A Belated Welcome To CCAM 2017!

Hello, and a belated welcome to CCAM (cervical cancer awareness month) 2017!

To start, I’d like to go over the basics of cervical cancer: types of cervical cancer, cervical cancer symptoms, cervical cancer risk factors, and stages of cervical cancer. (Information credited to Cancer Treatment Centers of America)

TYPES OF CERVICAL CANCER: There are two main types of cervical cancer, squamous cell and adenocarcinoma. Squamous cell cervical cancer begins in the thin, flat cells that line the bottom of the cervix. This type of cervical cancer accounts for 80 to 90 percent of cervical cancers. Adenocarcinomas develop in the glandular cells that line the upper portion of the cervix. These cancers make up 10 to 20 percent of cervical cancers.

CERVICAL CANCER SYMPTOMS: In most cases, cervical cancer does not cause noticeable symptoms in the early stages of the disease. Routine Pap screening is important to check for abnormal cells in the cervix, so they can be monitored and treated as early as possible. Most women are advised to get a Pap test starting at age 21.

The Pap test is one of the most reliable and effective cancer screening methods available, and women should have yearly exams by an OB-GYN. However, the Pap test may not detect some cases of abnormal cells in the cervix. The HPV test screens women for the high-risk HPV strains that may lead to cervical cancer. It is approved for women over age 30.

Although screening methods are not 100 percent accurate, these tests are often an effective method for detecting cervical cancer in the early stages when it is still highly treatable. Talk with your doctor about which type of cervical cancer screening is right for you.

CERVICAL CANCER RISK FACTORS: Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. However, not all women with an HPV infection will develop cervical cancer.

Routine Pap testing is the best way to detect abnormal changes to the cervix before they develop into cancer. Because of this, women who do not regularly have a Pap test are at increased risk of developing the disease.

OTHER RISK FACTORS:

GENERAL

Pregnancy: Women who have had three or more full-term pregnancies, or who had their first full-term pregnancy before age 17, are twice as likely to get cervical cancer.

GENETICS

Family history: Women with a sister or mother who had cervical cancer are two to three times more likely to develop cervical cancer.

LIFESTYLE

Sexual history: Certain types of sexual behavior are considered risk factors for cervical cancer and HPV infection. These include: sex before age 18, sex with multiple partners and sex with someone who has had multiple partners. Studies also show a link between chlamydia infection and cervical cancer.

Smoking: A woman who smokes doubles her risk of cervical cancer.

Oral contraceptive use: Women who take oral contraceptives for more than five years have an increased risk of cervical cancer, but this risk returns to normal within a few years after the pills are stopped.

OTHER CONDITIONS

Weakened immune system: In most people with healthy immune systems, the HPV virus clears itself from the body within 12-18 months. However, people with HIV or other health conditions or who take medications that limit the body’s ability to fight off infection have a higher risk of developing cervical cancer.

Diethylstilbestrol (DES): Women whose mothers took DES, a drug given to some women to prevent miscarriage between 1940 and 1971, have a higher risk of developing cervical cancer.

HPV: Though HPV causes cancer, having HPV does not mean you will get cancer. The majority of women who contract HPV clear the virus or have treatment so the abnormal cells are removed. HPV is a skin infection, spread through skin-to-skin contact with a person who has the virus. Learn about the HPV vaccine to prevent HPV infections.

Additional facts about HPV:

There are more than 100 types of HPV, 30-40 of which are sexually transmitted.

Of these, at least 15 are high-risk HPV strains that can cause cervical cancer. The others cause no symptoms or genital warts.

Up to 80 percent of women will contract HPV in their lifetime. Men get HPV, too, but there is no test for them.

A healthy immune system will usually clear the HPV virus before there is a symptom, including the high-risk types of HPV.

Only a small percentage of women with high-risk HPV develop cervical cancer.

STAGES OF CERVICAL CANCER: Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of cervical cancer is one of the most important factors in evaluating treatment options.

Our cancer doctors use a variety of diagnostic tests to evaluate cervical cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information, and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

TNM System for cervical cancer

Cervical cancer is staged using the TNM system:

Tumor (T) describes the size of the original tumor.

Lymph Node (N) indicates whether the cancer is present in the lymph nodes.

Metastasis (M) refers to whether cancer has spread to other parts of the body, usually the liver, bones or brain.

Once the T, N and M scores have been determined, an overall cervical cancer stage is assigned.

STAGES

Stage 0 cervical cancer

Stage 0 cervical cancer means that the cancer cells are confined to the surface of the cervix. This stage is also called carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III (CIN III).

Stage I cervical cancer

In stage I cervical cancer, the cancer has grown deeper into the cervix, but has not spread beyond it. This stage is further separated into two subcategories:

o   Stage IA: There is a very small amount of cancer, less than 5 mm deep and less than 7 mm wide, that can only be seen under a microscope.

o   Stage IB: The cancer can be seen and measures 4 cm or less; or the cancer can only be seen under a microscope and measures more than 5 mm deep and 7 mm wide.

Stage II cervical cancer

Stage II cervical cancer means that the cancer has grown beyond the cervix and uterus, but has not reached the walls of the pelvis or the lower part of the vagina. In this stage of cervical cancer, the disease has not spread to lymph nodes or distant sites. Stage II has two additional subcategories:

o   Stage IIA: The cancer has not spread into the tissues next to the cervix, the parametria, but it may have grown into the upper part of the vagina.

o   Stage IIB: The cancer has spread into the tissues next to the cervix, the parametria.

Stage III cervical cancer

Stage III cervical cancer means that the cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to nearby lymph nodes or other parts of the body. This stage is separated into two subcategories:

o   Stage IIIA: The cancer has spread to the lower third of the vagina, but not to the walls of the pelvis.

o   Stage IIIB: The cancer has grown into the walls of the pelvis and/or has blocked both ureters, but has not spread to the lymph nodes or distant sites. Or the cancer has spread to the lymph nodes in the pelvis, but not to distant sites.

Stage IV cervical cancer

In this cervical cancer stage, the disease has spread to nearby organs or other parts of the body. Stage IV is separated into two subcategories:

o   Stage IVA: The cancer has spread to the bladder or rectum, but not to the lymph nodes or distant sites.

o   Stage IVB: The cancer has spread to organs beyond the pelvis, such as the lungs or liver.

Recurrent cervical cancer

Cervical cancer develops when cells that line the cervix mutate and become cancerous. The two main types of cervical cancer are squamous cell carcinoma and adenocarcinoma.

Recurrent cervical cancer occurs when the cancer is detected months or years after the completion of an initial cancer treatment regimen, which may have included surgery, radiation therapy and/or chemotherapy. The recurrence of cervical cancer may be a local recurrence, which is contained to the cervix region. A metastatic recurrence occurs when the cancer has spreads to other organs, such as the kidney, bladder or lymph nodes. This recurrence happens when the cervical cancer cells break off from the original tumor and travel to other parts of the body through the lymphatic or circulatory system. The cells then reattach at a new location. When the disease appears in another part of the body, it may be referred to as regional or distant reccurrence.

Symptoms of recurrent cervical cancer vary from patient to patient. Signs and symptoms of local cervical cancer recurrence may include:

• Bleeding between periods, after sexual intercourse or after menopause
• Periods that are heavier and last longer than usual
• Unusual vaginal discharge that may be watery, pink or foul-smelling
• Pelvic pain or pain during intercourse
• Signs and symptoms of distant cervical cancer recurrence may include:
• Weight loss
• Fatigue
• Back pain
• Leg pain or swelling
• Leakage of urine from the vagina
• Bone pain that does not go away 

Follow-up appointments with your oncologist may help detect cervical cancer relapse early. Your doctor may ask you about symptoms or problems that you may be experiencing. The doctor may perform a pelvic examination and a Pap smear. Further lab and/or imaging tests may also be necessary.

A number of treatment options are available for cancer that has relapsed, especially when it is detected early. An estimated 35 percent of patients with invasive cervical cancer develop persistent or recurrent disease following treatment. The recurrent cervical cancer rate is lower for those with early-stage disease. The majority of cancer recurrences occur within two years of treatment.