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Ung thư và Phòng ngừa : Glossary
Cervical Cancer
[2007-09-21 10:39] (1,037)

It is known that invasive cervical cancers can be prevented. This is because precancerous lesions eventually progress to invasive cancer over a long period of time but the papanicolaou smear (PAP smear) as a screening test is widely used at its early stage and such precancerous lesion (Cervical Intraepithelial Neoplasia) is treated very effectively.

 

It takes approx. 7 years for the cervical dysplasia- the beginning stage of cervical cancer to progress to cervical intraepithelial neoplasia, and another 14 years to progress to minute invasive cancer. Once it reaches the stage of minute invasive cancer, the progress becomes so fast taking only approx. 3 years until the cancer is visually seen.

As known from such apoptosis of the cancer cell, cervical cancer requires a relatively long period of time to pass through the pre-cancer stages, which enables the early diagnosis. That is why this cancer can be cured once treated at the early stages.

 

Cervical cancer ranks fourth among the cancers that occur frequently in our nation, while first among the cancers that occur in women, raising a serious issue in our society. According to 1995 Cancer Registry Survey Data Analysis for Korean by the Ministry of Health and Welfare the registered number of patients with cervical cancer had reached 5,895 representing 22% of the total female patients with cancers. Furthermore, the recent survey data shows the extremely high degree of frequency; 29.9 per 100,000 in the female population of Seoul.

 

Synonym

 

Cervical cancer, Uterine cervical cancer, etc.

 

Definition

 

Cervical cancer is the cancer that spreads within the cervical region of the uterus. A precancerous lesion in the cervix caused by HPV can progress to cancer over a long period of time unless treated at an early stage.

 

Symptoms

 

It occurs in the multipara at the age of 45~55. The main symptom is vaginal bleeding after sex. Vaginal bleeding or postmenopausal bleeding may occur intermittently. The patient whose lesion has progressed may suffer from the repeated and massive vaginal bleeding and from a foul-smelling vaginal discharge. When pelvic side wall and sciatic nerve, are affected, the pain may occur in the lateral abdominal region or lower limb.

 

Furthermore, the patient may also suffer from dysuria, hematuria, rectal bleeding, and constipation that occur when bladder or rectum is affected.

 

Cause, conditions and physiological

 

Currently, it is widely known that cervical cancer is caused by an infection sustained through sexual intercourse. Starting a sex life at an early age, multiple sex partners, male elements, human papillomavirus (HPV) infection, HIV infection, etc. are the risk factors for cervical cancer. Out of these risk factors, HPV is presumably the most possible cause.

 

Other risk factors include:  

  1. Lower level socio-economic status, the frequency of occurrence is 5 times higher than the upper level. 
  2. Starting sex at early age and having several sex partners.
  3. Reportedly cigarette smoking and oral contraceptive use increase the risk of cervical cancer, but the biological mechanisms has not been clear yet.
  4. Cervical cancer is known to be related to vitamin A, vitamin C, carotene, folic acid, etc.

Diagnosis

 

In case the cervical region of the uterus looks normal during examination, a Pap smear can screen for the possibility of early invasive cancer. The patient has to undergo colposcopy as a screening test. Invasion can be detected by signs such as abnormal blood vessels, irregular surface of the cervix, loss and discoloration of the surface epithelial cells.

 

Most of these can be detected by colposcopy-directed conization, but conization is necessary when biopsy of the cervix failed to detect invasive cancer. Once an accurate diagnosis is reached, the patient is required to undergo fundamental examinations such as chest X-ray, cystoscopy, speculum examination, Intravenous Pyelogram (IVP), abdominopelvic MRI, etc., to identify the clinical stage and to determine the appropriate treatment.

 

Progress, Prognosis

 

Approximately 85% of patients survived for 5 years after operation or radiation therapy for stage I cervical cancer. According to the domestic report, 85-95% of patients with stage Ib disease survived for 5 years while approx. 75% of patients with stage IIa survived after 5 years. A foreign report showed that after undergoing radical hysterectomy, the 5 year survival rates of patients with cervical cancer are 86.3% for stage I, 75.0% for stage IIa, 58.9% for stage IIb, 34.1% for stage III-IV.

 

Reportedly the 5-year survival rates after radiation therapy by stages are 91.5% for stage I, 83.5% for stage IIa, 66.5% for stage IIb, 45.0% for stage IIIa, 36.0% for stage IIIb, 14.0% for stage IV. The recurrence rate has been reported to be 60-75% within 2 years and 90% or more within 5 years after the initial treatment. Therefore, follow-up examination should be conducted every three months for the first two years, every six months for the next three years, and once a year thereafter. 

 

Complications

 

Patients may have acute complications after surgery such as bleeding, uteroureteric fistula, uterovesical fistula, pulmonary embolism, small-bowel obstruction, and pyogenic contraction . Special care is required for pulmonary embolism since it may cause death after operation. Subacute complications include bladder dysfunction, lymph cysts, etc. while chronic complications include bladder atony, ureteral stricture, etc. On the other hand, the complications after radiation therapy include uterine perforation, fever, stomach ache, hematuria, melena, rectal bleeding, rectovaginal fistula, uterovesical fistula, vesicovaginal fistula, enterovesical flstula, enterostenosis, ureteral stricture, etc.

 

Treatment

 

As the fundamental treatment, surgery or radiation therapy can be adopted. While radiation therapy can be implemented at every stage of the disease, surgery is done during stages I and IIa only. When treating the patient through surgery and radiation therapy, there is no significant difference in the outcome between the 2 methods. Therefore, the treatment method depends on the condition of the patient, but surgery is recommended in the following cases or conditions.  

  1. To preserve the ovarian function of a young woman
  2. To preserve the sexual function of vagina (prevention of atrophy)
  3. Pregnancy complicated by cervical cancer
  4. Presence of Inflammatory bowel disease
  5. Patient who underwent radiation therapy
  6. Presence of visceral pelvic pain
  7. Presence of uterine adnexal tumor

 

Typically the operations such as radical hysterectomy and pelvic lymph node dissection are implemented. Furthermore, even after the surgery, supportive radiation therapy can be performed for the purpose of reducing the risk of recurrence in case the boundary area for excision is near the cancer lesion or is invaded by cancer or when the pelvic lymph node metastasis was detected.

 

Adjuvant chemotherapy. Adjuvant chemotherapy is advantageous in its efficacy to cure disseminated cancer as well as localized cancer, but is ineffective for squamous cell carcinoma which comprises 95% of cervical cancers. Therefore, its use is limited to the following cases: the patient has already undergone radiation therapy, the cancer recurred after operation, or when surgery or radiation therapy is not suitable since the cancer has already progressed deeply.

 

Preventions

 

Even if they have no extraordinary sign or symptom, women of child-bearing age who started sexual relation are required to undergo PAP smear every six months to check whether uterine cervix is in sound condition, since cervical cancer can be perfectly cured by surgery at the stage of precancerous lesion.

 

Consult a doctor in the following cases. 

  • Vaginal bleeding after sexual intercourse
  • Postmenopausal bleeding
  • Consistent and massive vaginal bleeding
  • Vaginal swab discharging a foul odor
  • Dysuria, hematuria, rectal bleeding, etc. 

Signs showing the recurrence of cervical cancer in a patient who underwent the initial treatment for cervical cancer

  • Loss of weight without any specific reason
  • Severe Unilateral lower extremity edema
  • Pain inside pelvis, thigh or hips
  • Serous vaginalis is detected.
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