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

Womens Cancer Network: www.wcn.org

Confidential
gynecologic (ovarian,
endometrial, cervical)
and breast cancer risk
assessment
Comprehensive
womens 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 tests

Women with immune problems

Steroid medications
Transplanted organs
Chemotherapy
HIV
Women who smoke

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 cant 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. DeCherney and M. Pernoll,
Current Obstetric and Gynecologic
Diagnosis and Treatment (The
McGraw-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! Dont 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 1-800-444-4441
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 doesnt 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
800-444-4441

www.wcn.org/gcf
gcf@smithbucklin.com