CERVICAL CANCER :

PROBLEM & EARLY

DETECTION
urad MH, Asi N, Alsawas M, Alahdab M. New evidence pyramid. Evid Based Med August 2016, vol 21, no 4
INTRODUCTION
 New Cervical Cancer Patient 2014

3-4 PATIENTS
DIAGNOSED CERVICAL CANCER EVERY
WORKING DAY
DISTRIBUTION OF NEWLY DIAGNOSED
CERVICAL CANCER BASED ON STAGE
GROWTH OF NEWLY DIAGNOSED CERVICAL
CANCER BASED ON STAGE AND THERAPY
SOETOMO GENERAL HOSPITAL 2011 - 2014

<IIB

IIB

>IIB

NEED FOR RADIOTHERAPY INCREASED

ONLY 13% HAD RADIATION AFTER
SYSTEM FAILURES LEADING TO
CERVICAL CANCER DIAGNOSIS
Health care providers
do not screen women
at visits
Patient does not get
appropriate therapy

Women do not
come in for
screening
Colposcopy for
Patient gets cervical abnormal screen
cancer not done

Courtesy of Connie Trimble, MD, Johns Hopkins University School of Medicine, Baltimore, MD
ANATOMY
ECTOCERVIX
ENDOCERVIX
EARLY DETECTION OF CERVICAL
CANCER
 Cervical cancer is the most preventable
cancer
WHY?

The Natural History is wellknown

Needs a long time from normal to cancer
The HPV Vaccine
Normal Cervix

Low Grade Lesion

(CIN 1)

High Grade Lesion

(CIN 2 & CIN 3)

Cervical Cancer
EARLY DETECTION MODALITIES

PAP SMEAR
VIA (IVA : Inspeksi visual dengan asam asetat)
Tes HPV
Kolposkopi
PAP SMEAR
The mainstay of cervical cancer
screening for the last 60 years has
been the Papanicolaou test.

Developed in the 1940 by Georgios

Papanikolaou.

It involves exfoliating cells from

the transformation zone of the
cervix to enable examination of
these cells microscopically for
detection of cancerous or
precancerous lesions.
1883-1962
CERVICAL CANCER SCREENING
All women should begin cervical cancer screening at age 21.
Women between the ages of 21 and 29 Pap test every 3 years.
HPV test is unnecessary
Women between the ages of 30 and 65 Pap test and HPV test
every 5 years or a Pap test alone every 3 years.
Women over age 65 who have had regular screenings with
normal results should not be screened for cervical cancer.
Women who have been diagnosed with cervical pre-cancer
should continue to be screened.
CERVICAL SCREENING GUIDELINE
Age Guideline Frequency / Note
21-29 Pap test Every 3 years
HPV test uncessary
30-65 Pap Test and HPV test Every 5 years
negative
Pap test only Every 3 years
> 65th No more Screening If 2 consecutive Co-
test are negative
>65 with Pap test only every 3 years Until 20 years after
history of CIN2 initial post tretament
or higher
American College of Obstetrics and Gynecology
LESI PRA-KANKER SERVIKS
(BACAAN SISTEM BETHESDA)

Low grade squamous intraepithelial lesion (LSIL) :

- CIN I
- HPV Infection
High grade squamous intraepithelial lesion (HSIL)
- CIN II
- CIN III
- Ca In situ
 PADANAN DARI KLASIFIKASI
Class I Class II Class III Class IV Class V

Mild Mod Sev

Normal Inflam Cancer
Dysplasia CIS
CIN I CIN II
Normal Atypia CIN III Cancer
Koilocytosis

Benign
AS
WNL Cellular LGSIL HGSIL HGSIL Carcinoma
CUS
Changes

AS
NEGATIF LGSIL HGSIL HGSIL Carcinoma
CUS
HPV TEST

To detect HPV in cervical epithelium

2 kinds of HPV test :
Just only high risk HPV test positive /
negative
Determining the type of HPV
IVA
(INSPEKSI VISUAL ASAM ASETAT)

Sankaranarayanan dkk (Thailand)

Effective, cheap, easily available
Non invasive
Only in developing countries
VIA (IVA)

Less accurate than pap smear

But, this methode can be easily done in Indonesia, it
doesnt need Pathologist
Can be done by the general doctor
Abnormal acetowhite lesions
SERVIKS NORMAL
NORMAL CERVIX
ACETOWHITE EPITHELIUM
COLPOSCOPY
INDICATION FOR COLPOSCOPY

Abnormal pap smear Colposcopy

Targeted biopsy if necessary
Pelajarilah ilmu, sesungguhnya
mempelajari ilmu karena Allah adalah
suatu kebaikan,
mencarinya adalah ibadah,
mengkajinya adalah tasbih,
menelitinya adalah jihad,

THANK
mengajarkannya pada yang tidak
tahu adalah sadaqah.

Ilmu adalah penghibur di kala sunyi,

sahabat di kala sendiri, menjadi
petunjuk, dan dapat menjadi
penyabar di kala hati senang maupun
YOU
susah. Ilmu adalah pangkal
kebahagiaan abadi dan kenikmatan
kekal yang tiada berujung, dengan
ilmu manusia meraih kemuliaan di