+ Fakultas

Kedokteran
Universitas
Tarumanagara

2018
Cervical Cancer

Disusun oleh : Pembimbing :

Dila Nur Fitriani dr. Hendrik Sutopo,

406172113 M.Biomed, Sp.OG

Kepaniteraan Klinik Obstetrik & Ginekologi

RS Sumber Waras - Jakarta

Periode 11 Maret – 19 Mei 2019

 Cervical Cancer
+
 Cervical cancer is the 2nd most common cancer in women
worldwide
 Caused by sexually-acquired infection with Human
papillomavirus (HPV)
 Vaccination against HPV, regular screening, adequate treatment
are key tools to prevent new cervical cancer cases
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Primary prevention:
reduce the risk of HPV infection

Interventions include:

 Vaccinations for girls aged 9–13 years (or the age range
referred to in national guidelines) before they initiate
sexual activity;
 Healthy sexuality education for boys and girls
 Condom promotion or provision for those who are
sexually active
 Male circumcision where relevant and appropriate
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HPV Vaccines

Protection against high-risk  Both vaccines contain

HPV types 16 and 18 : virus-like particles
(VLPs)
 The bivalent vaccine  vaccines stimulate
(protection against types 16 development of
and 18 only) antibodies
 The quadrivalent vaccine  Quantity of antibodies
(contains additional produced after HPV
protection against types 6 vaccination is greater in
and 11, which are girls below the age of
responsible for 90% of 15 than in girls and
benign anogenital warts or women aged 15 years
condyloma) and older
+ HPV Vaccines

Safety & adverse events Contraindications

 Both vaccines have  Severe allergic reactions

been well tolerated after a previous dose of
 Most common the vaccine
complaints : pain &  Severe febrile illness
swelling at the injection  Pregnant women
site
+ Quadrivalent Vaccines

 HPV types in vaccine 

6,11,16,18
 2 doses, the second dose
6 months after the rst
dose
 intramuscular injection:
0.5 ml of liquid
suspension

Bivalent Vaccines

 HPV types in vaccine 

16,18
 2 doses, the second dose
6 months after the rst
dose
 intramuscular injection:
0.5 ml of liquid
suspension
+ Secondary prevention:
reduce the risk of HPV infection

Screening methods for cervical pre-cancer

 HPV DNA Test

 Visual inspection with acetic acid (VIA)
 Pap smear
 Liquid-based cytology (LBC)

HPV DNA Test VIA

 detection of DNA from high-  inspect the cervix after

risk HPV types in vaginal applying dilute (3–5%)
and/or cervical samples acetic acid
 reserved for women over the  appropriate to use in
age of 30 women whose
 collect a sample of cells by squamocolumnar
inserting a small brush or junction (SCJ) is visible,
other appropriate device typically in those
deep into the vagina younger than 50
+ Secondary Prevention :

Screening And Treatment Of Cervical Pre-cancer

Cytology-based screening

 taking a sample of cells from

the entire transformation zone
 2 available methods: the
conventional Pap smear (or
Pap test) or liquid-based
cytology (LBC)
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Diagnostic tests for
detection of cervical
pre-cancer

 Colposcopy
 Biopsy
 Endocervical curettage

Colposcopy

examination of the cervix,

vagina and vulva with an
instrument that provides
strong light and magni es a
eld, allowing specific patterns
in the epithelial (surface)
layer and surrounding blood
vessels to be examined
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Biopsy

Biopsy is the removal of

small samples of
abnormal tissue for
microscopic examination
to achieve a diagnosis

Endocervical curettage

some surface cells are

gently scraped from the
endocervical canal
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Treatment options for Cryotherapy
cervical pre-cancer
 eliminates precancerous
 Cryotherapy areas on the cervix by
 Loop electrosurgical excision freezing (an ablative
procedure (LEEP) method)
 Cold knife conization  The supercooling of the
cryoprobe is accomplished
using a tank with
compressed carbon
dioxide (CO2) or nitrous
oxide (N2O) gas
 Eligibility criteria : screen-
positive women,
histologically CIN2+
+Loop electrosurgical
procedure (LEEP)
excision

 removal of abnormal areas

from the cervix using a loop
made of thin wire powered by
an electrosurgical unit
 aims to remove the lesion and
the entire transformation zone
 Eligibility criteria : screen-
positive women, histologically
CIN2+

Cold knife conization

 removal of a cone-shaped
area from the cervix,
including portions of the
outer (ectocervix) and inner
cervix (endocervix
 Eligibility criteria: for cases
that cannot be resolved with
cryotherapy or LEEP
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