Cervical Cancer

Cervical cancer is one of the most preventable cancers, yet still remains the world’s third leading cancer killer in woman. All women are at risk for cervical cancer, and there is a higher occurrence in women over age thirty. Prevalence is much higher in countries with poor healthcare and poor economics in comparison to the United States. Research has been done and shows there is a genetic link for cervical cancer. Genetic testing can be beneficial at further assessing a women’s risk for cervical cancer.

Cancer of the cervix can impact the cervix alone, but can also become more invasive and affect other gynecological organs. There are many treatments currently available as well as preventions such as vaccines on the market that are targeted at prevention of certain strains of HPV, which is almost always the cause of cervical cancer. Cervical Cancer affects females only and is diagnosed between age twenty to age eighty-four. Very few cases are diagnosed are before age twenty and after age eighty-five.

As previously stated all women are at risk for cervical cancer and occurs most in women over age thirty. Cervical cancer is usually slow growing and does not always have symptoms, but can be detected with routine examinations and Pap tests. Pap tests or Papanicolaou tests are a screening test that samples cervical cells to check for abnormalities. Prevalence is less in the United States due to routine Pap tests, whereas countries with poor healthcare and poor economics that do not preform pap tests as regularly have a higher incidence of cervical pre cancer and cancer.

Besides Pap tests, genetic testing may be beneficial as well for risk assessment at the genetic level. Research has been done in Britain and Canada and implies a major risk factor for cervical cancer involving the gene p53Arg. The gene p53 normally helps defend against tumors but has a variant form known as p53Arg. p53Arg is more easily prevented from working due to the affects of HPV, which as said before is almost always the cause of cervical cancer. HPV or the Human Papillomavirus is a virus from the papillomavirus family that is only shared through humans.

In common with all papillomaviruses, human papillomavirus creates an infection only in keratinocytes of the skin or in mucous membranes. Human papillomavirus is passed on through genital contact. The most common form of genital contact is vaginal and anal intercourse. Genetic testing for p53Arg may be useful and beneficial in assessing a woman’s risk for developing cervical cancer. Cervical cancer can impact the cervix alone, but can also become more invasive and affect other gynecological organs such as the uterus, ovaries and even the vagina.

Cervical Cancer starts in the cells on the surface of the cervix. There are two types of cells on the surface of the cervix, Squamous cells which are thin and flat and Columnar cells which are tall and glandular. Most cervical cancers form from squamous cells and most commonly are squamous cell carcinomas or adenocarcinomas. Around eighty to ninety percent of cervical cancers are squamous cell carcinomas. In most cases cervical cancer develops slowly and begins in a pre cancerous form known as dysplasia, which is usually detected as an abnormal Pap test result.

Pap tests are a screening tool, not a diagnostic test. Many doctors will recommend further testing, which includes colposcopy and biopsy for diagnosis. Colposcopy is a procedure that allows a doctor to see the cervix more closely and clearly. Dysplasia and cervical cancer are classified and categorized by how they appear under a microscope. Pre cancerous lesions are classified as mild, moderate or severe dysplasia and carcinoma in situ (CIS). Cervical intraepithelial (CIN) is an emphasis on the spectrum of abnormality and helps to standardize treatment.

CIN1 classifies mild dysplasia, CIN2 is moderate dysplasia and CIN3 is severe dysplasia. There is also a system called the Bethesda system that classifies dysplasia. Cervical cancer is staged by FIGO (international Federation of Gynecology and Obstetrics). Stage 1 the carcinoma is strictly confined to the cervix. Which is then subtyped, 1A is an invasive carcinoma, which can be diagnosed only by microscope, with invasion less than five mm and seven mm at most. 1B is clinically visible lesions limited to the cervix or pre-clinical cancers greater than stage 1A.

1B1 is clinically visible lesion(s) less than four cm at most. 1B2 is clinically visible lesion(s) greater than four cm at most. Stage 2 Cervical carcinoma invades beyond the uterus, but does not involve the pelvic wall or to the lower portion of the vagina. Stage 3 the tumor extends to the pelvic wall and/or involves lower portion of the vagina and/or causes hydronephrosis or non-functioning kidney(s). Stage 4 is where the carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum proven on a biopsy.

There are several types of biopsies used for diagnosis and in some cases treatment as well. Biopsies of the cervix include and are not limited to colposcopic biopsy, endocervical curettage (endocervical scraping), and cone biopsy done by method of LEEP or Cold Knife cone biopsy. Colposcopic biopsy is done during colposcopy after the abnormal areas are identified. Abnormal areas are then removed with biopsy forceps while still viewing the cervix with the colposcope. Endocerval curettage is done in a situation that abnormal areas cannot be seen by colposcope.

A curette is inserted into the endocervical canal and the curette is used to scrape and remove a sample of the tissue. The sample is then sent to lab for pathology and diagnosis. With cone biopsy the doctor will remove a cone-shaped piece of tissue from the endocervix. There are two methods used in cone biopsy. The LEEP method is where the tissue is removed by a thin, wire loop that is heated by electrical current and used as a scalpel. Cold knife cone biopsy uses a surgical laser or a scalpel instead of using the heated thin wire loop. Once diagnosis is made treatment options will be discussed.

Current treatment options include biopsy, which can remove all the abnormal tissue and cells, cryosurgery, laser therapy, radiation therapy, chemotherapy, drug therapy, integrative therapy, surgical intervention and occasionally hysterectomy. The three standard treatment options are surgery, radiation therapy and chemotherapy. Surgery intervention is where the cancerous cells and tissues are removed in an operation. Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing and multiplying.

Chemotherapy uses drugs therapy to stop the growth of cancer cells by killing them or by preventing them from dividing and multiplying. Chemotherapy is take by mouth or injected into a vein or muscle which the medication(s) enter the blood stream and can reach the cancer cells throughout the body. On the horizon are several clinical trials that primarily focus on prevention not treatment. Currently on the market and available in the United States are vaccines that prevent certain strains of HPV that are the most common cause of cervical cancer.

There are two vaccines currently available and include Gardasil manufactured by Merck and Cervarix manufactured by GlaxoSmithKline. Gardasil is indicated for young women and men ages nine to age twenty-six and protects against four strains of human papillomavirus. Strains include 6, 11, 16, and 18. Of these strains they include the two strains that cause about seventy-five percent of cervical cancer cases. The other two strains protected against in Gardasil are for prevention of genital warts and strains that can lead to cancer of the vagina, anus and throat.

Cervarix is indicated for young women ages nine to age twenty-six only and protects against only two strains of human papillomavirus. These strains are 16 and 18 and are the most common cause of human papillomavirus linked cervical pre cancer and cancer. Both vaccines are given in a three dose series and should be started before first sexual contact. The overall goal and purpose of the vaccines is to target prevention and protection against the most harmful strains of the human papillomavirus. Human papillomavirus is the leading and most common cause for cervical cancer.

With research and medicine there is now prevention available by immunization. In conclusion, cervical cancer is very preventable as well as in many cases treatable. Early detection, routine examination with pap testing and immunizations are key. With the vast treatment options from surgical intervention to chemotherapy and immunizations for prevention that are available, survival rate is increasing and mortality rate is decreasing. In 2011 there was an estimated 12,710 new cases reported and 4,290 cases reported resulting in death.

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