Pathophysiology is the study of changes in the normal functions of the organism due to a disease or an abnormal syndrome. These mechanical, physical and biochemical functions are actually symptoms of the disease and are essential in diagnosing the condition or in developing or establishing treatment.
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In cervical cancer, pathophysiology is also very important and talks to us about origins and grow patterns in the cancer. Cervical cancer develops usually from dysplasia, a premalignant lesion and transforms into invasive carcinoma. This however happens within several years and can follow very complex and different growing patterns in every case. The ulcerative growth pattern is the one most closely linked to seropurulent discharge from the vagina which can complicate the cancer through infections. This particular symptom is an important element in cervical cancer pathophysiology. Cervical cancer tumors can cause leukorrhea, which is the name for this manifestation of the disease and leads to white vaginal discharge.



Leukorrheic discharge, also known as vaginitis, can be a symptom for many local or systemic disorders not just cervical cancer. This may occur in almost all women at one point in their lives. The most common cause is however a simple infection in the reproduction tract. Apart from tumors also estrogen, psychic stimulation, inflammation and estrogen depletion can cause leukorrhea.

Vaginal mucus can be a normal thing to live with but if it is accompanied by discomfort and local distressing symptoms it should be considered abnormal and tests should follow.

Diagnosing leukorrhea as well as the accurate indication of its cause can be done through cytologic study of a smear of vaginal secretion. This is indicated as a regular test for all patients who are sexually active and especially for those suspected of cancer. Cytologic study of a smear of vaginal secretion can be a precious indicator of cancer, trichomonada, candida and other organisms that can sometimes rule out cancer.



The treatment can vary a lot depending of course on the cause of the discharge, cause that is in fact the main disease implicated in the process. General treatment includes using internal menstrual tampons to reduce odor and to eliminate vulvar soiling. Sexual intercourse should be postponed until a cure or a final diagnosis has been obtained. Ask your doctor about what you are recommended to do and not to do during treatment. In some cases the doctor might tell you that your partner requires treatment as well so it is essential to be honest about your suspicions with your partner. This is not the case if cancer is the cause but even cancer too can be incidentally accompanied by some other disorders like trichomonal and candida infections which are transmitted through intercourse.

Other types of procedures include cauterization, cryosurgery or conization of the cervix. In the case or cervical cancer leparotomy, irradiation or another treatment your doctor recommends are usually necessary.

More than one disease can lead to rectal bleeding as a main symptom but probably the most prominent nowadays is cervical cancer. Rectal bleeding means bleeding from the anus or rectum, or, simply put, blood in your stool. In any case, this is a very serious symptom and needs prompt professional medical advice. You don't even have to feel any pain in order to start worrying.
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Cancer of the cervix, a very common kind of cancer in women, is a type of cancer in which malignant cells develop and spread starting from the tissues of the cervix. Thanks to Pap screenings becoming a regular test for most women, the cervical cancer incidence has dropped substantially in the last years. However, that makes the remaining cases even the more tragic. If not detected early, when the condition is called dysplasia and is 100% curable, it becomes very hard to treat even through very aggressive treatment.



The ideal way to go about the problem is having the Pap smears on a regular basis. If rectal bleeding is the first sign you have that you might have developed cervical cancer, you are most likely to be in a very advanced stage with little to no chances of being cured.

The way in which rectal bleeding manifests itself in cervical cancer is through blood in the stool. Blood in the stool can be both a sign of rectal bleeding as well as of gastrointestinal bleeding. Certain conditions may even lead to bloody diarrhea. Many other things can cause this symptom but if you haven't recently undergone a Pap test you should schedule for one, just to be sure.

Alongside the Pap screening, a good rectal and colon examination with proctoscopy and or colonoscopy would be called for. The other causes beside cervical cancer could be any that lead rectal bleeding in anybody, disregarding individual conditions: hemorrhoids, polyps, colon cancer, colitis, ulcers, and even recurrent cervical cancer. Many of these alternatives are sure to be missed by a barium enema or barium swallow. It is very important that you consult a doctor before deciding on the test you want to do and make sure it is safe for you to take those particular tests.



Rectal bleeding can also occur during treatment. Radiation-induced rectal bleeding is such a treatment but optimal management of this affection can be achieved in patients with cancer of the cervix. In a study where a group of patients were monitorized while they underwent external beam radiotherapy with high-dose-rate brachytherapy grade 2 and 3 rectal bleeding occurred in 8.5% of patients. Immediate treatment with a combination of sucralfate enema and coagulation was effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture. Ask you doctor more about this and just make sure you've considered all options and that immediate appropriate intervention in always on stand by.

There are small chances of having a baby after you've had cervical cancer. Cervical cancer develops in the cells lining the cervix. The cervix is the passage between the uterus and the vagina. But what makes it unlikely for you to have children afterwards, even if you are cures, is in fact the treatments. Luckily you can nowadays easily prevent developing these cancerous cells by having regular Pap screenings in order to detect any eventual risk on time as in its early age of development cervical cancer is 100% treatable without any severe intervention.
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As far as having children is concerned the main problem is with radiation therapy. This type of treatment which exposes your organism to intense radiation exposure is meant to kill cancerous cells but ends up killing a lot of healthy cells too. Many healthy cells that it kills are essential to the reproductive organs.

This terrible side effect can make the patient infertile and completely disrupts the reproduction system. Another treatment often recommended with cervical cancer and with great if not unavoidable risks to make it impossible for you to bare children is hysterectomy. However, if diagnosed in an early stage the best treatment is radical trachelectomy which will also enable you to have children. Radical trachelectomy and laparoscopy for pelvic lymph node dissection remove the cervix and area lymph nodes but not the uterus.

Another surgical intervention that doesn't eliminate your chances for having babies is a cone biopsy or loop electrosurgical excision procedure. This procedure removes a wedge of cervical tissue that contains the cancer. This intervention is unfortunately also effective in the first stages of the cancer.

Your best chance out there for both cure and having children is therefore getting periodical Pap smears and constantly monitor your health.

Even though those last two options for surgical intervention can maintain your ability to have children the risk for miscarriage and premature death are very high. It's a chance you have to take and there have been numerous successful births after curing cervical cancer as well.


Complications can also occur along with the progress of the treatment. With a first stage of the cancer, there is only a very small risk of the cancer spreading to the lymph nodes and becoming invasive. Trachelectomy can eliminate cancerous cells in this early stage but if any of your lymph nodes are later found to contain even the smallest amount of cancer cells, your specialist is likely to recommend radiation therapy. Unfortunately, radiotherapy will also make you infertile and so you will not be able to have children even after the trachelectomy.
To find out more about how cervical cancer can affect your daily life and what your chances for normal life after the disease are you should seek counseling alongside consulting with your oncologist.

The cervical cancer is the second most common disease in the world that affects the women organism.

The cervical cancer is often related with human papilloma virus, that is a sexually transmitted virus that may influence the abnormality of the cells located into the cervix. Certain changes of the cervix cells may develop in time into early symptoms of cervical cancer and even cervical cancer if not diagnosed and treated in proper time.

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The cervical cancer is a cancer located in the cervix, that has a slow-growing progress and sometimes the women don’t know about its existence in their body.

The cervix is the opening to the uterus. It varies in diameter from 1 mm to 3 mm depending on what phase of the menstrual cycle when there is measurement. The cervix is sometimes covered with cervical mucus to protect from infection, during ovulation the mucus becomes a thin fluid to permit the passage of sperm.

Because of its location, the cervical cancer has the fallowing early symptoms:

-pelvic pain and pain during the sexual intercourse;
-vaginal bleeding after sexual intercourse;
-unexplained change of menstruation manifested by heavy bleeding and bleeding in the menstruation cycle period;
-abnormal vaginal discharge containing mucus that may be tinged blood;
-urinary frequency increased.
-bleeding and pain when you insert a diaphragm

The most common and recommended test for this early symptoms is the Pap smear test. This test can diagnose the pre-cancerous and cancerous cells located in the cervix. The results of the Pap smear test are rated: Class I ( signifies the normal cells), Class II (signifies means an irritation or an inflammation of the cervix), Class III (signifies a true cervical dysplasia that can range from mild to serious) , Class IV (signifies that one of a variety of pre-cancers or cancerous cells are present) and Class V (represents the sign of a serious invasive cervical)

After the cervical cancer diagnosis the patients are subjected to these medical investigations to detect the stage of the cervical cancer:

-Lymphangiogram – this procedure x-rays the lymph system to detect if the cancer has spread to the lymph nodes. This procedure is made by injecting a dye into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages.
-Computerized Axial Tomography – this procedure makes a series of detailed pictures of the areas inside the body, from different angles, through a computer liked to an x-ray machine. In order to determine the tissues or organs to be seen better the patient may swallow a dye or to have a day injected into the vein.
-Chest x-ray – this procedure represents an x-ray made to the organs and the bones located inside the chest.
-Surgery - pretreatment surgical staging an operation made to find out if the cancer has spread within the cervix or to other parts of the body.
-Ultrasound exam – this procedure is made to get the sonogram the echoes from the ultrasound exam that represent a picture of the tissues.

I have a very strong recommendation for all the women in the world, do the Pap smear test. If you have any of the listed symptoms don't hesitate to go to the doctor immediately. And if you don't have the symptoms do the test anyway. Our healthy is the most valuable thing in this world.

Although conducted on a small number of patients, this study suggests that in patients with uterine cancer small and strictly localized, clearly informed, seeking a subsequent pregnancy, conservative surgical treatment by cone biopsy and removal of lymph pelvic lymph, preceded by three months of chemotherapy, is effective, well tolerated and allows these young women to carry a pregnancy.
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There are over 100 types of human papillomavirus (HPV). HPV is a virus that can infect many parts of the body. Some types of HPV are sexually transmitted and can cause warts or have other consequences, such as cancer (eg, cancer of the cervix, penile and anal) in the anogenital area in men and women. The types of HPV that infect the anogenital region are different from those that infect other body parts, like fingers, hands and face. The guys who are causing anogenital warts generally do not cause cancer.

The various types of HPV are often classified as low risk and high risk, given their association with cancer. The types of "low risk" are rarely associated with cancer. The types of "high risk" are more likely to lead to the development of cancer.
There are DNA tests that in some situations, can be used to detect HPV infection. In Canada, analysis of HPV DNA have been approved for women, but their accessibility and availability is limited.

Testing for HPV DNA is not part of the review of current health, the pelvic exam, testing for sexually transmitted infections or a Pap test (Pap test). In areas that recommend and use the analysis of HPV DNA in some situations, it is used in conjunction with the Pap test results to determine the need for screening and subsequent management. Ask your health care provider what recommendations on screening for HPV DNA in your area.


The Pap test is used to detect abnormal cells in the cervix, Pap tests regularly can help detect abnormalities or changes in the cervix before cancer develops. For more information, see the factsheet "Your Health" on the screening of cervical cancer New window. The recommendations for screening Pap tests vary depending on the province or territory where you live. Ask your health care provider what are the recommended intervals on the Pap test in your area.

No analysis of HPV DNA is currently approved for men except in the context of scientific studies. For more information, please see the factsheet The human papillomavirus (HPV) and Men.


Is it possible to prevent cancer of the cervix?

It is possible to prevent cervical cancer through screening to detect abnormal cells and precancerous changes before they turn into cancer. The Pap test can detect cervical cancer and precancerous changes in women. There is the presence of cervical cancer more often in women who have not undergone regular Pap tests.

What about pregnancy and anogenital warts?

HPV is not involved in the ability of a woman becoming pregnant. Most pregnant women with a history of anogenital warts, and did more, probably will not have complications or problems during pregnancy or childbirth. However, during pregnancy, the size and number of anogenital warts may increase.

It is rare for a pregnant woman transmit HPV to her baby during childbirth by vaginal delivery. A caesarean is not recommended unless warts obstruct the birth canal.

Cervical Cancer SMALL AND WELL LOCATED

In the presence of invasive cervical cancer (the term "invasive" opposed to "in situ"), a surgical approach with total removal of the uterus (radical hysterectomy =) and lymph nodes in the pelvis (= lymphadenectomy) is the rule.
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However, sometimes a type of cancer occurring in a young woman old enough to have kids. Can I receive some of these young women, and under strict security, limited surgery, leaving open the possibility of having a child?

We can compare this approach to that used when conservative treatment of breast (lumpectomy) has been proposed at the time the removal of the breast was the rule and that, whatever the size of the tumor. It took solid studies, and several years in order to offer it in good conscience for patients with small tumor well localized.
In the case of cervical cancer, a team of Italian researchers conducted a trial of treatment for young women with cervical cancer, small and well localized to retain their uterus.

The principle is to initially reduce the size of the tumor with chemotherapy first (called "neoadjuvant") chemotherapy that will destroy any cancer cells that may already exist in the peri-cervical tissues and pelvic lymph nodes, then surgery involves very limited.


Method
Between 1995 and 1997 were included 21 patients, aged under 40, nulliparous, with cancer of the cervix located less than 3 cm, without lymph node invasion or uterus, confirmed by MRI (magnetic resonance imaging = Nuclear ) and a PET scan, whenever possible.
Treatment includes chemotherapy with neoadjuvant combination of three anti-cancer and surgery with a cervical cone biopsy (removal of the cervix =) associated with the removal of all pelvic lymph nodes (lymphadenectomy pelviennne total). These nodes are of course fully analyzed. This time is essential to ensure maximum safety.

Results

→ Epidemiology:
- The average age of patients was 30 years (17-39 years);
- The average size of the tumor is 15 mm (10-30 mm);
- Histological type is adenocarcinoma (cancer of glandular type =) in 57% of cases of carcinoma or epithelial type in 43% of cases;
- Histological grade reflecting the aggressiveness of the cells is: 33% Grade I, Grade II 19% and 48% grade III, aggressiveness is increasing according to rank.
→ Results after neoadjuvant chemotherapy:
In all cases, there is a dramatic clinical regression. Microscopically, there was complete remission in 5 cases out of 21 have accepted the protocol, a small residue in 12 cases and 4 cases of invasive carcinoma penetrating more than 3 mm deep.
→ Surgical treatment:
- Four patients were deemed unsuitable for conservative treatment and underwent radical hysterectomy with lymphadenectomy;
- But the majority, 17 patients, have benefited from conservative treatment.
The postoperative course is simple.

→ Long-term monitoring:
After an average follow-up of 69 months, 17 patients as well as the 4 hysterectomy are alive without recurrence. More than half of the patients chose this treatment in hopes of motherhood.
Ten pregnancies occurred in six patients. One of them was interrupted by a spontaneous abortion. nine have been completed seven caesarean sections, and two by natural means.

Anogenital warts are diagnosed during a physical examination during a consultation with a health professional. It is not for men or women, reliable test that enables detection of anogenital warts. You may have anogenital warts even if you do not see them. They may be small or in a place where they are not visible, as inside the vagina or rectum.
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Do I need a Pap test if I am not sexually active or if I am monogamous?

Women who are not currently sexually active or who are beyond childbearing age may believe they do not need to undergo Pap tests regularly, but this is false. It is important to continue to undergo regular Pap tests, because HPV can become active many years after an infection has occurred. For the same reason, monogamous women who may feel that the risk of contracting HPV is low should also have regular Pap tests. Talk to a health professional to see what is recommended in your case.

What happens if the results of your Pap test are abnormal?

If the Pap smear reveals abnormal cells, the health professional must determine what to do given the type of changes in cells. The health professional may simply follow you to see if other changes occur or request further investigation. This could include repeat Pap tests, screening for HPV DNA (when indicated, the test is available and is among the recommendations provincial or territorial) or a referral to a colposcopist to consider the cells of your cervix using specialized equipment.

We may make minor biopsies of the uterine tissue to determine the extent of cellular abnormality. Cryotherapy (cold application), electro (using an electric current) or laser surgery may be necessary to remove the abnormal cells. The decision on how to handle the situation due to many factors, including the degree of abnormality revealed by the Pap test.

Can we treat HPV?

Although HPV infection does not heal, warts, lesions and precancerous or cancerous changes caused by the virus manage or deal. No treatment can ensure that the body is rid of HPV infection.

Some treatments indicated against anogenital warts as cryotherapy (remove warts by freezing them), are followed in a clinic or doctor's office while others, such as prescription creams, can be administered in itself. It often takes repeated treatments. Failure to see the wart does not mean that HPV infection is eliminated, the virus may remain present, which means that you may develop warts in the absence of further exposure to the virus. For most people, warts disappear on their own over time.

The lesions and precancerous changes caused by HPV types at high risk can be treated if health care providers believe that this is necessary. Many of these infections can be removed without treatment. A small number only at high risk of infections become cancers. Like many other cancers, early detection is a key factor for treatment that is working.

You should discuss treatment options with a health professional to determine what is the best choice of treatment in each case. Immunocompromised persons, particularly those who are HIV positive, may require special care.

How to protect against HPV?

To reduce the risk of HPV infection, always use a condom during sexual intercourse. Although condoms do not eliminate the risk of infection, use a condom consistently and correctly during vaginal, anal and oral hygiene will reduce the likelihood of getting HPV or transmitted to its partner . Remember that a condom protects only the area it covers so it is possible to be infected by uncovered warts (for example, on the scrotum).

Using a condom can also protect against other sexually transmitted infections and reduce the likelihood of unwanted pregnancies.

Other ways to reduce the risk of infection include the postponement of sexual activity later (wait to be older), limit the number of sexual partners and take account of his sexual history partners because it may constitute a risk to themselves (eg. if the partners have previously had multiple partners).

Regarding women, it is possible to avoid the four types of HPV most commonly through vaccination. This is important because there is no treatment that can cure an HPV infection.Vaccines against HPV are under development for many years, and one of them has recently been approved for use in Canada (July 11, 2006).

This vaccine protects against infection in the case of the four types of HPV most common (types 6, 11, 16 and 18). There is currently studying the possibility of using vaccines against HPV in men. For more information on the vaccine against HPV, see fact sheet Preventing Human Papillomavirus (HPV) vaccine and against HPV.

Infection with human papillomavirus or HPV is a sexually transmitted viral infection very frequent, since 70% of women who have sex come into contact with this virus at one time or another in their life .
Every year in Belgium, about 650 new boxes of Cancer Of The Cervix are Recorded, and 270 women die from the disease. In western Europe, Two Vaccines Against Major human papillomavirus (HPV) Carcinogens are available. Theys protects against HPV 16 and HPV-18, Which cause Approximately 70% of the cells of cancer of the cervix.
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Many Individuals contact the Foundation to Obtain Information about the disease and vaccination. The calls come from girls, moms and young goal Aussi Men Who feel increasingly Concerned About the Health of Their partner. Here are answers to frequently asked questions MOST issues.
What is HPV?

HPV (Human Papilloma Virus) are a broad family of viruses That are Transmitted-through sexual intercourse or intimate contact. There are different types of Hundreds. Most are harmless, purpose sacrifice part of 'em can cause a chronic infection. Then this can trigger cancer of the cervix Eventually uteri. These Are Mainly HPV 16 and 18 carry the risk of Which cervical cancer.


Other HPV (types 6 and 11) causes warts (genital warts) are the lips of the vulva, vagina or cervix, lesions do not aim thesis Develop Into cervical cancer.
Cancers of the cervix are common?

Each year, this type of cancer diagnosed in about 650 IS women in Belgium. Through screening, a large number of precancerous lesions can Be Discovered and Treated Before They Evolve Into Cancer.
What Are the Symptoms of HPV infection year?

In most cases, HPV Infection Is Not Accompanied by "any symptoms. Some types of HPV can cause genital warts, order dissertation notre connection with cervical cancer of the uterus.
What are the chances of cure in cancer of the cervix?

If the disease IS Treated When It Is still in a precancerous stage, Before Changing Into Cancer of the cervix, the recovery IS assured. In cancer of the cervix Itself, the numbers of Surviving are five years Between 90 and 5%, DEPENDING on the stage of cancer development. Therefor It Is essential to detect cancer and Treats At The Earliest possible internship to Maximize the chances of recovery. Hence the Pap smear screening of Usefulness.
If I am Infected by HPV, Docs That mean my spouse It That has-been unfaithful?

Not Necessarily. The Virus in Humans Is So Widespread and Has Existed for so long That the Majority of Sexually active people Eventually Become Infected. It Is very difficulty to say Since When someone IS Infected (Because There Are No specific symptoms) And Also Who is "responsible" for contamination. No Need To Condemn anyone!
Condoms Protect Against HPV ET?

The Condom Does not offer complete protection Against HPV transmission can Occur Because the genital areas "-through are not Covered by the condom. It Is recommended to use it, Especially if multiple sexual partners.

The cervical cancer are among the tumors (malignant) most common. But the vast majority of women who were diagnosed with this disease are completely cured. Because the tumors tend to grow slowly. Women are encouraged to have regular Pap tests (Pap smear), which allows early detection of tumors, thereby leaving ample time to treat them in many cases.
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Young women aged 9 to 26 years can also reduce their risk of cervical cancer by getting vaccinated against this type of cancer. The recommendations on the frequency of screening vary from one province to another. All provincial programs target women aged 18 to 69 years.

During a typical year, about 1 450 women in Canada are diagnosed with cervical cancer, and about 430 will not survive. Most women who die are in the older group, cancer and most of them have been detected whereas it had already spread.

This kind of situation is not likely to happen if you do not undergo regular Pap smears. Since the implementation of Pap smears in 1941, the death rate from cervical cancer has fallen by 90%. The Pap smear can detect those at risk of contracting cervical cancer in the near future, so this allows doctors to take steps to prevent the disease from appearing.

The tissues of the cervix are particularly vulnerable to abnormal changes, and many women have tumors or neoplasms (new growths) in these areas of the genitals. Only a small number of these changes are actually cancerous.

Some are benign, which means they do not multiply and spread to other organs, and therefore they are not cancerous. Others are considered precancerous and the pacient may have to seek surgical treatment .Similar to that applied to cure the cancer itself. Many women who, frankly, do not have cancer still need the care of an oncologist (a doctor specializing in cancer treatment).

Prevention of cancer may require a range of diagnostic and surgical procedures that take a long time. Similarly, women who have been cured of cervical cancer often need further treatment, especially if radiation was used.

The method of prevention is the most recent vaccination against 4 types of HPV most common. HPV, or human papillomavirus is a virus that is passed on by intercourse and it can cause a number of health problems including cervical cancer. The vaccine protects against HPV types that cause about 70% of all cervical cancers. It is a very effective method to reduce the possibility of developing many diseases caused by human papillomavirus. The vaccination is available for young women ages 9 to 26 years.
Causes

We do not yet understand very well what triggers uncontrolled division of cells that eventually form a tumor, but some features seen in people with cancer shed light on risk factors.

This article will help you understand the signs of this dreadfull diease and how to prevent or combat it.

If you submit a regular Pap smear to detect lesions caused by human papillomaviruses, the anomalies will be detected before they can develop into cancer cells or precancerous.
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In case of genital warts, treatment consists of ablation lesions (by surgery or burn) and administration of specific drugs. The treatment of lesions is effective in the short term, but it can be painful. In addition, the problem resurfaces frequently and the disease may persist.

What are the potential consequences of treatment?

The less invasive procedures, such as those performed to remove precancerous lesions, may trigger premature labor.

For most women, it is psychologically very stressful to learn that this smear abnormalities and having to wait for the results of further tests.

Infertility is a consequence of treatment in case of removal of the uterus (hysterectomy).

Treatment and prevention of cancer of the cervix

Talk to your doctor about HPV, cancer of the cervix and its screening (cervical smear). By detecting anomalies early, you have more chances to avoid developing cancer of the cervix.

Vaccination as primary prevention

Pap smear is essential because it can detect abnormal cells associated with human papillomavirus, but it does not, however, protects diseases. The combination of screening and vaccination will optimize the effectiveness of a program against cervical cancer of the uterus.

Cancers of the cervix caused by HPV infection are viral and therefore, vaccination can help prevent these diseases and precancerous lesions that precede them. Vaccination will prevent a primary step before testing the injury. The smears remain necessary for monitoring women, especially to detect cervical cancer of the uterus not associated with the types covered by the vaccine.

It is very important to keep in mind that by submitting you to regular cervical smears can reduce your risk of developing cancer of the cervix. The simple examination, which can detect cervical abnormalities, has significantly reduced deaths from cancer of the cervix in Europe. This is because of abnormal cervical cells or cervical cancers can be treated successfully if detected before they are disseminated. Cancer of the cervix that can affect all women, routine screening was held in most European countries.

Cervical abnormalities caused by HPV can be detected by taking a sample of cervical cells to detect the presence of abnormal cells. These samples are needed given that the anomalies do not generally show symptoms or pain or other signs at an early stage.

The majority of lesions regress naturally. If abnormal cells are detected by your doctor, it may decide to monitor their natural development without intervening. However, if the injury worsens, it may be necessary for their removal.