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Cervical cancer

Cervical Cancer

Outline

1. Introduction

What is cancer of the cervix?

Statistical evidence about cancer of the cervix?

2. Risk factors and preventions

3. Detection and Symptoms

4. Types of treatment

What Is Cervical Cancer

The cervix is the lower part of the uterus (womb). The uterus is divided into two parts. The upper part or body of the uterus is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endo-cervix. The part next to the vagina is the ecto-cervix.

Cervical cancer is a type of cancer that begins in the lining of the cervix. Cervical cancers do not form suddenly; there is a gradual change of normal cells within the cervix. Some women with pre-cancerous changes of the cervix will develop cancer. This usually takes several years but sometimes can happen in less than a year. For some women, pre-cancerous changes may go away without any treatment. More often, if these pre-cancers are treated, true cancers can be prevented.

Precancerous changes can be separated into several categories based on how the cells of the cervix look under a microscope. There are several systems for naming and describing these categories of potentially cancerous or pre-cancerous changes. There are two main types of cervical cancers: "squamous cell carcinoma and adenocarcinoma. About 85%-90% of cervical cancers are squamous cells carcinomas. They begin in the ectocervix, most often at its border with the endocervix. The remaining 10%-15% of cervical cancers are adenocarcinomas. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

"The American Cancer Society estimates that during 2000, about 12,800 cases of invasive cervical cancer will be diagnosed in the United States. Some researchers estimate that noninvasive cervical cancer (carcinoma in situ) is about 4 times more common than invasive cervical cancer. About 4,600 women will die from cervical cancer in the United States during 2000. Cervical cancer was once one of the most common causes of cancer death for American women. Between 1955 and 1992, the number of cervical cancer deaths in the United States declined by 74%. The main reason for this change is the increased use of the Pap test, a screening procedure that permits diagnosis of pre-invasive and early invasive cancer. The death rate continues to decline at a rate of about 2% a year. The 5-year relative survival rate for the earliest stage of invasive cervical cancer is 91%. The overall (all stages combined) 5-year survival rate for cervical cancer is about 70%. For cervical precancer the 5-year survival rate is nearly 100%. "(cite a source here)

Risk Factors

There are several factors that increase a woman’s risk of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it is not possible to say with certainty that a particular risk factor was the cause.

One risk factor of cancer is age; the average age of women newly diagnosed with cervical cancer is between 50 and 55 years. The risk of developing this cancer is very low among girls less than fifteen. This risk increases between the late teens and mid-thirties. Unlike many other cancers that rarely affect young adults, cervical cancer can affect young women in their twenties and even in their teens. Many older women do not realize that they have the highest risk of developing cervical cancer. (put quote somewhere in here)

The most common risk factor related to cervical cancer is infection by human papillomavirus. HPVs are a group of more than 70 types of viruses called papillomaviruses which cause warts, or papillomas. Certain HPV types can infect the female and male genital organs and the anal area. These HPV types are passed from one person to another during sexual contact. When HPV infects the skin of the external (outer) genital organs and anal area (around the opening of the intestinal tract), they often cause raised flaky warts. These may be barely visible or they may be several inches across. Two HPV types, HPV 6 and HPV 11, cause most genital warts. These rarely develop into cancer and are called "low risk" viruses. However, other sexually transmitted HPVs have been linked with genital or anal cancers in both men and women. These are called "high risk" HPV types and include HPV 16, HPV 18, HPV 33, HPV 35, HPV 45, as well as some others.

Human immunodeficiency virus (HIV) infection: HIV is the virus that causes the acquired immunodeficiency syndrome (AIDS). Because this virus damages the body’s immune system, it makes women more susceptible to HPV infections, which may increase the risk of cervical cancer. Scientists believe that the immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV infection, a cervical precancer might develop into an invasive cancer faster than it normally would. This is particularly true if her CD4 cell count is very low. The CD4 cells are the blood cells most affected by HIV.

Low socioeconomic status: Low socioeconomic status is also a risk factor for cervical cancer. Many people with low incomes do not have quick access to adequate health care services, including Pap tests and treatment of pre-cancerous cervical disease. Such women may also be undernourished, which may play a role in increasing their risk.

PREVENTIONS

The vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable precancerous changes, there are two ways to prevent this disease. Avoiding risk factors can prevent most precancers of the cervix. Delaying onset of sexual intercourse if you are young can help avoid HPV infection. Limiting your number of sexual partners and avoiding sex with people who have had many other sexual partners decreases your risk of exposure to HPV. HPV infection does not always produce warts or other symptoms, so a person may be infected with, and pass on, HPV without knowing it. Recent research shows that condoms ("rubbers") cannot protect against infection with HPV. This is because HPV can be passed from person to person with any skin-to-skin contact with any HPV-infected area of the body, such as skin of the genital or anal area not covered by the condom. The absence of visible warts cannot be used to decide whether caution is warranted, since HPV can be passed on to another person even when there are no visible warts or other symptoms. HPV can be present for years with no symptoms. It is still important, though, to use condoms to protect against AIDS and other sexually transmitted diseases that are passed on through some body fluids. Not smoking is another way to reduce the risk of cervical cancer and precancer.

The second way to prevent invasive cancer is to have a Pap test to detect HPV infection and precancers, Pap smear tests are performed by a certified Gynecologist. The doctor inserts a metal or plastic speculum inot he vagina and then gently swabs the cervix with a cotton swab. She/he then puts the sample of cells into a petri dish for observation. Most invasive cervical cancers are found in women who have not had regular Pap tests.

"The American Cancer Society recommends that all women begin yearly Pap tests at age 18 or when they become sexually active, whichever occurs earlier. If a woman has had three negative annual Pap tests in a row, this test may be done less often at the judgment of a woman’s health care provider."

I will use the importance of pap testing in my conclusion

The Importance of the Pap Test in Finding Cervical Cancer and Precancerous Changes

Cervical cancer deaths are higher in populations around the world where women do not have access to routine Pap tests. These cases are usually diagnosed at an invasive late stage, rather than as precancers or early cancers.

Despite the recognized benefits of Pap test screening, not all American women take advantage of it. Between 60% and 80% of American women with newly diagnosed invasive cervical cancer have not had a Pap smear in the past 5 years, and many of these women have never had a Pap test. In particular, elderly, African-American, and low-income women are less likely to have regular Pap tests.

Signs and Symptoms of Cervical Cancer

It is important to remember that cervical pre-cancers and early cancers usually show no symptoms or signs. A woman usually develops symptoms when the cancer has become invasive. An unusual discharge from the vagina (separate from your normal monthly menstrual period) can be a sign of cervical cancer. Such discharges may include blood spots or light bleeding and may occur in between or following your periods. Bleeding following intercourse is a common symptom. Pain during intercourse may also indicate cervical cancer. However, all of these signs and symptoms can be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. If you have any of these signs or other suspicious symptoms, it is important that you see your health care provider right away. Ignoring symptoms may allow the cancer to progress to a more advanced stage and lower your chance for effective treatment. Even better, don't wait for symptoms to appear. Have a regular Pap test and pelvic examination.

Types Of Treatments

Options for treating each patient with cervical cancer depend on the stage of the disease. The three main types of treatment used for patients with cervical cancer are surgery, radiation therapy and, chemotherapy. In Laser surgery: A focused laser beam is used to vaporize (burn off) abnormal cells or to remove a small piece of tissue for study. Laser surgery is used as treatment for preinvasive cervical cancer. It is not used in the treatment of invasive cancer. Cone biopsy : A cone-shaped piece of tissue is removed from the cervix using a surgical or laser knife (cold knife cone) or using the LEEP (LEETZ) procedure. The LEEP (LEETZ) procedure uses a thin wire heated by electricity to remove tissue. See the section on "Can Cancer of the Cervix be Prevented?" for more information. A cone biopsy is rarely used as the sole treatment, except in those women with early (Stage IA) cancer who might want to have children. It may be used to establish the diagnosis of cancer, prior to treatment with additional surgery or radiation.

Hysterectomy: This is surgical removal of the uterus, the uterus is removed through a surgical incision in the front of the abdomen or through the vagina the ovaries and fallopian tubes are left in place unless the cancer infects them. Complications are unusual, but could include excessive bleeding, wound infection, or damage to the urinary or intestinal systems. A hysterectomy is done to treat some Stage IA cervical cancer. The operation is used for some stage 0 cancers. Radiation therapy uses high energy x-rays to kill cancer cells. These x-rays may be given externally in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. The second type of radiation therapy is called brachytherapy. It may be given as a capsule of radioactive material placed into the vagina near the tumor, or the radioactive material may be placed into thin needles that are inserted directly into the tumor.

Chemotherapy uses anticancer drugs that are given in a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancer that has spread beyond the cervix. Drugs most often used in treating cervical cancer include cisplatin, ifosfamide, , and fluorouracil. If this treatment is chosen, you may receive a combination of drugs. Combination chemotherapy is sometimes more effective in treating cancer than one drug alone. These drugs kill cancer cells but can also damage normal cells.

"You may want to seek a second opinion for personal or practical reasons. On the personal level, a second opinion can help you learn more about treatment options and help you decide whether to work with your initial medical team or with those proposing a second view. On the practical side, some insurance companies require a second opinion before agreeing to pay for certain treatments." (will find source for this)

I will base my conclusion on this stuff below

Conclusion

Follow-up Care: An important part of your treatment plan is a specific schedule of follow-up visits after surgery, chemotherapy, or radiation therapy to be sure what, if any, additional treatment is necessary. Follow up may involve procedures such as x-rays, CT scans, ultrasound studies, or MRI (magnetic resonance imaging) scans. There also may be biopsies to get tissue samples for laboratory microscopic evaluation, blood tests, and other examinations. Which tests should be done and how often will depend on the stage of the cancer.

Lifestyle Factors: You can help in your own recovery from cancer by making healthy lifestyle choices. If you use tobacco, stop now. If you use alcohol at all, limit how much you drink. Good nutrition can help you get better after treatment. Choose most of your foods from plant sources. Eat less fat, especially animal fat. Most patients should eat more fruits, vegetables, whole grains, and high-fiber foods. But, if you developed diarrhea or cramping pain after radiation therapy, your health care team may recommend a low-fiber diet. Exercise once you are well. Ask your cancer care team for advice on when you may begin, and what type of activities might be a good way to start.

During treatment for cancer, radiation therapy and chemotherapy add to the fatigue caused by the disease itself. Give your body the rest it needs so you will feel better as time goes on.

Bibliography:



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