Cervical Cancer Cervical dysplasia Cervical cancer Causes Risk factors Detection: Pap Smear & Colposcopy Treatment

Cervical Cancer Overview Cervical cancer develops in the lining of the cervix and this condition usually develops over time.

I. Cervical dysplasia = abnormal tissue growth Remain within the cervical tissue, easy to treat High-grade dysplasia =

II. From cervical dysplasia to cancer Cancerous condition usually develops over time. Normal cervical cells may gradually undergo changes to become precancerous and then cancerous Cervical intraepithelial neoplasia (CIN) is the term used to describe these abnormal changes. CIN is classified according to the degree of cell abnormality. Low-grade CIN indicates a minimal change in the cells and high-grade CIN indicates

Most (80-90%) invasive cervical cancer develops in flat, scaly surface cells that line the cervix Approximately 10-15% of cases develop in glandular surface cells

B. Incidence & Prevelance Cervical cancer is the 2nd most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. !

III. What causes cervical cancer? HPV strains found most frequently in precancerous lesions and in cervical cancer are types 16 and 18. Other strains with high malignant potential include 31, 33, 35, 39, 45, 51, 52, 56, 58, and 68.

A. HPV – carries oncogenes It is proposed that HPV interferes with p53 & pRB http://www-ermm.cbcu.cam.ac.uk/swf003mac.swf

B. Risk factors The risk of developing cervical cancer is directly associated with the risk of contracting HPV Having multiple sexual partners or having sex with a promiscuous partner History of sexually transmitted disease (STD) Sexual intercourse at a young age – hormonal shifts that occur w/adolescence appear to make the cervical cells more susceptible to infection with HPV Smoking decreases the ability of the immune system and women who smoke have a higher incidence of cervical cancer

IV. Symptoms Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding) Abnormal (yellow, odorous) vaginal discharge Low back pain Painful sexual intercourse (dyspareunia) Painful urination (dysuria)

V. Detection PAP smear DNA testing of Colposcopy – Fluid-based test allows for the separation of cervical cells for more accurate examination DNA testing of Colposcopy –

VI. Treatment For cervical dysplasia In its earliest stages pre-cancerous tissue can be removed Cryotherapy Loop electrosurgical excision procedure (LEEP) Laser surgery Cone biopsy

B. Treatment for cervical cancer Because the cells can spread, more extensive treatment necessary. Treatment depends on the stage, the size and shape of the tumor, the age and general health of the woman, and her desire for future childbearing. Radical hysterectomy prescribed for more advanced stages Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred

C. Cure rate – early detection, 85% 80 - 85% for tumors limited to the cervix and uterus 60 - 80% when the upper part of the vagina is involved 30 - 50% for tumors beyond the cervix and upper vagina, but still in the pelvis 14% when the cancer has invaded the bladder or rectum or has spread beyond the pelvis Race & Poverty is an issue

ACS info site http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=8 Institute of Human Virology site http://www.ihv.org/guides/cervical_cancer.html

Vaccine!!! “Cervical cancer prevented in 2-year study Experimental vaccine shows promise in halting early stages of disease” – Chronicle The new vaccine prevents cervical cancer by blocking certain strains of HPV. Merck & Co., the vaccine targets two strains of HPV that are known to cause at least 70% of cervical cancers, and two other strains that cause genital warts.