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.
