GYNECOLOGIC ONCOLOGY

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Background
The cervix is the portion of the uterus that extends into the vagina. Recent research into the cause of cervical cancer has discovered that persistent infections with the Human Papillomavirus (HPV) is necessary and causative in virtually all cases of cervical cancer. Cervical cancer develops slowly in cells infected with the virus.

Cancer of the cervix is a devastating disease throughout the world. It is the second leading cause of cancer deaths in developing countries. In the United States, however, screening of the cells of the cervix with Pap tests has dramatically reduced cervical cancer.

Risk Factors
Women who have the greatest risk of developing cervical cancer are those who do not get regular gynecologic examinations and appropriate cervical cancer screening. Other women with an increased risk are those who have multiple sexual partners, a partner with multiple partners, sexual activity at an early age, tobacco use, or some condition leading to decreased functioning of the immune system as HIV, chemotherapy, or organ transplant.

Symptoms and Diagnosis
Early physical signs of cervical cancer are abnormal vaginal bleeding, discharge or pelvic pain. Often, these symptoms occur during or after intercourse. These symptoms should never be ignored, even if a woman has not been sexually active for years, since cervical cancer may take more than 10 years to grow from a minor abnormality. Fortunately, most patients' routine cervical screening tests show abnormal cellular changes long before an actual cancer has developed.

Treatment Methods
Abnormal cellular changes detected in a Pap test are usually removed before they can grow into a cancer. These treatments include minor procedures on the cervix such as biopsies, laser, and freezing that is known as cryotherapy. Recent development of outpatient LEEP (loop electrical excision procedure) has greatly simplified and decreased complications in the treatment of precancerous cervical abnormalities.

Treatment of cervical cancer depends upon the type and extent of the disease when it is diagnosed. The very earliest of stages can be treated and cured with a simple hysterectomy. For those in whom the cancer is believed to be confined to the cervix, a more extensive hysterectomy, known as a radical hysterectomy can be performed. This procedure removes some tissue around the cervix to assure all cancer is removed. Lymph nodes in the pelvis are generally removed along with this procedure to remove any tumor that has spread to these areas and to determine the best means of treating these patients postoperatively. Radiation in combination with chemotherapy is the preferred treatment of more advanced stages and can be used in those with early stage cancers as well. The prognosis for patients with cervical cancer depends upon its type, its degree of cellular abnormality, and its amount of spread or stage when first diagnosed and treated.

Research and Vision
Strategies to prevent infection of patients with HPV include the development of prophylactic vaccines. These vaccines preventing viral infection first became available in 2006 and are predicted to decrease significantly sickness and death from cervical cancer in future generations.

Clinical trials are the only way new drugs and treatments can be evaluated in a systematic manner to prove or disprove improved efficacy. These trials offer patients the opportunity to receive the latest and most advanced treatment. Patients should discuss with their doctor what clinical trials are available for them and if they might benefit from participating in one.

In the last few decades medical science has made incredible progress in the understanding, prevention, diagnosis, and treatment of cervical cancer. Hopefully, these amazing advances will soon be available globally to all women.

For more detailed information about the staging and treatment of cervical cancer, please see the National Cancer Institute's website at www.nci.nih.gov/cancertopics next click on women's cancers, and then click on cervical cancer.