CERVICAL CANCER

1. INTRODUCTION
What is cervix?

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The cervix is part of female reproductive system. It is usually called the neck of the womb. The cervix connects the uterus to the vagina. It is the lower, narrow part of uterus (womb).

Adapted from www.cancerhelp.org.uk Function of cervix Producing moistness to lubricated the vagina Producing mucus to help the sperm movement Holding baby in the uterus during pregnancy Allowing the flow of menstrual blood from the uterus into the vagina

What is cancer cervix? Cancer is a disease in which cells grow up abnormally. When cancer starts in the cervix, it is called cervical cancer. Cervical cancer develops from cell changes caused by virus that is called human papillomavirus (HPV). It can be transferred by touch skin-to-skin during sexual activities.

Types of cervical cancer There are two main types of cervical cancer Squamous cell carcinoma-common type of cervical cancer. It develops fromthe flat cells that cover the outer surface of the cervix Adenocarcinoma less common type of cervical cancer. It develops in the glandular cells, which are found in the cervical canal

Stage Stage 0- the cancer is only in the cells of the surface of the cervix Stage 1 -the cancer invaded deeper into the cervix Stage 2 - the cancer has begun to spread around the neck of the womb Stage 3 - the cancer has spread into the pelvis Stage 4 - the cancer has spread into other body organs

2.

SYMPTOMS AND RISK FACTORS

Symptoms Pain and bleeding during sexual activities Abnormal vagina bleeding Bleeding from vagina between period Vagina bleeding after menopause Leg pain or swelling Low back pain Tiredness Unusual vagina discharge and smelly

Risk factors Early sexual activities at a young age Have many sexual partners. Giving birth to many children. Human papillomavirus (HPV) infection Smoking Less care of vagina hygienic The immunity to protect body from disease infections are less because of certain disease like AIDs and others Women not doing pap smear test Have sex partners who have other sex partners Women from poor family

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3.

SCREENING

The Pap test -What is it? Pap test also is called Pap smear. It is a way to examine the sample cell from womans cervix. The test is used to check for changes in the cell of the cervix that show cervical cancer. This test can tell if you have any abnormal (unhealthy) cervical cells, or cervical cancer -Do all women need Pap test? No if you are still virgin 21 years and older Under 21 years and have been sexually active for three years and more -What to do before Pap test Many things can causes wrong result. Two days before treatment you are to avoid: Using tampons Using vaginal creams, suppositories, and medicines Using vaginal deodorant sprays or powders Having sex -When do I need do Pap test? It depends on your age and healthy history. The American Cancer Society (ACS), The American College of Obstetricians and Gynaecologist (ACOG) and the U.S. Preventive Services Task Fore (USPSTF) recommend: Age 21 to 29 years ACS ACOG USPSTF Pap tests at least every three years

Every two years Annual Pap tests with a liquid-based test or annually with a conventional test Every two or three years if you've had three negative tests in a row Every two or three years if you've had three negative tests in a row

Over 30 years

Pap tests at least every three years

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- How is Pap test done? Lie on the exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. The speculum will hold the walls of vagina apart, so doctor can easily see your vagina Doctor then will use brush and swab to take a few cells from inside and around the cervix. The cells are placed on a glass slide and sent to a lab for examination. This result can get at least 2 week If the Pap test result abnormal, doctor will suggest more powerful test like colposcopy and biopsy.

Adapted from www.acog.org

Colposcopy -What is it? This test will done if your pap test abnormal It can be closely examine your cervix and identify the sources of the abnormal cell -What to do before colposcopy Many things can causes wrong result. 24 hours before treatment you are avoiding to: Using tampons Having sex Vaginal medication -How is colposcopy done? Lie on the exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. The speculum will hold the walls of vagina apart, so doctor can easily see your vagina Then, colposcope (special lighted microscope) will used. The colposcope never enters to vagina. This colposcope can enlarge cell sizw image 10-40 time large from normal size. We can see that are cannot see with naked eye.

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A solution will be used to clean the vagina Next, a mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see.

Colposcope

Adapted from www.revolutionhealth.com

Adapted from http://en.wikipedia.org/wiki/Colposcopy

Biopsy -What is it? It is done if doctor see abnormal area during colposcopy. The small pieces of abnormal tissue are removed from the cervix. It will be examined under a microscope in a laboratory.

4.

TREATMENT

SURGERY The types of surgery depend on the location and extent of cervical cancer. - Surgery choice For very early stage and preserve ability to have children. A cone biopsy or loop electrosurgical excision procedure (LEEP) - remove pieces of the cervical tissue that contain the cancer. Radical trachelectomy and laparoscopy for pelvic lymph node dissection removes the cervix and area lymph nodes, but not the uterus.

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For most stage of cervical cancer and cannot preserve ability to have children. Hysterectomy with or without removal of the ovaries, to remove the cervix and related organs where recurrence would be most likely to occur. Radical hysterectomy and pelvic lymph node dissection- the uterus, upper part of the vagina and the lymph nodes from the pelvis are removed. But, it does not remove ovaries. THERAPY Radiotherapy -What is it? Radiotherapy that means use radiation. Radiation can kill the cell cancer very accurately The aim of radiotherapy is to destroy cell cancer but it can do destroy normal cell and can be causes side affect. There are two types of radiation that are usually used - X-ray - Gamma ray There are two types of radiotherapy - Internal radiotherapy- radioactive metal or liquid use directly to the uterus and around the cervix - External radiotherapy- radiation from machine that are use for outside the body Radiotherapy machine

Adapted from www.radiationatpmh.com -Side effect Emotional changes Level of red blood cell is low Low white blood cell count Low platelet count Tiredness Dryness in vagina Less interest in sex No period

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Chemotherapy -What is it? Chemotherapy treatment will use of chemical agent to stop the cancer from spreading and growing This chemical will enter blood flowing movement system It can kill the cell of cancer that are cannot be remove from surgery and radiotherapy. When more than one type of chemical use, it is call combination chemotherapy. -Side effect Emotional changes Low white blood cell count Low red blood cell count Low platelet count Nausea Vomiting Hair loss Fatigue

5.

LIVING AFTER TREATMENT

Nutrition Decrease amount of fat and choose low-fat milk Eat more higher fibre food (e.g.: cabbage, .broccoli and potato) Buy fresh fruit, vegetable, low-fat food, or whole grain product Spicy sauces should be avoided. Drink alcohol with limited quantity Avoid smoking

Physical Activities Walking is the best exercise Work with normal schedule Avoid sexual activities after treatment

Follow Up See a doctor to check if cancer has return or spread to other parts of body. Doctor may run follow up test: Imaging procedure (producing picture of areas inside the body) Endoscopy (use of thin, lighted tube to examine organ inside the body) Blood test

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6.

STATISTICS
According to National Cancer Registry, 12,064 cancer cases were diagnosed among Malaysian females in the year 2003. Cervical cancer is second common cancer among women after breast cancer. A total of 1557 cases (12.9%) of cervix cancer recorded ( Cervical cancer incidence increases from 12.0 % in year 2002 to 12.9% in year 2003. Females from age 40-49 have the highest percentage of cervical cancer (28.2%). Chinese women have the highest percentage of cervical cancer (56.4%). It is followed by Malay (32.8%) and Indian (10.8%).
Cervical Cancer Cases ( % ) per 100,000 Population by Ethnic Group

10.8%

CHINESE MALAY INDIAN 32.8% 56.4%

Percentage of Cervical Cencer per 100,000 population by Age 30.0%

28.2% 26.5%

25.0%

20.0%
PERCENTAGE

19.1%

15.0% 12.5% 10.0% 11.6%

5.0% 1.7% 0.1% 0.0% 0-9 10-19 20-29 30-39

AGE

0.3% 40-49 50-59 60-69 70-79

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7.

RESOURCES

www.answers.com www.cancerbackup.org.uk www.riversideonline.com www.nlm.nih.gov www.medicinenet.com www.webmd.com www.oncologychannel.com www.nhsdirect.nhs.uk www.cancerhelp.org.uk www.oncolink.org www.abc.net.au www.womenshealth.gov www.revolutionhealth.com www.acog.org www.mayoclinic.com www.womenshealth.about.com www.cancer.about.com www.chemotherapy.com www.cancer.org www.cancer.gov www.jotrust.co.uk www.crc.gov.my Compilation by: Ms Nurul Syuhada Mohd Zin

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