HEALTH - CERVICAL CANCER (CANCER OF THE CERVIX) SYMPTOMS
What is Cervical Cancer or Cancer of the Cervix?
Cervical cancer is cancer of the uterine cervix (the tip of the uterus that extends into the vagina). Invasive cervical cancer accounts for 2.5 percent of all cancers that afflict women in the U.S. About 13,500 cases of invasive carcinoma of the cervix are diagnosed in the U.S. each year, while there are at least 50,000 new cases of a pre-invasive cancer, known as carcinoma in situ, where the cancer cells are confined to the surface skin of the cervix.
The cervix is part of a woman's reproductive system. It is the lower, narrow part of the uterus (womb). The uterus is a hollow, pear- shaped organ in the lower abdomen. The cervix connects the uterus to the vagina. The vagina leads to the outside of the body. The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus. The mucus helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.
Since 1940, there has been a steady decrease in the incidence of carcinoma of the cervix because most women with no symptoms are screened with cervical and vaginal Pap smears. The probability at birth that a white woman will eventually develop cervical cancer dropped from 1.1 percent in 1975 to 0.7 percent in 1985. Similarly, for black women, the probability dropped from 2.3 percent in 1975 to 1.6 percent in 1985. Overall, mortality declined 45 percent between 1992 and 1994 and, because of increased effectiveness of screening procedures, continues to drop to this day.
Most scientists believe that cervical warts or pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the human papilloma virus (HPV). This early tumor, known as mild dysplasia or cervical intraepithelial neoplasia (CIN-1) or Grade 1, can progress to moderate dysplasia (CIN-2), then to severe dysplasia and carcinoma in situ (CIN-3) and eventually to invasive carcinoma. Most physicians believe that about two-thirds of all cases of severe dysplasia will progress to invasive cancer if left untreated. This transformation takes anywhere from 3 to 30 years; about 10 years on the average.
Once the cervical cancer becomes invasive, it can spread locally to the upper vagina and into the tissues surrounding the upper vagina and the cervix (the parametrium). Eventually, it grows toward the pelvic sidewall, obstructing the tubes (ureters) that drain urine from the kidney to the bladder. It can also spread to the bladder and rectum.
Cervical tumor cells can invade the lymphatic system and spread to the lymph nodes in the pelvic wall. Eventually they may spread to the iliac lymph nodes higher in the pelvis, the aortic lymph nodes, the nodes above the collarbone and occasionally to the groin nodes.
Metastases
can also spread through the bloodstream to the outer vagina, vulva,
lungs, liver and brain. Invasion of the pelvic nerves is common in
advanced cases. There may also be spread within the abdomen when the
tumor penetrates the full thickness of the cervix.
Health: Risk Factors of Cervical Cancer (Cancer of the Cervix)
In general, the major risk factors for cervical cancer appear to include initiation of sexual activity at an early age, multiple sexual partners (or a partner who has had multiple sex partners), infection with human papilloma virus 16, and cigarette smoking.
More than 90 percent of all cervical cancers are squamous cell carcinomas, and researchers believe that this cancer may be a sexually transmitted disease. There is much evidence that cervical carcinoma is related to sexually transmitted organisms.
Most researches believe that the human papilloma virus (HPV) is a strong cofactor in the development of pre-invasive and invasive carcinomas of the cervix, as well as pre-invasive and invasive squamous cell cancer of the vagina and vulva. Ninety to nintey-five percent of squamous cell carcinomas of the cervix contain the human papilloma virus DNA.
The virus is a sexually transmitted disease. There are more than 50 types of human papilloma virus (HPV) that infect humans. Types 6 and 11 usually cause warts, while types 16, 18, 31 and 33 usually result in high-grade cervical dysplasia (CIN-2 and CIN-3) and carcinomas. The virus infects the tissues of the lower genital tract and may produce obvious genital warts or mild, moderate or severe dysplasia and carcinoma in situ. Genital warts are associated with cervical, vaginal and vulvar dysplasia and invasive carcinoma (in 25 percent of all cases).
However, although infection with HPV does increase the risk of cervical cancer, many women infected by HPV do not go on to develop cervical cancer. Co-factors such as immune system functioning, nutrition and diet, hormones, smoking and other sexually transmitted diseases (STDs) are currently being evaluated by researchers.
Several factors can reduce the risk of cervical cancer a woman faces. In general, any steps to avoid sexually transmitted infection will reduce cervical cancer risk.
Lower than average risk is associated with:
- First intercourse deferred until age 18 to 20 or older
- Intercourse with only one male partner
- Use of condoms
- Use of a diaphragm
- Use of spermicide
- Circumcision and Jewish ethnicity, thought in the past to be protective factors, are now known to be unrelated to cancer risk (except to the extent that they correlate with sexual monogamy and abstinence before marriage).
Factors associated with higher than average cancer risk are:
- Previous CIN (cervical intraepithelial neoplasia, also called dysplasia)
- Genital wart virus infection (some strains)
- Previous vulvar or vaginal cancer
- Exposure to a male whose previous partner(s) had cervical cancer or CIN
- Exposure to a sexual partner who has (or had) penile cancer
- Exposure to more than one male sexual partner (compared to the risk for a woman with one lifetime partner, two partners increase the risk 250 percent; six partners, 600 percent)
- Smoking cigarettes
- DES (diethylstilbestrol) exposure during fetal development
- Birth control pills used four years or more
- Previous herpes, gonorrhea, syphilis or other sexually transmitted infections
- First intercourse before the age of 18 to 20
- First pregnancy before the age of 18 to 20
CANCER FREE
_______________________________________________________________________________________________________
Health: Symptoms of Early Cervical Cancer (Cancer of the Cervix):
- Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
- Abnormal vaginal bleeding between periods, after intercourse, or after menopause
- Periods become heavier and last longer than usual
- Any bleeding after menopause
Symptoms of advanced Cervical Cancer may include:
- Loss of appetite
- Weight loss
- Fatigue
- Pelvic pain
- Back pain
- Leg pain
- Single swollen leg
- Heavy bleeding from the vagina
- Leaking of urine or feces from the vagina
- Bone fractures
Health: Diagnosis of Cervical Cancer (Cancer of the Cervix)
The following tests may be used to diagnose cervical cancer:
Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes samples of the cells for testing.
Pelvic examination. In this examination, the doctor feels a woman’s uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and rectum to check for any unusual changes. A Pap test is often done at the same time.
If the doctor finds abnormal changes to the cervix during a pelvic examination and a Pap test, the doctor may test for HPV. An HPV test is similar to a Pap test, where the test is done on a sample of cells from the patient’s cervix. Certain strains (kinds) of HPV, such as HPV 16, are seen more often in women with cervical cancer and may help confirm a diagnosis. Many women carry HPV, so HPV testing alone is not an accurate test for cervical cancer. But if the Pap tests show some cellular abnormality, and the HPV test is also positive, the doctor may suggest one or more of the following diagnostic tests:
Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful, can be done in the doctor's office, and has no side effects. It can be done on pregnant women.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and diagnosing disease). If the lesion is small, the doctor may remove all of it during the biopsy. There are several types of biopsies:
- One common method uses an instrument to pinch off small pieces of cervical tissue.
- Sometimes, the doctor wants to check an area inside the opening of
the cervix that cannot be seen during a colposcopy. To do this, the
doctor uses a procedure called endocervical curettage (ECC). Using a
small, spoon-shaped instrument called a curette, the doctor scrapes a
small amount of tissue from inside the cervical opening.
- A loop electrosurgical excision procedure (LEEP) uses an electrical
current passed through a thin wire hook. The hook removes tissue for
examination in the laboratory. A LEEP may also be used to remove a
precancer or an early stage cancer.
- Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early stage cancer.
The first three procedures are usually done in the doctor's office using a local anesthetic to numb the area. There may be some bleeding and other discharge and, for some women, discomfort similar to menstrual cramps. Conization is done under a general or local anesthetic and may be done in the doctor's office or the hospital.
If the biopsy indicates that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix.
Pelvic examination. The specialist may re-examine the pelvic area while the patient is under anesthetic to see if the cancer has spread to organs near the cervix, including the uterus, vagina, bladder, and rectum.
Cystoscopy. This procedure allows the doctor to view the inside of the bladder and urethra (canal that carries urine from the bladder) with a cystoscope (a thin, flexible tube with a camera). A cystoscopy is used to determine whether cancer has spread to the bladder.
Proctoscopy (also called a sigmoidoscopy). This procedure allows the doctor to view the colon and rectum using a sigmoidoscope (a thin, flexible tube with a camera). A proctoscopy is used to see if the cancer has spread to the rectum.
Laparoscopy. This procedure allows the doctor to see the abdominal area with a laparoscope (a thin, lighted, flexible tube with a camera).
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
Health: Staging of Cervical Cancer (Cancer of the Cervix):
If your doctor determines that you have cervical cancer, you'll undergo further tests to determine whether your cancer has spread and to what extent — a process called staging. Your cancer's stage is a key factor in deciding on your treatment. Staging exams include:
- Imaging tests. Tests such as X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
- Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cytoscopy) and rectum (proctoscopy).
Your doctor then assigns your cancer a stage — typically a Roman numeral. Stages of cervical cancer include:
- Stage 0. Also called carcinoma in situ or noninvasive cancer, this early cancer is small and confined to the surface of the cervix.
- Stage I. Cancer is confined to the cervix.
- Stage II. Cancer at this stage includes the cervix and uterus, but hasn't spread to the pelvic wall or the lower portion of the vagina.
- Stage III. Cancer at this stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina.
- Stage IV. At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.
Talk to your doctor about when to begin screening for cervical cancer. The American College of Obstetricians and Gynecologists recommends that girls have their first visit with an obstetrician-gynecologist between ages 13 and 15 to discuss sexual activity and ways to prevent sexually transmitted infections, such as HPV.
_______________________________________________________________________________________________________
Natural Alternative Treatment Option: NATURAL CANCER TREATMENT
_______________________________________________________________________________________________________
Health: Conventional Treatment for Cervical cancer (Cancer of the Cervix)
The most common treatments for cervical cancer are surgery, radiation therapy, and chemotherapy. The type of treatment used depends on the stage of the disease, the size of the tumor, the woman's age, her health, and her desire to have children. A woman who is pregnant should talk with her doctor about how treatments could affect both her and the unborn child, and whether treatment can be delayed until after the baby is born.
Because cancer treatment often damages healthy cells and tissues, unwanted side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
Radiation therapy alone or surgery is generally used for a small tumor. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with invasive cervical cancer. Surgery and radiation therapy are both called local therapies because they affect only the area around the cancer site. Chemotherapy is a systemic therapy because it affects the entire body.
Surgery
In surgery, the doctor operates on the patient to remove the cancerous tissue. For cervical cancer that has not spread beyond the cervix, these procedures are often used:
- Conization is the use of the same procedure as a cone biopsy.
- Diagnosis to remove all of the abnormal tissue. It can be used to remove microinvasive cervical cancer.
- LEEP is the use of an electrical current passed through a thin wire
hook. The hook removes the tissue. It can be used to remove
microinvasive cervical cancer.
- A hysterectomy is the removal of the uterus and cervix.
Hysterectomy can be either a simple hysterectomy, which is the removal
of the uterus and cervix, or a radical hysterectomy which is the
removal of the uterus, cervix, upper vagina, and the tissue around the
cervix. In addition, a radical hysterectomy includes an extensive
pelvic lymph node dissection (removal of the lymph nodes). If needed, a
bilateral salpingo-oophorectomy (the removal of both fallopian tubes
and both ovaries) is done at the same time as the hysterectomy.
- Radical trachelectomy (surgery to remove the cervix that leaves the uterus intact) with pelvic lymph node dissection may be used for young patients who desire fertility preservation (to have children in the future). This procedure has gained acceptance as an alternative to a hysterectomy.
For cervical cancer that has spread beyond the cervix, one of these procedures may be used:
- Radical hysterectomy is the removal of the cervix, uterus, part of the vagina, and the nearby lymph nodes.
- Exenteration is the removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs following radiation therapy.
Complications or side effects from surgery vary depending on the extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems.
If extensive surgical procedures have affected sexual function, other surgical procedures can construct an artificial vagina. Because these surgical procedures can affect a woman's sexual health, women should talk with their doctor about their symptoms in detail. The doctor may be able to help reduce the side effects of surgery.
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects.
Although chemotherapy can be given orally (by mouth), most drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a thin tube called a catheter, a tube temporarily put into a large vein to make injections easier.
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
Other potential longer-term side effects include the inability to become pregnant and premature menopause. Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation therapy may be given alone or before surgery to shrink the tumor. Some women may be treated with a combination of radiation therapy and chemotherapy.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.
Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.
Advanced cervical cancer
Cancer that has spread beyond the cervix may be called advanced cervical cancer. Palliative treatment with radiation therapy may be given to relieve pain. Chemotherapy and surgery may be used to treat or remove newly affected areas both within the pelvic area and in other parts of the body. The doctor may also suggest entering a clinical trial, which is a research study to test a new treatment.
Health: Complications of Cervical Cancer (Cancer of the Cervix)
Treatments for invasive cervical cancer often make it impossible to become pregnant in the future. For many women — especially younger women and those who have yet to begin a family — infertility is a distressing side effect of treatment. If you're concerned about your ability to get pregnant in the future, discuss this with your doctor.
For a specific subgroup of women with early cervical cancer, fertility-sparing surgery may be a treatment option. A surgical procedure to remove your cervix and surrounding lymphatic tissue only (radical trachelectomy) may preserve your uterus. Early studies of radical trachelectomy suggest that cervical cancer can be cured using this technique, though it isn't appropriate for every woman and there may be added risks to this surgery. Future pregnancies may be possible, but are considered high risk because removing the cervical tissue can lead to a higher incidence of miscarriage and premature birth.
Tell your doctor about your concerns about infertility before your treatment begins. In most cases, preserving fertility is more successful than trying to restore fertility after treatment.
You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body — not just intercourse. Use a condom every time you have sex in order to reduce your health risk of contracting HPV.
In addition to using condoms, the best ways to prevent cervical cancer are to:
- Delay first intercourse
- Have fewer sexual partners
- Avoid smoking
Get vaccinated against HPV
A new vaccine called Gardasil offers protection from the most dangerous
types of HPV — the virus that causes most cervical cancers. The
national Advisory Committee on Immunization Practices recommends
routine vaccination for girls ages 11 and 12, as well as girls and
women ages 13 to 26 if they haven't received the vaccine already. The
vaccine is most effective if given to girls before they become sexually
active.
Although the vaccine could prevent up to 70 percent of cervical
cancer cases, it can't prevent infection with every virus that causes
cervical cancer. Routine Pap tests to screen for cervical cancer remain
important health wise.
Have routine Pap tests
Routine Pap tests are the most effective way to detect cervical cancer
in the earliest stages. Work with your doctor to determine the best
schedule for Pap tests. Current health guidelines suggest:
- An initial Pap test within three years of when you begin having sex or at age 21, whichever comes first.
- From ages 21 to 29, a regular Pap test every year or two.
- From ages 30 to 69, a regular Pap test every two or three years if you've had three normal Pap tests in a row.
- From age 70 on, you may stop having Pap tests if you've had three or more normal tests in a row and no abnormal results in the last 10 years.
If you're at high risk of cervical cancer, you'll need more frequent Pap tests. If you've had a hysterectomy, talk with your doctor about whether to continue getting Pap tests. If the hysterectomy was done for a noncancerous health condition, such as fibroids, you may discontinue routine Pap tests, but not pelvic exams. If the hysterectomy was done for a precancerous or cancerous condition, your vaginal canal still needs to be checked for abnormal health changes.
_______________________________________________________________________________________________________
Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
<<Previous (Home Page) Next>>
