be in awe to know that in every 7 minutes one woman dies of cervical cancer. Not just this, every year 1,32,000 new cases of cervical cancer are being reported and 74,000 deaths/year are being registered. But, this doesn’t mean that you have to run away from cervical cancer treatment. In fact, you need to get vaccinated on a periodic basis because cervical cancer if detected in early stages can be successfully treated. However, the treatment depends on several factors such as your age, your tests, location of the cancer, stage of the cancer and health problems you may have. Chemotherapy, surgery and radiation or a combination of all three are used for the treatment of cervical cancer.
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Dr. Satinder Kaur Consultant Gynae Oncologist Dharamshila Hospital And Research Centre
Opening of the uterus (womb) into the vagina The cervix connects the uterus and vagina Only Gynae cancer that can be prevented through routine screening.
Cervical cancer is the most common cancer in Indian women. • ~1,32,000 new cases/ year & ~74,000 deaths/year. • Every 7 min one woman dies of Cervical cancer! • 1 out of 4 woman who dies due to Cervical cancer in the world is an Indian!!
The central cause of cervical cancer is a virus. • This virus is called human papillomavirus or HPV: • HPV is sexually transmitted
>100 HPV Types 40 HPV Types infect ano-genital region • High Risk Types • types are Oncogenic- • HPV 16, 18, 31, 33 and 45 Low-Risk Types HPV 6, 11 In India, these 5 HPV types are responsible for 90 - 95% of Cervical Cancers
About 50% of sexually active women are infected with HPV within 3 years of onset of sexual activity 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
Multiple sexual partner • Sexual intercourse at young age • Poor diet, and other infections. • Cigarette smoking. • Immune defenses are low (e.g., AIDS.
Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding). • Abnormal (yellow, odorous) vaginal discharge, often of a yellow or green color and foul smelling. • Low back pain • Cervical Pain, noted when a tampon, finger or penis is inserted into the vagina. • Painful sexual intercourse • Painful urination is seen with advancing disease • Some women have no symptoms at all.
PAP SMEAR • COLPOSCOPY • CERVICAL BIOPSY
When do I need my first Pap test? Three years after the onset of sexual intercourse How often do I need a Pap test? Atleast three yearly
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? • 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 It is the easiest gynecologic cancer to prevent through screening
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 • If you have an abnormal result, it is extremely important to follow-up for the recommended testing
If you had treatment for pre cancer 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
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
May feel like getting a Pap test or like a menstrual cramp that lasts a few seconds
Surgery (hysterectomy) • Radiation Therapy • Chemotherapy
Bivalent vaccine (CERVARIXTM ) - Against HPV types 16 & 18 • Quadrivalent vaccine (GARDASIL®) - Against HPV types 6,11, 16 & 18 Both are licensed for use in > 100 countries & are approved by the Indian FDA
What is the optimal age for vaccination? Prophylactic vaccine :- Immunization before onset of sexual activity
Gardasil: 9-11 yrs • Cervarix 10-12 yrs • Can be given 13-26 yrs • Cervarix can be given upto 45 yrs but the role is doubtful
Intramuscular injection of 3 doses/0.5mL each 1st dose 0 2nd dose at 1 month (Cervarix) at 2 months (Gardasil) 3rd dose at 6 months
People who get vaccinated will still need Pap tests because the vaccine will not prevent all types of HPV that can cause cervical cancer.
Local reactions commonest (pain, swelling) • Syncope – Give vaccine in sitting / lying down position, and observe for 15 minutes after vaccination • No serious adverse reactions reported *similar to reports in placebo recipients (9%)
Cervical cancer causes significant morbidity/ mortality • HPV vaccine to be offered to all appropriate females who can afford the vaccine • Vaccine should be given prior to sexual debut www.fogsi.org/hpv vaccine
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
Cervical cancer treatment and surgery in India is available at Dharamshila Hospital And Research Centre (DHRC). Based in India, Delhi NCR, DHRC is the first cancer hospital of India established with an aim at making cancer treatment available, accessible and afforadable. At DHRC, a multidisciplinary team (MDT) of oncologists is always available to treat cervical cancer and tailor the treatment programme for the cancer patients. Besides this, DHRC is well-equipped with advanced treatment technologies and world class infrastructure. And, this may be the reason why patients from over 30 countries around the world choose DHRC for the treatment.