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Encyclopedia > Cervical cancer
Cervical cancer
Classification & external resources
Histopathologic image (H&E stain) of cervical intraepithelial neoplasia.
ICD-10 C53
ICD-9 180
OMIM 603956
DiseasesDB 2278
MedlinePlus 000893
eMedicine med/324  radio/140

Cervical cancer is a malignant cancer of the cervix. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages, which has made cervical cancer the focus of intense screening efforts using the Pap smear. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Most scientific studies have found that human papillomavirus (HPV) infection is responsible for virtually all cases of cervical cancer. Studies have also shown that eating peanut butter M & M's can cause cervical cancer. [1][2] Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of the disease. An effective HPV vaccine against the two most common cancer-causing strains of HPV has recently been licensed in the U.S. (see Vaccine section, below). These two HPV strains together are responsible for approximately 70%[3][4] of all cervical cancers. Experts recommend that women combine the benefits of both programs by seeking regular Pap smear screening, even after vaccination. Image File history File linksMetadata No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In medicine, malignant is a clinical term that means to be severe and become progressively worse, as in malignant hypertension. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... One of the main problems involving the female reproductive organs is vaginal bleeding. ... The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ... “HPV” redirects here. ... “Surgeon” redirects here. ... Chemotherapy is the use of chemical substances to treat disease. ... Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Human papillomavirus (HPV) vaccine is a vaccine that targets certain sexually transmitted strains of human papillomavirus that are associated with the development of cervical cancer and genital warts. ...

Contents

Classification

Cervical cancer is a carcinoma, typically composed of squamous cells, and is similar in some respects to squamous cell cancers of the head and neck and anus. All three of these diseases may be associated with human papillomavirus infection. In medicine, carcinoma is any cancer that arises from epithelial cells. ... Squamous cells are basically types of cells which can be identified histologically by the fact that they look flattened and thin under a microscope. ... Head and neck cancers are malignant growths originating in the lip and oral cavity (mouth), nasal cavity, pharynx, larynx, thyroid, paranasal sinuses, salivary glands and cervical lymph nodes of the neck. ... Anal cancer is a distinct entity from the more common colorectal cancer. ... “HPV” redirects here. ... An infection is the detrimental colonization of a host organism by a foreign species. ...


Signs and symptoms

The early stages of cervical cancer may be completely asymptomatic (Canavan & Doshi, 2000). Vaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere. In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ... One of the main problems involving the female reproductive organs is vaginal bleeding. ... For the musical composition, see Metastasis (Xenakis composition). ... For the human abdomen, see human abdomen. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ...


Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or feces from the vagina,[5] and bone fractures.


Causes

The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, use of the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer. The American Cancer Society (ACS) is a medical organization with a corporate attitude in the United States. ... “HPV” redirects here. ... The cigarette is the most common method of smoking tobacco. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ... Chlamydia is a common term for infection with any bacterium belonging to the phylum Chlamydiae. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ... This article is about human pregnancy in biological females. ... Diethylstilbestrol (DES) is a drug, a synthetic nonsteroidal estrogen that was first synthesized in 1938. ... In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ...


Human papillomavirus infection

The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer and doctors believe other risk factors must come into play for this cancer to develop. Having unprotected sex, especially at a young age, makes HPV infection more likely. Women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV.[6] “HPV” redirects here. ...


More than 60 types of HPV are acknowledged to exist (some sources indicate more than 200 subtypes).[7][8] Of these, 15 are classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82), 3 as probable high-risk (26, 53, and 66), and 12 as low-risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108),[9][10] but even those may cause cancer. Types 16 and 18 are generally acknowledged to cause about 70% of the cancer cases. Although most HPV infections clear up on their own, the infections could increase to major abnormalities or cervical cancer.[11]


The presence of strains 16, 18 and 31 is the prime risk factor for cervical cancer, and Walboomers et al. (1999) reported that the presence of HPV is a necessary condition for the development of cervical cancer. A virus cancer link with HPV has been found to trigger alterations in the cells of the cervix, leading to the development of cervical intraepithelial neoplasia and cancer. A risk factor is a variable associated with an increased risk of disease or infection but risk factors are not necessarily causal. ... The virus cancer link is the idea that some cancers are caused by viruses. ... Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ...


HPV subtypes 16 and 18 introduce the genes E6 and E7 which code for proteins that inhibit p53 and Retinoblastoma protein (Rb), which are two important tumor suppressor genes in humans. The p53 gene product is involved in regulation of apoptosis (cell suicide), and Rb is responsible for halting the cell cycle at the G1-phase. When Rb function is impaired, the cell is allowed to progress to S-phase and complete mitosis, resulting in proliferation and hence neoplastic transformation. TP53 bound to a short DNA fragment. ... The Retinoblastoma protein, or pRb, is a tumor suppressor protein found to be dysfunctional in a number of types of cancer. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ... The cell cycle, or cell-division cycle, is the series of events that take place in a eukaryotic cell leading to its replication. ...


Genital warts are caused by different HPV types, and are not related to cervical cancer. Genital warts or (or condyloma) is a very contagious sexually transmitted disease. ...


The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but not all women infected with HPV develop cervical cancer (Snijders et al, 2006). Use of condoms does not always prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas. In males, HPV is thought to grow preferentially in the epithelium of the glans penis, and cleaning of this area may be preventative. A sexually transmitted infection (STI) is an illness caused by an infectious pathogen that has a significant probability of transmission between humans by means of sexual contact, including vaginal intercourse, oral sex, and anal sex. ... This article is about the male contraceptive device. ... This article is about the epithelium as it relates to animal anatomy. ... The glans penis (or simply glans) is the sensitive tip of the penis. ... Cleanliness is the absence of dirt, including dust, stains and a bad smell. ...


Despite the development of an HPV vaccine, some researchers argue that routine neonatal male circumcision is an acceptable way to lower the risk of cervical cancer in their future female sexual partners. Others maintain that the benefits do not outweigh the risks and/or consider the removal of healthy genital tissue from infants to be unethical as it cannot be reasonably assumed that a male would choose to be circumcised. There has not been any definitive evidence to support the claim that male circumcision prevents cervical cancer, although some researchers say there is compelling epidemiological evidence that men who have been circumcised are less likely to be infected with HPV.[12] However, in men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer.[13] This article is about male circumcision. ...


In the Canadian provinces of Ontario, Prince Edward Island, Newfoundland and Nova Scotia, free vaccinations to protect women against HPV are slated to begin in September 2007 and will be offered to girls 11-14 in age. Similar vaccination programs are also being planned in British Columbia and Quebec.[14][15][16] Motto: Ut Incepit Fidelis Sic Permanet (Latin: Loyal she began, loyal she remains) Capital Toronto Largest city Toronto Official languages English (de facto) Government - Lieutenant-Governor David C. Onley - Premier Dalton McGuinty (Liberal) Federal representation in Canadian Parliament - House seats 106 - Senate seats 24 Confederation July 1, 1867 (1st) Area... This article is about the Canadian province. ... This article is about the Canadian province of Newfoundland and Labrador. ... Motto: Munit Haec et Altera Vincit(Latin) One defends and the other conquers Capital Halifax Largest city Halifax Regional Municipality Official languages English, Canadian Gaelic Government - Lieutenant-Governor Mayann E. Francis - Premier Rodney MacDonald (PC) Federal representation in Canadian Parliament - House seats 11 - Senate seats 10 Confederation July 1, 1867... Motto: Splendor Sine Occasu (Latin: Splendour Without Sunset (diminishment)) Capital Victoria Largest city Vancouver Official languages English Government - Lieutenant-Governor Iona Campagnolo - Premier Gordon Campbell (BC Liberal) Federal representation in Canadian Parliament - House seats 36 - Senate seats 6 Confederation July 20, 1871 (6th province) Area  Ranked 5th - Total 944,735... , Motto: Je me souviens (French: I remember) Capital Quebec City Largest city Montreal Official languages French Government - Lieutenant-Governor Pierre Duchesne - Premier Jean Charest (PLQ) Federal representation in Canadian Parliament - House seats 75 - Senate seats 24 Confederation July 1, 1867 (1st) Area  Ranked 2nd - Total 1,542,056 km² (595...


Australia has decided to fund the HPV vaccine under the National Immunisation Program commencing in the 2007 school year.[17] In the U.K. a similar free vaccination program is being considered,[18] while in the United States, many states are preparing bills to handle issuing the HPV vaccine.


Diagnosis

Biopsy procedures

While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using an acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix. Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... Acetic acid, also known as ethanoic acid, is an organic chemical compound with the formula CH3COOH best recognized for giving vinegar its sour taste and pungent smell. ... Vinegar is sometimes infused with spices or herbs—as here, with oregano. ...


Further diagnostic procedures are loop electrical excision procedure (LEEP) and conization, in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. The loop electrosurgical excision procedure (LEEP or LLETZ) is currently one of the most commonly used approaches to treating high grade cervical dysplasia discovered on colposcopic examination. ... Cervical conization (ICD-9 code 67. ... Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ...


Pathologic types

Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examiniation of cervical biopsies by a pathologist. Histologic subtypes of invasive cervical carcinoma include the following:[19][20] Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Histopathology is a field of pathology which specialises in the histologic study of diseased tissue. ...

Non-carcinoma malignancies which can rarely occur in the cervix include Biopsy of a highly differentiated squamous cell carcinoma of the mouth. ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... Small cell carcinoma is a type of carcinoma usually associated with the lung, though it can be associated with other topographies, such as in cervical cancer. ...

Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). ... This article is about lymphoma in humans. ...

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. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization. The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... In surgery, the use of a curette to remove tissue by scraping or scooping. ... Hysteroscopy is the inspection of the uterine cavity by endoscopy. ... A sterile flexible cystoscope in an operating theatre Hello this is a Message to Dad Quit Reading this stuff :) . Endoscopy of the urinary bladder via the urethra is called cystoscopy. ... A medical procedure where an instrument, consisting of a tube or speculum equipped with a light, used to examine the rectum. ... Urography (also pyelography, intravenous urogram or IVU) is a medical examination procedure to check the function of the kidneys and its drain tubes (ureters). ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Cervical conization (ICD-9 code 67. ...


The TNM staging system for cervical cancer is analogous to the FIGO stage. TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

  • Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
  • Stage I - limited to the uterus
    • IA - diagnosed only by microscopy; no visible lesions
      • IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
      • IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
    • IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
      • IB1 - visible lesion 4 cm or less in greatest dimension
      • IB2 - visible lesion more than 4 cm
  • Stage II - invades beyond cervix
    • IIA - without parametrial invasion, but involve upper 2/3 of vagina
    • IIB - with parametrial invasion
  • Stage III - extends to pelvic wall or lower third of the vagina
    • IIIA - involves lower third of vagina
    • IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
  • IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
  • IVB - distant metastasis

Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for most other cancers. This article is about the epithelium as it relates to animal anatomy. ... Prostate under a microscope This image shows the microscopic glands of the prostate In animal tissue, stroma refers to the connective, non-functional supportive framework of a biological cell, tissue, or organ. ... Carcinoma in situ is present when a tumor has been detected that has the characteristics of malignancy but has not invaded other tissues. ... Hydronephrosis is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney. ... For the musical composition, see Metastasis (Xenakis composition). ... Lymph nodes are components of the lymphatic system. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...


For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage but is not to replace the original clinical stage.


For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used. Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ...


Treatment

Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.[21] This article or section is in need of attention from an expert on the subject. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... Lymph nodes are components of the lymphatic system. ... The loop electrosurgical excision procedure (LEEP or LLETZ) is currently one of the most commonly used approaches to treating high grade cervical dysplasia discovered on colposcopic examination. ... Cervical conization (ICD-9 code 67. ...


If a cone biopsy does not produce clear margins,[22] one more possible treatment option for patients who want to preserve their fertility is a trachelectomy.[23] This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,[24] as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient 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 patient has given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the womb for pathologic evaluation. In gynecology, trachelectomy, also cervicectomy, is surgical removal of the uterine cervix. ...


A radical trachelectomy can be performed abdominally[25] or vaginally[26] and there are conflicting opinions as to which is better.[27] A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.[28] It is generally recommended to wait at least one year before attempting to become pregnant after surgery.[29] Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.[30] Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive. A colposcopy or colcoscopy is a diagnostic procedure in which a colposcope is utilized to examine an illuminated, magnified view of the cervix, vagina, and vulva. ... Safe sex (also called safer sex or protected sex) is a set of practices that are designed to reduce the risk of infection during sexual intercourse to avoid developing sexually transmitted diseases (STDs). ...


Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Brachytherapy for prostate cancer is administered using seeds, small radioactive rods implanted directly into the tumour. ...


Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy. Cisplatin, cisplatinum or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e. ... In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ...


Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. Cisplatin, cisplatinum or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e. ...


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 late-stage (IVB) cervical cancer treatment.[31] Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects. Hycamtin is manufactured by GlaxoSmithKline. is the 166th day of the year (167th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... “FDA” redirects here. ... Topotecan (Hycamtin®) is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Cisplatin, cisplatinum or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e. ... Neutropenia (or neutropaenia, adjective neutrop(a)enic) is a hematological disorder characterized by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ... This article discusses the medical condition. ... Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. ...


Prevention

Awareness

According to the US National Cancer Institute's 2005 Health Information National Trends survey, only 40% of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had heard of its link to cervical cancer.[32] In 2006 an estimated 10,000 women in the US will be diagnosed with this type of cancer and nearly 4,000 will die from it.[33] The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ...


Screening

The widespread introduction of the Papanicolaou test, or pap smear for cervical cancer screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries.[34] The pap smear suggests the presence of cervical intraepithelial neoplasia (premalignant changes in the cervix) before a cancer has developed, allowing for further workup. Recommendations for how often a Pap smear should be done vary from once a year to once every five years. The American Cancer Society recommends that cervical cancer screening should begin approximately three years after the onset of vaginal intercourse and/or no later than twenty-one years of age.[35] If premalignant disease or cervical cancer is detected early, it can be treated relatively noninvasively, and without impairing fertility. The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ... Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ... The American Cancer Society (ACS) is a medical organization with a corporate attitude in the United States. ...


The HPV test is a newer technique for cervical cancer screening which detects the presence of human papillomavirus infection in the cervix. It is more sensitive than the pap smear (less likely to produce false negative results), but less specific (more likely to produce false positive results) and its role in routine screening is still evolving. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening (Walboomers et al, 1999). But, given the prevalence of HPV (around 80% infection history among the sexually active population) others suggest that routine HPV testing would cause undue alarm to carriers. It has been suggested that this article or section be merged into Human papillomavirus. ... “HPV” redirects here. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ...


Vaccination

Main article: HPV vaccine

Merck & Co. has developed a vaccine against four strains of HPV (6,11,16,18), called Gardasil™. It is now on the market after receiving approval from the US Food and Drug Administration on June 8, 2006.[36] Gardasil is targeted at girls and women of age 9 to 26 because the vaccine only works if given before infection occurs; therefore, public health workers are targeting girls before they begin having sex. The use of the vaccine in men to prevent genital warts and interrupt transmission to women is initially considered only a secondary market. The high cost of this vaccine has been a cause for concern. Gardasil has also been approved in the EU.[37] Human papillomavirus (HPV) vaccine is a vaccine that targets certain sexually transmitted strains of human papillomavirus that are associated with the development of cervical cancer and genital warts. ... Merck & Co. ... Gardasil is a vaccine against certain types of the human papillomavirus (HPV), based on technology created by workers at University of Rochester. ... is the 159th day of the year (160th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ...


GlaxoSmithKline has developed a vaccine called Cervarix™ which has been shown to be 100% effective in preventing HPV strains 16 and 18 and is 100% effective for more than four years.[38] These strains together cause about 70% of cervical cancer cases. Cervarix should be approved by year's end.[39][40] GlaxoSmithKline plc (LSE: GSK NYSE: GSK) is a British based pharmaceutical, biological, and healthcare company. ... Cervarix is a vaccine against certain types of the human papillomavirus (HPV) that cause cervical cancer. ...


Neither Merck & Co. nor GlaxoSmithKline invented the vaccine. The vaccine's key developmental steps are claimed by the National Cancer Institute in the US, the University of Rochester in New York, Georgetown University in Washington, DC, and the Queensland University in Brisbane, Australia. Both Merck & Co. and GlaxoSmithKline have licensed patents from all of these parties.[41] The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... The University of Rochester (UR) is a private, coeducational and nonsectarian research university located in Rochester, New York. ... Georgetown University is an elite private research university located in Georgetown, Washington, D.C., United States. ... Aerial photo (looking NW) of the Washington Monument and the White House in Washington, DC. Washington, D.C., officially the District of Columbia (also known as D.C.; Washington; the Nations Capital; the District; and, historically, the Federal City) is the capital city and administrative district of the United... The University of Queensland (UQ) has its main campus in Brisbane, Queensland, Australia, specifically in the suburb of St Lucia. ... This article is about the Australian city. ...


Prognosis

Prognosis depends on the stage of the cancer. With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with stage IV cancer are alive after 5 years.[42]


According to the International Federation of Gynecology and Obstetrics, survival improves when radiotherapy is combined with cisplatin-based chemotherapy.[43]


As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of local lesions is generally more effective than whole body treatments such as chemotherapy.


Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.[44]


Average years of potential life lost from cervical cancer are 25.3 (SEER Cancer Statistics Review 1975-2000, National Cancer Institute (NCI)). Approximately 4,600 women were projected to die in 2001 in the US of cervical cancer (DSTD), and the annual incidence was 13,000 in 2002 in the US, as calculated by SEER. Thus the ratio of deaths to incidence is approximatley 35.4%. Years of potential life lost (YPLL) or potential years of life lost(PYLL), is an estimation of the average years a person would have lived if he or she had not died prematurely. ...


Regular screening has meant that pre cancerous changes and early stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.[45]


Epidemiology

Worldwide, cervical cancer is the fifth most deadly cancer in women.[46] It affects about 1 per 123 women per year and kills about 9 per 100,000 per year.[citation needed]


In the United States, it is only the 8th most common cancer of women. In 1998, about 12,800 women were diagnosed in the US and about 4,800 died (Canavan & Doshi, 2000). Among gynecological cancers it ranks behind endometrial cancer and ovarian cancer. The incidence and mortality in the US are about half those for the rest of the world, which is due in part to the success of screening with the Pap smear.[47] Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Ovarian cancer is a malignant tumor (a kind of neoplasm) located on an ovary. ... The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ...


In Great Britain, the incidence is 8.8/100,000 per year (2001), similar to the rest of Northern Europe, and mortality is 2.8/100,000 per year (2003) (Cancer Research UK Cervical cancer statistics for the UK). With a 42% reduction from 1988-1997 the NHS implemented screening programme has been highly successful, screening the highest risk age group (25-49 years) every 3 years, and those ages 50-64 every 5 years.


A study published in 2002 (Castellsagué et al) reports that male circumcision can reduce the risk of penile HPV infection in a man, and so the risk of cervical cancer in his female partner. The authors state that "it would not make sense to promote circumcision as a way to control cervical cancer in the US, where Pap smears usually detect it at a treatable stage". However, Menczer (2004) quotes research that male circumcision probably does not contribute to a lower incidence of cervical cancer in Jewish populations.


One study suggests that prostaglandin in semen may fuel the growth of cervical and uterine tumours and that affected women may benefit from the use of condoms.[48][49] E1 - Alprostadil I2 - Prostacyclin A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. ... Horse semen being collected for breeding purposes. ... This article is about the male contraceptive device. ...


History

Epidemiologists working in the early 20th century noted that: Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. ...

  1. Cervical cancer was common in female sex workers.
  2. It was rare in nuns, except for those who had been sexually active before entering the convent. (Rigoni in 1841)
  3. It was more common in the second wives of men whose first wives had died from cervical cancer.
  4. It was rare in Jewish women.[50]
  5. In 1935, Syverton and Berry discovered a relationship between RPV (Rabbit Papillomavirus) and skin cancer in rabbits. (HPV is species specific and therefore cannot be transmitted to rabbits)

This led to the deduction that cervical cancer could be caused by a sexually transmitted agent. Initial research in the 1950s and 1960s put the blame on smegma (e.g. Heins et al 1958), but it wasn't until the 1970s that human papillomavirus (HPV) was identified. A description by electron microscopy was given earlier in 1949 and HPV-DNA was identified in 1963. It has since been demonstrated that HPV is implicated in virtually all cervical cancers.[51] Specific viral subtypes implicated are HPV 16, 18, 31 and 45. A sex worker in Germany A sex worker is a person who earns money by providing sexual services. ... For other uses, see Nun (disambiguation). ... For other uses, see Rabbit (disambiguation). ... Smegma, a transliteration of the Greek word σμήγμα for sebum, is a combination of exfoliated (shed) epithelial cells, transudated skin oils, and moisture, and can accumulate under the foreskin of males and within the vulva of females. ... “HPV” redirects here. ... The electron microscope is a microscope that can magnify very small details with high resolving power due to the use of electrons rather than light to scatter off material, magnifying at levels up to 500,000 times. ...


Notes

  1. ^ [1]
  2. ^ [2]
  3. ^ [3]
  4. ^ [4]
  5. ^ [5]
  6. ^ [6] American Cancer Society
  7. ^ [7]
  8. ^ [8]
  9. ^ [9]
  10. ^ [10]
  11. ^ [11]
  12. ^ [12]
  13. ^ [13]
  14. ^ [14] Ontario Government Website
  15. ^ [15] Government of Nova Scotia News Release June 20, 2007
  16. ^ [16] Kaiser Daily Women's Health Policy Aug 09, 2007
  17. ^ [17]
  18. ^ [18]
  19. ^ [19]
  20. ^ [20]
  21. ^ [21]
  22. ^ [22]
  23. ^ [23]
  24. ^ [24]
  25. ^ [25]
  26. ^ [26]
  27. ^ [27]
  28. ^ [28]
  29. ^ [29]
  30. ^ [30]
  31. ^ [31]
  32. ^ Most women unaware about HPV (MSNBC).
  33. ^ [32]
  34. ^ [33]
  35. ^ Saslow D, Runowicz CD, Solomon D, et al (2002). "American Cancer Society guideline for the early detection of cervical neoplasia and cancer". CA: a cancer journal for clinicians 52 (6): 342-62. PMID 12469763. 
  36. ^ [34]
  37. ^ BBC EU approves cervical cancer jab 22 September 2006
  38. ^ [35]
  39. ^ The Grand Rapids Press About the cervical cancer vaccine 17 August 2006
  40. ^ BBC Cancer jab 'stops 75% of deaths' 4 September 2006
  41. ^ [36]
  42. ^ Cervical Cancer. Cervical Cancer: Cancers of the Female Reproductive System: Merck Manual Home Edition. Merck Manual Home Edition. Retrieved on 2007-03-24.
  43. ^ Committee on Practice Bulletins-Gynecology (2002). "ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002". Obstetrics and gynecology 99 (5 Pt 1): 855-67. PMID 11978302. 
  44. ^ Cervical Cancer. Cervical Cancer: Pathology, Symptoms and Signs, Diagnosis, Prognosis and Treatment. Armenian Health Network, Health.am.
  45. ^ Cervical cancer statistics and prognosis. Cancer Research UK. Retrieved on 2007-03-24.
  46. ^ [37]
  47. ^ [38]
  48. ^ BBC Semen 'may fuel cervical cancer' 31 August 2006
  49. ^ Medical Research Council Semen can worsen cervical cancer
  50. ^ [39]
  51. ^ [40]

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 83rd day of the year (84th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 83rd day of the year (84th in leap years) in the Gregorian calendar. ... Current MRC logo The Medical Research Council (MRC) is a UK organisation dedicated to promot[ing] the balanced development of medical and related biological research in the UK. // The MRC is one of seven Research Councils and is answerable to, although politically independent from, the Office of Science and Innovation...

References

  • Canavan TP, Doshi NR. Cervical cancer. Am Fam Physician 2000;61:1369-76. Fulltext. PMID 10735343.
  • Castellsagué X, Bosch FX, Munoz N, Meijer CJ, Shah KV, de Sanjose S, Eluf-Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Moreno V, Franceschi S; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Male circumcision, penile human Papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002;346:1105-12. Fulltext. PMID 11948269.
  • Heins HC, Dennis EJ, Pratt-Thomas HR. The possible role of smegma in carcinoma of the cervix. Am J Obstet Gynec 1958:76;726-735. PMID 13583012.
  • Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, Roteli-Martins CM, Teixeira J, Blatter MM, Korn AP, Quint W, Dubin G; GlaxoSmithKline HPV Vaccine Study Group. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004;364(9447):1757-65. PMID 15541448.
  • Menczer J. The low incidence of cervical cancer in Jewish women: has the puzzle finally been solved? Isr Med Assoc J 2003;5:120-3. PDF. PMID 12674663.
  • Lehtinen M, Dillner J. Preventive human papillomavirus vaccination. Sex Transm Infect 2002;78:4-6. Fulltext. PMID 11872848.
  • Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004;364:249-56. PMID 15262102.
  • Snijders PJ, Steenbergen RD, Heideman DA, Meijer CJ. HPV-mediated cervical carcinogenesis: concepts and clinical implications J Pathol. 2006;208:152-64. PMID 16362994.
  • Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Munoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12-9. PMID 10451482.
  • International Angency for Research on Cancer, Lyons, France [41] The 7 most common types of HPV virus.

The New England Journal of Medicine (NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ...

External links

Courseware

  • Jo's Trust - fighting cervical cancer
  • Woman's Cancer Awareness
  • U.S. National Cancer Institute: Cervical cancer
  • What are the risk factors for cervical cancer? (American Cancer Society).
  • People Living With Cancer (PLWC): Cervical Cancer
  • Canadian Guidelines for Cervical Cancer Screening
  • Cervical Cancer Awareness 2007
  • The Cervical Cancer Blog
  • The European Parliament's Cervical Cancer Interest Group
  • Glenis Willmott MEP - Member of the European Parliament campaigning on cervical cancer issues
  • Australian Cancer Research Foundation
  • The Yellow Umbrella Tour - Raising Funds for Cervical Cancer

  Results from FactBites:
 
Cervical cancer - Wikipedia, the free encyclopedia (2707 words)
Cervical cancer is a malignancy of the cervix.
A Pap smear is insufficient for the diagnosis.
Cervical cancer is staged by the FIGO staging system, which is based on clinical examination, rather than surgical findings.
Cervical Cancer Treatment - National Cancer Institute (782 words)
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.
Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy.
  More results at FactBites »

 
 

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