Women's Health | October 9, 2014 | Author: The Super Pharmacist
Cervical cancer is a condition in which abnormal, malignant cells develop in the neck of the womb. This structure is a junction between the vagina and womb, also known as the cervix. This type of cancer is also associated with a high rate of mortality. Advanced forms of the cancer can cause structural damage to the cervix, and possibly to the uterus, which may result in pain and bleeding.
HPV is understood to act by integrating its genome into that of the cells that make up the cervical lining (cervical epithelial cells), which is done to ensure the synthesis of new virus particles as new cells are produced. If the virus integrates into a certain region of the cervical DNA sequence, it increases the risk of abnormal gene reproduction, which in turn increases the risk of cells becoming abnormal and malignant, or dysplastic.
Abnormal cell growth begins as cervical intraepithelial neoplasia (CIN).
This is a precursor stage to the establishment of tumours, and onwards to advanced cervical cancer. CIN, or mild dysplasia, progresses to moderate dysplasia (CIN2), which develops into formal cancer in situ (CIS).
There are a number of cancer types that can develop in the cervix from the CIN2 stage, which all fall under the category of cervical cancer. These include:
These are generally differentiated by the type of cell or location in the cervix from which they arise. Dysplasia and CIN may take five to ten years to develop, and malignancy may take a decade or more to progress. Therefore, the majority of cervical cancer cases tend to be found in women of 35 to 55 years of age, arising from infections contracted up to twenty years beforehand.
Smoking is another major risk factor for cervical cancer development.
Early cervical cancer may be asymptomatic. As the condition progresses, it may result in pelvic or abdominal pain and/or swelling. Cervical cancer may be associated with other signs and symptoms, including:
Prospective prophylactic measures may be the best strategy to avoid cervical cancer development. These include:
Vaccination against HPV
An increasingly popular and effective measure is the vaccine against HPV, which inoculates against two major strains of the virus associated with cervical cancer.
Safe sex practices
Behaviours such as practicing safe sex such as the use of condoms and other protective devices to avoid transmission of the HPV virus.
Screening is an important component of cervical cancer prevention
As cervical cell dysplasia and early cancer development is largely asymptomatic, this increases the risk of malignant tumour growth and even metastasis progressing undetected without treatment. Screening techniques, such as the Papanicolaou test (or 'Pap smear') have demonstrated significant efficacy in detecting dysplasia and CIS16.
Lack of awareness
Factors that affect the efficacy of preventative measures include the lack of awareness of cervical cancer, its symptoms, the importance of screening and the role of HPV in cancer development. A lack of awareness, or inavailability of, the HPV vaccine may also contribute to a reduced rate of inoculation against the virus, and thus an increased risk of cervical cancer.
Treatment options for cervical cancer include:
Removal of cervical cancer cells or tumours is one of the most effective treatments for this condition.
However, the application of surgery may be complicated by factors including the availability of treatment (particularly relevant to developing countries) and the wishes of patients to retain gynaecological integrity (i.e. to preserve their fertility or reproductive integrity as much as possible).
This issue may be affected by surgeon skill, the severity of cancer progression, and by the availability of surgeons skilled enough to spare enough tissue to retain fertility. However, the latency of treatment after diagnosis is not associated with reduced survival. Therefore, if a patient wants to wait for a fertility-saving treatment to become available to her, it may be safe for her to do so.
Types of cervical cancer surgery include:
This is often performed in response to the detection of dysplasia or early cervical cancer. As the name suggests, a conical portion of tissue containing cancerous cells or small tumours is removed from the cervix. If this tissue contains a significant portion of the malignant cells (i.e. there are no abnormal cells at the margins of this sample, indicating that the cancer has not spread further) this procedure may be effective in halting the progression of cervical cancer. If not, the next phase in surgical treatment may be required.
In this procedure, all or most of the cervix is removed. Ideally, this prevents further cancer progression, i.e. metastasis to the womb or other organs. Trachelectomy may be preferred by patients, as it leaves reproductive organs in place. However, if tumours are detected in the womb in the course of trachelectomy, more extensive surgery (i.e. hysterectomy) may also be performed as part of the procedure. This should not be done without prior informed consent from the patient.
A course of chemotherapy may be administered following surgery, to ensure that further dysplasia or malignant cell growth does not arise. Chemotherapy for cervical cancer takes the form of one or more drugs designed to kill abnormal cells.
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