Defining CancerCervicalCancerCancer is a termused for diseasesin which abnormalcells dividewithout controland are able toinvade othertissues.Cancer cells can spread to other partsof the body through the blood andlymph systems.Cancer cells can spread to other partsof the body through the blood andlymph systems.Cancer is not just one disease butmany diseases.There are more than 100 differenttypes of cancer.
Cancer TypesCervicalCancerCancer types can be grouped into broader categories.The main categories of cancer include:• Carcinoma cancer that begins in the skin or in tissues that line orcover internal organs.• Sarcoma cancer that begins in bone, cartilage, fat, muscle,blood vessels, or other connective or supportivetissue.• Leukemia cancer that starts in blood-forming tissue such as thebone marrow and causes large numbers of abnormalblood cells to be produced and enter the blood.• Lymphoma andmyelomacancers that begin in the cells of the immune system.• Central nervoussystem cancerscancers that begin in the tissues of the brain andspinal cord.
The CervixCervicalCancerThe cervix is part of awoman’s reproductivesystem.It’s in the pelvis.Is the lower, narrowpart of the uterus(womb).The cervix is apassageway:The cervix connects the uterus to thevagina. During a menstrual period,blood flows from the uterus throughthe cervix into the vagina. The vaginaleads to the outside of the body.The cervix makes mucus. During sex,mucus helps sperm move from thevagina through the cervix into theuterus.During pregnancy, the cervix is tightlyclosed to help keep the baby insidethe uterus. During childbirth, thecervix opens to allow the baby topass through the vagina.
Cervix and nearby organsThe CervixCervicalCancer
Cancer CellsCancer begins incells, the buildingblocks that makeup tissues. Tissuesmake up theorgans of thebody.• Normal cells grow and divide toform new cells as the bodyneeds them.• When normal cells grow old orget damaged, they die, and newcells take their place.Sometimes, thisprocess goeswrong. New cellsform when thebody does not needthem, and old ordamaged cells donot die as theyshould.• The buildup of extra cells oftenforms a mass of tissue called agrowth or tumor.CervicalCancer
Cancer CellsCervicalCancerGrowths on the cervix can be benign or malignant.Benign growths are not cancer. They are not as harmful as malignantgrowths (cancer).Benign growths (polyps, cysts, or genital warts):• are rarely a threat to life• don’t invade the tissues around themMalignant growths (cervical cancer):• may sometimes be a threat to life• can invade nearby tissues and organs• can spread to other parts of the body
CervicalCancer How does cervical cancer start?The spread of cancer is called metastasis.The cancer cells may attach to other tissues and grow toform new tumors that may damage those tissues.The cancer cells can spread by breaking away from theoriginal (primary) tumor. They enter blood vessels or lymphvessels, which branch into all the tissues of the body.Cervical cancer begins in cells on the surface of the cervix.Over time, the cervical cancer can invade more deeply intothe cervix and nearby tissues.
Risk FactorsCervicalCancerWhen you get a diagnosis of cancer, it’s natural to wonder what mayhave caused the disease. Doctors cannot always explain why onewoman develops cervical cancer and another does not.However, we do know that a woman with certain risk factors may bemore likely than others to develop cervical cancer. A risk factor issomething that may increase the chance of developing a disease.Studies have found a number of factors that may increase the riskof cervical cancer.Infection with HPV (human papillomavirus)is the main cause of cervical cancer. HPV infection and other riskfactors may act together to increase the risk even more.
Risk FactorsCervicalCancerHPV infection:HPV is a group ofviruses that caninfect the cervix. AnHPV infection thatdoesn’t go away cancause cervical cancerin some women.HPV is the cause ofnearly all cervicalcancers.HPV infections are very common.These viruses are passed from person toperson through sexual contact. Mostadults have been infected with HPV atsome time in their lives, but mostinfections clear up on their own.Some types of HPV can cause changes tocells in the cervix.If these changes are found early, cervicalcancer can be prevented by removing orkilling the changed cells before they canbecome cancer cells.
Risk FactorsCervicalCancer• Lack of regularPap Smear tests:Cervical cancer is more common among women whodon’t have regular Pap tests. The Pap test helpsdoctors find abnormal cells. Removing or killing theabnormal cells usually prevents cervical cancer.• Smoking: Among women who are infected with HPV, smokingcigarettes slightly increases the risk of cervical cancer.• Weakenedimmune system:the body’s natural defense system): Infection withHIV (the virus that causes AIDS) or taking drugs thatsuppress the immune system increases the risk ofcervical cancer.• Sexual history: Women who have had many sexual partners have ahigher risk of developing cervical cancer. Also, awoman who has had sex with a man who has hadmany sexual partners may be at higher risk ofdeveloping cervical cancer. In both cases, the risk ofdeveloping cervical cancer is higher because thesewomen have a higher risk of HPV infection.
Risk FactorsCervicalCancer• Using birth controlpills for a longtime:Using birth control pills for a long time (5 or moreyears) may slightly increase the risk of cervicalcancer among women with HPV infection.However, the risk decreases quickly when womenstop using birth control pills.• Having manychildren:Studies suggest that giving birth to many children(5 or more) may slightly increase the risk of cervicalcancer among women with HPV infection.• DES(diethylstilbestrol):DES may increase the risk of a rare form of cervicalcancer in daughters exposed to this drug beforebirth. DES was given to some pregnant women inthe United States between about 1940 and 1971.(It is no longer given to pregnant women.)Having an HPV infection or other risk factors does not mean that awoman will develop cervical cancer. Most women who have riskfactors for cervical cancer never develop it.
IncidenceCervicalCancerCervix Cancer is the second most common cancer among women worldwide, with anestimated 529,409 new cases and 274,883 deaths in 2008. About 86% of the cases occurin developing countries, representing 13% of female cancers.Worldwide, mortality rates of cervical cancer are substantially lower than incidence with aratio of mortality to incidence to 52%. The majority of cases are squamous cell carcinomaand adenocarcinomas are less common.This section describes the current burden of invasive cervical cancer in Saudi Arabia andthe Western Asia region with estimates of annual number of new cases, deaths, andincidence and mortality rates.Incidence of cervical cancer in Saudi Arabia, Western Asia and the World
IncidenceCervicalCancerIncidence of cervical cancer compared to other cancers in womenof all ages in Saudi Arabia
MortalityCervicalCancer• Mortality of cervical cancer in Saudi Arabia, Western Asia and the World• Cervical cancer mortality compared to other cancers in women of all ages inSaudi Arabia
SymptomsCervicalCancerEarly cervical cancersusually don’t causesymptoms.When the cancer growslarger, women may noticeone or more of thesesymptoms.Infections or other healthproblems may also causethese symptoms.Only a doctor can tell forsure. A woman with anyof these symptoms shouldtell her doctor so thatproblems can bediagnosed and treated asearly as possible.Abnormal vaginal bleeding—Bleeding that occurs between regularmenstrual periods—Bleeding after sexual intercourse, douching,or a pelvic exam—Menstrual periods that last longer and areheavier than before—Bleeding after going through menopause.Increased vaginal discharge—Pelvic pain—Pain during sex
Detection and DiagnosisCervicalCancerDoctors recommend that women helpreduce their risk of cervical cancer by havingregular Pap tests. A Pap test (sometimescalled Pap smear or cervical smear) is asimple test used to look at cervical cells. Paptests can find cervical cancer or abnormalcells that can lead to cervical cancer.Finding and treating abnormal cells can prevent most cervical cancer.Also, the Pap test can help find cancer early, when treatment is morelikely to be effective.For most women, the Pap test is not painful. It’s done in a doctor’soffice or clinic during a pelvic exam. The doctor or nurse scrapes asample of cells from the cervix. A lab checks the cells under amicroscope for cell changes.Most often, abnormal cells found by a Pap test are not cancerous.The same sample of cells may be tested for HPV infection.
Detection and DiagnosisCervicalCancerIf you have abnormal Pap or HPV test results, your doctor will suggest othertests to make a diagnosis:Colposcopy: The doctor uses a colposcope to look at the cervix. Thecolposcope combines a bright light with a magnifying lens tomake tissue easier to see. It is not inserted into the vagina. Acolposcopy is usually done in the doctor’s office or clinic.Biopsy: Most women have tissue removed in the doctor’s office withlocal anesthesia. A pathologist checks the tissue under amicroscope for abnormal cells.—Punch biopsy: The doctor uses a sharp tool to pinch off smallsamples of cervical tissue.—LEEP: The doctor uses an electric wire loop to slice off a thin, roundpiece of cervical tissue.—Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix.Some doctors may use a thin, soft brush instead of a curette.—Conization: The doctor removes a cone-shaped sample of tissue. Aconization, or cone biopsy, lets the pathologist see if abnormal cells are inthe tissue beneath the surface of the cervix. The doctor may do this testin the hospital under general anesthesia.
StagingCervicalCancerIf the biopsy shows that you have cancer, your doctor needs to learnthe extent (stage) of the disease to help you choose the besttreatment.Staging is a careful attempt to find out whether the tumor hasinvaded nearby tissues, whether the cancer has spread and, if so, towhat parts of the body. Cervical cancer spreads most often to nearbytissues in the pelvis, lymph nodes, or the lungs. It may also spread tothe liver or bones.When cancer spreads from its original place to another part of thebody, the new tumor has the same kind of cancer cells and the samename as the original tumor.For example, if cervical cancer spreads to the lungs, the cancer cellsin the lungs are actually cervical cancer cells. The disease ismetastatic cervical cancer, not lung cancer. For that reason, it’streated as cervical cancer, not lung cancer. Doctors call the newtumor “distant” or metastatic disease.
CervicalCancer• Stage I: The tumor has invaded the cervix beneath the top layer ofcells. Cancer cells are found only in the cervix.• Stage II: The tumor extends to the upper part of the vagina. It mayextend beyond the cervix into nearby tissues toward thepelvic wall (the lining of the part of the body between thehips). The tumor does not invade the lower third of thevagina or the pelvic wall.• Stage III: The tumor extends to the lower part of the vagina.It may also have invaded the pelvic wall.If the tumor blocks the flow of urine, one or both kidneysmay not be working well.• Stage IV: The tumor invades the bladder or rectum.Or the cancer has spread to other parts of the body.• Recurrentcancer:The cancer was treated, but has returned after a period oftime during which it could not be detected. The cancer mayshow up again in the cervix or in other parts of the body.Staging
TreatmentCervicalCancerWomen with cervical cancer havemany treatment options.The options areSurgeryRadiation TherapyChemotherapyor a combinationof methods.The choice of treatment depends mainly onthe size of the tumor and whether thecancer has spread. The treatment choicemay also depend on whether the womanwishes to become pregnant someday.Cancer treatments often damage healthycells and tissues, so side effects are common.Side effects may not be the same for eachperson, and they may change from onetreatment session to the next.
CervicalCancerIs an option for women with Stage I or II cervical cancer.The surgeon removes tissue that may contain cancer cells: RadicalTrachelectomy:Removal of the cervix, part of the vagina, and the lymphnodes in the pelvis.Recommended for a small number of women with smalltumors who wants to try to get pregnant later on. TotalHysterectomy:Removal of the cervix and uterus. RadicalHysterectomy:Removal of the cervix, some tissue around the cervix,the uterus, and part of the vagina. Fallopian Tubesand Ovaries:The surgeon may remove both fallopian tubes andovaries. This surgery is called a salpingo-oophorectomy. Lymph Nodes:The surgeon may remove the lymph nodes near thetumor to see if they contain cancer.If cancer cells have reached the lymph nodes, it meansthe disease may have spread to other parts of the body.Surgery
Radiation TherapyCervicalCancerRadiation therapy (also called radiotherapy) is anoption for women with any stage of cervical cancer.• Early stages of cervical cancer can be treated withradiation therapy instead of surgery.• It may also be used after surgery to destroy any cancercells that remain in the area.• Cancer that extends beyond the cervix may haveradiation therapy and chemotherapy.• Radiation therapy uses high-energy rays to kill cancercells. It affects cells only in the treated area.
CervicalCancerDoctors use two types of radiation therapy to treatcervical cancer. Some women receive both types: ExternalRadiationTherapy:A large machine directs radiation at your pelvis or othertissues where the cancer has spread. The treatmentusually is given in a hospital or clinic. You may receiveexternal radiation 5 days a week for several weeks.Each treatment takes only a few minutes. InternalRadiationTherapy:A thin tube is placed inside the vagina. A radioactivesubstance is loaded into the tube. You may need to stay inthe hospital while the radioactive source is in place (up to3 days). Or the treatment session may last a few minutes,and you can go home afterward.Once the radioactive substance is removed, noradioactivity is left in your body. Internal radiation may berepeated two or more times over several weeks.Radiation Therapy
ChemotherapyCervicalCancerFor the treatment of cervical cancer, chemotherapy isusually combined with radiation therapy.For cancer that has spread to distantorgans, chemotherapy alone may be used.• Chemotherapy uses drugs to kill cancer cells.• The drugs for cervical cancer are usually giventhrough a vein (intravenous).• You may receive chemotherapy in a clinic, at thedoctor’s office, or at home.• Some women need to stay in the hospital duringtreatment.
ChemotherapyCervicalCancerThe side effects depend mainly on which drugs are given and howmuch. Chemotherapy kills fast-growing cancer cells, but the drugscan also harm normal cells that divide rapidly: Blood cells:When chemotherapy lowers the levels of healthy bloodcells, you’re more likely to get infections, bruise or bleedeasily, and feel very weak and tired. Your health care teamwill check for low levels of blood cells. If your levels arelow, your health care team may stop the chemotherapyfor a while or reduce the dose of drug. There are alsomedicines that can help your body make new blood cells. Cells inhair roots:Chemotherapy may cause hair loss. If you lose your hair, itwill grow back, but it may change in color and texture. Cells thatline thedigestivetract:Chemotherapy can cause a poor appetite, nausea andvomiting, diarrhea, or mouth and lip sores. Your healthcare team can give you medicines and suggest other waysto help with these problems.
ChemotherapyCervicalCancerThe side effects depend mainly on which drugs are given and howmuch. Chemotherapy kills fast-growing cancer cells, but the drugscan also harm normal cells that divide rapidly:• Blood cells: When chemotherapy lowers the levels of healthy blood cells,you’re more likely to get infections, bruise or bleed easily, and feel veryweak and tired. Your health care team will check for low levels of bloodcells. If your levels are low, your health care team may stop thechemotherapy for a while or reduce the dose of drug. There are alsomedicines that can help your body make new blood cells.• Cells in hair roots: Chemotherapy may cause hair loss. If you lose yourhair, it will grow back, but it may change in color and texture.• Cells that line the digestive tract: Chemotherapy can cause a poorappetite, nausea and vomiting, diarrhea, or mouth and lip sores. Yourhealth care team can give you medicines and suggest other ways to helpwith these problems.
Second OpinionBefore starting treatment, you might want a second opinion about yourdiagnosis and treatment plan.Some people worry that the doctor will be offended if they ask for asecond opinion. Usually the opposite is true.Most doctors welcome a second opinion. And many health insurancecompanies will pay for a second opinion if you or your doctor requestsit.If you get a second opinion, the doctor may agree with your firstdoctor’s diagnosis and treatment plan. Or the second doctor maysuggest another approach.Either way, you have more information and perhaps a greater sense ofcontrol.You can feel more confident about the decisions you make, knowingthat you’ve looked at your options.CervicalCancer
Follow-up CareYou’ll need regular checkups after treatment forcervical cancer. Checkups help ensure that anychanges in your health are noted and treated ifneeded. If you have any health problems betweencheckups, you should contact your doctor.Your doctor will check for the return of cancer.Even when the cancer seems to have beencompletely removed or destroyed, the diseasesometimes returns because undetected cancercells remained somewhere in the body aftertreatment. Checkups may include a physical exam,Pap tests, and chest x-rays.CervicalCancer
ResourcesCervicalCancerVideo Animations by:http://www.nucleusinc.com/medical-animationMusic : SeasonsArtist: Yanni (Album: Truth of Touch)
CervicalCancerGroup8 Gehan RostomGhayda SemsemIshteyaq MohammedLama Bin ObaidReham Abdul AzizLearning Skills