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Cervical Cancer

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

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  1. Cervical Cancer

  2. Cervical Cancer Dr. SwapnaChaudhary M.S. (MUM) Consultant Obstetrician & Gynaecologist Infertility Specialist

  3. Cervix

  4. Cervix • Cervix constitutes lower 1/3rd of uterus

  5. Epidemiology

  6. Epidemiology • 5 lac new cases / year around world

  7. Epidemiology • 5 lac new cases / year around world • 80% in developing countries

  8. Epidemiology • 5 lac new cases / year around world • 80% in developing countries • Commonest gynecological malignancy in India

  9. Epidemiology • 5 lac new cases / year around world • 80% in developing countries • Commonest gynecological malignancy in India • 2nd is breast cancer

  10. Risk Factors / Causes

  11. Risk Factors / Causes • Multiple sexual partners (> 1)

  12. Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse

  13. Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity

  14. Risk Factors / Causes • Multiple sexual partners (> 1) • Young age at marriage / first intercourse • Early childbearing / Multiparity • Prior STDs (HSV II, genital warts, vaginal infections)

  15. 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

  16. 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

  17. 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

  18. Age Groups

  19. Age Groups • Cervical Intraepithelial Neoplasia (CIN) 35 years

  20. Age Groups • Cervical Intraepithelial Neoplasia (CIN) 35 years • Invasive Cervical Cancer 45 - 55 years

  21. Symptoms

  22. Symptoms • CIN (dysplasia): Asymptomatic

  23. Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation

  24. Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation • Abnormal bleeding -- intercycle -- post coital -- post menopausal

  25. Symptoms • CIN (dysplasia): Asymptomatic • Invasive Cancer • No classic presentation • Abnormal bleeding -- intercycle -- post coital -- post menopausal 3. Foul smelling vaginal discharge

  26. Chronic backache / pelvic pain

  27. Chronic backache / pelvic pain Late sign -- weight loss -- mild fever -- anemia

  28. Dysplasia / CIN

  29. Dysplasia / CIN • Precancerous stage

  30. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer

  31. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs

  32. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN

  33. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN

  34. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I mild

  35. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I II mild mod

  36. Dysplasia / CIN • Precancerous stage • First series of changes leading to cancer • Age of presentation – 35 yrs CIN I II III mild mod severe

  37. 25 % patients progress from CIN 1 to CIN 3 in 2 yrs

  38. 25 % patients progress from CIN 1 to CIN 3 in 2 yrs • 40 % patients of CIN 3 progress to Cancer over 10 – 15 yrs.

  39. Pap Smears

  40. Pap Smears • Non invasive OPD procedure

  41. Pap Smears • Non invasive OPD procedure • No pain / no discomfort

  42. Pap Smears • Non invasive OPD procedure • No pain / no discomfort • No anesthesia required

  43. When to Get Pap Smears

  44. When to Get Pap Smears • ACOG Recommendations

  45. When to Get Pap Smears • ACOG Recommendations • 1st Pap Smear at age when patient becomes sexually active (or by age 18)

  46. 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

  47. 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

  48. 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.

  49. Routine screening can stop at age of 60 yrs provided….

  50. Routine screening can stop at age of 60 yrs provided • Previous 2 normal smears

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