14 Jul 2011

Cervical cancer

Cancer – cervix

Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina.
Causes, occurrence, and risk factors
Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears.
Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix's surface: Squamous and columnar. Most cervical cancers are from squamous cells.
Cervical cancer usually develops very slowly. It starts as a precancerous condition called dysplasia. This precancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women who are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal Pap smear results.
Undetected precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for precancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.
Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV. Some strains lead to cervical cancer. (Other strains may cause genital warts, while others do not cause any problems at all.)
Risk factors for cervical cancer include:
    Having sex at an early age
    Multiple sexual partners
    Poor economic status (may not be able to afford regular Pap smears)
    Sexual partners who have multiple partners or who participate in high-risk sexual activities
    Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
    Weakened immune system
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:
    Abnormal vaginal bleeding between periods, after intercourse, or after menopause
    Any bleeding after menopause
    Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
    Periods become heavier and last longer than usual
Symptoms of advanced cervical cancer may include:
    Back pain
    Bone fractures
    Heavy bleeding from the vagina
    Leaking of urine or feces from the vagina
    Leg pain
    Loss of appetite
    Pelvic pain
    Single swollen leg
    Weight loss
Cipher and tests
Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions.
    Pap smears screen for precancers and cancer, but do not make a final diagnosis.
    If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.
Other tests may include:
    Endocervical curettage (ECC) to examine the opening of the cervix
    Cone biopsy
If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:
    Chest x-ray
    CT scan
    Intravenous pyelogram (IVP)
Action - Treatment
Treatment of cervical cancer depends on:
    The stage of the cancer
    The size and shape of the tumor
    The woman's age and general health
    Her desire to have children in the future
Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.
Types of surgery for early cervical cancer include:
    Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue
    Cryotherapy -- freezes abnormal cells
    Laser therapy -- uses light to burn abnormal tissue
A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.
Treatment for more advanced cervical cancer may include:
    Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
    Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed.
Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.
    Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home.
    External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.
Chemotherapy uses drugs to kill cancer. Some of the drugs used for cervical cancer chemotherapy include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.
    Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009 Jul 16;361(3):271-8. [PubMed]
    Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:Chap 28.
    National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical Cancer Screening. V.1.2011.
    Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60:99-119. [PubMed]
    NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.Nccn.Org. Accessed December 28, 2009.

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