Cancer Cervix

Cancer Cervix=

General Information

Cervical cancer is a disease in which malignant (cancer) cells form= in the tissues of the cervix.

The cervix = is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).<= /o:p>

Cervical ca= ncer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dyspla= sia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix an= d to surrounding areas.

Risk Factors

Infection of the = cervix with human pa= pillomavirus (HPV) is the major risk factor and the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnorm= al cells in the cervix are at increased risk of cervical cancer.

Other possi= ble risk factors:

· = ; Giving birth to = many children.

· = Having many sexual partners.

· = Having first sexual intercourse at a young age. <= /span>

· = Smoking cigarettes.

· = Oral contraceptive pills use.

· = Weakened immune system.

Signs & Symptoms

Early cervical cancer may not cause noticeable s= igns or symptoms. Women should have yearly check-ups, including a Pap smear to c= heck for abnormal cells in the cervix. The prognosis (chance of recovery) is bet= ter when the cancer is found early.

Possible signs of cervical cancer include vaginal bleeding and pelvic pain.

These and other s= ymptoms may be caused by cervical cancer. Other conditions may cause the same sympt= oms. A doctor should be consulted if any of the following problems occur:

· &n= bsp; Vaginal bleeding

= · = Unusual vaginal discharge. <= /p>

= · = Pelvic pain.

= · = Pain during sexual intercourse.

Tests that are u= sed to detect (find) and diagnose cervical cancer

The following pro= cedures may be used:

· &n= bsp; Pap smear= : A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brus= h, or a small wooden stick is used to gently scrape cells from the cervix and vag= ina. The cells are viewed under a microscope to find out if they are abnormal. T= his procedure is also called a Pap test.

= · = Co= lposcopy: A procedure to look inside the vagina and cervix by u= sing Colposcope for abnormal areas. Tissue samples may be taken for bio= psy.

= · = Biopsy: If abnormal cel= ls are found in a Pap smear, the doctor may do a Colposcopy and biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that rem= oves only a small amount of tissue is usually done in the doctor’s office.= A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).

= ·      =         Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the va= gina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor = or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

= ·      =         Endocervical curettage: A procedure to collect cells or tissue from the cervi= cal canal using a curette (spoon-shaped instrument). Tissue samples may be taken for biopsy. This procedure is sometimes done at the same time as a colposcopy.

Certain factors = affect prognosis and treatment options

The prognosis (ch= ance of recovery) depends on the following:

·        &n= bsp;     The stage of the cancer (whether it affects part of the cerv= ix, involves the whole cervix, or has spread to the lymph nodes or other places= in the body).

= ·      =         The type of cervical cancer.

= ·      =         The size of the tumor.

Treatment options= depend on the following:

= ·      =         The stage of the cancer.

= ·      =         The size of the tumor.

= ·      =         The patient's desire to have children.

= ·      =         The patient’s age.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.

=

= Stages of Cervical Can= cer

After cervical cancer has been diagnosed, tests are done to find ou= t if cancer cells have spread within the cervix or to other parts of the body. <= /span>

The process= used to find out if cancer has spread within the cervix or to other parts of the bo= dy is called staging. The information gathered from the staging process determ= ines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

·        &n= bsp;     Chest x-ray: An x-ray of th= e organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. =

= ·      =         CT scan (CAT sca= n): A procedure th= at makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs = or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

= ·      =         Ly= mphangiogram: A procedure us= ed to x-ray the lymph system. A dye is injected into the lymph vessels in the fee= t. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out wheth= er cancer has spread to the lymph nodes.

= ·      =         Ultrasound exam<= /span>: A procedure in= which high-energy sound waves (ultrasound) are bounced off internal tissues or or= gans and make echoes. The echoes form a picture of body tissues called a sonogra= m.

= ·      =         MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a compute= r to make a series of detailed pictures of areas inside the body. This procedure= is also called nuclear magnetic resonance imaging (NMRI).
= ·      =         Pretreatment sur= gical staging: Surgery (an operation) is done to find out if the cancer has spread within = the cervix or to other parts of the body. In some cases, the cervical cancer ca= n be removed at the same time. Pretreatment surgical staging is usually done onl= y as part of a clinical trial.

The results= of these tests are viewed together with the results of the original tumor biop= sy to determine the cervical cancer stage.

The fol= lowing stages are used for cervical cancer:

Stage 0 (Carcino= ma in Situ)

In stage 0,= cancer is found only in the first layer of cells lining the cervix and has not inv= aded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.=

Stage I

In stage I,= cancer is found in the cervix only. Stage I is divided into stages IA and IB, base= d on the amount of cancer that is found.

·        &n= bsp;     Stage IA<= /b>: A very small a= mount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The cancer is not deeper than 5 millimeters and not wider than 7 millimeters.

= ·      =         Stage IB<= /b>: In stage IB, c= ancer is still within the cervix and either:

= ·      =              can only be seen with a microscope and is deeper than 5 mill= imeters or wider than 7 millimeters; or

= ·      =              can be seen without a microscope and may be larger than 4 ce= ntimeters.

Stage II<= /span>

In stage II= , cancer has spread beyond the cervix but not to the pelvic wall (the tissues that l= ine the part of the body between the hips). Stage II is divided into stages IIA= and IIB, based on how far the cancer has spread.

·        &n= bsp;     Stage IIA: Cancer has spread beyond the cervix to the upper = two thirds of the vagina but not to tissues around the uterus.

= ·      =         Stage IIB: Cancer has spread beyond the cervix to the upper = two thirds of the vagina and to the tissues around the uterus.

Stage I= II

In stage II= I, cancer has spread to the lower third of the vagina and may have spread to the pelv= ic wall and nearby lymph nodes. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

·        &n= bsp;     Stage IIIA: Cancer has spread to the lower third of the vagi= na but not to the pelvic wall.

= ·      =         Stage IIIB: Cancer has spread to the pelvic wall and/or the = tumor has become large enough to block the ureters (t= he tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to ly= mph nodes in the pelvis.

Stage IV<= /span>

In stage IV= , cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.

·        &n= bsp;     Stage IVA: Cancer has spread to the bladder or rectal wall a= nd may have spread to lymph nodes in the pelvis.

= ·      =         Stage IVB: Cancer has spread beyond the pelvis and pelvic ly= mph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs.

Treatme= nt options for Cancer Cervix

Different t= ypes of treatment are available for patients with cervical cancer. Some treatments = are standard (the currently used treatment), and some are being tested in clinical trial= s. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for pati= ents with cancer. When clinical trials show that a new treatment is better than = the standard treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used:

Surgery <= /span>

Surgery (re= moving the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:

·        &n= bsp;     Co= nization: A procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. A = pathologist views the tissue under a microscope to look for cancer cells. Conization may be used to diagnose or treat a cervical condition. This procedure is also called a cone biopsy. <= /p>
= ·      =         Cryosurgery: A treatment th= at uses an instrument to freeze and destroy abnormal tissue, such as carcinoma= in situ. This type of treatment is also called cryotherap= y.

= ·      =         Laser surgery: A surgical pro= cedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

= ·      =         L= oop electrosurgical excision procedure (LEEP)<= span style=3D'font-size:10.0pt;font-family:Arial;color:#4D4D4D'>: A treatment th= at uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.

= ·      =         Total hysterecto= my: A surgical pro= cedure to remove the uterus, including the cervix. If the uterus and cervix are ta= ken out through the vagina, the operation is called a vaginal hysterectomy. If = the uterus and cervix are taken out through a large incision (cut) on the abdom= en, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparo= scope, the operation is called a total laparoscopic hysterectomy.

= ·      =         Bilateral salpingo-oophorectomy: A surgical procedure to remove bo= th ovaries and both fallopian tubes.

= ·      =         Radical hysterec= tomy: A surgical pro= cedure to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.

= ·      =         Pelvic exenteration: A surgical pro= cedure to remove the lower colon, rectum, and bladder. In women, the cervix, vagin= a, ovaries, and nearby lymph nodes are also removed. Artificial openings (stom= a) are made for urine and stool to flow from the body to a collection bag. Pla= stic surgery may be needed to make an artificial vagina after this operation.

Radiation therap= y

Radiation t= herapy is a cancer treatment that uses high-energy x-rays or other types of radiat= ion to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a= radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherap= y is a cancer treatment that uses drugs to stop the growth of cancer cells, either= by killing the cells or by stopping the cells from dividing. When chemotherapy= is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column,= an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells = in those areas (regional chemotherapy). The way the chemotherapy is given depe= nds on the type and stage of the cancer being treated.

Treatment Options by S= tage

Stage 0 Cervical Cancer (Carcinoma in Situ)

Treatment of stage 0 cervical cancer may include the following:

·        &n= bsp;     Loop electrosurgical excision procedure (LEEP). <= /span>

= ·      =         Laser surgery.

= ·      =         Conization.

= ·      =         Cryosurgery.

= ·      =         Total hysterectomy for women who cannot or no longer want to have children.

= ·      =         Internal radiation therapy for women who cannot have surgery.

Stage IA Cervical Cancer

Treatment of stage IA cervical cancer m= ay include the following:

·        &n= bsp;     Total hysterectomy with or without bilateral salpingo-oophorectomy.

= ·      =         Conization.

= ·      =         Radical hysterectomy and removal of lymph nodes

= ·      =         Internal radiation therapy.

Stage IB Cervical Cancer

Treatment of stage IB cervical cancer m= ay include the following:

·        &n= bsp;     A combination of internal radiation therapy and exter= nal radiation therapy.

= ·      =         Radical hysterectomy and removal of lymph nodes. =

= ·      =         Radical hysterectomy and removal of lymph nodes followed by = radiation therapy plus chemotherapy.

= ·      =         Radiation therapy plus chemotherapy.

= ·      =         A clinical trial of high-dose internal radiation therapy combined with external radiation therapy.

Stage IIA Cervical Cancer

Treatment of stage IIA cervical cancer = may include the following:

·        &n= bsp;     A combination of internal radiation therapy and external radiation therapy.

= ·      =         Radical hysterectomy and removal of lymph nodes. =

= ·      =         Radical hysterectomy and removal of lymph nodes followed by = radiation therapy plus       chemotherapy=

= ·      =         Radiation therapy plus chemotherapy.

= ·      =         A clinical trial of high-dose internal radia= tion therapy combined with external radiation therapy. <= /a>

Stage IIB Cervical Cancer

Treatment of stage IIB cervical cancer = may include internal and external radiation therapy combined with chemotherapy.=

Stage III Cervical Cancer

Treatment of stage III cervical cancer = may include internal and external radiation therapy combined with chemotherapy.=

Stage IVA Cervical Cancer

Treatment of stage IVA cervical cancer = may include internal and external radiation therapy combined with chemotherapy.=

Stage IVB Cervical Cancer

Treatment of stage IVB cervical cancer = may include the following:

·        &n= bsp;     Palliative radiation therapy to relieve symptoms caused by t= he cancer and improve quality of life.

= ·      =         Chemotherapy.

= ·      =         Clinical trials of new anticancer drugs or drug combinations= .

By Dr= . Sreeramulu Kotakondla, Co= nsultant Anaesthetist        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                  =             &nb= sp;            =             &nb= sp;   General Hospital/Grenada Cancer Society, Grenada=