Cervical Cancer By:Marisela Esparza

Cervical Cancer is cancer in the cervix (the lower part of the cervix that connects to the vagina.)

Causes: Abnormal Change in tissue Human Papillomavirus There are 80 types of HPV Transmitted Sexually Cause 90% of Cervical Cancer Cause Genital Warts Human Papillomavirus There are 80 types of HPV Transmitted Sexually Cause 90% of Cervical Cancer Cause Genital Warts

Symptoms Unusual Vaginal Discharge Bleeding or “spotting” outside of menstruation Pain or vaginal bleeding during sexual intercourse Post- menopausal bleeding Pain during urination Pelvic Pain Unusual Vaginal Discharge Bleeding or “spotting” outside of menstruation Pain or vaginal bleeding during sexual intercourse Post- menopausal bleeding Pain during urination Pelvic Pain

Risk Factors Unprotected Sex Multiple Sex partners Using Oral Contraceptives Immunosuppression Smoking Chlamydia Unprotected Sex Multiple Sex partners Using Oral Contraceptives Immunosuppression Smoking Chlamydia

Treatment Radiation Surgery Chemotherapy New drugs still on clinical trials

Prevention Vaccines (Gradasil, Cervarix) Protected Sex Regular Pap Tests

Scientific Article Human papilloma vaccines launch a era of cervical cancer prevention. This was a study to see which vaccine was better gardasil or ceravix Human papilloma vaccines launch a era of cervical cancer prevention. This was a study to see which vaccine was better gardasil or ceravix

Table 1: Characteristics of the HPV vaccines Gardasil and Cervarix Characteristic Gardasil Cervarix Manufacturer Merck Frosst Canada Ltd. GlaxoSmithKline Inc. Type Prophylactic vaccine Prophylactic vaccine consisting of virus-like consisting of virus-like particles containing L1 particles containing L1 capsid proteins capsid proteins Antigens Quadrivalent vaccine: Bivalent vaccine: HPV types 6 HPV types (20 [micro]g/dose), 16 (20 [micro]g/dose) and 11 (40 [micro]g/dose), 18 (20 [micro]g/dose) 16 (40 [micro]g/dose) and 18 (20 [micro]g/dose) Antigen Yeast Baculovirus expression system Adjuvant Alum: ASO4: 225 [micro]g aluminum 500 [micro]g aluminum hydroxyphosphate sulfate hydroxide and 50 [micro]g 3-deacylated monophosphoryl lipid A Dose and 0.5 mL intramuscular 0.5 mL intramuscular schedule injection at 0, 2 and injection at 0, 1 and 6 months 6 months Availability Approved for sale Not yet available in Canada Table 1: Characteristics of the HPV vaccines Gardasil and Cervarix Characteristic Gardasil Cervarix Manufacturer Merck Frosst Canada Ltd. GlaxoSmithKline Inc. Type Prophylactic vaccine Prophylactic vaccine consisting of virus-like consisting of virus-like particles containing L1 particles containing L1 capsid proteins capsid proteins Antigens Quadrivalent vaccine: Bivalent vaccine: HPV types 6 HPV types (20 [micro]g/dose), 16 (20 [micro]g/dose) and 11 (40 [micro]g/dose), 18 (20 [micro]g/dose) 16 (40 [micro]g/dose) and 18 (20 [micro]g/dose) Antigen Yeast Baculovirus expression system Adjuvant Alum: ASO4: 225 [micro]g aluminum 500 [micro]g aluminum hydroxyphosphate sulfate hydroxide and 50 [micro]g 3-deacylated monophosphoryl lipid A Dose and 0.5 mL intramuscular 0.5 mL intramuscular schedule injection at 0, 2 and injection at 0, 1 and 6 months 6 months Availability Approved for sale Not yet available in Canada

Table 2: Immune response and disease outcomes* for the HPV vaccines Gardasil and Ceravix Variable Gardasil Cervarix Published trial * Phase 2 and 3 * Phase 2 and 3 results trials (21-27) trials (28-31) Sample size * (27) * (31) Maximum duration of * 5 years * 5.5 years follow-up (phase 2) (23) (phase 2) (30) * 3 years * 1.25 (phase 3) (25) (phase 3) (31) Immune response 1 * Over 99% * Over 99% month after seroconversion seroconversion completion of vaccine series * Antibody titres 11 * Antibody titres 107 times (HPV type 6), times (HPV type 16) 7 times (HPV type and 82 times (HPV 11), 105 times (HPV type 18) higher type 16) and 19 than titres times (HPV type 18) following natural higher than titres infection (28) following natural HPV infection (22) Duration of immune * 96% seropositive to * 100% seropositive to response HPV types 6, 11 and HPV types 16 and at 24 months at months29 * 68% seropositive to HPV type 18 at 24 months (25) Persistent * Vaccine efficacy * Vaccine efficacy infection ([dagger]) 93.5% (95% CI 80.4% (95% CI from HPV types 16 83%-98%) (23) 70%-87%) (31) and 18 Cervical * Vaccine efficacy * Vaccine efficacy intraepithelial 98% (95% CI 90.4% (95% CI neoplasia (grade 2 93%-100%) (27) 53%-99%) (31) or higher) related to HPV types 16 and 18 Vaginal and vulvar * Vaccine efficacy * No data intraepithelial 97% (95% CI neoplasia (grade 2 79%-100%) (26) or higher) related to HPV types 16 and 18 Persistent * No data * Vaccine efficacy infection ([dagger]) 59.9% (95% CI of HPV type 45 3%-85%) (31) Persistent * No data * Vaccine efficacy infection ([dagger]) 36.1% (95% CI of HPV type %-60%) (31) Protection from * Vaccine efficacy * No data genital warts 96% (95% CI 86%-99%) (24) Table 2: Immune response and disease outcomes* for the HPV vaccines Gardasil and Ceravix Variable Gardasil Cervarix Published trial * Phase 2 and 3 * Phase 2 and 3 results trials (21-27) trials (28-31) Sample size * (27) * (31) Maximum duration of * 5 years * 5.5 years follow-up (phase 2) (23) (phase 2) (30) * 3 years * 1.25 (phase 3) (25) (phase 3) (31) Immune response 1 * Over 99% * Over 99% month after seroconversion seroconversion completion of vaccine series * Antibody titres 11 * Antibody titres 107 times (HPV type 6), times (HPV type 16) 7 times (HPV type and 82 times (HPV 11), 105 times (HPV type 18) higher type 16) and 19 than titres times (HPV type 18) following natural higher than titres infection (28) following natural HPV infection (22) Duration of immune * 96% seropositive to * 100% seropositive to response HPV types 6, 11 and HPV types 16 and at 24 months at months29 * 68% seropositive to HPV type 18 at 24 months (25) Persistent * Vaccine efficacy * Vaccine efficacy infection ([dagger]) 93.5% (95% CI 80.4% (95% CI from HPV types 16 83%-98%) (23) 70%-87%) (31) and 18 Cervical * Vaccine efficacy * Vaccine efficacy intraepithelial 98% (95% CI 90.4% (95% CI neoplasia (grade 2 93%-100%) (27) 53%-99%) (31) or higher) related to HPV types 16 and 18 Vaginal and vulvar * Vaccine efficacy * No data intraepithelial 97% (95% CI neoplasia (grade 2 79%-100%) (26) or higher) related to HPV types 16 and 18 Persistent * No data * Vaccine efficacy infection ([dagger]) 59.9% (95% CI of HPV type 45 3%-85%) (31) Persistent * No data * Vaccine efficacy infection ([dagger]) 36.1% (95% CI of HPV type %-60%) (31) Protection from * Vaccine efficacy * No data genital warts 96% (95% CI 86%-99%) (24)

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Works Cited Gale Encyclopedia of Cancer # 2 Gale cengage Learning =IAC-documents =IAC-documents Fred Hutchinson Cancer Research Center ex.html Cervical Cancer: information at gargasil.com National Cancer Institute National Cervical Cancer Coalition American Cancer Society rvical_cancer_8.asp Gale Encyclopedia of Cancer # 2 Gale cengage Learning =IAC-documents =IAC-documents Fred Hutchinson Cancer Research Center ex.html Cervical Cancer: information at gargasil.com National Cancer Institute National Cervical Cancer Coalition American Cancer Society rvical_cancer_8.asp

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