Cervical cancer is a cancer that arises from the cervix. This is due to the growth of abnormal cells that have the ability to attack or spread to other parts of the body. Initially, usually no symptoms are seen. Further symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.
Human papillomavirus (HPV) infections account for more than 90% of cases; most people who have HPV infection, however, do not develop cervical cancer. Other risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having multiple sexual partners, but this is less important. Cervical cancer usually develops from precancerous changes for 10 to 20 years. Approximately 90% of cases of cervical cancer are squamous cell carcinoma, 10% are adenocarcinomas, and a small number are other types. Diagnosis is usually with cervical screening followed by biopsy. Medical imaging was then performed to determine whether the cancer had spread.
The HPV vaccine protects against two to seven high-risk strains of this viral group and can prevent up to 90% of cervical cancers. Because the risk of cancer still exists, the guidelines recommend that Pap tests continue regularly. Other preventive methods include: having few or no sexual partners and condom use. Cervical cancer screening using Pap tests or acetic acid can identify precancerous changes that, when treated, can prevent cancer progression. Cervical cancer treatment can consist of several combinations of surgery, chemotherapy, and radiation therapy. The five-year survival rate in the United States is 68%. The results, however, are highly dependent on how early the cancer is detected.
Worldwide, cervical cancer is the fourth most common cause of cancer and the fourth most common cause of death from cancer in women. In 2012, an estimated 528,000 cases of cervical cancer occur, with 266,000 deaths. This is about 8% of the total cases and total deaths from cancer. About 70% of cervical cancers occur in developing countries. In low-income countries, it is the most common cause of cancer deaths. In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer. In medical research, the most famous cell line that is immortalized, known as HeLa, is developed from cervical cancer cells from a woman named Henrietta Lacks.
Video Cervical cancer
Signs and symptoms
The early stages of cervical cancer may be completely symptom free. Vaginal bleeding, bleeding contact (one of the most common forms of bleeding after sexual intercourse), or (rarely) vaginal masses may indicate malignancy. Also, moderate pain during intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastasis can be found in the stomach, lungs, or elsewhere.
Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, foot pain, swelling legs, heavy vaginal bleeding, fractures, and (rarely) urine leak or feces from the vagina. Bleeding after douching or after pelvic examination is a common symptom of cervical cancer.
Maps Cervical cancer
Cause
Infections with some HPV types are the biggest risk factors for cervical cancer, followed by smoking. HIV infection is also a risk factor. Not all causes of cervical cancer are known, however, and some contributing factors have been involved.
Human papillomavirus
Human papillomavirus types 16 and 18 are the cause of 75% of cases of cervical cancer globally, while 31 and 45 are other causes 10%.
Women who have sex with men who have many other sexual partners or women who have multiple sexual partners are at greater risk.
Of the 150-200 known HPV types, 15 are classified as high risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82), three as high risk probability (26, 53, and 66), and 12 as low risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108).
Genital warts, which form benign tumors of epithelial cells, are also caused by various types of HPV. However, this serotype is usually not associated with cervical cancer. It is common to have multiple strains at the same time, including those that can cause cervical cancer along with those that cause warts.
Infections with HPV are generally believed to be necessary for cervical cancer.
Smoking
Cigarette smoking, both active and passive, increases the risk of cervical cancer. Among women infected with HPV, current and former smokers have about two to three times the incidence of invasive cancer. Passive smoking is also associated with increased risk, but to a lesser extent.
Smoking is also associated with the development of cervical cancer. Smoking can increase risk in women in several different ways, which can be by direct and indirect method of inducing cervical cancer. How to get infected with this cancer is a smoker has a higher possibility occurred CIN3 which has the potential to form cervical cancer. When CIN3 lesions cause cancer, most of them have help from the HPV virus, but that's not always the case, which is why it can be regarded as a direct link to cervical cancer. Severe smoking and long-term smoking seem to be more at risk of getting CIN3 injuries than mild smoking or no smoking at all. Although smoking has been linked to cervical cancer, it helps in the development of HPV which is a major cause of this type of cancer. Also, it not only helps in the development of HPV, but also if the woman is already positive for HPV, she is more likely to develop cervical cancer.
Oral contraceptives
Long-term use of oral contraceptives is associated with an increased risk of cervical cancer. Women who have used oral contraceptives for 5 to 9 years have about three times the incidence of invasive cancer, and those who use it for 10 years or more have about four times the risk.
Double pregnancy
Having multiple pregnancies is associated with an increased risk of cervical cancer. Among women infected with HPV, those who have had seven or more long-term pregnancies have about four times the risk of cancer compared to women without pregnancy, and two to three times the risk of women who have one or two full term. pregnancy.
Diagnosis
Biopsy
Pap tests can be used as screening tests, but produce false negatives in up to 50% of cases of cervical cancer. Confirmation of cervical or precancerous cancer diagnosis requires cervical biopsy. This is often done through colposcopy, an enlarged visual examination of the cervix is ​​aided by the use of dilute acetic acid solution (eg vinegar) to highlight abnormal cells on the surface of the cervix. Medical devices used for cervical biopsy include blow punch, SpiraBrush CX, SoftBiopsy, or Soft-ECC.
The impression of colposcopy, the estimated severity of the disease based on visual examination, is part of the diagnosis.
Further diagnostic and treatment procedures are electrical loop removal procedures and cervical conization, in which the inner lining of the cervix is ​​removed for pathologic examination. This is done if the biopsy confirms severe cervical intraepithelial neoplasia.
Often before a biopsy, doctors ask for medical imaging to rule out other causes of female symptoms. Imaging modalities such as ultrasound, CT scan and MRI have been used to look for alternative diseases, tumor spread and effects on adjacent structures. Usually, they appear as heterogeneous masses in the cervix.
Precancerous lesions
Cervical intraepithelial neoplasia, a potential precursor to cervical cancer, is often diagnosed on cervical biopsy examination by pathologists. For premalignant dysplastic changes, a cervical intraepithelial grading of grading is used.
The classification of naming and histology of precursor lesions of cervical carcinoma has changed many times over the 20th century. The World Health Organization classification system is a description of the lesion, naming them mild, moderate, or severe dysplasia or in situ carcinoma (CIS). The term, cervical intraepithelial neoplasia (CIN) was developed to place emphasis on the spectrum of abnormalities in these lesions, and to help standardize treatment. It classifies mild dysplasia as CIN1, moderate dysplasia such as CIN2, and severe dysplasia and CIS as CIN3. Recently, CIN2 and CIN3 have been combined into CIN2/3. These results are what pathologists may report from a biopsy.
This should not be confused with the Bethesda system terms for Pap test results (cytopathology). Among the results of Bethesda: Low Class Gastric Intraepitharal Lesions (LSIL) and High-grade Squamous Intraepithelial Lesions (HSIL). A Pap LSIL may be compatible with CIN1, and HSIL may correspond to CIN2 and CIN3; however, they are the result of different tests, and Pap test results do not necessarily correspond to histologic findings.
Cancer subtype
Histologic subtypes of invasive cervical carcinoma include the following: Although squamous cell carcinoma is the most common cervical cancer, the incidence of cervical adenocarcinoma has increased in recent decades.
- squamous cell carcinoma (about 80-85%)
- adenocarcinoma (about 15% of cervical cancers in the UK)
- adenosquamous carcinoma
- small cell carcinoma
- neuroendocrine tumor
- glass cell carcinoma
- adenocarcinoma villoglandular
Malignancies of rare non-carcinoma may occur in the cervix including melanoma and lymphoma. The FIGO stage does not combine lymph node involvement in contrast to TNM staging for most other cancers.
For cases treated surgically, information obtained from a pathologist may be used in establishing a separate pathologic stage, but not to replace the original clinical stage.
Staging
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. This allows only diagnostic tests to be used in determining stages: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization.
Prevention
Screening
Examining the cervix with a Papanicolaou test, or a Pap test, for cervical cancer has been credited with dramatically reducing the number of cases and deaths from cervical cancer in developed countries. A Pap test examination every three to five years with proper follow-up can reduce the incidence of cervical cancer by up to 80%. Abnormal results may indicate precancerous changes, allowing for examination and possible preventive treatment. Treatment of low-grade lesions may affect fertility and subsequent pregnancies. Personal invitations that encourage women to be screened are effective to increase their chances of doing so. Educational materials also help increase the likelihood that women will go for screening, but they are not as effective as invitations.
According to European guidelines 2010, the age at which to start screening ranges between 20 and 30 years, but is special before the age of 25 or 30 years, and depends on the burden of disease in the population and available resources.
In the United States, screening is recommended to begin at age 21, regardless of the age at which a woman begins to have sex or other risk factors. Pap tests should be performed every three years between the ages of 21 and 65. In women over age 65, screening may be discontinued if no abnormal screening results are seen in the previous 10 years and no history of CIN 2 or higher. The HPV vaccination status does not change the screening rate. Screening can occur every 5 years between the ages of 30 and 65 when a combination of cervical cytology screening and HPV testing is used and this is preferred. However, it is acceptable to screen this age group with Pap tests every three years. Screening is not useful before the age of 25 because of low illness. Screening is not useful in women older than 60 if they have a negative outcome history. The American Society of Clinical Oncology (ASCO) guidelines have recommended various levels of resource availability.
Liquid-based cytology is another potential screening method. Although it may be intended to improve the accuracy of the Pap test, the main advantage is reducing the amount of inadequate stain from about 9% to about 1%. This reduces the need to remember women for further examination. The US Preventive Services Task Force supports screening every 5 years among those aged between 30 and 65 years when cytology is used in combination with HPV testing.
Pap tests have not been effective in developing countries. This is partly because many of these countries have poor health-care infrastructure, too few skilled and skilled professionals to obtain and interpret Pap tests, women who are not getting lost information, and long turn-around times to get results. This fact has resulted in an investigation of cervical screening approaches that use fewer resources and offer quick results such as visual inspection with acetic acid or HPV DNA testing.
Barrier protection
Protective barrier and/or use of spermicide gel during intercourse decreases cancer risk. Condoms offer protection against cervical cancer. Evidence of whether condoms protect against HPV infection is mixed, but they can protect against genital warts and cervical cancer precursors. They also provide protection against other STDs, such as HIV and Chlamydia , which are associated with a greater risk of cervical cancer.
Condoms can also be useful in treating potential precancerous changes in the cervix. Sperm exposure appears to increase the risk of precancerous changes (CIN 3), and the use of condoms helps cause these changes to back off and helps clear HPV. One study showed that prostaglandin in semen can trigger the growth of cervical and uterine tumors and that affected women may benefit from condom use.
Abstinence also prevents HPV infection.
Vaccinations
Two HPV vaccines (Gardasil and Cervarix) reduced the risk of cervical or perineal changes in cervical and pericaral cancer by about 93% and 62%, respectively. Vaccines between 92% and 100% effective against HPV 16 and 18 for at least 8 years.
The HPV vaccine is usually given at the age of 9 to 26, because the vaccine is only effective if administered before infection occurs. Vaccines have proven to be effective for at least four to six years, and they are believed to be effective for longer; However, the duration of effectiveness and whether the booster will be needed is unknown. The high cost of this vaccine has been a concern. Some countries have considered (or are considering) a program to fund HPV vaccination.
Since 2010, young women in Japan have been eligible to receive cervical cancer vaccination for free. In June 2013, Japan's Ministry of Health, Labor, and Welfare mandated that, prior to vaccinations, medical institutions should notify women that the Ministry does not recommend it. However, the vaccine is still available at no cost to Japanese women who choose to receive vaccinations.
Nutrition
Vitamin A is associated with lower risks such as vitamin B12, vitamin C, vitamin E, and beta-carotene.
Treatment
The treatment of cervical cancer varies worldwide, largely due to access to skilled surgeons in radical pelvic surgery, and the emergence of fertility therapy-saving in developed countries. Because cervical cancer is radiosensitive, radiation can be used at all stages where surgical options are absent. Surgical intervention may have a better outcome than the radiological approach. In addition, chemotherapy can be used to treat cervical cancer, and has been found to be more effective than radiation alone.
Microinvasive cancer (stage IA) can be treated with hysterectomy (removal of the entire uterus including part of the vagina). For stage IA2, the lymph nodes are also removed. Other alternatives include local surgical procedures such as a loop electrical discharge procedure or a cone biopsy.
If conical biopsy does not produce clear margins (biopsy findings suggest that the tumor is surrounded by cancer-free tissue, showing all tumors removed), one possible treatment option for women who want to maintain their fertility is trachelectomy. This effort to surgically remove cancer while preserving the ovaries and uterus, provides a more conservative operation than hysterectomy. This is a viable option for those in stage I of cervical cancer who have not spread; However, this has not been considered a standard of care, as few doctors are skilled in this procedure. Even the most experienced surgeons can not promise that a trachelectomy can be performed until after microscopic surgical examination, as far as the spread of cancer is unknown. If the surgeon can not microscopically confirm clear cervical tissue margins after the woman is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the woman has given prior approval. Because of the potential risk of cancer spread to lymph nodes in stage 1b cancer and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathological evaluation.
Radical trachelectomy can be done abdomen or vagina and contrary to what is better. Radical abdominal trachelectomy with lymphadenectomy usually takes only two to three days of hospitalization, and most women recover quickly (about six weeks). Complications are rare, although women who are able to conceive after surgery are prone to preterm labor and the possibility of further miscarriage. A minimum of one year waiting is generally recommended before attempting to conceive after surgery. Recurrence in the left cervix is ​​very rare if the cancer has been cleansed with trachelectomy. However, women are advised to take follow-up measures including Pap testing/colposcopy, with biopsy of the required lower uterine segment (every 3-4 months for at least 5 years) to monitor any recurrence other than minimizing any new exposure to HPV through practice sex is safe until someone is actively trying to conceive.
Initial stages (IB1 and IIA less than 4 cm) may be treated with a radical hysterectomy by removal of lymph nodes or radiation therapy. Radiation therapy is given as external radiant radiotherapy to the pelvis and brachytherapy (internal radiation). Women treated with surgery that have high-risk features found in pathological examinations are given radiation therapy with or without chemotherapy to reduce the risk of relapse.
Larger early stage tumors (IB2 and IIA over 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy. When cisplatin is present, it is considered to be the single most active agent in periodic disease. The addition of platinum-based chemotherapy to chemoradiation appears not only to improve survival but also reduce the risk of recurrence in women with early-stage cervical cancer (IA2-IIA).
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin, for women with end-stage cervical cancer treatment (IVB). Combination treatments have significant risks to neutropenia, anemia, and side effects of thrombocytopenia.
For surgery to be curative, all cancers should be removed without cancer found on the edge of tissue that is removed on examination under a microscope. This procedure is known as the eksentasi.
Prognosis
Stage
The prognosis depends on the stage of the cancer. The survival rate opportunity is almost 100% for women with microscopic forms of cervical cancer. With treatment, the relative five-year survival rate for the early stages of invasive cervical cancer was 92%, and the overall five-year survival rate (all stages combined) was about 72%. These statistics may be increased when applied to newly diagnosed women, keeping in mind that these results may be based in part on the state of treatment five years ago when the woman studied was first diagnosed.
With treatment, 80-90% of women with stage I and 60-75% of those with stage II cancer are alive 5 years after diagnosis. Survival rates decreased to 30-40% for women with stage III cancer and 15% or less of those with stage IV cancer five years after diagnosis. Recurrent cervical cancer detected at the earliest stage may be successfully treated with surgery, radiation, chemotherapy, or a combination of all three. Approximately 35% of women with invasive cervical cancer have persistent or recurrent disease after treatment.
By country
The five-year survival in the United States for white women is 69% and for black women is 57%.
Regular screening means that precancerous changes and early-stage cervical cancer have been detected and treated early on. Figures show that cervical screening saves 5,000 lives each year in the UK by preventing cervical cancer. About 1,000 women per year die of cervical cancer in the UK. All Nordic countries have cervical cancer screening programs in place. The Pap test was integrated into clinical practice in the Nordic countries in the 1960s.
In Africa, outcomes are often worse because the diagnosis is often in the late stages of the disease.
Epidemiology
Worldwide, cervical cancer is the fourth most common cause of cancer and cancer deaths in women. In 2012, 528,000 cases of cervical cancer are thought to have occurred, with 266,000 deaths. This is the second most common cause of cancer-specific women after breast cancer, accounting for about 8% of all cases of cancer and total cancer deaths in women. About 80% of cervical cancers occur in developing countries. This is the most commonly detected cancer during pregnancy, with an incidence of 1.5 to 12 for every 100,000 pregnancies.
Australia
Australia has 734 cases of cervical cancer (2005). The number of women diagnosed with cervical cancer has dropped by an average of 4.5% every year since the organized screening began in 1991 (1991-2005). A regular Pap test twice a year can reduce the incidence of cervical cancer by up to 90% in Australia, and rescue 1,200 Australian women from deaths from the disease each year.
Canada
In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380 will die.
India
In India, the number of people with cervical cancer increases, but overall the adjusted age level decreases. The use of condoms in the female population has increased the survival of women with cervical cancer.
European Union
In the European Union, about 34,000 new cases per year and more than 16,000 deaths from cervical cancer occurred in 2004.
United Kingdom
Cervical cancer is the 12th most common cancer in women in the UK (about 3,100 women diagnosed with the disease in 2011), and accounts for 1% of cancer deaths (about 920 die by 2012). With a 42% reduction from 1988-1997, NHS screening programs have been very successful, screening the highest risk age group (25-49 years) every 3 years, and those aged 50-64 every 5 years.
United States
An estimated 12,900 new cervical cancers and 4,100 cervical cancer deaths will occur in the United States by 2015. In the United States, it is the eighth most common female cancer. The median age at diagnosis was 48. Hispanic women were significantly more likely to be diagnosed with cervical cancer than the general population. In 1998, approximately 12,800 women were diagnosed in the US and about 4,800 people died. By 2014, an estimated 12,360 new cases are expected to be diagnosed, and about 4,020 are thought to die of cervical cancer. Among the cancers in the female reproductive tract it is less common than endometrial cancer and ovarian cancer. The rate of new cases in the United States was 7 per 100,000 women in 2004. The death of cervical cancer decreased by about 74% in the last 50 years, largely due to extensive Pap screening. The annual direct medical costs of cervical cancer prevention and treatment before the introduction of the HPV vaccine are estimated at $ 6 billion.
History
- 400 BC - Hippocrates notes that cervical cancer can not be cured
- 1925 - Hinselmann finds the colposcope
- 1928 - Papanicolaou develops Papanicolaou technique
- 1941 - Papanicolaou and Traut: Filtering Pap tests begin
- 1946 - The Aylesbury Spatula was developed to erode the cervix, collect samples for the Pap test
- 1951 - The first successful in-vitro cell, HeLa, comes from a biopsy of cervical cancer Henrietta Disadvantages
- 1976Ã, - Harald zur Hausen and Gisam discovered HPV DNA in cervical and genital warts; Hausen then won the Nobel Prize for his work
- 1988 - Bethesda system for reporting Pap results developed
- 2006 - The first HPV vaccine is approved by the FDA
Epidemiologists who worked at the beginning of the 20th century noted that cervical cancer behaves like a sexually transmitted disease. Conclusion:
- Cervical cancer is common in female sex workers.
- Very rarely in nuns, except for those who are sexually active before entering a monastery. (Rigoni in 1841)
- It is more common in the wives of both men whose first wife died of cervical cancer.
- That rarely happens to Jewish women.
- In 1935, Syverton and Berry found an association between RPV (Rabbit Papillomavirus) and skin cancer in rabbits. (HPV is species-specific and therefore can not be transmitted to rabbits)
This historical observation shows that cervical cancer can be caused by sexually transmitted agents. Initial studies in the 1940s and 1950s linked cervical cancer with smegma (eg Heins et al. 1958). During the 1960s and 1970s it was suspected that infection with the herpes simplex virus was the cause of the disease. In short, HSV is seen as a possible cause as it is known to survive in the female reproductive tract, to be sexually transmitted in ways that are compatible with known risk factors, such as promiscuity and low socioeconomic status. Herpes virus is also involved in other malignant diseases, including Burkitt's lymphoma, nasopharyngeal carcinoma, Marek's disease and Lucken's renal adenocarcinoma. HSV recovers from cervical tumor cells.
Description of human papillomavirus (HPV) with an electron microscope was given in 1949, and HPV-DNA was identified in 1963. It was not until the 1980s that HPV was identified in cervical cancer tissue. It has since been shown that HPV is involved in almost all cervical cancers. The specific virus subtypes involved were HPV 16, 18, 31, 45 and others.
In work beginning in the mid-1980s, HPV vaccine was developed, in parallel, by researchers at Georgetown University Medical Center, the University of Rochester, the University of Queensland in Australia, and the National Cancer Institute. In 2006, the US Food and Drug Administration (FDA) approved the first HPV prevention vaccine, marketed by Merck & amp; Co under the trade name Gardasil.
Society and culture
Australia
In Australia, Aboriginal women are more than five times more likely to die of cervical cancer than non-Aboriginal women, suggesting that Aboriginal women tend to have regular Pap tests. There are several factors that may restrict indigenous women from engaging in routine cervical screening practices, including sensitivity in discussing topics in Aboriginal communities, embarrassment, anxiety and fears about procedures. Difficulties in accessing screening services (eg, transport difficulties) and lack of female physicians, skilled Pap test providers and trained women Aboriginal Health Workers are also a problem.
The Australian Cervical Cancer Foundation (ACCF), established in 2008, promotes 'women's health by eliminating cervical cancer and enables treatment for women with cervical cancer and related health problems, in Australia and in developing countries'. Ian Frazer, one of the developers of cervical cancer vaccine Gardasil, is a scientific advisor to ACCF. Janette Howard, the wife of former Australian Prime Minister John Howard, was diagnosed with cervical cancer in 1996, and first spoke of her battle with the disease in 2006.
United States
A 2007 survey of American women found that 40% had heard of HPV infection and less than half of them knew it caused cervical cancer. During a longitudinal study from 1975 to 2000, it was found that people from lower socioeconomic brackets had higher rates of late-stage cancer diagnoses and higher morbidity rates. After controlling the stage, there is still a difference in the survival rate.
References
Further reading
External links
- Cervical cancer in Curlie (based on DMOZ)
Source of the article : Wikipedia
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