Cervical Cancer Screening Evaluation Treatment About this Presentation

Cervical Cancer Screening · Evaluation· Treatment

About this Presentation This presentation is intended to help women take an active role in their health care. It does not replace the judgment of a health care professional in diagnosing and treating disease.

GCF Mission Statement The mission of the Gynecologic Cancer Foundation (GCF) is to ensure public awareness of gynecologic cancer prevention, early diagnosis and proper treatment. In addition the Foundation supports research and training related to gynecologic cancers. GCF advances this mission by increasing public and private funds that aid in the development and implementation of programs to meet these goals. GCF gratefully acknowledges the National Cervical Cancer Coalition (NCCC) for their support of this educational presentation. For more information on NCCC, call (800) 685 -5531 or visit the Web site at www. nccc -online. org.

Information Hotline: (800) 444 -4441 § A list of specially trained gynecologic oncologists practicing in your local area can be received by phone, fax or mail § A directory of all GCF members practicing in the U. S. can also be mailed upon request § Free educational brochures on gynecologic health

Women’s Cancer Network: www. wcn. org § Confidential gynecologic (ovarian, endometrial, cervical) and breast cancer risk assessment § Comprehensive women’s cancer information including gynecologic, breast, lung and colon cancers § Links to other sources of cancer information

Cervical Cancer Screening and Prevention

New cancer diagnoses in the U. S. 2003 Statistics: § § § Breast Uterus (womb) Ovary Cervix Vulva Source: American Cancer Society. 211, 300 40, 100 25, 400 12, 200 4, 000

What is cervical cancer? § It is a cancer of the female reproductive tract § It is the most common cause of cancer death in the world where Pap tests are not available § It is the easiest gynecologic cancer to prevent through screening

What is the female reproductive tract? § § § Vulva Vagina Cervix Uterus Fallopian tubes Ovaries

What is the cervix? § Opening of the uterus (womb) into the vagina § Two cell types present (squamous and glandular ) § Cervical cancers tend to occur where the two cell types meet Source: TAP Pharmaceuticals, “Female Reproductive Systems. ”

How common is cervical cancer? § 500, 000 women worldwide die of cervical cancer annually § 50 -60 million women in the U. S. have a Pap test each year § 3 -5 million women in the U. S. have an abnormal result § 12, 200 new cervical cancers diagnosed in the U. S. per year § 4, 100 deaths from cervical cancer in the U. S. per year Most cervical cancer can be prevented

What causes cervical cancer? The central cause of cervical cancer is human papillomavirus or HPV: § HPV is sexually transmitted § The HPV detected today could have been acquired years ago § There are many different types of HPV • Low-risk types can cause warts • High-risk types can cause precancer and cancer of the cervix

If I have HPV, does it mean I will get cancer? § NO! § In most cases HPV goes away § Only women with persistent HPV (where the virus does not go away) are at risk for cervical cancer

How common is HPV? § Most men and women who have had sex have been exposed to HPV § More than 75% of sexually active women tested have been exposed to HPV by age 18 -22

Who is at risk? § Women who have ever had sex § Women who have had more than one partner § Women whose partner (s) has had more than one sexual partner § Women with other sexually transmitted diseases

Who is at risk? § Women who do not have Pap § Women with immune problems Steroid medications Transplanted organs Chemotherapy HIV § Women who smoke tests

How do I lower my risk? § Delay onset of sexual activity § Know your sexual partner § Do not smoke § Maintain a healthy diet and lifestyle § Practice safe sex Get your Pap test

What is a Pap test? § A test which collects cells from the surface of the cervix and looks for any abnormal cells § Abnormal cells can be treated before cervical cancer develops § When cancer is detected early, it is easier to treat

What a Pap test is NOT! § A pelvic exam § A test for ovarian or uterine cancer § A biopsy

When do I need my first Pap test? § Three years after the onset of sexual intercourse § No later than age 21

How often do I need a Pap test? § Every year until age 30 § After age 30, if you have only had normal results, you may have them every two to three years after discussion with your physician and evaluation of your risk factors

I feel fine, so why do I need a Pap test? § A Pap test can find treatable changes of the cervix (precancer ) before you have a symptom or notice a problem § Once a problem is symptomatic, it is harder to treat

Why do I need to keep getting tested? § The test is not perfect § Changes (abnormalities) may occur since the last test § It may take many years for changes to develop or be detected § Your risk changes if you have new partners

What is the best time to have a Pap test? § Schedule your Pap when you are not having a menstrual period § It is best to abstain from intercourse and avoid use of tampons or douches for two days before your Pap test

What should I expect when I have a Pap test? § Feet are placed in stirrups (foot holders) § A speculum (thin duck-billed instrument) is inserted into vagina to see the cervix § You may have brief discomfort which is usually mild § You may have some spotting afterward

How do I find out about my Pap test results? § You may ask to have a copy mailed to you § You may call for your results § If you have an abnormal result, it is extremely important to follow-up for the recommended testing § Even after a normal Pap test, it is still important to report any symptoms of abnormal vaginal bleeding, discharge or pain to your doctor and call to be seen right away

Do I need a Pap test if I had a hysterectomy? § If you had treatment for precancer or cancer of the cervix, you may need a Pap test § If the cervix was left in place at the time of your hysterectomy, you will still need Pap tests § Preventive health care is still important even if you do not need a Pap test

Is there an age when I can stop having Pap tests? The American Cancer Society recommends that screening stop at age 70, if three or more recent tests are normal, and there have been no abnormal results in the last 10 years.

What is new in screening and prevention? § Liquid cytology-thin layer cytology § Combination of HPV test and Pap is now available for women 30 years of age and older § Pap test computer reviews § Vaccines for HPV currently being tested

Evaluation of the Abnormal Pap Test and Treatment of Precancer

Abnormal Pap test – How common is it? 12, 200 cancers 300, 000 HSIL 1. 25 million LSIL 2 -3 million ASC 50 -60 million women screened

What is an HPV test? § A test sometimes used to determine if you need further evaluation § Cells are collected just like a Pap test § It checks for high-risk HPV

What happens if I have an abnormal Pap test? § ASC-US management options: HPV testing Repeat Pap Colposcopy § ASC-H, LSIL, HSIL, AGC, AIS, cancer Colposcopy Possibly endometrial biopsy for AGC AIS / cancer: referral to gynecologic oncologist

What is a colposcopy ? Colposcopy : § Use of a magnifying instrument § Application of a vinegar-like solution onto the cervix Source: This is a copyrighted image of the California Family Health Council, Inc. and may not be § See abnormalities reproduced in any way without the expressed written of the California Family Health Council. that can’t be seen permission California Department of Health Services "What You Know if your Pap Test is Abnormal"- Your with the naked eye Should Colposcopy Exam, Donna Bell Sanders (Education § Feels like getting a Programs Associates 1995; Campbell, CA). Pap test, but lasts longer

What is a cervical biopsy? Biopsy: § Removal of a small piece of tissue from the cervix § May feel like getting a Pap test or like a menstrual cramp that lasts a few seconds Source: A. De. Cherney and M. Pernoll , Current Obstetric and Gynecologic Diagnosis and Treatment (The Mc. Graw-Hill Companies, Inc. ) 586. Source: TAP Pharmaceuticals, “Female Reproductive Systems. ”

What does the biopsy result mean? § Mildly abnormal (CIN I) observation preferred § More abnormal (CIN II) treatment § Precancer (CIN III) treatment § Cancer Gynecologic oncology consultation

What are the treatment options for CIN? § § § LEEP Laser Cryotherapy Cone Biopsy In special circumstances a hysterectomy may be recommended

What can I expect after treatment for CIN? § Estimates of cure range from 73 -90% with a single treatment § The risk for invasive cancer following treatment is about 1% § Therefore, you still need to have regular Pap tests § Minimal, if any, impact on fertility

What you can do? Take Control - Protect Yourself 1) Ask your doctor about an appropriate Pap test screening interval for you 2) Make sure that you get a Pap test at the recommended time 3) Find out how and when you will learn about the results of your Pap test 4) Follow-up! Don’t assume that no news is good news 5) Do not smoke

Cervical Cancer

What are the symptoms of cervical cancer? § Abnormal bleeding Between periods With intercourse After menopause § Unusual vaginal discharge § Other symptoms Leg pain Pelvic pain Bleeding from the rectum or bladder § Some women have no symptoms

What should I do if I have just been diagnosed with cervical cancer? § Find a gynecologic oncologist Call 1 -800 -4441 § Discuss treatment options Conization Hysterectomy Radical hysterectomy Radiation with chemotherapy § Ask about clinical trials (Gynecologic Oncology Group) § Other considerations Preserve your fertility Preserve your ovaries

Clinical staging of cervical cancer Source: “FIGO Annual Report on The Results of Treatment in Gynaecological Cancer” Journal of Epidemiology and Biostatistics, (2001) vol. 6 no. 1, page 14.

What is a cervical conization ? § Conization : • Removes a coneshaped piece of tissue • Often allows for diagnosis and treatment • Performed with local anesthesia in the office or under general anesthesia in the operating room Source: TAP Pharmaceuticals, “Female Reproductive Systems. ”

What is a radical hysterectomy? § Treatment option for early stage cancer § Not the same as the usual hysterectomy § Surgical removal of the uterus, cervix and upper vagina with the surrounding tissues § Lymph nodes are removed § Removal of the ovaries is not required

What is radiation with chemotherapy ( chemoradiation )? § Standard of care for advanced cancer § Treatment requires: 1. External radiation 2. Internal radiation 3. Low dose chemotherapy given at the same time

Cervical cancer: What is the chance of survival after treatment? FIGO Stage 5 -Year Survival Stage I 81 -96% Stage II 65 -87% Stage III 35 -50% Stage IVA 15 -20%

Re-establishing Wellness § Restoring wellness is a gradual process § Some women find strength from: Friends and family Support groups Spiritual work Counseling Exercise § The challenges and the journey are different for each woman with cervical cancer

How do I get my friends to have a Pap test? § Tell her it doesn’t hurt § Offer her a ride § Offer help with child care § Help her get an appointment § Help her find the right health care provider § Empower her with information: Tell your friend about the importance of health prevention

Cervical Cancer Presentation Participants GCF gratefully acknowledges the following individuals who contributed to this educational presentation: §Bobbie Gostout , M. D. , Editor §Saralyn Mark, M. D. §Wendy Brewster, M. D. §F. J. Montz , M. D. , K. M. (1955 -2002) §Karen Carlson §Mitchell Morris, M. D. §Thomas Cox, M. D. §Karl Podratz , M. D. , Ph. D. §Juan Felix, M. D. §Karen Riordan §Hollis Forster §Debbie Saslow, Ph. D. §Christine Holschneider , M. D. §Evelyn Schulman §Beth Karlan, M. D. §Alice Spinelli, M. S. N. , A. R. N. P. §Alan Kaye §Joan Walker, M. D. §Hershel Lawson, M. D. §Leslie Walton, M. D. §Suzy Lockwood, R. N. , M. S. N. , Ph. D. §Thomas Wright, Jr. , M. D.

GCF Supporting Organization This educational effort was undertaken by the Gynecologic Cancer Foundation with support from the National Cervical Cancer Coalition (NCCC). GCF gratefully acknowledges and thanks NCCC for its efforts related to cervical cancer public outreach. For more information: National Cervical Cancer Coalition 16501 Sherman Way Suite #110 Van Nuys, CA 91406 Toll Free Hotline (800) 685 -5531 Phone: (818) 909 -3849 Fax: (818) 780 -8199 Email: info@nccc-online. org Web site: www. nccc-online. org

Gynecologic Cancer Foundation 401 N. Michigan Avenue Suite 2200 Chicago, IL 60611 800 -4441 www. wcn. org/gcf @ smithbucklin. com