COMMONEST FEMALE GYNAECOLOGICAL CANCER AND HPV VACCINATION

1. DR SUNITA YADAV
SENIOR SPECIALIST OBS AND GYNAE
VMMC AND SAFDARJUNG HOSPITAL

3.  Cervical Cancer
 Breast Cancer
 Ovarian cancer
 Colorectal Cancer
 Uterine cancer

4.  MOST COMMON CANCER OF FEMALES IN INDIA.
 1 in 5 CASES OF CERVICAL CANCER WORLDWIDE IS
FROM INDIA.
 SECOND MOST COMMON CANCER WORLDWIDE.
 LEADING CAUSE OF DEATH IN FEMALES.
 EASIEST CANCER IN FEMALES TO PREVENT THROUGH
SCREENING AND VACCINATION.

5.  OVARIAN CANCER IS SECOND MOST
COMMON CANCER SEEN BY THE
GYNAECOLOGISTS IN INDIA.
 BREAST CANCER IS THE SECOND COMMONEST
MALIGNANCY OF FEMALES.

6.  TESTING ASYMPTOMATIC POPULATION TO
DETECT PRECANCEROUS LESIONS OR EARLY
STAGE OF CANCER.
 EFFECTIVE SCREENING AVAILABLE FOR
CERVICAL AND BREAT CANCER.

8.  42 YEARS FEMALE, 2 CHILDREN C/O
IRREGULAR BLEEDING PV - 6 MTHS. WITH
ANEMIA.
 70 YEAR FEMALE , 5 CHILDREN C/O
BLEEDING AFTER MENOPAUSE ,FOWL
SMELLING DISCHARGE.
 40 YEAR INSPECTOR POLICE, 2 CHILDREN C/O
HEAVY AND PROLONGED BLEEDING SINCE 1
YEAR.

9.  BLEEDING FOLLOWING COITUS
 IRREGULAR BLEEDING IN BETWEEN PERIOD
 HEAVY OR PROLONGED BLEEDING
 POSTMENOPAUSAL BLEEDING
 VAGINAL DISCHARGE
 PAIN
 URINARY SYMPTOMS AND RECTAL BLEEDING
 WT. LOSS,WEAKNESS
 ASYMPTOMATIC

10. ALL CASES OF VAGINAL
DISCHARGE ARE NOT DUE TO
CANCER CERVIX.
CAUSE CAN BE-
physiological
pathological

11.  SECRETIONS FROM GLANDS AND VAGINAL
TRANSUDATE.
 COLOUR
 AMOUNT
LEUKORRHEA
 excessive normal vaginal discharge.
◦ Fear of cancer and STD
◦ Cause-puberty, chronic cervicitis, erosion ,polyp
OCP ,regular douching,sedentary occupation

12.  CAUSE
 AMOUNT
 COLOUR
 ODOUR
 ITCHING
 URINARY COMPLAINTS

13.  HPV INFECTION
 EARLY MARRIAGE
 MULTIPLE SEX PARTNERS
 MUTIPLE BIRTH
 CIGARETTE SMOKING
 LOW SOCIOECONOMIC STATUS
 POOR PERSONAL HYGIENE

14. The main cause of cervical cancer is infection with
Human Papillomavirus or HPV.
Virus that is spread by sex.
Infection is asymptomatic.
There are many different types of HPV-low and high
risk.
Certain “high-risk” HPV types can cause cell changes
and cervical cancer

15. MAJORITY OF FEMALES ACQUIRE HPV BY 30
YEARS.
MOST CLEAR THE INFECTION WITHIN 1-2
YEARS.
ONLY IN FEW –PRECANCEROUS CHANGES
WHICH MAY RESOLVE OR DEVELOP CANCER
OVER 10-20 YEARS.
SEVERAL TYPES OF HPV AROUND 100.
13 TYPES CAUSE CANCER.

16. Most men and women who have had
sex(vaginal,oral,anal) acquire HPV within 2
years of active sexual life.
People who are not sexually active almost never
acqire HPV infection.
Correct and consistent use of condoms can
reduce HPV transmission.Areas not covered
can be infected hence not absolute protection.

17.  CAUSATIVE AGENT IN MAJORITY OF CASES
OF CERVIX CANCER.
 SEVERAL TYPES- TYPE 16 AND 18
(ASSOCIATED WITH70% CASES OF CANCER
CERVIX).

18. CANCER PRECURSOR
AND CANCER
HPV PERSISTENCE
HPV ACQUISITION

19.  Anyone who has had more than one sex
partner .
 Anyone whose sex partner(s) has had
more than one sex partner .

20.  Get regular Pap tests and follow up, if
necessary.
 Limit your number of sex partners
 Choose a sex partner who has had no or few
prior sex partners
 Do not smoke cigarettes.
 Keep a healthy diet and lifestyle.
 Use condoms consistently and correctly
during sexual activity.

21. CERVICAL CANCER PREVENTABLE BY
REGULAR SCREENING.
METHODS OF SCREENING
PAP SMEAR
(CONVENTIONAL,LIQUID BASED
CYTOLOGY)
HIGH RISK HPV TESTING

22.  TO BEGIN AT 21 YEARS (EXCEPTIONS- HIV
POSITIVE,IMMUNOCOMPROMISED OR YOUNG PT.
WITH PREVIOUSLY TREATED HIGH GRADE
PRECANCEROUS OR CANCER .
 STOP SCREENING AT 65 YRS AGE IN THOSE WITH
PREVIOUSLY NORMAL SCREEN AND NO HIGH RISK
FACTORS.
 SCREENING GUIDELINES SAME FOR HPV
VACCINATED .

23.  PRESENT VACCINES DO NOT PROTECT
AGAINST ALL HPV TYPES THAT CAN
CAUSE CANCER.

24.  SCREEN WITH PAPS 3 YEARLY
 HPV COTESTING WITH PAPS- 5 YEARLY
 HPV TESTING NOT DONE BEFORE 30 YEARS

25.  NO LONGER ANNUAL PAPS .
 LATEST RECOMMENDATION 3 YEARLY.
 UNNECESSARY COLPOSCOPY DUE TO ANNUAL
SCREEN.NO ADDITIONAL BENEFIT.
 NEGLIGIBLE RISK OF MISSING CANCER WITH
3 YRLY SCREEN.

26.  BEGIN SCREENING ON DIAGNOSIS (CDC)/21
YEARS(ACS).
 SCREEN EVERY 6 MTHS. FOR FIRST YEAR AFTER
DIAGNOSIS.
 1 YEARLY PAPS SUBSEQUENTLY.
 COLPOSCOPY TOFOLLOW ABNORMAL PAP .
(CENTRE FOR DISEASE CONTROL AND
PREVENTION)

27.  BEGIN AT 21 YEARS IRRESPECTIVE OF SEXUAL
INITIATION OR NO. OF SEX PARTNERS.
 SCREENING BEFORE THIS AGE-HIV
POSITIVE,IMMUNOCOMPROMISED,PREVIOUSLY
TREATED PRECANCEROUS OR CANCER.
 PRECANCEROUS LESIONS MORE LIKELY TO
REGRESS.ALSO HPV INFECTION CLEARS IN
MAJORITY.
 DON’T REQUIRE IMMEDIATE COLPOSCOPY AND
TREATMENT.

28.  AT 65YEARS PROVIDED 3CONSECUTIVE
NEGATIVE PAPS OR2 CONSECUTIVE NEGATIVE
COTEST(PAPS WITH HPV) WITHIN 10
YEARS.MOST RECENT TEST WITHIN PAST 5
YEARS.
 CIN2,CIN3,AIS TO CONTINUE SCREENING FOR
20 YEARS AFTER NORMAL REPORT OR
TREATMENT.

29.  Just like mammogram screening, Pap testing is
not a one-time test.
 The test is not perfect.
 New changes (abnormalities) can occur after you
get tested, even if you have not had new
partners.
 It could take many years for changes to develop
or to be noticed.
 Your risk changes if you have new partners, or if
your partner has other partners.

30.  Cells are collected from the surface of your
cervix by a doctor.
 These cells are then checked under a
microscope for any abnormalities.
 If abnormal (or precancerous) cells are found,
they can be treated before they turn into
cancer.
 Cervical cancer can be found in the early
stages, when it is easier to treat.

31.  SENSITIVITY (47-62%)
 CAUSE OF LOW SENSITIVITY-
 inappropriate site,inadequate
sample,poor quality smear due to delay in
fixing or blood,lab errors in interpretation.

38.  HOW IS IT DONE
 METHODS-THINPREP TEST AND AUTOCYTE
PREP.
 TESTING-HYBRID CAPTURE OR PCR
TECHNIQUE
 ADVANTAGE-BETTER DETECTION,HPV
TESTING CAN BE DONE SIMULTANEOUSLY.

39.  NOT TO BE DONE DURING PERIODS
 AVOID FOR 2 DAYS BEFORE SCREEN
 douching
 tampons
 vaginal tablet or gel
 intercourse
 no birth control foam or jelly

40. That the cells in your cervix are…
 Normal
 Abnormal:
◦ Minor cell changes of unknown importance, possibly
unrelated to precancer (ASCUS)
◦ Minor cell changes (LSIL)
◦ Moderate to Severe cell changes (HSIL)
 Possibly cancerous

41.  Abnormal Pap test results are quite common.
 They are usually only slightly abnormal.
 80-90% of low grade cervical abnormalities
regress on their own.
 If followed up and treated early, you can
prevent the abnormality from turning into
cervical cancer.

42.  No! Most people get HPV infection, but very
few get cervical cancer
 In most cases, HPV infection goes away on its
own
 Sometimes, the HPV infection does not go
away after many years. This type is called
“persistent”. It can lead to cervical cancer

43.  If you had treatment for precancer or
cancer of the cervix, you will need a Pap
test.
 If the cervix was left in place at the time of
your hysterectomy, you will need Pap tests.

44.  TREAT INFECTION AND REPEAT
 HIGH RISK HPV TESTING
 COLPOSCOPY TO LOCALIZE LESION
Excisional/ ablative procedures
 CERVICAL PUNCH/CONE BIOPSY
 LEEP/LLETZ
 CRYO/CAUTERY
 LASER ABLATION

50.  LACK OF AWARENESS
 FEAR OF EXAMINATION AND PAIN
 NONAVAILABILITY OF TEST
 INCREASED PATIENT LOAD IN HOSPITALS
 MAY REQUIRE REPEAT VISIT

51.  VISUAL INSPECTION AFTER APPLICATION OF
3-5% ACETIC ACID (VIA).
 VISUAL INSPECTION AFTER APPLICATION OF
LUGOL IODINE (VILI).

52.  LIQUID BASED CYTOLOGY
 COMBINATION OF PAPS WITH HIGH RISK HPV
 SCREENING INTERVAL 3-5 YEARLY
 HPV VACCINES

53.  HPV RESPONSIBLE FOR CERVICAL,VAGINAL
VULVAR,ANAL,OROPHARYNGEAL
CANCER,PRECANCEROUS LESIONS,GENITAL
WARTS.
 ALSO ANAL, PENILE ,OROPHARYNGEAL
CANCER AND GENITAL WARTS IN MALES.

54.  FIRST INTRODUCED IN 2006.
 HPV 16 AND 18 CAUSE 70% OF CERVICAL
CANCERS.
 ALL HPV VACCINES PREVENT HPV 16 AND 18
INFECTION.
 GIVE STRONGER AND PROLONGED PROTECTION
THAN NATURAL INFECTION.
 TWO FDA APPROVED AVAILABLE IN INDIA-
CERVARIX AND GARDASIL.

55.  CERVARIX (BIVALENT-16 AND 18 )
 GARDASIL(QUADRIVALENT -16 ,18,6, 11)
TYPE 6 AND 11 CAUSE 90% OF GENITAL
WARTS.
 NONAVALENT VACCINE NOT YET AVAILABLE
IN INDIA.

56.  3 INJECTIONS I/M OVER 6 MONTHS.
 MOST EFFECTIVE WHEN GIVEN BEFORE PERSON IS
SEXUALLY ACTIVE.
 INDIAN ACADEMY OF PAEDIATRICS HAS
INCLUDED IN ITS SCHEDULE-
 2 DOSES - (9-14 YRS FEMALE)
 3 DOSES - (>15 YRS, IMMUNOCOMPROMISED)
 FOR 2 DOSES MINIMUM INTERVAL 6 MTHS.
 FOR 3 DOSES - 0, 1 / 2 & 6 MTHS.

57.  GARDASIL APPROVED FOR MALES.
 AGE OF ADMINISTRATION- 9-26 YRS

58.  100% PROTECTION
 PROTECTION LASTS FOR 8-9 YEARS.

59.  FDA APPROVED.
 NO SERIOUS SIDE EFFECTS
 HAS BEEN INCLUDED IN MANY
NATIONAL IMMUNIZATION
PROGRAMME INCLUDING UK,USA
AUSTRALIA AND EUROPEAN
COUNTRIES.

60.  REGULAR SCREENING AND
PROPHYLACTIC VACCINATION
CAN PREVENT YOU FROM
DEVELOPING THE MOST
COMMON AND DREADFUL
CANCER .PROTECT YOURSELF.