What is Cervical Cancer ?
Cancer of the cervix: - Our understanding of cervical cancer has changed markedly over recent years. Arising in the lining cell of the cervix, cervical cancer seems to be
related to factors of sexual behavior and exposure in a complex but intimate way. It has been recognized that celibate women rarely get this disease, and its incidence is much lower in women whose sexual exposure has been limited to men who have been circumcised. On the other hand, women with multiple sexual partners, particularly during their teens, are at high risk.
Certain viruses including those of the herpes and papilloma group are increasingly suspected of playing a role in the cause of this disease and studies are now confirming that diet and other environmental factors play a significant role in the development of all cancers. There are also many who believe that emotional factors also influence this cancer.
Therefore, at present, there are a combination of possible causative factors relevant to cancer of the cervix including diet, genetic susceptibility, sexual exposures to viruses and psychological factors.
Symptoms of cervical cancer
Once symptoms occur, cervical cancer is often advanced. This is why the Pap smear (see below) is important. Symptoms include vaginal bleeding between periods, pain with intercourse, and a vaginal discharge.
Diagnosis
Cervical cancer can be detected in the very early stages when in fact it is more accurately described as dysplasia or pre- cancerous. This is thanks to the development of the Pap smear. During a pelvic exam, the physician takes a small scraping of the outside of the cervix which is sent for microscopic analysis. Although established cancers can be diagnosed this way, more commonly certain changes in the cells can be identified which are thought to precede the development of cancer, or else cancer confined to the very earliest stages (carcinoma-in- situ) may be identified.
When suspicious findings are found on Pap smears, the next approach is often colposcopy, whereby the physician views the cervix through a magnifying lens. In this way, abnormal areas invisible to the naked eye may be seen, guiding any further biopsies, or treatment. A more extensive biopsy under anesthesia may include a circular cuff or the cervix (cone biopsy) or even a hysterectomy in extensive cases (see below).
Please remember, however, that smear tests are the subject of some controversy because the results are not always accurate. The cervix is subject to minor changes at various times, some of which may be interpreted in a smear test as being abnormal. Remember also that the smear test itself has been known to be taken improperly and thereby produced unreliable results.
Conventional Treatment for cervical cancer
Pre-invasive cancer detected with the Pap smear can often be successfully treated with surgical removal, freezing, burning, or lasers. These techniques can be done under local anaesthetic except when the tissue area is extensive and, in some cases, a hysterectomy may be advised. The more invasive cancers will require hysterectomy of a more extensive nature, with removal of surrounding lymph nodes and other sites of likely spread and there are times when the ovaries may also have to be removed.
Radiation is the usual treatment for more advanced cervical cancers, and is used by some even in the early cancers as an alternative to surgery. A unique aspect of radiation therapy for this disease is the implantation of radioactive substances within the uterus and cervix, allowing higher doses to the tumour while largely sparing surrounding healthy tissue. This is generally used along with standard external radiation.
Advanced and disseminated cervical cancer are sometimes treated with drugs such as methotrexate, bleomycin, platinum and others.
Prognosis for pre-invasive cancers or pre-cancerous changes using conventional medicine is considered to be good; those cancers which are invasive only within the cervical tissue are estimated to be curable in over 90% of cases. But where cancerous tissue extends even just to the immediately surrounding areas, the prognosis is only approximately 55% and those which have affected the other pelvic organs drop to about 32%.
As with other medical procedures, there is some controversy surrounding not just the smear test (see above), but also the treatments themselves.
The Controversy - There are five main possible results from a smear test: -
1. Inflammatory Changes - an inflammation caused by bacteria, viruses, etc. and creating cell changes.
2. CIN 1 - Mild dysplasia: Abnormal cell changes in the bottom third or less of the covering of the skin of the cervix.
3. CIN 2 - Moderate dysplasia - Cell changes in the bottom third to two-thirds of the epithelium.
4. CIN 3 - (a) Severe dysplasia - Cell changes in a minimum of two thirds of the epithelium but not the whole layer.
(b) Carcinoma-in-situ - Cancer cells in the epithelium or surface layer of the cervix.
5. Cancer - micro invasive - first stage of more serious cancer. Cancer cells shown below the epithelium of the cervix into the deeper tissues.
It is important to note that not all cases of CIN 1 and 2 develop into cancer and, even with more severe changes in CIN 3, it has been reported that only 50% will go on to become cancerous if they remain untreated.
However, as with many medical procedures, there are risks associated with the aforementioned treatments. For instance, cone biopsies can leave fibrosis (scarring), weaken the cervix, and make subsequent labours more difficult. Other treatments may damage the cervix walls and lead to more painful period pains. It is always advisable to be fully informed of all that a treatment entails before choosing which treatment might be best for you and these can always be discussed with your doctor.
Remember also, that conventional medical procedures focus on the symptom, in this case, eradicating the abnormal cells or cancerous growth. They generally ignore the underlying causative factors, especially diet, lifestyle and emotional aspects. Fortunately there is increasing clinical, epidemiological and emperical research revealing that alternative therapies may significantly help in the treatment and prevention of cervical dysplasia/cancer.
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