1. Cervical Cancer

2. Female Gynecologic Cancers

3. Cervical Cancer

4. How Common is Cervical Cancer?  Second most common cancer in women world wide >500,000 new cases/year globally*  In Africa 53,000 women die every year In Eastern Africa, leading cause of cancer- related death In Eastern and Southern Africa, leading female cancer affecting women aged 15-44** *WHO 2008 **Arbyn et al 2011

5. What Causes Cervical Cancer?  Virtually all cervical cancer and precancerous changes to the cervix are caused by a virus called HPV  HPV is sexually transmitted It is the most common sexually transmitted infection in the world HPV can infect areas not covered by a condom Skin to skin contact is sufficient for transmission Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370:890–907.

6. Does HPV Always Lead to Cancer?  No. Most HPV infections are temporary and resolve on their own without causing cancer.  HPV is like the common cold of the vagina: You are exposed to cold virus all the time, but only become sick sometimes because your immune system usually protects you If you do catch a cold, your body tries to fight it and you often get better without treatment. If the virus is too strong or your body is weak, though, the cold may lead to pneumonia. For HPV, a strong virus or weak immune system may lead to the persistent HPV that causes cancer.

7. Risk Factors for Cervical Cancer  Early age at first intercourse (<20 years)  Multiple sexual partners  Many children  Smoking  HIV  Nutrition  Chronic steroid medication use

8. Prevention of Cervical Cancer  There are two main ways to prevent cervical cancer: Prevent infection with HPV If infected, make sure HPV doesn’t turn into cancer

9. How to Prevent HPV Infection  Vaccine Two vaccines available (Cervarix, Gardasil) that protect that protect against the most common HPV strains that cause cancer Most effective if given to adolescents before they become sexually active  Reduce exposure and boost immune system Stop smoking Reduce number of partners Delay first time of vaginal intercourse Use condoms Eat healthfully

10. How to Prevent HPV Progression  Screening for changes in the cervix Pap smear  Treating pre-cancerous changes to the cervix

11. Pap Smear  Take cells from the cervix and look at them under the microscope  A pathologist decides if “these are normal” OR “these look like they have been infected with HPV”  Cells that look like they have been infected are “an abnormal pap smear”

12. Abnormal Pap Smears  The pathologist can grade how abnormal the cells look “Low grade” is a mild abnormality “High grade” is a more severe abnormality that needs to be investigated further and may require treatment.

13. If the Pap smear is abnormal  The doctor may want to perform something called a colposcopy.  During this procedure, the doctor will look at your cervix using a special magnifying instrument. Vinegar can be applied to turn HPV-infected cells white The clinician takes a sample (biopsy) of the tissue from abnormal areas

14. Treating Pre-Cancerous Cells  Some of the abnormal areas may contain pre-cancerous cells. A pre-cancerous cell means that it is not cancerous yet, but could become cancerous and it should be monitored or treated  If an abnormality is not very advanced, the clinician may wait to see if the body can fight the virus on it’s own.  If the abnormality is advanced, though, the treatment is to remove or destroy affected cells using radiation, chemotherapy, or surgery.