1. CA CERVIX
KISOMORO HC III-KABAROLE DISTRICT
Leadership and community placement June 201502/11/15
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2. Incidence /Prevalence /Mortality:
Worldwide, every two minutes, a woman dies of cervical cancer
There were an estimated 266,000 global deaths from cervical cancer in
2012,
accounting for 7.5% of all female cancer deaths. Almost nine out of ten
(87%)
cervical cancer deaths occur in less developed regions.
About 527,624 new cervical cancercases are diagnosed annually in the
World (estimations for2012).
About 3,915 new cervical cancer cases are diagnosed annually in Uganda
(estimations for 2012).
Cervical cancer ranks as the 1st cause of female cancer in Uganda.
Cervical cancer is the 1st most common female cancer in women aged 15
to 44 years in Uganda.
02/11/15
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3. Reasons forthe higherincidence and mortality in
developing countries
lack of awareness of cervical cancer among the population,
health care providers and policy-makers;
absence or poor quality of screening programmes for precursor
lesions and early-stage cancer.
In women who have never been screened, cancer tends to be
diagnosed in its later stages, when it is less easily treatable
limited access to health care services
lack of functional referral systems.
02/11/15
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4. Cause
Caused by Human Papilloma Virus
Transmission is through skin to skin contact and sexual contact
– vagina & anal sex
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5. Riskfactors
Tobacco smoking,
long-term hormonal contraceptive use(Oral contraceptives),
Early onset of sexual activity – compared with age at first
intercourse of 21 years or older, the risk is approximately 1.5-
fold for 18 to 20 years and two-fold for younger than 18 years
Multiple sexual partners – compared with one partner, the risk
is approximately two-fold with two partners and three-fold with
6 or more partners
A high-risk sexual partner (e.g., a partner with multiple sexual
partners or known human papillomavirus infection)
02/11/15
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6. Riskfactors Cont’d
Immunosuppression (e.g., human immunodeficiency virus infection),
women HIV positive.
Uncircumcised sexual partner
Early age at first birth (younger than 20 years old) and increasing
parity (3 or more full term births)
Familial History(Sister or mother)
High number of live childbirth/high fertility rate
History of sexually transmitted infections (e.g., Chlamydia
trachomatis, genital herpes)
History of vulvar or vaginal squamous intraepithelial neoplasia or
cancer (HPV infection is also the etiology of most cases of these
conditions)
02/11/15
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7. Clinical Presentation
Early cervical cancer is frequently asymptomatic, underscoring
the importance of screening.
Irregular or heavy vaginal bleeding
Pain during sexual intercourse
Post coital bleeding
vaginal discharge that may be watery, mucoid, or purulent and
malodorous
Advanced disease may present with pelvic or lower back pain,
hematuria, hematochezia, or vaginal passage of urine or stool
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9. Tests forCa Cervix
VIA (Visual inspection using acetic acid)
Pap Smear
Biopsy
HPV DNA Testing
Others
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10. Screening
The following groups of women should be offered screening:
Any woman between the ages of 15 and 50 years, who has never
had a Pap smear before or who had one 3 or more years ago (or
according to national guidelines).
3 years after a woman begins having vaginal intercourse
Women whose previous Pap smear was reported as inadequate or
showed a mild abnormality.
Women who have abnormal bleeding, bleeding after intercourse or
after the menopause, or other abnormal symptoms.
Women who have been found to have abnormalities on their cervix.
02/11/15
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11. Screening Cont’d
Until age 30, cervical screening should be carried out every
year.
At or after age 30, a woman who has had three normal
Test results in a row may be screened every 2 to 3 years with a
Pap test
A woman 70 years of age and older who has had three or
more normal Pap test results and no abnormal results in the
previous 10 years may choose to stop cervical cancer
screening. 02/11/15
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12. Patient instructions
Schedule the examination 2 weeks after the first day of the last
menstrual period. (It is preferable to avoid examination during
menses because blood may obscure significant findings.)
Do not use vaginal medication, vaginal contraceptives, or
douches for 48 hours before the appointment.
Intercourse is not recommended the night before the
appointment
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13. Prevention
Avoid the risk factors mentioned above
Vaccination with HPV Vaccine before initial sexual intercourse
Effective screening and treatment of precancerous lesions
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14. Treatment
Cryotherapy
Surgery e.g. radical or partial hysterectomy
Radiation therapy
Chemotherapy
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15. Thanks for Actively listening.
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