Cervical Cancer_ECHOIndia_PPT_Template (2) (2).pptx

Cervical Cancer

1. ECHO India ECHO India Cervical Cancer Prevention, Detection, Awareness and Advocacy Capacity Building ECHO for Nurses Moving Knowledge, Not People

2. Introduction Childhood cervical cancer and vaginal cancer are very rare types of cancer. Cervical cancer forms in the cells of the cervix, and vaginal cancer forms in the cells of the vagina. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal). The vagina is the canal leading from the cervix to the outside of the body. At birth, a baby passes out of the body through the vagina

3. S ymptoms The most common symptom of cervical cancer and vaginal cancer in children is bleeding from the vagina. Other conditions may also cause vaginal bleeding. If child has vaginal bleeding, it is important to tell their doctor/nurse. The doctor will ask when it started and how often it occurs as a first step in making a diagnosis.

4. Tests to diagnose C hild has symptoms that suggest vaginal or cervical cancer, find out if they are due to cancer or another condition. They may ask about child’s personal and family medical history and do a physical exam. Depending on child’s symptoms and medical history and the results of their physical exam, may recommend more tests to find out if your child has vaginal or cervical cancer, and if so, its extent (stage). The results of tests and procedures done to diagnose vaginal and cervical cancer are used to help make decisions about treatment.

5. The following tests and procedures may be used to diagnose and stage childhood cervical cancer or vaginal cancer: Pap test The Pap test (also called a Pap smear or cervical cytology) collects cervical cells from the surface of the cervix and vagina using a soft, narrow brush or tiny spatula. The cells are viewed under a microscope to find out if they are abnormal.

6. Biopsy Transvaginal needle biopsy is the removal of tissue using a needle that is guided by ultrasound. A pathologist views the tissue under a microscope to check for signs of cancer.

7. Serum tumor marker test Serum tumor markers are substances found in the blood that are either made by vaginal or cervical cancer cells or that the body makes in response to vaginal or cervical cancer. For this test, a sample of blood is checked in the lab to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body.

8. Ultrasound An ultrasound uses high-energy sound waves (ultrasound), which bounce off internal tissues or organs in the pelvis and make echoes. The echoes form a picture of body tissues called a sonogram.

9. Magnetic resonance imaging (MRI) MRI uses a magnet and radio waves to make a series of detailed pictures of areas inside the body, such as the pelvis. The pictures are made by a computer. This procedure is also called nuclear magnetic resonance imaging.

10. CT scan (CAT scan) A CT scan is a procedure that makes a series of detailed pictures of areas inside the body, such as the pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography

11. CT scan vaginal cancer

12. Getting a second opinion Some people may want to get a second opinion to confirm their child’s cervical or vaginal cancer diagnosis and treatment plan. If choose to seek a second opinion, get important medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans before giving a recommendation. The doctor who gives the second opinion may agree with the first doctor, suggest changes or another approach, or provide more information about your child’s cancer.

13. S tages Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of the cervical or vaginal cancer to plan the best treatment.

14. There are several staging systems for cancer that describe the extent of the cancer. The International Federation of Gynecology and Obstetrics (FIGO) staging system is used for cervical and vaginal cancers. child’s cancer described by this staging system in the pathology report. Based on the FIGO results, a stage is assigned to the cancer, ranging from stage I, stage II, stage III, or stage IV (may also be written as stage 1, stage 2, stage 3, or stage 4). child’s doctor may describe it as one of these stages.

15. Recurrent cervical cancer or vaginal cancer Recurrent cancer is cancer that has come back after it has been treated. Cervical or vaginal cancer may come back in the cervix or vagina or as metastatic tumors in other parts of the body. Tests will be done to help determine where the cancer has returned in the body, if it has spread, and how far. The type of treatment that child will have for recurrent cancer will depend on how far it has spread.

16. Types of treatment for childhood cervical and vaginal cancer There are different types of treatment for children and adolescents with cervical cancer or vaginal cancer. cancer care team will work together to decide treatment. Many factors will be considered, such as your child’s overall health and whether the cancer is newly diagnosed or has come back.

17. A pediatric oncologist, a doctor who specializes in treating children with cancer, will oversee treatment. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

18. Pediatrician Pediatric surgeon Gynecologist P ediatric nurse specialist R ehabilitation specialist S ocial worker Psychologist F ertility specialist

19. C hild’s treatment plan will include information about the cancer, the goals of treatment, treatment options, and the possible side effects. It will be helpful to talk with child’s cancer care team before treatment begins about what to expect. A cervical cancer diagnosis can raise concerns about whether treatment will affect child’s fertility.

20. Surgery Surgery is used to remove as much cancer as possible from the cervix or vagina. If cancer cells remain after surgery or cancer has spread to the lymph nodes, more treatment may be needed.

21. Types of surgeries for cervical cancer

22. Surgery for vaginal cancer

23. Radiation therapy Radiation therapy uses high-energy x-rays or other types of  radiation to kill cancer cells or keep them from growing. Cervical cancer and vaginal cancer are sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy may be given alone or with other types of treatment, such as chemotherapy.

24. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy for vaginal cancer or cervical cancer is injected into a vein. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body.

25. It is not known if chemotherapy is an effective treatment for childhood cervical cancer or vaginal cancer, although drugs commonly used to treat these cancers in adults, such as carboplatin and  paclitaxel, may be used.

26. Clinical trials A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be an option.

27. Treatment of newly diagnosed childhood cervical cancer and vaginal cancer Treatment of newly diagnosed cervical cancer and vaginal cancer in children may include: Surgery will be done to remove as much of the cancer as possible, followed by radiation therapy, if cancer cells remain after surgery or cancer has spread to the lymph nodes. Chemotherapy may also be used, but it is not yet known how well this treatment works. Sometimes childhood cervical cancer and vaginal cancer can recur (come back) after treatment. If your child is diagnosed with a recurrent cervical cancer or vaginal cancer, child's doctor will work to plan treatment.

28. Side effects of treatment Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Physical problems, such as problems with fertility, may be a late effect of treatment. Some late effects may be treated or controlled. It is important to talk with child's doctors about the possible late effects caused by some treatments

29. Follow-up testing Some of the tests that were done to diagnose the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

30. Coping and support When a child has cancer, every member of the family needs support. Honest and calm conversations build trust as talk with child and their siblings. Taking care of yourself during this difficult time is also important. Reach out to your child’s treatment team and to people in your family and community for support

31. Related researches Common warts could indicate cervical cancer susceptibility, as both are caused by human papillomavirus (HPV). Eczema was also investigated, as atopic eczema has been negatively associated with warts, but non-atopic eczema may be associated with compromised host defences , as observed in patients with HIV, suggesting increased susceptibility to HPV infection and cervical cancer. ‘Cervical cancer’ was self-reported during an interview by 87 of 7594 women members of two longitudinal British birth cohorts. The accuracy of the diagnoses

32.   limited by lack of confirmation using medical records. Odds ratios are adjusted for common warts and eczema in childhood; and cigarette smoking, number of cohabiting partners and social class in early adult life. The odds ratios of warts and eczema with cervical cancer are 2.50 (95% confidence interval 1.14–5.47) and 3.27 (1.95–5.49), respectively. The association of eczema with cervical cancer is independent of hay fever as a marker of atopy , suggesting the importance of non-atopic eczema. Both heavier smoking compared with non-smoking and

33. four or more cohabiting partners compared with one/none have odds ratios for cervical cancer of 8.26 (4.25–15.10) and 4.89 (1.39–17.18), respectively. Common warts in childhood may indicate cervical cancer susceptibility; this and the relationship with eczema deserves investigation.

34. Materials and methods The data are from two British longitudinal birth cohort studies: the National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS70), which follow everyone in Great Britain born in the weeks 3–9 April 1958 and 5–11 March 1970, respectively ( Ekinsmyth et al, 1992;  Ferri , 1993;  Bynner et al, 1998 ) . Each study is based on approximately 16 000 individuals followed from birth to 42 or 30 years in NCDS and BCS70, respectively ( Ekinsmyth et al, 1992 ;  Ferri , 1993;  Bynner et al, 1998). After exclusion of males and those with

35. incomplete data, some 3654 and 3941 were available for analysis in NCDS and BCS70, respectively. Response rates varied by sweep and have been reported in detail elsewhere ( Ekinsmyth et al, 1992;  Ferri , 1993;  Bynner et al, 1998). Totals of 11 419 (5795 female) and 11 261 (5790 female) cohort members participated in data collection sweep at ages 42/30 years in NCDS and BCS70, respectively. Despite greater loss from more disadvantaged groups, the cohorts are largely representative ( Ferri , 1993;  Bynner et al, 1998). However, in the data used here, the proportion of females from a family in social class V (the most disadvantaged) at birth declined from 8.5 to 7.3% and 5.0 to 4.0% in NCDS and BCS70, respectively.

36. Response rates varied by sweep and have been reported in detail elsewhere ( Ekinsmyth et al, 1992;  Ferri , 1993;  Bynner et al, 1998). Totals of 11 419 (5795 female) and 11 261 (5790 female) cohort members participated in data collection sweep at ages 42/30 years in NCDS and BCS70, respectively. Despite greater loss from more disadvantaged groups, the cohorts are largely representative ( Ferri , 1993;  Bynner et al, 1998). However, in the data used here, the proportion of females from a family in social class V (the most disadvantaged) at birth declined from 8.5 to 7.3% and 5.0 to 4.0% in NCDS and BCS70, respectively.

37. In summary, the following data were used (and collected at these ages). NCDS: eczema and common warts (11 and 16 years); diagnosis of any cancer, hay fever and smoking (16 years); social class and cohabiting partners (33 years); and cervical cancer after age 17 years (42 years). BCS70: eczema (5 and 10 years); diagnosis of any cancer and hay fever (10 years); smoking, social class, cohabiting partners and cervical cancer after age 11 years (30 years).

38. A diagnosis of ‘cervical cancer’ was reported during interviews at ages 42 years in NCDS and 30 years in BCS70. Eczema and common warts (on arms and legs) were identified in NCDS by medical examination conducted by a local authority medical officer at 11 and 16 years. As warts were assessed by a medical examination at two time points, rather than record review, the estimates of prevalence for warts may be conservative, but a positive record is likely to be accurate. Hay fever was recorded at age 16 years in NCDS. In BCS70, eczema at age 5 years was identified by health visitor interviews with parents and medical records. At age 10 years,

39. community medical officers and school nurses recorded a diagnosis of eczema during a medical examination. Hay fever was recorded at age 10 years in BCS70. A history of chronic disease, including cancer, was recorded from review of medical records at ages 16 years and 10 years in NCDS and BCS70, respectively. Cigarette smoking was reported in NCDS at age 16 years by a self-completed questionnaire. Number of cigarettes smoked was dichotomised into under three or three and more packets of 20 per week. In BCS70, smoking history was recorded by interview at age 30 years and dichotomised into less than a packet of 20 or at least a packet of 20 cigarettes smoked per

40. day. The number of cohabiting partners to date was recorded during interviews at ages 33 and 30 years for NCDS and BCS70, respectively. Social class using the Registrar General's classification was based on current or most recent job at ages 33 and 30 years for NCDS and BCS70, respectively. The social class measure was divided into three groups: non-manual, manual and class not ascertained.

41. Statistical analysis Women with cancer of any type by age 16 years in NCDS or 10 years in BCS70 were excluded (one woman in BCS70). Cervical cancer was the dependent variable in multiple logistic regression using SPSS ( Norusis , 1989). Adjustment was made for the susceptibility measures and potential confounding factors, modelled as series of binary dummy variables. Additional analysis adjusted for hay fever.

42. A combined analysis of both cohorts required modification of some variables for comparability. As common warts were only assessed in NCDS, the wart status for all those in BCS70 was set as not known. This also introduced an adjustment for cohort and thus age at follow-up. Cigarette smoking was recoded so that never-smokers were in the no smoking category; ex-smokers, occasional smokers and those smoking less than three packets per week at 16 years or less than one packet per day at 30 years were classified as moderate smokers; the other smokers were combined in a heavy smoker category. In examining the association of single factors with cervical cancer without adjustment for potential confounding, adjustment was made for cohort (and thus age) using a dummy variable for cohort.

43. Results Common warts and eczema at ages 11 or 16 years were statistically significantly associated with cervical cancer. If common warts and eczema are combined into a single variable, those with either common warts or eczema 

44. Table 1 The risk of cervical cancer between ages 17 and 42 years in the 1958 birth cohort (NCDS)

45. Table 2 The risk of cervical cancer between ages 11 and 30 years in the 1970 birth cohort (BCS70)

46. Table 3 The risk of cervical cancer in the 1958 (NCDS) and 1970 (BCS70) birth cohorts combined

47. Conclusion As common warts were not assessed in BCS70, the estimates for their association with cervical cancer are unaltered by combining the two cohorts. The precision of the estimates for eczema is improved and indicates a robust positive relationship with subsequent cervical cancer The collapsing of categories necessary to combine the cohorts, accounts for the reduction in odds ratios for cervical cancer in some smoking groups, although this positive association remains highly statistically significant. Number of cohabiting partners remains significantly positively associated with cervical cancer after adjustment for the potential confounding factors. A slight reduction in the impact of adjusting for smoking on the association between number of cohabiting partners and cervical cancer is due to the collapsed smoking categories.

48. The increased statistical power of the combined model reveals a statistically significant association between manual social class and cervical cancer, but this was eliminated by adjustment for the potential confounding factors . Hay fever was not significantly associated with cervical cancer in the combined analysis, with an odds ratio of 1.04 (0.50–2.17),  P =0.922 and is not a confounding factor.

49. Referances - https://www.cancer.gov/types/cervical/childhood-cervical-vaginal-cancer#:~:text=Childhood%20cervical%20cancer%20and%20vaginal,organ%20where%20a%20fetus%20grows). https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12610 https://my.clevelandclinic.org/health/diseases/15579-vaginal-cancer

50. https://www.nejm.org/doi/full/10.1056/NEJMoa2030391 https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12610

51. Thank You!