Cervical cancer

Cervical cancer

Cervical cancer is a malignant neoplasm of  cervix or in  the area of cervix. It may be vaginal bleeding but symptoms could be absent until the cancer is at an advanced stage. Treatment included , surgery (including local area excision) in early stages of cancer ,other one is chemotherapy and radiotherapy in advanced stages of cancer.

Pap smear screening can you identify potentially precancerous changes. Treatment of high-level changes may prevent cancer development. In developed countries, widespread use of screening programs for cervical cancer decrease the incidence of invasive cervical cancer by 50% or more. Human Papilloma Virus (HPV) is a significant factor in the development of nearly all cases of cervical cancer.HPV effective vaccines against two strains of HPV that are currently responsible for approximately 70% of cancers of the uterine cervix were registered in the United States, Canada, Australia and the EU.

The cervix is the narrowest part of the uterus where it joins the upper vagina. Most cervical cancers are squamous cell carcinoma ,can arise in the squamous (flattened) epithelial cells lining in the cervix. Adenocarcinoma can originate in glandular epithelial cells are the second most common form of cancer. In very rare cases, cancer may occur in other types of cells in the cervix of the uterus.

Since vaccines only cover some of the carcinogens (high risk) HPV types, women should seek regular Pap tests, even after vaccination.

Causes

Human Papillomavirus (HPV) in high-risk types were found to be essential for the development of cervical cancer. HPV DNA can be detected in almost all cervical cancers. Not all etiologies of cervical cancer is known. Many other factors are involved.

• Human papillomavirus infection :

In the U.S each year over 6.2 million new HPV infections in men and women, according to the CDC, 10 percent will continue to develop renewable displaysia or cancer of the cervix uterus. That is why HPV is known as cold  sexually transmitted infections worldwide. It is common, affecting about 80 percent of all sexually active people, whether or not symptoms. The factor of greatest risk of developing cervical cancer is infection by a strain of high-risk human papillomavirus. The virus cancer link works by triggering changes in the cells of the cervix that may lead to the development of cervical intraepithelial neoplasia, which could  lead easily to cancer. Women who have multiple sexual partners (or having sex with men who had many partners) have a higher risk.

More than 150 HPV has been recognized (some sources indicate more than 200 subtypes). Of these, 15 are classified as at great 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 at lower risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108). Types 16 and 18 are generally recognized as being responsible for approximately 70% of cervical cancers. Together with type 31, they are the most important risk factor for cervical cancer.

Genital warts are usually caused by different strains of HPV that are not normally associated with cervical cancer. However, it is possible to have more shares in the same time, including those that can cause cervical cancer with those that cause warts. 
The accepted medical paradigm, officially endorsed by the American Cancer Society and other organizations, is that the patient must have been infected with HPV develop cervical cancer, so it is considered a sexually transmitted disease, but Most Women infected with high risk HPV will not develop cervical cancer.Use of condoms reduces, but does not always prevent transmission. Likewise, HPV can be transmitted through skin to skin contact with infected areas. Among men, there is no commercially available test for HPV, but HPV is thought to grow preferentially in the epithelium of the glans penis, and cleaning this area may be preventative.

• Cofactors

The American Cancer Society offers the following list of risk factors for cervical cancer: human papilloma virus (HPV), smoking, HIV infections, chlamydia infection, stress and stress disorders, factors Dietary, hormonal contraception, multiple pregnancies, exposure to the hormone diethylstilbestrol (DES) and a family history of cancer of the cervix. There is a great possible genetic risk factor associated with the HLA-B7. There was no conclusive evidence to support the claim that male circumcision reduces the risk of members of cervical cancer, although some researchers say there is no convincing epidemiological evidence that men who are circumcised are less likely to be infected with HPV. However, among men with low risk sexual behaviors and monogamous couples, circumcision makes no difference in risk of cervical cancer.

Sign and symptoms

The early stages of cervical cancer could be completely asymptomatic. Vaginal bleeding, contact bleeding or ( very rare ) a vaginal mass can indicate the presence of a malignant tumor. In addition, moderate pain during intercourse and vaginal discharge are symptoms of cancer of the cervix. In advanced disease, metastases may be present in the stomach, lungs or elsewhere. Symptoms of cancer of the cervix uteri advanced 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 faeces through the vagina, and fractures.



Diagnosis

Although cytology is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often the colposcopy, a magnified visual inspection of the cervix aided by using dilute acetic acid (eg vinegar) solution to highlight abnormal cells on the surface of the cervix. Colposcopic impression assessment of disease severity based on visual inspection, which is part of the diagnosis. Other diagnostic and treatment procedures are loop electrical cutting procedure (LEEP) and conization with the inner surface of the cervix was examined pathologically. These are facts, if the biopsy confirms severe cervical intraepithelial neoplasia.

Potentially precancerous lesions :

Cervical intraepithelial neoplasia potential precursor of cervical cancer is often diagnosed at the examination of cervical biopsies by a pathologist. In premalignant dysplastic changes, CIN (cervical intraepithelial neoplasia) grading is commonly used. Designation and grading for cervical precursor lesions has changed several times during the 20th century. World Health Organization classification system was descriptive lesions mention mild dysplasia, moderate or severe or carcinoma in situ (CIS). The term cervical intraepithelial neoplasia (CIN) was developed to focus on the spectrum of abnormalities in these lesions and help normalize treatment.It classified as mild dysplasia CIN 1, moderate dysplasia and severe dysplasia, CIN2 and CIN3 CIS. Recently, CIN2 and CIN3 are combined to CIN2 / 3 These results are what the pathologist can report from a biopsy.


Sub types of cervical cancer

Histological subtypes of invasive cervical cancer are: Although squamous cell carcinoma is cancer of the cervix with the most impact, the incidence of cervical adenocarcinoma has increased in recent decades .

• Squamous cell carcinoma (80-85% ).
• Adenocarcinoma (approximately 15% of cervical cancers in the United Kingdom).
• Adenosquamous carcinoma .
• Small cell carcinoma .
• Neuroendocrine carcinoma .
• Non malignant carcinoma may rarely occur in the cervix .included lympoma and melanoma .

Note uterus include FIGO stage melanoma that does not include the lymph nodes in contrast to the TNM classification for most other cancer condition . For cases  which treated surgically, information collected from the pathologist may use to assign a separate pathologic stage but not to replace the initial clinical phase.