Cervical Cancer

Reviewed by Louise Chang, MD on September 21, 2011
Sources: © 2011 WebMD

What Is Cervical Cancer?
Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus. More than 12,000 new cases are diagnosed each year in the U.S. A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable.

Symptoms of Cervical Cancer
When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses, symptoms may include:
Unusual vaginal discharge
Vaginal bleeding between periods
Bleeding after menopause
Bleeding or pain during sex

Top Cause of Cervical Cancer: HPV
The human papillomavirus (HPV) is a large group of viruses. About 40 types can infect the genital areas, and some have high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix. And it's these changes that may lead to cancer. Worldwide, over 90% of cervical cancers are caused by an HPV infection.

Symptoms of HPV
HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It's important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms.

Who Is at Risk for HPV?
HPV is so common that most people who have ever had sex -- both women and men -- will get the virus at some point in life. Because HPV can linger quietly, it's possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis, and to anal and oral cancers in both sexes.

How HPV Causes Cervical Cancer
If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer.  But over time, the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas.

What Else Raises Your Risk?

Hispanic and African-American women have higher rates of cervical cancer than white women. The risk is also higher in infected women who:
Smoke
Have many children
Use birth control pills for a long time
Are HIV positive or have a weakened immune system

Early Detection: Pap Test
The Pap test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormalities, often before cancer appears. Women should start having Pap tests three years after becoming sexually active and no later than age 21. How often tests are done depends on the type of test, your personal risk factors, and your medical history.  Skipping Pap tests raises your risk for invasive cervical cancer.
Of note: You'll still need Pap tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.

What If Your Pap Test Is Abnormal?
If test results show a minor abnormality, you may need a repeat Pap test. Your doctor may schedule a colposcopy -- an exam with a lighted magnifying device -- or biopsy to get a better look at any changes in the cervical tissue. If abnormal cells are precancerous, they can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.

Early Detection: HPV DNA Test
In some cases, doctors may offer the option of the HPV DNA test in addition to a Pap test. This test checks for the presence of high-risk forms of HPV. It may be used in combination with a Pap test to screen for cervical cancer in women over 30. It may also be recommended for a woman of any age after an abnormal Pap test result.

Diagnosing Cervical Cancer: Biopsy
A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells, and cancer cells. In most cases, a biopsy takes place in a doctor's office with local anesthesia. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix, but this test may require general anesthesia.

Stages of Cervical Cancer
Stage 0 describes cancer cells found only on the surface of the cervix.  More invasive cancers are separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the tumor has spread to the upper part of the vagina. A Stage III tumor extends to the lower part of the vagina and may block urine flow. In Stage IV, the tumor has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumors.

Treatment: Surgery
If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer. Typically this involves a hysterectomy, the removal of the cervix and uterus as well as some of the surrounding tissue. The surgeon may also remove the fallopian tubes, ovaries, and lymph nodes near the tumor.

Treatment: Radiation
External radiation therapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the tumor. Women with cervical cancer are often treated with a combination of radiation and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting, and loose stools.

Treatment: Chemotherapy
Chemotherapy uses drugs to reach cancer wherever it is in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting, and loss of appetite.

Coping With Cancer Treatments
Cancer treatments may make you tired or uninterested in food. But it's important to take in enough calories to maintain a healthy weight. Check with a dietitian for tips on eating well during cancer treatment. Staying active is also important. Gentle exercise can increase your energy while reducing nausea and stress. Check with your doctor to find out which activities are appropriate for you.

Cervical Cancer and Fertility
Treatment for cervical cancer often involves removing the uterus and may also involve removing the ovaries, ruling out a future pregnancy. However, if the cancer is caught very early, you still may be able to have children after surgical treatment. A procedure called a radical trachelectomy can remove the cervix and part of the vagina while leaving the majority of the uterus intact.

Survival Rates for Cervical Cancer
The odds of surviving cervical cancer are tied to how early it's found. Depending on the stage, between 93% and 15% of women will survive for at least five years after diagnosis. Keep in mind that these numbers are based on women treated between 2000 and 2002. The treatments and outlook may be better for those diagnosed today. And statistics don't predict how well any one individual will respond to treatment.

Vaccine to Help Prevent Cervical Cancer
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Both Cervarix and Gardasil require three doses over a six-month period. Studies suggest the vaccines are effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers.  Gardasil also protects against two types of HPV that cause genital warts.

Who Should Get the HPV Vaccine?
The vaccines are only used to prevent, not treat, HPV infection. They are most effective if administered before an individual becomes sexually active. The CDC recommends girls get an HPV vaccine series when they are 11 or 12.  It can also be given as a catch-up vaccine for girls and women from ages 13 to 26.

Read More

Cervical Cancer

Reviewed by Louise Chang, MD on September 21, 2011
Sources: © 2011 WebMD

What Is Cervical Cancer?
Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus. More than 12,000 new cases are diagnosed each year in the U.S. A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable.

Symptoms of Cervical Cancer
When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses, symptoms may include:
Unusual vaginal discharge
Vaginal bleeding between periods
Bleeding after menopause
Bleeding or pain during sex

Top Cause of Cervical Cancer: HPV
The human papillomavirus (HPV) is a large group of viruses. About 40 types can infect the genital areas, and some have high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix. And it's these changes that may lead to cancer. Worldwide, over 90% of cervical cancers are caused by an HPV infection.

Symptoms of HPV
HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It's important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms.

Who Is at Risk for HPV?
HPV is so common that most people who have ever had sex -- both women and men -- will get the virus at some point in life. Because HPV can linger quietly, it's possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis, and to anal and oral cancers in both sexes.

How HPV Causes Cervical Cancer
If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer.  But over time, the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas.

What Else Raises Your Risk?

Hispanic and African-American women have higher rates of cervical cancer than white women. The risk is also higher in infected women who:
Smoke
Have many children
Use birth control pills for a long time
Are HIV positive or have a weakened immune system

Early Detection: Pap Test
The Pap test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormalities, often before cancer appears. Women should start having Pap tests three years after becoming sexually active and no later than age 21. How often tests are done depends on the type of test, your personal risk factors, and your medical history.  Skipping Pap tests raises your risk for invasive cervical cancer.
Of note: You'll still need Pap tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.

What If Your Pap Test Is Abnormal?
If test results show a minor abnormality, you may need a repeat Pap test. Your doctor may schedule a colposcopy -- an exam with a lighted magnifying device -- or biopsy to get a better look at any changes in the cervical tissue. If abnormal cells are precancerous, they can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.

Early Detection: HPV DNA Test
In some cases, doctors may offer the option of the HPV DNA test in addition to a Pap test. This test checks for the presence of high-risk forms of HPV. It may be used in combination with a Pap test to screen for cervical cancer in women over 30. It may also be recommended for a woman of any age after an abnormal Pap test result.

Diagnosing Cervical Cancer: Biopsy
A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells, and cancer cells. In most cases, a biopsy takes place in a doctor's office with local anesthesia. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix, but this test may require general anesthesia.

Stages of Cervical Cancer
Stage 0 describes cancer cells found only on the surface of the cervix.  More invasive cancers are separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the tumor has spread to the upper part of the vagina. A Stage III tumor extends to the lower part of the vagina and may block urine flow. In Stage IV, the tumor has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumors.

Treatment: Surgery
If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer. Typically this involves a hysterectomy, the removal of the cervix and uterus as well as some of the surrounding tissue. The surgeon may also remove the fallopian tubes, ovaries, and lymph nodes near the tumor.

Treatment: Radiation
External radiation therapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the tumor. Women with cervical cancer are often treated with a combination of radiation and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting, and loose stools.

Treatment: Chemotherapy
Chemotherapy uses drugs to reach cancer wherever it is in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting, and loss of appetite.

Coping With Cancer Treatments
Cancer treatments may make you tired or uninterested in food. But it's important to take in enough calories to maintain a healthy weight. Check with a dietitian for tips on eating well during cancer treatment. Staying active is also important. Gentle exercise can increase your energy while reducing nausea and stress. Check with your doctor to find out which activities are appropriate for you.

Cervical Cancer and Fertility
Treatment for cervical cancer often involves removing the uterus and may also involve removing the ovaries, ruling out a future pregnancy. However, if the cancer is caught very early, you still may be able to have children after surgical treatment. A procedure called a radical trachelectomy can remove the cervix and part of the vagina while leaving the majority of the uterus intact.

Survival Rates for Cervical Cancer
The odds of surviving cervical cancer are tied to how early it's found. Depending on the stage, between 93% and 15% of women will survive for at least five years after diagnosis. Keep in mind that these numbers are based on women treated between 2000 and 2002. The treatments and outlook may be better for those diagnosed today. And statistics don't predict how well any one individual will respond to treatment.

Vaccine to Help Prevent Cervical Cancer
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Both Cervarix and Gardasil require three doses over a six-month period. Studies suggest the vaccines are effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers.  Gardasil also protects against two types of HPV that cause genital warts.

Who Should Get the HPV Vaccine?
The vaccines are only used to prevent, not treat, HPV infection. They are most effective if administered before an individual becomes sexually active. The CDC recommends girls get an HPV vaccine series when they are 11 or 12.  It can also be given as a catch-up vaccine for girls and women from ages 13 to 26.

Read More

Colorectal Cancer Overview

Reviewed by Brunilda Nazario, MD on August 03, 2009
Source: © 2009 WebMD

Colorectal Cancer: What Is It?

Colorectal cancer is the third most frequently diagnosed cancer in men and women and the second highest cause of cancer deaths in the U.S. Yet, when found early, it is highly curable. This type of cancer occurs when abnormal cells grow in the lining of the large intestine (colon) or rectum. Learn more about who gets colorectal cancer, how it is detected, and what the latest treatments can accomplish.

Colorectal Cancer: How It Starts
Colorectal cancers often begin as polyps – benign growths on the surface of the colon. The two most common types of intestinal polyps are adenomas and hyperplastic polyps. They develop when there are errors in the way cells grow and repair the lining of the colon. Most polyps remain benign, but some have the potential to turn cancerous. Removing them early prevents colorectal cancer.

Risk Factors You Can't Control
Your risk of colorectal cancer depends on genetics and lifestyle. Factors you can't control include:
-Age – most patients are older than 50
-Polyps or inflammatory bowel disease
-Family history of colorectal cancer
-History of ovarian or breast cancer

Risk Factors You Can Control
Some factors that raise the risk of colorectal cancer are within your control:
-Diet high in red, processed, or heavily cooked meats
-Being overweight (excess fat around the waist)
-Exercising too little
-Smoking or drinking alcohol

 Colorectal Cancer Warning Signs
There are usually no early warning signs for colorectal cancer. For this reason it's important to get screened. Detecting cancer early means it's more curable. As the disease progresses, patients may notice blood in the stool, abdominal pain, a change in bowel habits (such as constipation or diarrhea), unexplained weight loss, or fatigue. By the time these symptoms appear, tumors tend to be larger and more difficult to treat.



Colorectal Cancer Screening
Because colorectal cancer is stealthy, screenings are the key to early detection. Beginning at age 50, most people should have a colonoscopy every 10 years. This procedure uses a tiny camera to examine the entire colon and rectum. These tests not only find tumors early, but can actually prevent colorectal cancer by removing polyps (shown here).

Virtual Colonoscopy
There is now an alternative to colonoscopy that uses CT scan images to construct a 3-D model of your colon. Called virtual colonoscopy, the procedure can reveal polyps or other abnormalities without actually inserting a camera inside your body. The main disadvantage is that if polyps are found, a real colonoscopy will still be needed to remove and evaluate them.

X-Rays of the Colon (Lower GI)
X-Rays of the colon -- using a chalky liquid known as barium as a contrast agent -- allow your doctor a glimpse at the interior of the colon and rectum, offering another way to detect polyps, tumors, and changes in the intestinal tissue. Shown here is an "apple core" tumor constricting the colon. Like the virtual colonoscopy, any abnormalities that appear on the X-rays will need to be followed up with a conventional colonoscopy.

Diagnosing Colorectal Cancer
If testing reveals a possible tumor, the next step is a biopsy. During a colonoscopy, your doctor will remove polyps and take tissue samples from any parts of the colon that look unusual. This tissue is examined under a microscope to determine whether or not it is cancerous. Shown here is a color-enhanced, magnified view of colon cancer cells.

Taging Colorectal Cancer
If cancer is detected, it will be "staged," a process of finding out how far the cancer has spread. Tumor size may not correlate with the stage of cancer. Staging also enables your doctor to determine what type of treatment you will receive.
-Stage I – Cancer has not spread beyond the inside of the colon or rectum
-Stage II – Cancer has spread into the muscle layer of the colon or rectum
-Stage III - Cancer has spread to one or more lymph nodes in the area
-Stage IV – Cancer has spread to other parts of the body, such as the liver, lung, or bones. This stage does NOT depend on how deep the tumor has penetrated or if the disease has spread to the lymph nodes near the tumor.

Colorectal Cancer Survival Rates
The outlook for your recovery depends on the stage of your cancer, with higher stages meaning more serious cancer. The five-year survival rate refers to the percentage of patients who live at least five years after being diagnosed. Stage I has a 93% five-year survival rate while stage IV has a five-year survival rate of only 8%.

Colorectal Cancer Surgery
In all but the last stage of colorectal cancer, the usual treatment is surgery to remove the tumor and surrounding tissue. In the case of larger tumors, it may be necessary to take out an entire section of the colon and/or rectum. The good news is that surgery has a very high cure rate in the early stages. If the cancer has spread to the liver, lungs, or other organs, surgery is not likely to offer a cure -- but removing the additional tumors, when possible, may reduce symptoms.

Treating Advanced Colorectal Cancer
When colorectal cancer has spread to one or more lymph nodes (stage III), it can still be cured. Treatment typically involves a combination of surgery, radiation (being administered here), and chemotherapy. If the cancer comes back after initial treatment or spreads to other organs, it becomes much more difficult to cure. But radiation and chemotherapy can still relieve symptoms and help patients live longer.

Coping With Chemotherapy
Chemotherapy has come a long way from the days of turning people's stomachs. Newer drugs are less likely to cause this problem, and there are also medications to control nausea if it does occur. Clinical trials continue to search for chemotherapy drugs that are more effective and tolerable.

Radiofrequency Ablation
Radiofrequency ablation (RFA) uses intense heat to burn away tumors. Guided by a CT scan, a doctor inserts a needle-like device that delivers heat directly to a tumor and the surrounding area. This offers an alternative for destroying tumors that cannot be surgically removed. In patients with a limited number of liver metastases that cannot be removed by surgery, chemotherapy is sometimes combined with RFA for tumor destruction.

Preventing Colorectal Cancer: Diet
There are steps you can take to dramatically reduce your odds of developing colorectal cancer. Researchers estimate that eating a nutritious diet, getting enough exercise, and controlling body fat could prevent 45% of colorectal cancers. The National Cancer Institute recommends a low-fat diet that includes plenty of fiber and at least five servings of fruits and vegetables per day.

Preventing Cancer With Exercise

Physical activity appears to be a powerful weapon in the defense against colorectal cancer. In one study, the most active participants were 24% less likely to have the cancer than the least active people. It didn't matter whether the activity was linked to work or play. The American Cancer Society recommends exercising for at least 30 minutes most days of the week.

Read More