Monday, August 17, 2009

What is Cervical Cancer?

Cervical cancer is malignant cancer of the cervix uteri or cervical area. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages.[1] Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of the disease.

Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.[citation needed]

Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccine effective against the two strains of HPV that cause the most cervical cancer has been licensed in the U.S. and the EU. These two HPV strains together are currently responsible for approximately 70% of all cervical cancers. Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening, even after vaccination.
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Cervical Cancer Causes

Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes has been associated with certain factors, including previous infection with human papillomavirus (HPV), early sexual contact, multiple sexual partners, cigarette smoking, and taking oral contraceptives (birth control pills).

Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin and body surface disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer.

* Genetic material that comes from certain forms of HPV has been found in cervical tissues that show cancerous or precancerous changes.

* In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer that has genetic material matching the strain of virus that caused the infection.

* These findings demonstrate a strong link between the virus and cervical cancer.

* Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.

Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer.

Oral contraceptives ("the pill") may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than 5 years.

Cervical Cancer Symptoms

As in many cancers, you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage.

* Cervical cancer does not usually cause pain, although it may in very advanced stages.

* The most common symptom is abnormal vaginal bleeding. This is any bleeding from the vagina other than during menstruation.

* Abnormal vaginal discharge also may occur with cervical cancer.

When to Seek Medical Care

The range of conditions that can cause vaginal bleeding are diverse, range in seriousness, and vary based on your age, fertility, and medical history.

Vaginal bleeding after menopause is never normal. If you have gone through menopause and have vaginal bleeding, see your health care provider as soon as possible.

Very heavy bleeding during your period or frequent bleeding between periods warrants evaluation by your health care provider.

Bleeding after intercourse, especially after vigorous sex, does occur in some women. If this occurs only occasionally, it is probably nothing to worry about. Evaluation by your health care provider is advisable, especially if the bleeding happens repeatedly.

If you have vaginal bleeding that is associated with weakness, feeling faint or light-headed, or actual faint, go to a hospital emergency department for care.

Exams and Tests

As with all cancers, early diagnosis is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues.

The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear).

* The Pap smear is done as part of a regular pelvic examination.

* Named after the pathologist who developed the test, the Pap smear is a quick, painless, and relatively inexpensive way of screening women for precancerous or cancerous changes in their cervix.

* Cells from the surface of the cervix are collected on a slide and examined. Any abnormality found on a Pap smear mandates further evaluation.

Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope.

* This tissue sample can be obtained in a number of ways.

* A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist).

* The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist).

Colposcopy is a procedure similar to a pelvic examination.

* The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye to make abnormal cells easier to see.

* The colposcope magnifies the cervix by 8-10 times, allowing easier identification of any abnormal-appearing tissue that may need biopsy.

* This procedure can usually be done in your gynecologist's office.

* These abnormalities may be an early step in the slow series of changes that can lead to cancer.

Sometimes a larger biopsy is needed to fully check for invasive cervical cancer.

* The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix.

* This procedure can often be performed in your gynecologist's office.

A cone biopsy is performed in the operating room while you are under anesthesia.

* A small cone-shaped sample of your cervix is removed for examination.

* Like LEEP, cone biopsy procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined.

Precancerous changes

Over the years, different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. These changes are now most often called squamous intraepithelial lesion (SIL). "Lesion" refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells. Changes in these cells can be divided into 2 categories.

* Low-grade SIL: Early, subtle changes in the size and shape of cells that form the surface of the cervix are considered low grade.

o These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion.

o SIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).

o These early changes in the cervix most often occur in women aged 25-35 years but can appear in women of any age.

* High-grade SIL: A large number of precancerous cells, which look very different from normal cells, constitute a high-grade lesion.

o Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix.

o These lesions are also called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ.

o They develop most often in women aged 30-40 years but can occur at any age.

Precancerous cells, even high-grade lesions, usually do not become cancerous and invade deeper layers of the cervix for many months, perhaps years.

Some laboratories may still use an older system for describing abnormalities. This system classifies changes into 1 of 5 groups, 1 being the most mild changes and 5 being the most severe.

Ask you health care provider if you do not understand the way the result of your Pap smear is reported.

Invasive cancer

If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women aged 40 years or older.

If the biopsy results show invasive cancer, a series of tests will be performed, all designed to see whether the cancer has spread and, if so, how far.

* A chest x-ray looks for spread to the lungs.

* Blood tests can indicate whether the liver is involved. A CT scan may be necessary if results are not definitive.

* Special x-rays or a CT scan can be used to look at the bladder.

* The vagina and rectum are also examined, sometimes under anesthesia.

These tests are used to "stage" the cancer.

* By finding out how far it has spread, your health care providers can make a reasonable guess about your prognosis and the kind of treatment you will need.

* Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe).

* Staging is based on size and depth of the cancerous lesion, as well as degree of spread.
Article Source : Wikipedia, eziarticles.

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