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Conventional Treatment for Cervical Dysplasia/Cervical Cancer March 06, 2007 8:35 PM

Process of Cervical Changes The cervix is the part of the uterus that extends into the vagina. There are two types of cells which line the cervix, one lines the outer cervix (portio) and another lines the inner cervix (endocervix). There is a distinct junction between the two cell types called the transformation zone. The Pap test is taken from this area because this where dysplasia (pre-cancer) and cancer most often arise. Two common changes in cells are metaplasia and dysplasia. Metaplasia - Metaplasia is generally described as a process of cell growth or cell repair which is benign (not cancerous). This process normally occurs in unborn babies, during adolescence, and with the first pregnancy. Studies have shown that metaplasia is present in more than one half of all women at some point in their development. Dysplasia - In dysplasia, there is an increase in the number of cells formed, which do not mature as expected. This changes the inside of the cell. The higher the grade of dysplasia found on the cervix, the more likely that it will progress to invasive cancer. For this reason, dysplasia is thought as a "pre-cancerous" condition. Dysplasias are nearly 100% curable if managed appropriately. A small proportion of mild dysplasias (CIN I or low-grade SIL) will regress without treatment. However, it is not possible distinguish between dysplastic areas of the cervix that will return to normal and dysplastic areas which will progress and ultimately become cancer. Causes of Cervical Cell Changes Inflammation often results in mildly abnormal Pap tests. These may result in the diagnosis of CIN I in the CIN grading system, ASCUS in the Bethesda System or changes consistent with Human Papilloma Virus (HPV) infection. An inflamed cervix may appear red, irritated, or eroded. Some of the common causes of cervical inflammation are: 1. bacteria (from an infection) 2. viruses, especially herpes infections and condyloma cuminata (warts) 3. yeast or monilia infections 4. trichomonas infections 5. pregnancy, miscarriage, or abortion 6. chemicals (for example, medications) 7. hormonal changes When the inflammation is treated and cleared, repair through metaplasia usually will follow. In several months, a repeat Pap test will often then be normal. Colposcopy: The next diagnostic step All abnormal Pap smears require further evaluation. If the abnormality is minor (i.e. inflammation, or HPV changes) your healthcare provider may choose to repeat the Pap test in a few months. If the abnormalities have persisted or worsened, colposcopy is indicated. Colposcopy will enable your physician or nurse to make a more accurate diagnosis. Colposcopy - A colposcope is a lighted microscope that is used to magnify the cervical tissue during a pelvic examination. The colposcope is used to visualize abnormal areas of the cervix and vagina which are too small to see with the naked eye. The entire transformation zone must be seen. The colposcopic examination is an office procedure and is no more uncomfortable than a routine pelvic examination. It takes 5 to 10 minutes to perform. During the examination, the examiner may take small samples of cervical tissue (biopsies). Another specialist, a pathologist, will examine the tissue samples and cells. These diagnostic biopsies will guide further management. Colposcope from examiner's view From the examiner's perspective Colposcope from the patient's view From the patient's perspective Treatment Options for Cervical Dysplasia Cone Biopsy - A cone biopsy is a minor operation which is usually performed in an outpatient surgical facility. In the operating room, the physician removes a cone shaped tissue sample from your inner cervix. This tissue is sent to a pathologist for detailed examination under a microscope. This procedure does not remove any of your reproductive organs and should have little impact on your future ability to become pregnant. If only dysplasia is found in the cone specimen, then often no additional treatment will be required. However, if invasive cancer is discovered, additional treatment (i.e. surgery or radiation therapy) is indicated. Therefore, a cone biopsy may be considered as therapeutic (if all of the dysplasia is removed) or diagnostic (if it discovers a worse problem that requires additional treatment). Loop Electrosurgical Excision Procedure (LEEP) The LEEP procedure is similar to a cone biopsy in that it removes a tissue sample from your cervix. Likewise, a pathologist examines the tissue under a microscope. The LEEP procedure has the advantage of being easily performed in the office with local anesthesia. However, the LEEP procedure and cone biopsy are not equivalent and your physician will recommend which is the best option in your case. Cryosurgery - Cryosurgery is another treatment option. This procedure is done in the doctor's office. During the procedure, the doctor freezes and thereby destroys the dysplasia on your cervix. You may notice a brief unpleasant cold sensation during the freezing procedure. A disadvantage of cryosurgery is that no specimen is obtained for the pathologist to examine in order to exclude the possibility of invasive cancer.  [ send green star]  [ accepted]
The stages: CIN 1- Invasive Cervical Cancer March 06, 2007 8:44 PM

Description of Cervical Cancer Stages and Their Treatments Stage 0: Cancer in situ confirmed by biopsy and confined to the first layer of cervical tissue (the epithelium). Treatment options include loop electrosurgical excision procedure (LEEP), laser therapy, conization, or cryotherapy. Stage I: Invasive cancer (tumor confined to the cervix). In Stage IA cancer cells are microscopic, there is minimal invasion (less than 3 mm) into the supportive tissue around the cervix (the stroma), and the horizontal extent of the tumor is less than 7mm. Treatment options include simple hysterectomy. Conization is an alternative that is sometimes possible for women who want to preserve fertility and who have a nonaggressive tumor that has spread less than 3 mm with no lymph or blood vessel involvement. In Stage IA2 there is deeper invasion (greater than 3 mm but less than 5 mm) and the horizontal extent of the tumor is less than 7 mm. Treatment options include radical hysterectomy with surgical lymph node removal (lymphadenectomy) is a common approach. Five-year survival rates for Stage IA can be 95% or more. In Stage IB1 the tumor is typically visible (not usually microscopic) and diameter may be up to 4 cm. Treatment options include radical hysterectomy with pelvic lymph node removal (lymphadenectomy). Primary radiation can be used instead of surgery in patients who are poor surgical candidates or who do not plan on being sexually active. In Stage IB2 the tumor is more than 4 cm and considered "bulky." Treatment options are the same as for stage IB1 but relapse rates after surgery are higher. Primary treatment with concurrent radiation plus platinum-based chemotherapy is reasonable. Five-year survival rates for stage IB cervical cancer can be 80% to 90% with either radiation or surgery. Survival rates are lower if lymph nodes are involved. Stage II: Invasive cancer that extends beyond the cervix but not does not involve the pelvic side wall. In Stage IIA the upper two-thirds of the vagina are involved but not the parametrium (the connective tissue between the pelvic floor and upper part of the cervix). Treatment options are the same as for stage IB1 unless the tumor is bulky. In this latter case, treatment is the same as stage IB2. Cure rates for stage IIA cervical cancer can be as high as 75% to 80% with either radiation or radical hysterectomy. Survival rates are lower if lymph nodes are involved. Note: Postoperative concurrent radiation and platinum-based chemotherapy may be considered for stages IA2 through IIA tumors if the following high risk features are found at the time of primary surgery: lymph node involvement, cancerous cells found in the margins of the tumor, and involvement of the parametrium. In Stage IIB the cancer has spread to the parametrium. Treatment options include radiation therapy with concurrent cisplatin-based chemotherapy. Five-year survival rates are about 60%. Stage III: Invasive cancer with tumor extending to the lower third of the vagina (stage IIIA) or to the side walls of the pelvis (Stage IIIB). The kidney may be affected. Treatment options include radiation therapy with concurrent cisplatin-based chemotherapy. Five-year survival rates are about 40%. Stage IV: Invasive cancer with tumor spread beyond the pelvis or to the mucosal lining of the bladder or rectum. Five-year survival rates are less than 20%. In stage IVA, the cancer involves the inner lining of the bladder or rectum. Treatment options include radiation therapy with concurrent cisplatin-based chemotherapy. Note: Stages IB2 through IVA are often referred to as locally advanced disease and are frequently treated similarly. In addition to treatments mentioned above, experimental approaches for some women with locally advanced cervical cancer employ radiation therapy with hyperthermia (high heat often provided by ultrasound) and neoadjuvant (preoperative) chemotherapy and radical surgery. In stage IVB, the cancer has metastasized beyond the pelvis. Treatment options include platinum-based chemotherapy, which yields short-lived response in 20% of patients. Clinical trial participation is reasonable. Recurrent or Persistent Cancer: Cervical cancer may recur locally in the lymph nodes near the cervix, or it may metastasize to distant sites, such as the lung or bones, or it may appear both locally and in distant locations. Treatment options include pelvic exenteration if cancer has spread to only local areas. (This involves removal of the cervix, uterus, vagina, and perhaps bladder, lower colon, or rectum. It is an aggressive surgical approach that may lead to cure in a small percentage of patients with recurrent cervical cancer.) Radiotherapy is another option if it is technically possible, generally if patients have not had it previously. If cancer has metastasized, platinum-based chemotherapy is reasonable. Other agents may be useful under certain circumstances.  [ send green star]  [ accepted]
correction March 06, 2007 8:51 PM

sorry, i titled my last post wrong. those are the stages of cervical cancer. however, stage 0 of cervical cancer is the severe stage (carcinoma in situ stage) of cervical dysplasia.  [ send green star]  [ accepted]
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