Wart Treatments

Cervical cancer develops progressively. Before the actual cancer appears, the cervical cells mutate (a process called dysplasia) and turn into abnormal cells belonging to the cervical tissue. Later on, neoplastic cells multiply and spread throughout the cervical colon until they reach neighbouring organs.

Infection with the HPV virus is the most frequent cause of cervical cancer.

There are no symptoms for this type of cancer, but it can be diagnosed by means of annual testing. Early cancer may not present any symptoms or visible signs. Women should check in with their doctor annually, and have the Papanicolaou test (Pap test) carried out, in order to check if there are any modified cells within the cervix.

Risk factors for cervical cancer

The most important risk factor for cervical cancer is HPV-virus infection. HPV stands for "Human Papiloma Virus). However, not all women with HPV virus develop cervical cancer.

Other possible risk factors:

An increased number of pregnancies; Multiple sexual partners; First sexual contact at a very young age; Smoking; Oral contraceptives; Weak natural immunity. Symptoms for cervical cancer

There are no symptoms that announce cervical cancer. Nonetheless, cancer may be diagnosed by means of annual testing. Cancer, in its earliest development, may not present any relevant signs of its presence at all.

Women should take the Pap test early in order to see if there are any modified cells within their cervix. The chances of recovery are better when the cancer is diagnosed at an early stage.

Possible cancer clues include vaginal bleeding and pain. It is recommended you see the doctor if the following symptoms are present:

Vaginal bleeding; Unusual vaginal discharges; Pelvic pain; Pain during sex (also referred to as dyspareunia). Investigations in cervical cancer

Tests for cervix examination are used to detect and diagnose cervical cancer. The following investigations are usual and recommended:

The Papanicolau test (or "Pap test")

This test consists of harvesting cell samples from the cervical colon and from the vagina. A small piece of cotton, wood of brush is used when gently harvesting the cells (this does not hurt at all). The cells are, afterwards, studied at a microscope to see if they are modified.

Colposcopy

This is the method through which the doctor may take a look inside the vagina and the cervix in order to spot modified areas. The colposcope (a thin tube with a light-bulb at its tip) is introduced into the cervix through the vagina. This method is also used in order to harvest some tissue samples for biopsy.

Biopsy

If, during the Pap test, modified cells are fond, the doctor will also conduct a biopsy. A small tissue sample is harvested from the cervix and studied at the microscope for signs of cancer.

Pelvic objective examination

This consists of an examination of the vagina, the cervix, the uterus, the Fallopian tubes and the rectum. Two lubricated fingers inside a medical glove are introduced into the vagina and the other hand is placed on the patient's lower abdominal area in order to feel the size, shape and position of the uterus and the ovaries. A speculum is used to analyse the aspect of the vagina and the cervix.

Endocervical curettage

This is a method used for harvesting tissue or cell samples from the cervical area with the help of a scoop (a medical instrument shaped like a spoon).

Chances of recovery from cervical cancer

There is a number of factors that affect the chances of recovery and the treatment option.

The chances of recovery depend on:

The stage in which the cancer is. Specifically, if it only affects a part of the cervical colon or has already invaded the whole cervix and spread to the lymph nodes or other parts of the body; The type of cervical cancer (see below); The size of the tumor.

The treatment opted for depends on:

The stage in which the cancer is; The size of the tumor; Whether the patient wants to have children or not; Patient's age. Stages of cervical cancer

After the cancer is diagnosed, research is carried out in order to find out if cancer cells have spread throughout the cervix or other parts of the body. The method by means of which cell invasion is studied is called cancer staging. Information retrieved through the process of staging determines the stage of the cancer. Stage is, in its turn, essential for opting for the best type of treatment. The following investigations may be used during the process of staging:

Chest radiography. This X-Rays the organs and bones of the chest. A radiography is obtained by exposing the chest to X-rays that pass through the body and project themselves on a film, resulting in a "photo" of the anatomical regions of interest; Computer tomography. This is an investigation by means of which detailed photos of the anatomical regions of interest are taken, from different angles. The photographs are taken by a computer connected to the X-Ray machine. Contrast substance may be used, in which case it is injected in veins or swallowed, so that it may afterwards stress out the image; Lymphangiography is an investigation method for the lymphatic system. A contrast substance is injected into the lymphatic vessels in your legs. The contrast substance moves upwards through the lymph nodes and radiographies are taken to spot any obstructions. This investigation helps detect tumor invasions within the lymphatic area;Surgical pre-therapeutic staging consists of an investigation of the area to see if tumor cells have extended within the cervix or other parts of the body. In some cases, cervical cancer may be excised in the same time; Echography is the ultra-sonic examination through which ultra-sounds reflect or change their direction when they meet tissues or organs, producing echoes. Echoes afterwards produce an image of the tissues, called sonogram; NMR (Magnetic Nuclear Resonance) is a method in which a magnet, some magnetic waves and a computer are used in order to take a series of detailed photos of the body.

These results are analysed and concurred with those from the biopsy in order to determine one of the following stages of cervical cancer.

Stages of cervical cancer

Cervical cancer has the following stages of development:

Stage 0 (zero). The tumor cells are located only in the first layer of the cervix cells and has not, thus, invaded profound layers.

Stage I. The cancer is limited to the cervix. Based on the quantity of the tumor tissue, this stage is divided into stage IA and stage IB:

Stage IA: the tumor tissue found in the cervix may only be observable through the microscope. The cancer does not go below 5mm in tissue depth and does not spread more than 7mm in width; Stage IB: cancer is observable only through the microscope and goes deeper into the tissue than 5mm and wider than 7mm. Also, there are cases where cancer may be observed without the microscoper and may be spread over 4 cm, but still within the limits of the cervix.

Stage II. The cancer has spread beyond the cervix, but still not beyond the pelvic wall. Stage II is also divided into A and B, based upon the incisiveness of the cancer:

Stage IIA: the cancer spreads beyond the cervix up until the superior 2/3 area of the vagina, but still it is not present within the tissues around the uterus;Stage IIB: the cancer spreads beyond the cervix up until the superior 2/3 area of the vagina and within the tissues around the uterus.

Stage III. The cancer invades the inferior part of the vagina and may also invade the pelvic wall, alongside its neighbouring lymph nodes. This stage is also divided into A and B, according to how much tumor cells have spread:

Stage IIIA: the cancer invades the lower part of the vagina, but not the pelvic wall;Stage IIIB: cancer cells have spread within the pelvic wall and / or they have spread so much that the ureters (the channels that connect the kidneys and the bladder) are blocked. These "jams" lead to swells in kidneys and, eventually, to their failure. Cancer cells may also invade the lymph nodes from the pelvis.

Stage IV. In this stage, the cancer affects the bladder, the rectum or any other separate organ from the body. Stage IV is divided into stages IVA and IVB, according to the localisation of the tumor cells:

Stage IVA: the cancer has spread to the bladder or to the rectal wall, or to the lymph nodes from the pelvis; Stage IVB: the cancer has spread beyond the pelvis and the pelvic lymph nodes, to other parts of the body, e.g. the abdomen, liver, intestines or lungs.

Recurrent cervical cancer. This nomenclature is used for cervical cancer which appears once more after it has been treated. Cervical cancer may once again appear within the cervix, or other areas of the body.

Treatment of cervical cancer

There are multiple treatment options for women with cervical cancer. Some of these are standard (used frequently), and others are tested in clinical studies. Before beginning a treatment, women may consider the possibility of participating within a clinical trial. A treatment that is included in a clinical trial is a research study that strives to better standard treatments or to obtain new information on new treatments that concern cancer therapy. When a clinical trial proves that a new treatment is better than a standard one, that new treatment may, in its turn, become standard.

Choosing the most adequate treatment for cancer is a decision that usually implies patients, family and doctors. There are three standard treatments:

Surgery in cervical cancer

Surgery is sometimes curative. The following surgical procedures are practiced:

Conization is a method by means of which a conical part of the tissue is removed from the cervix and the cervical colon. Doctors analyse the tissue with the help of a microscope and afterwards choose the best type of treatment, or the best diagnosis. This method is also called conical biopsy; Total hysterectomy is a method by means of which the uterus and the cervix are removed surgically. If the uterus and the cervix are removed through the vagina, the method is called vaginal hysterectomy. Other types of hysterectomies are: abdominal hysterectomy and Laparoscopic hysterectomy;Bilateral salpingo-oophorectomy is a surgical method used for the ablation of both ovaries, as well as of the Fallopian tubes; Radical hysterectomy does the same thing as the total hysterectomy, but also additionally removes part of the vagina. The ovaries and the Fallopian tromps, as well as the neighbouring lymph nodes, may also be removed during this procedure; Pelvic exenteration is a method through which the lower colon, the rectum and the bladder are removed. At women, the cervix, vagina, ovaries and lymph nodes are also removed. Artificial openings are created in order to eliminate urine and fecal matter. Plastic surgery is necessary in order to rebuild a new vagina after the operation; Cryosurgery is a treatment that uses a special machine for cryogenics and destruction of abnormal tissue. This is also called cryotherapy; Laser vaporization is a method in which laser beams are used similar to a knife in order to cut out cancer tissue. Laser is better than a knife because it cuts without provoking bleedings.

Radiotherapy in cervical cancer

Radiotherapy is a cancer treatment that uses X-rays of very high energy, or other types of rays, in order to destroy cancer tumors. There are two types of radiotherapy. External radiotherapy uses a machine that sends radiation towards the cancer, while internal radiotherapy uses a radioactive substance contained in needles, seds and wires that are placed directly into or near the cancer. The irradiation method depends on the type and the stage of the cancer to be treated.

Chemotherapy in cervical cancer

Chemotherapy is a treatment of cancer that uses pharmaceutic substances in order to stop the growth or division of cancer cells. When chemotherapy is conducted orally or through injection in veins/muscles, the substances enter the bloodstream and reach malignant cells from the organism. This is called systematic chemotherapy. Another way to conduct chemotherapy is straight into the spinal cord, into an organ or a cavity (such as the abdomen). This is called regional chemotherapy.

Treatment options according to cancer stage

Stage 0 (zero). Treatment includes:

Laser surgery; Conization; Cryosurgery; Total hysterectomy for women that cannot have children or do not wish to have future children; Internal radiotherapy for women that cannot be submitted to surgery.

Stage IA. Treatment includes:

Total hysterectomy with or without bilateral salpingo-oophorectomy; Conization; Radical hysterectomy and the removal of lymph nodes; Internal radiotherapy.

Stage IB. Treatment includes:

A combination between internal and external radiotherapy; Radical hysterectomy and the removal of lymph nodes, followed by radiotherapy and chemotherapy;

Stage IIA. Treatment includes:

A combination between internal and external radiotherapy; Radical hysterectomy and resection of lymph nodes; Radiotherapy and chemotherapy

Stage IIB, III and IVA. Treatment may include internal and external radiotherapy, combined with chemotherapy.

Stage IVB. Treatment includes:

Palliative radiotherapy; Chemotherapy.

Treatment for recurrent cancer includes the following:

Pelvic exenteration; Radiotherapy, combined with chemotherapy, as a palliative treatment.

During pregnancy, treatment of cervical cancer depends on the stage of the cancer and the age of the fetus. In late pregnancies, treatment may be delayed until after the birth of the baby.

 

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