Cancer of the Cervix Albuquerque NM

All sexually active women are at risk for the development of cervical cancer. The risk seems to be increased withsmoking and promiscuity of the woman or her male partner. This is the standard text book explanation for an increasedrisk. But, in my experience, it is not a likely explanation for the patients that I have treated. It is not increasedby the use of birth control pills, family history or the development of genital warts. Almost all cases occur inwomen who have not had regular screening with Pap tests. This is one cancer that can be prevented, in most cases,by screening for the premalignant changes.

James Vance McKinnell, MD
(505) 272-4461
2211 Lomas Blvd NE,
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Medical School: Oh State Univ Coll Of Med, Columbus Oh 43210
Graduation Year: 1986

Data Provided by:
Meera Ravindranathan
(505) 272-2751
900 Camino De Salud
Albuquerque, NM
Specialty
Internal Medicine, Hematology / Oncology

Data Provided by:
Stuart Sheldon Winter, MD
2211 Lomas Boulevard North East,
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Medical School: Univ Of Wi Med Sch, Madison Wi 53706
Graduation Year: 1988

Data Provided by:
Yehuda Z Patt, MD
(505) 272-5837
900 Camino De Salud,
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Medical School: The Hebrew Univ, Hadassah Med Sch, Jerusalem, Israel
Graduation Year: 1967

Data Provided by:
Don M Morris, MD
(505) 272-6612
MSC 08 4630 University of New Mexico,
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Graduation Year: 2007

Data Provided by:
Dr.Bernard Agbemadzo
(505) 559-6100
8300 Constitution Ave
Albuquerque, NM
Gender
M
Education
Medical School: Univ Of Science And Tech, Sch Of Med, Kumasi
Year of Graduation: 1991
Speciality
Oncologist
General Information
Hospital: Lovelace
Accepting New Patients: Yes
RateMD Rating
5.0, out of 5 based on 1, reviews.

Data Provided by:
Dr.Jeffrey Hanrahan
(505) 841-1063
2211 Lomas Boulevard Northeast
Albuquerque, NM
Gender
M
Education
Medical School: St GeorgeS Univ, Sch Of Med, St GeorgeS
Year of Graduation: 1998
Speciality
Oncologist
General Information
Accepting New Patients: Yes
RateMD Rating
5.0, out of 5 based on 1, reviews.

Data Provided by:
Leslie Allan Donaldson, MD
(505) 272-0190
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Medical School: Univ Of Nm Sch Of Med, Albuquerque Nm 87131
Graduation Year: 1997

Data Provided by:
Dr.Francisco Ampuero
(505) 843-7813
201 Cedar St SE # 306
Albuquerque, NM
Gender
M
Education
Medical School: Univ Boliviana Mayor San Francisco X Chuguisaca, Fac Cien
Year of Graduation: 1967
Speciality
Oncologist
General Information
Accepting New Patients: Yes
RateMD Rating
4.0, out of 5 based on 2, reviews.

Data Provided by:
Melanie Royce, MD, PHD
(505) 797-1931
900 Camino de Salud NE MSC 08-4630,
Albuquerque, NM
Specialties
Oncology (Cancer)
Gender
Male
Education
Graduation Year: 2007

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Cancer of the Cervix

by William M. Rich, MD,
OBGYN.net Correspondent for Gynecologic Oncology

  • Cause
  • Screening
  • Symptoms
  • Diagnosis
  • Staging
  • Treatment
  • Prognosis
  • Recurrences
  • Cervical Cancer During Pregnancy
*terms will open definitions in new windows The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal. About 85% of cervical cancers are squamous cell cancers and the remainder adenocarcinomas. Each of these major types has several subtypes that may require special treatment; otherwise they are all managed similarly. Squamous cell cancers are unique because there is a well established progression through premalignant changes before a cancer develops. These premalignant changes are easy to detect by a simple screening test called the Pap test. Cause
The cause of cervical cancer is unknown. There is a strong association with certain subtypes of the Human Papilloma Virus (HPV) for the squamous cell cancers. HPV can be transmitted sexually, so there is an association with sexual activity. The strongest association, however, is that women who have been celibate all their lives almost never develop a squamous cell cancer of the cervix. They are at risk, however for an adenocarcinoma of the endocervix. Infection with HPV, which also causes genital warts, is common; cervical cancer is not. HPV changes are often noted on the Pap test report and should not cause alarm. If there are any premalignant changes diagnosed then they will be treated. Treatment of these premalignant changes is usually simple and almost 100% effective.

Sixty years ago cancer of the cervix was the leading cause of cancer deaths in women in this country, surpassing even those from breast cancer. The death rate began to fall in the 1940's and has continued to fall, in spite of the sexual revolution, third world immigration and the prevalence of HPV. The reason for this large decrease is unknown. It began before Pap test screening became prevalent. Cervical cancer is still the leading cause of cancer deaths in women in many third world countries. There are about 16,000 new cases diagnosed each year in the USA, with about 5,000 deaths. There are about 180,000 new cases of breast cancer each year and about 60,000 women die of lung cancer each year.

All sexually active women are at risk for the development of cervical cancer. The risk seems to be increased with smoking and promiscuity of the woman or her male partner. This is the standard text book explanation for an increased risk. But, in my experience, it is not a likely explanation for the patients that I have treated. It is not increased by the use of birth control pills, family history or the development of genital warts. Almost all cases occur in women who have not had regular screening with Pap tests. This is one cancer that can be prevented, in most cases, by screening for the premalignant changes. Screening
Screening means to test for the presence of a cancer before there are any symptoms or findings on examination. If there are symptoms or abnormal findings on examination then a diagnostic test must be done; not a screening test. The major benefit of the Pap test is to detect changes on the cervix before they become cancerous. These premalignant changes are referred to as dysplasias or as intraepithelial neoplasias. They are easily and effectively treated.

When a Pap test is reported as abnormal a well established evaluation is begun. Only after this evaluation is completed can a diagnosis be made as to the true condition of the cervix. Only after the diagnosis is established can treatment be recommended. It is a major mistake to treat on the basis of an abnormal Pap test without a diagnosis. An abnormal Pap test is not a diagnosis. It is only an abnormal screening test that must be evaluated. This evaluation is described in ALL ABOUT PAP TESTS. Symptoms
There may be no symptoms of a very early cervical cancer, but by the time it is large enough to detect visually it is usually symptomatic with abnormal bleeding. Often this abnormal bleeding occurs after sexual intercourse. Cancers must make new blood vessels as they grow. These new blood vessels are often abnormal and break easily which is why bleeding is a sign of cancer. The cancer also outgrows some of its blood supply, so portions of it are deficient in oxygen. This causes some of the cells to die and for the tissue to become infected. In the cervix this causes a foul discharge that will be noticeable and resistant to most treatments for the usual vaginal infections.

As the cancer increases in size it usually grows laterally toward the pelvic wall. The tubes from the kidneys (ureters) that bring urine to the bladder pass through this area and they are easily obstructed. If that happens to both of the ureters, then this will result in renal failure, coma and death. If the cancer grows into the pelvic wall it will press on the nerves that go to the leg and cause unremitting leg pain. These are symptoms of an advanced cancer. Premalignant changes have no symptoms and are usually not noticeable on visual examination.

Cervical cancers usually do not spread early. They tend to be slow growing and cause most of their problems in the pelvis. Although distant metastases occur they are usually late events. Cervical cancers can spread by way of the lymphatic system. The lymphatic vessels drain from the cervix to clusters of lymph glands along the pelvic wall. The lymphatics follow the large blood vessels so the route of drainage is upward along the pelvic wall, then along the midline of the backbone and then to the chest. If the pelvic lymph nodes on one side of the pelvis become obstructed with cancer then that will cause swelling in the leg on that side. This is another sign of advanced cancer. Diagnosis
The diagnosis of cervical cancer is usually not difficult. It is usually big enough to be seen and can be biopsied. If it arises from up inside the cervical canal then it may not be visible. This will require that a portion of the cervix be removed for diagnosis. These large biopsies can be accomplished by either a LEEP or cone procedure. A major mistake is to rely on a Pap test to rule out a cancer in a woman who has symptoms or findings that could be due to a cancer. A normal Pap test never excludes a cancer. Cancer can only be excluded by the proper biopsies. It is known that about 10% of women with an obvious cancer of the cervix will have a Pap test that is essentially normal. This is because there is so much inflammation and dead cell debris that it masks the cancer cells. Very rarely, the cervix may be too small or inaccessible to biopsy properly. In these situations a simple hysterectomy may have to be done for diagnosis.

Staging
Whenever a cancer is diagnosed the next step is staging. This is a determination of the extent of the cancer. For cervical cancer this is determined by physical examination, chest x-ray, kidney x-rays and looking inside the bladder and rectum. CT scans and MRI scans can be done but they are not used to assign a stage. Likewise, surgical exploration is not used to assign a clinical stage.

CLINICAL STAGES OF CANCER OF THE CERVIX Stage I Cancer confined to the cervix IA Invasive cancer detectable microscopically only IA1 Invasion less than 3 mm and width less than 7 mm IA2 Invasion more than 3 mm but less than 5 mm IB All others, any visible cancer IB1 Cervix less than 4 cm in diameter IB2 Cervix greater than 4 cm Stage II Spread to adjacent structures IIA Spread onto the vagina IIB Spread laterally toward the pelvic wall Stage III More extensive but still within the pelvis IIIA Extends to the lower vagina IIIB Extends onto the pelvic wall, obstructed ureter Stage IV Distant spread or involvement of a pelvic organ IVA Involves the inside of the bladder or rectum IVB Distant metastases, i.e. lung, liver or bone Treatment
In general, cancers of the cervix are treated with radiation. The major exceptions are for those that are stage I and some that are stage IV. Stage IA cancers that invade less than 3mm deep can sometimes be treated by simple hysterectomy or even in special cases by cone biopsy. All other Stage I cancers are treated either by radical surgery or radical radiation. Some stage IIA cancers can also be considered for surgery. Otherwise, all stage II, III and IV cancers are treated with radiation. Occasionally ultra-radical surgery is done on some stage IVA cancers. Surgery for stage IB and some IIA cancers requires a radical hysterectomy and removal of the pelvic lymph nodes. Radical hysterectomy means that the cervix is removed by staying as far away from it and the cancer as possible. A regular or simple hysterectomy removes the cervix by staying as close to it as possible.

Cancer surgery requires that the cancer be removed with as good a margin of uninvolved tissue as can safely be taken. The radical hysterectomy technique removes all the supporting ligaments to the cervix which means that the dissection is very close to the bladder and to the rectum. The ureters have to be dissected out and the tissue around them removed. A radical hysterectomy with removal of the lymph nodes takes about 4 hours to perform. A simple hysterectomy takes only about 1-2 hours. The ovaries are not a part of the problem with cervical cancer and can be left in place. If after surgery the pathology indicates that there are positive lymph nodes or that the surgical margins are close, then pelvic irradiation with or without chemotherapy may be advised.

Ultraradical pelvic surgery for advanced or recurrent cancer means that all the pelvic organs are removed. The uterus and cervix, vagina, bladder and rectum are removed. Sometimes a vagina can be reconstructed. If the rectum can be reattached then there will be no need for a colostomy. Sometimes a continent urinary reservoir can be constructed. Otherwise a bag will have to be placed for the urine to drain through an ostomy in the abdominal wall. This ultra-radical surgery is done if there is an extensive cancer involving the bladder or rectum, but without spread beyond these structures. It is also done for cancers that recur after pelvic radiation if they are confined to the pelvis.

Radiation therapy usually requires a treatment each day, five days a week, for about five weeks. Each treatment takes only several minutes. This is called external or teletherapy. The entire pelvic area is irradiated by an x-ray beam usually generated by a linear accelerator. Everything in the pelvis is irradiated, bladder, rectum, large intestine, small intestine, bone and skin. Following this treatment, a radioactive source is placed inside the cervix and vagina and left in place several hours or several days. This is called an implant, radium implant, intracavitary implant or any of several other names. A more accurate term is brachytherapy which means slow therapy.

Often when cancer of the cervix is being treated with radiation, chemotherapy is also given to increase the effects of the radiation. Otherwise, chemotherapy is not used as initial treatment for cancer of the cervix. There are some investigational studies in which chemotherapy is given first and then either surgery or radiation performed.

Complications from treatment with surgery are related to anesthesia and injury to other organs such as the bladder and ureters. There is also the risk associated with blood transfusions and infection. These complications usually occur early and are remediable. Radiation complications can occur years later and are difficult to fix. ...

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