Cervical cancer is the cancer of the cervix, the passage way between the uterus and the vagina, and it consists in cells beginning to divide and grow out of control and forming a mass called a tumor. This tumor can become invasive and spread to surrounding tissue and eventually to other organs and parts of the body.
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Because HPV, a sexually transmitted virus, is the main condition leading to cervical cancer, Pap smears that detect it and lesions present on the cervix have become primary tools to prevent or offer early diagnose of the cancer. However, HPV is not present in 100% of the cases so it cannot be established as a direct and exclusive cause for cervical cancer. We must be aware of the existence of other risk factors that can make us more exposed to developing cervical cancer.



The second most harmful thing for the cervix and a cause for cervical cancer is smoking.  The risk also increases the bigger the number of years the woman has smoked. The reason behind this is that the chemicals contained by cigarette smoke can be very harmful for the cells in the cervix. Contrary to popular belief, these can affect more organs other than the lungs. They are absorbed through the lungs and then the bloodstream spreads them throughout the body. This has been proven by cervical mucus tests that have found traces of tobacco by-products. These substances not only weaken your resistance to cancer but are also a reason for the developing of cancerous cells and encourage the infection with HPV to lead to lesions and precancerous conditions.

Women who are smokers have double the risk of developing cervical cancer compared to non-smokers. The exact relationship between smoking and cervical cancer however still holds some mysteries for the medical community. Even so, another undisputed fact is that smoking can also inhibit the immune system. All in all, smoking is at least a major risk factor and significantly reduces survival rates in smokers struggling with cervical cancer. The idea that cigarette smoke can also directly cause abnormal changes of the cervix cells that are likely to then become cancerous remains a very probable theory. Even second hand smoke can affect survival after diagnosis of cervical cancer and has been proven through medical research to be an important risk factor that increases the chance of developing cervical neoplasia.



Not smoking as well as limiting your exposure to second hand smoke is sure to help you prevent cervical cancer or can give you higher chances for survival if you are already struggling with it. Ask your doctor of ways of minimizing your risks and about other harmful effects of smoking and exposure to second hand smoke.

Stages are vital when it comes to making a life expectancy prognosis for patients with cervical cancer. Cervical cancer is a form of cancer that develops in the cervix and like most cancers, in its early stages, it can be eliminated completely through surgery. Beginning with stage 0 and going through stages 1 to 4, this cancer can spread to the lymph nodes, to other organs and throughout the body. Once the cancer becomes invasive, the survival rates decrease and treatment options for more than alleviating symptoms are limited.
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Your best weapon against reaching an advanced stage is undergoing a regular Pap screening. This test can detect any abnormalities in the cervix even before they become cancerous. Precancerous conditions, also known as stage 0, are 100% curable.

If cancer has however begun to grow and spread you're best chance is for it not to have advanced further than stage 1 micro-invasive cancer.

Stage 1 cervical cancer is a microcarcinoma which has the following characteristics: it can be diagnosed by microscope only and it is limited to a maximal stromal invasion of 5.0 mm and a maximal horizontal invasion not bigger than 7.0. Whether or not vascular space is involved the stage remains the same.



For stage 1A1 the stromal invasion is no bigger than 3.0mm and for stage 1A2 it can reach 5.0mm. Both these are usually asymptomatic but proximately 33% of the cases were diagnosed after a Pap screening and many are usually diagnosed incidentally when treating CIN.

Stage 1A2 is unfortunately more like invasive cancer and is a little more difficult to cure. For this stage a simple hysterectomy would be a wrong treatment. However, other valid options for treatment remain and some of them are even fertility sparing. The ones that allow you to have babies later on are radical trachelectomy and the cone biopsy both accompanied by PND. Chemotherapy and radiotherapy are also valuable weapons against the cancer and are suitable for this stage. These need a certain adaptation to the treatment as, for example, external beam radiotherapy is medically unfit for this stage.



Statistics for this stage are pretty encouraging. With a death rate of less than 3% and overall risk of recurrence of 5%, it's definitely worth getting a regular Pap smear in order to be diagnosed in this stage or earlier even.

All in all this stage should be viewed are curable and treatment and side-effects don't get too aggressive. However, even if cured some follow-up treatment in required. Vault cytology and returning for tests confirming the cure are very important as well as continuing with a healthy life-style and by being aware of the fact that patients that have had the cancer once are at a higher risk to develop it again.

Cervical cancer is the developments of cancerous cells in the cervix, namely the passage that connects the uterus to the vagina. In recent years survival rates have grown incredibly because of more and more women taking the Pap test regularly. This is vital because, though the progression of cervical cancer is slower than other forms of cancer, it has almost no symptoms in its early stages, while it is 100% curable.  Later stages are much more difficult to treat and offer a small chance for eliminating the cancer for good.
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However, the fact that it spreads relatively slow gives you the chance to discover it on time and it gives the doctor the chance to develop a suitable treatment plan to also prevent relapse. It usually takes more years for the cancer to develop but that is not 100% sure as there have been cases of cervical cancers metastasizing in 12 months.



The cancer begins in its stage 0 with precancerous lesions on the cervix which is left untreated can develop into cervical cancer. But even before that, what represents the biggest risk for developing the disease is infection with HPV, the Human Papiloma Virus as this virus can generate abnormal growth that can become malignant. But the virus does not mean you'll automatically get cervical cancer. Doctors think that the cancer is not likely to develop in the case of women who live a healthy life and don't smoke.

If you do develop the cancer, the precancerous condition also known as dysplasia can turn malignant and then the cancer begins its development to complete invasiveness. During the early stage you will most likely experience symptoms like vaginal bleeding, vaginal discharge, weakness and discomfort. Treat such signs with great seriousness.

The cancer then progresses slowly but every day has a big impact on your chances for survival. 90% of women survive for 5 years or more after diagnosis at an early stage of development while a later stage offers very few chances for survival. Only 20% of the patients diagnosed at a later stage live for the next 5 years.



From the point it becomes malignant the cancer goes through stages graded from I to IV B. In stages I to II, the cancer grows from being only visible through the microscope to growing larger than 4 cm and spreading outside the cervix.

In the next stages the cancer continues to spread to the upper region of the vagina, then to lower vagina, to the pelvic wall and the bladder, until it finally spreads to other organs, such as the lungs.

In conclusion, even if inside the body the progress of cervical cancer is relatively slow, on the surface it can seem much faster as from the first day you notice a symptom and go in for a consultation, you may not have so much time to fight the disease.

After the cervical cancer was diagnosed the women have to take some tests in order to determine if the cancer has spread and affected also other parts of the body.

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The cancer spreads into the organism in 3 ways:

-through tissue
-through the lymph system
-through the blood.

The process of finding out if the cancer has spread and affected other parts of the body is staging. The information gathered from the medical investigation made in staging determine the stage of the cancer. The stage of the cervical cancer is very important because it represents the factor that determines the treatment to be applied in the healing process.

The cervical cancer has 4 stages and is classified in the first stages according to the dimension of the tumor and in the terminal stages according to the amount of tissues and organs that the cancer had affected.



STAGE 0:



In this stage, the abnormal cells are found in the innermost lining of the cervix. These abnormal cells may become cancer and spread into nearby normal tissue.



STAGE 1:



In stage 1 the cancer has formed, is located only in the cervix and is divided based on the amount of cancer in two stages Stage IA and stage IB.

Stage IA is divided in stage IA1 (the cancer is not more than 3 mm deep and not more than 7 mm wide and stage IA2 (the cancer is more than 3 but not more than 5 mm deep, and not more than 7 mm wide.)

Stage IB can only be seen with the microscope, is more than 5 mm deep or more than 7 mm wide, and divided into stages IB1 (the cancer can be seen without a microscope and is not larger than 4 cm) and IB2 (the cancer can be seen without a microscope and is larger than 4 cm).

Stage II:



In stage II, the cancer has spread beyond the cervix, but not to the pelvic wall or to the lower third of the vagina and is also divided in stage IIA (the cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus) and stage IIB (the cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus).

Stage III:



In stage III , the cancer has spread to the lower third of the vagina, may have spread to the pelvic wall, and/or has caused the kidney to stop working. Stage III is divided into stages IIIA (the cancer has spread to the lower third of the vagina but not to the pelvic wall) and stage IIIB ( the cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder), based on how far the cancer has spread.

Stage IV:

In stage IV, cancer has spread to the bladder, rectum, or other parts of the body and is divided in stages IVA (the cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis) and stages IVB (the cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs), based on where the cancer is found.

The uterus is a hollow organ, pear-shaped, located in the lower abdomen of the woman, between the bladder and rectum. The lower part of the uterus, the closer, opens to the vagina.This is the cervix. The upper, widest, is called "the body". It communicates with the tubes and ovaries and hosts the fetus during pregnancy. It is composed of two layers of fabric: an inner layer called the endometrium and an outer layer, the myometrium.
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When the woman is not pregnant, the uterus is small (about ten centimeters long). During pregnancy, the myometrium is weakened: the size of the uterus expands to accommodate the fetus.

Among women age design, the endometrium is experiencing a series of monthly changes associated with hormonal changes of menstrual cycle. Each month the endometrium grows and thickens in anticipation of receiving a fertilized egg. Menstruation occurs when fertilization has not occurred. The unfertilized and dead cells of the endometrium is then removed with the menstrual blood.

Early symptoms of the most frequent cancer of the cervix is bleeding occurring outside the menstrual period, either spontaneously or after sex. An abnormal increase of vaginal discharge can also be regarded as a symptom, although in the vast majority of cases it is caused by other diseases or infections. These warning signs do not necessarily mean it is cancer, but they require the advice of a doctor, a clinical examination and possible further investigations.

If the clinical examination of the cervix led the doctor to find abnormal areas, it may take a small tissue sample to be tested under a microscope. If clinical examination reveals nothing abnormal, but the result of a smear indicates the presence of precancerous or cancerous cells, the doctor then applies reagents that 'reveal' injuries. These areas can then lead to a biopsy for smear alone does not suggest the diagnosis of cancer.

To facilitate biopsies of the cervix, the doctor may use a colposcope. It is an instrument that magnifies the image of the vagina and uterus. It allows a very accurate observation of suspicious areas before biopsy. The examination is called colposcopy.

The tissues are sent to a pathologist, a doctor specializing in the observation of cells under a microscope. It can recognize and interpret cellular changes caused by the disease. It examines the samples and determine if their appearance reveals dysplasia (which is not cancer, but a lesion that can become cancerous) carcinoma in situ, or cervical cancer. Carcinoma in situ is a precancerous lesion, located in a very shallow area of the cervix.

If the analysis indicates the presence of cervical cancer, it is possible to estimate the degree of extension of clinical examination and practicing some imaging tests (CT and MRI).

This is some info about the human papilloma virus or HPV.We must understand that all women come in contact with it at least once in their lives.In rare cases the infection caused by the virus can become cancer ( malignant neoplasm ).

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Cancer of the cervix and HPV infection - Cancer of the cervix is the long-term consequence of an infection caused by human papillomavirus (HPV). There are over 100 genotypes of HPV. Fifteen of these papillomavirus, known as high risk or oncogenes are associated with the development of cancer of the cervix uteri. The transmission occurs through contact with skin and mucous membranes, most often during sex, with or without penetration. Therefore, the condom, it can limit their contact with the virus, can not provide complete protection.

HPV infection is very common and is acquired mostly in the five years following the first sexual intercourse. In most cases, infection is transient and is eliminated naturally in 1 to 2 years after sexual contamination. But in 10% of cases, the infection persists and can cause abnormalities (lesions) in the cells of the cervix, these lesions can themselves evolve into cancer.

There are several stages of precancerous lesions (called CIN 1, CIN 2, CIN 3), may regress to a cervical normal persist or even develop into cancer of the cervix. This cancer is on average fifteen to twenty years to develop after the persistence and progression of HPV infection in high risk, which leaves a significant window of action for screening and early detection of precancerous lesions and cancer .

Two modes of action exist:  The vaccination used preventively, that is to say, before contact with the virus. There are two vaccines currently marketed in France: a bivalent vaccine for protecting said against HPV genotype 16 and 18 and a quadrivalent vaccine protects against HPV types 6,11, 16 and 18.The High Council of Public Health recommends preferably, in its opinion of December 14, 2007, the quadrivalent vaccine.

The population targeted by this vaccine consists of:  girls 14 years before exposure to the risk of HPV infection
girls and young women 15 to 23 years who have not had sex or, later in the year following the start of sexual life. This vaccination does not protect 100% against cancer of the cervix and does not replace the Pap smear screening. These two actions are complementary.

Screening is essential because of the partial protection of HPV vaccination. It is based on a cervical smear performed every three years for women 25 to 65 years (after the first two normal smears performed one year apart). From 25 years, all young women, whether vaccinated or not, should benefit from screening swabs.

Here is some info that hopefully will help you diagnose or prevent this horrible disease. Early detection is vital so the best you can do is be informed.

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What is the cervix? The cervix is the lower part of the uterus that connects the body of the uterus to the vagina. At each milestone in the life of a woman (puberty, childbirth, menopause, etc..), the cervix undergoes changes. At the junction of the outer cervix (ectocervix) and the inner part (endocervix), is a very fragile area. It is in this area that most cancers of the cervix begin.

CANCER CERVICAL  - Cancer of the cervix, which there is still 3 300 new cases per year in France, back through the screening strategies. The vaccination of young girls should further increase this fall.

The cervix is the part of the uterus palpable (vaginal) and visible (speculum examination) in the vagina. Cancer occurring in this part of the uterus could almost always be prevented through Pap smear, and now also with the HPV vaccine.

85% of cancers of the cervix occur after changing "warts (benign lesion). Risk factors are threefold: infection with HPV (Human Papillomavirus), smoking and HIV infection (AIDS virus).HPV infections are transmitted sexually, the man is generally healthy carrier (no visible lesion) of the virus and transmit it to his partner during unprotected sex. The virus gains the cells of the cervix where it multiplies, creating inflammation, which over many years may progress slowly to cancer, initially in situ and invasive.
In case of contamination, it is recommended partner to be examined.

Prevention is the first smoking abstinence and safe sex, especially without a stable partner or in cases of multiple partners. It is also regular monitoring of the cervix during gynecological examinations performed every 3 years (from 25) in the absence of abnormality detected on previous Pap smear, if not more frequent.

As for the HPV vaccine, which appeared very recently, it is for young girls before the onset of sexual activity or at the latest during the first two years of their sex life. There are two vaccines currently available, one protects against two types of HPV, the other against four types. If these vaccines reduce the risk of contamination, their protection is not absolute and does not exempt a regular gynecologic surveillance.

The telltale signs are not specific. There may be vaginal bleeding, but in most cases, cervical cancers are discovered on the Pap smear.  The treatment will depend on the stage. In cases of carcinoma in situ, ie superficial, a laser conization ensures healing in all cases. When the tumor is more advanced, invasive treatment is based on hysterectomy (removal of uterus) or on the local radiation (brachytherapy), and in some cases chemotherapy.

HPV and cancer of the cervix  - Some 200 known HPV that can infect humans. Some of these viruses affect the skin, mucous membranes of other oral, anal or genital. The consequences of these infections are most often benign - skin warts, anogenital warts. But some HPV transmitted sexually cause cancer of the cervix.
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The last real public health problem, is the second most common cancer in women worldwide. In addition, HPV can be detected in the skin and mucous membranes of most of the non-patient population where the virus remains at low level by a mechanism not pathological.

Epidemiology - The human papillomavirus, or HPV infect the epithelial cells of the skin or mucous membranes, and are transmitted by the spread of these cells during desquamation. We distinguish between low-risk HPV, agents benign lesions of high-risk HPV that are responsible for cancer. HPV affect the genital mucosa are transmitted through sexual contact and are frequent, this early in the sexual life as they are detected in 1 / 3 of women between adolescence and early twenties.

The infections they cause, if they are common throughout adult life in women sexually active, and often disappear spontaneously without clinical sign. But the infection will persist in 3 to 10% of infected women, and some among them will develop precancerous lesions called cervical intraepithelial neoplasia epithelium is a precursor of cancer of the cervix uteri. Several years may elapse between the onset of infection with oncogenic HPV and the appearance of such a cancer.

A dozen of HPV can cause cancer of the first to be recognized by WHO as being 100% due to a viral infection, but most frequently involved are the HPV16 (involved in 55% of cases) and HPV18 (12% of cases). The HPV oncogenes can also affect other mucous membranes and cause cancers including ano-rectal or oropharyngeal.

Globally, cancer of the cervix accounts for approximately 250 000 to 300 000 deaths and 500 000 new cases per year (80% in developing countries) from the International Center for Research on Cancer. In Europe, nearly 65 000 women are affected, and about 25 000 new cases are reported each year, with a mortality of 4.7%. In France, there were 3,000 cases each year, more than 1,000 deaths, and a diagnosis of cervical neoplasia or high-grade cancer is raised each year in 50 000 women.

Treatment  - The current treatment of precancerous lesions is usually surgery (cone biopsy). The cervical cancer it is treated by a combination of surgery and radiotherapy with adjuvant chemotherapy, effective in early stages. Therapeutic vaccine that would treat precancerous lesions and cancers of the cervix caused by HPV16 and / or HPV18 are in clinical trials.

Prevention  - Currently, prevention of cervical cancer of the uterus through the prevention of sexually transmitted diseases (condoms, tests for the partner) and above the routine cervical smears in women. A prophylactic vaccine that protects against infection with HPV16 and 18, thus preventing 2 / 3 of cancers of the cervix, is currently available. This vaccine has no therapeutic effect and does not protect women infected. The opinion rendered March 9, 2007 by the Technical Committee on Vaccinations and the Higher Council of Public Hygiene of France, it is recommended to vaccinate girls aged 14 to protect them before they are infected. The vaccine is also available for young women 15 to 23 years have not had sex or sexuality that began in the year.

Research conducted in recent years have uncovered the link between cancer of the cervix and human papillomavirus, a sexually transmitted virus. Today, it is estimated that virtually all such cancers are related to these viruses. Zoom in on this tiny enemy with Dr Francoise Thierry de l'Institut Pasteur.
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Cancer of the cervix develops from precancerous lesions called induced by different viruses of the family of human papillomavirus (HPV or HPV for Human Papillomavirus). Researcher in the unit gene expression and disease of the Pasteur Institute, Françoise Thierry tells us more about these viruses.

Portrait of a family of viruses - Papillomavirus Cancer uterusLe Dr. Thierry tells us that: "Overall, these viruses are divided into two large families. Some affect the skin and mucous membranes seconds. Some of these infections are benign (warts of the hand and foot arch) while others may progress to cancer development. As is sometimes the case in the cervix.

If these sexually transmitted infections are most often benign, they operate in some cases by precancerous lesions (dysplasia) that they can even evolve into cancer of the cervix if not treated. There are every year and 258 000 deaths worldwide, including 1 000 in France. The papillomaviruses are present in 80 to 100% of cancers of the cervix. Conversely, the risk of cancer among women not infected is virtually nil.

Among the different types of viruses (there are nearly 120 genotypes), not all have the same carcinogenic. In Europe, the most harmful is undoubtedly that of type 16, involved in more than a cancer on deux1 cervix. Other types of this virus are oncogenic HPV18 (20% of cases) and less often HPV31, HPV33 and HPV35. "We can not necessarily say they are less dangerous, they are certainly less present in our European environment. In Colombia, human papillomavirus found in over half of cancerous lesions of the cervix is HPV45. It are so large geographical variability "said Dr. Thierry.

Finally, there are Asian or African variants of HPV found in Europe. Some studies suggest they are more persistent and less easily eliminated by the body. But this remains controversial.However, all HPV infections do not progress to cancer, fortunately!
All infections do not progress to cancer  - HPV infections are very common in young women and most often regress spontaneously. Thus, at least one sexually active woman in two was exposed to the virus during its life. The virus was detected in 30% of women under 30 years and in 10% of women beyond that age. The risk of infection increases to 60%, 5 years after the onset of sexual activity, it decreases and then drops to 5-10% after 40-45 years2.

HPV infections by the same virus type oncogene are usually trivial because the body eliminates it within 6 to 13 months following the contamination. "We do not know many factors that cause the infection will resolve spontaneously or lead to cancer. It is estimated that today is the length of this infection will run the cancer process," says Dr. Thierry. It is the persistence of infection by this oncogene virus, which causes abnormal cells - the most important marker of tumor

Cancer of the cervix begins in the cells of the cervix is the narrow passage that connects the uterus to the vagina.
* In 2008, an estimated 1 300 Canadian women will be diagnosed with cancer of the cervix and 380 will die.
* Cancer of the cervix represents approximately 1.1% of all cancer deaths in women.
* One woman in 150 will suffer from cancer of the cervix during her lifetime and one in 423 will die.

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* Before the appearance of this type of cancer cells of cervical change and become abnormal.This change is called cervical dysplasia. Without treatment, this precancerous condition can turn into cancer over time. However, most women with dysplasia do not develop cancer.

* What should I know about cervical cancer?
Risk Factors  - The main risk factor associated with cancer of the cervix is the human papillomavirus (HPV), which is transmitted sexually and infects the cervix.

Some other risk factors associated with cancer of the cervix.
* Becoming active sexually at a young age, having multiple sexual partners or having a partner who has had many.
* Smoking.
* A weakened immune system by drugs after a transplant or is suffering from a disease like AIDS.
* Prolonged use of the pill.
* Having many children.
* The prior use of diethylstilbestrol (DES) or having a mother who took.

* What should be done to reduce the risk of cancer?
* How should I eat to reduce cancer risk?
* Does physical activity reduces the risk of cancer?

Controlling cancer of the cervix uteri
* How is cancer treated?
* How do I deal with cancer?
* How can I help someone with cancer?

Top of page  - Facts and Figures
* Facts and figures on cancer of the cervix uteri
* Cancer Surveillance On-Line
* Chronic Disease Infobase
* Economic Burden of Illness in Canada

Development and exchange of knowledge
* Publications on cancer of the cervix uteri
* Guidelines for cancer cervix
* The Gate Canadian Best Practices
* Chronic Diseases in Canada (CMC)

Initiatives, strategies, systems and programs - The Network for the Prevention of cervical cancer of the uterus (RPCCU) is an informal group of representatives from federal and provincial agencies and clinics, for example: the Society of Obstetricians and Gynecologists of Canada, the College of Physicians Family Physicians of Canada, the Canadian Society of Cytology, the Society of Gynecologic Oncologists of Canada, Canadian Colposcopists and the Association of Nurses in Canada.

The RPCCU aims to further reduce mortality and morbidity from cancer of the cervix uteri and its precursors in the country through the implementation or enhancement of organized screening programs.

The RPCCU focuses its efforts on strengthening the three components of an organized screening program: strategies for effective recruitment, information systems and an integrated set of guidelines as a basis for program management quality within the provincial screening programs.

In conjunction with the sectors of health and education and other partners, the Agency of Health Canada promotes the well-being and psychosocial Canadians through activities to promote health and strategies against cancer. These activities include:
* The establishment of national guidelines, including recommendations on immunization;
* The establishment of surveillance initiatives and the achievement of targeted studies;
* Coordinating the dissemination and exchange of information.
The Agency supports public health efforts to fight against sexually transmitted infections and their complications, including cancer and infertility, and to prevent them. The National Advisory Committee on Immunization recommendations on vaccine use and issued a statement on the vaccine against HPV.