Cervical cancer

Cervical cancer is a disease in which the cells of the cervix become abnormaland start to grow uncontrollably, forming tumors. The cervix is the lower part or the neck of the uterus (womb). It connects the uterus to the vagina (birth canal). Cervical cancer generally begins as an abnormality in the cells on the outside of the cervix. It is a very slow growing cancer. The change inthe cells from normal to pre-cancerous to cancerous is very gradual and may take several years to develop. For this reason, routine screening tests for cervical cancer are very important. When detected early, it is nearly 100% curable.

The cause of cervical cancer is not known. However, certain factors are believed to increase one's risk of developing cervical cancer. Engaging in sexualactivity at a young age is one such factor. The cells lining the cervix do not fully mature until the age of 18 and, therefore, are more susceptible to cancer causing-agents and viruses.

More than 90% of women with cancer of the cervix are infected with the humanpapilloma virus (HPV). Hence, HPV infection is the single most important riskfactor for cervical cancer. The HPV belongs to a group of 70 viruses that can cause warts (papillomas). HPV usually causes warts in the genital area. Theviruses are passed from one person to another during unprotected sex. Havingmultiple sexual partners increases one's risk of getting this cancer, because the greater the number of sexual partners, the greater is the risk of acquiring HPV infection. Even if a woman has only one sexual partner, but the manhas several partners, he is considered a "high-risk male" and can transmit HPV to the woman.

Smoking is considered a risk factor, possibly because smoking causes some abnormal changes in the cells and these cells have a higher likelihood of becoming cancerous.

In its early stages, cervical cancer may have no symptoms. Often, the diagnosis is made during a routine pelvic examination. Some women experience symptoms such as bleeding between periods (irregular vaginal bleeding); post-menopausal vaginal bleeding; vaginal bleeding after intercourse; and vaginal discharge with an unpleasant odor. When the cancer is in an advanced stage and has invaded the tissue surrounding the cervix, a woman may have pain in the pelvicarea, and heavy bleeding from the vagina.

A Pap smear is the best screening test used to detect cancer of the cervix. It is done as a part of a regular pelvic exam. A medical swab or brush is rubbed against the cervix. The tissue sample collected is smeared on a slide andsent to the laboratory for microscopic examination. This test detects cervical abnormalities more than 95% of the time. A negative test means that no abnormalities are present. If a Pap test is positive, an abnormality has been detected in the cell lining the cervix.

Because the Pap test is a screening test, rather than a diagnostic test, thedoctor will order a biopsy. The purpose of the biopsy is to check if the abnormality is due to a pre-cancerous change or if cancer is present. During thebiopsy, a piece of cervical tissue is removed and examined under a microscope. A cervical biopsy can be performed in several different ways. In a procedure known as colposcopy, the doctor uses a magnifying scope to view the surfaceof the cervix clearly. If any abnormal areas are seen, the doctor can use apair of biopsy forceps to remove a small piece of the suspicious area for further testing. The tissue is then sent to the laboratory for examination.

Treatment for cervical cancer depends on the stage of the disease and the extent of its spread. The three standard modes of treatment are surgery, radiation therapy, and chemotherapy.

A radical hysterectomy removes the entire uterus, the ovaries, the upper partof the vagina that is next to the cervix, and the lymph nodes from the pelvic region.

Radiation therapy, which involves the use of high energy x rays to kill cancer cells, can also be used for treating cervical cancer. However, radiation therapy to the pelvic region has many effects. It could cause a narrowing of the vagina (vaginal stenosis) that makes intercourse painful. It may also stopthe ovaries from releasing eggs and producing the female hormone estrogen. When this happens, it causes premature menopause in young women and they will need estrogen replacement therapy. Many women are treated with both surgery and radiation therapy.

Chemotherapy, or the use of anticancer drugs to kill the cancer cells, is nota common form of treatment for cervical cancer because it is not as effective as other methods. Nevertheless, the effectiveness of combination chemotherapy, (where more than one drug is used to treat the cancer), is being tested in clinical trials.

The prognosis for cervical cancer is very good. When detected in the early stages, approximately 91% of the women survive 5 years or more.

Most cases of cervical cancers can be prevented, since they start with easilydetectable pre-cancerous changes. One of the best ways to prevent cervical cancers is by having regular Pap tests. If pre-cancerous changes are detected,appropriate treatment can prevent them from developing into invasive cancers. Another way to prevent cervical cancers is to avoid the risk factors. Abstaining from sexual relations when one is very young, and using appropriate precautions (condoms) when engaging in sexual activity will help to avoid HPV infections. Quitting smoking will also help to reduce the risk for cervical andmany other cancers.

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