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Cervical Cancer. Cervical Cancer. Dr. Swapna Chaudhary M.S. (MUM) Consultant Obstetrician & Gynaecologist Infertility Specialist. Cervix. Cervix. Cervix constitutes lower 1/3 rd of uterus. Epidemiology. Epidemiology. 5 lac new cases / year around world. Epidemiology.
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Cervical Cancer Dr. SwapnaChaudhary M.S. (MUM) Consultant Obstetrician & Gynaecologist Infertility Specialist
Cervix • Cervix constitutes lower 1/3rd of uterus
Epidemiology • 5 lac new cases / year around world
Epidemiology • 5 lac new cases / year around world • 80% in developing countries
Epidemiology • 5 lac new cases / year around world • 80% in developing countries • Commonest gynecological malignancy in India
Epidemiology • 5 lac new cases / year around world • 80% in developing countries • Commonest gynecological malignancy in India • 2nd is breast cancer
Risk Factors / Causes • Multiple sexual partners (> 1)
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity • Prior STDs (HSV II, genital warts, vaginal infections)
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity • Prior STDs (HSV II, genital warts, vaginal infections) • Cigarette Smoking
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity • Prior STDs (HSV II, genital warts, vaginal infections) • Cigarette Smoking • Immunodeficiency
Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity • Prior STDs (HSV II, genital warts, vaginal infections) • Cigarette Smoking • Immunodeficiency • Human Papiloma Virus (HPV) – transforms normal cell into malignant cells
Age Groups • Cervical Intraepithelial Neoplasia (CIN) 35 years
Age Groups • Cervical Intraepithelial Neoplasia (CIN) 35 years • Invasive Cervical Cancer 45 - 55 years
Symptoms • CIN (dysplasia): Asymptomatic
Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation
Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation • Abnormal bleeding -- intercycle -- post coital -- post menopausal
Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation • Abnormal bleeding -- intercycle -- post coital -- post menopausal 3. Foul smelling vaginal discharge
Chronic backache / pelvic pain Late sign -- weight loss -- mild fever -- anemia
Dysplasia / CIN • Precancerous stage
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I mild
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I II mild mod
Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I II III mild mod severe
25 % patients progress from CIN 1 to CIN 3 in 2 yrs • 40 % patients of CIN 3 progress to Cancer over 10 – 15 yrs.
Pap Smears • Non invasive OPD procedure
Pap Smears • Non invasive OPD procedure • No pain / no discomfort
Pap Smears • Non invasive OPD procedure • No pain / no discomfort • No anesthesia required
When to Get Pap Smears • ACOG Recommendations
When to Get Pap Smears • ACOG Recommendations • 1st Pap Smear at age when patient becomes sexually active (or by age 18)
When to Get Pap Smears • ACOG Recommendations • 1st Pap Smear at age when patient becomes sexually active (or by age 18) • Yearly pap smears thereafter
When to Get Pap Smears • ACOG Recommendations • 1st Pap Smear at age when patient becomes sexually active (or by age 18) • Yearly pap smears thereafter • Others contend that monogamous women with no history of abnormal pap smears can have them done every 3 years
When to Get Pap Smears • ACOG Recommendations • 1st Pap Smear at age when patient becomes sexually active (or by age 18) • Yearly pap smears thereafter • Others contend that monogamous women with no history of abnormal pap smears can have them done every 3 years • After 40 – yrly pap test for 3 yrs – if normal then 3 yrly.
Routine screening can stop at age of 60 yrs provided….
Routine screening can stop at age of 60 yrs provided • Previous 2 normal smears