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SIGNS AND SYMPTOMS
Cervical Cancer is the second most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. It is one of the most common cancers that affect a woman's reproductive organs. Cervical cancer symptoms often go unnoticed because they mimic so many other ailments. Many women pass these symptoms off as PMS or ovulation pains. Many times, however, cervical cancer has no symptoms. When symptoms are present, they usually do not appear until the cancer is more advanced. This does vary from woman to woman. Signs and Symptoms of early Cervical Cancer Early cervical cancer does not show any signs or symptoms. It is usually a very slow growing cancer. Cervical cancer when diagnosed early can be treated successfully. In women who receive regular screening, the first finding of the disease is usually an abnormal Pap test result. Pap smears are the best screening technique currently available to evaluate the cells on the face of the cervix. Signs and Symptoms of progressed Cervical Cancer: Some of the common symptoms observed during the later stages of cervical cancer are: Vaginal bleeding after sexual intercourse Pelvic pain Pain during sexual intercourse Offensive vaginal discharge may occur -pale, pink, brown, blood streaked, and foulsmelling Abnormal bleeding between menstrual periods Heavy bleeding during your menstrual period Increased urinary frequency Bleeding after menopause Painful urination - dysuria Low back pain Urethritis or urinary infection can be a sign of cervical cancer
DIAGNOSIS
Cervical cancer is a common form of cancer found in a woman's reproductive tissues normally caused by different strains of the human papillomavirus (HPV), which is a sexually transmitted disease. Usually, the immune system is able to keep HPV from forming cervical cancer. However, in some women, the immune system is unable to keep the virus at bay and over the course of several years it can cause cancer cells to form on the cervix. Pap Smears Cervical cancer diagnosis is mainly found through Pap smears, which are normally performed on an annual basis once a woman is sexually active or after their 21st birthday. Pap tests, which have been utilized by physicians for over 50 years, have helped reduce cervical cancer diagnoses due to their preventative measures. However, the American Cancer Society reports that more than 11,000 American women are diagnosed with cervical cancer every year and over 4,000 die from the disease. More than a third of cancer-related deaths in women around the world are due to cervical cancer. Stages Cervical cancer can take many forms, but it is usually in the form of squamous cell carcinomas. Squamous cell carcinomas cause 90 percent of cervical cancers. Cervical cancer is typically asymptomatic in its earliest stages. When a physician completes a Pap smear on a patient, they take a sample of cervical cells from the woman and test it for precancerous cells, which result in an abnormal Pap smear. Once it is determined that the cells are abnormal, the physician conducts a colposcopy of the cervix, which involves using a magnifying glass to look at the cervix. A biopsy of the cervix is also performed, which involves taking a piece of cervical tissue and running tests on it to establish whether or not it is cancerous. If cancer is found in the cervical tissue, a cervical cancer diagnosis is made. Cervical cancer is classified into five different stages: Stage 0, Stage I, Stage II, Stage III and Stage IV. In Stage 0 cervical cancer, abnormal cells are found only in the cervical lining. Stage I cervical cancer is cancer found only in the cervix. This stage is often broken down into four sub-stages depending on the size and depth of the
cancer in the tissues. In Stage II cancer, the cancer has spread from the cervix into the uterus and beyond, but it still contained to the pelvis. Stage III cervical cancer is found outside of the pelvic wall, into the vagina and may affect the kidney ureters. In the final stage, Stage IV, cervical cancer has moved outside of the pelvis to nearby organs such as the bladder and may be present in other major organs.
PATHOPHYSIOLOGY OF CERVICAL CANCER

What causes cervical cancer: The cervix is the lower part of the uterus, which leads into the vagina. Mainly due to sexual intercourse, the cervix can be exposed to carcinogenic viruses. These viruses belong to the same family as the virus that causes warts on the skin: the Human Papilloma Virus (HPV). The chance that infection occurs depends on a number of factors, such as the age when the woman became sexually active and the number of sexual partners. In a sense, cervical cancer can be considered a sexually transmitted disease. To a large extend, safe sex protects most women from cervical cancer as well. According to the latest research, contact with a carcinogenic type of HPV is an essential condition for cervical cancer to develop. Fortunately it does not mean that every woman who is infected with HPV actually gets cervical cancer as well. The cells that are affected by HPV are usually recognized by the immune system and destroyed, eliminating the threat. If this does not happen, the DNA (chemical substrate of the genetic materials in cells) of the virus is integrated in the cell nucleus of the infected cells. This is the first step in the malignant development of the cell. Proteins that are created by the genes of the virus have a negative effect on the natural 'protection' that the cell has against changes in the DNA. For example, protein p53 - which under normal circumstances protects the cell against malignant changes - is eliminated. When this form of protection is gone, the cells with irregular DNA can multiply without restraint, increasing the chance of one of the infected cells changing into a cancerous cell. Cancer of the cervix typically originates from a dysplastic or premalignant lesion previously present at the active squamocolumnar junction. The transformation from mild dysplastic to invasive carcinoma generally occurs slowly within several years, although the rate of this process varies widely. Carcinoma in situ is particularly known to precede invasive cervical cancer in most cases. In different reported series of patients with untreated carcinoma in situ who were followed up for many years, invasive carcinoma developed in about 30% of patients at 10 years and in about 80% of patients at 30 years. However, the carcinoma-in-situ lesion may regress after the initial diagnosis; such an occurrence was reported in 17 (25%) of 67 patients who were followed up for at least 3 years. Progression to invasive carcinoma becomes established and is considered irreversible
once the malignant process extends through the basement membrane and invasion of the cervical stroma occurs. Multiple local growth patterns of invasive cervical cancer have been described, with combination growth patterns being common. The patterns include the following: exophytic, nodular, infiltrative, and ulcerative. The exophytic variety is the most common growth pattern. It usually arises from the exocervix and is often polypoid or papillary in form. Exophytic cervical cancer may result in a large, friable, bulky mass that involves only the superficial aspect of the cervix and has the tendency for excessive bleeding. The nodular variety typically arises in the endocervix and grows through the cervical stroma into confluent, firm masses that cause the cervix and isthmus to expand. Large, nodular-type tumors that circumferentially involve the endocervical region and large, exophytic-type tumors that originate from the endocervix and extend into the endocervical canal result in what has been referred to as a barrel-shaped cervix. The infiltrative growth pattern leads to a stone-hard cervix that may be predicated to have minimal visible ulcerations or an exophytic mass. Infiltrative exocervical lesions tend to invade the vaginal fornices and the upper part of the vagina. On the other hand, infiltrative endocervical lesions tend to extend into the corpus and the lateral parametrium. The ulcerative growth pattern is associated with tumor necrosis and sloughing, with the formation of a cavity that is marginated by the invasive tumor. This process is usually complicated by infection that causes seropurulent discharge.

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SIGNS AND SYMPTOMS

PATHOPHYSIOLOGY OF CERVICAL CANCER

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