Catcinoma Cervix / Cervix Cancer

The cervix is the smooth organ that forms the entrance to a woman’s uterus. Cancer of the cervix has no symptoms. That’s why the only way to detect it is through a Pap smear, a standard life-saving screen that is performed as part of a woman’s yearly pelvic examination.

Every year, nearly 600,000 American women are diagnosed with cervical dysplasia; 9,710 women are diagnosed with cases of invasive cervical cancer. Early detection of abnormal changes can save lives. Unfortunately, of those women who die of cervical cancer today, 80 percent have not had a Pap smear in five years or more. Cervical cancer, even though falling 2 percent per year, is still the second most common cause of cancer deaths in women. Ironically, it is one of the most preventable and curable by “early identification” of cervical intra-epithelial neoplasia (CIN) and micro-invasive disease.

What is a Pap test?

A Pap test or Pap smear, named after the doctor (George Papanicolaou) responsible for initiating the procedure, is the main way doctors check to see if a woman has developed abnormal cells on the coating (the very top layer of cells) of her cervix. The test is quick, simple, and painless, and shows the presence of an infection, inflammation, abnormal cells, or cancer. The doctor collects a sample and the lab pathologist (cytology lab) analyzes the “smear” under a microscope.

The Pap test may reveal abnormal cell growth, or dysplasia (precancerous cell changes), in the area of the cervix. Abnormal cells look different microscopically from normal cells in that their nuclei show certain specific changes, and that they divide more quickly than normal cells.

How is a Pap test done?

A Pap test is done during an internal pelvic examination. During a Pap test, the doctor uses a tiny wooden spoon to painlessly scrape some cells from the surface of the cervix and smear these cells onto a small glass slide, which will be stained with a special dye that identifies abnormal cells.

For accurate results, a Pap smear should be done when a woman is not menstruating. Additionally, she should avoid douching, using vaginal medicines, spermicidal birth control foams, and other creams or jellies because these substances may wash away or hide abnormal cells. If that should happen, her doctor might mistakenly believe that the woman’s Pap test is normal.

Current guidelines from the National Cancer Institute recommend that all women who are or have been sexually active, or are 18 years of age or older, should have regular Pap tests and pelvic exams.

Why are Pap tests so important?

• A Pap test can catch early signs of cancer before the disease spreads deeper into the cervix and before the cancer spreads to other parts of the body.

• About 50 million Pap tests are performed every year in the United States, with up to 7 percent of the women tested having some type of abnormal results.

• Between 60 percent and 80 percent of American women who are diagnosed with invasive cancer (cancer that spreads) each year, did not have a Pap smear in the earlier year, according to doctors at the Memorial Sloan-Kettering Cancer Center in New York City.

What is the link between the human papilloma virus and cervical cancer?

Research published in the British Journal of Obstetrics and Gynecology reveals that DNA from the human papilloma virus (HPV) is present in almost all invasive cervical cancers. Therefore, having a yearly Pap test, which screens for HPV, is crucial in detecting cervical cancer. Researchers have also discovered “compelling evidence” that persistent HPV infection is the “pivotal step” in the development of cervical cancer. In addition, there are high-risk types of HPVs: numbers 16 and 18 are “definite” carcinogens in humans and HPV 16 is the most common high-risk type. In fact, there are studies that show a greater odds ratio for “the association between HPV and cervical carcinoma than for smoking and lung cancer.”

How is cervical cancer diagnosed?

When a Pap test uncovers abnormalities, a diagnosis of cervical dysplasia is made, and the dysplasia is classified according to a system. Cervical dysplasia, also called cervical intraepithelial neoplasia (CIN), is rated as mild, moderate, or severe. Cervical dysplasia sometimes, but not always, evolves into cervical cancer. A Pap test can catch early signs of cancer before the disease spreads deeper into the cervix and before the cancer spreads to other parts of the body.

Abnormal cells are classified as atypical squamous cells of undetermined significance (ASCUS). Other abnormal cells that are mild but more definite are called low-grade squamous intraepithelial lesions (LSIL). How to handle these mild abnormalities is controversial; some physicians take a “wait-and-see” attitude. That’s because often the cell abnormalities clear up without treatment. So a more conservative physician recommends follow-up Pap tests at three or six months. Others suggest a more aggressive approach: colposcopy, a procedure that allows a physician to use a special microscope to provide closer examination of the cervix, and/or biopsy.

During the procedure the doctor may take tissue samples (a cervical biopsy) from the area. If still more tissue is needed, the patient undergoes a cold cone biopsy. The patient is put in the hospital under general anesthesia and a large tissue sample is taken. The cone biopsy often removes all the cancerous tissue. The reason for all these tests is to accurately match a patient’s medical condition with the most effective therapies available.

What are the signs of cancer of the cervix?

Signs and symptoms of cervical cancer usually don’t appear until precancerous cervical cells become cancerous and invade nearby tissue. Because precancerous changes in the cervix do not cause pain or abnormal bleeding, there are usually no signs that would make a woman suspect that she had precancerous cells in her reproductive organs.

The most common symptom of cervical cancer is abnormal bleeding. This could include:

• Any spotting or bleeding that occurs between normal periods, after sexual intercourse, douching, or during an internal pelvic examination
• Menstrual bleeding that lasts longer and is heavier than usual
• Increased vaginal discharges
• Painful intercourse
• Bleeding after menopause

Risk factors for cervical cancer

Fortunately, cervical cancer is a slow-growing disease. Therefore, a yearly Pap smear will flag any abnormal changes in the cervix that need to be checked out to determine their exact cause, amount, behavior, and type. A physician will decide whether other risk factors warrant further testing. African-American, Hispanic, Native-American women, and women over age 65 are at increased risk because of their general lack of access to good medical care.

Other risk factors for cervical cancer and dysplasia are:

• Starting sexual intercourse at an early age (16 or younger)
• Having multiple sexual partners
• Smoking cigarettes or passive smoking
• Having a history of gynecological cancer
• Using oral contraceptives for five years or more
• Having a diet that is low in vitamin A
• Having a history of sexually transmitted disease, especially HPV infection
• Having the HIV (human immunodeficiency infection), which causes AIDS
• Having been exposed to the drug known as DES (diethylstilbestrol), which had been used by the medical community between 1938 and 1971 to prevent miscarriages

In the journal Nature, some startling statistics in a Swedish study revealed that sometimes, there is a genetic link between women who had cervical cancer and their biological relatives. Over 126,000 relatives of over 71,000 cases of women with cervical cancer helped determine the conclusion of that study.

What is cervical cancer staging?

Cancer “staging” means determining the amount of a cancer a person has, especially when the disease has spread from one spot to another. It is very important to know the exact “grade” or amount of cancer a patient has developed, to plan the best treatment for her. Tissue removed during a cervical biopsy will be staged as follows:

• Stage I: Cancer has not spread to nearby locations in the body.
• Stage II: A small amount of cancer (only visible using a microscope) has spread. The cancer has extended beyond the cervix but not to the pelvic sidewall or the vagina.
• Stage III: A large amount of cancer is deep in the cervix. The cancer extends to the pelvic sidewall, involves the lower third of the vagina or obstructs one or both ureters.
• Stage IV: The cancer spreads to distant organs beyond the pelvis or involves the pelvis or involves the bladder or rectum.
• Stage IVA: The five-year survival rate is between 20 percent to 30 percent
• Stage IVB: It is unusual to survive five years.

The survival rate (living for five years or more after treatment) for women with stage I cancer is good: 80 percent to 85 percent. For women with stage IV cervical cancer, survival is less than 12 percent.

How is cancer of the cervix treated?

Cancer of the cervix is treated differently from other types of cancer in the body, and it may be treated differently from other types of cancer found in the female reproductive tract, such as the ovaries and uterus. Every cancer treatment will depend on the size, amount, and type of cancer a patient has developed. The most common cervical cancer treatments may include:

• Some type of surgery.

• Radiation therapy.

• A combination of surgery and radiation.

• Chemotherapy for advanced stage disease.

• Laser surgery (a thin beam of light aimed at the abnormal cells) may be used to destroy abnormal cells, as well as those cells that have already turned into cervical precancer cells.

• Surgery (cutting out abnormal cells) is used to remove cancerous cells that have already spread outside the cervix.

• Hysterectomy (removal of the uterus, or the uterus and cervix) is used to treat patients whose cancer has spread from the cervix to other reproductive organs.

• Combined radiation therapy and chemotherapy (cisplatin) is a powerful treatment that is used for patients whose cervical cancer has spread to other reproductive organs, and possibly to other places in the body.

• Chemotherapy (5-FU with platinum) can enhance the value of radiotherapy for specific indications.

Preventing cancer of the cervix

Yearly pelvic examinations to identify and treat precancerous conditions remain the most effective ways to prevent cervical cancer. A woman should think preventively by avoiding partners with high-risk sexual histories and insisting on the use of a condom.

The good news is that scientists have developed a vaccine that can potentially prevent cancer of the cervix associated with HPV 16 and 18. The FDA recently approved this vaccine in June 2006 for use in young women ages 9 to 26.

Genital Herpes

What Is It?

Genital herpes is caused by a virus called herpes simplex (HSV). There are two different types of herpes virus that cause genital herpes — HSV-1 and HSV-2. Most forms of genital herpes are HSV-2. But a person with HSV-1 (the type of virus that causes cold sores or fever blisters around the mouth) can transmit the virus through oral sex to another person’s genitals.

HSV-2 is a sexually transmitted disease (STD). It causes herpes sores in the genital area and is transmitted through vaginal, oral, or anal sex, especially from unprotected sex. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.

Symptoms of a Genital Herpes Outbreak

Someone who has been exposed to the genital herpes virus may not be aware of the infection and may never have an outbreak of sores. However, if a person does have an outbreak, the symptoms can cause significant discomfort.

Someone with genital herpes may first notice itching or pain, followed by sores that appear a few hours to a few days later. The sores, which may appear on the vagina, penis, scrotum, buttocks, or anus, start out as red bumps that soon turn into red, watery blisters. The sores may make it very painful to urinate. The sores may open up, ooze fluid or bleed, and then heal within the next 2 to 4 weeks.

The entire genital area may feel very tender or painful, and the person may have flu-like symptoms including fever, headache, and swollen lymph nodes. If someone has an outbreak in the future, it will tend to be less severe and shorter in duration, with the sores healing in about 10 days.

How Long Until Symptoms Appear?

Someone who has been exposed to genital herpes will notice genital itching and/or pain about 2 to 20 days after being infected with the virus. The sores usually appear within days afterward.

What Can Happen?

After the herpes blisters disappear, a person may think the virus has gone away — but it’s actually hiding in the body. Both HSV-1 and HSV-2 can stay hidden away in the body until the next herpes outbreak, when the virus reactivates itself and the painful sores return.

Over time, the herpes virus can reactivate itself again and again, causing discomfort and episodes of sores each time. Usually a person has about four to five herpes outbreaks each year — but in some people, the number of outbreaks will lessen over time.

There is no cure for herpes; it will always remain in the body and can always be passed to another person with any form of unprotected sex. This is the case even if blisters aren’t present on the genitals. Many cases of genital herpes are transmitted when symptoms are not present.

Genital herpes also increases the risk of HIV infection. This is because HIV can enter the body more easily whenever there’s a break in the skin (such as a sore) during unprotected sexual contact. In addition, if a pregnant woman with genital herpes has an active infection during childbirth, the newborn baby is at risk for getting herpes infection. Herpes infection in a newborn can cause meningitis (an inflammation of the membranes that surround the brain and spinal cord), seizures, and brain damage.

How Is It Prevented?

The only surefire way to prevent genital herpes is document.write(defabstinence120) abstinenceabstinence. Teens who do have sex must properly use a latex condom every time they have any form of sexual intercourse (vaginal, oral, or anal sex). Girls receiving oral sex should have their partners use dental dams as protection. These sheets of thin latex can be purchased online or from many pharmacies.

If one partner has a herpes outbreak, avoid sex — even with a condom or dental dam — until all sores have healed. Herpes can be passed sexually even if a partner has no sores or other signs and symptoms of an outbreak.

How Is It Treated?

If you think you may have genital herpes or if you have had a partner who may have genital herpes, see your family doctor, adolescent doctor, gynecologist, or health clinic for a diagnosis. Right now, there is no cure for genital herpes, but a doctor can prescribe antiviral medication to help control recurring HSV-2 and clear up the painful sores. The doctor can also tell you how to keep the sores clean and dry and suggest other methods to ease the discomfort when the virus reappears.

Woman Genital Helath (2)

Common genital problems

Vaginal problems

A variety of bacteria, yeasts and other micro-organisms occur naturally in the vagina. Specific bacteria (lactobacilli) normally keep the vagina slightly acidic, keeping the growth

of other bacteria under control.

The vaginal balance can be upset by external factors. This can lead to a change in the balance of the natural bacteria in the vagina, causing problems. Some women are more prone than others to disturbance of the vaginal environment.

A course of antibiotics may reduce the numbers of bacteria that the vagina needs to keep

its normal acidic balance. Stress, illness and hormone changes can also alter the vaginal environment.

Signs of a vaginal problem may be:

• itching, irritation or soreness around the vaginal opening

• a burning sensation when urinating

• increased or unusual discharge

• swelling of the labia

• abnormal bleeding

• uncomfortable or painful sex

• an unpleasant odour

If you are experiencing any of the above problems, see a doctor or FPWA clinician.

Genital itch

Genital itch is a common problem among women. Many assume that any genital itch is due to thrush (see below for more information), but there are other conditions that can cause itching and soreness, such as eczema (dermatitis).

If you are experiencing persistent genital itch, it is important to see a doctor or FPWA clinician to get an accurate diagnosis, so that you can be given the right treatment.

Vulval pain

Vulval pain is a problem for many women, and can be caused by both physical and psychological factors. It can make inserting tampons or having sex difficult or impossible. Some women find the area too painful to even touch.

Some vulval problems have noticeable signs, such as a growth, sore or rash on the vulva. These can often indicate an infection or skin condition such as eczema or dermatitis, and need to be checked by a doctor.

Some women experiencing vulval pain have no other physical symptoms but experience pain some or all of the time, in particular when urinating or sitting for long periods.Because of the lack of other symptoms, these problems can be difficult to diagnose. Physical therapy is often used to treat vulval pain, but avoiding intercourse, wearing loose clothing and using cold packs can help. Your doctor may prescribe antidepressants or anti-epileptic medication to reduce the pain, or a special cream to apply to the area. Counselling or therapy may be beneficial if the pain is due to psychological causes.

Although not usually an indication of a serious condition, if you are experiencing recurring vulval pain it is important to see a doctor - don’t try and treat the problem yourself. Occasionally however, pain can be related to conditions such as cancer.

Vaginal infections

Infection can be avoided by:

• wiping from front to back when using toilet paper

• being particularly careful with hygiene if you have a bowel upset e.g. washing rather than wiping

• eating a healthy, well balanced diet

• not douching (flushing liquids into the vagina)

Common vaginal infections

Thrush

This infection is also called monilia or candida. The organism is a yeast which is commonly found in the body without causing any problems. At times a woman may notice symptoms, particularly during pregnancy, or when she is on antibiotics or some other medication. Women who are diabetic or who have other illnesses may have recurring problems with thrush.

Common symptoms of thrush can include itchiness, burning, soreness, a thick white or yellow discharge, discomfort during intercourse and pain when urinating. Sometimes men may also notice irritation and redness of the penis after sex if their partner has thrush, but it is not considered to be a sexually transmissible infection (STI).

Thrush is diagnosed by examination and confirmed by taking swabs.

It may also be detected on a routine Pap smear.

Thrush does not have to be treated if it is not bothering you. Some women find their symptoms can be relieved by sitting in a warm salty bath or by using cold compresses.

If you are certain that thrush is the cause of your symptoms, antifungal vaginal creams and pessaries are available over the counter at pharmacies. If you are finding that thrush is a frequent problem it is advisable to visit your doctor or the FPWA clinic. Your doctor will examine you to confirm that thrush is the cause of your symptoms and may prescribe other treatments such as oral antifungal tablets. The doctor may take this opportunity to rule out the possibility of STIs, which can also cause irritation.

Putting yogurt on an irritated vulva will not get rid of the infection.

Bacterial vaginosis

This is a common condition in women and is caused by an overgrowth

of bacteria that normally live in the bowel but may be found in the vagina. The organisms often multiply in the vagina when the acid level falls.

Bacterial vaginosis may cause a white to grey discharge with an unpleasant ‘fish‘ or stale odour. Vulval irritation can occur and sex may be uncomfortable. Bacterial vaginosis is diagnosed by an examination testing the acidity of the vaginal fluid, and confirmed by swabs.

Bacterial vaginosis does not have to be treated if it is not bothering you.

If it is a problem your doctor may prescribe antibiotics in the form of tablets or vaginal