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CERVICAL CANCER
& ITS PREVENTION
Dr. Ashutosh Gupta
G.M.C. Jammu

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Sad but True…
In India, 200 women die each day due
to Cervical cancer

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For you & your daughter …..a
wonderful gift
Guard Yourself means
Protect yourself
very special Programme
to prevent cervical cancer.

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where is cervix in woman?
Educational Program 2015 5
CERVIX

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India ~1,32,000
World ~ 4,93,000
India ~27% of new
Cervical Cancer cases in world
India ~ 74,000
World ~ 2,73,000
India ~27%
Rest of World - 73%
India ~27% of deaths
due to Cervical Cancer in world
Rest of World - 73%
India - 27%
Cervical Cancer – Disease Burden
New Cervical Cancer Cases Deaths due to Cervical cancer
India ~27%
Rest of World - 73%

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HPV 16
HPV 18
HPV 6
HPV 11
Cancer causing Types1,2,4 Non-cancer causing types1,2
• >75% of Cervical Cancer5
• >50% of Vaginal & Vulvar Cancer5
90% of Anogenital warts5
HPV is a necessary cause of cervical cancer – 99.7%4
HPV
1.Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 2. Wiley DJ, Douglas J, Beutner K, et al. Clin Infect Dis. 2002;35(suppl 2):S210–S224. 3. Muñoz N, Bosch FX, Castellsagué X, et al. Int J
Cancer. 2004;111:278–285. Reprinted from J Virol. 1994;68:4503–4505 with permission from the American Society for Microbiology Journals Department. 4. Walboomers JM, Jacobs MV, Manos MM, et al. J
Pathol. 1999;189:12–19. 5. X. Castellsagué, S. de Sanjose, T. Aguado, K. S. Louie, L. Bruni, J.Muñoz, M. Diaz, K. Irwin, M. Gacic, O. Beauvais, G. Albero, E. Ferrer, S. Byrne,F. X. Bosch. HPV and Cervical
Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Available at: www.who.int/hpvcentre
Human Papillomavirus (HPV)

 Anogenital Disease: cervix, vulva, vagina, anus, penis
 Condylomata accuminatum
 Squamous intraepithelial neoplasia
 Cancer
 Head/Neck Disease:
 Mouth, tongue, tonsils
 Sinuses
 Oropharangeal
 Respiratory mucosa (children; type 6, 11)
 Cancer: usually HPV 16
 Cofactors: Smoking, Alcohol

5 – 10 years to develop cancer from time of infection
Infects only the epithelium – no viremia
• Resolution of infection and cytologic changes occurs secondary to
antibodies, and NKC, activated CD-4 and T lymphocytes
Most cases – no histologic or cytologic changes (66% - 90%)

HPV
Infection
Cervical
Lesions
Normal
Development of Precancerous lesions
CIN1, CIN2 & CIN3
Invasive
Cancer
Ranges
from
Measured by HPV DNA
detection in cervical cells
Relative frequency
increases with severity of
lesion

Long term use of Hormonal Contraceptive
-> 5-9yrs :: 3 times Risk
-> 10yrs or more :: 4 times Risk
High Parity :: 4 times Risk
Early initiation of Sexual Activity
Multiple Sex Partners
Tobacco Smoking (Both active & passive)
HIV Infection
Other STI’s
->Chlamydia Trachomatis
-> HSV 2
Immune Suppression
Low S/E status ; Diet poor in anti oxidants

cervical cancer screening 2017 copy.pptx

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How HPV infection can occur?
 Through sexual intercourse, vertical
transmission i.e. mother to child &
fomites.
 It is found that in every 10 women 8
women might have HPV infection at
anytime in life.*
*Ref: CDC Factsheet on Genital HPV infection
www.cdc.gov/STD/healthcomm/factsheet.html

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Beware of this symptoms
Consult your doctor immediately if you have
• Continuous vaginal discharge,inspite of treatment
• Foul smelling, thick discharge,
• Repeated vaginitis and UTI
• Post coital bleeding(bleeding after sex)
• Non healing or recurrent cervical erosion
• Irregular or intermenstrual bleeding specially in pre
menopausal phase

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Cervical cancer screening
• Chronic pain
• distension
• loss of weight
• Heavy prolong bleeding ,before or during
menopausal age
• Post menopausal bleeding-important
• Cervical polyp
• tumor during or before menopause age

Cervical Cancer is now a virtually preventable disease due to
 Early Vaccination
 Screening strategies
 Long natural history
 Cervix is easily accessible

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Secondary Prevention
Screening may help in early detection
of cervical abnormalities

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What is the use of screening
program?
• Secondary prevention or screening
program are helpful in detecting cancer
at the early stage hence useful in saving
lives.

Visual Inspection
VIA
VILI
Pap Smear
Conventional
LBC
HPV DNA Testing
Cervicography
Pap Net
Polar Probe
Community low
resource settings
Still Experimental

MOH&FW SCREENING
GUIDELINES
• Age of beneficiary. 30 -65 yrs.
• Method of Screening Visual Inspection
with acetic acid( VIA)
• Frequency of Screening. Once in 5 yrs
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• Examination done by lady physician/ staff
nurse/ ANM
• Examination done in separate room/ privacy
• Referral networks in place
• 30 women can be screened per day
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Women excluded from screening
• Pregnancy
• Menstruation
• Within 12 weeks of pregnancy/ abortion
• Previous history of treatment of cancer
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VIA PROCEDURE
• Counselling
• Speculum examination with light source
• Gloves
• Clean cervix
• Spray cervix with 3-5% Acetic Acid and wait for
1-2 minutes
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Early invasive cancer: note the raised irregular mosaics with umbilication (a), breaking
mosaics (b), surface irregularity & the atypical vessels after the application of 5% AA
Preclinical invasive
Carcinoma

Reddish “angry-looking”, inflamed columnar
epithelium with loss of the
villous structure & with inflammatory exudate
(before application of 5% AA)
Inflammatory lesions of the
Uterine Cervix
Chronic cervicitis: This cervix is
extensively inflammed with a reddish
appearance &
bleeding on touch, there are ill-
defined, patchy acetowhite areas
scattered all over the cervix after the
application of AA

TV after Acetic acid
T.V. After Lugol’s
Multiple red spots (a) suggestive of Trichomonas
vaginalis colpitis ( strawberry appearance), after
application of 5% AA
Trichomonas vaginalis colpitis
after application of Lugol’s iodine
(leopard-skin appearance)

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Is it possible
to get
protection
against
cervical cancer?

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Primary Prevention
by HPV Vaccine
GARDASIL®
[Human Papillomavirus Quadrivalent
(Types 6, 11, 16, and 18)
Vaccine 0.5ml prefilled syringe]
CERVERIX
[Human Papillomavirus Bivalent
(Types 16 and 18)
Vaccine 0.5ml prefilled syringe]
09-2009-GRD-2008-AP-(IN)-1601-SS

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HPV Vaccines- made by
recombinant DNA technology

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INDICATION
FOR Gardasil
For the prevention of
Cervical Cancer
Vulvar/ Vaginal Precancers
Cervical Dysplasia
Genital Warts
Cerverix is only indicated for
Cervical cancer

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Effectiveness
 Gardasil vaccine’s efficacy is 98 to
100%.
 Cerverix vaccine’s efficacy is 92 to
94%

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When we can give this vaccine?
 This vaccine can be given to any
girl above 9 years. Recommended
for women of 9-45 years age group
 The most effective time to
vaccinate girls and young women
is before they become sexually
active.

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How many dose recommended?
 Three doses
 First .(as elected date)
 Second (after 2 month of first dose)
 Third (after 6 month of first dose)
Cerverix – 0,1 & 6
6
months
2
Months
0

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Side effects
• HPV Vaccines demonstrated a favorable safety profile.
• Following injection-site reactions occurred at a greater
incidence in the group that received VACCINE
– Very common: erythema, pain, and swelling.
– Common: pruritis.
– Most injection-site reactions were mild to moderate.
– Very Common (≥1/10); Common (≥1/100, <1/10); Uncommon (≥1/1,000, <1/100); Rare
(≥1/10,000, <1/1,000); Very Rare (<1/10,000)

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Special Population
PREGNANT WOMEN
 Because of insufficient trial there is no
recommendation of this vaccine in
pregnancy.
 If woman gets pregnant after first dose ,then
remaining dose should be taken after
delivery.
LACTATING MOTHER
 Lactating woman can take this vaccine.
Cerverix is not indicated during lactation

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Is vaccine costly?
 No, if we can see the mortality
rate of the cervical cancer or its
treatment ,vaccine cost is
nothing against it.
 If we see the modern life style of
people ,vaccine cost is nothing.
 People give lacks of rupees of
dowry to their daughters ,vaccine
cost is nothing against it.
 It is cost effective
Educational Program 2009
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But
PRIMARY PREVENTION
is most important.

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Preventing aspects-lifestyle change
Social change –avoid early marriages
Multiparity_ role of family planning
Avoid multiple partners
Use of condom to avoid STD,and HPV diseases
Improve nutrition and personal hygiene
Prevents smoking ,alcoholism ,etc
Regular exercise
Health awareness-health check up

To produce a Cancer Free Society
Screening and identification of High Risk groups
Education – Think of Cervical Cancer as an
extension of STD
Behavioral changes
Limit number of sexual partners
Delay initial age of sexual intercourse
Avoid STD – Use of Condoms/ Spermicidals;
Avoid Smoking
HPV Vaccines to be promoted at the right age

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