Carcinoma Of The Cervix Website Links For
Cervical 		 

Information About

Carcinoma Of The Cervix
  CATEGORIES ABOUT CERVICAL CANCER
   
gynecology
   
types of cancer
   
oncology
   
SHOPPER'S DELIGHT
 
Shop For:  
Department
Price Minimum:
Price Maximum:
      



  ICD10 C53
  ICD9


Cervical cancer is a Malignancy of the Cervix . Worldwide, it is the second most common Cancer of women. It may present with Vaginal Bleeding but symptoms may be absent until the cancer is in advanced stages, which has made cervical cancer the focus of intense screening efforts utilizing the Pap Smear . Most scientific studies point to Human Papillomavirus (HPV) infection as a necessary pre-requisite for development of cervical cancer. Treatment is with Surgery (including Cryosurgery ) in early stages and Chemotherapy and Radiotherapy in advanced stages of the disease. An effective vaccine for the two most common strains of HPV has recently been licenced (see below).


SIGNS AND SYMPTOMS

The early stages of cervical cancer may be completely Asymptomatic (Canavan & Doshi, 2000). Vaginal Bleeding , contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. In advanced disease, Metastases may be present in the Abdomen , Lung s or elsewhere.

The possibility to identify premalignant changes on a cervical smear has made Screening the major cause for referral of women with possible cervical neoplasia. In many countries, women are advised to have a regular Pap Smear to check for premalignant changes. {Link without Title} Recommendations for how often a Pap smear should be done vary from once a year to once every five years. If cervical cancer is detected early, it can be treated without impairing fertility. Consistently abnormal smears may be a reason for further diagnosis despite complete absence of symptoms.


DIAGNOSIS

Diagnosis is made by doing a Biopsy of the cervix, which often involves Colposcopy , or a magnified visual inspection of the cervix aided by using an Acetic Acid solution to produce color changes in precancerous or cancerous areas. A Pap Smear is insufficient for the diagnosis. Many researchers recommend that since more than 99% of invasive cervical cancers worldwide contain Human Papillomavirus , HPV testing should be carried out together with routine cervical screening (Walboomers ''et al'', 1999). However, given the prevalence of HPV (around 80% infection history among the sexually active population) others suggest that routine HPV testing would cause undue alarm to carriers.

Further diagnostic procedures are Loop Electrical Excision Procedure (LEEP) and Conisation , in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe dysplasia.


HISTOLOGY

Types of malignant cervical tumors include the following: [http://www.oncolink.upenn.edu/types/article.cfm?c=6&s=17&ss=129&id=8226



STAGING

Cervical cancer is staged by the , and X-ray examination of the lungs and skeleton, and cervical conization.

The TNM staging system for cervical cancer is analogous to the FIGO stage.

Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for most other cancers.

For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage but is not to replace the original clinical stage.

For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used.


PATHOPHYSIOLOGY

The infection, Smoking , HIV infection, Chlamydia infection, dietary factors, Oral Contraceptive s, multiple Pregnancies , low socioeconomic status, use of the hormonal drug Diethylstilbestrol (DES) and a Family History of cervical cancer.

The presence of strains 16, 18 and 31 of Human Papillomavirus (HPV) is the prime Risk Factor for cervical cancer, and Walboomers ''et al.'' (1999) reported that the presence of HPV is a necessary condition for the development of cervical cancer. A Virus Cancer Link with HPV has been found to trigger alterations in the cells of the cervix, leading to the development of Cervical Intraepithelial Neoplasia and cancer. The ''E6'' gene introduced by the virus inhibits the P53 gene, the central cellular switch for Apoptosis (the process by which damaged cells kill themselves). The Mitosis rate accelerates, and the cell accumulates more DNA damage that makes it capable of invading other tissues.

Genital Warts are caused by different HPV types, and are not related to cervical cancer.

The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a Sexually Transmitted Disease . Not all women infected with HPV also develop cervical cancer (Snijders ''et al'', 2006). Use of Condom s will not always prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas. HPV is thought to grow preferentially in the Epithelium of the Glans Penis , and scrupulous Washing and Cleaning of this area may be preventative. The position on Circumcision is controversial: some researchers argue that routine neonatal circumcision is an acceptable way of preventing various diseases (which include cervical carcinoma); others maintain that the benefits do not outweigh the risks.


TREATMENT

Microinvasive cancer (stage IA) is usually treated by Hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to maintain fertility is a local surgical procedure such as a LEEP or Cone Biopsy {Link without Title} .

If a cone biopsy was not able to produce , with biopies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrance in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.

Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or Radiation Therapy . Radiation therapy is given as external beam radiotherapy to the pelvis and Brachytherapy (internal radiation). For patients treated with surgery who have high risk features found on pathologic examination, radiation therapy with or without chemotherapy is given in order to reduce the risk of relapse.

Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and Cisplatin -based chemotherapy, hysterectomy (which then usually requires Adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy.

Advanced stage tumors (IIB-IVA) are treated with radiation therapy and Cisplatin -based chemotherapy.


EPIDEMIOLOGY

Worldwide, cervical cancer is the second most common cancer in women (after Breast Cancer ) and is the third leading killer (behind breast and Lung Cancer ). It affects about 16 per 100,000 women per year and causes death in about 9 per 100,000 per year.

In the United States , however, cervical cancer is only the 8th most common cancer of women. About 12,800 women in the United States are diagnosed with cervical cancer and about 4,800 die each year (Canavan & Doshi, 2000). Among gynecological cancers it ranks behind Endometrial Cancer and Ovarian Cancer . The incidence and mortality figure for the U.S. are about half that of the rest of the world, a difference which can be attributed in part to the success of screening with the Pap Smear . {Link without Title}

In Great Britain the incidence of cervical cancer has reached alarming proportions in that the mortality in England and Wales in women younger than 35 years rose three-fold from 1967 to 1987. In a study published in 2004 (Peto J ''et al'') scientists from the London School Of Hygiene And Tropical Medicine found that had it not been for effective cervical screening, one in 65 of all British women born since 1950 would have died from cancer of the cervix.

A study published in 2002 (Castellsagué ''et al'') reports that male circumcision can reduce the risk of penile human papillomavirus (HPV) infection in the man, and as a result that of cervical cancer in his female partner. The authors do state that "it would not make sense to promote circumcision as a way to control cervical cancer in the United States, where Pap smears usually detect it at a treatable stage". In contrast to this claim, Menczer (2004) quotes research that male circumcision probably does not contribute to a lower incidence of cervical cancer in Jewish populations.


HISTORY

Epidemiologists working in the early 20th century noted that:
#Cervical cancer was common in female Sex Worker s.
#It was rare in Nun s, except for those who had been sexually active before entering the convent.
#It was more common in the second wives of men whose first wives had died from cervical cancer.
#It was rare in Jewish women. {Link without Title}

This led to the deduction that cervical cancer could be caused by a sexually transmitted agent. Initial research in the 1950s and 1960s put the blame on Smegma (e.g. Heins ''et al'' 1958), but it wasn't until the 1970s that Human Papillomavirus (HPV) was identified. It has since been demonstrated that HPV is implicated in all cervical cancers. Specific viral subtypes implicated are HPV 16, 18 and 33.


VACCINE

See Also: HPV vaccine



Merck & Co. has developed a vaccine against four strains of HPV called Gardasil™.

A bi-valent vaccine to prevent HPV infection has been also developed by Israel and tested (Harper ''et al'' 2004). It confers immunity against the two (thus, bi-valent) HPV strains 16 & 18. This vaccine, when it is licenced and goes into production, could substantially reduce the incidence of HPV infection, the incidence of cervical cancer, and mortality (Lehtinen & Dillner 2002).

.


EXTERNAL LINKS



REFERENCES