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….is Cervical Cancer

As you might know by now, Cervical cancer incidence and mortality rates have decreased by more than 50% over the past three decades with the Papanicolaou (Pap) test, which can detect both cervical cancer and precancerous lesions. Please make sure you get your PAP exam yearly.

They are three types of cervical cancer

Squamous cell carcinoma — This type of cervical cancer is by far the most common it’s accounts for about 70 percent of all cases. Squamous cell carcinomas cover the outer part of the cervix closest to the uterus.

Adenocarcinomas — This type of cervical cancer accounts for about 25 percent of all cases. Adenocarcinomas start in the mucus-producing gland cells that line the endocervix.

Adenosquamous carcinomas — This cervical cancer which has both squamous cell and adenocarcinoma cell types is the rarest of the three types.

Symptoms

Cervical cancer presents a special challenge because you may not notice any signs or symptoms, especially when the condition is in its earliest stages. Because it can stay “hidden,” it’s important to start getting regular cervical cancer screening at age 21, regardless of how old you were when you first had sexual intercourse.

If you do have symptoms, they may include:

  • pain or bleeding during or after sex, douching, or a pelvic examination
  • pelvic pain
  • unusual vaginal discharge
  • blood or bleeding beyond your normal menstrual period

Since other conditions can cause these symptoms as well, it is important to see your doctor if you experience any of these symptoms.

Cervical cancer is classified into several stages

The process of finding out how far the cancer has spread is called staging. Information from exams and diagnostic tests is used to determine the size of the tumor, how deeply the tumor has invaded tissues in and around the cervix, and the spread to lymph nodes or distant organs (metastasis). This is an important process because the stage of the cancer is the key factor in selecting the right treatment plan.

The stage of a cancer does not change over time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by the stage it was given when it was first found and diagnosed, only information about the current extent of the cancer is added. A person keeps the same diagnosis stage, but more information is added to the diagnosis to explain the current disease status

A staging system is a way for members of the cancer care team to summarize the extent of a cancer’s spread. The 2 systems used for staging most types of cervical cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the AJCC (American Joint Committee on Cancer) TNM staging system, are very similar. Gynecologists and gynecologic oncologists use the FIGO system, but the AJCC system is included here to be complete. The AJCC system classifies cervical cancer on the basis of 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). The FIGO system uses the same information. The system described below is the most recent AJCC system, which went into effect January 2010. Any differences between the AJCC system and the FIGO system are explained in the text.

This system classifies the disease in stages 0 through IV. Staging is based on clinical rather than surgical findings. This means that the extent of disease is evaluated by the doctor’s physical examination and a few other tests that are done in some cases, such as cystoscopy and proctoscopy − it is not based on the findings during surgery or on imaging tests.

When surgery is done, it might show that the cancer has spread more than the doctors first thought. This new information could change the treatment plan, but it does not change the patient’s stage.

Tumor extent (T)

Tis: The cancer cells are only found on the surface of the cervix (in the layer of cells lining the cervix), without growing into deeper tissues. (Tis is not included in the FIGO system)

T1: The cancer cells have grown from the surface layer of the cervix into deeper tissues of the cervix. The cancer may also be growing into the body of the uterus, but it has not grown outside the uterus.

T1a: There is a very small amount of cancer, and it can be seen only under a microscope.

  • T1a1: The area of cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide.
  • T1a2: The area of cancer invasion is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide.

T1b: This stage includes stage I cancers that can be seen without a microscope. This stage also includes cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm.

  • T1b1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
  • T1b2: The cancer can be seen and is larger than 4 cm.

T2: In this stage, the cancer has grown beyond the cervix and uterus, but hasn’t spread to the walls of the pelvis or the lower part of the vagina. The cancer may have grown into the upper part of the vagina.

T2a: The cancer has not spread into the tissues next to the cervix (called the parametria).

  • T2a1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
  • T2a2: The cancer can be seen and is larger than 4 cm.

T2b: The cancer has spread into the tissues next to the cervix (the parametria)

T3: The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder).

  • T3a: The cancer has spread to the lower third of the vagina but not to the walls of the pelvis.
  • T3b: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters (this is called hydronephrosis).

T4: The cancer has spread to the bladder or rectum or it is growing out of the pelvis

Lymph node spread (N)

NX: The nearby lymph nodes cannot be assessed

N0: No spread to nearby lymph nodes

N1: The cancer has spread to nearby lymph nodes

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant organs (such as the lungs or liver), to lymph nodes in the chest or neck, and/or to the peritoneum (the tissue coating the inside of the abdomen).

Stage grouping and FIGO stages

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers. FIGO stages are the same as AJCC stages, except that FIGO staging doesn’t include the lymph nodes until stage III. In addition, stage 0 doesn’t exist in the FIGO system.

Stage 0 (Tis, N0, M0): The cancer cells are only in the cells on the surface of the cervix (the layer of cells lining the cervix), without growing into (invading) deeper tissues of the cervix. This stage is also called carcinoma in situ (CIS) which is part of cervical intraepithelial neoplasia grade 3 (CIN3). Stage 0 is not included in the FIGO system.

Stage I (T1, N0, M0): In this stage the cancer has grown into (invaded) the cervix, but it is not growing outside the uterus. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IA (T1a, N0, M0): This is the earliest form of stage I. There is a very small amount of cancer, and it can be seen only under a microscope.

The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • Stage IA1 (T1a1, N0, M0): The cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • Stage IA2 (T1a2, N0, M0): The cancer is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB (T1b, N0, M0): This includes stage I cancers that can be seen without a microscope as well as cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm. These cancers have not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB1 (T1b1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB2 (T1b2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): In this stage, the cancer has grown beyond the cervix and uterus, but hasn’t spread to the walls of the pelvis or the lower part of the vagina.

Stage IIA (T2a, N0, M0): The cancer has not spread into the tissues next to the cervix (called the parametria). The cancer may have grown into the upper part of the vagina. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • IIA1 (T2a1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IIA2 (T2a2, N0, M0): The cancer can be seen and is larger than 4 cm.
  • IIB (T2b, N0, M0): The cancer has spread into the tissues next to the cervix (the parametria).

Stage III (T3, N0, M0): The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • IIIA (T3a, N0, M0): The cancer has spread to the lower third of the vagina but not to the walls of the pelvis. It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IIIB (T3b, N0, M0; OR T1-T3, N1, M0): either:
  • cancer has grown into the walls of the pelvis and/or has blocked one or both ureters (a condition called hydronephrosis),

OR

  • cancer has spread to lymph nodes in the pelvis (N1) but not to distant sites (M0). The tumor can be any size and may have spread to the lower part of the vagina or walls of the pelvis (T1 to T3).

Stage IV: This is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.

  • IVA (T4, N0, M0): The cancer has spread to the bladder or rectum, which are organs close to the cervix (T4). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver.

Do we know what causes cervical cancer?

In recent years, scientists have made much progress toward understanding what happens in cells of the cervix when cancer develops. In addition, they have identified several risk factors that increase the odds that a woman might develop cervical cancer (see the previous section).

The development of normal human cells mostly depends on the information contained in the cells’ chromosomes. Chromosomes are large molecules of DNA. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually look like our parents because they are the source of our DNA. However, DNA affects more than the way we look.

Some genes (packets of our DNA) have instructions for controlling when our cells grow and divide. Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes.

HPV causes the production of 2 proteins known as E6 and E7 which turn off some tumor suppressor genes. This may allow the cervical lining cells to grow too much and to develop changes in additional genes, which in some cases will lead to cancer.

But HPV does not completely explain what causes cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.

Screening Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People

Cervical cancer screening should begin at age 21. For women ages 21-29, screening should be done every 3 years with conventional or liquid-based Pap tests. For women ages 30-65, screening should be done every 5 years with both the HPV test and the Pap test (preferred), or every 3 years with the Pap test alone (acceptable). Women ages 65+ who have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the past 10 years, with the most recent test occurring within 5 years, and women who have had a total hysterectomy should stop cervical cancer screening. Women should not be screened annually by any method at any age.

We need to spread the word about important steps women can take to stay healthy.

  • Encourage women to get their well-woman visit this year.
  • Let women know that the health care reform law covers well-woman visits and cervical cancer screening. This means that, depending on their insurance, women can get these services at no cost to them.
  • Talk to parents about how important it is for their pre-teens to get the HPV vaccine. Both boys and girls need the vaccine.

Please visit American Cancer Society which has more information on Cervical Cancer.[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]